Nokea
The nurse is providing discharge education for a patient with a new diagnosis of Mnires disease. What food should the patient be instructed to limit or avoid?
- A. Sweet pickles
- B. Frozen yogurt
- C. Shellfish
- D. Red meat
Correct Answer: C
Rationale: Patients with Meniere's disease are often advised to limit their intake of salt as excess salt can worsen symptoms such as dizziness and vertigo. Shellfish tend to be high in sodium, so patients with Meniere's disease should be instructed to avoid or limit their consumption of shellfish to help manage their condition. It is important for the nurse to provide comprehensive diet education to the patient to help them minimize symptoms and improve their overall quality of life.
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The nurse is caring for a 52-year-old woman whose aunt and mother died of breast cancer. The patient states, My doctor and I talked about Tamoxifen to help prevent breast cancer. Do you think it will work? What would be the nurses best response?
- A. Yes, its known to have a slight protective effect.
- B. Yes, but studies also show an increased risk of osteoporosis.
- C. You wont need to worry about getting cancer as long as you take Tamoxifen.
- D. Tamoxifen is known to be a highly effective protective measure.
Correct Answer: A
Rationale: The nurse's best response should be to provide accurate information and manage the patient's expectations realistically. Tamoxifen is known to have a slight protective effect in reducing the risk of developing breast cancer in high-risk individuals like the patient in the scenario. However, it is not a guarantee against developing breast cancer. It is essential for the nurse to convey this information to the patient to ensure that she understands the benefits and limitations of Tamoxifen therapy. Additionally, discussing potential side effects and risks associated with Tamoxifen, such as an increased risk of osteoporosis, is important for the patient to make an informed decision about her health care.
A small-bore feeding tube is placed. Which technique will the nurse use tobestverify tube placement?
- A. X-ray
- B. pH testing
- C. Auscultation
- D. Aspiration of contents
Correct Answer: A
Rationale: At present, the most reliable method for verification of placement of small-bore feeding tubes is x-ray examination. X-ray allows for direct visualization of the tube's placement within the gastrointestinal tract, ensuring it is correctly positioned in the stomach without any risk of inadvertent placement in the lungs, pharynx, or esophagus. This method provides a definitive confirmation of tube placement, which is crucial for patient safety during enteral feeding. While pH testing and aspiration of contents can be useful as supplementary methods, x-ray remains the gold standard for verifying tube placement due to its precision and accuracy. Auscultation, on the other hand, is no longer recommended as a reliable method for tube placement verification, as it may lead to misinterpretation of sounds and potential errors in placement assessment.
The nurse in the ED is caring for a 4 year-old brought in by his parents who state that the child will not stop crying and pulling at his ear. Based on information collected by the nurse, which of the following statements applies to a diagnosis of external otitis?
- A. External otitis is characterized by aural tenderness.
- B. External otitis is usually accompanied by a high fever.
- C. External otitis is usually related to an upper respiratory infection.
- D. External otitis can be prevented by using cotton-tipped applicators to clean the ear.
Correct Answer: A
Rationale: External otitis, also known as swimmer's ear, is an infection of the outer ear canal. It is often characterized by aural tenderness, which means that the ear is sensitive to touch and can be painful, especially when pressure is applied to the area. This tenderness is a hallmark symptom of external otitis and helps differentiate it from other ear conditions. Other common symptoms of external otitis include ear pain, itchiness, redness, and swelling of the ear canal. External otitis is usually not accompanied by a high fever, and it is not typically related to an upper respiratory infection. Using cotton-tipped applicators to clean the ear can actually increase the risk of developing external otitis by disrupting the natural protective barrier of the ear canal.
A nurse is teaching a patient about the largeintestine in elimination. In which order will the nurse list the structures, starting with the first portion?
- A. Cecum, ascending, transverse, descending, sigmoid, and rectum
- B. Ascending, transverse, descending, sigmoid, rectum, and cecum
- C. Cecum, sigmoid, ascending, transverse, descending, and rectum
- D. Ascending, transverse, descending, rectum, sigmoid, and cecum
Correct Answer: A
Rationale: The order in which the structures of the large intestine are listed starting with the first portion is as follows: cecum (the pouch where the large intestine begins), ascending colon (runs vertically up the right side of the abdomen), transverse colon (crosses horizontally from the right side of the abdomen to the left), descending colon (descends vertically down the left side of the abdomen), sigmoid colon (the S-shaped curve that leads into the rectum), and rectum (the final portion where feces are stored before being eliminated from the body). Therefore, option A provides the correct order of structures in the large intestine during elimination.
A middle-aged female patient has been offered testing for HIV/AIDS upon admission to the hospital for an unrelated health problem. The nurse observes that the patient is visibly surprised and embarrassed by this offer. How should the nurse best respond?
- A. Most women with HIV dont know they have the disease. If you have it, its important we catch it early.
- B. This testing is offered to every adolescent and adult regardless of their lifestyle, appearance or history.
- C. The rationale for this testing is so that you can begin treatment as soon as testing comes back, if its positive.
- D. Youre being offered this testing because you are actually in the prime demographic for HIV infection.
Correct Answer: B
Rationale: Option B is the best response for the nurse to provide in this situation. By stating that the testing is offered to every adolescent and adult regardless of lifestyle, appearance, or history, the nurse conveys that HIV testing is a standard practice and not targeting the patient specifically. This can help reduce the patient's feeling of embarrassment or stigma associated with the offer of testing. It also emphasizes the importance of universal screening for HIV to promote early detection and treatment, regardless of risk factors or demographics. This response helps maintain the patient's dignity and encourages them to consider the testing in a non-judgmental way.