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Which patient could safely be cared for by a certified nurse-midwife?
- A. Gravida 3, para 2, with no complications
- B. Gravida 1, para 0, with mild hypertension
- C. Gravida 2, para 1, with insulin-dependent diabetes N R I G B.C M U S N T O
- D. Gravida 1, para 0, with borderline pelvic measurements
Correct Answer: A
Rationale: A patient who is Gravida 3, para 2, with no complications can safely be cared for by a certified nurse-midwife. This patient has had two previous pregnancies, both resulting in successful deliveries, and is currently not experiencing any complications. Nurse-midwives are trained to provide care for low-risk pregnancies and deliveries, making this patient an appropriate candidate for their care. Patients with mild hypertension (choice B), insulin-dependent diabetes (choice C), or borderline pelvic measurements (choice D) would likely require additional monitoring and potential intervention beyond the scope of practice of a certified nurse-midwife.
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What hormonal medication can be used in a premenopausal patient without the concurrent use of ovarian suppression?
- A. letrozole (Femara)
- B. exemestane (Aromasin)
- C. elacestrant (Orserdu)
- D. tamoxifen (Soltamox)
Correct Answer: D
Rationale: Tamoxifen is a hormonal medication that can be used in premenopausal patients without the concurrent use of ovarian suppression. It is a selective estrogen receptor modulator (SERM) that acts by blocking estrogen receptors in breast tissue, thereby inhibiting the growth of hormone-sensitive breast cancer cells. Tamoxifen is commonly prescribed for hormone receptor-positive breast cancer in both premenopausal and postmenopausal women. Unlike aromatase inhibitors (e.g., letrozole and exemestane) which require ovarian suppression in premenopausal patients, tamoxifen can be used as monotherapy in premenopausal patients due to its different mechanism of action. Elacestrant is a selective estrogen receptor degrader (SERD) and not commonly used in clinical practice for this indication.
What nursing intervention would the nurse include in the preoperative care plan for a patient scheduled for an outpatient lumpectomy of a fibroadenoma?
- A. Administer pain and antiemetic medications.
- B. Help the patient arrange for a cab home after the procedure.
- C. Advise the patient to avoid food or drink for 2 hours before surgery.
- D. Review discharge instructions.
Correct Answer: C
Rationale: It is essential to advise the patient to avoid food or drink for at least 2 hours before surgery to reduce the risk of aspiration during the procedure. An empty stomach helps prevent vomiting and aspiration of stomach contents that could potentially lead to respiratory complications during the surgical procedure. This is a crucial preoperative nursing intervention to ensure patient safety and preparation for the lumpectomy surgery. Administering pain and antiemetic medications, arranging for transportation home, and reviewing discharge instructions are important aspects of care but do not directly impact the patient's safety during the procedure like fasting before surgery does.
The nurse is caring for a 33-year-old female patient who has just undergone laparoscopic removal of endometrial lesions. Which statement by the patient illustrates her understanding of the disease process and prognosis?
- A. I realize that this is not a cure for the issue, but I want to have more children within the next year.
- B. I'm happy to know that the surgeon has been able to cure me of this disease without a hysterectomy.
- C. I realize that my type 2 diabetes will be cured now that I have those lesions removed
- D. I understand that I will not have to have a colostomy now that the growths were removed from my bowels.
Correct Answer: A
Rationale: Choice A is the correct answer because the patient acknowledges that the laparoscopic removal of endometrial lesions is not a cure for her issue. She demonstrates understanding by mentioning her desire to have more children within the next year, indicating that she recognizes the need for continued monitoring and management of her condition. Choices B, C, D, and E are incorrect because they do not accurately reflect the disease process and prognosis associated with endometrial lesions.
Regarding advanced roles of nursing, which statement related to clinical practice is the most accurate?
- A. Family nurse practitioners (FNPs) can assist with childbirth care in the hospital setting.
- B. Clinical nurse specialists (CNSs) provide primary care to obstetric patients.
- C. Neonatal nurse practitioners provide emergency care in the postbirth setting to high-risk infants.
- D. A certified nurse midwife (CNM) is not considered to be an advanced practice nurse.
Correct Answer: C
Rationale: The most accurate statement related to clinical practice among the choices presented is that neonatal nurse practitioners provide emergency care in the postbirth setting to high-risk infants. Neonatal nurse practitioners specialize in the care of newborns, particularly those who are premature or have health complications. They work in settings such as neonatal intensive care units (NICUs) and provide specialized care to meet the needs of high-risk infants. Neonatal nurse practitioners collaborate with neonatologists and other healthcare professionals to ensure that these fragile patients receive the necessary care and attention. This role involves advanced clinical skills and knowledge in the care of neonates, making it a crucial part of the healthcare team for newborns in need of specialized care.
Which patient could safely be cared for by a certified nurse-midwife?
- A. Gravida 3, para 2, with no complications
- B. Gravida 1, para 0, with mild hypertension
- C. Gravida 2, para 1, with insulin-dependent diabetes N R I G B.C M U S N T O
- D. Gravida 1, para 0, with borderline pelvic measurements
Correct Answer: A
Rationale: A patient who is Gravida 3, para 2, with no complications can safely be cared for by a certified nurse-midwife. This patient has had two previous pregnancies, both resulting in successful deliveries, and is currently not experiencing any complications. Nurse-midwives are trained to provide care for low-risk pregnancies and deliveries, making this patient an appropriate candidate for their care. Patients with mild hypertension (choice B), insulin-dependent diabetes (choice C), or borderline pelvic measurements (choice D) would likely require additional monitoring and potential intervention beyond the scope of practice of a certified nurse-midwife.