Correct Answer: B

Rationale: The correct answer is B: Ensuring that the patient receives adequate palliative care. Palliative care focuses on improving the quality of life for patients with serious illnesses, including managing symptoms and providing emotional support. In this case, since the patient is not receiving treatment for her brain metastases, palliative care would be most appropriate to help alleviate any pain or discomfort she may be experiencing and provide holistic support for her and her family. A: Promoting the patient's functional status and ADLs may not be the priority if the patient's prognosis is terminal and she is not receiving treatment for her brain metastases. C: Ensuring that the family does not tell the patient her condition is terminal goes against ethical principles of honesty and transparency in healthcare. D: Promoting adherence to the prescribed medication regimen may not be relevant if the patient is not receiving active treatment for her brain metastases.

Correct Answer: B

Rationale: The correct answer is B: Dribbling of urine. This finding should be followed up on after catheter removal because it may indicate urinary retention or incomplete bladder emptying, which can lead to complications such as urinary tract infection. A: Increasing fluid intake is important for overall hydration but is not a specific finding that requires follow-up after catheter removal. C: Voiding in small amounts may be a normal response initially after catheter removal and does not necessarily indicate a problem. D: Voiding within 6 hours of catheter removal is a positive sign of bladder function recovery and does not require immediate follow-up.

Correct Answer: B

Rationale: The correct answer is B: Denial of imminent death on the part of the family or the patient. This is a common cause of patient care dilemmas at the end of life because denial can lead to unrealistic expectations, difficulty in making important decisions, and inadequate planning for end-of-life care. This can result in unnecessary suffering for the patient and added stress for the family. Incorrect choices: A: Poor communication between the family and the care team can contribute to challenges in providing appropriate care but may not be the primary cause of patient care dilemmas at the end of life. C: Limited visitation opportunities for friends and family, while important for psychosocial support, may not directly cause patient care dilemmas. D: Conflict between family members can complicate decision-making processes, but it is not necessarily a primary cause of patient care dilemmas at the end of life.

Correct Answer: B

Rationale: The correct answer is B: Medication adverse effects. Gynecomastia in a 60-year-old man is often caused by medications like spironolactone, cimetidine, and certain antipsychotics. To determine the causative factor, a thorough medication history review is crucial. Age-related physiologic changes (choice A) do not typically lead to gynecomastia in men. Poor nutrition (choice C) and fluid overload (choice D) are not common causes of gynecomastia in this context.

Correct Answer: A

Rationale: The correct answer is A: Acute pain related to tissue manipulation and incision. This is the most likely major nursing diagnosis because post-surgical pain is a common and expected occurrence after breast surgery. The patient is likely to experience pain due to tissue manipulation and incision during the surgery. Addressing acute pain is crucial for the patient's comfort, well-being, and overall recovery. Choice B (Ineffective coping related to surgery) may be a secondary nursing diagnosis, but acute pain takes priority as it directly impacts the patient's immediate comfort and recovery. Choice C (Risk for trauma related to post-surgical injury) is not the most appropriate nursing diagnosis since the patient has already undergone surgery and is not at risk for further injury at this point. Choice D (Chronic sorrow related to change in body image) is not the most immediate concern post-surgery; addressing acute pain is more critical.