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A woman in active labor is receiving intravenous fentanyl for pain relief. What fetal assessment finding indicates potential neonatal opioid withdrawal syndrome (NOWS)?
- A. Hypertonicity
- B. Bradycardia
- C. Hypoglycemia
- D. Respiratory depression
Correct Answer: A
Rationale: Neonatal Opioid Withdrawal Syndrome (NOWS), previously known as Neonatal Abstinence Syndrome (NAS), can occur when a newborn is exposed to opioids in utero. Opioid exposure in utero can lead to physical dependence in the fetus, and when the drug is no longer available after birth, withdrawal symptoms can occur.
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A patient presents with chest pain at rest, unrelated to exertion, and not relieved by nitroglycerin. An electrocardiogram (ECG) shows ST-segment depression. 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: B
Rationale: Unstable angina is characterized by chest pain at rest, which is not relieved by nitroglycerin. The ECG findings in unstable angina typically show ST-segment depression or T-wave inversion. It is considered a medical emergency as it can progress to a myocardial infarction. Stable angina, on the other hand, is chest pain or discomfort that occurs with exertion and is relieved by rest or medications like nitroglycerin. Acute myocardial infarction would typically present with ST-segment elevation on ECG, while Prinzmetal's angina is characterized by transient ST-segment elevation due to coronary artery vasospasm.
To start a nursing improvement project, what is the FIRST step that a nurse must keep in mind?
- A. Implement plan to correct the problem
- B. Determine the nursing standards
- C. Determine findings if warrant correction
- D. Collect data determine if standards are met
Correct Answer: B
Rationale: The first step that a nurse must keep in mind to start a nursing improvement project is to determine the nursing standards. This is crucial because nursing standards provide guidelines and benchmarks for quality care delivery. By identifying and understanding the established standards, nurses can assess current practices, identify areas that need improvement, and develop strategies to enhance patient care. Setting a clear foundation based on nursing standards is essential before moving forward with implementing corrective actions, determining findings for correction, or collecting data. Understanding and aligning with nursing standards from the outset ensures that the improvement project is focused on promoting best practices and achieving positive outcomes for patients.
The QA team has been bombarded by complaints of patients on their long waiting period in the OPD, before the health care professionals are examining them. In response to this concern, which type of quality assessment should the team implement?
- A. Outcome evaluation
- B. Ongoing evaluation
- C. Process evaluation
- D. Structures evaluation
Correct Answer: C
Rationale: Process evaluation focuses on assessing how well the activities and procedures are being conducted to achieve the desired outcomes. In this situation, the long waiting period in the OPD is a process issue related to the efficiency of patient flow and appointment scheduling practices. By implementing a process evaluation, the QA team can analyze and improve the workflow, identify bottlenecks causing delays, and streamline the processes to reduce waiting times for patients. This approach allows the team to make targeted improvements in the processes directly associated with the patient experience, leading to a more effective and efficient OPD operation.
A patient presents with multiple, hyperpigmented, velvety plaques in flexural areas such as the axillae and neck. The lesions are associated with obesity and insulin resistance. Which of the following conditions is most likely responsible for this presentation?
- A. Acanthosis nigricans
- B. Seborrheic keratosis
- C. Dermatofibroma
- D. Epidermal nevus
Correct Answer: A
Rationale: Acanthosis nigricans is a skin condition characterized by multiple, hyperpigmented, velvety plaques typically seen in flexural areas such as the axillae, neck, and groin. These lesions are often associated with obesity and insulin resistance. The appearance of acanthosis nigricans is distinct from other skin conditions such as seborrheic keratosis, dermatofibroma, and epidermal nevus. Acanthosis nigricans is commonly seen in conditions like obesity, type 2 diabetes, and metabolic syndrome due to the insulin resistance that leads to the overgrowth of keratinocytes.
What symptom is an INDICATOR of cranial nerve involvement?
- A. Difficulty of speaking and chewing.
- B. Loss of pain sensation
- C. Spastic paralysis of the extremities
- D. Forgetfulness and syncope
Correct Answer: A
Rationale: Difficulty of speaking and chewing is an indicator of cranial nerve involvement. Cranial nerves are responsible for controlling various functions of the head and neck, including speech and mastication. Impairment of cranial nerve function can lead to difficulty in these activities. In the context of the question, with the patient in the stroke unit, cranial nerve involvement can occur due to the stroke affecting the brain regions responsible for cranial nerve function. Loss of pain sensation, spastic paralysis of the extremities, and forgetfulness with syncope are not specific indicators of cranial nerve involvement in this scenario.