Nokea
An African client has been diagnosed with Osteomyelitis. The nurse expects to assess which of the following?
- A. pale, cool, tender skin at site
- B. decreased white blood cell count
- C. positive wound cultures
- D. decreased erythrocyte sedimentation rate
Correct Answer: C
Rationale: Osteomyelitis is an infection of the bone often caused by bacteria. When a client is diagnosed with Osteomyelitis, the nurse would expect to assess for positive wound cultures. This means that the wound site is likely to show growth of infectious organisms, confirming the presence of infection in the bone. A positive wound culture result helps guide appropriate antibiotic therapy to treat the infection effectively. Therefore, option C is the most appropriate assessment finding to expect in a client diagnosed with Osteomyelitis.
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The nurse is preparing a client for magnetic resonance imaging (MRI) to confirm or rule out a spinal cord lesion. During the MRI scan, which of the following would pose a threat to the client?
- A. The client lies still.
- B. The client wears a watch and wedding
- C. The client asks questions. band.
- D. the client hears thumping sounds.
Correct Answer: B
Rationale: The client wearing a watch and wedding band would pose a threat during the MRI scan. MRI machines use strong magnetic fields that can interact with metal objects. The presence of metal objects such as a watch and wedding band can lead to serious safety risks for the client inside the MRI machine. These metal objects can become projectiles or heat up, causing burns or other injuries. Thus, it is crucial for the client to remove all metal objects before undergoing an MRI scan to ensure their safety.
The age of a child who can imitate construction of gate with 2-4 parts; draws longer lines; and draws a man with 5 cubes is
- A. 24 months
- B. 30 months
- C. 48 months
- D. 54 months
Correct Answer: B
Rationale: These milestones are typically achieved around 30 months.
Which of the following is most likely associated with a cerebrovascular accident (CVA) resulting from congenital heart disease?
- A. Polycythemia
- B. Cardiomyopathy
- C. Endocarditis
- D. Low blood pressure
Correct Answer: A
Rationale: Polycythemia, which is an abnormally elevated level of red blood cells in the blood, is commonly associated with congenital heart disease. In cases where there is a congenital heart defect that causes reduced oxygen levels in the blood, the body compensates by producing more red blood cells to try to improve oxygen delivery. This increased red blood cell production can lead to polycythemia. In turn, polycythemia can increase the risk of thrombosis, which is a known risk factor for cerebrovascular accidents (CVAs) or strokes. Therefore, polycythemia is most likely associated with a CVA resulting from congenital heart disease.
A client with pernicious anemia is receiving parenteral vitamin B12 therapy. Which client statement indicates effective teaching about this therapy?
- A. "I will receive parenteral vitamin B12 therapy until my signs and symptoms disappear."
- B. "I will receive parenteral vitamin B12 therapy until my vitamin B12 level returns to normal."
- C. "I will receive parenteral vitamin B12 therapy monthly for 6 months to a year."
- D. "I will receive parenteral vitamin B12 therapy for the rest of my life."
Correct Answer: D
Rationale: The correct client statement indicating effective teaching about parenteral vitamin B12 therapy for pernicious anemia is, "I will receive parenteral vitamin B12 therapy for the rest of my life." Pernicious anemia is a condition in which the body cannot absorb enough vitamin B12 from food due to a lack of intrinsic factor, a protein produced in the stomach. As a result, lifelong B12 supplementation is necessary to maintain adequate levels of the vitamin. Monthly injections are typically recommended for life to ensure proper B12 levels and prevent complications associated with the deficiency.
A patient who is recovering from a stroke becomes easily frustrated when unable to complete a task. Which of the ff. responses by the nurse will best help the patient get the task done?
- A. Perform the task for the patient
- B. Tell the patient not to worry about it
- C. Break the task down into simple steps
- D. Have another patient demonstrate how to perform the task
Correct Answer: C
Rationale: Breaking the task down into simple steps is the best response by the nurse to help the patient get the task done. By breaking the task into smaller, more manageable steps, the patient can focus on completing each step successfully, leading to a sense of accomplishment and reducing frustration. This approach promotes a positive and empowering experience for the patient, ultimately aiding in their recovery and rehabilitation process.