Mr. White develops 'heart_block' and has a temporary pacemaker inserted. If Mr. White required defibrillation and the pacemaker is on, it would be most important to

Correct Answer: C

Rationale: In this scenario, the most important action before defibrillation in a patient with a temporary pacemaker is to turn the pacemaker off and disconnect both wires. This is crucial to avoid interference between the pacemaker and the defibrillator, which could potentially lead to ineffective defibrillation or harm to the patient. Option A, giving pain medication before defibrillation, is not the priority in this case as the immediate concern is ensuring the safety and effectiveness of the defibrillation process. Option B, defibrillating the patient immediately while the pacemaker is still on, can lead to interference with the pacemaker's function and may not deliver the necessary shock to restore the heart's normal rhythm. Option D, calling the physician before defibrillation, may cause a delay in the life-saving intervention needed in an emergency situation like ventricular fibrillation. Immediate action to turn off the pacemaker and disconnect its wires is crucial to ensure successful defibrillation. Educationally, this question highlights the importance of understanding the potential interactions between medical devices in emergency situations. It emphasizes the need for healthcare providers to have the knowledge and skills to prioritize actions to maximize patient safety and outcomes during critical events.

Correct Answer: B

Rationale: In early pregnancy, simple anemia can develop due to increased blood volume and demands for iron by the growing fetus. The correct advice for the nurse to give the woman in this scenario is to increase dietary protein, iron, and vitamins (Option B). This recommendation is crucial as it helps to address the underlying cause of anemia and supports the woman and her developing baby's nutritional needs. Option A, checking the pulse three times a day, is incorrect as it does not directly address the nutritional deficiency that is causing the anemia. Monitoring the pulse may be important in certain situations but is not the priority in this case. Option C, restricting rest, is also incorrect. Rest is important during pregnancy, especially when anemia is present, but it is not the primary intervention needed to address the nutritional deficiencies causing the anemia. Option D, avoiding overeating, is not the correct advice either. While maintaining a healthy diet is important, simply avoiding overeating does not specifically address the need for increased intake of essential nutrients like iron, protein, and vitamins that are necessary to combat anemia. Educationally, this question highlights the importance of understanding the nutritional needs of pregnant women, especially when complications like anemia arise. It reinforces the significance of providing appropriate dietary advice to support both the mother and the developing fetus during pregnancy. By choosing the correct answer, nurses can help prevent and manage anemia effectively, promoting better maternal and fetal outcomes.

Correct Answer: B

Rationale: In the acute phase of pernicious anemia, nursing care should focus on addressing the symptoms and complications of the condition. Bed rest with range-of-motion exercises is the correct option because it helps prevent complications like deep vein thrombosis and promotes circulation without exerting excessive energy that the patient may lack due to anemia. Option A is incorrect as placing limits on food, fluids, and activity can worsen the patient's condition by restricting essential nutrients and preventing necessary movement. Option C, preparation for blood transfusion, is incorrect because pernicious anemia is primarily due to vitamin B12 deficiency, not necessarily a lack of blood that would require a transfusion. Option D, providing a heating pad, is incorrect as warmth does not address the underlying cause or symptoms of pernicious anemia. Educationally, understanding the rationale behind the correct answer emphasizes the importance of tailored nursing care for patients with pernicious anemia. It highlights the need for interventions that address the specific needs and symptoms of the condition to promote optimal patient outcomes. This question also reinforces the significance of knowledge in providing evidence-based care to individuals with hematologic disorders.

Correct Answer: A

Rationale: In understanding why option A is the correct answer in this question about hemophilia A, it is crucial to grasp the pathophysiology of the condition. Hemophilia A is a genetic disorder characterized by a deficiency in clotting factor VIII, leading to impaired blood clotting. Due to this deficiency, bleeding in individuals with hemophilia A is often delayed after trauma because the clotting process is disrupted. This delayed bleeding is a hallmark feature of hemophilia A and distinguishes it from other bleeding disorders. Regarding why the other options are incorrect: - Option B: Hemarthrosis, or bleeding into joint spaces, is actually a common and significant complication in individuals with hemophilia A due to their impaired clotting mechanism. - Option C: In hemophilia A, coagulation and bleeding time are prolonged, not severely prolonged, due to the deficiency in factor VIII. - Option D: Client education plays a crucial role in managing hemophilia A by empowering individuals to recognize symptoms early, seek appropriate care, and prevent complications. Therefore, stating that client education is ineffective is inaccurate. Educational context: Understanding the key clinical manifestations and complications of hemophilia A is essential for healthcare professionals working in hematology and oncology. By grasping the nuances of this condition, clinicians can provide optimal care and support to individuals with hemophilia A, emphasizing the importance of early recognition, prompt treatment, and ongoing education to prevent complications and improve outcomes.

Correct Answer: D

Rationale: The correct answer is option D) resting the joint when painful or swollen. Hemarthrosis, which is bleeding into joint spaces, is a common issue in individuals with hemophilia due to impaired blood clotting. Resting the joint when painful or swollen helps prevent further damage and allows the body to naturally reabsorb the blood, reducing pain and inflammation. Option A) restricting the individual's activity is incorrect because complete restriction may lead to joint stiffness and muscle weakness without addressing the immediate need for joint rest. Option B) applying heat at the first indication of pain or swelling is incorrect as heat can exacerbate bleeding by dilating blood vessels, increasing blood flow to the joint, and worsening the condition. Option C) giving frequent intramuscular injections of analgesics is incorrect as it does not address the underlying cause of hemarthrosis and can potentially lead to further bleeding complications. In an educational context, teaching families about the importance of recognizing early signs of hemarthrosis and the appropriate management, such as resting the joint, can help prevent complications and improve the quality of life for individuals with hemophilia. Encouraging open communication with healthcare providers for timely interventions is also crucial in managing hemarthrosis effectively.