A nurse practitioner assesses the patient and diagnoses Gardnerella vaginalis. What would be the most appropriate nursing action at this time?
- A. Advise the patient that this is an overgrowth of normal vaginal flora.
- B. Discuss the effect of this diagnosis on the patients fertility.
- C. Document the vaginal discharge as normal.
- D. Administer acyclovir as ordered.
Correct Answer: A
Rationale: The correct answer is A: Advise the patient that this is an overgrowth of normal vaginal flora. This is correct because Gardnerella vaginalis is a bacteria associated with bacterial vaginosis, which is an overgrowth of normal vaginal flora. By advising the patient of this, the nurse practitioner can provide education on the condition and treatment options.
B: Discussing the effect of this diagnosis on the patient's fertility is incorrect as Gardnerella vaginalis is not typically associated with fertility issues.
C: Documenting the vaginal discharge as normal is incorrect as Gardnerella vaginalis is indicative of an abnormal vaginal flora imbalance.
D: Administering acyclovir as ordered is incorrect as acyclovir is an antiviral medication used to treat herpes simplex virus infections, not bacterial vaginosis caused by Gardnerella vaginalis.
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The nurse is reviewing the health history of a newly admitted patient and reads that the patient has been previously diagnosed with exostoses. How should the nurse accommodate this fact into the patients plan of care?
- A. The nurse should perform the Rinne and Weber tests.
- B. The nurse should arrange for audiometry testing as soon as possible.
- C. The nurse should collaborate with the pharmacist to assess for potential ototoxic medications.
- D. No specific assessments or interventions are necessary to addressing exostoses.
Correct Answer: C
Rationale: Correct Answer: C
Rationale:
1. Exostoses are bony growths in the external auditory canal.
2. These growths can cause narrowing and obstruction of the canal, affecting hearing.
3. Collaborating with the pharmacist to assess for ototoxic medications is crucial to prevent further hearing impairment.
4. Performing Rinne and Weber tests (choice A) and arranging audiometry testing (choice B) are not directly related to exostoses.
5. Ignoring exostoses (choice D) can lead to worsening hearing loss and potential complications.
A 27-year-old female patient is diagnosed with invasive cervical cancer and is told she needs to have a hysterectomy. One of the nursing diagnoses for this patient is disturbed body image related to perception of femininity. What intervention would be most appropriate for this patient?
- A. Reassure the patient that she will still be able to have children.
- B. Reassure the patient that she does not have to have sex to be feminine.
- C. Reassure the patient that you know how she is feeling and that you feel her anxiety and pain.
- D. Reassure the patient that she will still be able to have intercourse with sexual satisfaction and orgasm.
Correct Answer: B
Rationale: The correct answer is B: Reassure the patient that she does not have to have sex to be feminine.
Rationale:
1. Acknowledges patient's feelings: By reassuring the patient that she does not have to have sex to be feminine, the nurse validates the patient's emotions and concerns.
2. Addresses societal norms: This intervention challenges societal stereotypes that equate femininity solely with reproductive capabilities.
3. Promotes self-acceptance: Encouraging the patient to embrace her femininity beyond physical aspects fosters self-acceptance and self-worth.
4. Supports holistic care: Recognizing the multifaceted nature of femininity shows a holistic approach to addressing the patient's body image issues.
Summary:
A, C, and D are incorrect as they do not directly address the patient's specific concerns about her body image and femininity. Choice B is the most appropriate intervention as it validates the patient's feelings and challenges societal norms, promoting self-acceptance and holistic care
In teaching mothers-to-be about infant nutrition, which instruction should the nurse provide?
- A. Supplement breast milk with corn syrup.
- B. Give cow’s milk during the first year of life.
- C. Add honey to infant formulas for increased energy.
- D. Provide breast milk or formula for the first 4 to 6 months.
Correct Answer: D
Rationale: The correct answer is D because breast milk or formula is recommended for the first 4 to 6 months as it provides essential nutrients for infant growth and development. Choosing A, B, or C is incorrect as they pose health risks to infants - corn syrup is not necessary, cow's milk is not suitable for infants, and honey can cause botulism in infants under 1 year old. Breast milk or formula is the safest and most nutritionally balanced option for infants in the first few months of life.
The hospice nurse has just admitted a new patient to the program. What principle guides hospice care?
- A. Care addresses the needs of the patient as well as the needs of the family.
- B. Care is focused on the patient centrally and the family peripherally.
- C. The focus of all aspects of care is solely on the patient.
- D. The care team prioritizes the patients physical needs and the family is responsible for the patients emotional needs.
Correct Answer: A
Rationale: The correct answer is A because hospice care is centered on a holistic approach that considers the physical, emotional, social, and spiritual needs of both the patient and their family. This principle recognizes that caring for a terminally ill patient involves supporting the entire family unit. Choice B is incorrect because family support is integral to hospice care. Choice C is incorrect because hospice care extends beyond just the patient to include their loved ones. Choice D is incorrect because the care team should address all aspects of care for both the patient and their family, not prioritize one over the other.
An advanced practice nurse has performed a Rinne test on a new patient. During the test, the patient reports that air-conducted sound is louder than bone-conducted sound. How should the nurse best interpret this assessment finding?
- A. The patients hearing is likely normal.
- B. The patient is at risk for tinnitus.
- C. The patient likely has otosclerosis.
- D. The patient likely has sensorineural hearing loss. Chapter 69: Select Neuro Topics: Trigeminal Neuralgia & Bell’s Palsy
Correct Answer: A
Rationale: The correct answer is A: The patient's hearing is likely normal. This interpretation is based on the normal Rinne test result, where air-conducted sound is expected to be louder than bone-conducted sound. This finding indicates that the patient has intact air conduction and no significant conductive hearing loss. Option B is incorrect because tinnitus is not directly related to the Rinne test results. Option C is incorrect as otosclerosis would typically present with abnormal Rinne test results showing bone-conducted sound to be louder. Option D is incorrect as sensorineural hearing loss would not typically affect the Rinne test results in this way.