A patient is brought to the emergency department experiencing a possible stroke. What initial diagnostic test for a stroke , usually performed in the emergency department would the nurse prepare the patient for?

Correct Answer: C

Rationale: In the emergency department setting, the initial diagnostic test typically performed for a patient suspected of having a stroke is a noncontrast computed tomography (CT) scan of the head. This imaging study is crucial in evaluating and diagnosing stroke because it can quickly identify whether the person is having a hemorrhagic stroke (bleeding in the brain) or an ischemic stroke (blood clot blocking a blood vessel). The results of the CT scan help guide immediate treatment decisions, such as administering clot-busting medications for ischemic strokes or preparing for surgical interventions for hemorrhagic strokes. Carotid ultrasound studies and transcranial Doppler flow studies may be performed after the initial CT scan to further assess the extent of damage and the underlying cause of the stroke. The 12-lead electrocardiogram is useful in assessing the heart's electrical activity but is not the primary test for diagnosing stroke.

Correct Answer: B

Rationale: Generalizability refers to the extent to which research findings and conclusions can be applied beyond the specific conditions of the study to a larger population or different settings. In this case, if the findings of a study on patients with myocardial infarction (MI) under stress can be applied to all such patients in the whole Philippines, it indicates that the study results are generalizable beyond the specific sample studied. Therefore, the criteria satisfied in this context is generalizability.

Correct Answer: A

Rationale: A woman experiencing irregular and ineffective uterine contractions with prolonged cervical dilation may indicate labor dystocia, also known as abnormal labor progression. To address this issue, the nursing intervention that should be implemented is to encourage the mother to ambulate and change positions frequently. This can help optimize fetal positioning and encourage descent through the birth canal by using gravity to aid in the progression of labor. Changing positions can also potentially improve the quality and effectiveness of contractions, leading to more successful cervical dilation and labor progress. Encouraging ambulation and position changes are non-invasive, patient-centered interventions that can be helpful in managing labor dystocia before considering more invasive interventions like cesarean section.

Correct Answer: C

Rationale: The nurse's best approach to address the patient's confusion about their medication regimen is to use a teach-back method to assess understanding and clarify any misconceptions. This method involves the nurse asking the patient to explain in their own words how they will take their medications, what each medication is for, and any potential side effects they should watch for. By using the teach-back method, the nurse can confirm the patient's comprehension and correct any misunderstandings in a supportive and non-judgmental manner. This approach promotes patient education, empowerment, and adherence to the medication regimen. Providing written instructions alone (Choice A) may not be sufficient if the patient has difficulty reading or understanding written information. Explaining the medication regimen using complex medical terminology (Choice B) can further confuse the patient, making it harder for them to grasp the information. Dismissing the patient's concerns and reassuring them that the medication is safe (Choice D) does not address the root of the issue and

Correct Answer: C

Rationale: When a nurse notices a discrepancy between the surgical consent form and the planned procedure, it is essential to consult the surgeon for clarification. The surgeon is the primary decision-maker regarding the surgical procedure and can provide insight into why the discrepancy exists and how to proceed. It is crucial to ensure that everyone is on the same page before moving forward with the surgery to prevent errors, ensure patient safety, and maintain legal and ethical standards. Consulting the surgeon allows for the issue to be addressed promptly and for the appropriate steps to be taken to resolve the discrepancy before proceeding with the surgery.

Correct Answer: A

Rationale: Administering systemic analgesia, such as pain medications or anesthesia, before the wound debridement procedure is the most effective way to minimize patient discomfort. These medications will help manage and reduce the pain experienced by the patient during the procedure, making it more tolerable for them. Topical anesthetic cream may provide some localized relief but may not be sufficient for significant pain management during a wound debridement procedure. Using sharp debridement techniques or performing the procedure quickly may help reduce manipulation or duration, respectively, but these actions alone may not adequately address the patient's pain and discomfort. Administering systemic analgesia ensures that the patient's overall pain is managed, promoting a more comfortable and successful wound debridement procedure.

Correct Answer: C

Rationale: In the case of Mang Luis, who has been diagnosed with chronic obstructive pulmonary disease (COPD) and is experiencing exacerbation, the most crucial health intervention to include in the teaching plan is to reduce the risk for infection. COPD exacerbations are commonly triggered by respiratory infections such as pneumonia and bronchitis. Preventing infections is essential in managing COPD as they can lead to worsening of symptoms and increased healthcare utilization. Therefore, educating Mang Luis on strategies to reduce the risk of infection, such as proper hand hygiene, avoiding exposure to sick individuals, getting vaccinated, and managing environmental factors, is paramount in his care plan.

Correct Answer: B

Rationale: When a patient with chronic kidney disease is prescribed erythropoietin-stimulating agents (ESAs) for anemia management, the parameter that should be monitored closely by the nurse is the hemoglobin levels. Hemoglobin levels indicate the patient's response to ESA therapy and are essential in assessing the effectiveness of the treatment in addressing anemia. Monitoring hemoglobin levels helps ensure that the patient's anemia is controlled within the target range to avoid both the risks of under-treatment (resulting in persistent anemia) and over-treatment (increased risk of adverse outcomes such as hypertension, stroke, or cardiovascular events).

Correct Answer: C

Rationale: The presentation described in the question (sensation of fullness and pressure in the left ear, hearing loss, occasional tinnitus, retracted tympanic membrane with decreased mobility on pneumatic otoscopy) is suggestive of serous otitis media, also known as otitis media with effusion. Serous otitis media occurs when fluid accumulates in the middle ear without signs of infection. This buildup of fluid in the middle ear space can cause the tympanic membrane to retract and reduce its mobility on pneumatic otoscopy.