Considering the pain assessment scale (1, is the least pain and 5 is the most painful) Mrs. P described her pain in the scale of 5, you expect that the doctor will order which of the following pain medication?

Correct Answer: B

Rationale: When a patient describes their pain as a 5 on the pain assessment scale, it indicates severe pain and the need for a strong pain medication. Morphine Sulphate is a potent opioid analgesic that is commonly used to manage severe pain, such as in cases where the pain is rated as 5. Meperidine HCl (Demerol) is another opioid analgesic, but it is not as commonly used due to its side effect profile and potential for toxicity. Fentanyl (Duragesic) is also a potent opioid analgesic that can be used for severe pain, but morphine is often preferred in this situation. Acetaminophen (Tylenol) is a milder pain reliever and is not typically sufficient for pain described at a level of 5 on the pain scale.

Correct Answer: B

Rationale: A prolapsed umbilical cord is a medical emergency during labor because it can cause compression of the umbilical cord, leading to decreased oxygen supply to the fetus. The priority nursing action in this situation is to prepare for an immediate cesarean section. This is necessary to quickly deliver the baby and relieve pressure on the cord, preventing potential fetal distress or death. Elevating the mother's hips may help reduce pressure on the cord temporarily, but it is not the definitive treatment for a prolapsed cord. Administering intravenous fluids rapidly may be necessary, but it is not the priority intervention when the fetus is at risk due to a prolapsed cord. Performing a vaginal examination to assess cervical dilation is contraindicated in the presence of a prolapsed umbilical cord as it can further compress the cord and worsen the situation.

Correct Answer: C

Rationale: The symptoms of polyuria (excessive urination), polydipsia (excessive thirst), and polyphagia (excessive hunger) are classic signs of diabetes mellitus. In this case, the presence of hyperglycemia (high blood sugar) and glycosuria (glucose in the urine) further support the diagnosis of diabetes mellitus. Insulin deficiency or resistance in diabetes leads to impaired glucose utilization and excessive glucose in the bloodstream, causing the classic symptoms observed in the patient. Hyperthyroidism, hypothyroidism, and Cushing's syndrome do not typically present with the hallmark symptoms of polyuria, polydipsia, and polyphagia associated with uncontrolled diabetes mellitus.

Correct Answer: B

Rationale: The right to refuse treatment is a fundamental patient right. In this case, the physician ordering medications for the client to take at home without the client's input or agreement could possibly violate the client's right to refuse treatment. It is important for patients to have the autonomy to make decisions regarding their own treatment, especially when they are still weak and symptomatic. Patients should have the opportunity to discuss their treatment plan with their healthcare provider and express any concerns or preferences they may have.

Correct Answer: B

Rationale: The importance of validation in the context of communication and nursing care does not include the assumption that most patients are cognitively impaired. It would be more appropriate to approach patient interactions with the assumption that patients are capable of understanding and coherent communication. Validation is important because it helps ensure that the nurse has truly understood the patient's message, prevents misinterpretation, and fosters a sense of empathy and trust in the nurse-patient relationship. Additionally, validating the patient's thoughts and feelings can help clarify confused thoughts and promote effective communication. The other options (A, C, and D) are all valid reasons emphasizing the significance of validation in effective communication.

Correct Answer: B

Rationale: The primary purpose of interdisciplinary collaboration in nursing practice is to improve communication and coordination of patient care. When healthcare providers from different disciplines work together as a team, they can share their unique perspectives, knowledge, and skills to develop comprehensive care plans that address all aspects of a patient's well-being. This collaborative approach helps ensure that the patient receives holistic and coordinated care, leading to better outcomes and patient satisfaction. Effective communication and coordination among team members also help prevent errors, reduce duplication of efforts, and promote efficient use of resources. Overall, interdisciplinary collaboration is essential for delivering high-quality, patient-centered care in healthcare settings.

Correct Answer: B

Rationale: The assessment of a patient who has ingested poison must include determining the poison ingested and the amount (I), the time from ingestion and the signs and symptoms (II), as well as the weight of the patient (III). These factors are essential in evaluating the severity of the poisoning and determining the appropriate treatment plan. However, the patient's immunization history (IV) is not directly relevant to the assessment of ingested poison and thus is not essential in this context.

Correct Answer: D

Rationale: Prinzmetal's angina, also known as variant angina, is characterized by episodes of chest pain that occur at rest and are relieved by nitroglycerin. Patients with Prinzmetal's angina may also have transient ST-segment elevation on an electrocardiogram (ECG) during episodes of chest pain. This is due to coronary artery vasospasm, which causes temporary obstruction of blood flow to the heart muscle. Stable angina typically presents with chest pain on exertion that resolves with rest, while unstable angina and acute myocardial infarction present with chest pain that is not relieved with nitroglycerin and are associated with more severe coronary artery disease.

Correct Answer: B

Rationale: The nurse should prioritize cleansing the insertion site with an alcohol-based antiseptic solution to maintain procedural asepsis during a peripherally inserted central catheter (PICC) insertion. Proper skin preparation is essential in reducing the risk of introducing pathogens into the patient's bloodstream during the insertion process. Alcohol-based antiseptic solutions are effective in reducing the number of microorganisms on the skin surface. Wearing sterile gloves and following other sterile techniques are also crucial, but preparing the insertion site with the antiseptic solution is the initial step in maintaining asepsis during the procedure.