A visiting nurse is making an initial home visit for a patient who has many chronic medical problems. Which type of data base is most appropriate to collect in this setting?

Correct Answer: C

Rationale: The correct answer is C, a complete health data base. In this initial home visit for a patient with chronic medical problems, the nurse's primary responsibility is to gather comprehensive information about the patient's health status, medical history, current medications, social support, and lifestyle factors. This type of data base allows for a holistic assessment and forms the foundation for ongoing care planning and monitoring. Choice A is incorrect because a follow-up data base is not suitable for an initial visit as it focuses on evaluating changes over time. Choice B is incorrect as an episodic data base is more appropriate for acute, single-issue visits. Choice D is incorrect as an emergency data base is used in urgent situations requiring rapid assessment and treatment, not for a routine initial visit for chronic medical problems.

Correct Answer: A

Rationale: The correct answer is A: Obtain an abdominal ultrasound. A pulsatile mass in an elderly smoker raises concern for an abdominal aortic aneurysm (AAA). An abdominal ultrasound is the best initial diagnostic test to confirm the presence of an AAA. If left untreated, AAA can lead to life-threatening complications such as rupture. Choice B (Reassess in 6 months) and C (Reassess in 3 months) are incorrect as immediate investigation is necessary due to the potential seriousness of an AAA. Choice D (Refer to a vascular surgeon) is premature without confirming the presence of an AAA through imaging. An ultrasound is needed first to guide further management.

Correct Answer: A

Rationale: The correct answer is A: Palpation. Palpation involves using the hands to feel for abnormalities such as crepitus (crackling or grating sensation), swelling, and pulsations. It allows the nurse to assess textures, temperatures, and tenderness. Inspection (B) involves visual examination, which may not detect subtle abnormalities like crepitus. Percussion (C) is tapping on the body to assess underlying structures and is not used for detecting crepitus, swelling, or pulsations. Auscultation (D) involves listening with a stethoscope and is used for assessing sounds like heartbeats or breath sounds, not the physical characteristics mentioned in the question.

Correct Answer: C

Rationale: Step-by-step rationale: 1. Increased ICP can lead to cerebral edema and worsen neurological outcomes. 2. Promoting carbon dioxide elimination helps reduce cerebral blood flow and intracranial pressure. 3. Hyperventilation decreases PaCO2, causing vasoconstriction and reducing ICP. 4. Preventing respiratory alkalosis (A) and lowering arterial pH (B) are incorrect as they can worsen cerebral vasoconstriction. 5. Maintaining PaO2 above 80 mm Hg (D) is important but not the primary goal in managing increased ICP.

Correct Answer: D

Rationale: The correct answer is D because a new onset of chest pain during a cardiovascular assessment could indicate a serious cardiac issue like a heart attack requiring immediate intervention. Chest pain can be a symptom of myocardial infarction, which is a medical emergency. Choices A, B, and C are not immediate concerns. A capillary refill of 3 seconds is within normal limits (2 seconds or less is normal). Blood pressure of 130/80 mmHg is within the normal range, and a heart rate of 110 beats per minute may be elevated but not necessarily an immediate concern without additional context.