Adult Health Nursing Study Guide Answers

Correct Answer: A

Rationale: Option A indicates an understanding of the normal psychosocial development of preschoolers. It reflects the fact that during this stage, children may demonstrate frustration and have temper tantrums as they strive for independence and attempt to do things by themselves. This behavior is a common part of their development as they learn self-control, autonomy, and decision-making skills. The other options do not directly relate to normal preschooler development but rather touch upon separate issues such as separation anxiety, possessiveness, and social behaviors that are not necessarily abnormal for preschoolers.

Correct Answer: A

Rationale: By randomly selecting individuals in the community for the project, Nurse Mary is upholding the ethical principle of autonomy. Autonomy refers to respecting individuals' right to make their own decisions and choices. In this scenario, Nurse Mary is not imposing her own preferences or biases but rather allowing individuals in the community to have an equal opportunity to participate in the project. Random selection ensures that the process is fair and gives everyone an equal chance to be involved, respecting their autonomy.

Correct Answer: B

Rationale: The most critical action to prioritize for ensuring patient safety during a cardiopulmonary exercise stress test is to monitor the patient's electrocardiogram (ECG) rhythm continuously during the test (Option B). This monitoring allows the healthcare team to promptly detect any abnormal heart rhythms or signs of cardiac distress, enabling timely intervention if necessary. Continuous ECG monitoring is essential during exercise testing as it helps in assessing the heart's response to physical activity and identifying any potential cardiac abnormalities or complications that may arise during the test. By closely monitoring the ECG rhythm, the nurse can ensure the patient's safety and well-being throughout the procedure. Administering a beta-blocker medication before the test (Option A) may be indicated in some cases but is not as crucial as continuous ECG monitoring during the test. Encouraging the patient to consume a heavy meal before the test (Option C) is contraindicated as it can interfere with the accuracy of the results

Correct Answer: C

Rationale: The most appropriate nursing action in this situation is to assess the client's blood pressure and other vital signs. The client's symptoms of severe headache, visual disturbances, and epigastric pain could be indicative of preeclampsia or eclampsia, which are serious conditions that require immediate medical attention. Checking the blood pressure and other vital signs will help determine if the client's symptoms are related to abnormal blood pressure levels, which is critical in identifying and managing hypertensive disorders in postpartum clients. Once the assessment is completed, appropriate medical interventions can be initiated promptly if necessary.

Correct Answer: C

Rationale: The correct response is "Because of the normal pooling of blood in the vagina when the woman lies down to rest or sleep." This phenomenon occurs due to gravity when a woman lies down, and the blood tends to pool at the top of the vagina. When she first arises from bed, the pooled blood is released, resulting in a gush of blood. This is a normal physiological process and not typically a cause for concern.