Nokea
A patient presents with recurrent episodes of severe headache associated with ipsilateral lacrimation, rhinorrhea, and ptosis. Symptoms are often triggered by alcohol consumption. Which of the following neurological conditions is most likely responsible for these symptoms?
- A. Migraine headache
- B. Cluster headache
- C. Tension-type headache
- D. Trigeminal neuralgia
Correct Answer: B
Rationale: The patient is presenting with symptoms consistent with cluster headache. Cluster headaches are characterized by recurrent episodes of severe unilateral (ipsilateral) headache accompanied by lacrimation (tearing from the eyes), rhinorrhea (runny nose), and ptosis (drooping of the eyelid). These headaches often occur in clusters over a period of weeks to months, hence the name "cluster headache."
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Which of the following is NOT a step of record keeping?
- A. Structuring
- B. Securing
- C. Storing
- D. Easy Disposa l
Correct Answer: D
Rationale: Record keeping involves several key steps such as structuring, securing, and storing information. However, easy disposal is not a step in record keeping. In fact, it is important to carefully consider the disposal of records in a secure and responsible manner to protect sensitive information and comply with relevant regulations. Proper disposal methods should be followed to ensure that records are not accessible to unauthorized individuals and that any sensitive information is properly destroyed to prevent misuse or breaches of privacy. Therefore, easy disposal is not a recommended practice in effective record keeping.
A patient with chronic kidney disease is prescribed calcium carbonate as a phosphate binder. Which instruction should the nurse provide to the patient regarding calcium carbonate administration?
- A. Take with meals
- B. Take on an empty stomach
- C. Take with a full glass of water
- D. Crush tablets before administration
Correct Answer: A
Rationale: Calcium carbonate should be taken with meals because it requires the presence of stomach acid to be properly absorbed. Taking it with meals helps ensure optimal absorption and effectiveness as a phosphate binder in patients with chronic kidney disease. Administering calcium carbonate on an empty stomach may lead to gastrointestinal side effects such as upset stomach, bloating, and constipation. Taking it with a full glass of water is also recommended to help prevent potential gastrointestinal issues and to ensure proper hydration. Crushing tablets before administration is not advised unless specifically instructed by a healthcare provider, as it can alter the drug's release and absorption properties.
Which assessment findings is INDICATIVE of the diagnosis of hypertension?
- A. Family members with high blood pressure
- B. Elevation of blood cholesterol level
- C. Stressful work environment
- D. Consistent evaluation of blood pressure
Correct Answer: D
Rationale: The assessment finding that is indicative of the diagnosis of hypertension is consistent evaluation of blood pressure. Hypertension is diagnosed based on repeated measurements of elevated blood pressure. Consistently high blood pressure readings, usually defined as systolic blood pressure consistently at or above 140 mmHg and diastolic blood pressure consistently at or above 90 mmHg, are a key factor in diagnosing hypertension. Family history of high blood pressure (Choice A), elevation of blood cholesterol level (Choice B), and a stressful work environment (Choice C) may be risk factors for hypertension but are not diagnostic criteria. In order to diagnose hypertension, healthcare providers rely on consistent measurement and evaluation of blood pressure over time.
Nurse Mauve should plan to initiate which action to provide a safe environment?
- A. Take the patient's vital signs every 4 hours.
- B. Encourage visits from family and friends for psychosocial support.
- C. Maintain fluid and sodium restrictions.
- D. Take off the room lights and draw the window shades.
Correct Answer: D
Rationale: Taking off the room lights and drawing the window shades would provide a calm and soothing environment for the five-year-old patient admitted due to pneumonia with symptoms of cough, respiratory distress, anxiety, and dehydration. By creating a dim and quiet atmosphere, it can help reduce the child's anxiety levels, promote rest and relaxation, and potentially aid in the management of distress caused by pneumonia. Providing a quiet and dark environment can also support the child's comfort and recovery process during the hospital stay.
Which of these measures will help stabilize mentally the parents of Nurse Lailanie?
- A. Establish a regular routine
- B. Repaint or buy a new furniture
- C. Move to small apartment
- D. Correct bad behaviors gently
Correct Answer: A
Rationale: Establishing a regular routine can be very helpful in stabilizing the mental state of parents. Consistency and structure in day-to-day activities can provide a sense of predictability and control, which can help reduce anxiety and stress. By having a routine, the parents can feel more organized, efficient, and better equipped to manage their responsibilities and emotions. Additionally, a regular routine can promote better sleep patterns, healthier habits, and overall well-being. This measure is practical, achievable, and can have positive effects on the mental stability of Nurse Lailanie's parents.