Correct Answer: A

Rationale: The correct answer is A: Assessment. In this scenario, the nurse failed to assess the patient's condition promptly after being informed of feeling dizzy and light-headed. Assessment involves collecting data to identify actual or potential health problems. By not promptly assessing the patient's worsening condition, the nurse missed an essential step in the nursing process. Choice B: Diagnosis comes after assessment and involves identifying the patient's health problems based on collected data. Choice C: Implementation is the phase where the nurse carries out the plan of care. Choice D: Evaluation occurs after implementation to determine if the interventions were effective.

Correct Answer: B

Rationale: The correct answer is B: Expressive aphasia and paralysis on the left side of the body. In a right-handed person, the left side of the brain controls language (Broca's area) and motor function for the right side of the body. A stroke affecting the left side of the cortex would lead to expressive aphasia (difficulty speaking) due to damage to Broca's area and paralysis on the right side of the body due to motor function impairment. Choices A, C, and D are incorrect because they do not align with the known neurological functions of the brain regions affected by the stroke.

Correct Answer: A

Rationale: Correct Answer: A Rationale: 1. Timing: Antiviral medications should be taken as prescribed to maintain consistent drug levels in the body. 2. Around meals: Taking medications with or without food can affect absorption, so timing around meals helps with consistency. 3. Compliance: Following the timing instructions increases medication effectiveness and reduces the risk of drug resistance. Other Choices: B) Avoiding harsh sunlight: Not directly related to medication administration; may be a precaution for other reasons. C) Having medications with fruit juice: This is not a standard instruction for antiviral medications; may not be suitable for all medications. D) Increasing dose for worsening symptoms: This is dangerous and should only be done under healthcare provider supervision; self-adjusting medication doses can be harmful.

Correct Answer: B

Rationale: The correct answer is B: To provide a means for further comparison and evaluation. By recording the color of drainage from each tube and catheter, the nurse can monitor changes over time, assess for any abnormalities, and evaluate the effectiveness of treatment. This helps in detecting complications early and making informed decisions. Rationale for other choices: A: To restore and maintain intravascular volume - Monitoring drainage color does not directly relate to intravascular volume status. C: To avoid interference with wound drainage - Monitoring drainage color does not prevent interference with wound drainage. D: To prevent pain related to obstruction - Monitoring drainage color does not directly prevent pain related to obstruction.

Correct Answer: C

Rationale: The correct answer is C: Introduce variations in styles of clothing. This suggestion promotes the client's self-image by helping her feel more comfortable and confident in her appearance despite the lymphedema. It allows her to express her personal style while accommodating the enlarged arm. A: Placing the arm in a sling does not address the client's self-image concerns and may further highlight the abnormality. B: Applying cold soaks may help with swelling but does not directly address the client's self-image. D: Tying a tight bandage can worsen lymphedema and does not address the client's self-image concerns.