Nokea
A patient with a tibial shaft fracture undergoes surgical fixation with an intramedullary nail. What postoperative complication should the healthcare team monitor for in the immediate postoperative period?
- A. Wound infection
- B. Nonunion
- C. Fat embolism syndrome
- D. Compartment syndrome
Correct Answer: C
Rationale: Following surgical fixation of a tibial shaft fracture with an intramedullary nail, healthcare providers should monitor for the development of fat embolism syndrome (FES) in the immediate postoperative period. FES is a serious complication that occurs when fat droplets from the bone marrow enter the bloodstream and cause respiratory and neurological symptoms. Clinical manifestations of FES may include dyspnea, tachypnea, petechial rash, altered mental status, and hypoxemia. Prompt recognition and treatment are essential in managing fat embolism syndrome to prevent serious complications such as respiratory failure and neurological deficits. Monitoring for signs and symptoms of FES is crucial in the postoperative care of patients undergoing surgical fixation of long bone fractures.
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The presence of any of these risk factors means that ______.
- A. Risk modification will have no effect on disease prevention
- B. The chances of getting the disease are increased
- C. A person with risk factors can get the disease
- D. The disease is guaranteed not to get disease
Correct Answer: B
Rationale: The presence of risk factors indicates an increased likelihood or susceptibility to developing a particular disease. While risk modification and healthy lifestyle choices can help reduce the risk, having these risk factors still increases the overall chances of getting the disease compared to individuals without the same risk factors. It is essential for individuals with risk factors to be proactive in managing their health to mitigate the increased risk.
When conducting a nursing history on the Health Perception, Health Management pattern of functioning what is the APPROPRIATE question to be asked pre-operatively?
- A. Do you experience your wound to heal quickly?
- B. Do you have shortness of breath when exercising?
- C. Are you aware of risk factors for your disease?
- D. Have you experience weight changes in the past?
Correct Answer: C
Rationale: When conducting a nursing history on the Health Perception, Health Management pattern of functioning pre-operatively, an appropriate question to ask would be "Are you aware of risk factors for your disease?" This question helps assess the individual's level of awareness and understanding of their health condition and the factors that may impact it. Understanding the patient's knowledge of their risk factors can help guide interventions and education before surgery to optimize their health outcomes. Asking about perceived wound healing, shortness of breath, or weight changes may not be directly related to the patient's awareness of their disease risk factors in the pre-operative setting.
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 presents with recurrent episodes of venous thrombosis, including deep vein thrombosis (DVT) and pulmonary embolism (PE), despite no apparent provoking factors. Which of the following conditions is most likely to cause these findings?
- A. Antithrombin III deficiency
- B. Protein C deficiency
- C. Protein S deficiency
- D. Factor V Leiden mutation
Correct Answer: D
Rationale: Factor V Leiden mutation is the most common inherited predisposition to venous thrombosis. In this condition, there is a specific mutation in the factor V gene (also known as factor V Leiden) that makes factor V resistant to inactivation by activated protein C. This resistance leads to excessive clot formation, increasing the risk of recurrent venous thrombosis like DVT and PE. Patients with Factor V Leiden mutation may have a history of recurrent unprovoked venous thrombosis at a young age. In comparison, antithrombin III deficiency, protein C deficiency, and protein S deficiency are other inherited thrombophilias that may increase the risk of venous thrombosis, but Factor V Leiden mutation is the most likely cause in this case based on the presentation of recurrent episodes without apparent provoking factors.
A patient presents with scrotal pain, swelling, and erythema. On physical examination, there is a tender, fluctuant mass in the scrotum. What is the most likely diagnosis?
- A. Testicular torsion
- B. Epididymitis
- C. Testicular cancer
- D. Hydrocele
Correct Answer: B
Rationale: The most likely diagnosis in this scenario is epididymitis. Epididymitis is an inflammation of the epididymis, a coiled tube at the back of the testicle that stores and carries sperm. Common symptoms include scrotal pain, swelling, erythema (redness), and a tender, fluctuant mass in the scrotum due to an abscess. Risk factors for epididymitis include urinary tract infections, sexually transmitted infections (such as gonorrhea or chlamydia), and recent urological procedures. It is important to differentiate epididymitis from testicular torsion, which would present with sudden, severe testicular pain, absent cremasteric reflex, and a high-riding testicle. Testicular cancer typically presents as a painless mass or swelling in the scrotum, and hydrocele presents as painless scrotal swelling due to a collection of fluid