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What should the nurse recognize as evidence that the patient is recovering from preeclampsia?
- A. 1+ protein in urine
- B. 2+ pitting edema in lower extremities
- C. Urine output >100 mL/hour
- D. Deep tendon reflexes +2
Correct Answer: C
Rationale: Step 1: Increased urine output indicates improved kidney function, a key indicator of recovery from preeclampsia.
Step 2: Adequate urine output helps regulate blood pressure and reduce swelling.
Step 3: Consistent urine output >100 mL/hour signifies the kidneys are functioning properly.
Step 4: Therefore, C is the correct answer as it directly reflects recovery progress from preeclampsia.
Summary: A, B, and D are incorrect as they do not directly correlate with kidney function or recovery from preeclampsia.
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The nurse is caring for a 39-year-old woman with a family history of breast cancer. She requested a breast tumor marking test and the results have come back positive. As a result, the patient is requesting a bilateral mastectomy. This surgery is an example of what type of oncologic surgery?
- A. Salvage surgery
- B. Palliative surgery
- C. Prophylactic surgery
- D. Reconstructive surgery
Correct Answer: C
Rationale: The correct answer is C: Prophylactic surgery. Prophylactic surgery involves removing tissue at risk of developing cancer to prevent the occurrence of cancer. In this case, the patient has a family history of breast cancer and has tested positive for a breast tumor marker, indicating a high risk of developing breast cancer. By opting for a bilateral mastectomy, the patient is proactively removing breast tissue to reduce her risk of developing breast cancer.
Salvage surgery (A) is performed to remove cancer that has recurred after initial treatment. Palliative surgery (B) aims to alleviate symptoms and improve quality of life but is not curative. Reconstructive surgery (D) is performed to restore the appearance and function of a body part after cancer treatment but is not the primary purpose in this scenario.
The patient with cardiovascular disease is receiving dietary instructions from the nurse. Which information from the patient indicates teaching is successful?
- A. Maintain a prescribed carbohydrate intake.
- B. Eat fish at least 5 times per week.
- C. Limittransfat to less than 1%.
- D. Avoid high-fiber foods.
Correct Answer: B
Rationale: Correct Answer: B - Eat fish at least 5 times per week.
Rationale:
1. Fish is rich in omega-3 fatty acids, which are beneficial for heart health.
2. Eating fish frequently can help reduce the risk of cardiovascular diseases.
3. Consuming fish aligns with dietary recommendations for cardiovascular health.
Summary of Incorrect Choices:
A: Maintaining carbohydrate intake is important, but it may not specifically indicate success in cardiovascular disease management.
C: Limiting trans fats is crucial, but it alone may not indicate overall success in dietary management for cardiovascular disease.
D: Avoiding high-fiber foods is not recommended, as fiber is beneficial for heart health and overall well-being.
In the past three to four decades, nursing has moved into the forefront in providing care for the dying. Which phenomenon has most contributed to this increased focus of care of the dying?
- A. Increased incidence of infections and acute illnesses
- B. Increased focus of health care providers on disease prevention
- C. Larger numbers of people dying in hospital settings
- D. Demographic changes in the population
Correct Answer: D
Rationale: The correct answer is D: Demographic changes in the population. This is because as the population ages, there is a higher prevalence of chronic illnesses and an increased number of people facing end-of-life care needs. This has led to a greater demand for palliative and hospice care services, shifting the focus of nursing towards providing care for the dying.
A: Increased incidence of infections and acute illnesses is not the primary factor contributing to the increased focus on care for the dying. While these conditions do require nursing care, they do not directly explain the shift in focus.
B: Increased focus of health care providers on disease prevention is important but does not directly explain the increased attention on care for the dying. Disease prevention aims to reduce the incidence of illnesses, not necessarily address end-of-life care needs.
C: Larger numbers of people dying in hospital settings may be a consequence of the increased focus on care for the dying, but it is not the underlying phenomenon driving the shift in nursing care towards end-of
A nurse is planning care for a group of patients.Which task will the nurse assign to the nursing assistive personnel?
- A. Obtaining a midstream urine specimen
- B. Interpreting a bladder scan result
- C. Inserting a straight catheter
- D. Irrigating a catheter
Correct Answer: A
Rationale: The correct answer is A: Obtaining a midstream urine specimen. This task is within the scope of practice for nursing assistive personnel as it involves collecting a specimen, which is a routine and non-invasive procedure. Nursing assistive personnel are trained to perform basic tasks like specimen collection. Choices B, C, and D involve more complex skills and procedures that require specialized training and knowledge, which are typically performed by licensed nurses. Interpreting bladder scan results (B), inserting a straight catheter (C), and irrigating a catheter (D) all require a higher level of expertise and assessment that nursing assistive personnel are not qualified to do.
The advanced practice nurse is attempting to examine the patients ear with an otoscope. Because of impacted cerumen, the tympanic membrane cannot be visualized. The nurse irrigates the patients ear with a solution of hydrogen peroxide and water to remove the impacted cerumen. What nursing intervention is most important to minimize nausea and vertigo during the procedure?
- A. Maintain the irrigation fluid at a warm temperature.
- B. Instill short, sharp bursts of fluid into the ear canal.
- C. Follow the procedure with insertion of a cerumen curette to extract missed ear wax.
- D. Have the patient stand during the procedure.
Correct Answer: A
Rationale: Correct Answer: A. Maintain the irrigation fluid at a warm temperature.
Rationale:
1. Warm fluid helps prevent vertigo and nausea by minimizing stimulation of the vestibular system.
2. Cold fluid can cause dizziness and nausea due to the temperature effect on the inner ear.
3. Warm fluid promotes patient comfort and relaxation during the procedure.
4. Cold fluid can lead to vasoconstriction, potentially exacerbating ear discomfort.
Summary of other choices:
B. Instilling short, sharp bursts of fluid can be uncomfortable and increase the risk of vertigo and nausea.
C. Following with a curette may not be necessary if the irrigation effectively removes the impacted cerumen.
D. Having the patient stand can increase the risk of falling or losing balance due to potential dizziness from the procedure.