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Which finding on a prenatal visit at 10 weeks might suggest a hydatidiform mole?
- A. Blood pressure of 120/80 mm Hg
- B. Complaint of frequent mild nausea
- C. Fundal height measurement of 18 cm
- D. History of bright red spotting for 1 day weeks ago
Correct Answer: C
Rationale: The correct answer is C: Fundal height measurement of 18 cm. This finding suggests a hydatidiform mole because it is larger than expected for a 10-week pregnancy due to excessive trophoblastic proliferation. A: Blood pressure is within normal range. B: Nausea is common in early pregnancy and not specific to a mole. D: History of bright red spotting is more indicative of a miscarriage or other complications, not necessarily a mole.
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A patient with otosclerosis has significant hearing loss. What should the nurse do to best facilitate communication with the patient?
- A. Sit or stand in front of the patient when speaking.
- B. Use exaggerated lip and mouth movements when talking.
- C. Stand in front of a light or window when speaking.
- D. Say the patients name loudly before starting to talk.
Correct Answer: A
Rationale: The correct answer is A: Sit or stand in front of the patient when speaking. This choice is correct because it allows the patient with otosclerosis to directly see the nurse's face and lip movements, aiding in lip-reading and understanding speech. Sitting or standing in front of the patient also ensures better eye contact and reduces background noise interference.
Choice B is incorrect because exaggerated lip and mouth movements may distort speech and make it harder for the patient to understand. Choice C is incorrect because standing in front of a light or window can create glare and make it difficult for the patient to see the nurse's face clearly. Choice D is incorrect because saying the patient's name loudly before starting to talk does not directly address the communication needs of a patient with otosclerosis.
After the completion of testing, a childs allergies have been attributed to her familys cat. When introducing the family to the principles of avoidance therapy, the nurse should promote what action?
- A. Removing the cat from the familys home
- B. Administering OTC antihistamines to the child regularly
- C. Keeping the cat restricted from the childs bedroom
- D. Maximizing airflow in the house
Correct Answer: A
Rationale: The correct answer is A: Removing the cat from the family's home. This is the most effective way to prevent allergic reactions in the child. By removing the source of allergens (cat), the child will be exposed to fewer allergens, leading to a reduction in symptoms.
B: Administering OTC antihistamines treats symptoms but does not address the underlying cause of the allergy.
C: Keeping the cat restricted from the child's bedroom helps reduce exposure, but allergens can still spread throughout the house.
D: Maximizing airflow may help reduce allergens in the air but does not eliminate the source of the allergy.
A 66-year-old patient is in a hospice receiving palliative care for lung cancer which has metastasized to the patients liver and bones. For the past several hours, the patient has been experiencing dyspnea. What nursing action is most appropriate to help to relive the dyspnea the patient is experiencing?
- A. Administer a bolus of normal saline, as ordered.
- B. Initiate high-flow oxygen therapy.
- C. Administer high doses of opioids.
- D. Administer bronchodilators and corticosteroids, as ordered.
Correct Answer: B
Rationale: The correct answer is B: Initiate high-flow oxygen therapy. Dyspnea in a patient with lung cancer can be caused by hypoxia due to compromised lung function. High-flow oxygen therapy can help improve oxygenation and alleviate dyspnea. Administering a bolus of normal saline (A) would not directly address the underlying cause of dyspnea. Administering high doses of opioids (C) may lead to respiratory depression and should be used cautiously in patients experiencing dyspnea. Administering bronchodilators and corticosteroids (D) may be appropriate for certain types of dyspnea, but in this case, addressing hypoxia with high-flow oxygen therapy is the most appropriate initial nursing action.
A patient develops a foodborne disease fromEscherichiacoli. When taking a health history, which food item will the nursemostlikely find the patient ingested?
- A. Improperly home-canned food
- B. Undercooked ground beef
- C. Soft cheese
- D. Custard
Correct Answer: B
Rationale: The correct answer is B: Undercooked ground beef. Escherichia coli is commonly found in undercooked ground beef, especially if it is contaminated during processing. Ground beef must be cooked to a safe internal temperature to kill any harmful bacteria. Improperly home-canned food (choice A) can also cause foodborne illnesses, but E. coli is more commonly associated with undercooked ground beef. Soft cheese (choice C) is often linked to Listeria contamination, not E. coli. Custard (choice D) is a less likely source of E. coli compared to undercooked ground beef.
The nurse is caring for a patient who is scheduled for a cervical discectomy the following day. During health education, the patient should be made aware of what potential complications?
- A. Vertebral fracture
- B. Hematoma at the surgical site
- C. Scoliosis
- D. Renal trauma
Correct Answer: B
Rationale: The correct answer is B: Hematoma at the surgical site. This is a potential complication of cervical discectomy due to the risk of bleeding post-surgery. Hematoma can compress nearby structures and lead to increased pain and swelling.
A: Vertebral fracture is not a typical complication of cervical discectomy, as the surgery aims to relieve pressure on the spinal cord caused by a herniated disc, not to cause fractures.
C: Scoliosis is a condition characterized by abnormal lateral curvature of the spine, and it is not directly related to cervical discectomy.
D: Renal trauma is not a common complication of cervical discectomy, as the surgery focuses on the cervical spine and does not involve the kidneys or renal system.