A nurse is caring for a male patient with urinaryretention. Which action should the nurse takefirst?

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Question 1 of 9

A nurse is caring for a male patient with urinaryretention. Which action should the nurse takefirst?

Correct Answer: C

Rationale: The correct answer is C: Assist to a standing position. This action helps utilize gravity to aid in emptying the bladder and may help the patient void without the need for invasive measures like catheterization or medications. It is a non-invasive and natural approach to promote urination. Limiting fluid intake (A) could worsen the situation by concentrating urine and worsening retention. Inserting a urinary catheter (B) should be considered only if other measures fail. Asking for a diuretic medication (D) does not address the immediate need for bladder emptying and may not be necessary if the patient can void naturally.

Question 2 of 9

A patient taking magnesium sulfate has a respiratory rate of 10 breaths per minute. In addition to discontinuing the medication, which action should the nurse take?

Correct Answer: B

Rationale: The correct answer is B: Administer calcium gluconate. Magnesium sulfate can cause respiratory depression, leading to a low respiratory rate. Calcium gluconate is the antidote for magnesium sulfate toxicity, as it antagonizes the effects of magnesium on the neuromuscular junction. Administering calcium gluconate helps reverse the respiratory depression caused by magnesium sulfate. Increasing IV fluids (Choice A) is not directly related to treating respiratory depression. Vigorously stimulating the patient (Choice C) can exacerbate respiratory depression. Instructing the patient to take deep breaths (Choice D) may not be effective in addressing the underlying cause of respiratory depression due to magnesium sulfate toxicity.

Question 3 of 9

A nurse works at a hospital that uses equity-focusedquality improvement. Which strategy is the hospital using?

Correct Answer: D

Rationale: The correct answer is D: Reduce disparities. In equity-focused quality improvement, the primary goal is to address and reduce disparities in healthcare outcomes and access. By focusing on reducing disparities, the hospital ensures that all patients receive equitable care regardless of their background. Documenting staff satisfaction (A) is important but not directly related to equity-focused improvement. Focusing on the family (B) is essential for patient-centered care but doesn't specifically address equity. Implementing change on a grand scale (C) may not necessarily target disparities directly. Therefore, reducing disparities aligns best with equity-focused quality improvement principles.

Question 4 of 9

A patient with ovarian cancer is admitted to the hospital for surgery and the nurse is completing the patients health history. What clinical manifestation would the nurse expect to assess?

Correct Answer: B

Rationale: The correct answer is B: Increased abdominal girth. In ovarian cancer, a common clinical manifestation is the accumulation of fluid in the abdomen, leading to increased abdominal girth. This is known as ascites. The presence of ascites can be observed through physical examination and abdominal imaging. A: Fish-like vaginal odor is not typically associated with ovarian cancer. It may be a symptom of other gynecological conditions. C: Fever and chills are not specific to ovarian cancer and can be seen in various infectious or inflammatory conditions. D: Lower abdominal pelvic pain is a common symptom in many gynecological conditions but is not a specific manifestation of ovarian cancer.

Question 5 of 9

A patient with a family history of allergies has suffered an allergic response based on a genetic predisposition. This atopic response is usually mediated by what immunoglobulin?

Correct Answer: D

Rationale: The correct answer is D: Immunoglobulin E. The atopic response in allergies is mainly mediated by IgE antibodies. IgE binds to allergens and triggers the release of histamine and other chemicals that cause allergic symptoms. IgA is mainly found in mucosal areas, IgM is involved in early immune responses, and IgG is important for long-term immunity. IgE is specifically associated with allergic reactions due to its role in sensitizing mast cells and basophils to allergens.

Question 6 of 9

A man tells the nurse that his father died of prostate cancer and he is concerned about his own risk of developing the disease, having heard that prostate cancer has a genetic link. What aspect of the pathophysiology of prostate cancer would underlie the nurses response?

Correct Answer: A

Rationale: The correct answer is A because several studies have indeed shown an association between BRCA-2 mutation and an increased risk of prostate cancer. BRCA-2 mutation is known to be linked to an increased risk of various cancers, including prostate cancer. This genetic mutation can be inherited and passed down through generations, leading to a higher likelihood of developing prostate cancer. Choices B, C, and D are incorrect because: B: HNPCC (Hereditary Nonpolyposis Colorectal Cancer) is not specifically associated with prostate cancer, and it is not an autosomal dominant mutation causing prostate cancer in men. C: TP53 gene is associated with other types of cancers, such as breast cancer, but not strongly linked to prostate cancer. D: Research has shown that genetics do play a role in the development of prostate cancer, contradicting the statement that genetics are unrelated to the disease.

Question 7 of 9

The nurse is planning the care of a patient with a diagnosis of vertigo. What nursing diagnosis risk should the nurse prioritize in this patients care?

Correct Answer: C

Rationale: The correct answer is C: Risk for falls. Patients with vertigo experience a false sensation of spinning or movement, which can lead to imbalance and increased risk of falls. Prioritizing the risk for falls is crucial to prevent injuries and ensure patient safety. Other choices are incorrect as they do not directly address the immediate safety concern of falls associated with vertigo. A: Risk for disturbed sensory perception may be present, but the priority is preventing falls. B: Risk for unilateral neglect is not typically associated with vertigo. D: Risk for ineffective health maintenance is important but falls take precedence due to the immediate risk of injury.

Question 8 of 9

The nurse is discussing the results of a patients diagnostic testing with the nurse practitioner. What Weber test result would indicate the presence of a sensorineural loss?

Correct Answer: C

Rationale: The correct answer is C because in sensorineural hearing loss, the sound is heard better in the ear with poorer hearing due to damage to the inner ear or auditory nerve. This is because the brain perceives the sound as louder in the affected ear to compensate for the hearing loss. Choice A is incorrect as it describes the result for conductive hearing loss. Choice B is incorrect as it indicates normal hearing. Choice D is incorrect as it describes the result for a lateralizing conductive hearing loss.

Question 9 of 9

The nurse is caring for a 63-year-old patient with ovarian cancer. The patient is to receive chemotherapy consisting of Taxol and Paraplatin. For what adverse effect of this treatment should the nurse monitor the patient?

Correct Answer: A

Rationale: The correct answer is A: Leukopenia. Taxol and Paraplatin are known to cause bone marrow suppression, leading to decreased white blood cell counts. Leukopenia can increase the patient's risk of infection, so monitoring for signs of infection is crucial. Metabolic acidosis, hyperphosphatemia, and respiratory alkalosis are not typically associated with Taxol and Paraplatin chemotherapy.

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