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Nurse Ime, is a member of the Quality Assurance team of the hospital and has been always rated as very assertive. Which of the following is NOT a characteristic of an assertive person?
- A. Intervene with the situation calmly and confidently.
- B. She stands up with what she believes & push control on others.
- C. Articulate clearly the importance of nursing perspective.
- D. Use "I" when stating thought and feelings & "YOU" when persuading others.
Correct Answer: B
Rationale: Being assertive means expressing one's thoughts, beliefs, and feelings in a confident and respectful manner while also considering the perspective of others. It does not involve pushing control on others. Assertive individuals do not impose their beliefs on others but express themselves clearly and confidently, respecting the opinions of others. So, standing up for what one believes in can be assertive, but pushing control on others is not a characteristic of assertiveness.
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A patient presents with multiple, discrete, flesh-colored papules with central umbilication on the trunk and extremities. The lesions are asymptomatic and have been present for several months. Which of the following conditions is most likely responsible for this presentation?
- A. Molluscum contagiosum
- B. Basal cell carcinoma
- C. Sebaceous hyperplasia
- D. Dermatofibroma
Correct Answer: A
Rationale: Molluscum contagiosum is a viral skin infection caused by the poxvirus. It typically presents as multiple, flesh-colored, dome-shaped papules with a central umbilication (dimple or depression in the center) on the skin. These lesions are often found on the trunk and extremities and can persist for several months. Molluscum contagiosum is commonly seen in children but can also occur in adults, especially those with weakened immune systems. The lesions are usually asymptomatic but can become inflamed or itchy in some cases. Treatment options include observation, topical therapies, cryotherapy, or curettage.
A patient in the ICU develops acute myocardial infarction (MI) with cardiogenic shock. What intervention should the healthcare team prioritize to manage the patient's shock?
- A. Perform emergent percutaneous coronary intervention (PCI).
- B. Administer inotropic medications to improve cardiac contractility.
- C. Initiate therapeutic hypothermia to reduce myocardial oxygen demand.
- D. Recommend anticoagulant therapy to prevent thromboembolism.
Correct Answer: A
Rationale: In a patient with acute myocardial infarction (MI) complicated by cardiogenic shock, the primary intervention to manage shock is emergent percutaneous coronary intervention (PCI). PCI is a procedure performed to restore blood flow in an occluded coronary artery that is causing the MI. By opening up the blocked artery and restoring blood flow to the heart muscle, PCI can help reduce myocardial damage, improve cardiac function, and stabilize the patient's condition. Prompt reperfusion via PCI is crucial in the setting of cardiogenic shock to improve survival outcomes and reduce the risk of further complications. Administering inotropic medications, initiating therapeutic hypothermia, or recommending anticoagulant therapy may be components of management in specific cases but are not the primary intervention for managing shock in a patient with acute MI and cardiogenic shock.
A patient presents with gradual, painless visual field loss in both eyes, particularly in the peripheral vision. Tonometry reveals elevated intraocular pressure (IOP). Which of the following conditions is most likely responsible for this presentation?
- A. Open-angle glaucoma
- B. Closed-angle glaucoma
- C. Age-related macular degeneration
- D. Diabetic retinopathy
Correct Answer: A
Rationale: The patient presents with gradual, painless visual field loss in both eyes, particularly in the peripheral vision, which is characteristic of glaucoma. The elevated intraocular pressure (IOP) on tonometry further supports a diagnosis of glaucoma. Open-angle glaucoma is the most common type of glaucoma and typically presents insidiously with a slow progression of vision loss. In open-angle glaucoma, the drainage angle of the eye remains open but becomes less efficient over time, leading to increased intraocular pressure and optic nerve damage. This results in peripheral visual field loss. Closed-angle glaucoma, on the other hand, presents more acutely with sudden eye pain, redness, and blurred vision due to a sudden increase in intraocular pressure from a blocked drainage angle. Age-related macular degeneration and diabetic retinopathy typically do not present with elevated IOP or peripheral visual field loss.
A patient with a displaced femoral neck fracture is scheduled for surgical intervention. Which surgical procedure is most appropriate for this type of fracture?
- A. Closed reduction and internal fixation (CRIF)
- B. Open reduction and internal fixation (ORIF)
- C. Closed reduction and external fixation (CREF)
- D. Closed reduction alone
Correct Answer: B
Rationale: For a displaced femoral neck fracture, the most appropriate surgical procedure is usually an open reduction and internal fixation (ORIF). This procedure involves making an incision to reposition the fractured bone fragments and securing them in place with screws or other fixation devices. ORIF allows for better alignment of the fracture, which is crucial for proper healing and minimizing the risk of complications like avascular necrosis or nonunion. Closed reduction and internal fixation (CRIF) may not be as effective for displaced femoral neck fractures due to the complex nature of the fracture and the need for precise realignment and stability provided by an open surgical approach. External fixation is less commonly used for femoral neck fractures and is typically reserved for certain specific cases where internal fixation is not feasible. Closed reduction alone is unlikely to provide adequate stability for a displaced femoral neck fracture and is generally not recommended as the primary surgical treatment for this type of injury.
A patient admitted to the ICU develops acute myocardial infarction (MI) with ST-segment elevation on electrocardiogram (ECG). What intervention should the healthcare team prioritize to manage the patient's MI?
- A. Perform emergent coronary angiography for revascularization.
- B. Administer fibrinolytic therapy to restore coronary blood flow.
- C. Implement strict bed rest to minimize cardiac workload.
- D. Recommend beta-blocker medications to reduce myocardial oxygen demand.
Correct Answer: A
Rationale: In a patient with acute myocardial infarction (MI) presenting with ST-segment elevation on ECG, the healthcare team should prioritize performing emergent coronary angiography for revascularization. This intervention, also known as primary percutaneous coronary intervention (PCI), involves opening up the blocked coronary artery responsible for the MI. Timely reperfusion of the affected artery is crucial in reducing myocardial damage and improving outcomes in acute MI patients. PCI is considered the preferred method for revascularization in patients with ST-segment elevation MI, as it has been shown to be more effective and associated with better outcomes compared to fibrinolytic therapy.