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A patient with a history of Hodgkin lymphoma presents with fever, chills, and generalized malaise. Laboratory tests reveal pancytopenia, circulating Reed-Sternberg cells, and bone marrow involvement. Which of the following conditions is most likely to cause these findings?
- A. Autoimmune hemolytic anemia (AIHA)
- B. Myelodysplastic syndrome (MDS)
- C. Aplastic anemia
- D. Paraneoplastic syndrome
Correct Answer: D
Rationale: The patient is presenting with symptoms and laboratory findings consistent with a paraneoplastic syndrome related to Hodgkin lymphoma. In this case, the fever, chills, generalized malaise, pancytopenia, circulating Reed-Sternberg cells, and bone marrow involvement are all indicative of a paraneoplastic syndrome associated with Hodgkin lymphoma. Paraneoplastic syndromes are a group of disorders that are triggered by an abnormal immune response to a neoplasm, such as Hodgkin lymphoma, leading to various systemic manifestations.
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Nurse Addison provides instructions about measures to prevent postpartum mastitis who is breast feeding her newborn. Which of the following would indicate that the mother needs further instruction? "I Should _______."
- A. wash my hands wel1 before breastfeeding
- B. breastfeed every 2-3 hours
- C. change the breast pads frequently
- D. wash my nipples with s0ap and water prior to feeding 3 hours
Correct Answer: D
Rationale: Nursing mothers should not wash their nipples with soap and water prior to feeding. Using soap can dry out the skin and potentially lead to irritation or cracking of the nipple, which can increase the risk of mastitis. It is recommended to simply clean the nipples with water, if necessary.
A patient receiving palliative care for end-stage lung disease experiences dyspnea and anxiety. What intervention should the palliative nurse prioritize to address the patient's symptoms?
- A. Administer supplemental oxygen therapy to improve oxygenation.
- B. Teach the patient diaphragmatic breathing exercises for respiratory support.
- C. Prescribe benzodiazepine medications to reduce anxiety and promote relaxation.
- D. Refer the patient to a pulmonologist for evaluation and treatment of dyspnea.
Correct Answer: B
Rationale: Teaching the patient diaphragmatic breathing exercises for respiratory support would be the most appropriate intervention to address the symptoms of dyspnea and anxiety in this scenario. Diaphragmatic breathing, also known as belly breathing, focuses on engaging the diaphragm for deep, slow breaths, which can help improve lung expansion and ventilation. This technique can help the patient manage their breathing difficulty and reduce anxiety by promoting relaxation and improving oxygen exchange in the lungs. It empowers the patient with a coping strategy they can use independently to alleviate distressing symptoms at any time. Administering oxygen therapy may be beneficial, but the priority is to teach the patient a technique they can use proactively and routinely. Prescribing benzodiazepines should be considered as an adjunct if non-pharmacological interventions are ineffective in managing anxiety. Referring to a pulmonologist may be necessary for comprehensive evaluation and treatment but may not directly address the immediate symptoms of dyspnea and anxiety.
Which of the following historical data MOST probably led to a post-traumatic stress disorder?
- A. Unstable relationship with ex-fiancee.
- B. No gang-relationship with peers
- C. Suicide of her mother
- D. Dropping out of school.
Correct Answer: C
Rationale: The suicide of her mother is the most probable historical data that led to post-traumatic stress disorder. Experiencing the suicide of a close family member, especially a parent, can be an extremely traumatic event that can have long-lasting psychological effects. Witnessing or dealing with such a tragic loss can lead to feelings of helplessness, depression, guilt, and intense emotional distress, all of which are common in individuals with post-traumatic stress disorder (PTSD). This significant and distressing event could have a profound impact on the individual's mental health and well-being, contributing to the development of PTSD symptoms such as intrusive memories, avoidance behaviors, negative mood alterations, and changes in arousal or reactivity.
A patient is prescribed a nonsteroidal anti-inflammatory drug (NSAID) for the management of osteoarthritis. Which adverse effect should the nurse monitor closely in the patient?
- A. Hypoglycemia
- B. Hyperkalemia
- C. Gastrointestinal bleeding
- D. Hypertension
Correct Answer: C
Rationale: NSAIDs are known to increase the risk of gastrointestinal complications, particularly gastrointestinal bleeding, ulcers, and perforation. This risk is higher in patients who are elderly, have a history of peptic ulcer disease, are taking high doses of NSAIDs, or are using them for a prolonged period. It is important for the nurse to closely monitor the patient for signs and symptoms of gastrointestinal bleeding, such as abdominal pain, black or tarry stools, vomiting blood, and anemia. Prompt identification and management of these complications are essential to prevent serious consequences. Monitoring for gastrointestinal adverse effects is crucial when a patient is prescribed NSAIDs for managing conditions like osteoarthritis.
No drugs cure this condition. Emphasis is put on delaying the onset of severe symptoms. Which of the following does NOT help improve Alzheimer's?
- A. Smoking
- B. Social connections and mental activity
- C. Eat balanced diet
- D. Exercise
Correct Answer: A
Rationale: Smoking is a harmful habit that is known to contribute to a variety of health problems, including heart disease, lung disease, and cancer. Smoking does not provide any benefits for Alzheimer's patients and, in fact, can worsen the condition due to its negative impact on overall health. Therefore, smoking does not help improve Alzheimer's and may exacerbate the symptoms and complications associated with the disease.