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The nurse is caring for a patient with a diagnosis of vulvar cancer who has returned from the PACU after undergoing a wide excision of the vulva. How should this patients analgesic regimen be best managed?
- A. Analgesia should be withheld unless the patients pain becomes unbearable.
- B. Scheduled analgesia should be administered around-the-clock to prevent pain.
- C. All analgesics should be given on a PRN, rather than scheduled, basis.
- D. Opioid analgesics should be avoided and NSAIDs exclusively provided.
Correct Answer: B
Rationale: The correct answer is B: Scheduled analgesia should be administered around-the-clock to prevent pain. After undergoing a wide excision of the vulva, the patient is likely to experience significant pain. Scheduled analgesia ensures that the patient receives pain relief consistently, preventing pain from becoming severe. This approach helps to maintain a therapeutic level of pain control and improves patient comfort and satisfaction.
Choice A is incorrect because withholding analgesia until the pain becomes unbearable can lead to unnecessary suffering and poor pain management. Choice C is incorrect as PRN dosing may result in inadequate pain relief and fluctuations in pain control. Choice D is incorrect as opioids are often necessary for postoperative pain management, and NSAIDs alone may not provide sufficient relief for the level of pain associated with a wide excision surgery.
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The nurse on the medicalsurgical unit is reviewing discharge instructions with a patient who has a history of glaucoma. The nurse should anticipate the use of what medications?
- A. Potassium-sparing diuretics
- B. Cholinergics
- C. Antibiotics
- D. Loop diuretics
Correct Answer: B
Rationale: The correct answer is B: Cholinergics. Glaucoma is a condition characterized by increased intraocular pressure due to impaired drainage of aqueous humor. Cholinergics help to constrict the pupil and improve the outflow of aqueous humor, thus reducing intraocular pressure. This medication class is commonly used to manage glaucoma.
A: Potassium-sparing diuretics are not typically used in the treatment of glaucoma. They are mainly used to manage conditions like hypertension and heart failure.
C: Antibiotics are not indicated for the routine management of glaucoma. They are used to treat infections.
D: Loop diuretics are not commonly used in the treatment of glaucoma. They are primarily used to manage conditions like edema and hypertension.
The nurse is reviewing the instructions given to a patient at 24 weeks’ gestation for a glucose challenge test (GCT). The nurse determines that the patient understands the teaching when she makes which statement?
- A. “I have to fast the night before the test.”
- B. “I will drink a sugary solution containing 100 g of glucose.”
- C. “I will have blood drawn at 1 hour after I drink the glucose solution.”
- D. “I should keep track of my baby’s movements between now and the test.”
Correct Answer: C
Rationale: The correct answer is C: “I will have blood drawn at 1 hour after I drink the glucose solution.” This statement demonstrates understanding of the GCT procedure. The glucose challenge test involves drinking a sugary solution, followed by blood drawn 1 hour later to measure blood glucose levels. This timing is crucial for assessing the body's ability to metabolize glucose, which helps in diagnosing gestational diabetes.
Explanation of why the other choices are incorrect:
A: “I have to fast the night before the test.” - This is incorrect as fasting is not required for the GCT.
B: “I will drink a sugary solution containing 100 g of glucose.” - This is incorrect as the GCT typically involves drinking a solution with a standardized amount of glucose, usually 50 g, not 100 g.
D: “I should keep track of my baby’s movements between now and the test.” - This is unrelated to the GCT procedure and does not demonstrate understanding of the
A 62-year-old woman diagnosed with breast cancer is scheduled for a partial mastectomy. The oncology nurse explained that the surgeon will want to take tissue samples to ensure the disease has not spread to adjacent axillary lymph nodes. The patient has asked if she will have her lymph nodes dissected, like her mother did several years ago. What alternative to lymph node dissection will this patient most likely undergo?
- A. Lymphadenectomy
- B. Needle biopsy
- C. Open biopsy
- D. Sentinel node biopsy
Correct Answer: D
Rationale: The correct answer is D: Sentinel node biopsy. This procedure involves identifying and removing the sentinel lymph node(s) which is the first lymph node(s) that cancer cells are likely to spread to from the primary tumor. This method helps determine if cancer has spread beyond the primary site without the need for a full axillary lymph node dissection. It is less invasive, has fewer side effects, and provides accurate staging information. Lymphadenectomy (A) refers to the removal of multiple lymph nodes, which is more extensive than necessary in this case. Needle biopsy (B) and open biopsy (C) are not specific to lymph node evaluation and do not provide accurate staging information for breast cancer.
A patient requests the nurse’s help to the bedside commode and becomes frustrated when unable to void in front of the nurse. How should the nurse interpret the patient’s inability to void?
- A. The patient can be anxious, making it difficult for abdominal and perineal muscles to relax enough to void.
- B. The patient does not recognize the physiological signals that indicate a need to void.
- C. The patient is lonely, and calling the nurse in under false pretenses is a way to get attention.
- D. The patient is not drinking enough fluids to produce adequate urine output.
Correct Answer: A
Rationale: The correct answer is A: The patient can be anxious, making it difficult for abdominal and perineal muscles to relax enough to void.
Rationale: Anxiety can lead to tension in the abdominal and perineal muscles, inhibiting the ability to relax and urinate. The sympathetic nervous system response to anxiety can cause urinary retention. So, the patient's frustration in voiding in front of the nurse may be due to anxiety hindering muscle relaxation.
Summary of other choices:
B: The patient not recognizing physiological signals is less likely as the patient requested assistance to void, indicating awareness of the need to urinate.
C: The patient being lonely and seeking attention is not relevant to the inability to void in front of the nurse.
D: Inadequate fluid intake may contribute to decreased urine output but is not directly related to the inability to void in front of the nurse.
A patient at high risk for breast cancer is scheduled for an incisional biopsy in the outpatient surgery department. When the nurse is providing preoperative education, the patient asks why an incisional biopsy is being done instead of just removing the mass. What would be the nurses best response?
- A. An incisional biopsy is performed because its known to be less painful and more accurate than other forms of testing.
- B. An incisional biopsy is performed to confirm a diagnosis and so that special studies can be done that will help determine the best treatment.
- C. An incisional biopsy is performed to assess the potential for recovery from a mastectomy.
- D. An incisional biopsy is performed on patients who are younger than the age of 40 and who are otherwise healthy.
Correct Answer: B
Rationale: The correct answer is B because an incisional biopsy is typically performed to confirm a diagnosis by obtaining a sample of the tissue in question. This allows for further analysis through special studies to determine the best course of treatment. The other choices are incorrect because:
A: The reason for performing an incisional biopsy is not primarily based on pain or accuracy comparisons with other testing methods.
C: An incisional biopsy is not done to assess potential recovery from a mastectomy but rather to diagnose the nature of the mass.
D: Age and general health status are not sole criteria for determining the need for an incisional biopsy.