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A 5-year-old presents with a history of urgency of micturition, occasional enuresis, and a slight, non-offensive vaginal discharge for 3 months. She has had no vaginal bleeding. Examination reveals some reddening of the labia majora. Which one of the following is the most likely diagnosis?
- A. Trichomonal infection.
- B. Gonorrhoea.
- C. Cystitis.
- D. Non-specific vulvo-vaginitis.
Correct Answer: D
Rationale: Non-specific vulvo-vaginitis (E) is common in young girls due to hygiene or irritation, causing these symptoms. Trichomonas (A) and gonorrhoea (B) are rare without sexual history, cystitis (C) lacks vaginal signs, and foreign body (D) typically causes bleeding or foul discharge.
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Which of the following are considered red flags for a communication disorder?
- A. Speech onset at 24 months, lack of pointing to indicate needs, and poor eye contact
- B. Short attention, odd intonation of speech, and poor pretend play
- C. Lack of pointing to show interests or needs, poor eye contact, and reduced joint attention
- D. Weak vocabulary, reduced joint attention, and poor interaction with peers
Correct Answer: C
Rationale: Red flags for communication disorders include lack of pointing to show interests/needs, poor eye contact, and reduced joint attention, as these indicate deficits in social communication, per developmental guidelines.
Which finding for a patient with an eating disorder most clearly indicates the need for hospitalization?
- A. Weight 15% below ideal weight
- B. Urine output less than 30 mL/hr
- C. Serum potassium 3.4 mEq/L
- D. Pulse rate 54 beats/min
Correct Answer: B
Rationale: The correct answer is B because urine output less than 30 mL/hr indicates severe dehydration and compromised kidney function, which can lead to organ failure. Hospitalization is necessary for immediate fluid resuscitation and monitoring. Option A is indicative of malnutrition but does not directly signify acute medical complications. Option C suggests hypokalemia, which can be managed on an outpatient basis. Option D, a low pulse rate, may be a sign of bradycardia but typically does not require immediate hospitalization unless accompanied by other severe symptoms.
Irrational and very specific fears that persist even when there is no real danger to a person are called
- A. anxieties
- B. dissociation's
- C. phobias
- D. obsessions
Correct Answer: C
Rationale: Phobias are specific, irrational fears persisting despite no real threat, distinct from general anxiety.
A nurse is caring for a patient who is confused, disoriented in all three spheres, and experiencing visual hallucinations. While preparing to provide personal care, the nurse should:
- A. ask the patient, "Do you remember who I am?"Â
- B. speak minimally so as not to disturb the patient.
- C. pat the patient on the forearm and say, "Let's get started."Â
- D. explain to the patient what will happen during the care.
Correct Answer: D
Rationale: The correct answer is D because explaining to the patient what will happen during care is essential to provide a sense of orientation and reduce anxiety in a confused patient. This approach helps the patient understand the situation and feel more in control, which can decrease agitation. Choice A is incorrect as the patient's memory deficit may lead to further confusion. Choice B is incorrect as minimal communication may not address the patient's needs. Choice C is incorrect as physical touch without explanation may escalate the patient's hallucinations.
A new nurse asks, 'My elderly patient has Lewy body disease. What should I do about assessing for pain?' Select the best response from the nurse manager.
- A. Ask the patients family if they think the patient is experiencing pain.'
- B. Use a visual analog scale to help the patient determine the presence and severity of pain.'
- C. There are special scales for assessing patients with dementia. Lets review how to use them.'
- D. The perception of pain is diminished by this type of dementia. Focus your assessment on the patients mental status.'
Correct Answer: C
Rationale: Lewy body disease is a form of dementia. There are special scales to assess the presence and severity of pain in patients with dementia. The Pain Assessment in Advanced Dementia Scale evaluates breathing, negative vocalizations, body language, and consolability. A patient with dementia would be unable to use a visual analog scale. The family may be able to help the nurse gain perspective about the pain, but this strategy alone is inadequate. The other distracters are myths.