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A hospitalized patient with impaired vision must get a picture in his or her mind of the hospital room and its contents in order to mobilize independently and safely. What must the nurse monitor in the patients room?
- A. That a commode is always available at the bedside
- B. That all furniture remains in the same position
- C. That visitors do not leave items on the bedside table
- D. That the patients slippers stay under the bed
Correct Answer: B
Rationale: It is crucial for the nurse to monitor that all furniture remains in the same position in the hospitalized patient's room. For a patient with impaired vision who needs to create a mental picture of the room to mobilize independently and safely, any changes in the position of furniture can disrupt this mental map and potentially lead to accidents or falls. By ensuring that all furniture remains unchanged, the nurse supports the patient's ability to navigate the room confidently and without obstacles. This monitoring helps promote the patient's safety and independence during their stay in the hospital.
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Which disease process improves during pregnancy?
- A. Epilepsy
- B. Bell’s palsy
- C. Rheumatoid arthritis
- D. Systemic lupus erythematosus (SLE)
Correct Answer: C
Rationale: Rheumatoid arthritis shows marked improvement during pregnancy, although the reason for this is not entirely clear. The improvement is often significant, leading to relief from symptoms for many pregnant individuals with this condition. However, it's important to note that this improvement is temporary, as relapse typically occurs within 36 months postpartum. The exact mechanisms behind this temporary improvement are not fully understood, but hormones and changes in the immune system during pregnancy are believed to play a role in modifying the disease process.
A patient expresses concerns over having blackstool. The fecal occult test is negative. Which response by the nurse is mostappropriate?
- A. “This is probably a false negative; we should rerun the test.”
- B. “You should schedule a colonoscopy as soon as possible.”
- C. “Are you under a lot of stress?”
- D. “Do you take iron supplements?”
Correct Answer: D
Rationale: Black or tarry stools can be caused by certain medications and supplements, such as iron supplements. Since the fecal occult test is negative, it indicates that bleeding is not occurring. Therefore, in this situation, it is important to consider factors that can affect the color of stool, including iron supplementation. Addressing this question can help determine the cause of the black stool and provide appropriate guidance or reassurance to the patient. This response shows a comprehensive understanding of potential causes and demonstrates a thoughtful approach in addressing the patient's concern.
The nurse in the ED is caring for a 4 year-old brought in by his parents who state that the child will not stop crying and pulling at his ear. Based on information collected by the nurse, which of the following statements applies to a diagnosis of external otitis?
- A. External otitis is characterized by aural tenderness.
- B. External otitis is usually accompanied by a high fever.
- C. External otitis is usually related to an upper respiratory infection.
- D. External otitis can be prevented by using cotton-tipped applicators to clean the ear.
Correct Answer: A
Rationale: External otitis, also known as swimmer's ear, is an infection of the outer ear canal. It is often characterized by aural tenderness, which means that the ear is sensitive to touch and can be painful, especially when pressure is applied to the area. This tenderness is a hallmark symptom of external otitis and helps differentiate it from other ear conditions. Other common symptoms of external otitis include ear pain, itchiness, redness, and swelling of the ear canal. External otitis is usually not accompanied by a high fever, and it is not typically related to an upper respiratory infection. Using cotton-tipped applicators to clean the ear can actually increase the risk of developing external otitis by disrupting the natural protective barrier of the ear canal.
A patients daughter has asked the nurse about helping him end his terrible suffering. The nurse is aware of the ANA Position Statement on Assisted Suicide, which clearly states that nursing participation in assisted suicide is a violation of the Code for Nurses. What does the Position Statement further stress?
- A. Educating families about the moral implications of assisted suicide
- B. Identifying patient and family concerns and fears
- C. Identifying resources that meet the patients desire to die
- D. Supporting effective means to honor the patients desire to die
Correct Answer: B
Rationale: The ANA Position Statement on Assisted Suicide stresses the importance of identifying patient and family concerns and fears. This reflects the nurse's responsibility to provide holistic care and support to patients and their families who may be struggling with end-of-life decisions. By identifying concerns and fears, the nurse can address these issues through compassionate communication, education, and appropriate interventions. This proactive approach aligns with the ethical principles of beneficence and nonmaleficence in nursing practice.
A nurse is providing discharge teaching for apatient who is going home with a guaiac test. Which statement by the patient indicates the need for further education?
- A. “If I get a blue color that means the test is negative.”
- B. “I should not get any urine on the stool I am testing.”
- C. “If I eat red meat before my test, it could give me false results.”
- D. “I should check with my doctor to stop taking aspirin before the test.”
Correct Answer: A
Rationale: The statement "If I get a blue color that means the test is negative" given by the patient indicates the need for further education. This is incorrect information because a blue color in the guaiac test indicates a positive result, which means the presence of fecal occult blood. The patient should be taught that a positive result indicates the need for further evaluation and follow-up with their healthcare provider. Proper understanding of the test results is vital to ensure accurate interpretation and appropriate management. Further clarification and education are necessary to correct this misconception and guide the patient towards understanding the significance of a positive result.