Nurse Reese is preparing the patient assignment t for the day and needs to assign patients to a midwife and nursing assistant. Which patient should the nurse assign to the midwife because of patient needs that cannot be met by the nursing assistant? A patient requiring________.

Correct Answer: A

Rationale: The patient requiring a dressing change of post-caesarian surgery should be assigned to the midwife because this task involves specialized knowledge and skills related to wound care and post-operative care. Performing a dressing change for a post-caesarian surgery patient requires expertise to ensure proper hygiene, wound healing, and prevention of post-operative complications. This task goes beyond the scope of practice for a nursing assistant and should be done by a healthcare professional with higher qualifications and training, such as a midwife.

Correct Answer: D

Rationale: Factor V Leiden mutation is the most common inherited predisposition to venous thrombosis. In this condition, there is a specific mutation in the factor V gene (also known as factor V Leiden) that makes factor V resistant to inactivation by activated protein C. This resistance leads to excessive clot formation, increasing the risk of recurrent venous thrombosis like DVT and PE. Patients with Factor V Leiden mutation may have a history of recurrent unprovoked venous thrombosis at a young age. In comparison, antithrombin III deficiency, protein C deficiency, and protein S deficiency are other inherited thrombophilias that may increase the risk of venous thrombosis, but Factor V Leiden mutation is the most likely cause in this case based on the presentation of recurrent episodes without apparent provoking factors.

Correct Answer: A

Rationale: The patient is most likely experiencing Type 1 diabetes mellitus based on the presentation of polyuria, polydipsia, polyphagia, hyperglycemia, and glycosuria. Type 1 diabetes is characterized by autoimmune destruction of the beta cells in the pancreas, leading to absolute insulin deficiency. This results in high blood sugar levels (hyperglycemia) and glucose spilling into the urine (glycosuria). Patients with Type 1 diabetes often present with the classic symptoms of polyuria (increased urination), polydipsia (increased thirst), and polyphagia (increased hunger) due to the body's inability to utilize glucose for energy effectively. Management of Type 1 diabetes typically involves lifelong insulin therapy to maintain blood sugar levels within a target range.

Correct Answer: C

Rationale: In Nadine's case, one major challenge that a beginning nurse may encounter in her service delivery is related to social determinants of health. Social determinants of health refer to the social and economic conditions that influence individual and group differences in health status. In this scenario, Nadine's bruises, bed-wetting, signs of anxiety, and potentially other health issues are likely influenced by factors such as her living environment, family dynamics, and social support systems. As a nurse, addressing social determinants of health requires a holistic approach that considers not only the physical symptoms but also the underlying social, economic, and environmental factors affecting the patient's health and well-being. This can be a complex challenge for beginning nurses who may not have as much experience or training in navigating these social determinants of health to provide comprehensive care to their patients.

Correct Answer: D

Rationale: Placing her hand over Marlene's shoulder and asking why the sad face is the best way for Nurse Myra to communicate her concern. This approach shows empathy and creates a safe space for Marlene to open up about her feelings. By using physical touch and showing genuine interest in Marlene's well-being, Nurse Myra can effectively address the situation and provide appropriate support or guidance as needed. Simply dismissing Marlene's feelings (option B and C) or resorting to religious advice (option A) may not effectively address the underlying cause of Marlene's sadness. It is important in situations like this to show empathy, compassion, and a willingness to listen in order to provide the best support for the individual in distress.

Correct Answer: B

Rationale: The healthcare team should prioritize implementing environmental modifications to promote orientation in a patient with delirium. Delirium is a state of acute confusion and agitation that can be triggered by various factors such as medications, infections, or metabolic disturbances. Environmental modifications involve creating a calm, quiet, and well-lit environment for the patient. Promoting proper orientation through the use of clocks, calendars, and familiar objects can help reduce confusion and improve the patient's understanding of their surroundings. These interventions are non-pharmacological and aim to address the underlying causes of delirium while minimizing the need for additional medications that may have potential side effects. Antipsychotic medications and benzodiazepines should be used judiciously and under close supervision due to the risk of adverse effects in older adults and critically ill patients. Referring the patient to a psychiatrist may be considered if the delirium is complex or if there are underlying psychiatric issues contributing to the presentation.

Correct Answer: B

Rationale: Atorvastatin is a medication commonly used for lipid-lowering therapy to reduce cholesterol levels and decrease the risk of cardiovascular events. However, one of the potential side effects of statin medications such as atorvastatin is liver injury. Therefore, monitoring liver function tests, including alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels, is crucial during atorvastatin therapy.

Correct Answer: D

Rationale: While all of the nursing measures listed are important considerations when managing a patient receiving oxytocin drip, the nurse would least consider informing the patient about potential complications. The reason for this is that it is the responsibility of the healthcare provider (such as the physician or advanced practice nurse) to inform the patient about potential complications of a medication or treatment. Nurses are instrumental in providing education and support to patients, but in the case of informing patients about potential complications, this task typically falls under the purview of the prescribing provider. The primary focus of the nurse in this situation would be to assess, administer, monitor, and educate the patient as appropriate, ensuring safe and effective care delivery.

Correct Answer: A

Rationale: The patient in this scenario presents with normocytic normochromic anemia, normal iron studies, and elevated serum erythropoietin levels. These findings are characteristic of anemia of chronic disease, which is commonly seen in patients with chronic kidney disease (CKD). In CKD, there is a decrease in renal production of erythropoietin, leading to reduced stimulation of erythropoiesis and subsequent anemia. The normocytic normochromic anemia pattern is typical in anemia of chronic disease, as opposed to microcytic hypochromic anemia seen in iron deficiency anemia and thalassemia. Aplastic anemia is characterized by pancytopenia, which is not described in the scenario. Therefore, the most likely cause of the patient's presentation is chronic kidney disease.