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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.
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A woman in active labor demonstrates persistent posterior fetal position, contributing to prolonged labor and severe back pain. What nursing intervention should be implemented to facilitate fetal rotation and optimize labor progress?
- A. Encourage frequent position changes, including hands-and-knees position.
- B. Administer intravenous analgesics to manage maternal discomfort.
- C. Prepare for immediate instrumental delivery.
- D. Initiate continuous fetal monitoring to assess fetal well-being.
Correct Answer: A
Rationale: Encouraging frequent position changes, including the hands-and-knees position, is the most appropriate nursing intervention in this scenario. This position is known to help rotate the baby from a persistent posterior position to an optimal anterior position for delivery. The hands-and-knees position can help take pressure off the mother's back, alleviate back pain, and facilitate the rotation of the baby's head to engage in the mother's pelvis, thus promoting labor progress. It is a non-invasive and effective way to promote fetal rotation without the need for immediate instrumental delivery or intravenous analgesics. Continuous fetal monitoring is important for assessing fetal well-being but would not directly address the issue of posterior fetal position and the associated prolonged labor.
A patient presents with sudden-onset severe headache, vomiting, and altered mental status. Imaging reveals a hyperdense lesion within the brain parenchyma, suggestive of acute bleeding. Which of the following neurological conditions is most likely responsible for these symptoms?
- A. Ischemic stroke
- B. Subdural hematoma
- C. Intracerebral hemorrhage
- D. Subarachnoid hemorrhage
Correct Answer: C
Rationale: Intracerebral hemorrhage is characterized by bleeding directly into the brain parenchyma, leading to the sudden onset of severe headache, vomiting, altered mental status, and neurological deficits. The hyperdense lesion seen on imaging is caused by the presence of blood within the brain tissue. This condition is often associated with hypertension and can be life-threatening if not promptly diagnosed and managed. Subdural hematoma is an accumulation of blood between the brain and its outermost covering (dura mater), typically presenting with a slower onset of symptoms compared to intracerebral hemorrhage. Subarachnoid hemorrhage involves bleeding into the space between the arachnoid membrane and the pia mater (subarachnoid space), commonly caused by the rupture of an aneurysm. Ischemic stroke results from the blockage of a blood vessel supplying the brain, leading to a lack of oxygen and nutrients to
Cultural competence is the process of
- A. Learning about vast cultures
- B. Acquiring specific knowledge, skills, and attitudes
- C. Influencing treatment and care of clients
- D. Motivation and commitment to caring
Correct Answer: B
Rationale: Cultural competence is the process of acquiring specific knowledge, skills, and attitudes to effectively work with individuals from diverse cultural backgrounds. It involves understanding and respecting the values, beliefs, languages, and practices of different cultures in order to provide appropriate care and services. Cultural competence goes beyond just learning about different cultures; it requires the development of skills and attitudes that promote effective communication, understanding, and collaboration with individuals of diverse backgrounds. This includes being aware of one's own biases, being open-minded, and adapting practices to be inclusive and respectful of cultural differences. Ultimately, cultural competence is essential in providing high-quality, respectful, and effective care to clients from various cultural backgrounds.
Ms. Cruz is the supervisor of a hospital on night shift. Several nurses did not report due to Jeepney strike. When the supervisor is executing proper allocation of nurses to the PRIORITY wards to address this concern, she is observing what type of principle?
- A. Beneficence
- B. Justice
- C. Non-maleficence
- D. Fidelity
Correct Answer: B
Rationale: When the supervisor allocates nurses to the priority wards in response to the situation of several nurses not reporting due to the Jeepney strike, she is practicing the ethical principle of justice. Justice in healthcare pertains to the fair distribution of resources and the equitable treatment of individuals. By ensuring that nurses are allocated fairly and appropriately to address the urgent needs of the hospital and its patients, the supervisor is upholding the principle of justice. This decision aims to ensure that all patients receive the care they need despite the unexpected staffing shortage.
The BEST example of how the nurse can create a climate in which clients do not feel threatened is by teaching on a topic about:
- A. Stress, where the nurse plays pop music throughout the first session
- B. Good nutrition, while the nurse provides a meal
- C. Exercise, where the nurse begins to share her difficulties she sometimes finds in trying to exercise
- D. Diabetes, where the nurse asks diabetics to talk to the class during the first session
Correct Answer: B
Rationale: The best example of how the nurse can create a climate in which clients do not feel threatened is by teaching on good nutrition while providing a meal. This approach not only addresses an important topic that is beneficial for the clients but also creates a comfortable and welcoming atmosphere. By offering a meal, the nurse is able to engage the clients in a familiar and non-threatening activity, making them more receptive to the information being shared. Additionally, sharing a meal can help to build rapport and create a sense of community among the clients and the nurse, leading to a more positive learning experience.