A nurse is caring for an older adult patient with left-sided heart failure. What assessment findings should the nurse expect?

Choice A rationale

Intussusception is a serious condition in which part of the intestine slides into an adjacent part of the intestine. This “telescoping” often blocks food or fluid from passing through.

Intussusception also cuts off the blood supply to the part of the intestine that’s affected. It can lead to a tear in the bowel (perforation), infection and death of bowel tissue.

Choice B rationale

Wilms’ tumor is a rare kidney cancer that primarily affects children. Also known as nephroblastoma, Wilms’ tumor is the most common cancer of the kidneys in children. Wilms’ tumor most often affects children ages 3 to 4 and becomes much less common after age 52.

Choice C rationale

Pyloric stenosis is a condition that affects infants between birth and 6 months of age and causes forceful vomiting that can lead to dehydration. It’s the second most common reason why newborns have surgery. Pyloric stenosis can be fixed with a surgical procedure called pyloromyotomy.

Choice D rationale

Nephrotic syndrome is a kidney disorder that causes your body to excrete too much protein in your urine. Nephrotic syndrome is usually caused by damage to the clusters of small blood vessels in your kidneys that filter waste and excess water from your blood.

Choice A rationale

Spending time with the patient is a therapeutic nursing approach when caring for a patient hospitalized for the treatment of severe depression. This approach shows the patient that they

are not alone and that their feelings are important. It can help build trust and rapport, which are essential for effective therapeutic communication and intervention.

Choice B rationale

Offering the patient choices of activities can be beneficial as it can provide a sense of control and improve mood. However, this approach should be used judiciously as the patient’s energy levels and interest in activities may be low due to depression.

Choice C rationale

Establishing a therapeutic relationship with the patient is an important aspect of care. However, this is a broad approach and involves more than just spending time with the patient. It includes building trust, maintaining confidentiality, and providing empathetic and nonjudgmental care.

Choice D rationale

Exploring the truth of the patient’s statements can be part of cognitive behavioral therapy (CBT), a common treatment for depression. However, this is usually done by a trained therapist and not by a nurse providing general care.