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What guideline s IMPORTANT in relation to incident report( IR)? It is ______.
- A. not made part of the patient's chart
- B. placed in the nurse's 201 file
- C. filed in the nurses station
- D. filed in the Records Section of the hospital
Correct Answer: D
Rationale: Incident reports (IR) are filed in the Records Section of the hospital. It is important for incident reports to be kept in the Records Section for various reasons. By being filed in the hospital's official records, incident reports are included in the hospital's documentation of events, which is crucial for legal and quality improvement purposes. Placing IRs in the Records Section ensures that they are accessible to relevant personnel who may need to refer to them in the future for investigations, audits, or further actions related to the incidents. Keeping incident reports in a centralized location like the Records Section also helps in standardizing the process of documenting and tracking incidents, maintaining consistency and accountability within the healthcare facility.
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Patient Haydee comes to the perinatal unit of Hospital DEE. Nurse Arcee does through SCREENING assessment. Which is the Least screening assessment to be used by the nurse/
- A. Physical examination
- B. Radiologic procedures
- C. Interview
- D. Laboratory review
Correct Answer: B
Rationale: Radiologic procedures are typically not used as the least screening assessment by nurses in a perinatal unit. The nurse's initial screening assessments usually focus on gathering information through techniques such as physical examination, interviews, and reviewing laboratory results. Radiologic procedures, such as X-rays or CT scans, are usually ordered by physicians once a more specific diagnostic need has been identified, based on the initial screening assessments performed by the nurse. Therefore, in this scenario, the least screening assessment to be used by the nurse would be radiologic procedures.
A patient with a history of chronic kidney disease presents with weakness, anorexia, and confusion. Laboratory tests reveal severe anemia, low reticulocyte count, elevated serum creatinine, and decreased erythropoietin levels. Which of the following conditions is most likely to cause these findings?
- A. Anemia of chronic disease
- B. Hemolytic uremic syndrome (HUS)
- C. Autoimmune hemolytic anemia (AIHA)
- D. Renal failure-associated anemia
Correct Answer: D
Rationale: The clinical presentation of a patient with chronic kidney disease (CKD) presenting with weakness, anorexia, confusion, severe anemia, low reticulocyte count, elevated serum creatinine, and decreased erythropoietin levels is most consistent with renal failure-associated anemia. In CKD, the kidneys are unable to produce adequate amounts of erythropoietin, a hormone responsible for stimulating red blood cell production in the bone marrow. The decreased erythropoietin levels lead to a state of anemia, characterized by low hemoglobin levels and subsequent symptoms of fatigue and weakness. The anemia in renal failure is typically normocytic and normochromic. Additionally, the elevated serum creatinine in this patient is a hallmark of kidney dysfunction.
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.
What is the first step in the management of a chemical splash to the eyes?
- A. Irrigate the eyes with clean water.
- B. Instill antibiotic eye drops.
- C. Cover both eyes with a sterile dressing.
- D. Assess visual acuity.
Correct Answer: A
Rationale: The first step in the management of a chemical splash to the eyes is to irrigate the eyes with clean water. Flushing the affected eye with water helps to remove the chemical and minimize any potential injury. It is important to continue irrigation for at least 15-20 minutes to ensure thorough removal of the chemical. This prompt action can help prevent further damage to the eye and surrounding tissue. It is crucial to remember not to delay irrigation to seek medical advice first, as immediate irrigation is vital in such situations. After irrigating the eyes, further assessment and treatment can be carried out based on the severity of the injury.
A patient presents with a small, painless, well-defined nodule on the lateral aspect of the neck, just above the clavicle. Fine-needle aspiration cytology reveals clusters of polygonal cells with abundant granular cytoplasm. Which of the following conditions is most likely responsible for this presentation?
- A. Thyroglossal duct cyst
- B. Branchial cleft cyst
- C. Lymphadenopathy
- D. Parathyroid adenoma
Correct Answer: D
Rationale: The presentation described is characteristic of a parathyroid adenoma. Parathyroid adenomas are benign neoplasms that can present as painless, well-defined nodules usually located in the lower pole of the thyroid gland or in close proximity, such as the lateral aspect of the neck above the clavicle. Fine-needle aspiration cytology of a parathyroid adenoma typically reveals polygonal cells with abundant granular cytoplasm, often referred to as chief cells. This is key in differentiating it from other conditions mentioned in the question.