A patient is being discharged home from the ambulatory surgery center after an incisional biopsy of a mass in her left breast. What are the criteria for discharging this patient home? Select all that apply.

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Question 1 of 9

A patient is being discharged home from the ambulatory surgery center after an incisional biopsy of a mass in her left breast. What are the criteria for discharging this patient home? Select all that apply.

Correct Answer: A

Rationale: Step-by-step rationale for why answer A is correct: 1. Ambulating is a crucial postoperative activity to prevent complications like blood clots. 2. Understanding when to ambulate ensures the patient follows proper recovery guidelines. 3. Proper ambulation aids in preventing postoperative complications and promotes healing. Summary of why other choices are incorrect: B. Having someone accompany the patient is important for support but not a strict criteria for discharge. C. While understanding activity restrictions is important, it is not a specific criteria for immediate discharge. D. Understanding care for the biopsy site is essential but not a strict criteria for immediate discharge. E. Removal of a urinary catheter is not typically related to discharge criteria for a breast biopsy.

Question 2 of 9

A patient is scheduled to have an electronystagmography as part of a diagnostic workup for Mnires disease. What question is it most important for the nurse to ask the patient in preparation for this test?

Correct Answer: A

Rationale: The correct answer is A: Have you ever experienced claustrophobia or feelings of anxiety while in enclosed spaces? This question is important because electronystagmography involves the patient being placed in a confined space with sensors attached to monitor eye movements. Claustrophobia or anxiety can significantly impact the patient's ability to tolerate the test, affecting its accuracy. Choice B: Do you currently take any tranquilizers or stimulants on a regular basis? While relevant in some cases, it is not as crucial as ensuring the patient can tolerate the test environment. Choice C: Do you have a history of falls or problems with loss of balance? While relevant to Mnire's disease, it is not directly related to the preparation for electronystagmography. Choice D: Do you have a history of either high or low blood pressure? While monitoring blood pressure is important for some procedures, it is not a primary concern for electronystagmography.

Question 3 of 9

Which finding would indicate concealed hemorrhage in abruptio placentae?

Correct Answer: B

Rationale: The correct answer is B: Hard boardlike abdomen. In abruptio placentae, concealed hemorrhage can lead to blood accumulating behind the placenta, causing the uterus to become tense and rigid, resulting in a hard boardlike abdomen. This finding indicates significant internal bleeding and requires immediate medical attention. Rationale: A: Bradycardia is a slow heart rate and is not typically associated with concealed hemorrhage in abruptio placentae. C: Decrease in fundal height may indicate intrauterine growth restriction, not specifically concealed hemorrhage. D: Decrease in abdominal pain is not a typical indicator of concealed hemorrhage; in fact, pain may increase due to the increased pressure in the uterus from the bleeding.

Question 4 of 9

A nurse is designing a form for lesbian, gay,bisexual, and transgender (LGBT) patients. Which design should the nurse use?

Correct Answer: C

Rationale: The correct answer is C: Use parents rather than guardian. This is the most inclusive and respectful choice for LGBT patients as it acknowledges different family structures. LGBT individuals may have non-traditional family dynamics, so using "parents" instead of "guardian" is more appropriate. Option A is incorrect because not all LGBT individuals are in partnerships. Option B is incorrect as it assumes traditional gender roles. Option D is incorrect as not all LGBT individuals may identify with the terms "wife" or "husband."

Question 5 of 9

A patient has returned to the floor after undergoing a transurethral resection of the prostate (TURP). The patient has a continuous bladder irrigation system in place. The patient tells you he is experiencing bladder spasms and asks what you can do to relieve his discomfort. What is the most appropriate nursing action to relieve the discomfort of the patient?

Correct Answer: D

Rationale: Rationale: Administering a smooth-muscle relaxant is the most appropriate nursing action to relieve bladder spasms post-TURP. The smooth-muscle relaxant helps relax the bladder muscles, reducing spasms and discomfort. Applying a cold compress (choice A) may provide temporary relief but won't address the underlying cause. Notifying the urologist (choice B) is important but not the immediate action for relieving spasms. Irrigating the catheter with normal saline (choice C) may not effectively address the spasms. Administering a smooth-muscle relaxant is the best choice for prompt relief.

Question 6 of 9

In teaching mothers-to-be about infant nutrition, which instruction should the nurse provide?

Correct Answer: D

Rationale: The correct answer is D because breast milk or formula is recommended for the first 4 to 6 months as it provides essential nutrients for infant growth and development. Choosing A, B, or C is incorrect as they pose health risks to infants - corn syrup is not necessary, cow's milk is not suitable for infants, and honey can cause botulism in infants under 1 year old. Breast milk or formula is the safest and most nutritionally balanced option for infants in the first few months of life.

Question 7 of 9

A patient with HIV is admitted to the hospital because of chronic severe diarrhea. The nurse caring for this patient should expect the physician to order what drug for the management of the patients diarrhea?

Correct Answer: B

Rationale: The correct answer is B: Sandostatin. This drug is a somatostatin analog that can help manage HIV-related chronic severe diarrhea by reducing gastrointestinal secretions. Sandostatin works by inhibiting the release of various hormones and neurotransmitters in the gut, which can help control diarrhea in HIV patients. Rationale: A: Zithromax is an antibiotic that is not typically used to manage chronic severe diarrhea in HIV patients. C: Levaquin is also an antibiotic and not indicated for managing diarrhea in HIV patients. D: Biaxin is another antibiotic and not the appropriate choice for managing chronic severe diarrhea in HIV patients. In summary, Sandostatin is the correct choice as it specifically targets the underlying cause of diarrhea in HIV patients by reducing gastrointestinal secretions, whereas the other options are antibiotics that are not indicated for this purpose.

Question 8 of 9

A school nurse is caring for a child who appears to be having an allergic response. What should be the initial action of the school nurse?

Correct Answer: A

Rationale: The correct initial action for the school nurse is to assess for signs and symptoms of anaphylaxis (Choice A). This is crucial as anaphylaxis is a severe allergic reaction that can be life-threatening and requires immediate intervention. Assessing for anaphylaxis symptoms such as difficulty breathing, swelling of the face or throat, and a rapid pulse helps the nurse quickly identify the severity of the situation. Administering OTC antihistamines (Choice C) or epinephrine (Choice D) should only be done after confirming the presence of anaphylaxis. Assessing for erythema and urticaria (Choice B) is important but not as immediate as assessing for signs of anaphylaxis in this scenario.

Question 9 of 9

The nurse is teaching breast self-examination (BSE) to a group of women. The nurse should recommend that the women perform BSE at what time?

Correct Answer: A

Rationale: The correct answer is A: At the time of menses. This is because breasts are less lumpy and tender during this time, making it easier to detect abnormalities. Performing BSE at other times may lead to false alarms due to hormonal changes. Choice B is incorrect because timing matters for accurate results. Choice C is incorrect as weekly BSE is unnecessary and may cause unnecessary anxiety. Choice D is incorrect as breasts are more lumpy and tender post-menses, potentially making it harder to detect abnormalities.

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