The nurse is caring for a preoperative patient. The nurse teaches the principles and demonstrates leg exercises for the patient. The patient is unable to perform leg exercises correctly. What is the nurse's best next step?

Correct Answer: B

Rationale: The correct answer is B) Assess for the presence of anxiety, pain, or fatigue. This is the best next step because it addresses potential underlying issues that could be hindering the patient from performing the leg exercises correctly. By assessing for anxiety, pain, or fatigue, the nurse can identify and address any physical or emotional barriers that may be impacting the patient's ability to engage in the exercises effectively. Option A) Encouraging the patient to practice at a later date does not address the root cause of why the exercises are not being done correctly and may not lead to improved outcomes. Option C) Asking the patient why exercises are not being done assumes that the patient is consciously choosing not to perform them correctly, which may not be the case. It does not address potential underlying issues that could be contributing to the problem. Option D) Evaluating the educational methods used to educate the patient is important, but it should come after assessing for immediate barriers such as anxiety, pain, or fatigue. This option does not address the patient's current inability to perform the exercises correctly. In an educational context, understanding the importance of assessing for underlying issues that may impact a patient's ability to learn or perform tasks is crucial for providing effective care. Nurses need to be able to identify and address barriers to learning or participation in order to promote optimal patient outcomes.

Correct Answer: C

Rationale: In this scenario, the most appropriate option is C) 2.5 mg of albuterol in a 3-mL solution, nebulized and delivered with ventilation. This choice is correct because nebulized albuterol is a common treatment for acute asthma exacerbation as it helps to dilate the airways, allowing for improved airflow. Delivering it with ventilation ensures adequate distribution and absorption in the lungs, addressing the patient's airway constriction effectively. Options A and B are incorrect because administering beta-agonists like levalbuterol or albuterol directly down the endotracheal tube may not be as effective as when delivered via nebulization. The patient's condition necessitates a broader distribution of the medication, which nebulization provides. Option D is also incorrect as the dose of levalbuterol is lower compared to the recommended dose for acute asthma exacerbation. Using a suboptimal dose may not achieve the desired therapeutic effect, especially in a critical situation like status asthmaticus. Educationally, this question highlights the importance of understanding the appropriate management of acute asthma exacerbation in critically ill patients, emphasizing the significance of delivering medications effectively to achieve the desired clinical outcomes. It reinforces the need for healthcare providers to be knowledgeable about evidence-based practices in managing respiratory emergencies.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Bell's palsy. Bell's palsy is a condition characterized by sudden weakness or paralysis of the facial muscles, typically on one side of the face. This condition is often caused by inflammation of the facial nerve, which controls the muscles on that side of the face. The absence of other neurological findings in the patient suggests a localized issue affecting the facial nerve, rather than a more widespread neurological condition. Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that primarily affects motor neurons, leading to muscle weakness and atrophy throughout the body. It typically does not present with isolated one-sided facial droop and paralysis. Multiple sclerosis is a chronic autoimmune disease that affects the central nervous system, leading to a wide range of symptoms such as fatigue, weakness, and coordination problems. While facial symptoms can occur in multiple sclerosis, they are usually not isolated to one side of the face. Huntington's disease is a genetic disorder that causes progressive degeneration of nerve cells in the brain. It primarily affects movement, cognition, and behavior, rather than causing isolated one-sided facial droop and paralysis. Educationally, understanding the specific manifestations of different neurological conditions is crucial for healthcare providers to accurately assess and care for patients. Recognizing the distinct features of Bell's palsy, such as one-sided facial weakness, helps in proper diagnosis and management, including timely referral to specialists for further evaluation and treatment.

Correct Answer: D

Rationale: In this question, the correct answer is D) Propranolol. Propranolol is a beta-blocker, which works by blocking the beta-adrenergic receptors in the heart. By doing so, it inhibits sympathetic nervous system stimulation, leading to a decrease in heart rate and force of contraction. This makes it an effective medication for conditions like hypertension, angina, and arrhythmias. A) Aldactone is a potassium-sparing diuretic and would not have a direct effect on blocking sympathetic stimulation of beta cells in the heart. B) Cardizem and C) Verapamil are calcium channel blockers that primarily affect calcium channels in the heart, not the beta-adrenergic receptors, so they would not effectively block sympathetic nervous system stimulation of the beta cells in the heart. Educationally, understanding the mechanism of action of different medications is crucial for nurses and healthcare providers in providing safe and effective care to patients. Knowing how medications work allows for appropriate selection based on the patient's condition and desired outcomes. In the case of this question, understanding the role of beta-blockers like Propranolol in managing heart rate and contractility is essential for nurses caring for patients with cardiovascular conditions.

Correct Answer: B

Rationale: In a closed-head injury patient, when intracranial pressure increases and mean arterial pressure decreases, a paramedic can expect the patient to have likely suffered a brainstem herniation. This occurs due to the pressure differential causing the brain to herniate through the foramen magnum, leading to compression of vital brainstem structures and potentially fatal consequences. Option A, stating that the patient's cerebral blood flow decreases, is incorrect. In this scenario, cerebral blood flow may actually increase initially due to the body's compensatory mechanisms to maintain perfusion to the brain. Option C, suggesting a marked increase in the patient's blood glucose level, is also incorrect. While stress responses can affect blood glucose levels, this is not a direct consequence of increased intracranial pressure and decreased mean arterial pressure. Option D, the formation of an intracranial abscess, is not relevant to the immediate physiological changes associated with increased intracranial pressure and decreased mean arterial pressure in closed-head injuries. Educationally, understanding the pathophysiology of closed-head injuries is crucial for healthcare providers to recognize and respond to changes in a patient's condition promptly. Recognizing the signs of brainstem herniation is vital for timely intervention and prevention of further complications, making option B the correct choice in this scenario.