The nurse is caring for a patient preparing for surgery. Which finding would concern the nurse?
Positive pregnancy test
Family history of hypertension
Signed advance directive
Medical history of diabetes
The Correct Answer is A
Choice A reason: A positive pregnancy test is a significant concern for a patient preparing for surgery as it can affect the type of anesthesia used and the surgical approach, due to the potential impact on the fetus.
Choice B reason: While a family history of hypertension is important, it is not as immediately concerning as a positive pregnancy test in a patient preparing for surgery.
Choice C reason: A signed advance directive is a document that outlines a patient's wishes regarding medical treatment and is not a concern but rather a part of preoperative preparation.
Choice D reason: A medical history of diabetes is important to consider in surgical patients due to potential complications with wound healing and blood glucose control, but it is not as urgent as confirming pregnancy status before surgery.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Evaluation is the final step of the nursing process, where the nurse determines the effectiveness of the nursing care provided.
Choice B reason: Assessment is the correct part of the nursing process for the mental status examination, as it involves collecting data about the patient.
Choice C reason: Planning involves setting goals and choosing appropriate nursing actions based on the assessment data.
Choice D reason: Implementation is the step where the nurse carries out the planned interventions.
Correct Answer is A
Explanation
Choice A reason: Clients with OCD often engage in compulsive behaviors, such as cleaning, to manage their anxiety levels. Recognizing this can help the nurse provide appropriate support and interventions.
Choice B reason: While the tasks may seem useful, the compulsive nature of the behavior is driven by anxiety rather than a focus on productivity.
Choice C reason: The behavior is not about limiting social interaction; it is a manifestation of the client's OCD.
Choice D reason: The behavior is not intended to manipulate or control others but is a symptom of the client's OCD.
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