Delegation Decision: The unit is very busy and short staffed. What could be delegated to the unlicensed assistive personnel (UAP)?

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Obtain orthostatic blood pressure (BP) readings for older patients. Delegating this task to unlicensed assistive personnel (UAP) is appropriate because it is within their scope of practice and does not require interpretation or adjustment of medications. Orthostatic BP readings are important in assessing for postural hypotension, especially in older patients who may be more prone to this condition. Option A, administering antihypertensive medications to stable patients, involves medication administration which should be performed by licensed nurses who have the training and knowledge to assess the patient's condition before giving medications. This task is not appropriate for delegation to UAP. Option C, checking BP readings for a patient receiving IV enalapril, requires monitoring a patient on a specific medication that may have potential side effects or interactions. This task involves a higher level of assessment and should be done by a licensed nurse. Option D, teaching about home BP monitoring and the use of automatic BP monitoring equipment, involves patient education which requires a nursing assessment, critical thinking, and the ability to tailor the teaching to the individual patient's needs. This task is not suitable for delegation to UAP. Educationally, understanding delegation principles is crucial for nursing practice. Nurses need to know the scope of practice for UAP and how to appropriately delegate tasks to ensure safe and effective patient care. Knowing which tasks can be delegated and which require nursing expertise is essential for maintaining quality care standards.

Correct Answer: C

Rationale: In the management of patients with Non-ST-segment Elevation Myocardial Infarction (NSTEMI), initial treatment often involves acute intensive drug therapy. This approach is chosen because NSTEMI patients do not typically have complete occlusion of a coronary artery, unlike patients with ST-segment Elevation Myocardial Infarction (STEMI). Acute intensive drug therapy aims to stabilize the patient, manage symptoms, prevent further clot formation, and improve blood flow to the heart muscle. This may include antiplatelet agents, anticoagulants, nitroglycerin, beta-blockers, and statins. This strategy is crucial in NSTEMI cases to prevent further ischemic damage and reduce the risk of complications. The other options - A) PCI (Percutaneous Coronary Intervention), B) CABG (Coronary Artery Bypass Grafting), and D) Reperfusion therapy with thrombolytics - are not typically the initial treatments for NSTEMI. PCI and CABG are more commonly used in STEMI cases where immediate restoration of blood flow to the occluded artery is critical. Thrombolytics are also used in STEMI to dissolve the clot causing the blockage. Understanding the differences in the management of NSTEMI and STEMI is essential for healthcare providers working in cardiology, emergency medicine, or critical care settings. It allows for timely and appropriate interventions, leading to better outcomes for patients with acute coronary syndromes.

Correct Answer: C

Rationale: In the pathophysiology of Acute Myocardial Infarction (AMI), the correct answer is C) Both A and B – Coronary artery blockage and Myocardial oxygen demand exceeds supply. Coronary artery blockage leads to a lack of blood flow to the heart muscle, resulting in ischemia and subsequent tissue damage. This blockage can be caused by atherosclerosis or a blood clot. When the myocardial oxygen demand exceeds supply, as seen during situations of increased workload on the heart or reduced oxygen delivery, it can lead to oxygen deprivation and cell death. Option A (Coronary artery blockage) alone is not sufficient to cause AMI without the additional factor of increased myocardial oxygen demand exceeding supply. Option B (Myocardial oxygen demand exceeds supply) is also not the sole cause of AMI unless there is an underlying issue like coronary artery blockage. Understanding the pathophysiology of AMI is crucial in clinical practice, as it helps healthcare professionals recognize the signs and symptoms early, initiate appropriate interventions promptly, and prevent complications. Educating healthcare professionals about the intricate interplay of these mechanisms can improve patient outcomes and reduce morbidity and mortality associated with AMI.

Correct Answer: C

Rationale: In the medical management of a patient with tuberculosis (TB), the most effective approach is the use of Directly Observed Treatment, Short-Course (DOTS) which involves a combination of antibiotics. Option C, "Both A and B" (Isoniazid and Rifampicin), is the correct answer because these two drugs are essential components of the first-line treatment for TB. Isoniazid works by inhibiting the synthesis of mycolic acids in the cell wall of the TB bacteria, while Rifampicin targets the RNA polymerase enzyme, disrupting bacterial RNA synthesis. Option A, Isoniazid alone, is incorrect because monotherapy with Isoniazid can lead to the development of drug-resistant TB strains. Option B, Rifampicin alone, is also incorrect as monotherapy with Rifampicin is not recommended due to the high risk of developing drug resistance. Option D, "None of the above," is incorrect as the standard of care for TB treatment involves a combination of antibiotics to prevent the development of drug resistance and ensure effective treatment. Educationally, understanding the rationale behind the use of combination therapy in TB treatment is crucial for healthcare providers to provide optimal care for their patients. It is essential to emphasize the importance of completing the full course of DOTS therapy to prevent treatment failure and the emergence of drug-resistant TB strains. Educating healthcare professionals on evidence-based treatment protocols for TB is vital in reducing the global burden of this infectious disease.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Buerger-Allen exercises. These exercises are specifically designed to improve peripheral vasodilatation by promoting blood flow to the extremities. Mrs. T., who has this condition, would benefit the most from these exercises as they target the underlying issue. Option A) Jogging 1 mile each day may be beneficial for cardiovascular health, but it may not specifically target peripheral vasodilatation as effectively as Buerger-Allen exercises. Option C) Sit-ups are more focused on core strength and may not directly impact peripheral vasodilatation. Option D) Bicycle riding is a good cardiovascular exercise but may not be as localized and targeted as Buerger-Allen exercises for improving blood flow to the extremities. In an educational context, understanding the specific therapeutic exercises for different conditions is crucial for healthcare professionals. By knowing the rationale behind each option, they can make informed decisions to tailor exercise prescriptions to individual patient needs, ultimately improving patient outcomes and quality of care.