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When the patient's signature is witnessed by the nurse on the surgical consent, which of the following does the nurse's signature indicate?
- A. The nurse obtained informed consent.
- B. The nurse provided informed consent.
- C. The nurse answered all surgical procedure questions.
- D. The nurse verified that the patient signed the consent.
Correct Answer: D
Rationale: The nurse's signature on the surgical consent form indicates that the nurse has verified and confirmed that the patient has signed the consent form. This step is crucial to ensure that the patient has voluntarily given their consent for the surgical procedure. It does not mean that the nurse obtained or provided informed consent, answered all surgical procedure questions, or made decisions on behalf of the patient. The nurse's role is to act as a witness to the patient's signature on the consent form to acknowledge that the patient has agreed to the procedure and signed the document.
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Toni's disease process involves a sacral plexus. Assessment should include:
- A. Bladder problems
- B. Sexual activity
- C. Bowel management
- D. All of the above
Correct Answer: D
Rationale: When a patient's disease process involves the sacral plexus, such as in the case of Toni, it is important to assess aspects related to bladder problems, sexual activity, and bowel management. The sacral plexus plays a significant role in controlling functions such as bladder and bowel movements, as well as sexual function. Therefore, a comprehensive assessment including all of these areas is essential to provide holistic care for the patient and address any potential issues related to the sacral plexus involvement.
A newborn's mother is alarmed to find small amounts of blood on her infant girl's diaper. When the nurse checks the infant's urine it is straw colored and has no offensive odor. Which explanation to the newborn's mother is most appropriate?
- A. "It appears your baby has a kidney infection"
- B. "Breast-fed babies often experience this type of bleeding problem due to lack of vitamin C in the breast milk"
- C. "The baby probably passed a small kidney stone"
- D. "Some infants experience menstruation like bleeding when hormones from the mother are not available"
Correct Answer: D
Rationale: The most appropriate explanation to the newborn's mother is option D, "Some infants experience menstruation-like bleeding when hormones from the mother are not available." This condition is known as neonatal menstrual-like bleeding or pseudo-menstruation. During pregnancy, babies are exposed to the mother's hormones in the womb. After birth, when the hormonal influence from the mother decreases, some female infants may experience vaginal bleeding, which can be seen in their diapers. This type of bleeding is usually benign and resolves on its own without any intervention. It is not a cause for concern and does not indicate any serious health issue. The straw-colored urine with no offensive odor is a normal finding and further supports the explanation of neonatal menstrual-like bleeding in this case.
A client was brought to the emergency room with complains of difficulty of breathing. What can lead the nurse to suspect that the client is experiencing acute respiratory distress syndrome (ARDS)?
- A. paO2 of 95, pCO2 of 43, x-ray showing enlarged heart, bradycardia
- B. Thick green sputum production, paO2 of 74, pH of 7.41
- C. restlessness, suprasternal retractions, paO2 of 62
- D. wheezes, slow, deep respirations, pCO2 of 52, pH of 7.35
Correct Answer: C
Rationale: Acute respiratory distress syndrome (ARDS) is a severe form of acute respiratory failure characterized by rapidly progressive dyspnea, hypoxemia, and noncardiogenic pulmonary edema. The key signs of ARDS include severe respiratory distress, low partial pressure of oxygen (paO2), and bilateral infiltrates on chest x-ray. In the given scenario, the client presenting with restlessness and suprasternal retractions along with a paO2 level of 62 indicates severe respiratory distress and hypoxemia, which are consistent with ARDS. Therefore, option C is the most indicative of ARDS among the choices provided.
The most common symptom of JRA that causes a patient to seek medical attention is:
- A. joint swelling.
- B. limited movement.
- C. fatigue.
- D. pain.
Correct Answer: D
Rationale: The most common symptom of Juvenile Rheumatoid Arthritis (JRA) that causes a patient to seek medical attention is pain. Joint pain is a hallmark symptom of JRA and can range from mild discomfort to severe pain. This pain can be persistent or intermittent, and it often worsens with movement or activity. Pain is a significant factor that leads patients to seek medical evaluation in order to diagnose and manage their condition. While joint swelling, limited movement, and fatigue are also common symptoms of JRA, pain is typically the primary reason patients seek medical attention.
Which food is recommended for the patient who must increase intake of potassium?
- A. Bread
- B. Potato
- C. Egg
- D. Cereal
Correct Answer: B
Rationale: Potassium is an essential mineral that plays a key role in numerous bodily functions, including muscle contractions and maintaining proper heart function. Among the options given, potatoes are an excellent source of potassium. One medium-sized potato can provide around 900 mg of potassium, making it a great choice for individuals who need to increase their potassium intake. Therefore, potatoes are recommended for the patient who must increase their intake of potassium.