Foundations and Adult Health Nursing Study Guide Answers

Correct Answer: A

Rationale: Precipitous labor is completed in less than 3 hours from the onset of labor to delivery. It is characterized by rapid labor progression, with contractions quickly increasing in intensity and frequency. This can pose risks for both the mother and baby, such as increased risk of maternal lacerations, fetal distress, and postpartum hemorrhage. It is important for healthcare providers to be prepared for rapid delivery in cases of precipitous labor.

Correct Answer: B

Rationale: In the scenario of a woman in active labor experiencing a prolonged second stage with inadequate expulsive efforts, the appropriate nursing intervention to facilitate fetal descent would be to apply fundal pressure. Fundal pressure, or applying pressure on the upper abdomen just above the uterine fundus, can help in directing the fetal head downwards and aiding in the descent through the birth canal. It is important to note that fundal pressure should be applied carefully and with proper technique to prevent excessive force that could potentially harm the mother or the baby. Encouraging the mother to push forcefully during contractions can be helpful, but the addition of fundal pressure can provide extra assistance in cases of inadequate progress. Immediate cesarean section may be considered if other interventions are unsuccessful or if there are concerns for fetal distress. Administering intravenous magnesium sulfate for uterine relaxation is not indicated in this situation.

Correct Answer: A

Rationale: Illiterate clients may have difficulty understanding spoken or written information. Using symbols and images can help convey important messages and instructions in a visual way that can be easily understood without relying on literacy skills. This communication intervention is effective in ensuring that the client understands the information being provided, promoting better adherence to treatment plans and overall health outcomes.

Correct Answer: A

Rationale: Aplastic anemia is a condition characterized by a reduction in the number of all three blood cell types: red blood cells, white blood cells, and platelets. The patient's presentation of bone pain, fatigue, frequent infections, pancytopenia (decreased counts of all blood cell types), hypocellular bone marrow (reduced cellularity in the bone marrow), and absence of reticulocytes is indicative of aplastic anemia.

Correct Answer: B

Rationale: The nurse's best response in this situation is to listen actively to the patient's concerns, acknowledge the inconvenience they are experiencing, and offer support. It is essential to validate the patient's feelings and show empathy towards their frustration. By actively listening and addressing the patient's concerns, the nurse can help alleviate some of their frustration and build a positive rapport with the patient. This approach demonstrates respect for the patient's feelings and promotes effective communication in the healthcare setting. Dismissing or ignoring the patient's frustration can lead to further dissatisfaction and impact the quality of care provided.