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A patient with a history of nephrolithiasis presents with sudden-onset severe colicky flank pain radiating to the groin. On physical examination, there is tenderness over the costovertebral angle and hematuria. What is the most likely diagnosis?
- A. Acute pyelonephritis
- B. Renal artery embolism
- C. Renal colic due to ureteral calculus
- D. Renal infarction
Correct Answer: C
Rationale: The correct answer is C: Renal colic due to ureteral calculus. The sudden-onset severe colicky flank pain radiating to the groin along with tenderness over the costovertebral angle and hematuria are classic symptoms of kidney stones (ureteral calculus). The pain results from the obstruction of urine flow by the stone, leading to increased pressure and spasm in the ureter. Acute pyelonephritis (choice A) presents with fever, chills, and systemic symptoms. Renal artery embolism (choice B) typically presents with acute onset severe flank pain but is associated with risk factors like atrial fibrillation. Renal infarction (choice D) presents with sudden-onset severe flank pain but is less likely than ureteral calculus in a patient with a history of nephrolithiasis.
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Mr. M is receiving hospice care for a terminal illness. He wants to make sure his daughter is allowed to make any decisions regarding his care should he become unable to do so. What document would permit his daughter to do this?
- A. Expressed contract
- B. Implied contract
- C. Durable power of attorney
- D. Living will
Correct Answer: C
Rationale: The correct answer is C: Durable power of attorney. This legal document allows Mr. M to appoint his daughter as his healthcare proxy, granting her the authority to make medical decisions on his behalf if he becomes incapacitated. A: Expressed contract involves clear terms agreed upon by both parties, not relevant here. B: Implied contract arises from actions rather than explicit agreement, not applicable in this situation. D: A living will outlines an individual's medical treatment preferences, but does not grant decision-making authority to another person.
A patient presents with sudden-onset, painless vision loss in the right eye. Fundoscopic examination reveals a cherry-red spot at the macula and attenuated retinal vessels. Which of the following conditions is most likely responsible for this presentation?
- A. Central retinal artery occlusion
- B. Central retinal vein occlusion
- C. Retinal detachment
- D. Acute angle-closure glaucoma
Correct Answer: A
Rationale: The correct answer is A: Central retinal artery occlusion. This condition presents with sudden-onset, painless vision loss, cherry-red spot at the macula due to lack of blood flow, and attenuated retinal vessels. The cherry-red spot is due to the transparency of the fovea when there is ischemia in the surrounding retina. Central retinal vein occlusion (B) presents with sudden vision loss accompanied by retinal hemorrhages and dilated tortuous veins. Retinal detachment (C) typically presents with sudden flashes, floaters, and a curtain-like visual field defect. Acute angle-closure glaucoma (D) presents with severe eye pain, blurred vision, halos around lights, and a fixed mid-dilated pupil.
A postpartum client complains of persistent, heavy vaginal bleeding beyond the expected timeframe. Which nursing action is most appropriate?
- A. Encouraging the client to increase fluid intake
- B. Applying a cold compress to the perineum
- C. Assessing vital signs and uterine tone
- D. Administering pain medication as ordered
Correct Answer: C
Rationale: In a postpartum client complaining of persistent, heavy vaginal bleeding, the most appropriate nursing action is to assess vital signs and uterine tone. This is important to determine if the bleeding is within normal limits or if there is a potential postpartum hemorrhage (PPH) occurring. Monitoring vital signs can help identify signs of shock, while assessing uterine tone can help determine if the uterus is contracting effectively to control bleeding. Prompt assessment and early detection of PPH are crucial for effective management and prevention of complications. Encouraging increased fluid intake, applying a cold compress, and administering pain medication may be appropriate interventions in some situations, but assessing vital signs and uterine tone take priority in this scenario.
Select the medication that should be discussed by the nurse with the attending physician before administering it to patient with acute angle closure glaucoma
- A. Isoptocarpineeyedrops
- B. Mannitol
- C. Corticosporin ophthalmic
- D. Atropine
Correct Answer: D
Rationale: The correct answer is D: Atropine. Atropine is a mydriatic agent that can exacerbate acute angle closure glaucoma by dilating the pupil and potentially worsening the condition. The nurse should discuss with the attending physician before administering it to avoid worsening the patient's condition.
A: Isopto carpine eye drops are actually used in the treatment of acute angle closure glaucoma as they help in lowering intraocular pressure, so there is no need to discuss this with the physician.
B: Mannitol is used as an osmotic diuretic to reduce intraocular pressure in acute angle closure glaucoma, and it does not directly affect the pupil, so it does not require discussion with the physician before administration.
C: Corticosporin ophthalmic is a combination of an antibiotic and a corticosteroid used to treat eye infections and inflammation, but it does not have a direct effect on worsening acute angle closure glaucoma, so it does
A patient is prescribed a selective serotonin reuptake inhibitor (SSRI) for the treatment of depression. Which adverse effect should the nurse monitor closely in the patient?
- A. Bradycardia
- B. Hyperkalemia
- C. Hyponatremia
- D. Hypertension
Correct Answer: C
Rationale: The correct answer is C: Hyponatremia. SSRI medications can lead to the syndrome of inappropriate antidiuretic hormone secretion (SIADH), causing hyponatremia. This occurs due to increased levels of serotonin affecting the hypothalamus, leading to excessive ADH release. Hyponatremia can result in neurological symptoms and must be closely monitored.
A: Bradycardia is not a common adverse effect of SSRIs.
B: Hyperkalemia is not typically associated with SSRIs.
D: Hypertension is not a common adverse effect of SSRIs; they may actually lower blood pressure.