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A patient is admitted to a medical unit with a diagnosis of heart failure. The patient reports that she has had increasing fatigue during the past 2 weeks. Which of the following is the most likely cause of this fatigue?
- A. Dyspnea
- B. Decreased cardiac output
- C. Dry cough
- D. Orthopnea
Correct Answer: B
Rationale: Fatigue in a patient with heart failure is commonly caused by decreased cardiac output. In heart failure, the heart is unable to pump enough blood to meet the body's demands, resulting in reduced delivery of oxygen and nutrients to the tissues. This can lead to generalized weakness and fatigue. Dyspnea (choice A) is commonly associated with heart failure but is more specific to difficulty breathing, while a dry cough (choice C) is a symptom that can be present but is not typically the primary cause of fatigue. Orthopnea (choice D) is a symptom of heart failure characterized by difficulty breathing when lying flat but is not directly related to the patient's increasing fatigue in this scenario.
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A nurse manager at a home-care agency is planning a continuing education program for the home-care staff nurses. Which type of continuing education program should the nurse manager plan?
- A. On-line training modules
- B. A structured written teaching module each nurse completes individually
- C. A workshop training day, with a professional speaker, where nurses can interact with each other
- D. One-on-one continuing education training with each nurse
Correct Answer: C
Rationale: A workshop training day with a professional speaker where nurses can interact with each other would be the most beneficial type of continuing education program for home-care staff nurses. This type of program allows for interactive learning and the opportunity for nurses to engage in discussions, ask questions, and share experiences with each other. It promotes a collaborative learning environment, fosters teamwork, and enhances communication among the staff. Additionally, bringing in a professional speaker can provide valuable insights and expertise on relevant topics, further enriching the education experience for the nurses. Overall, a workshop training day would be a more engaging and effective approach to continuing education for the home-care staff nurses compared to the other options listed.
You are evaluating a 6-year-old child with ALL on interim maintenance phase who has frequent mucositis and myelosuppression that needs frequent discontinuation of his treatment. Of the following, the MOST valuable test for this child is
- A. complete blood count
- B. pharmacogenetic testing of the thiopurine S-methyltransferase (TPMT) gene
- C. renal function test
- D. bone marrow study
Correct Answer: B
Rationale: TPMT gene testing helps determine the child's ability to metabolize thiopurine drugs, which may explain the adverse effects.
Which of the ff. nursing actions is most appropriate when doing perineal care on an uncircumcised male patient?
- A. Leave the foreskin retracted so air can keep the area dry
- B. Do not retract the foreskin during washing
- C. Replace the foreskin over the head of the penis after washing
- D. Use alcohol and a cotton swab to clean under the foreskin
Correct Answer: C
Rationale: When performing perineal care on an uncircumcised male patient, it is important to replace the foreskin over the head of the penis after washing. The foreskin should not be left retracted or pulled back forcibly as it can cause irritation and discomfort to the patient. Leaving the foreskin retracted can also lead to potential complications such as paraphimosis, where the foreskin becomes trapped behind the head of the penis. Proper hygiene involves gently retracting the foreskin to clean underneath it and then returning it to its natural position to protect the sensitive glans penis. Using gentle, warm water with mild soap is typically sufficient for cleaning, and alcohol should be avoided as it can cause irritation and dryness to the sensitive genital area.
Maintaining the infusion rate of hyperalimentation solutions is a nursing responsibility. What side effects would you anticipate from too rapid infusion rate?
- A. Cellular dehydration and potassium
- B. Hypoglycemia and hypovolemia
- C. Potassium excess and CHF
- D. Circulatory overload and hypoglycemia SITUATION: In the recall of the fluids and electrolytes, the nurse should be able to understand the calculations and other conditions related to loss or retention.
Correct Answer: D
Rationale: Too rapid infusion of hyperalimentation solutions can lead to circulatory overload due to the rapid volume expansion, which can strain the heart and lead to fluid overload. This can manifest as symptoms such as shortness of breath, crackles in the lungs, and edema. Additionally, a rapid infusion rate can cause a sudden surge in glucose levels, potentially leading to hypoglycemia due to increased insulin release in response to the elevated glucose levels. It is important for the nurse to maintain a careful and appropriate infusion rate to prevent these complications and ensure patient safety.
Potential sources of mercury include all of the following EXCEPT
- A. swordfish
- B. old teething powders
- C. quicksilver
- D. milk
Correct Answer: D
Rationale: Mercury is not typically found in milk. It is commonly found in fish, old teething powders, quicksilver, and other sources.