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A patient with a diagnosis of retinal detachment has undergone a vitreoretinal procedure on an outpatient basis. What subject should the nurse prioritize during discharge education?
- A. Risk factors for postoperative cytomegalovirus (CMV)
- B. Compensating for vision loss for the next several weeks
- C. Non-pharmacologic pain management strategies
- D. Signs and symptoms of increased intraocular pressure
Correct Answer: B
Rationale: The correct answer is B: Compensating for vision loss for the next several weeks. This is the priority subject for discharge education because vision loss is a common outcome post vitreoretinal procedure. The patient needs to understand how to adapt to this temporary impairment, such as using assistive devices and modifying their environment.
A: Risk factors for postoperative CMV is not the priority as it is not a common concern in this situation.
C: Non-pharmacologic pain management is important but not the priority compared to vision loss.
D: Signs and symptoms of increased intraocular pressure are important but not as crucial as managing vision loss.
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A nurse is planning discharge education for a patient who underwent a cervical diskectomy. What strategies would the nurse assess that would aid in planning discharge teaching?
- A. Care of the cervical collar
- B. Technique for performing neck ROM exercises
- C. Home assessment of ABGs
- D. Techniques for restoring nerve function
Correct Answer: A
Rationale: Correct Answer: A - Care of the cervical collar
Rationale:
1. Care of the cervical collar is essential post-cervical diskectomy to ensure proper immobilization and support.
2. Proper care prevents complications and promotes healing.
3. It is a crucial aspect of discharge education to prevent injury and promote recovery.
Summary of other choices:
B: Technique for performing neck ROM exercises - Important for rehabilitation but not directly related to discharge education post-cervical diskectomy.
C: Home assessment of ABGs - Irrelevant to post-cervical diskectomy discharge education.
D: Techniques for restoring nerve function - Important for recovery but not a primary focus of discharge education.
Examination of a newborn in the birth room reveals bilateral cataracts. Which disease process in the maternal history would likely cause this abnormality?
- A. Rubella
- B. Cytomegalovirus (CMV)
- C. Syphilis
- D. HIV
Correct Answer: A
Rationale: The correct answer is A: Rubella. Rubella infection during pregnancy can lead to congenital rubella syndrome, which includes bilateral cataracts as a characteristic feature. Rubella virus can cross the placenta and affect the developing fetus. Cytomegalovirus (CMV) can also cause congenital cataracts, but rubella is more commonly associated with this abnormality. Syphilis can cause other congenital abnormalities but not bilateral cataracts. HIV does not typically lead to bilateral cataracts in newborns.
A patient has just been diagnosed with Parkinsons disease and the nurse is planning the patients subsequent care for the home setting. What nursing diagnosis should the nurse address when educating the patients family?
- A. Risk for infection
- B. Impaired spontaneous ventilation
- C. Unilateral neglect
- D. Risk for injury
Correct Answer: D
Rationale: The correct answer is D: Risk for injury. Patients with Parkinson's disease are at risk for falls due to symptoms like tremors and impaired balance. Educating the family about fall prevention measures is crucial. Choice A, Risk for infection, is not directly related to Parkinson's disease. Choice B, Impaired spontaneous ventilation, is not a common concern in Parkinson's disease. Choice C, Unilateral neglect, is more commonly seen in conditions like stroke, not Parkinson's disease. Therefore, the most appropriate nursing diagnosis for the patient with Parkinson's disease is addressing the risk for injury to prevent falls.
A nurse is caring for a patient with a postsurgical wound. When planning care, which goal will be the priority?
- A. Reduce dependent nitrogen balance.
- B. Maintain negative nitrogen balance.
- C. Promote positive nitrogen balance.
- D. Facilitate neutral nitrogen balance.
Correct Answer: C
Rationale: The correct answer is C: Promote positive nitrogen balance. In a postsurgical patient, promoting positive nitrogen balance is crucial for wound healing and tissue repair. This goal helps prevent muscle wasting and promotes overall recovery. A: Reduce dependent nitrogen balance is incorrect as it does not address the need for positive nitrogen balance in wound healing. B: Maintain negative nitrogen balance is incorrect because negative nitrogen balance indicates a loss of protein stores, which is detrimental for healing. D: Facilitate neutral nitrogen balance is incorrect as it does not actively support the increased protein needs for wound repair.
The nurse in an allergy clinic is educating a new patient about the pathology of the patients health problem. What response should the nurse describe as a possible consequence of histamine release?
- A. Constriction of small venules
- B. Contraction of bronchial smooth muscle
- C. Dilation of large blood vessels
- D. Decreased secretions from gastric and mucosal cells
Correct Answer: B
Rationale: The correct answer is B: Contraction of bronchial smooth muscle. Histamine release can lead to bronchoconstriction, which narrows the airways and causes difficulty in breathing. This is a common symptom in allergic reactions like asthma. Constriction of small venules (Choice A) is not a typical consequence of histamine release. Dilation of large blood vessels (Choice C) is more associated with histamine's role in increasing vascular permeability. Decreased secretions from gastric and mucosal cells (Choice D) is not directly related to histamine's effects on smooth muscle contraction.