A nurse is assessing a patient's pain using a pain rating scale. What action by the nurse demonstrates cultural competence in pain assessment?

Correct Answer: C

Rationale: Choosing option C, asking the patient about their cultural beliefs and preferences related to pain, demonstrates cultural competence in pain assessment. Pain experiences can vary greatly across different cultures, and a patient's cultural background can influence how they perceive and express pain. By inquiring about the patient's cultural beliefs and preferences, the nurse can gain a better understanding of the patient's perspective on pain. This information is crucial for providing individualized and culturally sensitive pain management interventions. It also shows respect for the patient's unique cultural background and helps build a trusting and collaborative relationship between the nurse and the patient.

Correct Answer: D

Rationale: Cromolyn sodium (nasal crom) is a mast cell stabilizer that is commonly used to prevent symptoms of allergic rhinitis, such as sneezing, itching, and congestion. It works best when used before exposure to allergens. The most effective administration schedule for nasal crom is to start using it just after allergy symptoms begin, with a dose of twice-a-day. This helps to prevent the release of histamine and other inflammatory substances from mast cells, thereby reducing allergic symptoms. Using nasal crom in this way can help provide relief and improve the overall management of allergic rhinitis.

Correct Answer: B

Rationale: The responsibility of obtaining informed consent typically falls on the physician or the healthcare provider who is performing the procedure or treatment. Informed consent is a process where the healthcare provider explains the procedure, its risks, benefits, possible alternatives, and potential outcomes to the patient or their legal representative. The patient must have a comprehensive understanding of these aspects before agreeing to the treatment. While nurses, nurse managers, anesthesiologists, midwives, and other healthcare professionals may assist in the consent process by providing information or clarifications, the ultimate responsibility lies with the physician. This is because the physician is usually the one with the expertise and knowledge about the specific procedure or treatment being performed.

Correct Answer: B

Rationale: In this scenario, the firm and midline fundus at three hours postpartum indicates that the uterus is contracting well. The presence of a small constant trickle of blood on perineal inspection suggests ongoing bleeding. This combination of findings is concerning for retained placenta, where a portion of the placenta remains attached to the uterine wall and prevents proper contraction and closure of the blood vessels at the placental site. Retained placenta can lead to postpartum hemorrhage and requires prompt evaluation and intervention to prevent complications. Nurse Kayla should escalate this finding to the healthcare provider for further assessment and management.

Correct Answer: B

Rationale: Breast tenderness is a hallmark symptom of premenstrual syndrome (PMS), which occurs in the days leading up to menstruation. This symptom is often associated with hormonal fluctuations during the menstrual cycle. Women may experience increased sensitivity and soreness in their breasts, making them feel tender or swollen. It is a common symptom of PMS and can vary in severity from one individual to another. Pelvic pain, postmenopausal bleeding, and dyspareunia are not typically considered hallmark symptoms of PMS.

Correct Answer: B

Rationale: The clinical scenario described is consistent with a diagnosis of anterior epistaxis due to a prominent vascular lesion located in Little's area, which is an important site for nosebleeds. Silver nitrate cautery is the most appropriate intervention for managing this condition. Silver nitrate cautery is a commonly used method to chemically cauterize and eliminate the friable blood vessels responsible for recurrent epistaxis. It is a cost-effective and minimally invasive technique that can be easily performed in an outpatient setting. Nasal packing with anterior nasal tampons might be considered in cases of severe or refractory epistaxis, but in this scenario, where the source of bleeding is localized and identifiable, silver nitrate cautery is the treatment of choice. Endoscopic cauterization of the sphenopalatine artery and surgical excision of a nasal polyp are unnecessary and overly invasive for the described scenario.

Correct Answer: B

Rationale: Delegation by succession involves passing on responsibility and authority to a designated successor when the delegator is temporarily unavailable. In this scenario, the unit manager is planning to take her regular official business leave and has recommended her assistant unit manager to assume her position during her absence. This act follows the principle of succession, where the deputy or next in line is entrusted with the duties and decision-making power of the manager. This ensures a smooth transition of responsibilities and allows the operations to continue efficiently in the manager's absence.

Correct Answer: A

Rationale: The BEST position for a patient in shock is the modified Trendelenburg position. In this position, the patient's legs are elevated above the level of the heart to enhance blood flow back to the heart and vital organs. Placing the patient in the modified Trendelenburg position helps increase venous return, improves cardiac output, and promotes perfusion to vital organs, which can be crucial in managing shock. This position can help stabilize the patient's condition while awaiting further medical intervention.

Correct Answer: D

Rationale: The patient's presentation of central obesity, moon face, buffalo hump, purple striae, and elevated cortisol levels strongly suggest Cushing's syndrome. Cushing's syndrome is a disorder characterized by excessive levels of cortisol, either due to an endogenous (e.g., adrenal tumor) or exogenous (e.g., prolonged steroid use) source. The classic physical features of Cushing's syndrome include central obesity with thin extremities (truncal obesity), moon face (rounding and reddening of the face), buffalo hump (accumulation of fat between the shoulders), and purple striae (stretch marks that are wide and purple in color). In the context of the elevated cortisol levels, these clinical signs are highly indicative of Cushing's syndrome. Hyperthyroidism, hypothyroidism, and diabetes mellitus would not typically present with the specific combination of symptoms described.