Nokea
A 24-year-old female is admitted to the ER for confusion. This patient has a history of a myeloma diagnosis, constipation, intense abdominal pain, and polyuria. Based on the presenting signs and symptoms, which of the following would you most likely suspect?
- A. Diverticulosis
- B. Hypercalcemia
- C. Hypocalcemia
- D. Irritable bowel syndrome
Correct Answer: B
Rationale: The correct answer is Hypercalcemia. In this case, the patient's history of myeloma, constipation, intense abdominal pain, and polyuria suggests hypercalcemia. Elevated calcium levels can lead to polyuria, severe abdominal pain, and confusion. Diverticulosis (Choice A), characterized by small pouches in the colon wall, typically does not present with confusion and polyuria. Hypocalcemia (Choice C) is unlikely given the symptoms described. Irritable bowel syndrome (Choice D) does not typically cause confusion and polyuria as seen in hypercalcemia.
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A patient asks a nurse, "My doctor recommended I increase my intake of folic acid. What type of foods contain the highest concentration of folic acid?'
- A. Green vegetables and liver
- B. Yellow vegetables and red meat
- C. Carrots
- D. Milk
Correct Answer: A
Rationale: Green vegetables and liver are rich sources of folic acid. Green vegetables like spinach, asparagus, and broccoli are high in folic acid content. Liver, especially from chicken or beef, is also a good source of folic acid. Yellow vegetables and red meat (choice B) do not contain as high a concentration of folic acid as green vegetables and liver. Carrots (choice C) are nutritious but do not have the highest concentration of folic acid. Milk (choice D) is not a significant source of folic acid compared to green vegetables and liver.
A 20-year-old female attending college is found unconscious in her dorm room. She has a fever and a noticeable rash. She has just been admitted to the hospital. Which of the following tests is most likely to be performed first?
- A. Blood sugar check
- B. CT scan
- C. Blood cultures
- D. Arterial blood gases
Correct Answer: C
Rationale: The most likely test to be performed first in this scenario is blood cultures. Blood cultures are crucial to investigate the fever and rash symptoms in an unconscious patient. This test is used to detect foreign invaders like bacteria, yeast, and other microorganisms in the blood, which could indicate a blood infection (bacteremia). A positive blood culture result confirms the presence of bacteria in the blood. A blood sugar check (choice A) may be important but is less likely to be the first test in this context. A CT scan (choice B) and arterial blood gases (choice D) are generally not the initial tests performed to investigate a fever and rash with altered mental status.
An 85-year-old male has been losing mobility and gaining weight over the last two months. The patient also has the heater running in his house 24 hours a day, even on warm days. Which of the following tests is most likely to be performed?
- A. CBC (complete blood count)
- B. ECG (electrocardiogram)
- C. Thyroid function tests
- D. CT scan
Correct Answer: C
Rationale: The symptoms of weight gain and poor temperature tolerance in an elderly male suggest a potential thyroid dysfunction. Thyroid function tests are crucial in differentiating between hyperthyroidism, hypothyroidism, and a euthyroid state. These tests involve measuring the serum levels of thyroid hormones T3 and T4, also known as thyroxine, to evaluate thyroid function accurately. A complete blood count (Choice A) would not directly address the symptoms presented. An electrocardiogram (Choice B) assesses heart activity and would not be the primary test for these symptoms. A CT scan (Choice D) provides detailed images of internal organs and structures, which would not be the initial investigation for the described symptoms.
A client with a new colostomy is being taught how to care for the colostomy bag. Which statement from the client indicates the need for more education?
- A. I can clean the skin around the ostomy site with soap and water when I change the bag.
- B. I should irrigate the stoma regularly to avoid buildup of gas and odor.
- C. I need to wait 30 minutes after I irrigate to replace the colostomy bag.
- D. I should change the bag when it is one-third to one-fourth full.
Correct Answer: C
Rationale: A client with a new colostomy requires education on proper colostomy care. Waiting 30 minutes after irrigating to replace the colostomy bag is unnecessary. The client may reapply the bag once the skin is dry. Cleaning the skin around the ostomy site with soap and water, irrigating the stoma regularly to prevent gas and odor buildup, and changing the bag when it is one-third to one-fourth full are appropriate actions. Therefore, the statement indicating the need for more education is the one suggesting a specific time interval for bag replacement after irrigation.
The nurse is caring for a 27-year-old female client with a venous stasis ulcer. Which nursing intervention would be most effective in promoting healing?
- A. Apply dressing using sterile technique
- B. Improve the client's nutrition status
- C. Initiate limb compression therapy
- D. Begin proteolytic debridement
Correct Answer: B
Rationale: Venous stasis occurs when venous blood collects and stagnates in the lower leg due to incompetent venous valves. This leads to inadequate oxygen and nutrient supply to the cells in the lower extremities, resulting in cell death or necrosis. Venous stasis ulcers, characterized by shallow brown wounds with irregular margins, typically develop on the lower leg or ankle. The primary goal in managing clients with venous stasis ulcers is to promote healing. Proper nutrition plays a crucial role in wound healing. Nutritional deficiencies are common causes of venous ulcers, and a diet rich in protein, iron, zinc, and vitamins C and A is recommended to enhance wound healing. Applying dressings with sterile technique, initiating limb compression therapy, and beginning proteolytic debridement are important interventions in wound care but may not directly address the underlying issue of poor nutrition that is essential for healing venous stasis ulcers.