A year after the diagnosis of hypothyroidism, Mrs. T. is admitted to the hospital in January in myxedema coma. Which of the following most probably accounts for this medical emergency?

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Failure to take thyroid medication. Myxedema coma is a life-threatening complication of untreated or undertreated hypothyroidism, where severely low thyroid hormone levels lead to decreased metabolism and a cascade of physiological effects, such as hypothermia, altered mental status, and organ failure. Mrs. T's condition likely deteriorated due to a lack of thyroid hormone replacement therapy, leading to the development of myxedema coma. Option A) Hypothermia is a symptom of myxedema coma, not the cause. It results from the body's decreased ability to regulate temperature due to low thyroid hormone levels. Option C) Overdose of thyroid medication would typically lead to symptoms of hyperthyroidism, such as tachycardia, weight loss, and anxiety, rather than myxedema coma. Option D) Failure to follow a prescribed diet may impact overall health but would not directly lead to myxedema coma in the context of hypothyroidism. Educationally, this question highlights the critical importance of medication adherence in managing chronic conditions like hypothyroidism. It emphasizes the severe consequences that can arise from neglecting prescribed treatments and the need for patients to understand the significance of following medical recommendations to prevent life-threatening complications. By understanding this case, healthcare providers and patients can work together to ensure optimal management of chronic diseases and prevent avoidable emergencies.

Correct Answer: B

Rationale: When assisting urosto-mates with a pouch change, it is important to cut the pouch opening approximately 3 mm larger than the stoma to prevent irritation and ensure a proper fit. This allows for a better seal and reduces the risk of leakage or skin damage. Scrubbing the peristomal skin with a deodorant soap, drying the skin with alcohol wipes, or placing aspirin in the pouch are not recommended practices and may lead to complications.

Correct Answer: A

Rationale: The correct answer is A) Use simple language with the client or significant others. Rationale: The nurse should provide post-procedure care following an intravenous pyelogram by using simple language when communicating with the client or significant others. This is important for ensuring that the patient and their family can understand the instructions clearly. Post-procedure care typically involves providing information about any potential side effects, what to expect after the procedure, and any specific instructions for recovery. Option B, administering sedative medications as ordered, is not relevant as post-procedure care for an intravenous pyelogram does not involve administering sedatives after the procedure. Option C, explaining in detail all the technicalities about the test, is not necessary as the focus should be on providing clear and concise information that the patient can easily understand. Option D, telling the patient about the risk factors of the test, is not the immediate concern post-procedure; instead, the emphasis should be on providing instructions for care and recovery. In an educational context, it is crucial for nurses to communicate effectively with patients and their families to ensure that they have a clear understanding of post-procedure care. Using simple language promotes patient comprehension and compliance, ultimately leading to better outcomes and patient satisfaction.

Correct Answer: D

Rationale: Prostate cancer is a serious health concern that can manifest with various symptoms related to urinary function. The correct answer, option D, "All of the above," is the most appropriate choice because prostate cancer can present with a combination of symptoms, including nocturia (frequent urination at night), an intermittent stream of urination, diminished force of urinary stream, urgency, difficulty initiating the stream of urine, and increased frequency of urination. Option A, "Nocturia and intermittent stream of urination," is partially correct as these can be symptoms of prostate cancer, but it does not encompass all possible symptoms. Option B, "Diminished force of urinary stream and urgency," also captures some symptoms of prostate cancer but is not comprehensive enough. Option C, "Difficulty initiating stream of urine and frequency," similarly includes some symptoms but does not cover the full range typically associated with prostate cancer. Educationally, it is essential to understand the varied presentations of prostate cancer symptoms to facilitate early detection and timely intervention. By recognizing a constellation of symptoms, healthcare providers can recommend appropriate diagnostic tests and treatment options, ultimately improving patient outcomes. This question underscores the importance of comprehensive assessment and clinical knowledge in identifying potential genitourinary issues like prostate cancer.

Correct Answer: C

Rationale: In this scenario, the correct answer is C) Review the nursing care plan and add nursing interventions. Delegating the task of reviewing the nursing care plan and adding nursing interventions to the nursing assistant is appropriate because it aligns with their scope of practice and level of training. Nursing assistants are crucial members of the healthcare team who provide direct patient care under the supervision of licensed nurses. Option A, showing the patient how to secure a clean-catch urine sample, involves providing patient education and requires a higher level of clinical knowledge and skill that is typically outside the scope of practice for a nursing assistant. Option B, checking the patient's urine for color, odor, and sediment, involves assessing and interpreting clinical data, which again exceeds the nursing assistant's scope of practice. Option D, providing the patient with a clean-catch urine sample container, is a task that can be delegated to a nursing assistant. However, in the context of a patient with cystitis, reviewing the care plan and adding interventions is a higher priority as it directly impacts the patient's care and outcomes. In an educational context, understanding delegation is essential for effective teamwork and patient care. Nurses must delegate tasks appropriately based on the individual's scope of practice, competency, and the patient's condition. This question highlights the importance of delegation in optimizing patient care and utilizing the skills of each team member effectively.