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A 5-year old girl presents to ER with fever, convulsions and unconsciousness of one day duration. On examination she is pale, Glasgow coma scale is 8 and there are no signs of meningial irritation and no focal neurological signs. The most likely diagnosis is:
- A. Viral encephalitis
- B. Pyomeningitis
- C. Tuberculous meningitis
- D. Cerebral malaria
Correct Answer: D
Rationale: Cerebral malaria can cause fever, seizures, altered consciousness, and normal cerebrospinal fluid findings without focal neurological signs.
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The age by which the child can pull to stand, starting to pincer grasp, and plays pat-a-cake is
- A. 6 mo
- B. 7 mo
- C. 8 mo
- D. 9 mo
Correct Answer: D
Rationale: These milestones are typically achieved around 9 months of age.
Which points should a nurse includes in the discharge teaching plan for a client after cardiac surgery?
- A. Avoid showers and take tub bath until all incisions are healed
- B. Notify the physician if a painless lump is felt at the top of the chest incision
- C. Continue to wear support hose or elastic stockings during the night and remove them during the day
- D. Sexual relations typically can be resumed in 2-4 weeks depending on tolerance for activity
Correct Answer: B
Rationale: The correct answer is B. In the discharge teaching plan for a client after cardiac surgery, it is important for the nurse to include education on monitoring for signs of complications, such as notifying the physician if a painless lump is felt at the top of the chest incision. This could potentially indicate a seroma or hematoma, which may require medical attention. By educating the client on this specific point, the nurse helps to promote early detection and prompt management of any post-operative issues, which contributes to better outcomes for the client. The other options mentioned are important aspects of post-cardiac surgery care but do not address the specific concern of a painless lump at the chest incision site.
The nurse understands that a patient with status asthmaticus will likely initially evidence symptoms of:
- A. metabolic acidosis.
- B. metabolic alkalosis.
- C. respiratory acidosis.
- D. respiratory alkalosis.
Correct Answer: C
Rationale: In status asthmaticus, a severe and prolonged asthma attack can lead to inadequate ventilation due to airway obstruction. This results in retention of carbon dioxide (CO2) in the blood, leading to respiratory acidosis. As the CO2 levels rise, it combines with water in the blood to form carbonic acid, lowering the blood pH levels. Symptoms of respiratory acidosis can include shortness of breath, confusion, lethargy, and potentially life-threatening complications. Treatment for status asthmaticus aims to improve ventilation and restore normal blood gas levels to alleviate respiratory acidosis.
Which is the best position for an 8-year-old who has returned after an appendectomy for a ruptured appendix?
- A. Right side-lying.
- B. Semi-Fowler.
- C. Prone.
- D. Left side-lying.
Correct Answer: A
Rationale: Right side-lying promotes drainage of the peritoneal cavity and enhances comfort after surgery.
A 5-year old girl presents to ER with fever, convulsions and unconsciousness of one day duration. On examination she is pale, Glasgow coma scale is 8 and there are no signs of meningial irritation and no focal neurological signs. The most likely diagnosis is:
- A. Viral encephalitis
- B. Pyomeningitis
- C. Tuberculous meningitis
- D. Cerebral malaria
Correct Answer: D
Rationale: Cerebral malaria can cause fever, seizures, altered consciousness, and normal cerebrospinal fluid findings without focal neurological signs.