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The nurse has taken shift report on her patients and has been told that one patient has an ocular condition that has primarily affected the rods in his eyes. Considering this information, what should the nurse do while caring for the patient?
- A. Ensure adequate lighting in the patients room.
- B. Provide a dimly lit room to aid vision by limiting contrast.
- C. Carefully point out color differences for the patient.
- D. Carefully point out fine details for the patient.
Correct Answer: A
Rationale: Rationale: The correct answer is A because rods are responsible for vision in low light conditions. By ensuring adequate lighting in the patient's room, the nurse can optimize the patient's visual acuity. This will help the patient navigate their environment more safely.
Summary:
- B is incorrect because dim lighting would further limit the patient's already compromised vision.
- C is incorrect as the patient's ability to perceive color may not be affected by rod dysfunction.
- D is incorrect as the patient may struggle to see fine details due to rod impairment.
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The nurse is providing home care for a patient diagnosed with acquired immunodeficiency syndrome (AIDS). Which dietary intervention will the nurse add to the care plan?
- A. Provide small, frequent nutrient-dense meals for maximizing kilocalories.
- B. Prepare hot meals because they are more easily tolerated by the patient.
- C. Avoid salty foods and limit liquids to preserve electrolytes.
- D. Encourage intake of fatty foods to increase caloric intake.
Correct Answer: A
Rationale: The correct answer is A because providing small, frequent nutrient-dense meals helps maximize kilocalories, which is important for patients with AIDS who may have difficulty maintaining weight due to their compromised immune system. This approach ensures the patient receives essential nutrients and energy to support their immune function.
Choice B is incorrect as there is no evidence to suggest that hot meals are more easily tolerated by AIDS patients.
Choice C is incorrect because limiting liquids can lead to dehydration, which is especially detrimental for individuals with weakened immune systems.
Choice D is incorrect as encouraging the intake of fatty foods may not necessarily provide the necessary nutrients and energy required for immune support in AIDS patients.
A nurse is teaching the staff about health carereimbursement. Which information should the nurse include in the teaching session?
- A. Home health, long-term care, and hospital nurses’ documentation can affect reimbursement for health care.
- B. A clinical information system must be installed by 2014 to obtain health care reimbursement.
- C. A “near miss” helps determine reimbursement issues for health care.
- D. HIPAA is the basis for establishing reimbursement for health care.
Correct Answer: A
Rationale: The correct answer is A because documentation by nurses in various settings like home health, long-term care, and hospitals impacts reimbursement. Proper documentation ensures services provided are accurately reflected, influencing reimbursement. Choice B is incorrect as it refers to Meaningful Use requirements for EHRs, not reimbursement. Choice C is incorrect as a "near miss" relates to patient safety, not reimbursement. Choice D is incorrect because HIPAA focuses on privacy and security of patient information, not reimbursement.
A 23-year-old woman comes to the free clinic stating I think I have a lump in my breast. Do I have cancer? The nurse instructs the patient that a diagnosis of breast cancer is confirmed by what?
- A. Supervised breast self-examination
- B. Mammography
- C. Fine-needle aspiration
- D. Chest x-ray
Correct Answer: B
Rationale: The correct answer is B: Mammography. Mammography is the gold standard for diagnosing breast cancer as it can detect abnormalities such as lumps or tumors in the breast tissue. It provides detailed images that can help healthcare providers identify suspicious areas that may require further testing or biopsy. Supervised breast self-examination (choice A) is important for early detection but is not a diagnostic tool. Fine-needle aspiration (choice C) is a procedure used to obtain a sample of cells for further analysis but is not definitive for diagnosing breast cancer. Chest x-ray (choice D) is used to evaluate the lungs and heart, not the breast tissue for cancer.
An advanced practice nurse has performed a Rinne test on a new patient. During the test, the patient reports that air-conducted sound is louder than bone-conducted sound. How should the nurse best interpret this assessment finding?
- A. The patients hearing is likely normal.
- B. The patient is at risk for tinnitus.
- C. The patient likely has otosclerosis.
- D. The patient likely has sensorineural hearing loss. Chapter 69: Select Neuro Topics: Trigeminal Neuralgia & Bell’s Palsy
Correct Answer: A
Rationale: The correct answer is A: The patient's hearing is likely normal. This interpretation is based on the normal Rinne test result, where air-conducted sound is expected to be louder than bone-conducted sound. This finding indicates that the patient has intact air conduction and no significant conductive hearing loss. Option B is incorrect because tinnitus is not directly related to the Rinne test results. Option C is incorrect as otosclerosis would typically present with abnormal Rinne test results showing bone-conducted sound to be louder. Option D is incorrect as sensorineural hearing loss would not typically affect the Rinne test results in this way.
A 76-year-old with a diagnosis of penile cancer has been admitted to the medical floor. Because the incidence of penile cancer is so low, the staff educator has been asked to teach about penile cancer. What risk factors should the educator cite in this presentation? Select all that apply.
- A. Phimosis
- B. Priapism
- C. Herpes simplex infection
- D. Increasing age E) Lack of circumcision
Correct Answer: A
Rationale: The correct answer is A: Phimosis. Phimosis, the inability to retract the foreskin over the glans penis, is a significant risk factor for penile cancer. Phimosis can lead to poor hygiene, inflammation, and chronic irritation, increasing the risk of cancer development. The other choices (B: Priapism, C: Herpes simplex infection, D: Increasing age, E: Lack of circumcision) are not directly linked to penile cancer development. Priapism is prolonged and painful erection unrelated to penile cancer. Herpes simplex infection is a viral infection and not a primary risk factor for penile cancer. Increasing age is a general risk factor for many cancers, but it is not specific to penile cancer. Lack of circumcision has been associated with a slightly higher risk of penile cancer, but it is not as significant as phimosis.