Nokea
After the completion of testing, a childs allergies have been attributed to her familys cat. When introducing the family to the principles of avoidance therapy, the nurse should promote what action?
- A. Removing the cat from the familys home
- B. Administering OTC antihistamines to the child regularly
- C. Keeping the cat restricted from the childs bedroom
- D. Maximizing airflow in the house
Correct Answer: A
Rationale: The correct answer is A: Removing the cat from the family's home. This is the most effective way to prevent allergic reactions in the child. By removing the source of allergens (cat), the child will be exposed to fewer allergens, leading to a reduction in symptoms.
B: Administering OTC antihistamines treats symptoms but does not address the underlying cause of the allergy.
C: Keeping the cat restricted from the child's bedroom helps reduce exposure, but allergens can still spread throughout the house.
D: Maximizing airflow may help reduce allergens in the air but does not eliminate the source of the allergy.
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A 45-year-old woman has just undergone a radical hysterectomy for invasive cervical cancer. Prior to the surgery the physician explained to the patient that after the surgery a source of radiation would be placed near the tumor site to aid in reducing recurrence. What is the placement of the source of radiation called?
- A. Internal beam radiation
- B. Trachelectomy
- C. Brachytherapy
- D. External radiation
Correct Answer: C
Rationale: The correct answer is C: Brachytherapy. Brachytherapy involves placing a radiation source near or directly into the tumor site. In this case, after the hysterectomy, the source of radiation is placed near the cervical cancer site to deliver targeted radiation therapy. This method helps reduce the risk of cancer recurrence by delivering high doses of radiation to the tumor while minimizing exposure to surrounding healthy tissues.
Choice A (Internal beam radiation) typically refers to a type of external radiation therapy where radiation beams are directed at the tumor from outside the body, not placed internally like brachytherapy.
Choice B (Trachelectomy) is a surgical procedure that involves removal of the cervix while preserving the uterus, not related to radiation therapy.
Choice D (External radiation) involves delivering radiation from outside the body using a machine, unlike brachytherapy where the radiation source is placed internally near the tumor site.
A nurse practitioner assesses the patient and diagnoses Gardnerella vaginalis. What would be the most appropriate nursing action at this time?
- A. Advise the patient that this is an overgrowth of normal vaginal flora.
- B. Discuss the effect of this diagnosis on the patients fertility.
- C. Document the vaginal discharge as normal.
- D. Administer acyclovir as ordered.
Correct Answer: A
Rationale: The correct answer is A: Advise the patient that this is an overgrowth of normal vaginal flora. This is correct because Gardnerella vaginalis is a bacteria associated with bacterial vaginosis, which is an overgrowth of normal vaginal flora. By advising the patient of this, the nurse practitioner can provide education on the condition and treatment options.
B: Discussing the effect of this diagnosis on the patient's fertility is incorrect as Gardnerella vaginalis is not typically associated with fertility issues.
C: Documenting the vaginal discharge as normal is incorrect as Gardnerella vaginalis is indicative of an abnormal vaginal flora imbalance.
D: Administering acyclovir as ordered is incorrect as acyclovir is an antiviral medication used to treat herpes simplex virus infections, not bacterial vaginosis caused by Gardnerella vaginalis.
Which behaviors indicate the nurse is using criticalthinking standards when communicating with patients? (Select all that apply.)
- A. Instills faith
- B. Uses humility
- C. Portrays self-confidence
- D. Exhibits supportiveness
Correct Answer: B
Rationale: The correct answer is B: Uses humility. Critical thinking in nursing involves being open-minded, self-aware, and willing to consider different perspectives. Humility allows nurses to acknowledge their limitations, seek feedback, and continuously learn and improve. Instilling faith (A) may be important but does not directly relate to critical thinking standards. Self-confidence (C) can be beneficial, but excessive confidence can lead to closed-mindedness. Supportiveness (D) is valuable in patient care but does not specifically demonstrate critical thinking standards. In summary, humility enables nurses to approach patient communication with an open and reflective mindset, essential for applying critical thinking standards effectively.
A nurse is a member of an interdisciplinary teamthat uses critical pathways. According to the critical pathway, on day 2 of the hospital stay, the patient should be sitting in the chair. It is day 3, and the patient cannot sit in the chair. What should the nurse do?
- A. Add this data to the problem list.
- B. Focus chart using the DAR format.
- C. Document the variance in the patient’s record.
- D. Report a positive variance in the next interdisciplinary team meeting.
Correct Answer: C
Rationale: The correct answer is C: Document the variance in the patient’s record. By documenting the variance in the patient's record, the nurse can provide a clear record of the deviation from the critical pathway. This documentation is essential for tracking the patient's progress accurately and identifying potential issues that may require intervention. It allows for proper communication among the interdisciplinary team and ensures that everyone is aware of the deviation.
Choice A is incorrect because adding data to the problem list may not provide a comprehensive record of the variance. Choice B is incorrect because focusing on charting using the DAR format does not address the deviation from the critical pathway. Choice D is incorrect because reporting a positive variance in the next team meeting may not accurately reflect the patient's actual progress and may lead to miscommunication within the team.
The nurse is teaching breast self-examination (BSE) to a group of women. The nurse should recommend that the women perform BSE at what time?
- A. At the time of menses
- B. At any convenient time, regardless of cycles
- C. Weekly
- D. Between days 5 and 7 after menses
Correct Answer: A
Rationale: The correct answer is A: At the time of menses. This is because breasts are less lumpy and tender during this time, making it easier to detect abnormalities. Performing BSE at other times may lead to false alarms due to hormonal changes. Choice B is incorrect because timing matters for accurate results. Choice C is incorrect as weekly BSE is unnecessary and may cause unnecessary anxiety. Choice D is incorrect as breasts are more lumpy and tender post-menses, potentially making it harder to detect abnormalities.