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A patient with chronic bronchitis presents with chronic cough, sputum production, and exertional dyspnea. Which of the following interventions is most appropriate for managing the patient's symptoms and improving quality of life?
- A. Smoking cessation counseling
- B. Oral antibiotic therapy
- C. Home oxygen therapy
- D. Bronchodilator therapy
Correct Answer: D
Rationale: The correct answer is D: Bronchodilator therapy. Bronchodilators help to relax and open up the airways, which can improve airflow and reduce symptoms such as cough, sputum production, and dyspnea in patients with chronic bronchitis. This intervention can help manage the patient's symptoms and improve their quality of life by making it easier for them to breathe.
A: Smoking cessation counseling is important for overall management of chronic bronchitis, but it does not directly address the patient's current symptoms.
B: Oral antibiotic therapy may be indicated if there is evidence of a bacterial infection, but it is not the first-line treatment for managing chronic bronchitis symptoms.
C: Home oxygen therapy may be necessary for patients with severe hypoxemia, but it is not typically the first intervention for managing symptoms of chronic bronchitis without evidence of significant oxygen desaturation.
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A patient with chronic kidney disease presents with fatigue, dyspnea on exertion, peripheral edema, and hypertension. Laboratory findings reveal elevated serum creatinine and urea levels, metabolic acidosis, and hyperkalemia. What is the most appropriate initial management for this patient?
- A. Initiation of angiotensin-converting enzyme (ACE) inhibitor therapy
- B. Hemodialysis
- C. Intravenous administration of calcium gluconate
- D. Sodium bicarbonate administration
Correct Answer: B
Rationale: The most appropriate initial management for the patient described is hemodialysis. Hemodialysis is essential for managing chronic kidney disease with severe symptoms and electrolyte imbalances like hyperkalemia and metabolic acidosis. Hemodialysis helps to remove urea and creatinine from the blood, correct electrolyte abnormalities, and improve symptoms such as fatigue, dyspnea, and peripheral edema. Initiation of ACE inhibitor therapy (Choice A) is contraindicated in severe kidney disease due to the risk of worsening renal function. Intravenous administration of calcium gluconate (Choice C) is used for acute hyperkalemia with cardiac toxicity, not for initial management. Sodium bicarbonate administration (Choice D) may help correct metabolic acidosis, but it does not address the underlying cause or the need for urgent renal replacement therapy.
Which of the following is the best predictor of adolescents attempting suicide?
- A. Depressed mood
- B. Feeling of euphoria
- C. Joyful mood
- D. Feeling of hopelessness
Correct Answer: D
Rationale: The correct answer is D: Feeling of hopelessness. Adolescents who feel hopeless are at a higher risk of attempting suicide due to a lack of belief in positive outcomes. This feeling can lead to a sense of being trapped and unable to see a way out. Depressed mood (A) can contribute to suicide risk, but specifically feeling hopeless is a more direct predictor. Feeling of euphoria (B) and joyful mood (C) are actually less likely to be associated with suicide attempts, as they may temporarily mask underlying issues or provide a sense of distraction. Hopelessness is a key psychological factor that can lead to suicidal thoughts and behaviors in adolescents.
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 patient presents with sudden-onset severe headache, vomiting, and altered mental status. Imaging reveals a noncontrast-enhancing hemorrhagic lesion within the subarachnoid space. Which of the following neurological conditions is most likely responsible for these symptoms?
- A. Ischemic stroke
- B. Subdural hematoma
- C. Intracerebral hemorrhage
- D. Subarachnoid hemorrhage
Correct Answer: D
Rationale: The correct answer is D: Subarachnoid hemorrhage. This condition presents with sudden-onset severe headache, vomiting, and altered mental status due to bleeding in the subarachnoid space. This type of hemorrhage is typically noncontrast-enhancing on imaging.
A: Ischemic stroke does not typically present with sudden-onset severe headache and vomiting.
B: Subdural hematoma usually presents with a slower onset of symptoms and often develops after head trauma.
C: Intracerebral hemorrhage presents with focal neurological deficits rather than altered mental status and vomiting.
In summary, based on the sudden onset of symptoms, imaging findings, and clinical presentation, subarachnoid hemorrhage is the most likely diagnosis in this case.
A postpartum client presents with severe abdominal pain, nausea, and vomiting. Which nursing action is most appropriate?
- A. Administering antiemetic medication as ordered
- B. Encouraging the client to drink clear fluids
- C. Assessing for signs of peritonitis or surgical abdomen
- D. Providing a heating pad to alleviate abdominal discomfort
Correct Answer: C
Rationale: In a postpartum client who presents with severe abdominal pain, nausea, and vomiting, it is crucial to assess for signs of peritonitis or surgical abdomen. These signs may include rebound tenderness, guarding, rigidity, and fever. Peritonitis is a serious condition that may require immediate surgical intervention. Administering antiemetic medication, encouraging clear fluids, or providing a heating pad may not address the underlying cause of the symptoms and delay appropriate treatment. Assessing for signs of peritonitis or surgical abdomen is crucial for prompt identification and management of the client's condition.