A patient is prescribed a tricyclic antidepressant for the management of depression. Which adverse effect should the nurse monitor closely in the patient?

Correct Answer: A

Rationale: Tricyclic antidepressants (TCAs) are known to have anticholinergic effects, which can lead to various cardiovascular side effects, including orthostatic hypotension, tachycardia, and potential hypertension. While hypotension is a possible adverse effect, hypertension is more commonly associated with TCAs. Therefore, it is essential for the nurse to monitor the patient for signs of hypertension, such as elevated blood pressure readings, to prevent any adverse outcomes and ensure the patient's safety while on this medication.

Correct Answer: B

Rationale: Radiologic procedures are typically not used as the least screening assessment by nurses in a perinatal unit. The nurse's initial screening assessments usually focus on gathering information through techniques such as physical examination, interviews, and reviewing laboratory results. Radiologic procedures, such as X-rays or CT scans, are usually ordered by physicians once a more specific diagnostic need has been identified, based on the initial screening assessments performed by the nurse. Therefore, in this scenario, the least screening assessment to be used by the nurse would be radiologic procedures.

Correct Answer: D

Rationale: The presentation described is characteristic of a parathyroid adenoma. Parathyroid adenomas are benign neoplasms that can present as painless, well-defined nodules usually located in the lower pole of the thyroid gland or in close proximity, such as the lateral aspect of the neck above the clavicle. Fine-needle aspiration cytology of a parathyroid adenoma typically reveals polygonal cells with abundant granular cytoplasm, often referred to as chief cells. This is key in differentiating it from other conditions mentioned in the question.

Correct Answer: D

Rationale: The cough of a patient with lung cancer typically starts off as dry and persistent. This is because lung cancer can irritate the airways, leading to a persistent dry cough as an early symptom. As the cancer progresses, the cough may become more productive with blood-tinged or dark yellow sputum. However, in the early stages, the cough is often dry and persistent, which can be a warning sign for healthcare providers to further investigate potential underlying issues such as lung cancer.

Correct Answer: C

Rationale: Prolonged labor is a condition in which labor lasts for an extended period, typically more than 20 hours for first-time mothers and more than 14 hours for experienced mothers. Prolonged labor can contribute to slowing down uterine involution because the prolonged pressure and strain on the uterus can affect its ability to return to its pre-pregnancy size and position. The prolonged contractions and stretching of the uterine muscles can hinder the normal process of uterine involution, leading to a delay in the uterus shrinking back to its non-pregnant state. Additionally, prolonged labor can increase the risk of postpartum complications such as excessive bleeding and infection, which can further impact uterine involution. Therefore, it is crucial for healthcare providers to monitor labor progress closely to prevent prolonged labor and its potential effects on uterine involution.

Correct Answer: A

Rationale: Crisis intervention is an important part of secondary prevention in the care of families. Secondary prevention involves activities that aim to reduce the impact of a crisis or event that has already occurred. Crisis intervention provides immediate support and strategies to help families cope with and overcome a crisis situation. By addressing the crisis quickly and effectively, secondary prevention can help prevent further negative outcomes and promote the well-being of the family members.

Correct Answer: A

Rationale: The presentation described, involving multiple grouped vesicles on an erythematous base in the genital area, is classic for herpes simplex genitalis. This condition is caused by the herpes simplex virus (HSV) and is characterized by recurrent outbreaks of painful vesicles in the genital or perianal area. The history of similar lesions occurring during periods of stress is also suggestive of herpes simplex virus reactivation. Genital warts (condyloma acuminata) typically present as painless, fleshy growths in the genital area caused by human papillomavirus (HPV). Syphilis manifests as a painless ulcer known as a chancre, which is not described in the presentation. Molluscum contagiosum presents with pearly, dome-shaped papules with central umbilication, rather than vesicles.

Correct Answer: A

Rationale: The appropriate action for a nurse in this situation is to request the senior nurse to read the illegible order for clarification. It is essential to ensure accurate and safe patient care by confirming the correct interpretation of the order with a colleague familiar with the handwriting. This action helps prevent errors and misunderstandings that may occur due to illegible handwriting. Consulting with the senior nurse is a common practice in healthcare settings to maintain effective communication and avoid mistakes in patient care.

Correct Answer: A

Rationale: In this case, the patient is experiencing respiratory acidosis as indicated by the low pH (7.28), elevated PaCO2 (65 mmHg), and elevated HCO3- (30 mEq/L). The primary acid-base disturbance is respiratory acidosis due to the retention of carbon dioxide (PaCO2 >45 mmHg) leading to an increase in HCO3- as a compensatory mechanism to maintain pH within normal limits. The elevated HCO3- levels (metabolic compensation) are trying to counterbalance the increased PaCO2 levels (respiratory acidosis) by increasing bicarbonate to attempt to normalize the pH. Overall, the ABG analysis shows respiratory acidosis with metabolic compensation in this COPD patient with an acute exacerbation and severe dyspnea.