Nokea
A patient with a history of chronic kidney disease is prescribed a low-phosphorus diet. Which dietary choice indicates understanding of the prescribed diet?
- A. Grilled chicken breast
- B. Cheese omelet
- C. Whole wheat toast with peanut butter
- D. Spinach salad with almonds
Correct Answer: A
Rationale: Grilled chicken breast is a suitable choice for a low-phosphorus diet because poultry is typically lower in phosphorus compared to dairy products (like cheese), nuts (like almonds), and whole grains (like wheat toast). This option indicates an understanding of the need to restrict phosphorus intake, which is important for individuals with chronic kidney disease to prevent complications.
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A patient in the ICU develops acute gastrointestinal bleeding (GIB) requiring urgent intervention. What intervention should the healthcare team prioritize to manage the patient's bleeding?
- A. Perform endoscopic hemostasis with mechanical or thermal techniques.
- B. Administer proton pump inhibitors (PPIs) to reduce gastric acid secretion.
- C. Implement strict bed rest to minimize physical exertion and bleeding risk.
- D. Recommend transfusion of fresh frozen plasma to correct coagulopathy.
Correct Answer: A
Rationale: The healthcare team should prioritize performing endoscopic hemostasis with mechanical or thermal techniques in a patient with acute gastrointestinal bleeding (GIB) requiring urgent intervention. This approach involves directly visualizing the bleeding site and applying methods such as clipping, coagulation, or band ligation to stop the bleeding. Endoscopic hemostasis is considered the gold standard for managing acute GIB as it allows for both diagnostic and therapeutic intervention in real-time, offering a targeted and effective way to control bleeding and prevent recurrent episodes. Administering proton pump inhibitors (PPIs) may help in reducing gastric acid secretion and promoting ulcer healing but is not the primary intervention for actively bleeding patients. Implementing strict bed rest may be necessary in some cases to minimize physical exertion, but it is not the primary intervention to manage acute GIB. Transfusion of fresh frozen plasma to correct coagulopathy may be necessary if
A patient presents with central obesity, moon face, buffalo hump, and purple striae. Laboratory tests reveal elevated cortisol levels. Which endocrine disorder is most likely responsible for these symptoms?
- A. Hyperthyroidism
- B. Hypothyroidism
- C. Diabetes mellitus
- D. Cushing's syndrome
Correct Answer: D
Rationale: The patient's presentation of central obesity, moon face, buffalo hump, purple striae, and elevated cortisol levels strongly suggest Cushing's syndrome. Cushing's syndrome is a disorder characterized by excessive levels of cortisol, either due to an endogenous (e.g., adrenal tumor) or exogenous (e.g., prolonged steroid use) source. The classic physical features of Cushing's syndrome include central obesity with thin extremities (truncal obesity), moon face (rounding and reddening of the face), buffalo hump (accumulation of fat between the shoulders), and purple striae (stretch marks that are wide and purple in color). In the context of the elevated cortisol levels, these clinical signs are highly indicative of Cushing's syndrome. Hyperthyroidism, hypothyroidism, and diabetes mellitus would not typically present with the specific combination of symptoms described.
A patient with a history of chronic obstructive pulmonary disease (COPD) presents with increased dyspnea and cough productive of purulent sputum. On auscultation, coarse crackles are heard bilaterally. Which complication of COPD is the patient most likely experiencing?
- A. Acute exacerbation
- B. Pneumothorax
- C. Pulmonary embolism
- D. Pleural effusion
Correct Answer: A
Rationale: The patient with a history of COPD presenting with increased dyspnea, cough productive of purulent sputum, and coarse crackles on auscultation is most likely experiencing an acute exacerbation of COPD. Acute exacerbations in COPD are defined as sustained worsening of the patient's respiratory symptoms beyond normal day-to-day variations, leading to a change in medication. Common triggers for exacerbations include respiratory infections, air pollution, and non-compliance with medications.
Nurse Nanie is aware that history taking and physical exam are critical to the diagnostic process and often provide more information than can be gained broad testing strategies. History taking includes the by following, EXCEPT _______
- A. History of present illness
- B. Religious Affiliation
- C. Social & Family history
- D. Past medical history
Correct Answer: B
Rationale: Religious Affiliation is not typically included in the history taking process for diagnosing medical conditions. While a patient's religious beliefs may sometimes be relevant in certain situations, it is not a standard component of medical history. History taking usually includes aspects such as the history of present illness, social and family history, and past medical history as these can provide important information related to the patient's health condition.
A postpartum client presents with persistent, severe perineal pain despite analgesic medication. On assessment, the nurse observes ecchymosis and swelling of the perineum. Which nursing action is most appropriate?
- A. Applying ice packs to the perineum for pain relief
- B. Encouraging the client to sit on a donut cushion
- C. Notifying the healthcare provider immediately
- D. Administering additional analgesic medication
Correct Answer: C
Rationale: The presence of persistent, severe perineal pain along with ecchymosis and swelling of the perineum can indicate a complication such as a hematoma. A hematoma is a collection of blood that can occur in the perineal area postpartum, usually as a result of trauma during delivery. It is essential to notify the healthcare provider immediately to assess the situation, provide appropriate treatment, and prevent further complications. Applying ice packs or administering additional analgesic medication may not address the underlying issue of a possible hematoma, so prompt medical evaluation is crucial in this situation.