A patient receiving palliative care for end-stage renal disease expresses distress over changes in body image due to edema and weight gain. What intervention should the palliative nurse prioritize to address the patient's concerns?

Correct Answer: C

Rationale: The most appropriate intervention for the palliative nurse to prioritize in this situation is to offer emotional support and validate the patient's feelings about body image changes. End-stage renal disease can lead to significant physical changes such as edema and weight gain, which can impact a patient's body image and self-esteem. By providing emotional support and validating the patient's feelings, the nurse can help address the patient's distress and concerns, improving their overall psychological well-being. While providing education on dietary modifications (choice B) and prescribing diuretic medications (choice D) may be important aspects of managing fluid retention and edema, addressing the patient's emotional distress and body image concerns should be the initial priority in a palliative care setting. Encouraging the patient to accept their body changes (choice A) may overlook the emotional impact these changes have on the patient, making choice C the most appropriate intervention.

Correct Answer: C

Rationale: Cleaning the inner cannula daily helps prevent the accumulation of secretions and debris, which can lead to blockages and infections. It is an essential aspect of tracheostomy care to maintain the patency of the airway and prevent complications. Caregivers should be taught how to safely remove, clean, and reinsert the inner cannula as part of routine tracheostomy care.

Correct Answer: A

Rationale: The patient's presentation with fatigue, pallor, dyspnea on exertion, low hemoglobin level, decreased MCV, and decreased MCHC are all consistent with iron deficiency anemia. Iron deficiency anemia is the most common type of anemia and occurs when there is insufficient iron available for hemoglobin production. The low hemoglobin level results in symptoms such as fatigue and pallor, while the decreased MCV and MCHC indicate microcytic and hypochromic red blood cells, respectively, which are characteristic of iron deficiency anemia. Vitamin B12 deficiency anemia and thalassemia typically present with a different pattern of laboratory findings and clinical manifestations. Sickle cell anemia is characterized by sickle-shaped red blood cells due to a genetic mutation, and the laboratory findings in sickle cell anemia are different from those seen in the patient described in this scenario.

Correct Answer: D

Rationale: Demerol (meperidine hydrochloride) is an opioid analgesic commonly used as a preoperative medication to decrease intra-operative anesthetic requirements and provide analgesia. Opioids like Demerol act on the central nervous system to reduce pain sensations, making it an effective choice for preoperative pain management. This can help decrease the amount of anesthesia needed during surgery, leading to better pain control and overall patient comfort during and after the procedure. Celebrex, acetaminophen, and ibuprofen are also used for pain management, but they do not have the same potency and mechanism of action as opioids like Demerol for reducing intra-operative anesthetic requirements.

Correct Answer: B

Rationale: During the acute phase response, C-reactive protein (CRP) primarily serves to activate the complement system. CRP binds to phosphocholine on the surface of pathogens, allowing for the activation of the classical pathway of the complement system. This leads to the recruitment of immune cells, opsonization of pathogens, and enhancement of phagocytosis. The activation of the complement system by CRP plays a crucial role in the host defense against infections, aiding in the elimination of pathogens and the resolution of inflammation.

Correct Answer: D

Rationale: Nursing mothers should not wash their nipples with soap and water prior to feeding. Using soap can dry out the skin and potentially lead to irritation or cracking of the nipple, which can increase the risk of mastitis. It is recommended to simply clean the nipples with water, if necessary.

Correct Answer: C

Rationale: Rabies is a viral disease that affects the central nervous system. It is primarily transmitted through the bite of an infected animal, such as dogs, bats, raccoons, and foxes. The causative agent of rabies is the rabies virus, specifically from the genus Lyssavirus. Once the virus enters the body, it spreads through the nervous system to the brain, leading to severe neurological symptoms and, if left untreated, is almost always fatal. This is why prompt medical attention and vaccination following an animal bite are crucial in preventing the development of rabies in humans.

Correct Answer: B

Rationale: Acute otitis media is the most likely condition responsible for this presentation. The sudden onset of severe, unilateral ear pain, diminished hearing, and purulent otorrhea are classic symptoms of acute otitis media. Otoscopic examination revealing a bulging, erythematous tympanic membrane with obscured landmarks further supports the diagnosis. The bulging of the tympanic membrane is due to the accumulation of fluid and pus behind it, causing the characteristic appearance. Treatment typically involves antibiotics to help clear the infection and relieve symptoms. If left untreated, acute otitis media can lead to complications such as perforation of the eardrum or mastoiditis.

Correct Answer: B

Rationale: Baby Sharon's APGAR score can be determined by assessing five criteria: heart rate, respiratory effort, muscle tone, reflex irritability, and color. Each criteria is given a score of 0, 1, or 2 points, with 2 being the highest score.