A patient says, I know I have a brain tumor despite the results of the magnetic resonance image (MRI). The radiologist is wrong. People who have brain tumors vomit, and yesterday I vomited all day. Which response by the nurse fosters cognitive restructuring?

Correct Answer: B

Rationale: The correct answer is B because it encourages the patient to consider alternative explanations for their symptoms, which is key in cognitive restructuring. By exploring other possible reasons for the vomiting, the patient is guided to challenge their automatic assumption of having a brain tumor. This approach helps the patient to reevaluate their thoughts and beliefs in a more rational manner. Choices A, C, and D are incorrect: A: This response dismisses the patient's concerns without addressing the underlying irrational belief. It does not promote cognitive restructuring. C: While acknowledging the patient's emotions is important, this response does not actively challenge the patient's irrational belief or encourage critical thinking. D: Changing the subject does not address the patient's cognitive distortions and does not facilitate cognitive restructuring.

Correct Answer: A

Rationale: The correct answer is A) A 34-year-old patient newly diagnosed with multiple sclerosis (MS). This patient is the most suitable for assignment to the traveling nurse new to neurologic nursing care due to several reasons. Firstly, a newly diagnosed MS patient would likely not have complex care needs compared to patients with chronic conditions like ALS or GBS in respiratory distress. This would provide a good learning opportunity for the new nurse to gain confidence and skills in managing neurologic conditions. Additionally, as a newly diagnosed patient, there may be a focus on education, symptom management, and emotional support, which aligns well with the new nurse's learning objectives. Option B) The 68-year-old patient with chronic amyotrophic lateral sclerosis (ALS) may have complex care needs and require specialized care due to the progressive nature of the disease. The new nurse may not have the experience or skills yet to effectively manage the care needs of a patient with ALS. Option C) The 56-year-old patient with Guillain-Barré syndrome (GBS) in respiratory distress requires urgent and specialized care, including respiratory support. This patient's condition is critical and may be overwhelming for a nurse who is new to neurologic nursing care. Option D) The 25-year-old patient admitted with C4 level spinal cord injury (SCI) may also have complex care needs, including potential respiratory issues and neurologic deficits. This patient would require a nurse with more experience in neurologic nursing care to provide comprehensive and safe management. Assigning the newly diagnosed MS patient to the traveling nurse would offer a suitable learning experience while ensuring safe and appropriate care for the patient. This scenario provides a balance between the patient's needs and the nurse's learning requirements, fostering professional growth and quality patient care.

Correct Answer: D

Rationale: In this scenario, the correct observation that the LPN/LVN should report immediately is option D) Shallow respirations and decreased breath sounds. This is crucial because Guillain-Barre Syndrome (GBS) can lead to respiratory muscle weakness, which can progress to respiratory failure and is a life-threatening complication. Option A) Complaints of numbness and tingling are common symptoms of GBS but do not indicate an immediate life-threatening situation. Option B) Facial weakness and difficulty speaking are also signs of GBS but are not as critical as compromised respiratory function. Option C) Rapid heart rate of 102 beats per minute is not uncommon in patients with GBS due to autonomic dysfunction, but it is not as urgent as respiratory distress. Educationally, understanding the priority of assessments in neurological conditions like GBS is crucial for patient safety. Teaching healthcare providers to recognize and respond promptly to respiratory changes can prevent serious complications and improve patient outcomes in neurological emergencies.

Correct Answer: B

Rationale: The most appropriate nursing diagnosis for this patient is B) Caregiver Role Strain related to continuous need for providing care. This diagnosis is correct because the husband's statement indicates that he is experiencing strain and stress due to the constant need to monitor and care for his wife, who has Alzheimer's disease and is at risk of wandering during the night. This situation places a significant burden on the caregiver and can lead to physical, emotional, and mental exhaustion. Option A) Decreased Cardiac Output related to poor myocardial contractility is incorrect because there is no direct evidence in the scenario to support this nursing diagnosis. The patient's angina and Alzheimer's disease are not linked to poor myocardial contractility. Option C) Risk for Falls related to patient wandering behavior during the night is incorrect because while the patient's wandering behavior does pose a risk for falls, the focus of the question is on the caregiver's well-being, not solely on the patient's safety. Option D) Ineffective Therapeutic Regimen Management related to poor patient memory is incorrect because the husband's actions do not suggest an issue with the patient's memory affecting her ability to manage her therapeutic regimen. Instead, the scenario highlights the caregiver's struggle in managing the care of a patient with Alzheimer's disease. In an educational context, understanding and identifying caregiver role strain is crucial in providing holistic care to patients with chronic conditions like Alzheimer's disease. Nurses need to assess not only the patient's well-being but also the caregiver's ability to cope with the demands of caregiving. By recognizing and addressing caregiver role strain, healthcare professionals can support both the patient and the caregiver in maintaining their health and well-being.

Correct Answer: B

Rationale: In this scenario, the most appropriate initial collaborative intervention is to transfer the patient to radiology for a CT scan (Option B). This decision is based on the patient's presentation of acute lethargy, confusion, and incontinence following a fall down the stairs, which could suggest a traumatic brain injury or intracranial pathology. A CT scan would help identify any acute intracranial hemorrhage, contusions, or other traumatic brain injuries that may be contributing to the patient's symptoms. Option A, placing the patient on the hospital alcohol withdrawal protocol, is not the initial priority as the patient's symptoms are more indicative of a neurological issue rather than alcohol withdrawal. Option C, inserting a retention catheter, addresses incontinence but does not address the primary concern of the patient's altered mental status. Option D, giving phenytoin, is not indicated as there is no information provided to suggest a need for antiepileptic medication at this time. From an educational perspective, understanding the importance of prioritizing interventions based on the patient's presentation and symptoms is crucial in providing effective care. This case highlights the significance of conducting appropriate diagnostic tests promptly to identify and address potential life-threatening conditions in a timely manner.