A patient with a history of multiple myeloma presents with weakness, bone pain, and recurrent infections. Laboratory tests reveal anemia, hypercalcemia, renal insufficiency, and monoclonal spike on serum protein electrophoresis. Which of the following conditions is most likely to cause these findings?

Correct Answer: D

Rationale: Multiple myeloma is a plasma cell neoplasm characterized by the presence of abnormal monoclonal plasma cells in the bone marrow, which produce a monoclonal spike on serum protein electrophoresis. The clinical presentation of weakness, bone pain, and recurrent infections is typical of multiple myeloma. Anemia can result from bone marrow infiltration by the abnormal plasma cells, hypercalcemia is due to bone destruction and release of calcium, renal insufficiency can result from hypercalcemia and protein deposition in the kidneys, and the monoclonal spike in serum protein electrophoresis indicates the presence of a monoclonal protein. Waldenström macroglobulinemia, Hodgkin lymphoma, and chronic lymphocytic leukemia do not typically present with the classic tetrad of findings seen in multiple myeloma.

Correct Answer: D

Rationale: The aim of pelvic muscle exercises for a patient with urinary incontinence is to strengthen the muscles that control the vagina and urethra. These exercises, known as Kegel exercises, target the pelvic floor muscles that support the pelvic organs and help in controlling urinary function. Strengthening these muscles can help improve bladder control and reduce or eliminate urinary incontinence. Exercises that target the perineal area can also be beneficial in managing urinary incontinence, but the main focus is on strengthening the muscles that control the vagina and urethra.

Correct Answer: C

Rationale: The initial action the nurse should take when faced with a situation where a patient refuses to take medication after education and explanation is to notify the physician. The physician may need to be informed so they can reassess the medication and potentially explore alternative options or make adjustments based on the patient's concerns and preferences. It is important for medical decisions to be made in collaboration with the healthcare team to ensure the best care for the patient. Consulting the physician also helps in avoiding any potential negative outcomes resulting from the patient's refusal to take the prescribed medication. Once the physician is aware, further actions can be discussed and implemented to address the patient's concerns.

Correct Answer: C

Rationale: The first action the nurse should take when a patient post-thyroidectomy develops signs of hypocalcemia is to assess the patient's calcium level. By assessing the patient's calcium level through laboratory testing, the nurse can confirm the presence of hypocalcemia and determine the severity of the condition. This information will guide further interventions, such as administering calcium supplements or notifying the healthcare provider for additional management. It is important to confirm the diagnosis before proceeding with treatment to ensure appropriate and safe care for the patient.

Correct Answer: B

Rationale: In the given situation, the nursing diagnosis that is NOT RELEVANT to sexual health is option B, Health-seeking behaviors related to reproductive functioning. This diagnosis focuses on the patient's proactive approach to seeking healthcare services related to reproductive health matters. However, in the situation presented of a pregnant patient with sickle cell anemia experiencing fever, painful swelling, and in labor pain, the immediate priority lies in addressing the health issues related to sickle cell disease and the current pregnancy. Sexual health is not the primary concern in this scenario compared to managing the complications of sickle cell anemia during pregnancy. Therefore, the diagnosis related to health-seeking behaviors related to reproductive functioning is not as pertinent in this specific case.

Correct Answer: A

Rationale: The ethical principle that should guide the nurse's decision-making in this situation is beneficence, which emphasizes the nurse's obligation to act in the best interest of the patient. In this scenario, the nurse must balance the patient's request for pain medication with considerations related to the patient's history of substance abuse. The nurse should prioritize providing effective pain relief for the patient while also considering the potential risks of administering medication to someone with a history of substance abuse. By focusing on beneficence, the nurse can make decisions that promote the well-being and best interests of the patient, taking into account both the immediate need for pain relief and the patient's history of substance abuse.

Correct Answer: A

Rationale: Maternal dehydration can contribute to a prolonged latent phase during labor. Dehydration can lead to reduced blood volume and electrolyte imbalances, which can result in ineffective uterine contractions. Without adequate hydration, the uterus may not contract effectively, causing irregular and infrequent contractions. It is important for the nurse to assess the woman's hydration status and encourage her to stay hydrated during labor to help regulate contractions and progress labor.

Correct Answer: B

Rationale: Health education is a crucial component of public health aimed at promoting health, preventing diseases, and empowering individuals to make informed decisions about their health. It is not limited to only professionals like nurses but is the responsibility of every health worker across various disciplines. Health workers, including doctors, community health workers, public health educators, and others, play a vital role in delivering health education to the community they serve. By ensuring that health education is a shared responsibility among all health workers, a more comprehensive and effective approach to public health promotion can be achieved. It is continuously evolving to adapt to changing health needs and challenges, making it dynamic rather than remaining constant. Therefore, option B is the most accurate statement regarding health education in public health.

Correct Answer: D

Rationale: A descriptive case study design is the most suitable approach when Nurse Carmi decides to make an in-depth study of only one subject of domestic violence. This design involves a comprehensive and detailed exploration of a single individual or a specific situation, allowing for an in-depth analysis of various aspects related to the subject. Since Nurse Carmi is focusing on studying only one subject, a case study design will enable her to gather detailed information, delve deep into the complexities of the individual's experiences, behaviors, and outcomes related to domestic violence. This design will provide a rich and holistic understanding of the single case being studied, offering valuable insights and potential implications for practice and intervention strategies.