Nokea
A 4-year-old child has had fever, malaise, and vomiting and right-sided abdominal pain for 48 hours. The following are likely diagnoses:
- A. Acute pyelonephritis
- B. Shigella dysentery
- C. Ascaris lumbricoides infestation, if the child is living in the tropics
- D. Right sided tumour
Correct Answer: A
Rationale: Acute pyelonephritis is a common cause of fever, vomiting, and abdominal pain in children. Shigella dysentery typically causes diarrhea, and Ascaris infestation is rare in non-tropical regions. A right-sided tumour is unlikely without other signs.
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A VII nerve injury at the exit from the stylomastoid foramen would explain all except:
- A. Loss of sensation over the vallecula
- B. Loss of taste over the anterior third of the tongue
- C. Increased responsiveness to loud noises
- D. Inability to open the ipsilateral eye
Correct Answer: D
Rationale: The correct answer is D because the facial nerve (VII) does not control eye opening; this is controlled by the oculomotor nerve (III). The other options (a, b, c, e) are consistent with a VII nerve injury.
During a paracentesis, two liters of fluid are removed from the abdomen of a client with ascites. A drainage bag is placed, and 50 ml of clear, straw-colored fluid drains within the first hour. What action should the nurse implement?
- A. Palpate for abdominal distention
- B. Send fluid to the lab for analysis
- C. Continue to monitor the fluid output
- D. Clamp the drainage tube for 5 minutes
Correct Answer: C
Rationale: Monitoring fluid output is essential to assess for complications such as reaccumulation of fluid or bleeding.
A client who has a history of long-standing back pain treated with methadone (Dolophines), is admitted to the surgical unit following urological surgery. Which modifications in the plan of care should the nurse make for this client's pain management during the postoperative period?
- A. Consult with surgeon about increasing methadone in lieu of parenteral opioids.
- B. Use minimal parenteral opioids for surgical pain, in addition to oral methadone
- C. Maintain client's methadone, and medicate surgical pain based on pain rating
- D. Make no changes in the standard pain management for the surgery and hold methadone.
Correct Answer: C
Rationale: Maintaining the client's methadone regimen while addressing surgical pain ensures effective pain control without risking withdrawal or inadequate pain relief.
Which is a clinical manifestation of the systemic venous congestion that can occur with heart failure?
- A. Tachypnea
- B. Tachycardia
- C. Peripheral edema
- D. Pale, cool extremities
Correct Answer: C
Rationale: Peripheral edema, especially periorbital edema, is a clinical manifestation of systemic venous congestion. Tachypnea is a manifestation of pulmonary congestion. Tachycardia and pale, cool extremities are clinical manifestations of impaired myocardial function.
Management of thalassaemia includes:
- A. Whole blood transfusions
- B. Pneumovax
- C. Bone marrow transplant
- D. Penicillin V prophylaxis
Correct Answer: C
Rationale: The correct answer is C because bone marrow transplant is a curative treatment for thalassaemia. The other options (a, b, d, e) are supportive treatments but not curative.