A patient with a history of chronic obstructive pulmonary disease (COPD) is prescribed a metered-dose inhaler (MDI) with a spacer. Which instruction should the nurse include in the demonstration of MDI use?

Correct Answer: A

Rationale: The correct instruction for using a metered-dose inhaler (MDI) with a spacer for a patient with COPD is to inhale slowly and deeply while pressing the canister. This technique helps ensure that the medication reaches the lungs effectively. Inhaling slowly and deeply allows the medication to be properly delivered to the airways, maximizing its effectiveness in treating the symptoms of COPD. This instruction helps the patient coordinate pressing the canister with their inhalation, which is crucial for proper medication delivery in COPD management.

Correct Answer: B

Rationale: Avascular necrosis of the femoral head, also known as osteonecrosis, is a common complication associated with hip fractures in elderly patients. It occurs when there is a loss of blood supply to the femoral head following the fracture, leading to bone tissue death. This can result in pain, limitation of motion, and potentially the collapse of the femoral head, causing further complications. Timely diagnosis and appropriate management are crucial in order to prevent further degeneration of the hip joint. Other complications such as compartment syndrome, dislocation of the hip prosthesis, and Volkmann's contracture are not typically associated with hip fractures in elderly patients.

Correct Answer: B

Rationale: The type of incontinence that Patient Tita is demonstrating, with involuntary loss of urine occurring as a result of activities such as sneezing, coughing, or changing position, is known as stress incontinence. Stress incontinence occurs when there is increased pressure on the bladder, causing the sphincter muscles to weaken and leading to urine leakage. Activities that physically stress or put pressure on the bladder, such as the ones mentioned, can trigger episodes of stress incontinence.

Correct Answer: A

Rationale: Somatic hypermutation is the mechanism responsible for generating diversity in the antigen-binding sites of immunoglobulins. During somatic hypermutation, point mutations are introduced into the variable regions of immunoglobulin genes in B cells. These mutations occur randomly and lead to a wide range of amino acid changes in the antigen-binding sites of antibodies. As a result, a diverse repertoire of antibodies with varying specificities for different antigens is created. Gene rearrangement and isotype switching are other mechanisms that contribute to antibody diversity but do not specifically target the antigen-binding sites. Clonal expansion, on the other hand, refers to the proliferation of specific B cell clones after activation by antigens, which amplifies the immune response but does not directly impact the diversity of antigen-binding sites.

Correct Answer: C

Rationale: The correct action for the nurse to take when observing signs of distress and discomfort in a patient during assessment is to offer emotional support and actively listen to the patient's concerns. Ignoring the patient's distress may lead to worsening of the patient's condition and can be detrimental to the patient's well-being. Documenting the findings and informing the healthcare provider later is important but should not be the immediate response when a patient is in distress. Administering pain medication without further assessment is also not appropriate as the nurse needs to understand the underlying cause of the distress before providing appropriate interventions. Offering emotional support and actively listening to the patient's concerns can help the nurse understand the patient's needs, provide comfort, and potentially address the root cause of the distress.

Correct Answer: A

Rationale: The nurse should inform the public that rabies can be prevented. This is an extremely important piece of information to help raise awareness about the disease and promote preventive measures such as timely vaccination of both animals and humans. Rabies is a deadly viral infection that affects the central nervous system, and prevention through vaccination is highly effective in controlling its spread. By emphasizing the preventability of rabies, the nurse can educate the public on the importance of taking proactive steps to avoid contracting the disease.

Correct Answer: B

Rationale: The primary aim of this law is to regulate the practice of professional nursing within the country. By establishing regulations, standards, and guidelines for nursing practice, the law ensures that nurses provide safe and competent care to patients. It also sets forth licensing requirements, scope of practice, and ethical standards to maintain quality and consistency in nursing care delivery. While enhancing the competence of professional nurses, facilitating mobility of nurses, and promoting the well-being of health workers may be important secondary goals, the main focus of the law is to regulate and govern the practice of nursing within the country.

Correct Answer: B

Rationale: The most appropriate action in this situation is to perform abdominal thrusts, also known as the Heimlich maneuver. This technique is used to clear a blocked airway caused by a choking obstruction. Encouraging continued coughing may not be effective if the person is unable to dislodge the obstruction on their own. Delivering back blows can sometimes be effective, but abdominal thrusts are more commonly recommended in cases of choking in adults. Administering rescue breaths is not recommended if the person is conscious and able to cough, as it may worsen the situation by pushing the obstruction further down. By quickly performing abdominal thrusts, you can help dislodge the obstruction and potentially save the person's life.

Correct Answer: C

Rationale: Type 2 diabetes mellitus is characterized by insulin resistance in the peripheral tissues and defective beta cell secretion with loss of insulin. In type 2 diabetes, there is typically not destruction of beta cells from an autoimmune mechanism that leads to lack of insulin and hyperglycemia as seen in type 1 diabetes mellitus. Instead, in type 2 diabetes, the pancreas initially produces insulin, but the body's cells become resistant to its effects. This results in hyperglycemia due to the inability of the body to properly regulate blood sugar levels. Therefore, choice C is not true for type 2 diabetes mellitus.