A postpartum client reports severe perineal pain and difficulty passing stools following a vaginal delivery. Which nursing intervention should be implemented?

Correct Answer: A

Rationale: Administering a stool softener as ordered is the most appropriate nursing intervention for a postpartum client experiencing severe perineal pain and difficulty passing stools following a vaginal delivery. Stool softeners help to soften the stool, making it easier for the client to pass without straining, which can exacerbate perineal pain. It is important to follow the healthcare provider's orders when administering medications to ensure proper dosing and effectiveness. Encouraging the client to refrain from defecation may lead to constipation and worsen the situation. Applying ice packs to the perineum can provide temporary pain relief, but addressing the underlying issue of constipation with a stool softener is more effective in the long term. Providing education on proper perineal hygiene is important for overall postpartum care, but addressing the immediate issue of constipation with a stool softener takes precedence in this scenario.

Correct Answer: D

Rationale: In the scenario described, with the patient having an acute exacerbation of chronic kidney disease (CKD) leading to hyperkalemia and metabolic acidosis, the priority intervention to manage the metabolic derangements is to perform emergent hemodialysis for potassium removal. Hemodialysis is the most effective and rapid method to lower dangerously high potassium levels in the blood. It is crucial in cases of severe hyperkalemia where other measures such as medications or dietary modifications may not be sufficient or fast enough to correct the elevated potassium levels. Additionally, hemodialysis can also help in improving metabolic acidosis by removing waste products and excess electrolytes from the blood. Overall, emergent hemodialysis is the most appropriate intervention for managing the acute metabolic abnormalities in this critically ill patient.

Correct Answer: B

Rationale: Cultural competence is the process of acquiring specific knowledge, skills, and attitudes to effectively work with individuals from diverse cultural backgrounds. It involves understanding and respecting the values, beliefs, languages, and practices of different cultures in order to provide appropriate care and services. Cultural competence goes beyond just learning about different cultures; it requires the development of skills and attitudes that promote effective communication, understanding, and collaboration with individuals of diverse backgrounds. This includes being aware of one's own biases, being open-minded, and adapting practices to be inclusive and respectful of cultural differences. Ultimately, cultural competence is essential in providing high-quality, respectful, and effective care to clients from various cultural backgrounds.

Correct Answer: C

Rationale: In assigning rooms for the injured patients, the most appropriate and compassionate choice is to have mother and child together in one room. This decision prioritizes the well-being and emotional support for the child, as having the mother nearby can have a positive impact on the child's recovery. It also promotes family bonding during a difficult time, which can aid in the healing process. Additionally, the presence of a parent can provide comfort and reassurance to the child, contributing to a more positive hospital experience. Therefore, it is important for the nurses to coordinate with the Administration to ensure that mother and child are assigned to the same room whenever possible.

Correct Answer: C

Rationale: The most appropriate intervention for a patient with end-stage dementia experiencing agitation and restlessness is to create a calm and soothing environment to promote relaxation. Patients with dementia often respond positively to a familiar and tranquil setting, which can help reduce their symptoms of agitation and restlessness. This approach is preferred over administering antipsychotic medications or recommending physical exercise, as these may not be feasible or beneficial for patients in the advanced stages of dementia. Referring the patient to a psychiatrist may not address the immediate need for symptom management and can be considered if other interventions are ineffective. Creating a calm environment, such as dim lighting, soft music, and familiar objects, can help provide comfort and reduce distress for the patient.

Correct Answer: D

Rationale: All of the components -explanation of the procedure and alternatives to the procedure (I), discussion of potential risks and benefits of the procedure (II), and confirmation that the patient understands the risks, benefits, and any alterations (III) -are essential parts of informed consent. Providing information about the procedure and its alternatives, disclosing potential risks and benefits, and ensuring that the patient comprehends this information are crucial to obtaining valid informed consent prior to any medical procedure.

Correct Answer: B

Rationale: The Epidemiologic Triad model focuses on identifying the causative factors of diseases, particularly infectious diseases. The three components of the triad are the external agent, the susceptible host, and the environment. These factors interact to result in the occurrence of disease. Treatment Regimen, on the other hand, is not one of the causative factors but rather a response to manage and treat the disease once it has occurred. While treatment is essential, it is not part of the factors that contribute to the initial development of the disease within the Epidemiologic Triad model.

Correct Answer: B

Rationale: The global program that aims to end poverty and protect the planet is known as the Sustainable Development Goals (SDGs). The SDGs were adopted by all United Nations Member States in 2015 as a universal call to action to end poverty, protect the planet, and ensure prosperity for all. The goals address a wide range of social, economic, and environmental challenges that the world faces, including poverty, hunger, health, education, gender equality, clean water, and energy. By achieving the SDGs, countries can work together to create a more sustainable and equitable world for present and future generations.

Correct Answer: B

Rationale: The patient's presentation with recurrent episodes of vertigo, nausea, and nystagmus triggered by head movements, along with a positive Dix-Hallpike maneuver eliciting positional vertigo and rotary nystagmus, is classic for Benign Paroxysmal Positional Vertigo (BPPV). BPPV is the most common cause of vertigo due to a mechanical problem in the inner ear. In BPPV, brief episodes of vertigo are typically triggered by specific head movements, such as rolling over in bed or looking up. The characteristic rotary nystagmus observed in BPPV is consistent with the brief, intense episodes of vertigo that patients experience. The Dix-Hallpike maneuver, commonly used to diagnose BPPV, involves moving the patient from sitting to a supine head-hanging position and can induce vertigo and nystagmus in affected