Nokea
Which of the following interventions is most appropriate for managing a patient with acute respiratory failure and hypercapnia due to chronic obstructive pulmonary disease (COPD) exacerbation?
- A. Administration of supplemental oxygen via non-rebreather mask
- B. Initiation of non-invasive positive pressure ventilation (NIPPV)
- C. Placement of an indwelling arterial catheter for continuous monitoring
- D. Titration of inhaled bronchodilators and corticosteroids
Correct Answer: B
Rationale: In a patient with acute respiratory failure and hypercapnia due to a COPD exacerbation, the most appropriate intervention is the initiation of non-invasive positive pressure ventilation (NIPPV). NIPPV helps improve ventilation and oxygenation by providing mechanical support to the patient's breathing without the need for endotracheal intubation. It can reduce the work of breathing, decrease carbon dioxide retention, and improve respiratory muscle function. This intervention is particularly beneficial for COPD exacerbations as it can help alleviate hypercapnia and hypoxemia, leading to improved outcomes and potentially reducing the need for invasive ventilation methods. Therefore, NIPPV is the recommended management strategy in this scenario.
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While preparing the operating room (OR) for a surgical procedure, the nurse notices a malfunctioning anesthesia machine. What is the nurse's priority action?
- A. Use an alternative anesthesia machine
- B. Document the malfunction in the equipment log
- C. Inform the anesthesia provider immediately
- D. Continue with the surgical procedure as scheduled
Correct Answer: C
Rationale: The nurse's priority action when noticing a malfunctioning anesthesia machine in the operating room should be to inform the anesthesia provider immediately. Anesthesia providers are responsible for administering anesthesia safely during surgical procedures, and they need to be made aware of any equipment issues promptly to ensure patient safety. Continuing with the surgical procedure using a malfunctioning anesthesia machine can pose serious risks to the patient's well-being. Using an alternative anesthesia machine may be an option, but informing the anesthesia provider first ensures that the appropriate action is taken to address the issue effectively. Documenting the malfunction in the equipment log is important for record-keeping purposes, but it should not take precedence over informing the anesthesia provider and taking immediate action to address the problem.
A patient presents with generalized weakness, headache, and difficulty concentrating. Laboratory tests reveal normocytic normochromic anemia, normal iron studies, and elevated serum erythropoietin levels. Which of the following conditions is most likely to cause these findings?
- A. Chronic kidney disease (CKD)
- B. Iron deficiency anemia
- C. Thalassemia
- D. Aplastic anemia
Correct Answer: A
Rationale: The patient in this scenario presents with normocytic normochromic anemia, normal iron studies, and elevated serum erythropoietin levels. These findings are characteristic of anemia of chronic disease, which is commonly seen in patients with chronic kidney disease (CKD). In CKD, there is a decrease in renal production of erythropoietin, leading to reduced stimulation of erythropoiesis and subsequent anemia. The normocytic normochromic anemia pattern is typical in anemia of chronic disease, as opposed to microcytic hypochromic anemia seen in iron deficiency anemia and thalassemia. Aplastic anemia is characterized by pancytopenia, which is not described in the scenario. Therefore, the most likely cause of the patient's presentation is chronic kidney disease.
Which of the following is the most common type of ovarian tumor in women of reproductive age?
- A. Serous cystadenoma
- B. Mucinous cystadenoma
- C. Teratoma (dermoid cyst)
- D. Endometrioma
Correct Answer: C
Rationale: Among the given options, teratoma (dermoid cyst) is the most common type of ovarian tumor in women of reproductive age. Dermoid cysts are a type of ovarian teratoma that contains tissues derived from the ectoderm (skin), mesoderm (bone, muscle), and endoderm (mucous membranes). They are usually benign and can contain a variety of elements such as hair, teeth, bone, and sebaceous material. Serous cystadenomas and mucinous cystadenomas are more commonly seen in older women, whereas endometriomas are typically associated with endometriosis rather than being the most common ovarian tumor type in women of reproductive age.
A patient presents with sudden-onset weakness and sensory loss on one side of the body along with difficulty speaking and understanding speech. Imaging reveals an acute infarction involving the right middle cerebral artery territory. Which of the following neurological conditions is most likely responsible for these symptoms?
- A. Transient ischemic attack (TIA)
- B. Intracerebral hemorrhage
- C. Ischemic stroke
- D. Subarachnoid hemorrhage
Correct Answer: C
Rationale: The patient is presenting with sudden-onset weakness and sensory loss on one side of the body along with difficulty speaking and understanding speech, which are classic symptoms of a stroke. The involvement of the right middle cerebral artery territory on imaging suggests an acute infarction, confirming an ischemic stroke. Ischemic stroke occurs due to a blockage or obstruction within a blood vessel supplying blood to the brain, leading to a lack of oxygen and nutrients reaching brain tissue. This results in neurological deficits corresponding to the affected area of the brain. In contrast, a transient ischemic attack (TIA) would present with similar symptoms but resolve within 24 hours without evidence of acute infarction on imaging. Intracerebral hemorrhage and subarachnoid hemorrhage involve bleeding into the brain tissue or the space surrounding the brain, respectively, resulting in different clinical presentations.
A postpartum client is breastfeeding and expresses discomfort during feedings due to sore nipples. What nursing intervention should be prioritized to alleviate nipple soreness?
- A. Educating the client on proper latch technique
- B. Recommending the use of nipple shields during feedings
- C. Applying lanolin cream to the nipples after each feeding
- D. Encouraging the use of breast pumps instead of direct breastfeeding
Correct Answer: A
Rationale: Proper latch technique is the most important nursing intervention to alleviate nipple soreness in a breastfeeding client. When a baby latches on correctly, it helps prevent nipple trauma and soreness. Educating the client on how to achieve a proper latch, such as ensuring the baby's mouth covers both the nipple and areola, can significantly reduce discomfort during feedings. Improving the latch can also enhance milk transfer, leading to better breastfeeding outcomes for both the mother and baby. While lanolin cream (choice C) can provide some relief for sore nipples, addressing the root cause by correcting the latch is crucial for long-term comfort and successful breastfeeding. Using nipple shields (choice B) or encouraging the use of breast pumps (choice D) should not be the first line of intervention when addressing sore nipples, as they do not address the underlying issue of latch technique.