The patient is to receive multiple medications via the nasogastric tube. The nurse is concerned that the tube may become clogged. Which action isbestfor the nurseto take?

Correct Answer: D

Rationale: Rationale for Correct Answer (D): Checking with the pharmacy for availability of liquid forms of medications is the best action because it reduces the risk of clogging the nasogastric tube. Liquid medications are less likely to cause blockages compared to nonliquid medications. Additionally, liquid forms are easier to administer through the tube. By using liquid medications, the nurse can ensure that the medications flow smoothly through the tube without causing any obstructions. Summary of Incorrect Choices: A: Instilling nonliquid medications without diluting can increase the risk of tube clogging. B: Irrigating the tube with water after all medications are given may not prevent clogging effectively and could introduce unnecessary moisture into the tube. C: Mixing all medications together can lead to potential drug interactions and may not address the issue of tube clogging effectively.

Correct Answer: C

Rationale: The correct answer is C: Evidence of a more advanced lesion. A stoney hardening in the posterior lobe of the prostate gland that is not mobile is indicative of a more advanced lesion, such as prostate cancer. This finding suggests that the lesion has progressed beyond the early stages. In early prostate cancer, the prostate gland may feel firm but not stoney hard, and the lesion is usually mobile. Metastatic disease would involve spread of the cancer to other parts of the body, which is not evident from the DRE alone. A normal finding would not present as stoney hardening and lack of mobility in the prostate gland during a DRE.

Correct Answer: C

Rationale: The correct term for the involuntary, rhythmic eye movements seen in the patient with multiple sclerosis is nystagmus. Nystagmus is a condition characterized by repetitive, uncontrolled eye movements that can be horizontal, vertical, or rotary. In multiple sclerosis, nystagmus can occur due to damage to the nerves that control eye movement. Vertigo (choice A) is a sensation of spinning or dizziness, not related to eye movements. Tinnitus (choice B) is a perception of noise or ringing in the ears. Astigmatism (choice D) is a refractive error of the eye, not related to involuntary eye movements.

Correct Answer: B

Rationale: The correct answer is B because Rh incompatibility occurs when an Rh-negative mother carries an Rh-positive fetus. If fetal blood enters the mother's circulation during pregnancy or childbirth, the mother's immune system can produce antibodies against Rh-positive red blood cells, leading to potential harm to future pregnancies. Choices A, C, and D are incorrect because Rh incompatibility does not occur when the fetus is Rh-negative, the father is Rh-positive, or both the father and fetus are Rh-negative.

Correct Answer: A

Rationale: The correct answer is A: A minimum data set. In a long-term care setting funded by Medicare and Medicaid, completing standardized protocols for assessment and care planning for reimbursement involves using a minimum data set, which is a standardized instrument for assessing residents' health status. This set of data elements is necessary for comprehensive assessment and care planning to ensure appropriate reimbursement. The other choices (B, C, D) do not specifically address the standardized protocols required for reimbursement in this setting. An admission assessment and acuity level would be part of the process, but not the primary task being completed in this scenario. A focused assessment on a specific body system or an intake assessment form and auditing phase are not synonymous with the standardized protocols needed for reimbursement in a Medicare/Medicaid-funded long-term care facility.

Correct Answer: A

Rationale: The correct answer is A: Gay, bisexual, and other men who have sex with men. This group currently has the highest risk of contracting HIV due to various factors such as higher prevalence within this population, risky sexual behaviors, and limited access to healthcare services. Men who have sex with men have been disproportionately affected by HIV/AIDS since the beginning of the epidemic. Recreational drug users and blood transfusion recipients have lower overall risk compared to men who have sex with men. Health care providers, although at risk of occupational exposure, have lower risk compared to the other groups mentioned.

Correct Answer: A

Rationale: The correct answer is A: Testicular cancer is a highly curable type of cancer. This is the most appropriate point to emphasize because early detection through regular self-examinations can lead to early treatment and a high survival rate. Testicular cancer has a very high cure rate, especially when detected and treated early. Emphasizing this point encourages boys to perform monthly self-exams, leading to early detection and better outcomes. Explanation of other choices: B: Testicular cancer is very difficult to diagnose - This is incorrect because testicular cancer is actually one of the more easily detectable cancers through self-examinations. C: Testicular cancer is the number one cause of cancer deaths in males - This is incorrect as testicular cancer is not the leading cause of cancer deaths in males. D: Testicular cancer is more common in older men - This is incorrect as testicular cancer is more common in younger men, typically between the ages of 15 and 44.

Correct Answer: A

Rationale: The correct answer is A: Obtain an interpreter. This is the best action as it ensures effective communication and accurate understanding of the patient's history and needs. Using a professional interpreter maintains confidentiality, avoids misinterpretation, and promotes cultural sensitivity. Referring to a speech therapist (B) is not appropriate for language barriers. Letting a family member talk (C) may compromise privacy and accuracy. Finding a mental health nurse specialist (D) is not needed for language translation.

Correct Answer: B

Rationale: The correct answer is B: Sleep on a firm mattress. A firm mattress helps maintain proper spinal alignment, reducing pressure on the cervical spine. This promotes healing and prevents worsening of symptoms. A: Performing active ROM exercises may exacerbate symptoms and worsen the condition. C: Applying cool compresses may provide temporary relief but does not address the underlying issue of spinal alignment. D: Wearing a cervical collar for extended periods can weaken neck muscles and hinder natural healing processes. In summary, sleeping on a firm mattress is the most appropriate conservative measure as it supports proper spinal alignment.