Nokea
A child has just been diagnosed with juvenile idiopathic arthritis. Which of the following statements about the disease is most accurate?
- A. The child has a poor chance of recovery without joint deformity.
- B. Most children progress to adult rheumatoid arthritis.
- C. Nonsteroidal anti-inflammatory drugs are the first choice in treatment.
- D. Physical activity should be minimized.
Correct Answer: C
Rationale: The correct answer is that nonsteroidal anti-inflammatory drugs are the first choice in treatment for juvenile idiopathic arthritis (formerly known as juvenile rheumatoid arthritis). NSAIDs are important as a first-line treatment and typically require 3-4 weeks for the therapeutic anti-inflammatory effects to be realized. Choice A is incorrect as early treatment can improve outcomes and prevent joint deformities. Choice B is incorrect as juvenile idiopathic arthritis does not necessarily progress to adult rheumatoid arthritis. Choice D is incorrect as physical activity should be encouraged in children with arthritis to maintain joint mobility and overall health.
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Which finding would necessitate an immediate change in the therapeutic plan for a patient with grade 2 hepatic encephalopathy?
- A. Weight loss of 2 lb (1 kg)
- B. Positive urine pregnancy test
- C. Hemoglobin level of 10.4 g/dL
- D. Complaints of nausea and anorexia
Correct Answer: B
Rationale: A positive urine pregnancy test would require an immediate change in the therapeutic plan for a patient with grade 2 hepatic encephalopathy due to the teratogenic effects of ribavirin. Ribavirin needs to be discontinued immediately to prevent harm to the fetus. The other options, weight loss, hemoglobin level, and complaints of nausea and anorexia, are common adverse effects of the prescribed regimen and may necessitate interventions such as patient education or supportive care, but they would not mandate an immediate cessation of therapy as in the case of a positive pregnancy test.
A patient with severe Gastroesophageal Reflux Disease is receiving discharge teaching. Which of these statements by the patient indicates a need for more teaching?
- A. ''I'm going to limit my meals to 2-3 per day to reduce acid secretion.''
- B. ''I'm going to make sure to remain upright after meals and elevate my head when I sleep.''
- C. ''I won't be drinking tea or coffee or eating chocolate anymore.''
- D. ''I'm going to start trying to lose some weight.''
Correct Answer: A
Rationale: The correct answer is ''I'm going to limit my meals to 2-3 per day to reduce acid secretion.'' This statement indicates a need for more teaching because large meals increase the volume and pressure in the stomach, delaying gastric emptying, and worsening symptoms of Gastroesophageal Reflux Disease (GERD). The recommended approach is to eat smaller, more frequent meals (4-6 small meals a day) to reduce acid reflux. Choices B, C, and D demonstrate good understanding of GERD management by highlighting the importance of staying upright after meals, avoiding trigger foods like tea, coffee, and chocolate, and addressing weight management, which are all appropriate strategies to manage GERD symptoms.
While caring for the client during the first hour after delivery, the nurse determines that the uterus is boggy and there is vaginal bleeding. What should be the nurse's first action?
- A. Check vital signs.
- B. Massage the fundus.
- C. Offer a bedpan.
- D. Check for perineal lacerations.
Correct Answer: B
Rationale: The nurse's first action should be to massage the fundus until it is firm as uterine atony is the primary cause of bleeding in the first hour after delivery. Massaging the fundus helps to stimulate uterine contractions, which can help control the bleeding. Checking vital signs would be important but addressing the primary cause of bleeding takes precedence. Offering a bedpan is not a priority in this situation as the focus should be on managing the postpartum bleeding. Checking for perineal lacerations is also important but not the initial action needed to address the boggy uterus and vaginal bleeding.
What is the priority nursing diagnosis for a patient experiencing a migraine headache?
- A. Acute pain related to biologic and chemical factors
- B. Anxiety related to change in or threat to health status
- C. Hopelessness related to deteriorating physiological condition
- D. Risk for side effects related to medical therapy
Correct Answer: A
Rationale: The priority nursing diagnosis for a patient experiencing a migraine headache is 'Acute pain related to biologic and chemical factors.' Migraine headaches are characterized by severe throbbing pain, often accompanied by sensitivity to light and sound. Addressing the acute pain is crucial to improve the patient's comfort and quality of life. Choices B, C, and D are not the priority nursing diagnoses for a patient with a migraine headache. Anxiety, hopelessness, and risk for side effects may not be as urgent as managing the acute pain associated with a migraine.
The patient's symptoms, lack of antibodies for hepatitis, and the abrupt onset of symptoms suggest toxic hepatitis, which can be caused by commonly used over-the-counter drugs such as acetaminophen (Tylenol). Travel to a foreign country and a history of IV drug use are risk factors for viral hepatitis. Corticosteroid use does not cause the symptoms listed.
- A. Hemoglobin
- B. Temperature
- C. Activity level
- D. Albumin level
Correct Answer: D
Rationale: The low oncotic pressure caused by hypoalbuminemia is a major pathophysiologic factor in the development of edema. In this case, monitoring the albumin level is crucial to assess the patient's fluid balance and potential for edema. While hemoglobin, temperature, and activity level are important parameters to monitor in a patient's assessment, they are not directly associated with the patient's current symptoms of toxic hepatitis and edema development. Therefore, the correct choice is the albumin level.