Mr. RR is being prepared for surgery. Nursing care would include:

Correct Answer: A

Rationale: Nursing care for a patient being prepared for surgery includes conducting a careful assessment of neurologic signs to establish baseline data for post-operative care. Assessing the patient's neurologic status preoperatively is important for early detection of any post-operative complications such as changes in consciousness, sensation, or movement. This baseline data will be used to monitor and evaluate the patient's recovery and response to the surgery, anesthesia, and post-operative care interventions. Planning activities, administering enemas, and explaining post-operative complications are also important aspects of nursing care but assessing neurologic signs is the priority in this scenario.

Correct Answer: C

Rationale: Halos around lights are a common symptom observed in patients experiencing acute angle-closure glaucoma. This occurs due to the increased intraocular pressure causing corneal edema, which leads to light scattering and the appearance of halos. Other symptoms may include severe eye pain, redness in the eye, decreased vision, and headache. It is important for the nurse to recognize these symptoms promptly as acute angle-closure glaucoma is a medical emergency that requires immediate treatment to prevent permanent vision loss.

Correct Answer: C

Rationale: The nursing care for a client in Addisonian crisis, also known as adrenal crisis, should include offering extra blankets and raising the heat in the room to keep the client warm. Addisonian crisis is a life-threatening condition that occurs when the body does not have enough cortisol and aldosterone, which are hormones produced by the adrenal glands. Symptoms of Addisonian crisis include severe weakness, fatigue, abdominal pain, nausea, vomiting, and low blood pressure. By offering extra blankets and raising the room temperature, the nurse can help prevent hypothermia, which can worsen the client's condition. It is important to maintain the client's body temperature to promote comfort and prevent further complications during Addisonian crisis.

Correct Answer: C

Rationale: In a patient with hyperglycemic, hyperosmolar nonketotic coma (HHNK), the high blood glucose levels lead to osmotic diuresis, causing excessive urination and subsequent dehydration. Dehydration can manifest as symptoms such as dry mucous membranes, poor skin turgor, decreased urine output, increased heart rate, and low blood pressure. Therefore, the nurse should expect to find signs of severe dehydration in a patient with HHNK coma. The other options listed are not typical assessment findings associated with HHNK coma.

Correct Answer: A

Rationale: Administering oxygen therapy would be the priority intervention in this case because Arthur is experiencing pneumonia with a high fever (39° to 40° C). High fever can lead to increased oxygen demand in the body, and providing supplemental oxygen can help ensure that Arthur is receiving adequate oxygenation to support his respiratory function. Oxygen therapy can also help improve oxygen saturation levels, which may be compromised due to the pneumonia. Therefore, addressing the potential respiratory distress caused by the pneumonia and fever should be the top priority to optimize Arthur's oxygenation levels and respiratory function.