Nokea
Nurse Adalynn explains to the mothers that early indication for hypovolemia caused by postpartum hemorrhage is _____.
- A. increasing pulse and decreasing blood pressure
- B. altered mental status and level of consciousness
- C. dizziness and increasing respiratory rate
- D. Cool, clammy skin, and pale mucous membranes
Correct Answer: A
Rationale: Nurse Adalynn explains to the mothers that early indication for hypovolemia caused by postpartum hemorrhage is an increasing pulse and decreasing blood pressure. Hypovolemia is a condition where there is a decreased volume of circulating blood in the body, often characterized by fluid loss such as through bleeding. As blood volume decreases, the heart rate increases in an attempt to maintain adequate perfusion to organs and tissues. This results in an elevated pulse rate. Additionally, as the blood volume decreases, the blood pressure may drop due to the reduced amount of blood being pumped around the body. Therefore, monitoring for an increasing pulse and decreasing blood pressure is crucial in detecting hypovolemia early, allowing for prompt intervention to prevent further complications.
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A patient presents with acute onset of severe headache, visual disturbances, and vomiting. Imaging reveals a tumor compressing the optic chiasm. Which of the following neurological conditions is most likely responsible for these symptoms?
- A. Meningioma
- B. Glioblastoma multiforme
- C. Pituitary adenoma
- D. Medulloblastoma
Correct Answer: C
Rationale: A pituitary adenoma is a type of benign tumor that arises from the pituitary gland, which is located at the base of the brain. When a pituitary adenoma grows large enough, it can compress surrounding structures, including the optic chiasm – the point at which the optic nerves cross over in the brain. Compression of the optic chiasm can lead to symptoms such as vision problems (e.g., visual disturbances), headaches, and nausea/vomiting, which are consistent with the presentation described in the question. Meningiomas, glioblastoma multiforme, and medulloblastomas are less likely to compress the optic chiasm and present with different characteristic symptoms based on their locations and growth patterns.
Kris is a hospitalized movie star. A nursing assistant takes her picture without permission and sells it to a local newspaper. The nursing assistant could be quilts of:
- A. Invasion of privacy
- B. Defamation
- C. Abuse
- D. Assault and battery
Correct Answer: A
Rationale: This scenario falls under the category of invasion of privacy. Invasion of privacy occurs when a person's private information or images are shared or used without their consent, leading to an intrusion of their private life. In this case, Kris, as a hospitalized movie star, had her picture taken without permission by the nursing assistant, which was later sold to a local newspaper. Kris has a right to privacy, especially during a vulnerable time like being hospitalized, and the nursing assistant violated that right by taking and selling her picture without consent. This action constitutes an invasion of privacy.
Which communication technique should Nurse Cris employ in order to successfully capture the details of the meeting?
- A. Summarizing
- B. Restating
- C. Reassuring
- D. Validating
Correct Answer: A
Rationale: Nurse Cris should employ the communication technique of summarizing to successfully capture the details of the meeting. Summarizing involves condensing the information provided into a concise and organized form, which would help Nurse Cris remember and retain the key points discussed during the meeting. By summarizing the details, Nurse Cris can ensure that no important information is missed and can also confirm understanding by reflecting back the main points discussed. This technique promotes effective communication by enhancing clarity and reinforcing comprehension.
A postpartum client presents with sudden chest pain, dyspnea, and tachycardia. Which nursing action should be prioritized?
- A. Elevating the head of the bed
- B. Providing supplemental oxygen therapy
- C. Administering analgesics for pain relief
- D. Notifying the healthcare provider immediately
Correct Answer: D
Rationale: Sudden chest pain, dyspnea, and tachycardia in a postpartum client can be indicative of serious conditions such as pulmonary embolism or myocardial infarction. These conditions are emergencies that require immediate medical attention. Notifying the healthcare provider immediately is the priority to ensure prompt evaluation and intervention to address the potential life-threatening situation. While other nursing interventions such as elevating the head of the bed, providing supplemental oxygen therapy, and administering analgesics may be necessary, they should be done after notifying the healthcare provider to ensure appropriate management of the underlying cause.
While positioning the patient for surgery, the nurse notices that the patient's arms are not adequately padded. What should the nurse do?
- A. Proceed with the positioning as planned
- B. Document the observation in the patient's chart
- C. Apply soft padding to the patient's arms to prevent pressure injuries
- D. Inform the surgeon about the inadequate padding
Correct Answer: C
Rationale: If the nurse notices that the patient's arms are not adequately padded while positioning for surgery, the nurse should immediately take action to prevent pressure injuries. Applying soft padding to the patient's arms will help distribute the pressure more evenly, reducing the risk of skin breakdown and potential harm to the patient during the surgical procedure. It is essential to prioritize the patient's safety and comfort in such situations. Simply proceeding with the positioning as planned could lead to complications, so addressing the inadequate padding promptly is the appropriate course of action.