A postpartum client who experienced a traumatic birth expresses concerns about breastfeeding difficulties and emotional distress. What nursing intervention should be prioritized to address the client's concerns?

Correct Answer: A

Rationale: Providing emotional support and empathy for the client's experience should be prioritized to address concerns of a postpartum client who experienced a traumatic birth. Emotional support can help the client feel validated and heard, which can be instrumental in starting the healing process. By acknowledging the client's emotions and experiences, the nurse can establish trust and create a safe space for the client to express their feelings. This can also help in building a therapeutic relationship that can positively impact the client's emotional well-being. Providing a supportive environment is essential for addressing breastfeeding difficulties and emotional distress in this situation.

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: The presentation described is characteristic of acute angle-closure glaucoma. This condition typically presents with sudden-onset severe eye pain, headache, nausea, and vomiting. On examination, the affected eye may appear red due to conjunctival injection, and there may be a steamy cornea due to corneal edema. The mid-dilated, non-reactive pupil is a key finding in angle-closure glaucoma, as the iris bombe (forward movement of the peripheral iris) blocks the drainage angle, leading to increased intraocular pressure. If left untreated, acute angle-closure glaucoma can result in irreversible vision loss. Immediate intervention is crucial to lower the intraocular pressure and prevent further damage to the optic nerve. Prompt referral to an ophthalmologist for definitive treatment is necessary in cases of suspected acute angle-closure glaucoma.

Correct Answer: D

Rationale: Confusion is a potential adverse effect of digoxin therapy. Digoxin toxicity can manifest as various central nervous system symptoms, including confusion, delirium, and disorientation. It is important to monitor for signs of digoxin toxicity in patients taking this medication, especially those with a history of heart failure or renal impairment. Other common signs of digoxin toxicity may include visual disturbances (like halos around lights), gastrointestinal symptoms (like nausea and vomiting), and cardiac arrhythmias. Monitoring serum digoxin levels can help guide therapy and identify toxicity early.

Correct Answer: A

Rationale: The most important intervention for managing ventilator-associated pneumonia (VAP) caused by methicillin-resistant Staphylococcus aureus (MRSA) in a patient undergoing mechanical ventilation in the ICU is to start appropriate antimicrobial therapy targeting MRSA. Vancomycin or linezolid are commonly used antibiotics for MRSA infections. These medications are effective against MRSA and can help in treating the infection and preventing further complications. It is crucial to initiate antimicrobial therapy promptly once the diagnosis of VAP caused by MRSA is suspected or confirmed to improve patient outcomes. Other interventions such as bronchoalveolar lavage for diagnostic purposes, contact precautions, or antifungal therapy may be relevant but the priority is to start effective antibiotic therapy to target the specific pathogen causing the infection.

Correct Answer: D

Rationale: When giving health teaching to the mother on how to manage the patient at home, emphasizing the need for emotional support is crucial. Taking care of a patient at home can be emotionally taxing, and the mother needs to be aware of the importance of providing emotional support to the patient. This can greatly impact the patient's overall well-being and recovery. By emphasizing the need for emotional support, the mother can create a conducive and supportive environment for the patient to heal physically, mentally, and emotionally. It also helps foster a sense of connection and positivity, which is beneficial for the patient's overall health outcomes.

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: A

Rationale: Providing emotional support and empathy for the client's experience should be prioritized to address concerns of a postpartum client who experienced a traumatic birth. Emotional support can help the client feel validated and heard, which can be instrumental in starting the healing process. By acknowledging the client's emotions and experiences, the nurse can establish trust and create a safe space for the client to express their feelings. This can also help in building a therapeutic relationship that can positively impact the client's emotional well-being. Providing a supportive environment is essential for addressing breastfeeding difficulties and emotional distress in this situation.

Correct Answer: B

Rationale: Guava leaves are recommended by the Department of Health as a remedy for cough due to their natural expectorant properties. The leaves contain compounds that help to loosen mucus and make it easier to expel, providing relief from cough and congestion. Guava leaves are commonly used in traditional medicine for respiratory conditions such as cough, bronchitis, and asthma. They help soothe the throat, reduce inflammation, and promote overall respiratory health. It is important to note that while guava leaves can be a helpful remedy for cough, they should be used in conjunction with other treatments as advised by healthcare professionals for best results.