Upon further assessment, you notices that she had any scratches on her right ankle, a resulting infection, and cellulitis. When you asked her about the scratches, the patient states, "Oh, my cat might have been using my leg as a scratiching post again and I did not even feel it." Which diabetic complicatons suspect the patient to have?

Correct Answer: A

Rationale: The patient's lack of sensation in her right leg, allowing her cat to scratch her without her noticing, is indicative of neuropathy. Neuropathy is a common diabetic complication characterized by nerve damage that can result in loss of sensation or altered sensation in different parts of the body, including the extremities. In this case, neuropathy has likely affected the patient's right lower extremity, leading to her inability to feel the cat scratching her leg and resulting in the unnoticed scratches, infection, and subsequent cellulitis.

Correct Answer: B

Rationale: The first step that a nurse must keep in mind to start a nursing improvement project is to determine the nursing standards. This is crucial because nursing standards provide guidelines and benchmarks for quality care delivery. By identifying and understanding the established standards, nurses can assess current practices, identify areas that need improvement, and develop strategies to enhance patient care. Setting a clear foundation based on nursing standards is essential before moving forward with implementing corrective actions, determining findings for correction, or collecting data. Understanding and aligning with nursing standards from the outset ensures that the improvement project is focused on promoting best practices and achieving positive outcomes for patients.

Correct Answer: A

Rationale: A safe patient environment should address the physical, emotional, and psychological well-being of the patient. While socio-economic needs are important for overall patient care, they are not directly related to creating a safe environment within a healthcare setting. Factors such as maintaining sanitation, meeting basic needs, and reducing physical hazards are crucial to ensuring the safety and well-being of patients. However, addressing socio-economic needs falls more within the realm of holistic patient care beyond just the physical safety aspect.

Correct Answer: A

Rationale: Difficulty of speaking and chewing is an indicator of cranial nerve involvement. Cranial nerves are responsible for controlling various functions of the head and neck, including speech and mastication. Impairment of cranial nerve function can lead to difficulty in these activities. In the context of the question, with the patient in the stroke unit, cranial nerve involvement can occur due to the stroke affecting the brain regions responsible for cranial nerve function. Loss of pain sensation, spastic paralysis of the extremities, and forgetfulness with syncope are not specific indicators of cranial nerve involvement in this scenario.

Correct Answer: B

Rationale: In order to understand and interpret a message accurately, it is essential to consider the context in which it was delivered. Context provides the necessary background information, setting, and circumstances that give meaning and relevance to the message being communicated. Without context, it can be challenging to fully grasp the intention and significance of the communication. While the other options (process, phrases and sentences, thoughts and feelings) play roles in communication, it is the context that ultimately helps to give meaning and context to the message being conveyed.