The nurse in the ED is caring for a 4 year-old brought in by his parents who state that the child will not stop crying and pulling at his ear. Based on information collected by the nurse, which of the following statements applies to a diagnosis of external otitis?

Correct Answer: A

Rationale: External otitis, also known as swimmer's ear, is an infection of the outer ear canal. It is often characterized by aural tenderness, which means that the ear is sensitive to touch and can be painful, especially when pressure is applied to the area. This tenderness is a hallmark symptom of external otitis and helps differentiate it from other ear conditions. Other common symptoms of external otitis include ear pain, itchiness, redness, and swelling of the ear canal. External otitis is usually not accompanied by a high fever, and it is not typically related to an upper respiratory infection. Using cotton-tipped applicators to clean the ear can actually increase the risk of developing external otitis by disrupting the natural protective barrier of the ear canal.

Correct Answer: A

Rationale: The patient may be trying to protect loved ones from the emotional effects of the illness. This behavior could be a form of denial, a defense mechanism where the individual refuses to acknowledge the reality of the diagnosis in order to shield their loved ones from distress. By rejecting the diagnosis and refusing treatment, the patient may believe that they are preventing their family and friends from experiencing the emotional pain associated with the illness. This behavior is a common coping mechanism in response to overwhelming and distressing news like a terminal illness diagnosis. It serves a psychosocial purpose of trying to protect others from suffering, even though it may not align with the patient's best interest in terms of receiving appropriate medical care.

Correct Answer: C

Rationale: The most appropriate action for the home health nurse to take in this situation where a patient reports distortions when looking at an Amsler grid is to arrange for the patient to be assessed for macular degeneration. Distortions in straight lines on an Amsler grid are a common early symptom of macular degeneration, a progressive eye condition that affects central vision. Macular degeneration is a leading cause of vision loss in older adults, making assessment and early intervention crucial in preserving vision. It is important for the nurse to take the patient's symptoms seriously and facilitate timely evaluation and management to prevent further vision loss. This would involve referring the patient to an ophthalmologist or an eye care specialist for a comprehensive evaluation and appropriate treatment.

Correct Answer: A

Rationale: Mottling of the lower limbs is a common physical sign seen in patients approaching death. This occurs when there is poor circulation leading to a bluish or purplish discoloration of the skin, particularly on the extremities. The appearance of mottling indicates that the body is no longer able to maintain adequate blood flow to the extremities, signaling that the patient is in the final stages of life. It is a significant finding that strongly suggests imminent death in patients with terminal illness, such as in this case of a patient with terminal lung cancer who is unconscious.

Correct Answer: D

Rationale: Immunotherapy, also known as allergy shots, is a form of treatment that can help reduce symptoms for individuals with severe allergies to substances such as pollen, dust mites, or pet dander. This treatment involves exposing the patient to small, increasing doses of the allergen over time to help the immune system gradually build up a tolerance. Patients with severe allergies to grass and tree pollen would most likely benefit from immunotherapy as it can help reduce their allergy symptoms and improve their quality of life. On the other hand, individuals with anaphylactic reactions to insect stings (Choice A), allergies to eggs and dairy (Choice B), or a positive tuberculin skin test (Choice C) are not typically candidates for immunotherapy as their conditions are not related to the type of allergies that are commonly treated with this method.

Correct Answer: C

Rationale: In this scenario, the patient who has had a cervical diskectomy is experiencing severe pain with a sudden onset, which can be indicative of a complication such as bleeding, infection, or nerve impingement. The nurse's most appropriate action is to call the surgeon immediately to report the patient's pain. The surgeon needs to be informed promptly so that a further assessment can be made and appropriate interventions can be initiated to address the cause of the sudden pain. Palpating the surgical site or removing the dressing without consulting the surgeon first may worsen the situation or increase the risk of complications. Administering an NSAID is not appropriate in this situation without further evaluation and guidance from the surgeon. It is essential to prioritize patient safety and ensure that the patient receives timely and appropriate care by involving the surgeon in the decision-making process.

Correct Answer: A

Rationale: A person whose vision is measured at 20/40 can see an object from 40 feet away that a person with 20/20 vision can see from 20 feet away. In this measurement system, the first number represents how far away the person is from the eye chart (the testing distance), and the second number indicates how far away a person with normal vision can be from the chart to see the same line of letters or objects. Therefore, if someone has 20/40 vision, it means they need to be at 20 feet to see what a person with 20/20 vision can see at 40 feet.

Correct Answer: A

Rationale: The patient undergoing interstitial implant for high-dose radiation (HDR) for prostate cancer will emit radiation that poses a risk to others. Limiting the time that visitors spend at the patient's bedside is essential to minimize their exposure to radiation. It is important to follow safety measures to protect both the patient and others from potential harm. Other options such as teaching the patient to perform basic care independently, assigning male nurses, or situating the patient in a shared room with other brachytherapy patients do not directly address the safety concern of radiation exposure to visitors.

Correct Answer: C

Rationale: Megestrol is a synthetic progestational agent that has been found to promote significant weight gain in AIDS patients with wasting syndrome by increasing body fat stores. It is commonly used to stimulate appetite and increase caloric intake in patients experiencing anorexia and weight loss due to various medical conditions, including AIDS-related wasting. Megestrol works by increasing appetite and improving food intake, leading to weight gain and improved nutritional status in patients with HIV/AIDS. It has been shown to be effective in reversing weight loss and improving quality of life in these patients. Therefore, the drug megestrol is the most appropriate choice for promoting weight gain in AIDS patients with wasting syndrome and anorexia.