There are five criteria in prioritizing community health problems. If Nurse Maris is estimating the proportion of the population affected by the problem, she is using what criterion in prrioritization?
- A. Social concern
- B. Nature of the problem
- C. Magnitude of the problem
- D. Modifiability of the problem
Correct Answer: C
Rationale: When Nurse Maris is estimating the proportion of the population affected by the problem, she is assessing the magnitude of the problem. The magnitude criterion involves determining the extent of the issue within the community, such as the number of individuals affected or at risk. By understanding the magnitude of a health problem, nurses can better prioritize their efforts to address the most pressing issues that affect a large portion of the population. This criterion helps in identifying which health problems have the highest impact and require immediate attention in order to improve community health outcomes.
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A nurse is preparing to assist with a peripherally inserted central catheter (PICC) insertion for a patient. What action should the nurse prioritize to maintain procedural asepsis?
- A. Wearing sterile gloves and a surgical mask during the procedure
- B. Cleansing the insertion site with alcohol-based antiseptic solution
- C. Using a sterile drape to cover the patient during the procedure
- D. Avoiding unnecessary movement or talking during the procedure
Correct Answer: B
Rationale: The nurse should prioritize cleansing the insertion site with an alcohol-based antiseptic solution to maintain procedural asepsis during a peripherally inserted central catheter (PICC) insertion. Proper skin preparation is essential in reducing the risk of introducing pathogens into the patient's bloodstream during the insertion process. Alcohol-based antiseptic solutions are effective in reducing the number of microorganisms on the skin surface. Wearing sterile gloves and following other sterile techniques are also crucial, but preparing the insertion site with the antiseptic solution is the initial step in maintaining asepsis during the procedure.
A patient with a history of stroke is at risk for impaired skin integrity due to immobility. Which nursing intervention is most effective in preventing pressure ulcers in this patient?
- A. Turning and repositioning the patient every 2 hours
- B. Massaging bony prominences regularly
- C. Applying heating pads to areas of erythema
- D. Using a pressure-reducing mattress
Correct Answer: A
Rationale: Turning and repositioning the patient every 2 hours is the most effective nursing intervention in preventing pressure ulcers in a patient with a history of stroke and immobility. Pressure ulcers, also known as bedsores, are caused by prolonged pressure on the skin, leading to reduced blood flow and tissue damage. By regularly turning and repositioning the patient, pressure is relieved from specific areas of the body, helping to prevent the development of pressure ulcers. This intervention helps to redistribute pressure, improve blood flow, and reduce the risk of skin breakdown, thus promoting skin integrity in immobile patients.
A patient presents with acute pain, swelling, and deformity of the ankle following a twisting injury. X-ray reveals a fracture involving the distal fibula with associated widening of the ankle mortise. Which type of ankle fracture is most likely?
- A. Maisonneuve fracture
- B. Pilon fracture
- C. Tillaux fracture
- D. Trimalleolar fracture
Correct Answer: D
Rationale: A trimalleolar fracture is characterized by fractures involving the lateral malleolus (distal fibula), medial malleolus (distal tibia), and the posterior tubercle of the distal tibia. This fracture pattern results in instability of the ankle joint and is often associated with widening of the ankle mortise on X-ray. The deformity and swelling seen in this patient are indicative of a trimalleolar fracture and are typically caused by a high-energy injury, such as a forceful twisting motion. Treatment for trimalleolar fractures often involves surgical intervention to stabilize the ankle joint and restore normal function.
A patient with acute respiratory distress syndrome (ARDS) develops refractory hypoxemia despite maximal ventilatory support and prone positioning. Which of the following adjunctive therapies is most likely to improve oxygenation and reduce mortality in this patient?
- A. High-frequency oscillatory ventilation (HFOV)
- B. Continuous renal replacement therapy (CRRT)
- C. Extracorporeal membrane oxygenation (ECMO)
- D. Inhaled nitric oxide (iNO)
Correct Answer: C
Rationale: In a patient with ARDS who is experiencing refractory hypoxemia despite maximal ventilatory support and prone positioning, the use of extracorporeal membrane oxygenation (ECMO) is a potentially life-saving adjunctive therapy. ECMO works by providing temporary support for gas exchange outside the body, allowing the lungs to rest and heal while providing adequate oxygenation and carbon dioxide removal. The use of ECMO has been associated with improved oxygenation and reduced mortality in severe cases of ARDS, especially in patients who fail conventional therapies. High-frequency oscillatory ventilation (HFOV) has not consistently shown mortality benefit in ARDS, continuous renal replacement therapy (CRRT) is not directly indicated for hypoxemia in ARDS, and inhaled nitric oxide (iNO) has shown limited benefit in improving oxygenation in ARDS without a clear impact on mortality.
With diagnosis of hemorrhagic stroke, the nurse teaches the caregiver that with position of the bed should be in what position?
- A. High-Fowler's
- B. Prone
- C. Fowler
- D. Flat
Correct Answer: A
Rationale: For a patient diagnosed with a hemorrhagic stroke, the caregiver should ensure that the bed is positioned in a High-Fowler's position. This position involves elevating the head of the bed between 60 to 90 degrees. Elevating the head of the bed helps to reduce intracranial pressure and promote optimal cerebral perfusion. It also assists in maintaining proper ventilation and oxygenation, which are essential for the patient's recovery. It is important to avoid positioning the patient flat or in a prone position as these may exacerbate the condition and lead to further complications.