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While you are doing your physical assessment to patent Aster, she has been exhibiting a UNIQUE clinical manifestation different from patients Claire and Sonia which is characterized by________.
- A. Cyanosis, increasing growth of hands and feet
- B. anemia, weight 1oss and presence of
- C. moon facies, purple striae on trunk and buffalo hump
- D. moon facies, easy fatigability and peripheral edema
Correct Answer: A
Rationale: The clinical manifestations of Aster suggest acromegaly, a condition characterized by the excessive growth of hands and feet due to a tumor in the pituitary gland leading to overproduction of growth hormone. Cyanosis is a bluish discoloration of the skin caused by poor oxygenation, which is not typically associated with acromegaly. The other options do not match the unique clinical manifestation described for Aster. Anemia, weight loss, moon facies, and edema are more commonly associated with other conditions like Cushing's syndrome, anemia, or heart failure.
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In providing health teaching to the famil, Nurse Emma would include in her teachings the etioology of Scabies which is __________.
- A. virus
- B. bacteria
- C. fungi
- D. Parasite
Correct Answer: D
Rationale: Scabies is caused by an infestation of the microscopic mite Sarcoptes scabiei. This parasitic mite burrows into the upper layer of the skin, where it lays eggs and causes intense itching and skin irritation. The transmission of scabies usually occurs through close and prolonged skin-to-skin contact with an infested person. Unlike viruses, bacteria, and fungi, which are microorganisms that can also cause skin infections, scabies specifically refers to an infestation by a parasitic mite.
What is the FIRST priority which the nurse must observe in caring for patient with seizure?
- A. Safety
- B. Nutrition
- C. Airway
- D. Mobility
Correct Answer: A
Rationale: The first priority for a nurse caring for a patient experiencing a seizure is safety. Ensuring the safety of the patient is crucial to prevent injury during the seizure episode. This includes clearing the area around the patient of any harmful objects, preventing the patient from falling or hitting their head, placing them in a safe position to prevent aspiration if they vomit, and staying with the patient until the seizure ends. Once the patient is safe, the nurse can then focus on other aspects of care such as assessing airway, providing emotional support, and monitoring for complications.
A patient admitted to the ICU develops acute liver failure with hepatic encephalopathy. What intervention should the healthcare team prioritize to manage the patient's encephalopathy?
- A. Administer lactulose or other ammonia-lowering agents.
- B. Perform liver transplantation to restore liver function.
- C. Initiate enteral nutrition to support metabolic needs.
- D. Prescribe benzodiazepines for sedation and agitation.
Correct Answer: A
Rationale: The healthcare team should prioritize administering lactulose or other ammonia-lowering agents to manage hepatic encephalopathy in a patient with acute liver failure. Hepatic encephalopathy is a neuropsychiatric syndrome that occurs in patients with liver dysfunction, leading to the accumulation of ammonia and other neurotoxic metabolites in the bloodstream. Lactulose works by acidifying the colon, which promotes the conversion of ammonia to ammonium, a less toxic form that can be excreted in the stool. By reducing the levels of ammonia, lactulose helps improve the neurological symptoms associated with hepatic encephalopathy.
A woman in active labor is diagnosed with uterine rupture, resulting in fetal distress and maternal hemorrhage. What nursing intervention is essential in managing this obstetric emergency?
- A. Initiating immediate oxytocin infusion
- B. Preparing for immediate instrumental delivery
- C. Performing an emergency cesarean section
- D. Administering intravenous magnesium sulfate
Correct Answer: C
Rationale: Uterine rupture is a severe obstetric complication that requires prompt and decisive management to prevent adverse outcomes for both the mother and the baby. In cases of uterine rupture leading to fetal distress and maternal hemorrhage, performing an emergency cesarean section is crucial. This intervention allows for rapid delivery of the baby, relieving the distress on the fetus and enabling immediate access to manage the maternal hemorrhage. By performing a timely cesarean section, healthcare providers can expedite the delivery process and effectively address both the fetal and maternal complications associated with uterine rupture. This intervention is essential in saving lives and reducing the risk of further complications in such a critical obstetric emergency.
The newly hired nurse asks for advice from the supervisor. supervisor notices that the newly hired nurse felt uneasy upon learning that the fetus is on breech presentation. Which of the following is the BEST RESPONSE by the supervisor?
- A. "I understand how you feel. Tell me more."
- B. Is this your first time to witness a breech presentation"
- C. Are you afraid to assist the case"
- D. "Don' t worry. There's always a first time"
Correct Answer: A
Rationale: The best response by the supervisor is to acknowledge the newly hired nurse's emotions by saying, "I understand how you feel. Tell me more." This response shows empathy and validates the nurse's feelings, creating a supportive environment for open communication. It allows the nurse to express their concerns and fears, leading to a constructive discussion and providing an opportunity for guidance and reassurance. This approach fosters a positive mentorship and learning experience for the newly hired nurse.