Nokea
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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A client is diagnosed with megaloblastic anemia caused by vitamin B12 deficiency. The physician begins the client on cyanocobalamin (Betalin-12), 100mcg IM daily. Which substance influences Vitamin B12 absorption?
- A. Intrinsic factor
- B. Histamine
- C. Hydrochloric acid
- D. Liver enzyme
Correct Answer: A
Rationale: Intrinsic factor is a glycoprotein produced by the parietal cells of the stomach. It is essential for the absorption of vitamin B12 in the intestine. Vitamin B12 binds to intrinsic factor in the stomach, forming a complex that is absorbed in the ileum of the small intestine. Without intrinsic factor, vitamin B12 absorption is significantly impaired, leading to conditions like pernicious anemia, which is a type of megaloblastic anemia caused by vitamin B12 deficiency. By administering cyanocobalamin (Betalin-12) intramuscularly, the need for intrinsic factor in the absorption process is bypassed, which is necessary in cases where intrinsic factor production or function is disrupted.
Nurse Kara is giving instructions to an elderly client on diabetic foot care. Which teaching is not part of foot care?
- A. wear comfortable shoes that fit well and protect your feet
- B. trim your toenails straight across and file edges with emery board
- C. wash your feet in hot water to keep feet soft
- D. wear shoes at the beach or on hot pavement
Correct Answer: C
Rationale: Washing your feet in hot water is not recommended as it can actually worsen diabetic foot conditions. Hot water can lead to burns and damage the skin, especially for individuals with reduced sensation in their feet due to diabetes. It is advised to wash feet in warm water instead, avoiding hot temperatures to prevent injuries and complications. The other options provide important aspects of diabetic foot care such as wearing appropriate shoes, trimming toenails carefully, and being mindful of footwear choices to protect the feet.
Immunity to a disease after recovery is possible because the first exposure to the pathogen has stimulated the formation of which of the following?
- A. Antigens
- B. Complement
- C. Memory cells
- D. Natural killer cells
Correct Answer: C
Rationale: Immunity to a disease after recovery is possible because the first exposure to the pathogen has stimulated the formation of memory cells. Memory cells are a type of immune cell that "remembers" the specific pathogen encountered during the initial infection. When the same pathogen tries to infect the individual again, these memory cells quickly recognize the pathogen and mount a faster and stronger immune response, leading to a quicker recovery and preventing the person from getting sick again from the same pathogen. This immune memory is the basis of acquired immunity, providing long-lasting protection against future infections by the same pathogen.
Mr. RR is to have a brain scanning. Nursing intervention in preparation for this test includes:
- A. Discontinuing any anticonvulsant therapy
- B. Obtaining consent for the treatment
- C. Explaining to Mr. RR that although his head will be supported in place for a period of time, the test will not be painful.
- D. Informing Mr. RR that nausea and headache are frequent following this test
Correct Answer: C
Rationale: The nursing intervention in preparation for a brain scanning test such as an MRI or CT scan should include explaining to the patient (Mr. RR in this case) that although his head will be supported in place for a period of time during the test, the procedure itself will not be painful. Providing this explanation helps to alleviate any anxiety or fear Mr. RR may have about the test and ensures that he feels comfortable and well-informed before the procedure. This communication is key to promoting a positive patient experience and ensuring cooperation during the test. It also helps in managing patient expectations and reducing any potential stress or discomfort during the scanning process.
A narcotic analgesic is ordered for postoperative pain. Why are narcotics given in low doses to the laryngectomy patient?
- A. They depress the respiratory rate and cough reflex.
- B. They increase respiratory tract secretions.
- C. They have a tendency to cause stomal edema.
- D. They can cause addiction.
Correct Answer: A
Rationale: Narcotic analgesics, when given in high doses, can depress the respiratory rate and cough reflex in patients. Laryngectomy patients have had their larynx removed and may already have compromised respiratory function. Therefore, giving narcotics in low doses helps to minimize the risk of further respiratory depression in these patients. It is important to closely monitor respiratory status when administering narcotics to laryngectomy patients to prevent potential complications.