Nokea
A patient is admitted with a suspected myocardial infarction. Which cardiac biomarker is most specific for myocardial injury?
- A. Troponin
- B. Creatine kinase-MB (CK-MB)
- C. Myoglobin
- D. Brain natriuretic peptide (BNP)
Correct Answer: A
Rationale: Troponin is the most specific cardiac biomarker for myocardial injury. Troponin I and Troponin T are proteins released into the bloodstream when there is damage to the heart muscle, making them highly indicative of myocardial infarction. Troponin levels rise within a few hours of cardiac injury, peak within 24-48 hours, and can remain elevated for up to 2 weeks. Troponin is considered the gold standard biomarker for the diagnosis of acute myocardial infarction due to its high specificity and sensitivity for cardiac injury. In contrast, Creatine kinase-MB (CK-MB) and myoglobin are also used in diagnosing myocardial infarction but are less specific than troponin. Brain natriuretic peptide (BNP) is primarily used in heart failure diagnosis and management, and its levels are not specific to myocardial injury.
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The FIRST PRIORITY nursing intervention during the immediate postpartum period is focused on
- A. Monitoring urinary output
- B. Taking the vital signs every 4 hours
- C. Observing postpartum hemorrhage
- D. Checking level of responsiveness
Correct Answer: C
Rationale: Postpartum hemorrhage is a serious complication that can occur within the first 24 hours after childbirth. It is the leading cause of maternal mortality worldwide. Therefore, during the immediate postpartum period, the first priority nursing intervention should be focused on observing for signs and symptoms of postpartum hemorrhage, such as excessive bleeding, abnormal vital signs, and changes in uterine tone. Early detection and prompt intervention can prevent severe complications and save the mother's life. Monitoring urinary output, taking vital signs, and checking level of responsiveness are important aspects of postpartum care but observing for postpartum hemorrhage takes precedence due to its critical nature.
A patient with systemic lupus erythematosus (SLE) demonstrates a positive antinuclear antibody (ANA) test and elevated levels of anti-double-stranded DNA (anti-dsDNA) antibodies. Which of the following mechanisms is most likely responsible for the production of these autoantibodies?
- A. Loss of self-tolerance
- B. Failure of innate immunity
- C. Defective T cell activation
- D. Impaired phagocytosis
Correct Answer: A
Rationale: The development of autoantibodies such as antinuclear antibodies (ANA) and anti-double-stranded DNA (anti-dsDNA) antibodies in systemic lupus erythematosus (SLE) is primarily attributed to a loss of self-tolerance. Self-tolerance refers to the immune system's ability to recognize and differentiate self-antigens from foreign antigens. In individuals with SLE, there is a breakdown in immune tolerance mechanisms, leading to the production of autoantibodies against self-antigens like nuclear components (e.g., DNA, RNA, histones). This loss of self-tolerance results in the immune system targeting and attacking its tissues, leading to the systemic inflammation and tissue damage characteristic of SLE. The presence of elevated levels of ANA and anti-dsDNA antibodies in this patient suggests an autoimmune response against nuclear material, further supporting the role of self-tolerance breakdown in SLE
A patient receiving palliative care for end-stage lung disease experiences dyspnea and anxiety. What intervention should the palliative nurse prioritize to address the patient's symptoms?
- A. Administer supplemental oxygen therapy to improve oxygenation.
- B. Teach the patient diaphragmatic breathing exercises for respiratory support.
- C. Prescribe benzodiazepine medications to reduce anxiety and promote relaxation.
- D. Refer the patient to a pulmonologist for evaluation and treatment of dyspnea.
Correct Answer: B
Rationale: Teaching the patient diaphragmatic breathing exercises for respiratory support would be the most appropriate intervention to address the symptoms of dyspnea and anxiety in this scenario. Diaphragmatic breathing, also known as belly breathing, focuses on engaging the diaphragm for deep, slow breaths, which can help improve lung expansion and ventilation. This technique can help the patient manage their breathing difficulty and reduce anxiety by promoting relaxation and improving oxygen exchange in the lungs. It empowers the patient with a coping strategy they can use independently to alleviate distressing symptoms at any time. Administering oxygen therapy may be beneficial, but the priority is to teach the patient a technique they can use proactively and routinely. Prescribing benzodiazepines should be considered as an adjunct if non-pharmacological interventions are ineffective in managing anxiety. Referring to a pulmonologist may be necessary for comprehensive evaluation and treatment but may not directly address the immediate symptoms of dyspnea and anxiety.
A postpartum client who experienced a prolonged labor and instrumental delivery expresses concerns about breastfeeding difficulties. What nursing intervention should be prioritized to support successful breastfeeding in this situation?
- A. Providing education on techniques to facilitate milk let-down reflex
- B. Recommending supplemental formula feedings to ensure adequate nutrition
- C. Encouraging the client to consider exclusive formula feeding instead of breastfeeding
- D. Referring the client to a lactation consultant for specialized support
Correct Answer: D
Rationale: In the situation described, where the client experienced a prolonged labor and instrumental delivery, there may be physical and emotional factors impacting breastfeeding success. A lactation consultant is a specialized healthcare provider who can assess the client's breastfeeding difficulties, offer individualized support, and provide guidance on techniques to overcome challenges such as latch issues, positioning problems, and milk supply concerns. Referring the client to a lactation consultant will help ensure that she receives expert assistance tailored to her specific needs, thereby increasing the likelihood of successful breastfeeding. This proactive approach focuses on addressing the root causes of breastfeeding difficulties and supporting the client in achieving her breastfeeding goals.
A nurse is preparing to perform a wound debridement procedure for a patient with a necrotic wound. What action should the nurse prioritize to minimize patient discomfort during the procedure?
- A. Administering systemic analgesia before the procedure
- B. Using sharp debridement techniques to minimize manipulation
- C. Applying a topical anesthetic cream to the wound site
- D. Performing the debridement procedure quickly to reduce duration
Correct Answer: A
Rationale: Administering systemic analgesia, such as pain medications or anesthesia, before the wound debridement procedure is the most effective way to minimize patient discomfort. These medications will help manage and reduce the pain experienced by the patient during the procedure, making it more tolerable for them. Topical anesthetic cream may provide some localized relief but may not be sufficient for significant pain management during a wound debridement procedure. Using sharp debridement techniques or performing the procedure quickly may help reduce manipulation or duration, respectively, but these actions alone may not adequately address the patient's pain and discomfort. Administering systemic analgesia ensures that the patient's overall pain is managed, promoting a more comfortable and successful wound debridement procedure.