Nokea
Nurse Gay is assigned in the Medical Unit. She is guided that in documentation, she should use abbreviation that is ______.
- A. used automatically to save precious time.
- B. reduced to the minimum in all units.
- C. approved standard list by the hospital.
- D. not used at all because it can be misinterpreted.
Correct Answer: C
Rationale: Nurse Gay should use abbreviations that are part of an approved standard list by the hospital. Using standardized abbreviations ensures clarity, accuracy, and consistency in documentation. It helps in preventing misinterpretation, errors, and ambiguity in patient records. By following an approved list of abbreviations, healthcare professionals can communicate effectively and efficiently while maintaining patient safety and quality of care.
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A nurse involves well-being in her definition of health. What will the primary concern or focus of the nurse when she provides care to a family confronting the imminent death of a family member?
- A. Reinforcing the need for the whole family to adapt to the impending death.
- B. Sharing the nurse's knowledge on the client's symptoms of grief
- C. Discussing the perceived meaning of life with the family
- D. Administering pain medication so that the client can be kept comfortable
Correct Answer: A
Rationale: When a nurse involves well-being in her definition of health, it indicates a holistic approach that considers not only physical health but also emotional, mental, and social aspects of well-being. In the context of a family confronting the imminent death of a family member, the primary concern of the nurse would be to focus on reinforcing the need for the whole family to adapt to the impending death. This involves providing emotional support, facilitating communication, addressing coping mechanisms, and assisting the family in coming to terms with the situation. By emphasizing the importance of the whole family adapting to the imminent death, the nurse can help promote holistic well-being for the family during this challenging time.
Which of the following clinical manifestations will NOT be a complaint from Sarah's condition?
- A. Edema of the extremities
- B. Poor wound healing
- C. Decrease libido
- D. Absence of growth in the pubic area
Correct Answer: C
Rationale: Sarah's condition seems to be related to growth and wound healing issues, based on the provided clinical manifestations. Decrease libido is typically unrelated to conditions like edema, poor wound healing, and absence of growth in the pubic area. Therefore, it would not be a complaint stemming from Sarah's condition.
A patient with a chronic viral infection demonstrates persistently elevated levels of CD8+ cytotoxic T cells in their blood. Which of the following mechanisms is most likely responsible for this observation?
- A. Activation-induced cell death (AICD)
- B. T cell exhaustion
- C. Thymic involution
- D. Antigenic variation
Correct Answer: B
Rationale: T cell exhaustion is a state of T cell dysfunction that arises during chronic viral infections or cancer. In the case of a chronic viral infection, the persistent exposure to viral antigens leads to continuous stimulation of CD8+ cytotoxic T cells. Over time, this sustained stimulation can lead to T cell exhaustion, characterized by the upregulation of inhibitory receptors, impaired effector functions, and reduced proliferative capacity. As a result, despite the elevated levels of CD8+ T cells in the blood, their function may be compromised, ultimately impacting the immune response against the viral infection. In contrast, activation-induced cell death (AICD) may contribute to T cell loss during chronic infections but would not explain the persistently elevated CD8+ T cell levels. Thymic involution refers to the age-related decline in thymus function, which is not directly related to the observed increase in CD8+ T cells. Antigenic
A woman in active labor is diagnosed with postpartum hemorrhage (PPH) due to uterine atony. What is the priority nursing intervention?
- A. Massage the uterus to promote contraction.
- B. Prepare for immediate blood transfusion.
- C. Administer intravenous antibiotics.
- D. Elevate the mother's legs to promote venous return.
Correct Answer: A
Rationale: The priority nursing intervention for a woman in active labor diagnosed with postpartum hemorrhage (PPH) due to uterine atony is to massage the uterus to promote contraction. Uterine massage helps to stimulate uterine muscle tone and contraction, which can help control bleeding by reducing the size of blood vessels and promoting hemostasis. It is important to address the uterine atony promptly to prevent further blood loss and stabilize the patient's condition. Other interventions such as blood transfusion, administering antibiotics, and elevating the mother's legs can be considered based on the patient's response to the initial intervention of uterine massage.
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.