A patient receiving palliative care for end-stage amyotrophic lateral sclerosis (ALS) experiences difficulty swallowing and expresses concerns about choking. What intervention should the palliative nurse prioritize to address the patient's concerns?

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: A

Rationale: The described presentation of a pruritic, annular rash with central clearing and a raised, scaly border that spreads outward in a centrifugal pattern is characteristic of tinea corporis, commonly known as ringworm. This fungal infection affects the skin and is typically ring-shaped, with a well-defined, slightly raised, and scaly border. The central area often clears as the lesion enlarges peripherally, resembling a ring. It is important to note that ringworm is not caused by a worm but by a fungus. Treatment typically involves antifungal medications applied topically or taken orally, depending on the severity of the infection.

Correct Answer: D

Rationale: Insulinoma is a rare neuroendocrine tumor that arises from pancreatic beta cells, leading to excessive production and secretion of insulin. The symptoms described in the patient, such as weight loss, fatigue, nausea, vomiting, abdominal pain, hypoglycemia, and elevated insulin levels, are characteristic of insulinoma.

Correct Answer: A

Rationale: Task A, obtaining special food for the patient when she requests it, can be delegated to the nursing assistant. This task involves simple assistance with gathering food items and does not require specific medical knowledge or interventions. Tasks B, C, and D involve more direct patient care and assessment, which should be performed by the nursing staff who have the necessary training and expertise to address the complexities of anorexia nervosa.

Correct Answer: D

Rationale: Patients prescribed proton pump inhibitors (PPIs) for the treatment of GERD should be closely monitored for the development of osteoporosis. PPIs have been associated with an increased risk of developing osteoporotic fractures, particularly in long-term users. This risk is thought to be due to decreased calcium absorption as stomach acidity is reduced by PPIs, leading to potential alterations in bone metabolism and density. Therefore, it is important for healthcare providers to assess bone health, educate patients on calcium and vitamin D supplementation, and consider other risk factors for osteoporosis in individuals taking PPIs long-term. While hypoglycemia, hyperkalemia, and Clostridium difficile infection may be seen as adverse effects with other medications or conditions, osteoporosis is the adverse effect most closely monitored in patients taking PPIs for GERD.