Nursing a Concept Based Approach Test Bank

Questions 14

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Nursing a Concept Based Approach Test Bank Questions

Question 1 of 5

While teaching a wellness class on the warning signs of stroke, a participant asks the nurse, "What's the most important thing for me to remember?" What is an appropriate response by the nurse?

Correct Answer: A

Rationale: The most important thing to remember regarding the warning signs of stroke is to "be alert for sudden weakness or numbness." This is crucial because sudden weakness or numbness in the face, arm, or leg, especially on one side of the body, is one of the hallmark symptoms of a stroke. It is essential to recognize these signs promptly and seek immediate medical attention to minimize the potential damage caused by a stroke. Being aware of these sudden symptoms can help individuals receive timely treatment and improve their chances of recovery.

Question 2 of 5

The nurse is assessing a toddler diagnosed with tetralogy of Fallot (TOF). Which clinical manifestations does the nurse anticipate during the physical assessment? Select all that apply.

Correct Answer: A

Rationale: 1. A palpable thrill in the pulmonic area is a common finding in children with tetralogy of Fallot (TOF). This sensation is caused by turbulent blood flow across the pulmonic valve due to the structural abnormalities present in TOF.

Question 3 of 5

A nurse is caring for a child who is hospitalized for an exacerbation of asthma. The nurse is preparing discharge teaching, as the client will be going home on nebulizer treatments and an inhaler. The client and her family members, who are recent immigrants to the United States, speak little English. In addition to enlisting an interpreter to help with the language barrier, what should be a priority for the nurse in developing a teaching plan?

Correct Answer: D

Rationale: Addressing any healing beliefs the family has should be a priority for the nurse in developing a teaching plan for the child with asthma. The family's cultural beliefs and practices may influence their understanding and acceptance of medical treatments. By understanding and respecting the family's beliefs, the nurse can tailor the teaching plan to align with the family's values and ensure better adherence to the treatment plan. This approach promotes effective communication, trust, and collaboration between the healthcare team and the family, which is essential for the child's recovery and ongoing management of asthma. Providing culturally sensitive care is crucial in improving health outcomes and promoting family-centered care in a diverse healthcare setting.

Question 4 of 5

A nurse working on an antepartum unit is providing care for a client with preeclampsia. Which laboratory value does the nurse anticipate for this client?

Correct Answer: D

Rationale: In a client with preeclampsia, one of the laboratory values that the nurse might anticipate is an increased serum creatinine level. Preeclampsia is a hypertensive disorder of pregnancy characterized by high blood pressure and involvement of multiple organ systems, including the kidneys. An elevated serum creatinine level indicates impaired kidney function, as creatinine is a waste product that is normally filtered by the kidneys and excreted in the urine. In preeclampsia, reduced kidney perfusion due to the high blood pressure can lead to decreased glomerular filtration rate, resulting in elevated serum creatinine levels. Monitoring serum creatinine is essential in assessing kidney function and guiding management in clients with preeclampsia.

Question 5 of 5

A client diagnosed with disseminated intravascular coagulation (DIC) is currently bleeding through the gastrointestinal tract. Which does the nurse anticipate administering to this client as a first line treatment?

Correct Answer: C

Rationale: Disseminated intravascular coagulation (DIC) is a serious condition characterized by widespread clot formation in the small blood vessels, leading to bleeding tendencies. In DIC, the body consumes clotting factors and platelets faster than they can be replaced, resulting in both bleeding and clotting. Because of this complex pathophysiology, the first line treatment for DIC-related bleeding is to provide replacement of the consumed clotting factors and platelets. Fresh frozen plasma contains clotting factors, and platelets help in stopping bleeding by aiding in clot formation. Therefore, the administration of fresh frozen plasma and platelets helps to correct the coagulopathy in DIC and manage the bleeding episodes effectively. Aspirin, Warfarin (Coumadin), and Heparin are anticoagulants and would not be appropriate in the treatment of DIC-related bleeding as they can exacerbate the bleeding tendency in this condition.

Similar Questions

A client diagnosed with disseminated intravascular coagulation (DIC) is currently bleeding through the gastrointestinal tract. Which does the nurse anticipate administering to this client as a first line treatment?
While teaching a wellness class on the warning signs of stroke, a participant asks the nurse, "What's the most important thing for me to remember?" What is an appropriate response by the nurse?
The nurse is caring for a client diagnosed with dilated cardiomyopathy. Which clinical manifestations does the nurse anticipate during the physical assessment? Select all that apply.
Following a kidney transplant, the nurse notes that a patient�s urine is cloudy. What should the nurse do about this finding?
The nurse teaches a client about lifestyle modifications to help manage hypertension. Which client statement indicates teaching has been effective?

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