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A patient presents with petechiae, purpura, and mucosal bleeding. Laboratory tests reveal thrombocytopenia, elevated serum creatinine, and schistocytes on peripheral blood smear. Which of the following conditions is most likely to cause these findings?
- A. Thrombotic thrombocytopenic purpura (TTP)
- B. Idiopathic thrombocytopenic purpura (ITP)
- C. Hemolytic uremic syndrome (HUS)
- D. Disseminated intravascular coagulation (DIC)
Correct Answer: A
Rationale: Thrombotic thrombocytopenic purpura (TTP) is a rare but serious condition characterized by microangiopathic hemolytic anemia, thrombocytopenia, neurological abnormalities, fever, and renal dysfunction. The classic pentad of symptoms includes fever, neurologic changes, renal impairment, thrombocytopenia, and microangiopathic hemolytic anemia. The presence of petechiae, purpura, and mucosal bleeding along with thrombocytopenia, elevated serum creatinine, and schistocytes on peripheral blood smear are consistent with TTP. In TTP, there is usually a deficiency of ADAMTS13 (a von Willebrand factor-cleaving protease) leading to excessive platelet adhesion, aggregation, and microthrombi formation within small blood vessels. Treatment typically
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A patient with terminal cancer is experiencing dyspnea due to pleural effusion. What intervention should the palliative nurse prioritize to manage the patient's symptoms?
- A. Administer bronchodilator medications to improve airway clearance.
- B. Perform thoracentesis to drain the pleural fluid and relieve dyspnea.
- C. Recommend non-invasive positive pressure ventilation for respiratory support.
- D. Encourage the patient to practice relaxation techniques to reduce anxiety.
Correct Answer: B
Rationale: The palliative nurse should prioritize performing thoracentesis to drain the pleural fluid and relieve dyspnea in a patient with terminal cancer experiencing pleural effusion. Pleural effusion is a common complication in patients with advanced cancer and can cause significant respiratory distress. Drainage of the pleural fluid through thoracentesis can provide immediate relief by easing the pressure on the lungs and improving the patient's ability to breathe. This intervention is essential in managing dyspnea for comfort and quality of life in palliative care settings. Administering bronchodilator medications (option A) or recommending non-invasive positive pressure ventilation (option C) may not directly address the underlying cause of dyspnea in this case. While relaxation techniques (option D) can help with anxiety and overall well-being, they may not be sufficient in managing the physical symptom of dyspnea caused by pleural effusion.
What must be stressed to all participants attending a health fair?
- A. A screening program is not a substitute for ongoing health supervision from a health care provider.
- B. All test results are only tentative, and so participants who receive negative test results may nonetheless be suffering from a disease.
- C. Results are true today, but disease can develop any time, so participants should attend any future health fairs as well.
- D. There are many other diseases that may be attacking participants that the health fair did not screen for, and so continued vigilance is necessary.
Correct Answer: A
Rationale: Stressing to all participants attending a health fair that a screening program is not a substitute for ongoing health supervision from a healthcare provider is crucial for several reasons. Health fairs are intended to provide a snapshot of an individual's health at a specific point in time and are not comprehensive assessments. Participants need to understand that these screenings are not a replacement for regular check-ups with their healthcare provider, who can provide continued monitoring, follow-up care, and more in-depth evaluations if necessary. It's important for participants to recognize that the results from a health fair screening are just one piece of their overall health picture and that ongoing care from a healthcare provider is essential for maintaining their well-being.
A primigravida at 40 weeks gestation is in active labor. The nurse notes late decelerations on the fetal monitor tracing. What action should the nurse take first?
- A. Administer oxygen to the mother.
- B. Change the mother's position.
- C. Prepare for immediate delivery.
- D. Discontinue oxytocin infusion.
Correct Answer: D
Rationale: Late decelerations on the fetal monitor tracing indicate a potential uteroplacental insufficiency, which could be caused by decreased oxygen supply to the fetus. One common cause of late decelerations is uterine hyperstimulation due to excessive use of oxytocin. By discontinuing the oxytocin infusion, the nurse can help alleviate the stress on the fetus and decrease the likelihood of further late decelerations. This action should be prioritized before other interventions such as changing the mother's position or administering oxygen. Immediate delivery may be necessary if the fetus continues to show signs of distress despite discontinuing the oxytocin infusion.
Nurse Crissel also asked the participants if they got to know the transmission of HIV based from her lecture? Which is NOT correct?
- A. Accidental blood exposure
- B. Kissing
- C. Unprotected sex
- D. Mother to child transmission
Correct Answer: B
Rationale: Nurse Crissel likely informed the participants that HIV is not casually transmitted through activities like kissing. HIV transmission primarily occurs through activities that involve the exchange of bodily fluids, such as blood, semen, vaginal fluids, and breast milk. Accidental blood exposure, unprotected sex, and mother to child transmission are known routes of HIV transmission due to the direct exchange of bodily fluids containing the virus. However, the virus is not spread through saliva, including activities like kissing, which do not involve the exchange of significant amounts of bodily fluids.
A nurse is caring for a patient with a history of substance abuse who requests pain medication. What ethical principle should guide the nurse's decision-making in this situation?
- A. Beneficence
- B. Nonmaleficence
- C. Justice
- D. Veracity
Correct Answer: A
Rationale: The ethical principle that should guide the nurse's decision-making in this situation is beneficence, which emphasizes the nurse's obligation to act in the best interest of the patient. In this scenario, the nurse must balance the patient's request for pain medication with considerations related to the patient's history of substance abuse. The nurse should prioritize providing effective pain relief for the patient while also considering the potential risks of administering medication to someone with a history of substance abuse. By focusing on beneficence, the nurse can make decisions that promote the well-being and best interests of the patient, taking into account both the immediate need for pain relief and the patient's history of substance abuse.