Nursing Process 1 Test Questions -Nurselytic

Correct Answer: A

Rationale: The correct answer is A because green leafy vegetables and soybeans are high in Vitamin K, which counteracts the anticoagulant effect of warfarin. Warfarin works by inhibiting Vitamin K-dependent clotting factors in the liver. By consuming Vitamin K-rich foods, the medication's effectiveness is reduced, leading to an increased risk of blood clot formation.

Choices B, C, and D are incorrect because they do not address the specific interaction between Vitamin K and warfarin in affecting coagulation.
Choice B suggests the opposite effect of what actually occurs.

Choices C and D are irrelevant to the pharmacological mechanism of warfarin.

Correct Answer: D

Rationale: The correct answer is D:
To determine clients response to therapy. Evaluating BUN, creatinine, and serum electrolyte levels in a client being treated for acute pyelonephritis helps the nurse assess the effectiveness of the therapy. Changes in these levels indicate how well the kidneys are functioning and how the client is responding to treatment. Monitoring these parameters allows for adjustments in therapy if needed.

Incorrect choices:
A:
To determine the severity of the disorder - While these tests can provide information about the severity of kidney dysfunction, the primary focus is on monitoring the response to therapy.
B:
To identify signs of fluid retention - While BUN and creatinine levels can indirectly indicate fluid status, the main purpose of evaluating these tests is to assess therapy response.
C:
To determine the location of discomfort - These tests do not provide information about the location of discomfort but rather focus on kidney function and response to treatment.

Correct Answer: C

Rationale: The correct answer is C - the circulating and scrub nurse first assistant. The circulating nurse is responsible for counting needles, sponges, and instruments during the closing of the surgical incision to ensure nothing is left inside the patient. The scrub nurse first assistant also plays a crucial role in this process by assisting in the counting and keeping track of the items used during the procedure. The other choices are incorrect because the surgeon and anesthesiologist (
A) are not typically involved in counting items during the surgical closure, the surgeon and the registered (
B) may not have the necessary training for accurate counting, and the anesthesiologist and anesthetist (
D) are not directly involved in the surgical closing process.

Correct Answer: A

Rationale: The correct answer is A: Removal of the transplanted kidney. Hyperacute rejection is a severe and immediate immune response to the transplanted organ. In this case, the transplanted kidney must be removed promptly to prevent further complications, as it is irreversibly damaged. High-dose IV cyclosporine (
B) is used for immunosuppression but is not effective in treating hyperacute rejection. Bone marrow transplant (
C) is not indicated for kidney rejection. Intra-abdominal instillation of methylprednisolone sodium succinate (
D) is used for acute rejection, not hyperacute rejection.

Correct Answer: B

Rationale: The correct answer is B. Monitoring for signs of restlessness, sweating, and excessive weight loss during thyroid replacement therapy is essential in managing hyperthyroidism. Restlessness can indicate increased metabolic rate, sweating can be due to excessive heat production, and weight loss can be a sign of overactive thyroid function. Providing extra blankets (
Choice
A) may worsen symptoms of heat intolerance. Balancing activity and rest (
Choice
C) is important, but not specific to hyperthyroidism. Encouraging activity to prevent constipation (
Choice
D) is not directly related to managing hyperthyroidism.