A patient presents with progressive hearing loss, tinnitus, and vertigo. Audiometric testing reveals sensorineural hearing loss with a "carrot-shaped" configuration. Which of the following conditions is most likely responsible for this presentation?

Correct Answer: C

Rationale: Ménière's disease is characterized by the triad of symptoms including progressive sensorineural hearing loss, tinnitus, and vertigo. The audiometric testing in Ménière's disease often shows a "carrot-shaped" configuration, which refers to low-frequency hearing loss initially and eventually spreading to involve higher frequencies. This distinctive pattern of hearing loss helps differentiate Ménière's disease from other causes like Presbycusis (age-related hearing loss) or Noise-induced hearing loss. Acoustic neuroma can present with unilateral sensorineural hearing loss but typically does not exhibit the specific "carrot-shaped" configuration seen in Ménière's disease.

Correct Answer: A

Rationale: Option A indicates an understanding of the normal psychosocial development of preschoolers. It reflects the fact that during this stage, children may demonstrate frustration and have temper tantrums as they strive for independence and attempt to do things by themselves. This behavior is a common part of their development as they learn self-control, autonomy, and decision-making skills. The other options do not directly relate to normal preschooler development but rather touch upon separate issues such as separation anxiety, possessiveness, and social behaviors that are not necessarily abnormal for preschoolers.

Correct Answer: C

Rationale: In a critically ill patient admitted to the ICU with acute renal failure requiring renal replacement therapy (RRT), the healthcare team should prioritize the initiation of continuous renal replacement therapy (CRRT). CRRT is preferred in critically ill patients with hemodynamic instability as it allows for slow and continuous removal of solutes and fluids, making it a safer option compared to intermittent hemodialysis. CRRT can also provide better control of volume status and electrolyte imbalances over a longer period, which is beneficial in critically ill patients who are hemodynamically unstable. Peritoneal dialysis is not commonly used in the ICU setting for acute renal failure requiring RRT, and loop diuretics are not effective in treating acute renal failure. Temporary hemodialysis catheters may also be used, but CRRT is generally preferred in critically ill patients for better hemodynamic tolerance and control of solute and fluid removal.

Correct Answer: D

Rationale: Referring the client to a lactation consultant for specialized support should be prioritized to support successful breastfeeding in this situation. Breast augmentation surgery may impact milk production, let-down reflex, and proper latch due to alterations in breast tissue and nerve pathways. A lactation consultant can provide individualized guidance and support to address these specific challenges. Additionally, the consultant can assist in establishing a breastfeeding plan tailored to the client's unique needs, helping to optimize the breastfeeding experience for both the mother and the baby. It is crucial to seek expert assistance in navigating any potential difficulties that may arise from breastfeeding after breast augmentation to promote successful breastfeeding outcomes.

Correct Answer: C

Rationale: Autonomy is the ethical principle that upholds an individual's right to make decisions about their own medical treatment, free from coercion or undue influence. In this scenario, the 70-year-old patient has voluntarily decided not to have the pacemaker inserted despite the physician's recommendation. The fact that the decision is respected by the family further highlights the importance of autonomy in this situation. Respecting the patient's right to make choices regarding their own healthcare, even if it goes against medical advice, demonstrates a commitment to autonomy as an ethical principle.

Correct Answer: B

Rationale: When a medication is unavailable and therefore not given to the patient, it is important to document this in the Nurses Notes along with an explanation. Leaving it blank (Option A) may lead to confusion or errors as the reason for not administering the medication would not be clear. Using an asterisk or mark as per hospital protocol (Option C) may not provide enough information about why the medication was missed. Writing the letter (Option D) without any explanation would not suffice in terms of documentation and accountability. Therefore, signing and making an explanation in the Nurses Notes (Option B) is the correct way to chart when a medication is unavailable. This ensures proper documentation of the situation and helps in maintaining the continuity of care for the patient.

Correct Answer: B

Rationale: The most appropriate intervention for a patient with difficulty swallowing due to end-stage ALS and concerns about choking is to refer the patient to a speech therapist for swallowing exercises and techniques (Choice B). Speech therapists are trained to assess and manage swallowing difficulties in patients, especially those with neurodegenerative diseases like ALS. They can provide specific exercises and strategies to help the patient swallow safely and reduce the risk of choking. This intervention focuses on addressing the underlying issue causing the difficulty swallowing and aims to improve the patient's quality of life by enhancing their ability to eat and drink. The other options are not as effective or appropriate in addressing the patient's concerns.

Correct Answer: D

Rationale: Thyroid nodules are abnormal growths of thyroid cells that form a lump within the thyroid gland. When a thyroid nodule becomes large enough, it can cause compressive symptoms such as difficulty swallowing and breathing. The presence of colloid nodules on fine-needle aspiration biopsy indicates a benign and common type of thyroid nodule. In this case, the symptoms are likely due to the physical pressure exerted by the thyroid nodule, rather than an underlying endocrine disorder like Hashimoto's thyroiditis, Graves' disease, or diabetes mellitus. Therefore, the most likely cause of the patient's symptoms is the thyroid nodule itself.

Correct Answer: D

Rationale: A directional hypothesis predicts the direction of the relationship between variables. In this case, the statement "A significant relationship exists between the caring behaviors of the staff-nurses and degree of satisfaction of ostomized patients" clearly indicates the direction of the expected relationship. This hypothesis suggests that there will be a positive or negative relationship between the caring behaviors of staff nurses and the satisfaction of ostomized patients. The terms "significant relationship" and "degree of satisfaction" indicate that the hypothesis is specific and measurable, making it suitable for testing through research methods.