Nokea
A patient has come into the free clinic asking to be tested for HIV infection. The patient asks the nurse how the test works. The nurse responds that if the testing shows that antibodies to the AIDS virus are present in the blood, this indicates what?
- A. The patient is immune to HIV.
- B. The patients immune system is intact.
- C. The patient has AIDS-related complications.
- D. The patient has been infected with HIV.
Correct Answer: D
Rationale: The correct answer is D: The patient has been infected with HIV. Antibodies to the AIDS virus in the blood indicate a past or current infection with HIV. This is because the body produces antibodies in response to the presence of the virus.
A: The patient is immune to HIV is incorrect because antibodies indicate exposure, not immunity.
B: The patient's immune system is intact is incorrect because the presence of antibodies does not necessarily reflect the overall functionality of the immune system.
C: The patient has AIDS-related complications is incorrect because the presence of antibodies does not directly indicate the presence of AIDS-related complications.
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The nurse is teaching breast self-examination (BSE) to a group of women. The nurse should recommend that the women perform BSE at what time?
- A. At the time of menses
- B. At any convenient time, regardless of cycles
- C. Weekly
- D. Between days 5 and 7 after menses
Correct Answer: A
Rationale: The correct answer is A: At the time of menses. This is because breasts are less lumpy and tender during this time, making it easier to detect abnormalities. Performing BSE at other times may lead to false alarms due to hormonal changes. Choice B is incorrect because timing matters for accurate results. Choice C is incorrect as weekly BSE is unnecessary and may cause unnecessary anxiety. Choice D is incorrect as breasts are more lumpy and tender post-menses, potentially making it harder to detect abnormalities.
A nurse is preparing to document a patient whohas chest pain. Which information is critical for the nurse to include?
- A. The family is a “pain.”
- B. Pupils equal and reactive to light
- C. Had poor results from the pain medication
- D. Sharp pain of 8 on a scale of 1 to 10
Correct Answer: D
Rationale: The correct answer is D because documenting the patient's pain intensity using a pain scale (8 out of 10) is crucial for assessing the severity of the chest pain. This information helps in determining the appropriate intervention and monitoring the effectiveness of treatment. Choice A is irrelevant as it does not provide any useful information about the patient's condition. Choice B is important for neurological assessment but not specifically related to chest pain. Choice C is not as critical as knowing the current pain level.
A patient is scheduled to have an electronystagmography as part of a diagnostic workup for Mnires disease. What question is it most important for the nurse to ask the patient in preparation for this test?
- A. Have you ever experienced claustrophobia or feelings of anxiety while in enclosed spaces?
- B. Do you currently take any tranquilizers or stimulants on a regular basis?
- C. Do you have a history of falls or problems with loss of balance?
- D. Do you have a history of either high or low blood pressure?
Correct Answer: A
Rationale: The correct answer is A: Have you ever experienced claustrophobia or feelings of anxiety while in enclosed spaces? This question is important because electronystagmography involves the patient being placed in a confined space with sensors attached to monitor eye movements. Claustrophobia or anxiety can significantly impact the patient's ability to tolerate the test, affecting its accuracy.
Choice B: Do you currently take any tranquilizers or stimulants on a regular basis? While relevant in some cases, it is not as crucial as ensuring the patient can tolerate the test environment.
Choice C: Do you have a history of falls or problems with loss of balance? While relevant to Mnire's disease, it is not directly related to the preparation for electronystagmography.
Choice D: Do you have a history of either high or low blood pressure? While monitoring blood pressure is important for some procedures, it is not a primary concern for electronystagmography.
Which factor is known to increase the risk of gestational diabetes mellitus?
- A. Previous birth of large infant
- B. Maternal age younger than 25 years
- C. Underweight prior to pregnancy
- D. Previous diagnosis of type 2 diabetes mellitus
Correct Answer: A
Rationale: The correct answer is A: Previous birth of large infant. This factor increases the risk of gestational diabetes mellitus due to a history of delivering a large baby, indicating a higher likelihood of insulin resistance in subsequent pregnancies. Maternal age younger than 25 years (B) is not a known risk factor for gestational diabetes. Being underweight prior to pregnancy (C) is actually associated with a decreased risk of gestational diabetes. A previous diagnosis of type 2 diabetes mellitus (D) is a separate condition and does not directly increase the risk of gestational diabetes.
A 23-year-old woman comes to the free clinic stating I think I have a lump in my breast. Do I have cancer? The nurse instructs the patient that a diagnosis of breast cancer is confirmed by what?
- A. Supervised breast self-examination
- B. Mammography
- C. Fine-needle aspiration
- D. Chest x-ray
Correct Answer: B
Rationale: The correct answer is B: Mammography. Mammography is the gold standard for diagnosing breast cancer as it can detect abnormalities such as lumps or tumors in the breast tissue. It provides detailed images that can help healthcare providers identify suspicious areas that may require further testing or biopsy. Supervised breast self-examination (choice A) is important for early detection but is not a diagnostic tool. Fine-needle aspiration (choice C) is a procedure used to obtain a sample of cells for further analysis but is not definitive for diagnosing breast cancer. Chest x-ray (choice D) is used to evaluate the lungs and heart, not the breast tissue for cancer.