Adult Health Nursing Test Banks

Correct Answer: A

Rationale: A tension pneumothorax is a life-threatening condition where air accumulates in the pleural space and cannot escape, causing increased pressure in the chest cavity. This can lead to compression of the lung and major blood vessels, leading to inadequate oxygenation and circulation.

Correct Answer: D

Rationale: The most common symptom of scabies that the family would report to Nurse Emma is itchiness. Scabies is a contagious skin condition caused by the Sarcoptes scabiei mite, which burrows into the skin and lays eggs, leading to intense itching, especially at night. The itching is a result of the body's allergic reaction to the mites and their waste products. While rashes, scaling, and swelling can also occur with scabies, the hallmark and most bothersome symptom experienced by individuals with scabies is the intense itchiness, making it the most common symptom reported by affected individuals or their families during the history-taking process.

Correct Answer: A

Rationale: Battery refers to the intentional touching of another person without consent, resulting in harm or offense. In this scenario, the nurse inserted the urinary catheter into the client's urethra without the client's consent, leading to an injury. This action constitutes battery as the nurse carried out a medical procedure without the client's permission, resulting in harm to the client. The client can sue the nurse for battery in this situation.

Correct Answer: D

Rationale: Phenazopyridine HCl (Pyridium) is a medication commonly used to relieve the pain, burning, and discomfort associated with urinary tract infections (UTIs). One of the notable side effects of Phenazopyridine is the discoloration of urine, turning it a rusty-red or orange color. This color change is harmless and temporary, but it can be alarming to patients who are unaware of this side effect. Therefore, if a patient undergoing treatment for a UTI notices their urine has turned orange, it is most likely due to the administration of Phenazopyridine.

Correct Answer: D

Rationale: The most appropriate oxygen delivery device for a patient with chronic respiratory failure secondary to severe restrictive lung disease requiring continuous supplemental oxygen is a non-rebreather mask. A non-rebreather mask is designed to deliver high-flow oxygen and is typically used for short-term medical treatment in emergency situations or for critically ill patients. It is ideal for providing the highest concentration of oxygen available for inhalation, making it suitable for patients with severe hypoxemia.