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A patient with a history of deep vein thrombosis (DVT) is prescribed warfarin therapy. Which instruction is essential for the nurse to include in patient education about warfarin therapy?
- A. "Limit your intake of green leafy vegetables."
- B. "Avoid activities that may increase your risk of bleeding."
- C. "Take a double dose if you miss a dose to catch up."
- D. "Report any unusual bleeding or bruising to your healthcare provider."
Correct Answer: D
Rationale: It is essential for the nurse to instruct the patient to "Report any unusual bleeding or bruising to your healthcare provider." Warfarin is a medication that works by decreasing the clotting ability of the blood. This can increase the risk of bleeding, so it is important for the patient to be vigilant for any signs of abnormal bleeding. Prompt reporting of any unusual bleeding or bruising allows healthcare providers to adjust the dosage of warfarin to maintain a balance between preventing blood clots and minimizing the risk of bleeding complications. This instruction emphasizes the importance of close monitoring and communication with healthcare providers while on warfarin therapy.
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A patient admitted to the ICU develops acute liver failure with hepatic encephalopathy. What intervention should the healthcare team prioritize to manage the patient's encephalopathy?
- A. Administer lactulose or other ammonia-lowering agents.
- B. Perform liver transplantation to restore liver function.
- C. Initiate enteral nutrition to support metabolic needs.
- D. Prescribe benzodiazepines for sedation and agitation.
Correct Answer: A
Rationale: The healthcare team should prioritize administering lactulose or other ammonia-lowering agents to manage hepatic encephalopathy in a patient with acute liver failure. Hepatic encephalopathy is a neuropsychiatric syndrome that occurs in patients with liver dysfunction, leading to the accumulation of ammonia and other neurotoxic metabolites in the bloodstream. Lactulose works by acidifying the colon, which promotes the conversion of ammonia to ammonium, a less toxic form that can be excreted in the stool. By reducing the levels of ammonia, lactulose helps improve the neurological symptoms associated with hepatic encephalopathy.
A woman in active labor is diagnosed with an amniotic fluid embolism. What is the priority nursing intervention?
- A. Administering oxygen via face mask
- B. Preparing for immediate cesarean section
- C. Initiating cardiopulmonary resuscitation (CPR)
- D. Inserting an indwelling urinary catheter
Correct Answer: C
Rationale: An amniotic fluid embolism is a rare and life-threatening complication during labor and delivery. It occurs when amniotic fluid or fetal cells enter the maternal circulation, triggering a rapid immune response that can lead to cardiovascular collapse and respiratory failure. The priority nursing intervention for a woman in active labor diagnosed with an amniotic fluid embolism is to initiate cardiopulmonary resuscitation (CPR) to support her vital functions and circulation. Providing immediate CPR can help sustain her until further medical interventions can be implemented. Administering oxygen and preparing for a cesarean section may be necessary but should occur after CPR is initiated to stabilize the woman's condition. Inserting an indwelling urinary catheter is not the priority in this emergency situation, as maintaining adequate cardiac and respiratory function takes precedence.
In caring for this patient suffering from anorexia nervous, which task can be delegated to the nursing assistant?
- A. Obtaining special food for the patient when she request it
- B. Sitting with the patient during meals and for about an hour after/meals
- C. Weighing the patient daily and reinforcing that she is underweight
- D. Observing for reporting ritualistic behaviors related to food
Correct Answer: A
Rationale: Task A, obtaining special food for the patient when she requests it, can be delegated to the nursing assistant. This task involves simple assistance with gathering food items and does not require specific medical knowledge or interventions. Tasks B, C, and D involve more direct patient care and assessment, which should be performed by the nursing staff who have the necessary training and expertise to address the complexities of anorexia nervosa.
In this pandemic nurses are float to areas of most need in the time of a nursing shortage, this is an example of:
- A. Utilitarianism theory
- B. Justice
- C. Deontological theory
- D. Beneficence
Correct Answer: A
Rationale: Utilitarianism is an ethical theory that focuses on producing the greatest overall balance of good over bad consequences for everyone involved. In the context of the situation described, nurses being floated to areas of most need during a nursing shortage is an example of utilitarianism in action. The decision to float nurses is aimed at maximizing the benefit to the greatest number of patients by ensuring that critical care is provided where it is most needed, even if it may cause inconvenience or discomfort to the nurses being floated. This decision aligns with the principle of maximizing overall utility and promoting the greater good, which are central tenets of utilitarianism.
A patient presents with a thyroid nodule and signs of hyperthyroidism. Fine-needle aspiration biopsy reveals Hurthle cells and cellular atypia. Which endocrine disorder is most likely responsible for these symptoms?
- A. Hashimoto's thyroiditis
- B. Graves' disease
- C. Hurthle cell carcinoma
- D. Papillary thyroid carcinoma
Correct Answer: C
Rationale: Hurthle cell carcinoma is a type of thyroid cancer that arises from the Hurthle cells of the thyroid gland. Patients with Hurthle cell carcinoma may present with a thyroid nodule and signs of hyperthyroidism, which can mimic other thyroid disorders such as Graves' disease. Fine-needle aspiration biopsy revealing Hurthle cells and cellular atypia is suggestive of a Hurthle cell neoplasm, particularly Hurthle cell carcinoma. It is important to differentiate Hurthle cell carcinoma from benign Hurthle cell adenomas or other thyroid conditions to guide appropriate management and treatment.