Medical surgical Exam 1 (NSG 123)

The correct answer is B. The nurse's actions caused harm.

Explanation:

In a negligence suit, the plaintiff must prove the following elements of negligence:

Duty: The nurse owed a duty of care to the patient.

Breach: The nurse breached that duty by failing to provide the standard of care expected.

Causation: The nurse’s breach of duty directly caused harm or injury to the patient.

Damages: The patient suffered actual harm or damages as a result of the breach.

In the case of negligence, intent is not required. The key issue is whether the nurse’s actions (or lack of actions) caused harm, regardless of intent.

Why the other options are incorrect:

A. The nurse intended to cause harm: This is not necessary for negligence. Negligence refers to actions that unintentionally cause harm due to a failure to meet the standard of care.

C. The nurse knew she caused harm: Knowledge or intent is not a required element in a negligence claim. It is about the failure to meet the standard of care, not awareness of harm.

D. The nurse was sorry for causing harm: Apologies or expressions of regret are not necessary for proving negligence. What matters is whether harm occurred as a result of the nurse's actions.

Summary:

The plaintiff must prove that the nurse’s actions caused harm (Causation), making B the correct answer.

The correct answer is C. ethnocentrism.

Explanation:

Ethnocentrism refers to the belief that one's own culture, values, and beliefs are superior to others and that other cultures should be judged based on one's own cultural standards.

Why the other options are incorrect:

A. Cultural competency: Cultural competency refers to the ability to understand, communicate with, and effectively interact with people across cultures, which is the opposite of ethnocentrism.

B. Cultural diversity: Cultural diversity refers to the presence of multiple different cultures in a given environment, not the belief in the superiority of one's own culture.

D. Cultural sensitivity: Cultural sensitivity involves recognizing and respecting the differences between cultures, but it does not imply superiority, which is characteristic of ethnocentrism.

Summary:

The belief that one's own culture is superior to others is called ethnocentrism

Correct Answer: A. Progressive irreversible destruction of the kidneys

Rationale:

Chronic renal failure (CRF), now commonly referred to as chronic kidney disease (CKD), is a progressive and irreversible deterioration of kidney function. It occurs over months or years, leading to the accumulation of metabolic waste products, fluid overload, and electrolyte imbalances. As kidney function declines, the glomerular filtration rate (GFR) decreases, eventually resulting in end-stage renal disease (ESRD), where dialysis or kidney transplantation becomes necessary.

Why the Other Options Are Incorrect:

B. A rapid decrease in urinary output with an elevated BUN 

This describes acute renal failure (ARF)/acute kidney injury (AKI), which is a sudden onset condition characterized by rapid decline in kidney function and an elevated blood urea nitrogen (BUN) and creatinine. CKD is gradual and progressive, not sudden.

C. An increasing creatinine clearance with a decrease in urinary output 

In chronic renal failure, creatinine clearance actually decreases as kidney function worsens.

A decrease in urinary output (oliguria or anuria) may occur in later stages, but creatinine clearance does not increase—instead, it declines due to impaired filtration.

D. Prostration, somnolence, and confusion with coma and imminent death 

These are late-stage symptoms of uremic encephalopathy, which can occur in end-stage renal disease (ESRD) when waste products accumulate in the blood. However, this is not the defining characteristic of chronic renal failure—CKD progresses through stages before reaching this severe state.

Summary:

Chronic renal failure is a slow, progressive, and irreversible condition that leads to a gradual loss of kidney function over time. Unlike acute kidney injury, which has a sudden onset, CKD develops over years, requiring careful management to slow progression and prevent complications like fluid overload, electrolyte imbalances, and cardiovascular disease.

The correct answer is Perform a surgical scrub before entering the area.

Explanation:

In a surgical environment, maintaining asepsis (sterility) is crucial to prevent infections. Here’s why the correct answer and the other options are as they are:

Perform a surgical scrub before entering the area:

This is the correct action. Performing a surgical scrub is necessary to reduce the risk of introducing pathogens into the sterile field. The scrub helps remove bacteria and other microorganisms from the hands and forearms to ensure aseptic conditions when the nurse enters the restricted surgical area.

Why the other options are wrong:

Ensure that only surgical team members are entering this area:

While it's important to restrict entry to only necessary personnel, this alone does not address the aseptic requirements of the nurse who is entering the restricted area. A surgical scrub is still required even if only the surgical team members are allowed in.

Don scrub clothes, shoe covers, caps, and a mask before entering the area:

While it is important to wear appropriate attire such as scrub clothes, shoe covers, caps, and a mask, this action alone does not ensure the removal of microorganisms from the skin, which a surgical scrub is designed to do. Therefore, this step alone would not maintain asepsis.

Ensure that any family members entering the area are wearing surgical masks and gowns:

Family members should not be entering the restricted area in the first place, as the restricted area is typically reserved for the surgical team. Additionally, masks and gowns do not replace the need for a proper surgical scrub by the healthcare team.

Summary:

To maintain asepsis in the surgical area, the nurse must perform a surgical scrub before entering the restricted zone. This is to reduce the risk of infection and ensure sterile conditions during the surgical procedure.

Correct Answer: B. The kidneys have a great functional reserve

Rationale:

The kidneys have a high functional reserve, meaning they can compensate for damage or loss of nephrons over time. Up to 50-70% of kidney function can be lost before symptoms of chronic renal failure (CRF) become apparent. This is because the remaining nephrons adapt by increasing their filtration rate (hyperfiltration) to maintain homeostasis. However, this compensatory mechanism is not sustainable long-term, and as the disease progresses, symptoms such as fluid retention, electrolyte imbalances, and uremia become more noticeable.

Why the Other Options Are Incorrect:

A. Liver hormones mask the symptoms 

The liver does not produce hormones that specifically mask kidney failure symptoms. While the liver plays a role in metabolism and detoxification, it does not compensate for declining kidney function.

C. Other body systems take over some of the kidney's functions 

No other organ can fully take over the kidney's essential functions, such as filtering waste, regulating electrolytes, and maintaining acid-base balance. Other organs may help manage some effects (e.g., the lungs help with acid-base balance), but they do not replace kidney function.

D. The adrenal glands compensate for the kidney's decreased function

The adrenal glands produce hormones such as aldosterone and cortisol but do not directly compensate for renal failure. In fact, chronic kidney disease can disrupt adrenal hormone balance, worsening complications like fluid overload and hypertension.

Summary:

The kidneys' large functional reserve allows them to compensate for damage over time, delaying noticeable symptoms of chronic renal failure until the later stages. Other organs do not take over kidney function, and no specific hormones mask the disease.

The correct answer is  D. "The medication can slow the progression of heart failure allowing you to live longer."

Explanation:

Heart failure is a chronic and progressive condition, but medications such as angiotensin-converting enzyme (ACE) inhibitors play a crucial role in slowing its progression. ACE inhibitors help by:

Reducing the workload on the heart by dilating blood vessels.

Lowering blood pressure and reducing fluid buildup, which helps prevent worsening symptoms.

Improving survival rates and enhancing quality of life for individuals with heart failure.

This response acknowledges the client's concerns while also providing hope and accurate medical information about the benefits of treatment. It helps the client make an informed decision about their health.

Why the other options are incorrect:

A. "You will not die from heart failure with or without taking the medication."

This statement is inaccurate and misleading because heart failure can be fatal, especially if left untreated. It does not acknowledge the progressive nature of heart failure or provide any encouragement for treatment.

B. "Without the medication, you will be very uncomfortable from the symptoms of heart failure."

While untreated heart failure can cause worsening symptoms (such as shortness of breath, swelling, and fatigue), this response focuses on fear rather than empowerment. The client might feel pressured rather than supported in their decision-making.

C. "You do have the right to refuse the medication if you want to."

While it is true that the client has the right to refuse treatment, this response does not educate them about the potential benefits of the medication. It misses an opportunity to encourage a discussion about their concerns and provide reassurance.

Summary:

The best response is D. "The medication can slow the progression of heart failure allowing you to live longer." This answer provides factual information, acknowledges the client's concern about dying, and offers a positive perspective on the benefits of treatment. The other responses either provide misleading information, focus on fear, or miss the opportunity to educate and support the client.

Correct Answer: "When is the last time you had a bowel movement?"

Explanation:

The priority in assessing a client with constipation is to establish when their last bowel movement occurred to determine if there is a significant delay. Normal bowel movement patterns vary among individuals, and understanding the timeline helps the nurse differentiate between a mild, moderate, or severe case of constipation. If the client has not had a bowel movement in several days, it may indicate a need for immediate intervention.

Why the Other Options Are Incorrect:

 "How many bowel movements do you have each week?"

While frequency is important, it is a secondary question after establishing the timeline of the last bowel movement. If the client is already experiencing discomfort, knowing the current status takes precedence.

 "What symptoms are you experiencing?"

Symptoms can provide helpful details but should come after confirming whether the client has had a recent bowel movement. If they haven't, further questions can explore associated discomfort, pain, or straining.

 "What is the consistency of your stool?"

Stool consistency is relevant to assessing constipation severity (e.g., hard, lumpy stools in constipation vs. loose stools in diarrhea), but it does not establish urgency as effectively as knowing the last bowel movement.

Summary:

The nurse should first ask, "When is the last time you had a bowel movement?" to determine if immediate intervention is needed. The other options, while important for assessing constipation patterns and severity, should follow after establishing the timeline of the last bowel movement.

Correct Answer: Asthma

Why this is the correct answer?

Asthma is characterized by symptoms like cough, dyspnea (shortness of breath), and wheezing. These symptoms occur due to inflammation and narrowing of the airways, which leads to difficulty breathing, especially during an asthma attack. Wheezing, in particular, is a hallmark sign of asthma, which is caused by the turbulent airflow through narrowed airways.

Why the other options are incorrect:

Pneumonia

While pneumonia can cause cough and dyspnea, it is usually associated with other symptoms like fever, chills, and productive cough (with sputum). Wheezing is not a typical symptom of pneumonia. Pneumonia involves infection of the lungs, whereas asthma is a chronic inflammatory disease that causes airway constriction.

Respiratory failure

Respiratory failure is a serious condition where the lungs are unable to provide sufficient oxygen or remove enough carbon dioxide from the blood. While dyspnea can be a symptom of respiratory failure, it does not typically cause wheezing or cough by itself. Respiratory failure is usually a result of severe diseases like pneumonia, COPD, or ARDS, and it often involves more severe symptoms, such as confusion, cyanosis, or decreased consciousness.

Pulmonary hypertension

Pulmonary hypertension refers to high blood pressure in the arteries of the lungs. It can cause symptoms such as dyspnea, fatigue, and chest pain, but cough and wheezing are not typical presenting symptoms. Pulmonary hypertension is a more chronic condition that usually leads to right-sided heart failure.

Summary

The symptoms of cough, dyspnea, and wheezing are most consistent with asthma, a chronic condition involving airway inflammation and narrowing. Pneumonia, respiratory failure, and pulmonary hypertension may involve some overlapping symptoms but typically present with additional signs and features that differentiate them from asthma.

The correct answer is B. Avoid products that contain aspirin.

Rationale:

Thrombocytopenia is a condition characterized by a low platelet count, which can increase the risk of bleeding. When teaching safety precautions to a patient with thrombocytopenia, the nurse should emphasize measures to prevent bleeding and avoid anything that could further inhibit platelet function. Avoid products that contain aspirin: Aspirin can interfere with platelet function and increase the risk of bleeding, which is a concern for patients with thrombocytopenia. Therefore, the patient should avoid aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) that affect platelet aggregation.

Why the other options are incorrect:

A. Eat foods high in iron: While iron is important for general health and the treatment of iron deficiency anemia, it does not directly address the management of thrombocytopenia, which involves avoiding bleeding risks and promoting platelet function rather than iron intake.

C. Avoid people with respiratory tract infections: Although it’s important to prevent infections in general, this is not specifically related to thrombocytopenia. The primary concern with thrombocytopenia is bleeding, not infection.

D. Eat only cooked vegetables: While consuming cooked vegetables may be safer for certain conditions (e.g., avoiding the risk of infection from raw foods), it is not directly related to thrombocytopenia. The primary focus should be on avoiding bleeding risks, not dietary restrictions related to food preparation.

Conclusion:

For a patient with thrombocytopenia, the most important directive is to avoid aspirin and other blood-thinning substances that can increase bleeding risk. Therefore, the correct answer is B.