Priority Decision: The husband and daughter of a Hispanic woman dying from pancreatic cancer refuse to consider using hospice care. What is the first thing the nurse should do?

Correct Answer: A

Rationale: In this scenario, the correct answer is Option A: Assess their understanding of what hospice care services are. The first step for the nurse is to gather information about the family's knowledge and beliefs regarding hospice care. This is crucial as it allows the nurse to address any misconceptions, provide accurate information, and facilitate an open discussion about end-of-life care options. Option B is incorrect because asking how they will care for the patient without hospice care assumes that the family is capable or willing to provide appropriate care, which may not always be the case in a complex situation like terminal pancreatic cancer. Option C is incorrect because while it is important to involve the patient and family in decision-making, attempting to change their minds without first understanding their perspectives can lead to conflict and resistance. Option D is incorrect and culturally inappropriate as it assumes all Hispanic families have the same preferences for caring for their loved ones. It is essential to avoid stereotyping and instead focus on individual beliefs and needs. Educationally, this question highlights the importance of cultural competence, effective communication, and patient/family-centered care in end-of-life situations. Nurses must engage in open dialogue, respect diverse beliefs, and provide accurate information to support families in making informed decisions that align with their values and preferences.

Correct Answer: D

Rationale: The correct answer is D) Overuse and dependence on a substance that negatively affects functioning. Substance abuse refers to the excessive use of a substance such as alcohol or drugs, leading to negative consequences on an individual's physical, mental, and social well-being. This definition encompasses both the misuse of substances and the resulting impact on an individual's ability to function in their daily life. Option A) A compulsive need to experience pleasure, while related to addiction, does not fully capture the harmful consequences and impact on functioning that define substance abuse. Option B) Behavior associated with maintaining an addiction is too broad and does not specifically address the negative effects on functioning that characterize substance abuse. Option C) Absence of a substance will cause withdrawal symptoms is more aligned with physical dependence rather than the broader concept of substance abuse, which includes the impact on overall functioning. Educationally, understanding the definition of substance abuse is crucial for healthcare professionals, especially those in pharmacology, as it helps in recognizing, assessing, and intervening in cases of substance abuse to provide appropriate care and support to individuals struggling with addiction. It also highlights the importance of considering the holistic effects of substance abuse beyond just the physical aspects.

Correct Answer: B

Rationale: In this scenario, Mary is displaying symptoms of mania, which can be induced by antidepressants like fluoxetine in individuals with bipolar disorder. The correct answer is to start a mood stabilizer because Mary's symptoms suggest a switch from depression to a manic state. Mood stabilizers are essential in managing manic episodes to prevent potential harm and stabilize mood fluctuations. Option A is incorrect because continuing the selective serotonin reuptake inhibitor can exacerbate Mary's manic symptoms. Switching to a tricyclic antidepressant (Option C) is not recommended as they can also induce manic episodes. Adding a monoamine oxidase inhibitor (Option D) is not the best choice as it can worsen mania. Educationally, this question highlights the importance of recognizing and managing manic symptoms induced by antidepressants, especially in individuals with bipolar disorder. Understanding the need for mood stabilizers in such cases is crucial for safe and effective patient care.

Correct Answer: A

Rationale: The correct answer is option A) Develop a method of communication. The priority intervention for a patient diagnosed with advanced ALS is to ensure effective communication. ALS is a progressive neurodegenerative disease that affects motor neurons, eventually leading to muscle weakness and paralysis. As the disease progresses, the patient may lose the ability to speak, swallow, and move. Therefore, developing a communication method is crucial to understanding the patient's needs, preferences, and concerns. Option B) Provide six small meals high in protein and assist with feeding is incorrect because although nutrition is important in ALS, communication takes precedence as the priority intervention. Option C) Do not involve the patient in decisions about his healthcare because he is not in the mental state to respond is incorrect and goes against patient-centered care principles. Patients with ALS maintain their mental capacities even as their physical abilities decline, and it is important to involve them in decisions about their care whenever possible. Option D) Provide six normal meals high in protein and assist with feeding is incorrect as it does not address the immediate priority of communication to understand the patient's needs and preferences. In an educational context, this question highlights the importance of prioritizing interventions based on the patient's immediate needs and the progressive nature of ALS. Effective communication is essential in providing holistic care to patients with ALS, ensuring their dignity, autonomy, and quality of life are maintained.

Correct Answer: C

Rationale: The correct answer is C) Ulcerative colitis. Ulcerative colitis is an inflammatory bowel disease that primarily affects the colon and rectum. It presents with symptoms such as abdominal pain, bloody diarrhea, tenesmus, and weight loss. This is because the inflammation in ulcerative colitis is continuous and affects the innermost lining of the colon. Option A) Crohn's disease is incorrect because while it is also an inflammatory bowel disease, it can affect any part of the digestive tract from mouth to anus, not just the colon and rectum. Option B) Diverticulitis is characterized by inflammation or infection of small pouches that can develop in the walls of the colon, leading to symptoms like abdominal pain and fever, but not typically bloody diarrhea. Option D) Appendicitis is the inflammation of the appendix and presents with symptoms such as right lower quadrant abdominal pain, nausea, and fever, but not typically bloody diarrhea or weight loss. Understanding the key differences between these conditions is crucial for healthcare professionals to make accurate diagnoses and provide appropriate treatments. This knowledge helps in delivering quality patient care and improving patient outcomes in medical-surgical settings.