Which of the following is the appropriate nursing diagnosis?

Correct Answer: B

Rationale: The appropriate nursing diagnosis is Fluid volume deficit R/T uncontrolled vomiting. This diagnosis is the most specific and directly related to the issue of vomiting causing a loss of fluids, leading to a deficit in fluid volume. Uncontrolled vomiting can result in a significant loss of fluids and electrolytes, which can lead to dehydration. It is important to address the root cause of the fluid volume deficit, which in this case is the uncontrolled vomiting. The other options may not directly address the primary issue of fluid loss due to vomiting.

Correct Answer: D

Rationale: Early symptoms of cancer of the larynx typically include persistent hoarseness or a change in the voice quality. This may be due to the tumor affecting the vocal cords. Dysphagia, or difficulty swallowing, can also be an early sign. As the tumor grows, it may cause obstruction or compression in the throat, leading to difficulties in swallowing. These symptoms should prompt further evaluation by a healthcare provider for proper diagnosis and treatment planning. Anemia and fatigue (Choice A) are more general symptoms that can occur in cancer patients but are not typically specific to laryngeal cancer. The presence of a noticeable lump in the neck (Choice B) may indicate swelling of lymph nodes due to cancer spread but is not an early symptom commonly associated with laryngeal cancer. Crackles and stridor (Choice C) are respiratory sounds associated with conditions affecting the airways and are less likely to be early symptoms

Correct Answer: C

Rationale: Oxygen therapy for patients with emphysema aims to maintain adequate oxygen levels in the blood while avoiding toxic levels of oxygen. The recommended flow rate for oxygen administration in patients with emphysema is typically 1-3 liters per minute. Increasing the flow rate above this range may lead to oxygen toxicity in these patients. Therefore, a safe and appropriate oxygen flow rate for a patient with emphysema would be around 6 L/min, making option C, 6 L/min, the correct choice from the provided options.

Correct Answer: B

Rationale: Acute respiratory distress syndrome (ARDS) is a serious condition that can lead to various complications, including renal failure. When a client is experiencing ARDS, the lungs become severely inflamed and filled with fluid, which can lead to decreased oxygen levels in the blood. This decrease in oxygen can place a significant strain on the kidneys, potentially resulting in renal failure. Therefore, it is crucial for nurses to monitor the client for signs and symptoms of renal failure, such as changes in urine output, fluid imbalance, electrolyte abnormalities, and altered mental status. Timely detection and management of renal complications in clients with ARDS are essential to prevent further deterioration of the client's condition.

Correct Answer: B

Rationale: In the context of older adults with heart and blood vessel diseases being susceptible to thrombophlebitis, the correct answer is B) IV drugs and chemicals. This is because the administration of intravenous drugs and chemicals can irritate the blood vessel walls, leading to inflammation and clot formation, which increases the risk of thrombophlebitis. Option C) Impaired mobility is not directly related to the development of thrombophlebitis in older adults with heart and blood vessel diseases. While impaired mobility can contribute to venous stasis and increase the risk of deep vein thrombosis, it is not specifically linked to the susceptibility to thrombophlebitis in this population. Option D) Compromised circulation could be a contributing factor to the development of thrombophlebitis, but it is not as directly related as the administration of IV drugs and chemicals. Compromised circulation may lead to venous stasis, which can increase the risk of thrombus formation, but the immediate cause in this scenario is the introduction of irritants through IV administration. Educationally, understanding the risk factors for thrombophlebitis in specific populations, such as older adults with heart and blood vessel diseases, is crucial for healthcare professionals involved in their care. Recognizing the impact of interventions like IV drug administration on vascular health can inform preventive strategies and promote patient safety.