A patient receiving palliative care for end-stage pancreatic cancer experiences severe abdominal pain. What intervention should the palliative nurse prioritize to manage the patient's symptoms?

Correct Answer: A

Rationale: In a patient with severe abdominal pain due to end-stage pancreatic cancer, the priority intervention to manage their symptoms would be to provide adequate pain relief. Opioid analgesics are the cornerstone of pain management for cancer patients experiencing severe pain. They work by binding to opioid receptors in the central nervous system, thereby reducing the perception of pain. Opioids are highly effective in managing cancer pain, including abdominal pain, and can significantly improve the patient's quality of life by providing relief from distressing symptoms. Therefore, administering opioid analgesics should be the nurse's primary intervention in this case to address the patient's severe abdominal pain. Initiating enteral nutrition, recommending hot compresses, or referring to a gastroenterologist may be relevant interventions depending on the patient's overall care plan but addressing the pain should be the immediate priority in this scenario.

Correct Answer: A

Rationale: Opsonization refers to the process by which antibodies bind to the surface of pathogens, marking them for destruction by phagocytes or complement proteins. This coating of antibodies enhances the ability of the immune system to recognize and eliminate the pathogens effectively. Phagocytes (such as macrophages and neutrophils) are better able to engulf and digest pathogens that have been opsonized, as the antibodies attached to the pathogen surface signal to the phagocytes that they are foreign invaders. This process is crucial in the body's immune response to infections and helps in clearing pathogens from the system.

Correct Answer: B

Rationale: A temperature of 39.8 degrees Celsius (103.6 degrees Fahrenheit) in a patient following abdominal surgery and ongoing blood transfusion may indicate an ongoing potential infection. During surgery, the body is exposed to various microorganisms, and the stress of surgery can weaken the immune system, making the patient more susceptible to infections. Blood transfusions also carry a risk of introducing infections if not properly screened. Therefore, in this situation, an elevated temperature may be a sign that an infection is developing, and prompt notification of the surgeon is important for further evaluation and management.

Correct Answer: C

Rationale: Before initiating hydrotherapy for pain relief during labor, the nurse's priority action should be to assess the maternal and fetal conditions to determine if the mother is eligible for this form of pain management. It is essential to ensure that hydrotherapy is safe and appropriate for the specific situation. Assessing the maternal condition includes evaluating factors such as the stage of labor, maternal and fetal well-being, and any medical conditions that could impact the use of hydrotherapy. This assessment helps to identify any contraindications or risks that may affect the mother and baby during hydrotherapy. By conducting a thorough assessment, the nurse can make an informed decision about whether hydrotherapy is suitable for the woman in labor.

Correct Answer: D

Rationale: The causative agent of dengue fever is a virus. Dengue fever is primarily transmitted to humans by the bite of infected Aedes mosquitoes, particularly Aedes aegypti and Aedes albopictus. These mosquitoes act as vectors, carrying and transmitting the dengue virus (specifically four closely related but antigenically different serotypes: DEN-1, DEN-2, DEN-3, and DEN-4) to humans during the feeding process. The virus then replicates in the human body, causing symptoms of dengue fever. Therefore, the correct answer is D. Virus.

Correct Answer: A

Rationale: Demonstrating tandem breastfeeding positions and techniques should be prioritized as the nursing intervention to address the client's concerns about breastfeeding both infants simultaneously. Tandem breastfeeding involves nursing twins at the same time and can help enhance milk production, promote bonding with both infants, and save time for the mother. By showing the client the proper positions and techniques for tandem breastfeeding, the nurse can empower the client with the knowledge and skills needed to successfully breastfeed both infants together. This intervention can ultimately support the client in feeling more confident and competent in managing the challenges of breastfeeding twins.

Correct Answer: C

Rationale: Children with ADHD often display hyperactive and impulsive behaviors, such as excessive running, climbing, and fidgeting. These behaviors are characteristic symptoms of the hyperactive-impulsive subtype of ADHD. Children with ADHD may struggle to sit still, have difficulty engaging in quiet activities, and often seem on the go. Therefore, the nurse would expect to see signs of excessive movement and restlessness in a child with ADHD.

Correct Answer: A

Rationale: Acute respiratory distress syndrome (ARDS) is a serious and life-threatening condition characterized by rapid onset of respiratory failure, severe hypoxemia (low oxygen levels in the blood), and non-cardiogenic pulmonary edema. The hallmark of ARDS is severe hypoxemia that is difficult to correct even with high levels of supplemental oxygen. Patients with ARDS often require mechanical ventilation to maintain adequate oxygen levels. Severe cough with purulent sputum production, chest pain exacerbated by deep breathing, and productive cough with hemoptysis are not typical features of ARDS.

Correct Answer: B

Rationale: The right to refuse treatment is a fundamental patient right. In this case, the physician ordering medications for the client to take at home without the client's input or agreement could possibly violate the client's right to refuse treatment. It is important for patients to have the autonomy to make decisions regarding their own treatment, especially when they are still weak and symptomatic. Patients should have the opportunity to discuss their treatment plan with their healthcare provider and express any concerns or preferences they may have.