A patient with terminal illness expresses fear and anxiety about dying alone. What intervention should the palliative nurse prioritize to address the patient's concerns?

Correct Answer: A

Rationale: The most appropriate intervention for the palliative nurse to prioritize in this situation is to arrange for family members or loved ones to be present at the patient's bedside. Having loved ones nearby can provide emotional support, comfort, and reassurance to the patient during their final moments. This can help alleviate the fear and anxiety the patient is experiencing about dying alone. Additionally, it can contribute to a sense of connectedness and peace for both the patient and their loved ones during this challenging time. Offering practical solutions to address the patient's emotional needs is key in providing holistic palliative care.

Correct Answer: A

Rationale: Hashimoto's thyroiditis is an autoimmune disorder characterized by chronic inflammation of the thyroid gland. In this condition, lymphocytic infiltration and germinal centers can be seen in the thyroid tissue. This inflammation can lead to the formation of thyroid nodules and enlargement of the thyroid gland, causing symptoms such as difficulty swallowing and breathing due to compression of surrounding structures. Additionally, Hashimoto's thyroiditis can result in hypothyroidism over time, further contributing to the symptoms. Therefore, the patient in this case is most likely experiencing these symptoms due to Hashimoto's thyroiditis. Graves' disease, on the other hand, typically presents with hyperthyroidism and is less likely to manifest as compressive symptoms of the thyroid gland.

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: Bursitis is characterized by inflammation of the bursa, which is a small, fluid-filled sac that cushions and reduces friction between bones, tendons, and muscles near joints. In the shoulder, bursitis commonly affects the subacromial bursa, located between the rotator cuff tendons and the top of the shoulder blade. The inflammation of this bursa can lead to pain and restricted movement around the shoulder joint.

Correct Answer: B

Rationale: The palliative nurse should prioritize performing thoracentesis to drain the pleural fluid and relieve dyspnea in a patient with terminal cancer experiencing pleural effusion. Pleural effusion is a common complication in patients with advanced cancer and can cause significant respiratory distress. Drainage of the pleural fluid through thoracentesis can provide immediate relief by easing the pressure on the lungs and improving the patient's ability to breathe. This intervention is essential in managing dyspnea for comfort and quality of life in palliative care settings. Administering bronchodilator medications (option A) or recommending non-invasive positive pressure ventilation (option C) may not directly address the underlying cause of dyspnea in this case. While relaxation techniques (option D) can help with anxiety and overall well-being, they may not be sufficient in managing the physical symptom of dyspnea caused by pleural effusion.

Correct Answer: D

Rationale: In a 55-year-old postmenopausal woman presenting with vaginal bleeding and a healthy cervix on examination, the most likely cause would be a cervical polyp. Cervical polyps are benign growths that can occur on the cervix and are often asymptomatic but can occasionally cause postmenopausal bleeding. Their appearance on examination would typically be a non-malignant finding with no cervical motion tenderness. Cervical cancer, endometrial cancer, and vaginal cancer would typically present with different examination findings and risk factors.

Correct Answer: D

Rationale: Arterial blood gases (ABGs) do not directly assess the client's electrolyte and fluid balance. ABGs primarily evaluate the client's acid-base balance and oxygenation status by measuring levels of pH, partial pressure of carbon dioxide (PCO2), and bicarbonate (HCO3) in the arterial blood. While ABGs can provide some information about blood parameters, such as oxygen saturation, they do not comprehensively assess electrolyte levels or fluid balance. To specifically assess electrolytes and fluid balance, additional tests like basic metabolic panels or comprehensive metabolic panels would be required.

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: 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.