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During surgery, the nurse notices a discrepancy between the surgical count and the number of instruments on the sterile field. What should the nurse do?
- A. Re-count the instruments on the sterile field
- B. Document the discrepancy in the surgical count log
- C. Continue with the procedure as planned
- D. Inform the surgical team and initiate a thorough search
Correct Answer: D
Rationale: If a nurse notices a discrepancy between the surgical count and the number of instruments on the sterile field during surgery, it is crucial to inform the surgical team immediately and initiate a thorough search. Patient safety is of utmost importance, and any missing instruments could potentially pose a risk to the patient. By informing the team and conducting a thorough search, the missing instrument can be located promptly to ensure it is not inadvertently left inside the patient's body. Continuing with the procedure or ignoring the discrepancy without further investigation could lead to serious consequences for the patient's well-being. It is always better to address any discrepancies or concerns during surgery proactively to maintain a high standard of patient care and safety.
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A patient with advanced heart failure expresses fear and anxiety about the progression of their illness. What is the palliative nurse's most appropriate response?
- A. Provide reassurance and minimize discussions about end-of-life care.
- B. Encourage the patient to focus on positive thoughts and avoid discussing fears.
- C. Offer empathetic listening and explore the patient's concerns about the future.
- D. Suggest distraction techniques to divert the patient's attention from their worries.
Correct Answer: C
Rationale: The palliative nurse's most appropriate response in this scenario is to offer empathetic listening and explore the patient's concerns about the future. By providing a compassionate and supportive environment for the patient to express their fears and anxieties, the nurse can help the patient feel heard and understood. This approach allows the nurse to address the patient's emotional needs and provide appropriate support to help them cope with their feelings. Avoiding discussions or minimizing the patient's concerns may invalidate their emotions and hinder the therapeutic relationship. Encouraging distraction techniques or focusing solely on positive thoughts may not address the underlying fears and anxieties that the patient is experiencing. Therefore, offering empathetic listening and exploring the patient's concerns is the most appropriate way for the nurse to provide holistic care for the patient with advanced heart failure.
A patient with a history of heart failure is prescribed lisinopril for blood pressure management. Which adverse effect is most commonly associated with lisinopril therapy?
- A. Hyperkalemia
- B. Hypertension
- C. Dry cough
- D. Bradycardia
Correct Answer: C
Rationale: Dry cough is the most commonly reported adverse effect associated with lisinopril therapy. Lisinopril is an ACE inhibitor, and the mechanism behind the cough is not completely understood but is thought to be related to the accumulation of bradykinin and substance P. This annoying dry cough can be a persistent issue for some patients on lisinopril, and it typically resolves once the medication is discontinued. Patients who experience this side effect should not ignore it and should consult their healthcare provider for further evaluation and possible alternative medication options. Hyperkalemia, hypertension, and bradycardia are not commonly associated adverse effects of lisinopril therapy.
A patient with suspected pulmonary embolism (PE) presents with sudden onset dyspnea, pleuritic chest pain, and hemoptysis. Which of the following diagnostic tests is most appropriate for confirming the diagnosis?
- A. Chest X-ray
- B. Electrocardiography (ECG)
- C. D-dimer assay
- D. Spiral computed tomography (CT) angiography
Correct Answer: D
Rationale: Spiral CT angiography is the most appropriate test for confirming the diagnosis of pulmonary embolism (PE) in a patient with suspected PE. It is a non-invasive imaging modality that can detect filling defects within the pulmonary vasculature indicative of a clot. This diagnostic test has high sensitivity and specificity for diagnosing PE, making it a valuable tool in the management of patients with suspected PE.
A patient with terminal illness expresses fear and anxiety about dying alone. What intervention should the palliative nurse prioritize to address the patient's concerns?
- A. Arrange for family members or loved ones to be present at the patient's bedside.
- B. Offer reassurance that dying alone is a common experience in palliative care.
- C. Recommend distracting activities to divert the patient's attention from their fears.
- D. Administer sedative medications to alleviate anxiety and promote relaxation.
Correct Answer: A
Rationale: The most appropriate intervention for the palliative nurse to prioritize in this situation is to arrange for family members or loved ones to be present at the patient's bedside. Having loved ones nearby can provide emotional support, comfort, and reassurance to the patient during their final moments. This can help alleviate the fear and anxiety the patient is experiencing about dying alone. Additionally, it can contribute to a sense of connectedness and peace for both the patient and their loved ones during this challenging time. Offering practical solutions to address the patient's emotional needs is key in providing holistic palliative care.
A patient presents with fever, malaise, and a maculopapular rash that started on the face and spread to the trunk and extremities. Laboratory tests reveal leukopenia and thrombocytopenia. Which of the following is the most likely causative agent?
- A. Borrelia burgdorferi
- B. Plasmodium falciparum
- C. Rickettsia rickettsii
- D. Leishmania donovani
Correct Answer: C
Rationale: The clinical presentation of fever, malaise, maculopapular rash starting on the face and spreading to the trunk and extremities, along with leukopenia and thrombocytopenia, is highly suggestive of Rocky Mountain spotted fever (RMSF) caused by Rickettsia rickettsii. RMSF is a tick-borne illness transmitted by the American dog tick, Rocky Mountain wood tick, and brown dog tick. The constellation of symptoms described aligns well with the typical presentation of RMSF. Borrelia burgdorferi causes Lyme disease, which presents with erythema migrans but does not typically cause leukopenia or thrombocytopenia. Plasmodium falciparum is the causative agent of severe malaria and would present with symptoms such as cyclic fevers, anemia, and jaundice but not the described rash distribution.