A patient presents with muscle weakness and fatigue. Upon further examination, it is revealed that the patient has decreased acetylcholine receptors at the neuromuscular junction. Which of the following conditions is most likely responsible for this presentation?

Correct Answer: A

Rationale: The correct answer is A: Myasthenia gravis. In myasthenia gravis, there is a decrease in acetylcholine receptors at the neuromuscular junction, leading to muscle weakness and fatigue. This occurs due to autoimmune destruction of these receptors. ALS (B) affects motor neurons, not acetylcholine receptors. Guillain-Barre syndrome (C) is an autoimmune disorder affecting peripheral nerves, not neuromuscular junctions. Muscular dystrophy (D) is a genetic disorder causing muscle degeneration, not affecting acetylcholine receptors.

Correct Answer: C

Rationale: The correct answer is C: Secures clean ties before removing soiled ones. This is the priority action because securing clean ties prevents accidental dislodgement of the tracheostomy tube, ensuring the patient's airway remains patent. Cutting the dressing (A) or cleaning the incisions (B) can be important but not as critical as securing the tube. Using clean technique (D) is essential but not the priority in this situation.

Correct Answer: C

Rationale: The correct answer is C because encouraging the patient to ask questions and express concerns promotes patient empowerment and active participation in self-care. This approach fosters communication, understanding, and collaboration between the nurse and patient, leading to better medication adherence. Choice A is incorrect as it lacks patient involvement. Choice B is helpful but does not necessarily empower the patient. Choice D is directive and does not encourage active participation or empowerment.

Correct Answer: A

Rationale: The correct answer is A: Bleeding. Chemotherapy can lead to low platelet counts (thrombocytopenia), increasing the risk of bleeding. The priority goal of the nurse is to prevent bleeding by taking precautions such as avoiding invasive procedures, using soft toothbrushes, and monitoring for signs of bleeding. Infection (B) is important but not the priority as bleeding can be life-threatening. Hypotension (C) is not directly related to thrombocytopenia. Diarrhea (D) is a potential side effect of chemotherapy but is not the priority when considering thrombocytopenia.

Correct Answer: C

Rationale: Step 1: The Universal Health Care law aims to provide all Filipinos access to quality and affordable healthcare services, including medicines. Step 2: This law covers a broader scope compared to the other choices. Step 3: The Local Government Code focuses on local governance, not specifically on healthcare. Step 4: Primary Health Care is a concept rather than a specific law targeting affordable medicines. Step 5: The Generic Drug Act promotes the use of generic drugs but does not guarantee affordability for all Filipinos.

Correct Answer: B

Rationale: The correct initial step before starting TPN is to evaluate the patient's tolerance to glucose. This is crucial to ensure the patient can metabolize the glucose effectively and avoid complications such as hyperglycemia. Assessing affordability (A) is important but not the immediate concern. Identifying allergies (C) should be done but is not the first step. Assessing the patient's understanding (D) is important but not as critical as evaluating glucose tolerance before starting TPN.

Correct Answer: D

Rationale: The correct answer is D because confirming the insertion site and direction using imaging guidance ensures precise placement of the chest tube, minimizing the risk of complications. Imaging guidance allows the nurse to visualize the exact location of the pneumothorax and guide the tube insertion accurately. A: Positioning the patient in a semi-Fowler's position with arms elevated may be beneficial for comfort but does not directly ensure proper chest tube placement. B: Marking the insertion site with a pen may help as a reference point but does not guarantee accurate placement. C: Administering analgesia is important for the patient's comfort but does not impact the placement of the chest tube. In summary, choice D is the most critical step to ensure the chest tube is correctly placed and effectively treats the pneumothorax.

Correct Answer: A

Rationale: The correct answer is A: Rotator cuff tear. The presentation of acute shoulder pain and limited range of motion after a fall onto an outstretched hand, along with tenderness over the greater tuberosity and pain with passive abduction and external rotation, is classic for a rotator cuff tear. The mechanism of injury and physical exam findings are consistent with this condition. B: Glenohumeral dislocation typically presents with a visibly deformed shoulder and loss of normal shoulder contour. C: Acromioclavicular joint separation would present with tenderness over the AC joint rather than the greater tuberosity, and typically involves a history of direct trauma to the shoulder. D: Proximal humerus fracture would present with more diffuse shoulder pain and swelling, and not specific tenderness over the greater tuberosity.

Correct Answer: B

Rationale: The correct answer is B because actively listening, acknowledging the patient's concerns, and working towards rebuilding trust through transparency and reliability are essential steps in addressing distrust. By validating the patient's experiences and actively involving them in the process, the nurse can foster a supportive and trusting relationship. Choice A is incorrect because dismissing the patient's concerns can further damage trust and undermine the patient's feelings. Choice C is incorrect as ignoring the distrust can lead to a breakdown in communication and trust. Choice D is incorrect because telling the patient to trust the healthcare system without addressing their concerns is dismissive and unhelpful.