Nokea
A patient with acute exacerbation of chronic obstructive pulmonary disease (COPD) demonstrates hypercapnia and respiratory acidosis on arterial blood gas analysis. Which of the following ventilatory strategies is most appropriate for managing the patient's respiratory failure?
- A. Low tidal volume ventilation
- B. High-flow nasal cannula therapy
- C. Non-invasive positive pressure ventilation (NIPPV)
- D. Invasive mechanical ventilation with lung protective strategy
Correct Answer: D
Rationale: In a patient with acute exacerbation of COPD who presents with hypercapnia and respiratory acidosis, the most appropriate ventilatory strategy is invasive mechanical ventilation with a lung protective strategy. This involves using lower tidal volumes and limiting plateau pressures to prevent ventilator-induced lung injury.
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Nurse Edna admits a patient from the ER to the medical unit. The patient is very restless with IV lines and a urinary catheter. She was put to bed and the nurse applied a body restraint without the doctor's order. Nurse Edna's action can be liable for _____.
- A. invasion of privacy
- B. battery
- C. assault
- D. neglect
Correct Answer: B
Rationale: Battery in the context of healthcare refers to the intentional and unauthorized touching of a patient. By applying a body restraint without a doctor's order, Nurse Edna has potentially committed battery against the patient. It is important for healthcare providers to obtain proper authorization before implementing any physical restraints on a patient to avoid legal liabilities such as battery.
Which additional finding confirms the diagnosis that the patient has mastitis?
- A. Enlarged glands in the axilla
- B. Normal temperature
- C. Engorged both breasts
- D. Hard mass and reddened area
Correct Answer: D
Rationale: A hard mass and a reddened area on one breast are key clinical signs that confirm the diagnosis of mastitis. Mastitis is an infection of the breast tissue that often presents with localized redness, warmth, and swelling of the breast. The presence of a hard mass along with the other symptoms suggests inflammation and infection within the breast tissue. In contrast, the other findings such as enlarged glands in the axilla, normal temperature, and engorged breasts are not specific findings for mastitis and may be present in other conditions. Therefore, the presence of a hard mass and reddened area on one breast is the additional finding that strongly confirms the diagnosis of mastitis in this case.
What must be stressed to all participants attending a health fair?
- A. A screening program is not a substitute for ongoing health supervision from a health care provider.
- B. All test results are only tentative, and so participants who receive negative test results may nonetheless be suffering from a disease.
- C. Results are true today, but disease can develop any time, so participants should attend any future health fairs as well.
- D. There are many other diseases that may be attacking participants that the health fair did not screen for, and so continued vigilance is necessary.
Correct Answer: A
Rationale: Stressing to all participants attending a health fair that a screening program is not a substitute for ongoing health supervision from a healthcare provider is crucial for several reasons. Health fairs are intended to provide a snapshot of an individual's health at a specific point in time and are not comprehensive assessments. Participants need to understand that these screenings are not a replacement for regular check-ups with their healthcare provider, who can provide continued monitoring, follow-up care, and more in-depth evaluations if necessary. It's important for participants to recognize that the results from a health fair screening are just one piece of their overall health picture and that ongoing care from a healthcare provider is essential for maintaining their well-being.
A postpartum client presents with sudden onset of shortness of breath, chest pain, and cyanosis. Which nursing action is most appropriate?
- A. Placing the client in a semi-Fowler's position
- B. Administering supplemental oxygen therapy
- C. Notifying the healthcare provider immediately
- D. Assisting with chest physiotherapy to improve ventilation
Correct Answer: C
Rationale: The sudden onset of shortness of breath, chest pain, and cyanosis in a postpartum client could be indicative of a pulmonary embolism, a potentially life-threatening condition. Therefore, it is crucial to notify the healthcare provider immediately for further assessment and management. Prompt intervention is essential in this situation to prevent any potential complications and ensure the client receives appropriate care as soon as possible. Placing the client in a semi-Fowler's position or administering supplemental oxygen therapy may provide temporary relief, but the priority is to seek immediate medical attention. Consulting with the healthcare provider ensures that the client receives the necessary interventions promptly.
A patient with a history of multiple myeloma presents with weakness, bone pain, and recurrent infections. Laboratory tests reveal anemia, hypercalcemia, renal insufficiency, and monoclonal spike on serum protein electrophoresis. Which of the following conditions is most likely to cause these findings?
- A. Waldenstrom macroglobulinemia
- B. Hodgkin lymphoma
- C. Chronic lymphocytic leukemia (CLL)
- D. Multiple myeloma
Correct Answer: D
Rationale: Multiple myeloma is a plasma cell neoplasm characterized by the presence of abnormal monoclonal plasma cells in the bone marrow, which produce a monoclonal spike on serum protein electrophoresis. The clinical presentation of weakness, bone pain, and recurrent infections is typical of multiple myeloma. Anemia can result from bone marrow infiltration by the abnormal plasma cells, hypercalcemia is due to bone destruction and release of calcium, renal insufficiency can result from hypercalcemia and protein deposition in the kidneys, and the monoclonal spike in serum protein electrophoresis indicates the presence of a monoclonal protein. Waldenström macroglobulinemia, Hodgkin lymphoma, and chronic lymphocytic leukemia do not typically present with the classic tetrad of findings seen in multiple myeloma.