Nokea
A patient is prescribed a benzodiazepine for the management of anxiety. Which instruction should the nurse include in patient education about benzodiazepine therapy?
- A. "Take the medication with grapefruit juice for enhanced absorption."
- B. "Avoid consuming alcohol while on benzodiazepine therapy."
- C. "Take the medication on an empty stomach for better effectiveness."
- D. "Discontinue the medication abruptly if you experience side effects."
Correct Answer: B
Rationale: Consuming alcohol while on benzodiazepine therapy can increase the central nervous system depressant effects of benzodiazepines, leading to excessive sedation, respiratory depression, and even overdose. It is important for patients to avoid alcohol to prevent these potential dangerous interactions and to ensure the safe and effective use of their medication.
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A patient receiving palliative care for end-stage renal disease expresses distress over changes in body image due to edema and weight gain. What intervention should the palliative nurse prioritize to address the patient's concerns?
- A. Encourage the patient to focus on accepting their body changes as part of the illness.
- B. Provide education on dietary modifications to manage fluid retention and edema.
- C. Offer emotional support and validate the patient's feelings about body image changes.
- D. Prescribe diuretic medications to reduce fluid retention and alleviate edema.
Correct Answer: C
Rationale: The most appropriate intervention for the palliative nurse to prioritize in this situation is to offer emotional support and validate the patient's feelings about body image changes. End-stage renal disease can lead to significant physical changes such as edema and weight gain, which can impact a patient's body image and self-esteem. By providing emotional support and validating the patient's feelings, the nurse can help address the patient's distress and concerns, improving their overall psychological well-being. While providing education on dietary modifications (choice B) and prescribing diuretic medications (choice D) may be important aspects of managing fluid retention and edema, addressing the patient's emotional distress and body image concerns should be the initial priority in a palliative care setting. Encouraging the patient to accept their body changes (choice A) may overlook the emotional impact these changes have on the patient, making choice C the most appropriate intervention.
A pregnant woman presents with vaginal bleeding and crampy abdominal pain at 22 weeks gestation. On examination, the cervix is dilated, and the amniotic sac is visible at the cervical os. Which of the following conditions is the most likely cause of these symptoms?
- A. Ectopic pregnancy
- B. Threatened abortion
- C. Placenta previa
- D. Incompetent cervix
Correct Answer: D
Rationale: Incompetent cervix, also known as cervical insufficiency, is the most likely cause of the symptoms described. Incompetent cervix is a condition where the cervix begins to dilate and efface prematurely, typically in the second trimester, without contractions or labor. This can lead to painless cervical dilation and bulging of the amniotic sac into the vagina, which can cause vaginal bleeding and crampy abdominal pain. It is a leading cause of second-trimester pregnancy loss. Treatment may involve a cervical cerclage, a surgical procedure where the cervix is stitched closed to provide additional support.
You have observed presence of drainage in Claudia's eyes. Which of the following eye solution would you use in cleaning her eyes?
- A. Hydrochloric acid
- B. Mineral water
- C. Normal saline solution
- D. Soapsuds solution
Correct Answer: C
Rationale: Normal saline solution is the best choice for cleaning Claudia's eyes with drainage. It is a sterile solution that closely matches the natural pH of the eyes, making it gentle and safe for ocular use. Normal saline can help flush out any debris or discharge in the eye without causing further irritation or complications. On the other hand, hydrochloric acid is a corrosive substance that can cause significant harm if it comes into contact with the eyes. Mineral water may contain impurities that could further irritate the eyes. Soapsuds solution is not recommended for eye cleaning as it can cause irritation and damage to the delicate eye tissues. Therefore, normal saline solution is the most appropriate and safe option for cleaning Claudia's eyes in this situation.
A patient presents with sudden-onset severe headache, vomiting, and altered mental status. Imaging reveals a berry-shaped aneurysm at the junction of the anterior communicating artery and anterior cerebral artery. Which of the following neurological conditions is most likely responsible for these symptoms?
- A. Ischemic stroke
- B. Intracerebral hemorrhage
- C. Subdural hematoma
- D. Subarachnoid hemorrhage
Correct Answer: D
Rationale: The presentation of sudden-onset severe headache, vomiting, and altered mental status, along with the presence of a berry-shaped aneurysm on imaging, point towards a diagnosis of subarachnoid hemorrhage. The most common cause of a subarachnoid hemorrhage is the rupture of a saccular (berry) aneurysm, which commonly occurs at the junction of the anterior communicating artery and anterior cerebral artery. The sudden headache is often described as the "worst headache of my life" and is typically associated with nausea and vomiting. Altered mental status may be present due to the effects of increased intracranial pressure and possible associated brain injury. It is important to promptly diagnose and manage subarachnoid hemorrhage to prevent complications such as vasospasm, rebleeding, and ischemic deficits.
What is NOT important for Myra to do when listening to tape recordings?
- A. Do the listening as soon as possible after the interview.
- B. Note for the voice tone and voice inflection.
- C. Listen when she feels the motivation for a more productive time.
- D. Take notice of the pauses of the participants.
Correct Answer: C
Rationale: It is not important for Myra to listen to the tape recordings only when she feels motivated or productive. In a nurse-patient interaction relationship, listening to tape recordings promptly (Choice A) is crucial because it ensures that any important information or cues are not missed or forgotten. Additionally, noting voice tone and inflection (Choice B) and observing pauses (Choice D) are essential for understanding the nuances and emotions conveyed during the interaction, which can be crucial in effective communication. Listening based on motivation may lead to delays and hamper the timely analysis and understanding of the interactions. Hence, it is important for Myra to prioritize active and focused listening to the tape recordings, regardless of her current motivation levels.