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A postpartum client who experienced a traumatic birth expresses concerns about breastfeeding difficulties and emotional distress. What nursing intervention should be prioritized to address the client's concerns?
- A. Providing emotional support and empathy for the client's experience
- B. Recommending cessation of breastfeeding to alleviate stress
- C. Encouraging the client to avoid discussing the birth experience
- D. Referring the client to a mental health professional for counseling
Correct Answer: A
Rationale: Providing emotional support and empathy for the client's experience should be prioritized to address concerns of a postpartum client who experienced a traumatic birth. Emotional support can help the client feel validated and heard, which can be instrumental in starting the healing process. By acknowledging the client's emotions and experiences, the nurse can establish trust and create a safe space for the client to express their feelings. This can also help in building a therapeutic relationship that can positively impact the client's emotional well-being. Providing a supportive environment is essential for addressing breastfeeding difficulties and emotional distress in this situation.
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A patient presents with sudden-onset, severe eye pain, headache, nausea, and vomiting. On examination, the affected eye appears red, with a steamy cornea and mid-dilated, non-reactive pupil. Which of the following conditions is most likely responsible for this presentation?
- A. Acute angle-closure glaucoma
- B. Central retinal artery occlusion
- C. Optic neuritis
- D. Corneal ulcer
Correct Answer: A
Rationale: The presentation described is characteristic of acute angle-closure glaucoma. This condition typically presents with sudden-onset severe eye pain, headache, nausea, and vomiting. On examination, the affected eye may appear red due to conjunctival injection, and there may be a steamy cornea due to corneal edema. The mid-dilated, non-reactive pupil is a key finding in angle-closure glaucoma, as the iris bombe (forward movement of the peripheral iris) blocks the drainage angle, leading to increased intraocular pressure. If left untreated, acute angle-closure glaucoma can result in irreversible vision loss. Immediate intervention is crucial to lower the intraocular pressure and prevent further damage to the optic nerve. Prompt referral to an ophthalmologist for definitive treatment is necessary in cases of suspected acute angle-closure glaucoma.
After washing her hands and gently cleaning any discharge that can be removed easily from the outer ear, Nurse Selma positions the child. Which of the following steps follows?
- A. Gently press the tragus of the ear four times in a pumping motion.
- B. Gently pull the outer ear
- C. Drop the medicine into the ear canal.
- D. Keep the ear up for five minutes.
Correct Answer: C
Rationale: The correct next step after positioning the child is to drop the medicine into the ear canal. This is typically the next step in administering ear drops for a child. The cleaning and positioning steps are to prepare the ear for receiving the medication. Dropping the medicine into the ear canal ensures that the medication can reach the affected area effectively. Once the medicine is dropped into the ear canal, it is important to follow any additional instructions provided by the healthcare provider regarding keeping the ear in a certain position or any other post-administration care steps.
A nurse is caring for a patient with a history of substance abuse who requests pain medication. What ethical principle should guide the nurse's decision-making in this situation?
- A. Beneficence
- B. Nonmaleficence
- C. Justice
- D. Veracity
Correct Answer: A
Rationale: The ethical principle that should guide the nurse's decision-making in this situation is beneficence, which emphasizes the nurse's obligation to act in the best interest of the patient. In this scenario, the nurse must balance the patient's request for pain medication with considerations related to the patient's history of substance abuse. The nurse should prioritize providing effective pain relief for the patient while also considering the potential risks of administering medication to someone with a history of substance abuse. By focusing on beneficence, the nurse can make decisions that promote the well-being and best interests of the patient, taking into account both the immediate need for pain relief and the patient's history of substance abuse.
A patient is prescribed a proton pump inhibitor (PPI) for the treatment of gastroesophageal reflux disease (GERD). Which instruction should the nurse include in patient education about PPI therapy?
- A. "Take the medication with antacids for enhanced effectiveness."
- B. "Avoid consuming citrus fruits while on PPI therapy."
- C. "Take the medication 30 minutes before meals."
- D. "Report any signs of gastrointestinal bleeding promptly."
Correct Answer: C
Rationale: Patients prescribed proton pump inhibitors (PPIs) for gastroesophageal reflux disease (GERD) should be instructed to take the medication 30 minutes before meals. This is because PPIs work best when taken on an empty stomach, allowing them to inhibit the gastric proton pump effectively and reduce acid production in anticipation of food intake. Taking the medication before meals ensures optimal absorption and effectiveness in controlling symptoms of GERD.
Which type of plan should the nurse employ to assess the strengths and weaknesses of the organization?
- A. Nursing care
- B. Strategic
- C. Operational
- D. Program
Correct Answer: B
Rationale: To assess the strengths and weaknesses of the organization, the nurse should employ a strategic plan. A strategic plan involves setting overall goals, objectives, and strategies for the organization. It provides a comprehensive framework for evaluating the current state of the organization, identifying areas of improvement, and aligning resources to achieve long-term success. By using a strategic plan, the nurse can conduct a thorough analysis of the organization's internal and external factors, including its strengths and weaknesses, to determine the most effective course of action for the future.