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: C

Rationale: When a nurse discovers a discrepancy between the medication order and the patient's medication record, the priority action is to verify the medication order with the prescriber to ensure accuracy and patient safety. Administering the medication without clarification can put the patient at risk. Documenting the discrepancy and informing the charge nurse is important, but it should not delay verifying the order with the prescriber. Contacting the pharmacy for clarification may be necessary in some cases, but the immediate action should be to confirm the prescription with the prescriber to prevent errors and ensure the patient receives the correct medication.

Correct Answer: C

Rationale: The sudden onset of shortness of breath, chest pain, and cyanosis in a postpartum client could be indicative of a pulmonary embolism, a potentially life-threatening condition. Therefore, it is crucial to notify the healthcare provider immediately for further assessment and management. Prompt intervention is essential in this situation to prevent any potential complications and ensure the client receives appropriate care as soon as possible. Placing the client in a semi-Fowler's position or administering supplemental oxygen therapy may provide temporary relief, but the priority is to seek immediate medical attention. Consulting with the healthcare provider ensures that the client receives the necessary interventions promptly.

Correct Answer: D

Rationale: Patients with hypothyroidism have a decreased ability to regulate their body temperature due to the reduced hormone levels. Exposure to cold temperatures can exacerbate this issue and lead to symptoms such as cold intolerance, feeling cold all the time, and potentially even hypothermia. It is important for patients with hypothyroidism to avoid prolonged exposure to cold temperatures to prevent any negative impact on their health.

Correct Answer: A

Rationale: The sudden onset of severe vertigo, nausea, vomiting, and nystagmus in a patient with a recent upper respiratory tract infection is highly suggestive of vestibular neuritis. Vestibular neuritis is typically caused by inflammation of the vestibular nerve, often following a viral infection such as an upper respiratory tract infection. This condition presents with acute, severe, continuous vertigo without associated hearing loss. The presence of nystagmus, along with the absence of hearing loss, helps differentiate vestibular neuritis from Meniere's disease (which typically presents with episodic vertigo, hearing loss, and tinnitus) and acoustic neuroma (which presents with gradual onset of symptoms including unilateral hearing loss, tinnitus, and imbalance). Benign paroxysmal positional vertigo (BPPV) typically presents with brief episodes of vertigo triggered by specific head movements, rather than the continuous vertigo seen in this case.

Correct Answer: D

Rationale: Non-maleficence is the ethical principle that emphasizes the obligation to avoid causing harm to patients. In this scenario, the ER nurse clarifies the doctor's prescription to ensure the correct dosage of the pain medication based on the pain scale assessment and the patient's age. By doing so, the nurse is ensuring that the medication is safe and effective for the patient, thus adhering to the principle of non-maleficence. This action demonstrates the nurse's commitment to preventing harm and promoting the well-being of the patient through proper medication management.

Correct Answer: A

Rationale: Estrogen exerts negative feedback on the hypothalamus by inhibiting the release of GnRH (Gonadotropin-Releasing Hormone). GnRH plays a crucial role in the regulation of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) production from the pituitary gland. By inhibiting the release of GnRH, estrogen ultimately leads to a decrease in FSH and LH levels. This process helps to suppress the maturation of the egg and ovulation, providing contraceptive effects.

Correct Answer: D

Rationale: The nurse who uses appropriate therapeutic listening skills will display the best behavior by absorbing both the content and the feeling which the patient is conveying. In the given scenario, Belle is experiencing a range of symptoms due to her mental health issues, trauma, and past experiences. By actively listening and absorbing both the content (symptoms, concerns) and the feelings (depressed mood, worry, irritability) which Belle is conveying, the nurse can demonstrate empathy, understanding, and validation of Belle's experiences. This type of therapeutic listening helps to build trust, rapport, and a supportive therapeutic relationship between the nurse and the patient, which is crucial for effective communication, assessment, and treatment in mental health care settings.

Correct Answer: C

Rationale: Bruxism is the dental condition characterized by the involuntary grinding or clenching of teeth, often occurring during sleep. This habitual behavior can lead to tooth wear, muscle pain, headaches, and temporomandibular joint dysfunction. Dental caries (choice A) refers to tooth decay, while attrition (choice B) specifically refers to the wearing down of teeth due to forces like chewing. Periodontitis (choice D) is a condition involving inflammation and infection of the gums and supporting structures of the teeth. Among the choices provided, bruxism is the most fitting description for the condition characterized by tooth grinding and clenching.