A patient has been admitted to the neurologic unit for the treatment of a newly diagnosed brain tumor. The patient has just exhibited seizure activity for the first time. What is the nurses priority response to this event?

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Question 1 of 9

A patient has been admitted to the neurologic unit for the treatment of a newly diagnosed brain tumor. The patient has just exhibited seizure activity for the first time. What is the nurses priority response to this event?

Correct Answer: B

Rationale: The correct answer is B: Implement precautions to ensure the patient's safety. When a patient exhibits seizure activity for the first time, the immediate priority is to ensure the patient's safety by implementing precautions such as protecting the patient from injury during the seizure, ensuring a patent airway, and monitoring vital signs. Identifying triggers (Choice A) can be important for long-term management but is not the priority during an acute seizure. Teaching the family about the relationship between brain tumors and seizures (Choice C) can be done later but is not the immediate priority. Ensuring a private room (Choice D) is not the priority when the patient's safety during a seizure is the main concern.

Question 2 of 9

A male patient presents at the free clinic with complaints of impotency. Upon physical examination, the nurse practitioner notes the presence of hypogonadism. What diagnosis should the nurse suspect?

Correct Answer: A

Rationale: The correct answer is A: Prolactinoma. Hypogonadism is often associated with decreased testosterone levels, which can be caused by excessive prolactin secretion from a prolactinoma. Prolactin inhibits the secretion of gonadotropin-releasing hormone (GnRH), leading to decreased production of testosterone. Angioma, glioma, and ACTH-producing adenoma are not typically associated with hypogonadism. Angiomas are benign tumors of blood vessels, gliomas are tumors of the brain or spinal cord, and ACTH-producing adenomas are associated with Cushing's disease, not hypogonadism.

Question 3 of 9

A nurse is planning preoperative teaching for a patient with hearing loss due to otosclerosis. The patient is scheduled for a stapedectomy with insertion of a prosthesis. What information is most crucial to include in the patients preoperative teaching?

Correct Answer: B

Rationale: The correct answer is B: The patient is likely to experience resolution of conductive hearing loss after the procedure. This information is crucial to include in the preoperative teaching because it directly addresses the patient's expected outcome, providing reassurance and setting appropriate expectations. Stapedectomy with prosthesis insertion is a well-established treatment for otosclerosis-related conductive hearing loss. Choices A, C, and D are incorrect because they either provide misleading information (A, D) or are not directly relevant to the procedure or the patient's immediate postoperative experience (C). It is important to focus on accurate and relevant information to prepare the patient effectively for the upcoming surgery and its expected outcomes.

Question 4 of 9

The nurse care plan for a patient with AIDS includes the diagnosis of Risk for Impaired Skin Integrity. What nursing intervention should be included in the plan of care?

Correct Answer: C

Rationale: The correct answer is C: Keep the patient's bed linens free of wrinkles. This intervention is important in preventing pressure ulcers, a common complication in patients with impaired skin integrity. Wrinkles in bed linens can create pressure points on the skin, leading to skin breakdown. By keeping the bed linens smooth and wrinkle-free, the patient's skin is protected from excessive pressure, reducing the risk of impaired skin integrity. A: Maximizing fluid intake is important for overall health but is not directly related to preventing impaired skin integrity. B: Providing total parenteral nutrition may support the patient's nutritional needs but does not specifically address the risk of impaired skin integrity. D: Providing snug clothing can increase friction and pressure on the skin, potentially worsening the risk of impaired skin integrity.

Question 5 of 9

A nurse is assessing a patient who presented to the ED with priapism. The student nurse is aware that this condition is classified as a urologic emergency because of the potential for what?

Correct Answer: C

Rationale: The correct answer is C: Permanent vascular damage. Priapism is a prolonged erection that can lead to ischemia and damage to the penile tissue due to impaired blood flow, potentially resulting in permanent vascular damage. Urinary tract infection (A) is unrelated to priapism. Chronic pain (B) may occur but is not the primary concern. Future erectile dysfunction (D) can result from priapism but is not as immediate or severe as permanent vascular damage. Therefore, C is the most critical consequence to address in priapism.

Question 6 of 9

A patient has returned to the post-surgical unit after vulvar surgery. What intervention should the nurse prioritize during the initial postoperative period?

Correct Answer: C

Rationale: The correct answer is C: Monitoring the integrity of the surgical site. This is the priority intervention as it ensures early detection of any complications like infection or bleeding. The nurse should assess for signs of infection, such as redness, swelling, or drainage, and monitor for any changes in the wound appearance. Placing the patient in high Fowler's position (A) may be beneficial for comfort but is not the priority. Administering sitz baths (B) may be helpful for comfort but should not be the priority over monitoring the surgical site. Avoiding analgesics (D) unless the pain is unbearable is not appropriate as pain management is essential for the patient's comfort and recovery.

Question 7 of 9

An older-adult patient is wearing a hearing aid. Which technique should the nurse use to facilitate communication?

Correct Answer: D

Rationale: The correct answer is D because a dyspneic patient with a tracheostomy may have difficulty speaking due to impaired airflow and mobility of the tongue. In this case, using alternative communication methods such as writing or using communication boards would be more effective. Choice A is incorrect because being blind does not directly impact communication in this scenario. Choice B is incorrect as hunger, alertness, and self-esteem do not relate to the communication challenges presented. Choice C is incorrect as depression, while important to consider, is not the primary factor impacting communication in this case.

Question 8 of 9

A patient presents at the ED after receiving a chemical burn to the eye. What would be the nurses initial intervention for this patient?

Correct Answer: B

Rationale: The correct initial intervention for a chemical burn to the eye is to generously flush the affected eye with normal saline or water. Flushing helps to remove the chemical from the eye, preventing further damage. Antibiotic solution (choice A) is not the first intervention as the priority is to remove the chemical. Applying a patch (choice C) can trap the chemical against the eye, worsening the injury. Applying direct pressure (choice D) is not appropriate and can cause additional harm. Flushing with normal saline or water is the most effective and safest initial intervention to minimize damage from a chemical burn to the eye.

Question 9 of 9

The patient is asking the nurse about the best way to stay healthy. The nurse explains to the patient which teaching points? (Select all that apply.)

Correct Answer: A

Rationale: Step-by-step rationale for why choice A is correct: 1. Increasing physical activity helps in maintaining a healthy weight and overall health. 2. Regular exercise can reduce the risk of chronic diseases like heart disease and diabetes. 3. Physical activity improves mental health and overall well-being. 4. Exercise boosts immunity and helps in managing stress levels. Summary of why other choices are incorrect: B. Keeping total fat intake to 10% or less is a specific dietary recommendation and not a comprehensive approach to staying healthy. C. Maintaining body weight in a healthy range is important but does not encompass all aspects of staying healthy. D. Choosing and preparing foods with little salt is a specific dietary recommendation and does not address the importance of physical activity in staying healthy.

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