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The nurse is caring for a patient who has terminal lung cancer and is unconscious. Which assessment finding would most clearly indicate to the nurse that the patients death is imminent?
- A. Mottling of the lower limbs
- B. Slow, steady pulse
- C. Bowel incontinence
- D. Increased swallowing
Correct Answer: A
Rationale: Mottling of the lower limbs is a common physical sign seen in patients approaching death. This occurs when there is poor circulation leading to a bluish or purplish discoloration of the skin, particularly on the extremities. The appearance of mottling indicates that the body is no longer able to maintain adequate blood flow to the extremities, signaling that the patient is in the final stages of life. It is a significant finding that strongly suggests imminent death in patients with terminal illness, such as in this case of a patient with terminal lung cancer who is unconscious.
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A female patient tells the nurse that she thinks she has a vaginal infection because she has noted inflammation of her vulva and the presence of a frothy, yellow-green discharge. The nurse recognizes that the clinical manifestations described are typical of what vaginal infection?
- A. Trichomonas vaginalis
- B. Candidiasis
- C. Gardnerella
- D. Gonorrhea
Correct Answer: A
Rationale: The clinical manifestations of inflammation of the vulva and the presence of frothy, yellow-green discharge are indicative of a vaginal infection caused by Trichomonas vaginalis. Trichomoniasis is a sexually transmitted infection caused by a protozoan parasite. It commonly presents with symptoms such as frothy, yellow-green vaginal discharge, vaginal itching, inflammation of the vulva, and sometimes a foul odor. Testing for Trichomonas vaginalis can be done through microscopic examination of the vaginal discharge or through nucleic acid amplification tests. Treatment usually involves the use of antibiotics such as metronidazole or tinidazole. It is important to promptly diagnose and treat trichomoniasis to prevent complications and further transmission.
A nurse is providing care to a group of patients.Which situation will require the nurse to obtain a telephone order?
- A. As the nurse and health care provider leave a patient’s room, the primary care provider gives the nurse an order.
- B. At 0100, a patient’s blood pressure drops from 120/80 to 90/50, and the incision dressing is saturated with blood.
- C. At 0800, the nurse and health care provider make rounds, and the primary care provider tells the nurse a diet order.
- D. A nurse reads an order correctly as written by the health care provider in the patient’s medical record
Correct Answer: B
Rationale: In this situation, the nurse needs to obtain a telephone order because the patient's condition has changed significantly. The drop in blood pressure from 120/80 to 90/50 along with the saturated incision dressing indicates a potential complication or need for immediate intervention. The nurse must act quickly to address the situation and may require additional orders from the primary care provider over the phone to manage the patient's condition effectively. The urgency and critical nature of the situation necessitate obtaining a telephone order promptly to ensure the best outcome for the patient.
The patient hasH. pylori. Which action shouldthe nurse take?
- A. Encourage avoidance of wheat and oats.
- B. Encourage milkshakes as a nutritious snack.
- C. Encourage completion of antibiotic therapy.
- D. Encourage nonsteroidal antiinflammatory drugs.
Correct Answer: C
Rationale: The most appropriate action for a patient with H. pylori is to encourage completion of antibiotic therapy. H. pylori is a bacterium that causes peptic ulcers, and treatment involves a combination of antibiotics to eradicate the infection. Antibiotic therapy is crucial in eliminating the bacteria and preventing complications such as recurrent ulcers or stomach cancer. Therefore, the nurse should prioritize ensuring that the patient completes the prescribed course of antibiotics to effectively treat the H. pylori infection.
An oncology patient will begin a course of chemotherapy and radiation therapy for the treatment of bone metastases. What is one means by which malignant disease processes transfer cells from one place to another?
- A. Adhering to primary tumor cells
- B. Inducing mutation of cells of another organ
- C. Phagocytizing healthy cells
- D. Invading healthy host tissues
Correct Answer: D
Rationale: Malignant disease processes transfer cells from one place to another primarily through the invasion of healthy host tissues. Cancer cells have the ability to break away from the primary tumor site and invade nearby healthy tissues. Once invasive cancer cells find their way into blood vessels or lymphatics, they can be carried to distant sites in the body where they can form new tumors, establish metastases, and spread the disease. This invasive property of cancer cells underlies the ability of cancer to spread throughout the body, a process known as metastasis. Commanding the cells to appear to adhere to primary tumor cells, inducing mutation of cells of another organ, or phagocytizing healthy cells are not mechanisms by which malignant disease processes transfer cells from one place to another.
The public health nurse is presenting a health-promotion class to a group at a local community center. Which intervention most directly addresses the leading cause of cancer deaths in North America?
- A. Monthly self-breast exams
- B. Smoking cessation
- C. Annual colonoscopies
- D. Monthly testicular exams
Correct Answer: B
Rationale: Smoking cessation most directly addresses the leading cause of cancer deaths in North America, which is lung cancer. Tobacco use, particularly cigarette smoking, is the primary cause of lung cancer. By helping individuals quit smoking, the public health nurse is targeting the main risk factor for lung cancer and therefore addressing the root cause of the issue. This intervention has the potential to have a significant impact on reducing cancer-related deaths in the community. Monthly self-breast exams, annual colonoscopies, and monthly testicular exams are important for detecting breast, colon, and testicular cancers respectively, but they do not directly address the leading cause of cancer deaths in North America.