Nokea
A 9-mo-old infant is recently diagnosed with bilateral retinoblastoma; examination under anesthesia reveals bilateral multifocal involvement of the retina. An important next step in the management is
- A. radiotherapy of both eyes
- B. retinal examination of 1st degree relatives
- C. orbital ultrasonography
- D. bilateral enucleation
Correct Answer: B
Rationale: Retinal examination of first-degree relatives is crucial to identify hereditary forms of retinoblastoma.
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During preoperative teaching for a client who will undergo subtotal thyroidectomy, the nurse should include which statement?
- A. "The head of your bed must remain flat for 24 hours after surgery."
- B. "You should avoid deep breathing and coughing after surgery."
- C. "You won't be able to swallow for the first day or two."
- D. "You must avoid hyperextending your neck after surgery."
Correct Answer: D
Rationale: The correct statement to include during preoperative teaching for a client undergoing subtotal thyroidectomy is "You must avoid hyperextending your neck after surgery." This is important because hyperextending the neck can put strain on the suture line and may lead to dehiscence (wound opening). It is crucial for the client to avoid any activities or positions that could compromise the surgical site and hinder proper healing.
A preterm newborn, after spending 8 weeks in the NICU, is being discharged. The parents of the newborn express apprehension and worry that the newborn may still be in danger. How should the nurse interpret these statements?
- A. Normal
- B. A reason to postpone discharge
- C. Suggestive of maladaptation
- D. Suggestive of inadequate bonding
Correct Answer: A
Rationale: It is normal for parents of preterm newborns who have spent time in the NICU to express apprehension and worry upon discharge. The NICU experience can be stressful and overwhelming for families, and it is common for parents to feel anxious about taking their newborn home. The nurse should provide support and education to help alleviate the parents' concerns and ensure a smooth transition from the hospital to home. It is important to acknowledge the parents' feelings, offer reassurance, and reinforce the importance of follow-up care and monitoring.
Which is the most appropriate nursing intervention for the newborn who is jittery and twitching and has a high-pitched cry?
- A. Monitor blood pressure closely.
- B. Obtain urine sample to detect glycosuria.
- C. Obtain serum glucose and serum calcium levels.
- D. Administer oral glucose or, if newborn refuses to suck, IV dextrose.
Correct Answer: C
Rationale: The most appropriate nursing intervention for the jittery and twitching newborn with a high-pitched cry is to obtain serum glucose and serum calcium levels (Option C). These symptoms are indicative of possible hypoglycemia or hypocalcemia, which are common issues for newborns. Monitoring glucose and calcium levels will help identify and address any imbalances that may be causing these symptoms. Administering glucose (Option D) may be necessary if hypoglycemia is confirmed, but it should be based on the results of blood tests. Monitoring blood pressure (Option A) and obtaining a urine sample to detect glycosuria (Option B) are not the priority interventions in this scenario compared to assessing serum glucose and calcium levels.
During thoracentesis, which of the following nursing intervention will be most crucial?
- A. Place patient in a quiet and cool room
- B. Maintain strict aseptic technique
- C. Advice patient to sit perfectly still during needle insertion until it has been withdrawn from the chest
- D. Apply pressure over the puncture site as soon as the needle is withdrawn
Correct Answer: B
Rationale: Maintaining strict aseptic technique during thoracentesis is the most crucial nursing intervention. Thoracentesis is a procedure where a needle is inserted into the pleural space to obtain a sample of fluid for diagnostic purposes or to drain excess fluid for therapeutic relief. It is essential to prevent the introduction of pathogens or contaminants into the pleural space, as this can lead to serious complications such as infection. By following strict aseptic technique, the risk of complications can be minimized, ensuring the safety and well-being of the patient undergoing the procedure.
Which medication is most likely included in post-operative care of a child with repair of bladder exstrophy?
- A. Lasix
- B. Mannitol
- C. Meperidine
- D. Oxybutynin
Correct Answer: D
Rationale: Oxybutynin helps control bladder spasms and improves comfort after urinary reconstructive surgery.