A patient presents with multiple, flesh-colored, papular lesions with a central dell on the face and trunk. The lesions have a tendency to bleed upon minor trauma and have been increasing in number over time. Which of the following conditions is most likely responsible for this presentation?

Correct Answer: A

Rationale: The description of multiple flesh-colored papular lesions with a central dell that tend to bleed upon minor trauma and have been increasing in number over time is characteristic of basal cell carcinoma. Basal cell carcinoma is the most common type of skin cancer and typically presents as pearly or flesh-colored papules with telangiectasias (tiny blood vessels) and a characteristic central dell or ulceration. This type of skin cancer often occurs on sun-exposed areas like the face and trunk and can manifest as slow-growing lesions that may bleed easily with minor trauma. In contrast, squamous cell carcinoma typically presents as a scaly or crusted lesion, seborrheic keratosis is a benign skin growth with a waxy, stuck-on appearance, and actinic keratosis is a precancerous lesion characterized by rough, scaly patches on sun-exposed areas.

Correct Answer: B

Rationale: The nurse should monitor the International Normalized Ratio (INR) closely during anticoagulant therapy for the prevention of VTE. The INR measures the clotting ability of the blood and is used to monitor the effectiveness of anticoagulant therapy, such as warfarin. Maintaining the INR within the target therapeutic range is crucial to prevent both excessive bleeding due to over-anticoagulation and clotting events due to under-anticoagulation. Close monitoring of the INR helps healthcare providers adjust the anticoagulant dosage as needed to ensure optimal therapeutic outcomes and minimize risks. Platelet count, serum sodium levels, and blood urea nitrogen (BUN) are important laboratory parameters to monitor for other medical conditions but are not specific to anticoagulant therapy.

Correct Answer: C

Rationale: Hurthle cell carcinoma is a type of thyroid cancer that arises from the Hurthle cells of the thyroid gland. Patients with Hurthle cell carcinoma may present with a thyroid nodule and signs of hyperthyroidism, which can mimic other thyroid disorders such as Graves' disease. Fine-needle aspiration biopsy revealing Hurthle cells and cellular atypia is suggestive of a Hurthle cell neoplasm, particularly Hurthle cell carcinoma. It is important to differentiate Hurthle cell carcinoma from benign Hurthle cell adenomas or other thyroid conditions to guide appropriate management and treatment.

Correct Answer: A

Rationale: The first priority for a nurse caring for a patient experiencing a seizure is safety. Ensuring the safety of the patient is crucial to prevent injury during the seizure episode. This includes clearing the area around the patient of any harmful objects, preventing the patient from falling or hitting their head, placing them in a safe position to prevent aspiration if they vomit, and staying with the patient until the seizure ends. Once the patient is safe, the nurse can then focus on other aspects of care such as assessing airway, providing emotional support, and monitoring for complications.

Correct Answer: C

Rationale: An assumption is a belief or statement that is accepted as true without proof. In this case, the statement suggests a belief that the length of service does not affect the degree of patient safety practices among staff nurses, without providing evidence or data to support this claim. It is an assumption about the relationship between two variables without a proper basis or evidence to back it up, making it an example of an assumption.

Correct Answer: C

Rationale: In a primiparous patient who complains of unrelieved perineal pain on the first postpartum day, Nurse Kayla should assess for a perineal hematoma. A perineal hematoma is a collection of blood in the perineal tissues and can cause significant pain and discomfort. It can be a result of trauma during delivery or due to a blood vessel rupture. This condition requires prompt assessment and intervention to prevent complications such as infection or excessive bleeding. Vaginal laceration would typically be identified during the delivery process and would have been repaired by the healthcare provider. History of drug abuse, while important to know for overall patient care, is not as relevant in this immediate postpartum pain assessment. Puerperal infection usually presents with other signs such as fever, foul-smelling discharge, and uterine tenderness, which are not mentioned in this scenario.

Correct Answer: A

Rationale: Continuing Professional Development such as post-graduate study is the best strategy among the options provided for addressing short staffing in the hospital. By encouraging nurses to pursue post-graduate studies, Chief Nurse Cirila is investing in the long-term growth and development of her nursing workforce. Post-graduate studies can enhance the knowledge, skills, and expertise of nurses, making them more competent in their roles. This can lead to improved patient care outcomes, increased job satisfaction among nurses, and ultimately help in retaining and attracting talent in the hospital. Additionally, supporting nurses in their professional development can boost morale and motivation, which are crucial factors in addressing short staffing issues.

Correct Answer: D

Rationale: Quality improvement focuses on proactive measures rather than reactive responses. The medical director would be more interested in establishing processes and systems that prevent issues from occurring in the first place, rather than just reacting to problems as they arise. Continuous improvement involves identifying problems, analyzing root causes, and implementing long-term solutions to prevent the issues from recurring. Therefore, reacting to correct or bad situations is not a characteristic of quality improvement that the medical director would prioritize.

Correct Answer: A

Rationale: In collecting a sputum specimen, the nurse should instruct Roy to breathe slowly, cough, and then expectorate into the specimen container. This ensures that the sputum sample is collected from the lower respiratory tract where it is most likely to contain pathogens or other relevant substances for analysis. By instructing Roy to breathe slowly, it helps him to take deep breaths and effectively cough to produce a good sputum sample. Additionally, asking him to expectorate directly into the specimen container helps prevent contamination from saliva or other sources, ensuring the accuracy of the specimen collected for testing.