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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.
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Which of the following is a common complication associated with long-term corticosteroid use in patients with rheumatoid arthritis?
- A. Osteoporotic fracture
- B. Osteonecrosis of the femoral head
- C. Avascular necrosis of the talus
- D. Septic arthritis
Correct Answer: A
Rationale: Long-term corticosteroid use in patients with rheumatoid arthritis can lead to osteoporosis, which is a common complication. Osteoporosis causes weakening of the bones, increasing the risk of fractures, particularly in weight-bearing bones such as the hip, spine, and wrist. Osteoporotic fractures are a significant concern in patients on long-term corticosteroid therapy, highlighting the importance of monitoring bone health and considering preventive measures such as calcium, Vitamin D supplementation, and regular bone density testing. While osteonecrosis of the femoral head and avascular necrosis of the talus can also occur as complications of corticosteroid use, osteoporotic fractures are more commonly associated with this type of therapy in patients with rheumatoid arthritis. Septic arthritis, on the other hand, is not directly related to corticosteroid use but can occur due to other factors such as joint infections.
A nurse doubts that the physician has prescribed an unusually large dosage of a medication. The nurse ask the senior nurse on duty about the order if it is correct or wrong, the senior nurse tells the nurse that the order is correct. The nurse comply with the order and administer it to the patient. The patient eventually died. Who is liable for this situation.
- A. Physician
- B. Nurse
- C. Senior nurse
- D. Physician and nurse
Correct Answer: D
Rationale: The physician is ultimately responsible for prescribing the correct dosage of medication to the patient. However, the nurse also plays a critical role in ensuring patient safety by questioning any orders that appear to be unusual or incorrect. In this scenario, the nurse had doubts about the unusually large dosage but was reassured by the senior nurse that the order was correct. Both the physician and the nurse failed in their responsibilities, leading to the patient's unfortunate death. The senior nurse also shares liability as they provided incorrect guidance to the nurse administering the medication. Ultimately, the situation was a result of a breakdown in communication and adherence to proper procedures by both the physician and the nurse.
A patient receiving palliative care for end-stage heart failure experiences paroxysmal nocturnal dyspnea. What intervention should the palliative nurse prioritize to manage the patient's symptoms?
- A. Administer diuretic medications to reduce fluid overload.
- B. Elevate the head of the bed to improve respiratory mechanics.
- C. Encourage the patient to sleep in a reclined position to minimize dyspnea.
- D. Refer the patient to a sleep specialist for evaluation and treatment.
Correct Answer: B
Rationale: Elevating the head of the bed to improve respiratory mechanics is the most appropriate intervention for managing paroxysmal nocturnal dyspnea in a patient with end-stage heart failure. By keeping the head of the bed elevated, gravity helps reduce the pooling of fluid in the lungs, making it easier for the patient to breathe and reducing dyspnea. This strategy can help improve oxygenation and decrease the sensation of breathlessness, providing relief for the patient. Administering diuretic medications (Option A) can also be beneficial to reduce fluid overload, although positioning remains a key intervention. Encouraging the patient to sleep in a reclined position (Option C) can help alleviate symptoms, but specifically elevating the head of the bed is a more targeted approach. Referring the patient to a sleep specialist (Option D) may not be necessary at this time, as the primary concern is managing the acute symptom of paroxysmal nocturnal dyspnea
Who among the passengers will take PRIORITY for the rescue team to transport to the hospital?
- A. Student with Colle's fracture.
- B. Jay with lacerations
- C. Pregnant women
- D. Conductor with broken leg
Correct Answer: C
Rationale: In emergency situations, pregnant women are typically given priority when it comes to transportation to the hospital. This is because they have unique medical needs and potential complications that require immediate attention. It is important to ensure the well-being of both the mother and the unborn child. Additionally, the health and safety of the unborn child are critical considerations in determining priority for medical treatment and transport. Therefore, the pregnant woman should be the priority for the rescue team to transport to the hospital.
The patient 's wife is-so anxious about the condition of her husband. The MOST appropriate INITIAL intervention for the nurse to make is to ________.
- A. describe her husband 's medical treatment since admission
- B. reassure her that the important fact is her presence
- C. explain the nature of the injury and reassure her that husband's condition is stable
- D. allow her to verbalize her feelings and concerns
Correct Answer: C
Rationale: In situations where a patient's family member is expressing anxiety about their loved one's condition, it is important for the nurse to provide clear and accurate information about the patient's status. By explaining the nature of the injury and reassuring the wife that her husband's condition is stable, the nurse can help alleviate her anxiety and address her concerns in a meaningful way. This intervention focuses on open communication and providing emotional support, which are crucial in helping the family member cope with the situation. It is essential to establish trust and create a supportive environment for the family member during this stressful time.