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The nurse specialist cites a situation. If a patient experiences episodes of severe nausea and vomiting with more than 1,000 ml. of vomitus with in a period of four hours, which of the following is the nurses MOST appropriate action?
- A. Withhold fluids for four hours
- B. Observe the patient for another four hours
- C. Notify the physician
- D. Place the patient on a liquid diet
Correct Answer: C
Rationale: Severe nausea and vomiting with a large volume of vomitus can indicate a serious underlying issue such as gastrointestinal obstruction or other medical emergencies. In this situation, it is crucial for the nurse to notify the physician immediately so that further assessment and appropriate management can be initiated promptly. Delay in seeking medical help can lead to complications and worsen the patient's condition. It is important to act quickly and involve the physician in situations where the patient's health may be at risk.
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In as much as the research may have some risks on the part of the subject who is 21 years old, Nurse Carmi must assure the subject of her anonymity, confidentiality and respect for her human rights. ONE ABSOLUTE WAY is to get an informed and written consent from whom?
- A. Parents
- B. Husband
- C. Guardians
- D. Subject herself Situation
Correct Answer: D
Rationale: In research involving adults who are capable of providing informed consent, such as a 21-year-old subject, the absolute way to ensure autonomy and respect for the individual's rights is to obtain informed and written consent directly from the subject herself. The subject's autonomy and right to self-determination should be respected, and obtaining consent directly from the subject ensures that they are fully informed about the research, its risks, benefits, and their rights regarding anonymity and confidentiality. In this case, Nurse Carmi must explain the research process clearly to the 21-year-old subject, obtain her informed consent in writing, and ensure that her anonymity, confidentiality, and human rights are protected throughout the study.
A woman in active labor is receiving intravenous fentanyl for pain relief. What fetal assessment finding indicates potential neonatal opioid withdrawal syndrome (NOWS)?
- A. Hypertonicity
- B. Bradycardia
- C. Hypoglycemia
- D. Respiratory depression
Correct Answer: A
Rationale: Neonatal Opioid Withdrawal Syndrome (NOWS), previously known as Neonatal Abstinence Syndrome (NAS), can occur when a newborn is exposed to opioids in utero. Opioid exposure in utero can lead to physical dependence in the fetus, and when the drug is no longer available after birth, withdrawal symptoms can occur.
What symptom is an INDICATOR of cranial nerve involvement?
- A. Difficulty of speaking and chewing.
- B. Loss of pain sensation
- C. Spastic paralysis of the extremities
- D. Forgetfulness and syncope
Correct Answer: A
Rationale: Difficulty of speaking and chewing is an indicator of cranial nerve involvement. Cranial nerves are responsible for controlling various functions of the head and neck, including speech and mastication. Impairment of cranial nerve function can lead to difficulty in these activities. In the context of the question, with the patient in the stroke unit, cranial nerve involvement can occur due to the stroke affecting the brain regions responsible for cranial nerve function. Loss of pain sensation, spastic paralysis of the extremities, and forgetfulness with syncope are not specific indicators of cranial nerve involvement in this scenario.
A patient with a history of peptic ulcer disease is prescribed famotidine (Pepcid) for gastric acid suppression. Which instruction should the nurse include in patient education about famotidine therapy?
- A. "Take famotidine on an empty stomach."
- B. "Avoid taking antacids while on famotidine therapy."
- C. "Increase your intake of spicy foods while taking famotidine."
- D. "Notify your healthcare provider if you develop black, tarry stools."
Correct Answer: B
Rationale: Famotidine belongs to a class of medications known as H2 blockers which work to reduce the production of stomach acid. Antacids, on the other hand, work by neutralizing stomach acid. Taking antacids in conjunction with famotidine can decrease the effectiveness of famotidine as they can interfere with its absorption. Therefore, it is important for the patient to avoid taking antacids while on famotidine therapy to ensure optimal treatment outcomes for gastric acid suppression.
Which of the following gives cues to the nurse that the patient may be grieving for loss?
- A. Thoughts, feelings , behavior, and physiologic complaints
- B. Hallucination, panic 1evel of anxiety, sense of impending doom
- C. Sad affect, anger anxiety, and sudden change of mood
- D. Complaints of abdominal pain, diarrhea, loss of appetite
Correct Answer: A
Rationale: A grieving individual may show a range of cues across different aspects of their life. Thoughts may include constant preoccupation with the loss, difficulties in concentrating, or intrusive thoughts. Feelings may involve sadness, anger, guilt, confusion, or relief. Behavioral cues may include changes in sleep patterns, appetite, energy levels, social withdrawal, or the use of substances. Physiologic complaints can manifest as headaches, stomach issues, fatigue, or other physical symptoms. Therefore, when a nurse observes cues related to thoughts, feelings, behavior, and physiologic complaints in a patient, it can suggest that the patient is grieving for a loss.