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A patient presents with a painless, slowly enlarging mass in the right neck, just above the clavicle. Fine-needle aspiration cytology reveals clusters of polygonal cells with clear cytoplasm and centrally located nuclei. Which of the following conditions is most likely responsible for this presentation?
- A. Parathyroid adenoma
- B. Thyroglossal duct cyst
- C. Lymphadenopathy
- D. Thyroid carcinoma
Correct Answer: A
Rationale: The described presentation of a painless, slowly enlarging mass in the right neck just above the clavicle, along with the cytology findings of clusters of polygonal cells with clear cytoplasm and centrally located nuclei, is classic for parathyroid adenoma. Parathyroid adenomas are benign tumors arising from one of the parathyroid glands, which are typically located in the neck region close to the thyroid gland. The clear cytoplasm and centrally located nuclei of the cells are characteristic histological features of parathyroid adenomas. This condition can often lead to hyperparathyroidism, characterized by increased levels of parathyroid hormone (PTH) and hypercalcemia. Treatment involves surgical removal of the adenoma.
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A patient with a history of heart failure is prescribed spironolactone. Which electrolyte imbalance is the patient at risk for developing with spironolactone therapy?
- A. Hypernatremia
- B. Hyperkalemia
- C. Hypokalemia
- D. Hyponatremia
Correct Answer: B
Rationale: Spironolactone is a potassium-sparing diuretic commonly used in the management of heart failure. One of the significant side effects of spironolactone is hyperkalemia, which is an elevated level of potassium in the bloodstream. Spironolactone works by blocking the action of aldosterone, a hormone that regulates potassium and sodium balance in the body. By inhibiting aldosterone, spironolactone reduces potassium excretion in the urine, leading to potential accumulation of potassium in the body.
To ensure that the staff adheres to their job responsibilities which should be the appropriate toool should Nurse Mae utilize in evaluating staff performance?
- A. Memorandum
- B. Incident report
- C. Performance evaluation
- D. Anecdotal report
Correct Answer: C
Rationale: Nurse Mae should utilize performance evaluations to ensure that the staff adheres to their job responsibilities. Performance evaluations are structured assessments that provide a holistic view of an employee's performance against established standards and job responsibilities. By conducting regular performance evaluations, Nurse Mae can objectively measure staff performance, identify areas of strengths and weaknesses, provide feedback for improvement, and set goals for professional development. This tool is essential for monitoring and managing staff performance effectively in a healthcare setting.
Which of the following is a common oral manifestation of celiac disease characterized by enamel defects with horizontal or vertical grooves on the teeth?
- A. Dental caries
- B. Enamel hypoplasia
- C. Periodontal disease
- D. Oral candidiasis
Correct Answer: B
Rationale: Enamel hypoplasia is a common oral manifestation of celiac disease characterized by defects in the enamel of the teeth. These defects can appear as horizontal or vertical grooves on the teeth. Enamel hypoplasia is caused by disruptions in the formation of enamel during tooth development, leading to thin enamel or localized pitting. It can affect the appearance and strength of the teeth, making them more prone to sensitivity and breakdown. In individuals with celiac disease, enamel hypoplasia may occur due to malabsorption of essential nutrients like calcium and vitamin D. Therefore, when observing oral manifestations such as enamel defects with grooves, it is important to consider the possibility of celiac disease as an underlying cause.
A patient admitted to the ICU develops delirium characterized by acute onset confusion and agitation. What intervention should the healthcare team prioritize to manage the patient's delirium?
- A. Administer antipsychotic medications to reduce agitation.
- B. Implement environmental modifications to promote orientation.
- C. Refer the patient to a psychiatrist for further evaluation.
- D. Prescribe benzodiazepines for sedation and calming effect.
Correct Answer: B
Rationale: The healthcare team should prioritize implementing environmental modifications to promote orientation in a patient with delirium. Delirium is a state of acute confusion and agitation that can be triggered by various factors such as medications, infections, or metabolic disturbances. Environmental modifications involve creating a calm, quiet, and well-lit environment for the patient. Promoting proper orientation through the use of clocks, calendars, and familiar objects can help reduce confusion and improve the patient's understanding of their surroundings. These interventions are non-pharmacological and aim to address the underlying causes of delirium while minimizing the need for additional medications that may have potential side effects. Antipsychotic medications and benzodiazepines should be used judiciously and under close supervision due to the risk of adverse effects in older adults and critically ill patients. Referring the patient to a psychiatrist may be considered if the delirium is complex or if there are underlying psychiatric issues contributing to the presentation.
While preparing the operating room (OR) for a surgical procedure, the nurse notices a malfunctioning anesthesia machine. What is the nurse's priority action?
- A. Use an alternative anesthesia machine
- B. Document the malfunction in the equipment log
- C. Inform the anesthesia provider immediately
- D. Continue with the surgical procedure as scheduled
Correct Answer: C
Rationale: The nurse's priority action when noticing a malfunctioning anesthesia machine in the operating room should be to inform the anesthesia provider immediately. Anesthesia providers are responsible for administering anesthesia safely during surgical procedures, and they need to be made aware of any equipment issues promptly to ensure patient safety. Continuing with the surgical procedure using a malfunctioning anesthesia machine can pose serious risks to the patient's well-being. Using an alternative anesthesia machine may be an option, but informing the anesthesia provider first ensures that the appropriate action is taken to address the issue effectively. Documenting the malfunction in the equipment log is important for record-keeping purposes, but it should not take precedence over informing the anesthesia provider and taking immediate action to address the problem.