Foundations and Adult Health Nursing Test Bank

Correct Answer: C

Rationale: Cleaning the inner cannula daily helps prevent the accumulation of secretions and debris, which can lead to blockages and infections. It is an essential aspect of tracheostomy care to maintain the patency of the airway and prevent complications. Caregivers should be taught how to safely remove, clean, and reinsert the inner cannula as part of routine tracheostomy care.

Correct Answer: C

Rationale: When a nurse notices a discrepancy between the surgical consent form and the planned procedure, it is essential to consult the surgeon for clarification. The surgeon is the primary decision-maker regarding the surgical procedure and can provide insight into why the discrepancy exists and how to proceed. It is crucial to ensure that everyone is on the same page before moving forward with the surgery to prevent errors, ensure patient safety, and maintain legal and ethical standards. Consulting the surgeon allows for the issue to be addressed promptly and for the appropriate steps to be taken to resolve the discrepancy before proceeding with the surgery.

Correct Answer: A

Rationale: Attention deficit hyperactivity disorder (ADHD) is characterized by inattentiveness, overactivity, and impulsiveness. Individuals with ADHD may have difficulty paying attention, completing tasks, sitting still, or controlling their impulses. Mental retardation (now referred to as intellectual disability) is a separate condition characterized by limitations in intellectual functioning and adaptive behaviors. While individuals with ADHD may experience difficulties in school or work due to their symptoms, ADHD itself does not indicate mental retardation.

Correct Answer: C

Rationale: When the nurse collects data at one point in time, it is referred to as a cross-sectional study. Cross-sectional studies are observational research designs that provide a snapshot of a population or a sample at a specific point in time. This type of study can help identify associations or relationships between variables at a single time point but cannot establish causality or determine changes over time. In contrast, time series involve collecting data over multiple time points, longitudinal studies follow individuals or samples over time to track changes or outcomes, and crossover studies involve multiple interventions or treatments over different periods.

Correct Answer: A

Rationale: In prioritizing nursing diagnoses, the nurse should consider issues that pose the greatest risk to the patient's immediate well-being. A fluid volume deficit can lead to dehydration and potentially life-threatening complications, making it a priority to address. It is crucial to restore fluid balance to maintain normal body functions and prevent further deterioration of the patient's condition. Ensuring adequate hydration is essential for the patient's overall health and recovery. The other options, such as risk for pain, coping, and body image disturbances, while important, are not as urgent as addressing a fluid volume deficit.