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A patient with a history of chronic obstructive pulmonary disease (COPD) is prescribed tiotropium (Spiriva) inhaler. Which instruction should the nurse include in patient education about tiotropium inhaler use?
- A. "Use the inhaler only when you experience symptoms."
- B. "Rinse your mouth with water after each use."
- C. "Exhale forcefully before inhaling the medication."
- D. "Store the inhaler in the refrigerator between uses."
Correct Answer: B
Rationale: Tiotropium (Spiriva) is an anticholinergic bronchodilator used for the management of COPD. A common side effect of anticholinergic medications is dry mouth. Rinsing the mouth with water after using the inhaler can help reduce the risk of developing oral thrush or other mouth infections due to dryness. This instruction helps promote good oral hygiene and decreases the potential side effects associated with tiotropium inhaler use. This teaching is important for patients to follow to ensure their overall health and well-being while using the medication.
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A patient presents with a pruritic, annular rash with fine scaling and central clearing, affecting the trunk and proximal extremities. The patient reports recent exposure to a new soap and laundry detergent. Which of the following conditions is most likely responsible for this presentation?
- A. Tinea corporis (ringworm)
- B. Nummular eczema
- C. Pityriasis rosea
- D. Lichen planus Ear, Nose, and Throat (ENT)
Correct Answer: A
Rationale: The patient's presentation of a pruritic, annular rash with fine scaling and central clearing, affecting the trunk and proximal extremities, following exposure to a new soap and laundry detergent is most consistent with tinea corporis, commonly known as ringworm. Ringworm is a superficial fungal infection caused by dermatophytes that can present with circular or annular lesions with central clearing and scaling. The exposure to new soap and laundry detergent may have disrupted the skin's microbiome, making it more vulnerable to fungal infections like tinea corporis. Nummular eczema typically presents as coin-shaped plaques rather than annular lesions, while pityriasis rosea presents with a herald patch followed by smaller similar lesions in a "Christmas tree" distribution. Lichen planus would not typically be associated with exposure to new soap and laundry detergent but can have distinct purple, polygonal papules.
An infant's current weight indicates that the maximum safe dose of Tylenol is 30 mg by mouth. The physician orders 65 mg to be given, the pharmacist is responsible for filling the medication order, and the nurse administers Tylenol 65 mg. Who is legally responsible in the event that the infant has a toxic reaction to the medication?
- A. nurse
- B. physician
- C. pharmacist
- D. pharmacist and physician
Correct Answer: C
Rationale: The pharmacist is legally responsible in this situation because they are the healthcare professional authorized to dispense medications according to the physician's order. In this case, the physician ordered a dose higher than the maximum safe dose recommended based on the infant's current weight. While the nurse administers the medication, the pharmacist has the responsibility to ensure that the correct dose is dispensed and to alert the physician if there is a discrepancy in the order. If the pharmacist dispensed the incorrect dose without verifying with the physician, they would bear legal responsibility for any adverse effects resulting from the medication error.
A patient in the ICU develops acute respiratory distress syndrome (ARDS) with severe hypoxemia refractory to conventional oxygen therapy. What intervention should the healthcare team prioritize to improve the patient's oxygenation?
- A. Initiate prone positioning to optimize lung recruitment.
- B. Administer inhaled pulmonary vasodilators for vasodilation.
- C. Perform recruitment maneuvers to open collapsed alveoli.
- D. Recommend extracorporeal membrane oxygenation (ECMO) for respiratory support.
Correct Answer: D
Rationale: In the scenario described, the patient is experiencing severe hypoxemia refractory to conventional oxygen therapy, indicating a need for advanced respiratory support. When a patient with ARDS fails to respond to conservative management, including mechanical ventilation strategies, prone positioning, and recruitment maneuvers, the next step may involve extracorporeal membrane oxygenation (ECMO). ECMO provides a way to bypass the lungs and oxygenate the blood directly, allowing for enhanced gas exchange and support for severely compromised respiratory function. Therefore, in this critical situation, prioritizing the recommendation for ECMO can offer the patient the best chance of improving oxygenation and survival.
The lecturer reminded the committee members that bias is an influence that distorts study results. In quantitative research, which will eliminate bias?
- A. Trustworthiness
- B. Randomness
- C. Credibility
- D. Triangulation
Correct Answer: B
Rationale: In quantitative research, randomness plays a crucial role in eliminating bias. Random sampling ensures that every individual or element in the population has an equal chance of being selected for the study. This helps in reducing the possibility of bias creeping into the results due to selective sampling or favoritism towards certain groups. By using random sampling methods, researchers can increase the generalizability of their findings and have a higher level of confidence that the results are unbiased and representative of the entire population. Therefore, randomness is a key mechanism to eliminate bias in quantitative research studies.
Which of the following medications may produce a false-negative pregnancy test?
- A. Anti-hypertensive
- B. Diuretics
- C. Anticonvulsant
- D. Tranquilizers
Correct Answer: C
Rationale: Anticonvulsant medications, such as phenytoin and phenobarbital, can interfere with pregnancy tests by affecting the levels of human chorionic gonadotropin (hCG) in the body. HCG is the hormone detected in pregnancy tests. These medications may potentially lead to a false-negative result on a pregnancy test for women who are actually pregnant. Therefore, in the case of Almira, who is 6 months pregnant and taking anticonvulsant medication due to the risk of producing a false-negative pregnancy test result, healthcare providers should consider other clinical indicators, such as abdominal cramps and vaginal spotting, to assess her pregnancy status.