Nokea
A 7 year old boy came to OPD with history of difficulty in rising up from sitting position. Examination reveals hypertrophy of calf muscles with trendelenburg gait. The most likely diagnosis is:
- A. Becker's muscular dystrophy
- B. Duchenne muscular dystrophy
- C. Myotonic muscular dystrophy
- D. Cerebral palsy
Correct Answer: B
Rationale: Duchenne muscular dystrophy typically presents in early childhood with difficulty rising from a seated position (Gower's sign), calf muscle hypertrophy, and Trendelenburg gait.
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A male client age 78, complaints of dizziness, especially when he stands up after sleeping or sitting. The client also informs the nurse that he periodically experiences nosebleeds and blurred vision. Which of the ff conditions should the nurse assess for the client?
- A. Postural hypotension
- B. Postural Hypertension
- C. White coat hypertension
- D. White coat hypotension
Correct Answer: A
Rationale: The client's symptoms of dizziness upon standing up, along with nosebleeds and blurred vision, are suggestive of postural hypotension. Postural hypotension, also known as orthostatic hypotension, is a drop in blood pressure that occurs when a person stands up from a sitting or lying position. This drop in blood pressure can lead to symptoms such as dizziness, lightheadedness, blurred vision, and in some cases, nosebleeds. It is more common in older adults, like the 78-year-old male client in this scenario. Therefore, the nurse should assess for postural hypotension in this client to manage his symptoms and prevent complications.
What is the pathophysiologic mechanism of cystic fibrosis leading to obstructive lung disease?
- A. Fibrosis of mucous glands and destruction of bronchial walls
- B. Destruction of lung parenchyma from inflammation and scarring
- C. Production of secretions low in sodium chloride and therefore thickened mucus
- D. Increased serum levels of pancreatic enzymes that are deposited in the bronchial mucosa
Correct Answer: C
Rationale: Cystic fibrosis (CF) is caused by mutations in the CFTR gene, leading to altered transport of sodium and chloride ions in and out of epithelial cells. This results in the production of secretions that are low in sodium chloride, leading to thickened mucus. The abnormally thick, abundant secretions from mucous glands in the respiratory tract can obstruct the airways, leading to chronic, diffuse obstructive pulmonary disease in almost all patients with CF. This process impairs mucociliary clearance, predisposing individuals to recurrent lung infections, inflammation, and ultimately bronchiectasis. This mechanism is a key factor in the pathophysiology of cystic fibrosis-associated obstructive lung disease.
An 8-year-old child is receiving digoxin (Lanoxin). The nurse should notify the practitioner and withhold the medication if the apical pulse is less than _____ beats/min.
- A. 60
- B. 70
- C. 90
- D. 100
Correct Answer: A
Rationale: In pediatric patients receiving digoxin, the nurse should notify the practitioner and withhold the medication if the apical pulse is less than 60 beats/min in an 8-year-old child. Digoxin can cause bradycardia as a side effect, and a low heart rate (bradycardia) can indicate toxicity. Monitoring the apical pulse rate before administering digoxin is essential to ensure the child's safety and prevent complications related to digoxin toxicity.
An adult is being taught about a healthy diet. How can the food pyramid help guide the client on his diet?
- A. By indicating exactly how many servings of each group to eat
- B. By calculating how many calories the client should have
- C. By suggesting daily food choices
- D. By dividing the food into four basic groups
Correct Answer: C
Rationale: The food pyramid can help guide the client on his diet by suggesting daily food choices. The food pyramid categorizes different food groups based on their nutritional compositions and recommended daily servings. By following the food pyramid, the client can make informed choices about what types and amounts of food to consume each day to achieve a balanced and healthy diet. The visual representation of the food pyramid also helps in understanding the relative proportions of different food groups that are part of a nutritious diet.
During the first 4 days of hospitalization, Eric, age 18 months, cried inconsolably when his parents left him, and he refused the staff's attention. Now the nurse observes that Eric appears to be "settled in" and unconcerned about seeing his parents. The nurse should interpret this as which statement?
- A. He has successfully adjusted to the hospital environment.
- B. He has transferred his trust to the nursing staff.
- C. He may be experiencing detachment, which is the third stage of separation anxiety.
- D. Because he is "at home" in the hospital now, seeing his mother frequently will only start the cycle again.
Correct Answer: A
Rationale: Eric's change in behavior from crying inconsolably and refusing staff attention to now appearing settled and unconcerned about his parents leaving indicates that he has successfully adjusted to the hospital environment. This adaptation is a positive sign that Eric has become more comfortable with his surroundings and has developed a sense of security within the hospital setting. As a result, the nurse can interpret this change as Eric successfully acclimating to his new environment.