Correct Answer: A

Rationale: The correct answer is A: Hypoactive bowel sounds. When a patient has not had a bowel movement in 3 days, it indicates constipation. Constipation can lead to decreased peristalsis, resulting in hypoactive bowel sounds. Increased fluid intake (B) would be a potential intervention, not an expected assessment finding. A soft tender abdomen (C) may indicate other issues like inflammation or infection, not directly related to constipation. Jaundice in the sclera (D) is indicative of liver dysfunction, not a typical finding associated with constipation.

Correct Answer: C

Rationale: The correct answer is C: The patient has diabetes. Diabetes can lead to diabetic retinopathy, a common cause of low vision. By knowing the patient's medical history, the nurse can recommend appropriate low vision aids and refer the patient to an ophthalmologist for further evaluation and management. Incorrect choices: A: The patient uses OTC NSAIDs - NSAIDs are not relevant to managing low vision. B: The patient has a history of stroke - A history of stroke is not directly related to low vision. D: The patient has Asian ancestry - Ancestry is not a factor in managing low vision.

Correct Answer: D

Rationale: The correct answer is D: Perform gentle massage to stimulate neutrophil migration. Gentle massage helps to promote drainage of the infected area by stimulating neutrophil migration, which aids in fighting the infection. This can help alleviate the pain and discomfort associated with acute mastitis. Cold compresses (choice A) may provide some relief, but they do not address the underlying issue of promoting neutrophil migration. Avoiding washing the breasts (choice C) is not recommended as maintaining good hygiene is important in preventing further infections. Avoiding wearing a bra (choice B) may not directly address the infection and may not be practical for the patient's daily activities.

Correct Answer: B

Rationale: The correct answer is B: Focusing the patient's immune system exclusively on the tumor. Biologic response modifiers (BRMs) work by enhancing the body's natural defenses to target and attack cancer cells specifically. This approach helps the immune system to recognize and destroy cancer cells while minimizing harm to normal cells. A: Promoting the synthesis and release of leukocytes - This is not the primary mechanism of action for BRMs. While leukocytes play a role in the immune response, BRMs target the immune system's response to tumors. C: Potentiating the effects of chemotherapeutic agents and radiation therapy - While some BRMs may be used in combination with these treatments, their primary mode of action is not to enhance the effects of chemotherapy or radiation therapy. D: Altering the immunologic relationship between the tumor and the patient - This choice is too broad and vague. BRMs specifically aim to direct the immune response towards targeting the tumor cells, rather than altering the overall immunologic relationship

Correct Answer: A

Rationale: The correct answer is A: Assess for bladder distention. Oliguria indicates decreased urine output, which could be due to urinary retention. Assessing for bladder distention helps identify the underlying cause. Requesting diuretics (B) without assessing first is premature. Increasing IV fluid rate (C) may worsen the situation if there is urinary retention. Encouraging caffeinated beverages (D) is not appropriate as they can worsen dehydration.