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A primigravida patient at 34 weeks gestation presents with a history of not having felt fetal movements for 24 hours. Which one of the following statements is most appropriate?
- A. She probably has an intra-uterine fetal death.
- B. You should immediately arrange transfer to labour ward for early induction labour, providing the baby is still alive.
- C. She should have urgent antenatal cardiotocography (CTG).
- D. She should have an ultrasound scan.
Correct Answer: C
Rationale: Absent fetal movements at 34 weeks require urgent assessment. CTG (C) is the fastest way to check fetal heart rate and well-being. Presuming death (A), inducing without confirmation (B), or slower methods (D, E) are less appropriate initially.
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During a treatment team meeting, the point is made that a client with schizophrenia has recovered from the acute psychosis but continues to demonstrate apathy, avolition, and blunted affect. The nurse who relates these symptoms to serotonin (SHT2) excess will suggest that the client receive:
- A. Haloperidol (Haldol)
- B. Chlorpromazine (Thorazine)
- C. Olanzapine (Zyprexa)
- D. Phenelzine (NardiI)
Correct Answer: C
Rationale: Rationale: Olanzapine (Zyprexa) is an atypical antipsychotic that targets multiple neurotransmitter systems, including serotonin. Serotonin excess is associated with symptoms like apathy, avolition, and blunted affect. Olanzapine, by blocking serotonin receptors, can help alleviate these symptoms in schizophrenia.
Summary of Incorrect Choices:
A: Haloperidol and B: Chlorpromazine are typical antipsychotics that primarily target dopamine receptors, not serotonin. They are more effective for positive symptoms of schizophrenia, not apathy and avolition.
D: Phenelzine is a monoamine oxidase inhibitor (MAOI) used for depression and anxiety disorders, not for schizophrenia symptoms related to serotonin excess.
A nurse is performing an assessment for a 59-year-old man with a long history of hypertension. What is the rationale for including questions about prescribed medications and their effects on sexual function in the assessment?
- A. Sexual dysfunction may result from use of prescription medications for management of hypertension.
- B. Such questions are an indirect way of learning about the patient's medication adherence.
- C. These questions ease the transition to questions about sexual practices in general.
- D. Sexual dysfunction can cause stress and contribute to increased blood pressure.
Correct Answer: A
Rationale: 1. **Step 1**: Hypertension is a common condition managed with prescription medications.
2. **Step 2**: Many antihypertensive medications can cause sexual dysfunction as a side effect.
3. **Step 3**: Therefore, asking about prescribed medications and their effects on sexual function is important.
4. **Step 4**: This helps assess if the patient is experiencing any sexual side effects due to his hypertension medications.
5. **Step 5**: Identifying and addressing such side effects can improve patient outcomes and quality of life.
6. **Summary**: Option A is correct as it directly links the potential sexual dysfunction side effects of hypertension medications to the assessment, unlike the other choices which do not address this important aspect of medication management.
The characteristic in individuals with personality disorders that makes it most necessary for staff to schedule frequent meetings is:
- A. flexibility and unconventional responses to stress.
- B. a desire to achieve emotional intimacy with staff.
- C. a tendency to evoke countertransference and conflict.
- D. an impaired ability to develop trusting relationships.
Correct Answer: C
Rationale: The correct answer is C because individuals with personality disorders often evoke countertransference and conflict in staff due to their challenging behaviors and interpersonal dynamics. This can lead to potential misunderstandings and ineffective treatment if not addressed through frequent meetings. Option A is incorrect as flexibility and unconventional responses to stress are not typically the primary concern necessitating frequent meetings. Option B is incorrect as a desire for emotional intimacy is not necessarily a reason for staff to schedule frequent meetings. Option D is incorrect as an impaired ability to develop trusting relationships might be a symptom of a personality disorder, but it is not the characteristic that most necessitates frequent meetings.
Which of the following is an appropriate nursing intervention for a patient with anorexia nervosa?
- A. Promote gradual weight gain through a structured meal plan.
- B. Encourage the patient to restrict calorie intake to avoid weight gain.
- C. Offer emotional support without addressing food-related behaviors.
- D. Focus on daily exercise to improve physical fitness.
Correct Answer: A
Rationale: The correct answer is A because promoting gradual weight gain through a structured meal plan is essential in treating anorexia nervosa. This intervention helps the patient restore their nutritional status and physical health. By providing a structured meal plan, the patient can slowly increase their caloric intake, leading to healthy weight gain. This approach also helps address the underlying psychological and emotional issues associated with the eating disorder. Encouraging the patient to restrict calorie intake (B) is harmful as it perpetuates the cycle of malnutrition. Offering emotional support without addressing food-related behaviors (C) neglects the crucial aspect of nutritional rehabilitation. Focusing on daily exercise (D) may exacerbate the patient's physical health and reinforce unhealthy behaviors.
The nurse is assessing a patient with anorexia nervosa. What is the most important physical examination finding to monitor?
- A. Blood pressure and heart rate.
- B. Height and weight changes.
- C. Skin turgor and hydration status.
- D. Respiratory rate and lung function.
Correct Answer: B
Rationale: The correct answer is B: Height and weight changes. In anorexia nervosa, monitoring height and weight changes is crucial as it reflects the patient's nutritional status and overall health. Weight loss and changes in height can indicate severe malnutrition and potential complications. Blood pressure and heart rate (choice A) can be affected by various factors in anorexia nervosa but may not directly reflect the patient's nutritional status. Skin turgor and hydration status (choice C) are important indicators of hydration levels but may not provide a comprehensive assessment of the patient's nutritional status. Respiratory rate and lung function (choice D) are important, but they may not be the most critical physical examination findings to monitor in anorexia nervosa.