A 5-year-old child, recently diagnosed with ileocecal Burkitt lymphoma; lab investigations reveal: serum uric acid 12 mg/dl, serum sodium, 145 meq/dl; serum potassium, 4.5 meq/dl; serum phosphate 4.4 meq/dl; serum calcium, 8.9 mg/dl; blood urea, 22 mg/dl; serum creatinine, 0.8 mg/dl. Of the following, the MOST effective treatment is
- A. excessive hydration
- B. sodium bicarbonate
- C. xanthine oxidase inhibitor
- D. recombinant urate oxidase
Correct Answer: D
Rationale: Recombinant urate oxidase (rasburicase) effectively lowers uric acid levels in cases of tumor lysis syndrome.
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. Which of the following laboratory test results would suggest to the nurse that a client has a corticotrophin- secreting pituitary adenoma?
- A. High corticotropin and low cortisol levels
- B. high corticotropin and high cortisol levels
- C. Low corticotropin and high cortisol levels
- D. Low corticotropin and low cortisol levels
Correct Answer: B
Rationale: A corticotrophin-secreting pituitary adenoma, also known as Cushing's disease, results in an overproduction of adrenocorticotropic hormone (corticotropin). This excess corticotropin stimulates the adrenal glands to produce increased levels of cortisol. Therefore, a client with a corticotrophin-secreting pituitary adenoma would typically exhibit high levels of both corticotropin and cortisol. Option B is the correct choice, as it indicates elevated levels of both hormones, suggesting the presence of a corticotrophin-secreting pituitary adenoma.
About 500 children have just been exposed to radiation from a nuclear power plant accident. The most appropriate first step in your treatment of these children should be to
- A. prescribe potassium iodide to protect the thyroid
- B. order thyroid function tests
- C. order complete blood counts (CBCs)
- D. do nothing acutely; evaluate in 4-6 weeks
Correct Answer: A
Rationale: Potassium iodide can protect the thyroid from radioactive iodine exposure, which is a critical first step in radiation exposure.
The ABCD method offers one way to assess skin lesions for possible skin cancer. What does the A stand for?
- A. Actinic
- B. Arcus
- C. Asymmetry
- D. Assessment
Correct Answer: C
Rationale: In the ABCD method used to assess skin lesions for possible skin cancer, the letter A stands for Asymmetry. Asymmetry refers to the irregular shape of the lesion when one half of the lesion does not match the other half. Lesions that are symmetrical are less likely to be concerning for skin cancer, while asymmetrical lesions should be further evaluated by a healthcare professional. This characteristic helps in identifying potentially worrisome skin lesions early on for appropriate management.
Which assessment action will help the nurse determine if the patient with Bell's Palsy is receiving adequate nutrition?
- A. Monitor meal trays
- B. Check twice-weekly weights
- C. Measure intake and output
- D. Assess swallowing reflex
Correct Answer: D
Rationale: By assessing the patient's swallowing reflex, the nurse can determine if the patient is able to swallow food and liquids properly, which is crucial for adequate nutrition intake. Bell's Palsy can affect facial muscles, including those involved in chewing and swallowing. A impaired swallowing reflex can lead to difficulties in eating and drinking, which in turn may affect the patient's nutrition status. Monitoring meal trays (A) may not provide direct information about the patient's ability to swallow, as a patient may not be able to communicate swallowing difficulties. Checking twice-weekly weights (B) may indicate weight changes, but it may not necessarily give insight into nutrition adequacy related to swallowing ability. Measuring intake and output (C) may help track calorie intake and fluid balance, but it may not specifically address swallowing issues that can impact nutrition in a patient with Bell's Palsy. Assessing the swallowing reflex (D) directly addresses the patient's ability to consume food and
A client receiving ferrous sulfate (Fer-Iron) therapy to treat an iron deficiency reports taking an antacid frequently to relieve heart burn. Which nursing instruction should the nurse provide?
- A. "Take ferrous sulfate and the antacid together."
- B. "Take ferrous sulfate and the antacid at least 2 hours apart."
- C. "Avoid taking an antacid altogether."
- D. "Take ferrous sulfate and the antacid at least 1 hour apart."
Correct Answer: B
Rationale: Antacids can interfere with the absorption of iron from ferrous sulfate. Therefore, it is important to take these medications at least 2 hours apart to ensure proper absorption of the iron supplement. Taking them together can reduce the effectiveness of the ferrous sulfate therapy in treating the iron deficiency. It is not necessary to avoid taking an antacid altogether, but timing is crucial to optimize the benefits of both medications.