Nokea
A 55-year-old postmenopausal female patient presents to the family practice clinic for her annual examination. The nurse notes that the patient has lost inch in height. Upon further investigation, the nurse discovers that the patient has a slow-healing fracture of the left radius. What screening will most likely be initiated at this time for the patient?
- A. Assessment for domestic violence
- B. Dual-energy x-ray absorptiometry scan
- C. Follicle-stimulating hormone
- D. Serum levels of calcium and vitamin D
Correct Answer: B
Rationale: In this scenario, the postmenopausal female patient who has lost height and has a slow-healing fracture of the left radius presents with concerning factors for osteoporosis. The most appropriate screening to initiate in this case would be a dual-energy x-ray absorptiometry (DEXA) scan. DEXA scan is the gold standard for diagnosing osteoporosis by measuring bone mineral density. Given the patient's age, postmenopausal status, height loss, and fracture history, assessing bone health through a DEXA scan is crucial to determine the presence of osteoporosis and guide appropriate management and treatment strategies.
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A nurse who works in the emergency department (ED) is assigned to a patient who is experiencing heavy vaginal bleeding at 12 weeks’ gestation. An ultrasound has confirmed the absence of a fetal heart rate, and the patient is scheduled for a dilation and evacuation of the pregnancy. The nurse refuses to provide any further care for this patient based on moral principles. What is the nurse manager’s initial response to the nurse?
- A. “I recall you sharing that information in your interview. I will arrange for another nurse to take report on this patient.”
- B. “Because we are shorthanded today, you have to continue to provide care. There is no one else available to provide care for this patient.”
- C. “I understand your point of view. You were hired to work here in the ED so you had to know this situation was possible.”
- D. “Abandonment is a serious issue. I have to advise you to continue to provide care for this patient.”
Correct Answer: D
Rationale: The nurse manager's initial response should prioritize patient care and safety. In this situation, the patient requires urgent medical attention due to heavy vaginal bleeding and the need for a dilation and evacuation procedure. The nurse's refusal to provide care based on personal moral principles can be considered as patient abandonment, which is a serious ethical and legal issue in healthcare. The nurse manager must advise the nurse to continue providing care for the patient to ensure that the patient's needs are met and to prevent harm resulting from abandonment. The nurse manager should also address the nurse's concerns separately through appropriate channels, such as discussing ethical considerations, providing support, and exploring options for accommodation or transfer if necessary.
The RN is delegating tasks to the unlicensed assistive personnel (UAP). Which tasks can the nurse delegate? (Select all that apply.)
- A. Teaching the patient about breast care
- B. Assessment of a patient’s lochia and perineal area
- C. Assisting a patient to the bathroom for the first time after birth
- D. Vital signs on a postpartum patient who delivered the night before
Correct Answer: C
Rationale: A. Teaching the patient about breast care typically requires specialized knowledge and is best performed by the nurse.
The nurse is providing preoperative education on the laparoscope-assisted vaginal hysterectomy. Which statement by the patient verifies understanding of the procedure?
- A. I will use a mild douche solution to keep the surgical area clean.
- B. I'm relieved that I won't have any visible scars on my abdomen.
- C. I understand that there will be some light vaginal bleeding for several days.
- D. I understand that I must remain on bedrest until cleared by the surgeon.
Correct Answer: B
Rationale: The correct statement by the patient that demonstrates understanding of the laparoscope-assisted vaginal hysterectomy procedure is "I'm relieved that I won't have any visible scars on my abdomen." This is a relevant and accurate statement as the procedure involves minimal scarring due to the use of small incisions in the abdomen rather than a large incision. It shows understanding of one of the benefits of this surgical approach. The other statements are not accurate or relevant to the procedure.
The nurse is caring for a 33-year-old female patient who has just undergone laparoscopic removal of endometrial lesions. Which statement by the patient illustrates her understanding of the disease process and prognosis?
- A. I realize that this is not a cure for the issue, but I want to have more children within the next year.
- B. I'm happy to know that the surgeon has been able to cure me of this disease without a hysterectomy.
- C. I realize that my type 2 diabetes will be cured now that I have those lesions removed
- D. I understand that I will not have to have a colostomy now that the growths were removed from my bowels.
Correct Answer: A
Rationale: Choice A is the correct answer because the patient acknowledges that the laparoscopic removal of endometrial lesions is not a cure for her issue. She demonstrates understanding by mentioning her desire to have more children within the next year, indicating that she recognizes the need for continued monitoring and management of her condition. Choices B, C, D, and E are incorrect because they do not accurately reflect the disease process and prognosis associated with endometrial lesions.
A Vietnamese patient who speaks little English is admitted to the labor and birth unit in early labor. The nurse plans to use an interpreter during an initial assessment. Which should the nurse plan to implement with regard to using an interpreter? (Select all that apply.)
- A. Face the interpreter when speaking.
- B. Listen carefully to what the patient says.
- C. Speak slowly and smile when appropriate.
- D. Plan to use a male interpreter, even if a female interpreter is available.
Correct Answer: A
Rationale: A. Face the interpreter when speaking: By facing the interpreter when speaking, the nurse ensures clear communication and demonstrates respect for the interpreter's role in facilitating understanding between the patient and healthcare provider.