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A postpartum client who delivered preterm expresses concern about breastfeeding her premature infant. What nursing intervention should be prioritized to support successful breastfeeding in this situation?
- A. Providing education on strategies for initiating and maintaining milk supply
- B. Recommending the use of supplemental formula feedings to ensure adequate nutrition
- C. Encouraging the client to postpone breastfeeding until the infant reaches full term
- D. Referring the client to a lactation consultant for specialized support
Correct Answer: A
Rationale: Providing education on strategies for initiating and maintaining milk supply should be prioritized to support successful breastfeeding in this situation. Preterm infants can benefit significantly from breast milk due to its unique composition that supports their growth and development. Educating the client on techniques such as pumping to establish and maintain milk supply, proper latching techniques, and understanding the benefits of breastfeeding for preterm infants can help alleviate her concerns and increase her confidence in breastfeeding her premature infant. Additionally, promoting skin-to-skin contact and frequent feedings can also help stimulate milk production and foster bonding between the mother and infant. Encouraging and supporting the client with evidence-based information will be crucial in promoting successful breastfeeding outcomes for the preterm infant.
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A patient receiving palliative care for end-stage liver disease develops hepatic encephalopathy, presenting with confusion and altered mental status. What intervention should the palliative nurse prioritize to manage the patient's symptoms?
- A. Administer lactulose or other ammonia-lowering agents to reduce ammonia levels.
- B. Initiate intravenous fluid therapy to correct electrolyte imbalances.
- C. Refer the patient to a neurologist for evaluation and treatment of encephalopathy.
- D. Prescribe sedative medications to promote sleep and reduce agitation.
Correct Answer: A
Rationale: The most appropriate intervention for managing hepatic encephalopathy in this patient receiving palliative care for end-stage liver disease is to administer lactulose or other ammonia-lowering agents to reduce ammonia levels. Hepatic encephalopathy is believed to be primarily caused by the accumulation of ammonia in the bloodstream due to compromised liver function. Lactulose works by acidifying the gut lumen, which facilitates the excretion of ammonia in the form of ammonium ions. By reducing ammonia levels, hepatic encephalopathy symptoms, such as confusion and altered mental status, can be improved. Initiating other supportive measures like managing precipitating factors, maintaining hydration, and addressing nutritional issues should also be part of the holistic approach in managing hepatic encephalopathy in palliative care. However, addressing the underlying cause by reducing ammonia levels with lactulose is the priority intervention in this scenario.
Which of the following conditions does the nurse explain to the patient the contributory factor that slows uterine involution?
- A. Full bladder during labor
- B. Difficult birth
- C. Prolonged labor
- D. Infection during pregnancy
Correct Answer: C
Rationale: Prolonged labor is a condition in which labor lasts for an extended period, typically more than 20 hours for first-time mothers and more than 14 hours for experienced mothers. Prolonged labor can contribute to slowing down uterine involution because the prolonged pressure and strain on the uterus can affect its ability to return to its pre-pregnancy size and position. The prolonged contractions and stretching of the uterine muscles can hinder the normal process of uterine involution, leading to a delay in the uterus shrinking back to its non-pregnant state. Additionally, prolonged labor can increase the risk of postpartum complications such as excessive bleeding and infection, which can further impact uterine involution. Therefore, it is crucial for healthcare providers to monitor labor progress closely to prevent prolonged labor and its potential effects on uterine involution.
One error in record-keeping is illegible handwriting. What is the APPROPRIATE action by the nurse in this situation?
- A. Request the senior nurse to read the order for you.
- B. Let the resident-on-duty in the nurses station interpret it.
- C. Call the physician who made the order.
- D. Report the lapse to the Quality Assurance Committee
Correct Answer: A
Rationale: The appropriate action for a nurse in this situation is to request the senior nurse to read the illegible order for clarification. It is essential to ensure accurate and safe patient care by confirming the correct interpretation of the order with a colleague familiar with the handwriting. This action helps prevent errors and misunderstandings that may occur due to illegible handwriting. Consulting with the senior nurse is a common practice in healthcare settings to maintain effective communication and avoid mistakes in patient care.
A patient presents with tremors, rigidity, bradykinesia, and postural instability. On examination, the patient demonstrates a shuffling gait, stooped posture, and a masked facies. Which of the following neurological conditions is most likely responsible for these symptoms?
- A. Alzheimer's disease
- B. Parkinson's disease
- C. Multiple sclerosis (MS)
- D. Amyotrophic lateral sclerosis (ALS)
Correct Answer: B
Rationale: The symptoms described in the patient, such as tremors, rigidity, bradykinesia (slow movement), and postural instability, along with the presence of a shuffling gait, stooped posture, and masked facies, are classic features of Parkinson's disease. These motor symptoms are primarily caused by the degeneration of dopamine-producing neurons in the substantia nigra region of the brain. This results in an imbalance of neurotransmitters, particularly dopamine, leading to motor dysfunction and characteristic movement abnormalities seen in Parkinson's disease.
A 28-year-old woman presents with cyclic pelvic pain, dysmenorrhea, and infertility. On pelvic examination, tender nodules are palpated along the uterosacral ligaments. Which of the following conditions is most likely to be responsible for these findings?
- A. Polycystic ovary syndrome (PCOS)
- B. Endometriosis
- C. Adenomyosis
- D. Leiomyomas (uterine fibroids)
Correct Answer: B
Rationale: Endometriosis is a chronic gynecologic condition characterized by the presence of endometrial-like tissue outside the uterus, commonly on structures within the pelvis. The classic symptoms of endometriosis include cyclic pelvic pain, dysmenorrhea (painful periods), and infertility. On pelvic examination, tender nodules or masses may be palpated along the uterosacral ligaments. These nodules are often referred to as "endometriotic implants" or "chocolate cysts." Endometriosis can cause inflammation, scarring, and adhesions in the pelvis, leading to symptoms such as pain and infertility. Polycystic ovary syndrome (PCOS) is characterized by ovarian dysfunction and hormonal imbalances, often leading to irregular periods and symptoms related to excess androgens. Adenomyosis is the presence of endometrial tissue within the myometrium of the uterus, leading