A patient with advanced dementia is bedbound and at risk of developing pressure ulcers. What intervention should the palliative nurse prioritize to prevent pressure ulcer formation?

Correct Answer: C

Rationale: The most effective intervention to prevent pressure ulcers in bedbound patients at risk, such as those with advanced dementia, is to use pressure-relieving support surfaces like specialized mattresses or cushions. These surfaces help distribute the pressure evenly, reducing the risk of pressure ulcer formation on bony prominences. Turning the patient every 2 hours (choice A) can also help relieve pressure, but it may not be sufficient to prevent pressure ulcers in high-risk individuals. Applying barrier creams or moisture barriers (choice B) can help protect the skin but may not address the underlying issue of pressure on vulnerable areas. Administering prophylactic antibiotics (choice D) is not recommended for preventing pressure ulcers as it does not address the root cause of the problem and can lead to antibiotic resistance. Therefore, the priority intervention should be to use pressure-relieving support surfaces to minimize the risk of pressure ulcers in

Correct Answer: A

Rationale: The symptoms described - sudden-onset severe headache, nausea, vomiting, photophobia, neck stiffness, and positive Kernig and Brudzinski signs - are classic manifestations of meningitis. Meningitis is an inflammation of the meninges, the protective membranes covering the brain and spinal cord, often caused by infection. The sudden onset of these symptoms and signs, along with neck stiffness and positive Kernig and Brudzinski signs (indicative of meningeal irritation), strongly suggest meningitis as the most likely diagnosis in this scenario.

Correct Answer: B

Rationale: Morbidity refers to the state of being diseased or unhealthy, which is not directly related to population growth. On the other hand, fertility, mortality, and migration are three fundamental demographic variables that significantly influence population growth. Fertility refers to the ability of a population to produce offspring, mortality deals with death rates within a population, and migration involves the movement of individuals into or out of a particular area. These three variables play crucial roles in shaping the size and composition of a population over time.

Correct Answer: B

Rationale: In hypovolemic shock, isotonic electrolyte solutions are commonly used for fluid replacement to restore the circulating blood volume. The commonly used isotonic electrolyte solutions for this purpose are 0.9% sodium chloride (normal saline) and lactated Ringer's solution.

Correct Answer: C

Rationale: Battery occurs when there is an intentional harmful or offensive contact with a person without their consent. In this scenario, Nurse Edna applied a body restraint to the patient without the doctor's order, which constitutes unauthorized physical contact. The patient did not give consent for the restraint, and Nurse Edna's action could be considered battery. It is important for healthcare providers to obtain proper authorization before using any form of physical restraint on a patient to avoid legal implications such as battery.

Correct Answer: A

Rationale: Participating in professional organizations can be a valuable way for Nurse Bea to enhance her career in nursing aside from enrolling in graduate school. Professional organizations provide networking opportunities, access to resources and information, opportunities for professional development through workshops and conferences, and a platform for engaging in advocacy efforts to promote the nursing profession. By being an active member of a professional organization, Nurse Bea can further her knowledge, skills, and connections within the nursing field, which can contribute to her career advancement.

Correct Answer: C

Rationale: Battery occurs when there is an intentional touching of another person without their consent. In this case, the nurse began cardiopulintary resuscitation on a client who had requested a "Do Not Resuscitate" (DNR) order, which means the client did not consent to the resuscitation. This action can be considered as battery because the client's wishes were not respected, and the nurse proceeded with a medical intervention against those wishes, leading to harm and potential legal consequences. This is different from assault, which involves a threat of force, and from defamation and fraud, which are not applicable to this situation.

Correct Answer: D

Rationale: Bronze baby syndrome is the term used to describe the transient discoloration of a baby's skin while undergoing phototherapy treatment for jaundice. This phenomenon typically occurs in preterm infants and is believed to be caused by the breakdown of bilirubin into colored pigments during phototherapy. The discoloration can range from a bronze or brownish color to a grayish-green hue. One key characteristic of bronze baby syndrome is that the discoloration is reversible once phototherapy is complete and does not indicate any underlying health concerns. It is important for healthcare providers to be aware of this phenomenon to avoid unnecessary interventions or alarm to the caregivers.

Correct Answer: A

Rationale: Having a tracheostomy means that a patient has an artificial opening in their neck to help them breathe. Therefore, any issues related to breathing, such as blockages in the tracheostomy tube or difficulty in clearing secretions, can pose a major problem for a patient with a tracheostomy. It is crucial to monitor the patient's respiratory status closely and intervene promptly if any breathing difficulties arise to prevent potential respiratory distress or complications.