The nurse specialist cites a situation. If a patient experiences episodes of severe nausea and vomiting with more than 1,000 ml. of vomitus with in a period of four hours, which of the following is the nurses MOST appropriate action?

Correct Answer: C

Rationale: Severe nausea and vomiting with a large volume of vomitus can indicate a serious underlying issue such as gastrointestinal obstruction or other medical emergencies. In this situation, it is crucial for the nurse to notify the physician immediately so that further assessment and appropriate management can be initiated promptly. Delay in seeking medical help can lead to complications and worsen the patient's condition. It is important to act quickly and involve the physician in situations where the patient's health may be at risk.

Correct Answer: B

Rationale: In a patient experiencing an acute asthma exacerbation with severe respiratory distress and hypoxemia, the most appropriate intervention is to initiate non-invasive positive pressure ventilation (NIPPV). NIPPV can help improve ventilation, decrease work of breathing, and correct hypoxemia by providing positive pressure to keep the airways open, reduce air trapping, and increase the elimination of carbon dioxide. This intervention can help improve oxygenation and reduce the need for invasive mechanical ventilation in patients with severe asthma exacerbations. Administering high-flow oxygen via nasal cannula alone may not provide enough support for patients with severe respiratory distress. Nebulized albuterol/ipratropium combination therapy and intravenous corticosteroid therapy are also important treatments for asthma exacerbations but are not the first-line interventions for patients with severe respiratory distress and hypoxemia.

Correct Answer: B

Rationale: Unstable angina is characterized by chest pain at rest, which is not relieved by nitroglycerin. The ECG findings in unstable angina typically show ST-segment depression or T-wave inversion. It is considered a medical emergency as it can progress to a myocardial infarction. Stable angina, on the other hand, is chest pain or discomfort that occurs with exertion and is relieved by rest or medications like nitroglycerin. Acute myocardial infarction would typically present with ST-segment elevation on ECG, while Prinzmetal's angina is characterized by transient ST-segment elevation due to coronary artery vasospasm.

Correct Answer: D

Rationale: The planning function of Nurse Ellen in her role as a nurse manager best corresponds to option D, which is to determine how to achieve the mandate of work. Planning involves setting objectives, developing strategies, and outlining the steps to accomplish those objectives. As a nurse manager, Nurse Ellen would be responsible for creating plans to ensure the effective delivery of patient care, efficient allocation of resources, and meeting the organizational goals of the unit. By determining how to achieve the work mandate, Nurse Ellen can effectively lead her team, allocate resources efficiently, and navigate any challenges that may arise in the operation of the nursing unit.

Correct Answer: A

Rationale: Encouraging frequent position changes, including the hands-and-knees position, is the most appropriate nursing intervention in this scenario. This position is known to help rotate the baby from a persistent posterior position to an optimal anterior position for delivery. The hands-and-knees position can help take pressure off the mother's back, alleviate back pain, and facilitate the rotation of the baby's head to engage in the mother's pelvis, thus promoting labor progress. It is a non-invasive and effective way to promote fetal rotation without the need for immediate instrumental delivery or intravenous analgesics. Continuous fetal monitoring is important for assessing fetal well-being but would not directly address the issue of posterior fetal position and the associated prolonged labor.

Correct Answer: C

Rationale: The patient's presentation of excessive thirst, frequent urination, and fatigue align with the classic symptoms of diabetes mellitus. The laboratory findings of hypernatremia (high sodium levels), hyperglycemia (high blood sugar levels), and metabolic acidosis further support this diagnosis. In diabetes mellitus, the body is unable to properly regulate blood sugar levels due to either insufficient insulin production (Type 1 diabetes) or ineffective use of insulin by the cells (Type 2 diabetes). This leads to high blood sugar levels, causing symptoms such as polyuria (frequent urination), polydipsia (excessive thirst), and fatigue. The metabolic acidosis is a result of the body's breakdown of fats and proteins for energy due to the lack of glucose utilization in the cells.

Correct Answer: C

Rationale: The presentation described in the question, including the skin lesion resembling a "bull's eye" rash at the site of a tick bite, is characteristic of Lyme disease. Lyme disease is caused by the spirochete bacterium Borrelia burgdorferi, which is transmitted to humans through the bite of infected black-legged ticks (Ixodes scapularis). The symptoms of Lyme disease include fever, headache, myalgia, and the erythema migrans rash, which appears as a red circular rash with central clearing resembling a bull's eye.

Correct Answer: A

Rationale: Neonatal Opioid Withdrawal Syndrome (NOWS), previously known as Neonatal Abstinence Syndrome (NAS), can occur when a newborn is exposed to opioids in utero. Opioid exposure in utero can lead to physical dependence in the fetus, and when the drug is no longer available after birth, withdrawal symptoms can occur.

Correct Answer: B

Rationale: Malpractice is a type of tort that involves professional negligence or misconduct by a professional such as a nurse that results in harm to a patient. In this scenario, failing to obtain informed consent before performing a procedure is considered a breach of the standard of care expected from a healthcare professional, which falls under malpractice. This failure to obtain informed consent deprives the patient of the right to make an informed decision about their treatment and can lead to legal consequences for the nurse.