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A patient with advanced cancer experiences dyspnea and anxiety during episodes of breathlessness. Which intervention should the palliative nurse prioritize to address the patient's symptoms?
- A. Administer oxygen therapy to relieve dyspnea.
- B. Teach the patient pursed-lip breathing techniques.
- C. Recommend opioid medications for symptom management.
- D. Refer the patient to a respiratory therapist for breathing exercises.
Correct Answer: C
Rationale: Opioid medications are considered the first-line pharmacological treatment for dyspnea in palliative care patients with advanced cancer. Opioids help relieve dyspnea by reducing respiratory drive and the sensation of breathlessness, providing effective symptom management. In this case, addressing the patient's dyspnea with opioid medications would likely also help alleviate their anxiety related to breathlessness. Administering oxygen therapy (choice A) may not be effective at relieving dyspnea in this situation, as dyspnea in advanced cancer patients is often not primarily due to low oxygen levels. Teaching pursed-lip breathing techniques (choice B) and referring the patient to a respiratory therapist for breathing exercises (choice D) may be helpful complementary interventions, but opioid medications should be the priority for symptom management.
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A patient presents with chest pain that occurs at rest and is relieved by nitroglycerin. An electrocardiogram (ECG) may show transient ST-segment elevation. Which cardiovascular disorder is most likely responsible for these symptoms?
- A. Stable angina
- B. Unstable angina
- C. Acute myocardial infarction
- D. Prinzmetal's angina
Correct Answer: D
Rationale: Prinzmetal's angina, also known as variant angina, is characterized by episodes of chest pain that occur at rest and are relieved by nitroglycerin. Patients with Prinzmetal's angina may also have transient ST-segment elevation on an electrocardiogram (ECG) during episodes of chest pain. This is due to coronary artery vasospasm, which causes temporary obstruction of blood flow to the heart muscle. Stable angina typically presents with chest pain on exertion that resolves with rest, while unstable angina and acute myocardial infarction present with chest pain that is not relieved with nitroglycerin and are associated with more severe coronary artery disease.
A patient admitted to the ICU develops acute intracerebral hemorrhage (ICH) with elevated intracranial pressure (ICP). What intervention should the healthcare team prioritize to manage the patient's ICP?
- A. Initiate hypertonic saline therapy for osmotic diuresis.
- B. Perform emergent craniotomy for hematoma evacuation.
- C. Implement head-of-bed elevation to promote cerebral venous drainage.
- D. Recommend sedative medications to reduce agitation and anxiety.
Correct Answer: B
Rationale: In cases of acute intracerebral hemorrhage (ICH) with elevated intracranial pressure (ICP), a significant factor contributing to the elevated ICP is often the mass effect caused by the hematoma within the brain. Performing an emergent craniotomy for hematoma evacuation is a critical intervention to relieve the pressure within the intracranial space, thereby mitigating the risk of herniation and further neurological damage. While other interventions such as hypertonic saline therapy, head-of-bed elevation, and sedative medications may have supporting roles in managing ICP, none address the primary cause of elevated ICP in cases of acute intracerebral hemorrhage as effectively as hematoma evacuation through craniotomy.
It is not enough for the nurse to listen, but she also has, to validate what she has heard. The importance of validation are the following EXCEPT _____
- A. perceptions influence the interpretation of a message
- B. most patients are cognitively impaired
- C. Eye contact does not necessarily send the same message
- D. assists clarifying thoughts
Correct Answer: B
Rationale: The importance of validation in the context of communication and nursing care does not include the assumption that most patients are cognitively impaired. It would be more appropriate to approach patient interactions with the assumption that patients are capable of understanding and coherent communication. Validation is important because it helps ensure that the nurse has truly understood the patient's message, prevents misinterpretation, and fosters a sense of empathy and trust in the nurse-patient relationship. Additionally, validating the patient's thoughts and feelings can help clarify confused thoughts and promote effective communication. The other options (A, C, and D) are all valid reasons emphasizing the significance of validation in effective communication.
A patient presents with a painless, gradually enlarging mass in the left neck, anterior to the sternocleidomastoid muscle. Fine-needle aspiration cytology reveals thyroid follicular cells. Which of the following conditions is most likely responsible for this presentation?
- A. Thyroglossal duct cyst
- B. Lymphadenopathy
- C. Thyroid adenoma
- D. Thyroid carcinoma
Correct Answer: C
Rationale: The presentation described is most consistent with a thyroid adenoma. Thyroid adenomas are benign neoplasms of the thyroid gland and can present as painless, gradually enlarging masses in the neck. Fine-needle aspiration cytology revealing thyroid follicular cells further supports the diagnosis of a thyroid adenoma. Thyroglossal duct cysts typically present as midline neck masses that move with swallowing, while lymphadenopathy presents as enlarged lymph nodes and may be associated with infection or malignancy. Thyroid carcinoma may also present as a neck mass but is more likely to be associated with other features such as vocal cord paralysis, hoarseness, or enlarged cervical lymph nodes.
Evelyn was given iron as supplemental vitamin to prevent maternal anemia. She asks if
- A. Which of the following would be the best response of the nurse?
- B. "Take two other vitamins separately."
- C. Absorption of iron is enhanced with Vit C.
- D. "Drink milk when taking the iron supplement."
Correct Answer: C
Rationale: The correct response would be "Absorption of iron is enhanced with Vitamin C." Iron absorption is increased in the presence of Vitamin C. Therefore, recommending Evelyn to take her iron supplement with a source of Vitamin C such as orange juice or a Vitamin C tablet would optimize the absorption of iron in her body and help prevent maternal anemia more effectively. Taking iron with other vitamins separately, after a full meal, or with milk would not have the same beneficial effect on iron absorption as combining it with Vitamin C.