What is the step of the nursing process that includes data collection through health history taking, physical examination, and interview?

Correct Answer: D

Rationale: The correct answer is D: Assessment. Assessment is the first step in the nursing process where data is collected through health history, physical examination, and interview. This step helps in identifying the patient's needs and health problems. Planning (A) comes after assessment and involves setting goals and creating a care plan. Diagnosis (B) is the step where nursing diagnoses are formulated based on the assessment data. Evaluation (C) is the final step where the effectiveness of the care plan is assessed. In summary, Assessment is the initial step focused on data collection, making it the correct choice.

Correct Answer: A

Rationale: The correct answer is A: Administer antiemetics. This intervention helps to reduce nausea and vomiting by blocking the neurotransmitters responsible for triggering these symptoms. Administering antiemetics is the most direct and effective approach to address severe nausea and vomiting post-surgery. Choice B (Placing the client in a supine position) is incorrect because it does not directly address the underlying cause of nausea and vomiting. Choice C (Providing hydration) is important but may not alleviate the symptoms of severe nausea and vomiting. Choice D (Monitoring bowel sounds) is important for assessing gastrointestinal motility but does not directly address the immediate symptoms of nausea and vomiting.

Correct Answer: B

Rationale: The correct answer is B: Administer thrombolytics. Thrombolytics help dissolve blood clots, which may be causing the stroke. Administering thrombolytics promptly can improve blood flow to the brain, potentially reducing the severity of the stroke and its effects, including difficulty speaking. Calling for help (A) is important, but administering thrombolytics should be a priority. Performing a CT scan (C) may help confirm the type of stroke but may delay immediate treatment. Administering bronchodilators (D) is not indicated for difficulty speaking related to stroke.

Correct Answer: C

Rationale: The correct action is to obtain baseline information first, then do a complete assessment (Choice C). This is important as it allows the healthcare provider to gather initial vital signs and key information before proceeding with a thorough assessment. By obtaining baseline information first, the healthcare provider can assess the patient's current status and identify any urgent needs requiring immediate attention. This approach helps in prioritizing the assessment and subsequent interventions. Examining only the body areas related to the problem (Choice A) may lead to missing important clues to the patient's condition. Obtaining a thorough history and physical assessment from the family (Choice B) can provide valuable information but should not be the first step in assessing the patient's immediate needs. Examining the entire body to determine if the problem is linked to something else (Choice D) is not the most efficient approach as it may delay identifying and addressing the primary issue causing shortness of breath.

Correct Answer: A

Rationale: Correct Answer: A Rationale: 1. Sodium restriction helps prevent fluid retention and high blood pressure in CKD. 2. Limiting sodium intake is crucial in managing CKD-related complications. 3. Excess sodium can worsen fluid retention and strain the kidneys. 4. Proper understanding of sodium limitation shows patient's grasp of CKD management. Incorrect Choices: B. Increasing fluid intake can worsen fluid retention in CKD patients. C. Excessive protein intake can burden the kidneys in CKD. D. High potassium levels in CKD can lead to dangerous heart rhythm abnormalities.