Nokea
A 65-year-old woman has a two-year history of mucous diarrhoea due to a large villous adenoma of the rectum. She is also taking digoxin and diuretics for chronic congestive failure. Which of the following investigations would be the most helpful prior to surgery?
- A. Serum chloride.
- B. Serum digoxin.
- C. Serum calcium.
- D. Serum potassium.
Correct Answer: D
Rationale: Villous adenomas cause potassium loss via diarrhea, and diuretics exacerbate this, risking hypokalemia, which is dangerous with digoxin (toxicity risk). Serum potassium (D) is critical pre-surgery.
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A person diagnosed with a serious mental illness (SMI) living in the community was punched, pushed to the ground, and robbed of 7 during the day on a public street. Which statements about violence and serious mental illness in general are accurate? Select one tha does not apply.
- A. Persons with SMI are more likely to be violent
- B. SMI persons experience higher rates of sexual assault and victimization than others
- C. Impaired judgment and social skills can provoke hostile or assaultive behavior
- D. Lower incomes force SMI persons to live in high-crime areas, increasing risk
Correct Answer: A
Rationale: Mentally ill persons are more likely to be victims of crime than perpetrators of criminal acts. They are often victims of criminal behavior, including sexual crimes, at a higher rate than others. When a mentally ill person commits a crime, it is usually nonviolent. Mental illnesses interfere with employment and are associated with poverty, limiting SMI persons to living in inexpensive areas that also tend to be higher-crime areas. SMI persons may inadvertently provoke others because of poor judgment or socially inappropriate behavior, or they may be victimized because they are perceived as passive, less likely to resist, and less likely to be believed as witnesses.
When the family of a client who has been diagnosed with a dementia secondary to normal pressure hydrocephalus asks the nurse about prognosis, the nurse should reply:
- A. Unfortunately the prognosis is for a downhill course ending in death.'
- B. There will be good days and bad days for the rest of the client's life.'
- C. The symptoms usually remit after a shunt is inserted to drain fluid.'
- D. We'll try our very best, but only time will tell how successful we are.'
Correct Answer: C
Rationale: The correct answer is C because normal pressure hydrocephalus (NPH) symptoms typically improve after a shunt is inserted to drain the excess cerebrospinal fluid, leading to a better prognosis. This intervention can help alleviate symptoms such as gait disturbances, cognitive impairment, and urinary incontinence associated with NPH.
Choice A is incorrect as it inaccurately states that the prognosis is inevitably poor, which is not true for NPH with appropriate treatment. Choice B is incorrect because NPH symptoms can be effectively managed with treatment, so it is not accurate to say that there will always be good and bad days for the rest of the client's life. Choice D is incorrect as it does not provide specific information about the positive impact of shunt insertion on NPH symptoms and prognosis.
Attention Deficit Hyperactivity Disorder (ADHD) is equally common in boys and girls
- A. TRUE
- B. FALSE
Correct Answer: B
Rationale: ADHD is more commonly diagnosed in boys than girls, though it affects both genders.
A nurse would conclude that a patient with an eating disorder is exhibiting a cognitive distortion after hearing the patient make which statement?
- A. I see now that I need to establish my own preferences and routines.'
- B. Bingeing makes my feelings of both isolation and loneliness go away.'
- C. Controlling what I eat has been a way for me to exert control over my life.'
- D. I need to watch for hunger and fatigue as triggers for my eating disorder.'
Correct Answer: B
Rationale: The correct answer is B because the statement reflects emotional reasoning, a common cognitive distortion in eating disorders. The patient believes that bingeing is an effective way to cope with feelings of isolation and loneliness, which is not a healthy or rational belief. This cognitive distortion can perpetuate the cycle of disordered eating behavior.
A: This choice shows a healthy realization and decision-making process, indicating a positive step towards recovery.
C: While controlling food intake may be a coping mechanism, it doesn't necessarily indicate a cognitive distortion.
D: This choice demonstrates awareness of triggers, which is important for managing the disorder, but it doesn't necessarily indicate a cognitive distortion.
A researcher seeking an organic basis for schizophrenia would be well-advised to investigate the role of
- A. amphetamines and amphetamine receptors
- B. adrenaline and noradrenaline
- C. histamine and antihistamine
- D. dopamine and dopamine receptors
Correct Answer: D
Rationale: Dopamine dysregulation, particularly via receptors, is a primary organic focus in schizophrenia research.