Nokea
The nurse is arriving at the beginning of her shift and has taken report on four clients on a medical surgical unit. Which client should the nurse see first?
- A. A Client with pyelonephritis with nausea and vomiting
- B. A client with chronic obstructive pulmonary disease with an oxygen saturation of $90 \%$ on room air
- C. A client post vaginoplasty with bright red blood and clots in her catheter
- D. A client post-total abdominal hysterectomy with 9/10 pain
Correct Answer: C
Rationale: Bright red blood and clots post-vaginoplasty scream hemorrhage ABCs prioritize circulation, needing instant check for shock or transfusion. Pyelonephritis nags, COPD's stable at 90\%, pain's urgent but not bleeding. Nurses hit bleeding first, a life-line call in this post-op rush.
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Melatonin is a hormone that is involved in the regulation of the circadian rhythm. Features of melatonin include:
- A. It circulates in the cerebrospinal fluid and blood.
- B. It has a plasma elimination half-life of 4 h.
- C. It is derived from tryptophan.
- D. It activates the pituitary adenylate cyclase mechanism of circadian wakefulness.
Correct Answer: A
Rationale: Melatonin, produced by the pineal gland, regulates sleep-wake cycles. It circulates in blood and cerebrospinal fluid, crossing the blood-brain barrier to signal darkness via the suprachiasmatic nucleus (SCN). Its half-life is short, about 30-60 minutes, not 4 hours, enabling rapid response to light cues. Synthesized from tryptophan via serotonin, it's a biochemical derivative responsive to environmental triggers. It acts on melatonin receptors (MT1, MT2) in the SCN, suppressing wakefulness-promoting adenylate cyclase, not activating pituitary mechanisms for wakefulness that's a misattribution. Its role dampens alertness, promoting sleep. Circulation in bodily fluids ensures systemic distribution, aligning circadian rhythms with night, making it foundational to sleep physiology and fatigue management.
A female client is being treated for a deep-vein thrombus she developed post-operatively about one week ago and was treated with unfractionated heparin. Today she presents to the clinic with petechiae on bilateral hands and feet. Laboratory results show a platelet count of 42,000/mm³. The nurse is concerned about a drug reaction and anticipates the client has which of the following?
- A. Heparin-induced thrombocytopenia (HIT)
- B. Hemophilia A (classic hemophilia)
- C. Thrombotic thrombocytopenic purpura (TTP)
- D. Sickle cell crisis
Correct Answer: A
Rationale: Heparin can backfire petechiae and a platelet plunge to 42,000/mm³ post-DVT treatment scream HIT, an immune reaction trashing platelets, risking clots. Hemophilia's genetic, not drug-tied. TTP adds fever, neuro signs absent here. Sickle crisis pains, not bleeds like this. Nurses suspect HIT, anticipating heparin cessation and alternatives, a twist in this anticoagulation tale.
The BMI that does NOT INCREASE the risk of renal disease and CKD is X. What is X?
- A. 25 or more
- B. 30 or more
- C. 35 or more
- D. 40 or more
Correct Answer: A
Rationale: Body Mass Index (BMI) correlates with chronic kidney disease (CKD) risk, with higher values linked to increased incidence due to obesity-related glomerular hypertension and inflammation. A BMI of 25 or more defines overweight and obesity, elevating CKD risk, though 18.5-24.9 is the range typically not increasing risk. The question's phrasing implies the threshold where risk begins, making 25 or more the level where renal disease risk rises, per studies like the Framingham Heart Study. Higher BMIs (30+, 35+, 40+) progressively worsen risk, with 30 marking obesity. Thus, 25 or more is the correct cutoff, guiding family physicians in counseling patients on weight management to prevent CKD onset.
Inhaled medications, such as bronchodilators and glucocorticoids are the main medication treatment methods for COPD. What is the biggest reason for ineffective outcomes?
- A. Patient compliance with dose prescription
- B. Incorrect use of the device
- C. Incorrect prescribing
- D. Reduced drug inhalation due to respiratory disease
Correct Answer: B
Rationale: COPD inhalers flop most when puffed wrong technique, not timing, trumps compliance, bad scripts, or weak lungs. Spacers, shaky hands nurses fix this, a chronic breath's weak link.
The nurse is caring for a 6-year-old child with leukemia who is having an oncological emergency. Which of the following signs and symptoms would indicate hyperleukocytosis?
- A. Bradycardia and distinct S1 and S2 sounds
- B. Wheezing and diminished breath sounds
- C. Respiratory distress and poor tissue perfusion
- D. Intermittent fever and frequent vomiting
Correct Answer: C
Rationale: Hyperleukocytosis, a leukemia emergency with white blood cell counts over 100,000/mm³, causes blood hyperviscosity, leading to venous stasis and microvessel occlusion by blast cells. This results in respiratory distress (from lung infarction or hypoxemia) and poor tissue perfusion (from impaired circulation), critical signs requiring urgent intervention like leukapheresis or hydration. Bradycardia and clear heart sounds don't fit tachycardia might occur from hypoxia, not bradycardia. Wheezing and diminished breath sounds suggest asthma or infection, not hyperleukocytosis's systemic impact. Fever and vomiting are non-specific and less acute here. Nurses recognizing these symptoms prioritize airway and circulation support, aligning with oncology's focus on rapid response to life-threatening complications in pediatric leukemia care.