Nokea
A 6 months old boy presents with respiratory distress and feeding difficulty. On examination heart rate is 130/min and there is a pansystolic murmur at left lower sternal border. What is the most likely diagnosis?
- A. Mitral regurgitation
- B. Mitral valve prolapse
- C. Ventricular septal defect
- D. Coarctation of aorta
Correct Answer: C
Rationale: Ventricular septal defect (VSD) commonly presents with a pansystolic murmur and symptoms of congestive heart failure in infancy.
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Which of the ff. is a normal hemoglobin value?
- A. 38% to 48%
- B. 48 to 54 mg%
- C. 12 to 18 g/100mL
- D. 27 to 36 g/dL
Correct Answer: C
Rationale: The normal hemoglobin values are typically expressed in grams per deciliter (g/dL) or grams per 100 milliliters (g/100mL) of blood. The range of 12 to 18 g/100mL is considered the normal range for hemoglobin levels in adults. Hemoglobin values outside of this range may indicate various health conditions such as anemia or polycythemia. Option A (38% to 48%) is a range for hematocrit, not hemoglobin. Option B (48 to 54 mg%) and Option D (27 to 36 g/dL) are not within the standard normal range for hemoglobin levels.
A patient is diagnosed with acute bacterial conjunctivitis. In providing patient teaching the nurse would tell the patient that this condition is more commonly known as which of the following?
- A. Glaucoma
- B. Color blindness
- C. Astigmatism
- D. Pinkeye
Correct Answer: D
Rationale: Acute bacterial conjunctivitis is commonly known as "pinkeye." This condition is characterized by inflammation of the conjunctiva (the thin transparent layer covering the white part of the eye and the inside of the eyelids) due to a bacterial infection. It is a common eye condition that can cause symptoms such as redness, swelling, itching, and a discharge from the eye. Treatment often involves antibiotic eye drops or ointments to help clear the infection. It is important for patients with pinkeye to practice good hygiene, avoid sharing towels or pillows, and wash hands frequently to prevent the spread of infection to others.
Which of the following elements shows that the client does not understand the cause of exacerbation of system lupus erythematosus (SLE)?
- A. "I don't have to worry about changing my
- B. "I don't have to worry if I get a strep. throat diet."
- C. I need to work on managing stress in life."
Correct Answer: B
Rationale: Option B, "I don't have to worry if I get a strep throat," shows that the client does not understand the cause of exacerbation of systemic lupus erythematosus (SLE). Strep throat can trigger SLE exacerbations as infections are known to worsen autoimmune diseases like lupus. This statement indicates a lack of awareness regarding the potential impact of infections on SLE symptoms. Option A and C show a better understanding as they address the importance of diet and stress management, which are significant factors that can influence the course of SLE.
Which is an important nursing consideration in the care of the newborn with PKU?
- A. Suggest ways to make formula more palatable.
- B. Teach proper administration of phenylalanine hydroxylase.
- C. Encourage the breastfeeding mother to adhere to a low-phenylalanine diet.
- D. Give reassurance that dietary restrictions are a temporary inconvenience.
Correct Answer: C
Rationale: Encouraging the breastfeeding mother to adhere to a low-phenylalanine diet is an important nursing consideration in the care of the newborn with PKU. Phenylketonuria (PKU) is an inborn error of metabolism in which the body cannot metabolize phenylalanine properly. If a newborn with PKU consumes formula or breast milk that contains high levels of phenylalanine, it can lead to severe intellectual disability and other health complications. By encouraging the breastfeeding mother to follow a low-phenylalanine diet, the newborn's exposure to phenylalanine can be minimized, helping to prevent the negative effects of PKU.
The nurse is meeting a 5-year-old child for the first time and would like the child to cooperate during a dressing change. The nurse decides to do a simple magic trick using gauze. How should this action be interpreted?
- A. Inappropriate, because of child's age
- B. A way to establish rapport
- C. Too distracting, when cooperation is important
- D. Acceptable, if there is adequate time
Correct Answer: B
Rationale: Using a simple magic trick with gauze to engage a 5-year-old child during a dressing change is a way to establish rapport. This approach can help build trust and reduce anxiety by making the procedure more engaging and less intimidating for the child. By creating a positive interaction through a fun activity, the nurse can promote cooperation and make the dressing change a smoother experience for the child. Overall, the use of a magic trick in this context is appropriate and beneficial for enhancing the child's cooperation and comfort.