Nokea
A client goes to the Emergency Department with acute respiratory distress and the following arterial blood gases (ABGs): pH 7.35, PCO2 40 mmHg, PO2 63mmHg, HCO3 23, and oxygenation saturation (SAO2) 93%. Which of the following represents the best analysis of the etiology of these ABGs?
- A. tuberculosis (TB)
- B. pneumonia
- C. pleural effusion
- D. hypoxia
Correct Answer: D
Rationale: A combined low PO2 and low SAO2 indicates hypoxia. The pH, PCO2, and HCO3 are normal. ABGs are not necessarily altered in TB or pleural effusion. In pneumonia, the PO2 and PCO2 might be low because hypoxia stimulates hyperventilation, but the best analysis in this case is hypoxia due to the combination of low PO2 and low SAO2.
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What happens if folic acid is administered to treat anemia without determining its underlying cause?
- A. Erythropoiesis is inhibited
- B. Excessive levels of folic acid might accumulate, causing toxicity
- C. The symptoms of pernicious anemia might be masked, delaying treatment
- D. Intrinsic factor is destroyed
Correct Answer: C
Rationale: When folic acid is given without determining the underlying cause of anemia, the symptoms of pernicious anemia may be masked, potentially delaying the correct treatment. Folic acid alone does not protect against the central nervous system changes seen in pernicious anemia, which are related to Vitamin B12 deficiency. Folic acid and Vitamin B12 are both crucial for cell growth and division. Administering folic acid without knowing the specific type of anemia could lead to a delay in addressing the root cause. Option A is incorrect because folic acid is essential for erythropoiesis, the production of red blood cells. Option B is incorrect as excessive folic acid can cause toxicity, but it is not the primary concern in this context. Option D is incorrect because folic acid treatment for anemia does not directly impact intrinsic factor, which is related to Vitamin B12 absorption.
A 64-year-old Alzheimer's patient has exhibited excessive cognitive decline resulting in harmful behaviors. The physician orders restraints to be placed on the patient. Which of the following is the appropriate procedure?
- A. Secure the restraints to the bed rails on all extremities.
- B. Notify the physician that restraints have been placed properly.
- C. Communicate with the patient and family the need for restraints.
- D. Position the head of the bed at a 45-degree angle.
Correct Answer: C
Rationale: In cases where restraints are considered necessary for a patient, it is crucial to communicate effectively with both the patient and their family about the reasons for this decision. This helps ensure that all parties involved understand the necessity of restraints and are informed about the potential risks and benefits. Option A, securing restraints to the bed rails on all extremities, is not appropriate as it does not involve proper communication or ethical considerations. Option B, notifying the physician that restraints have been placed properly, overlooks the importance of patient and family involvement in decision-making. Option D, positioning the head of the bed at a 45-degree angle, is unrelated to the use of restraints and does not address the situation at hand.
A patient has fallen off a bicycle and fractured the head of the proximal fibula. A cast was placed on the patient's lower extremity. Which of the following is the most probable result of the fall?
- A. Peroneal nerve injury
- B. Tibial nerve injury
- C. Sciatic nerve injury
- D. Femoral nerve injury
Correct Answer: A
Rationale: The correct answer is peroneal nerve injury. The head of the proximal fibula is in close proximity to the peroneal nerve, making it susceptible to injury when there is a fracture. The peroneal nerve runs along the fibula and can be affected by trauma to this area. Choice B, tibial nerve injury, is incorrect as the fracture site is closer to the peroneal nerve, not the tibial nerve. Choice C, sciatic nerve injury, is incorrect as the injury is more localized to the fibular head area where the peroneal nerve is affected. Choice D, femoral nerve injury, is incorrect as the femoral nerve is not immediately adjacent to the proximal fibula and is not typically affected by this type of injury.
The test used to differentiate sickle cell trait from sickle cell disease is:
- A. Sickle cell preparation.
- B. Peripheral smear.
- C. Sickledex.
- D. Hemoglobin electrophoresis
Correct Answer: D
Rationale: The correct test to differentiate between sickle cell trait and sickle cell disease is hemoglobin electrophoresis. This test separates different types of hemoglobin based on their electrical charge, allowing for the identification of specific hemoglobin variants like HbS in sickle cell disease. Sickle cell preparation and Sickledex are not specific tests for this differentiation. While a peripheral smear can show sickle cells, it does not provide a definitive differentiation between the trait and the disease as it doesn't identify the specific hemoglobin variant present.
When choosing a needle gauge for an intramuscular injection in a 12-year-old boy, which of the following gauges would you choose?
- A. 27 gauge
- B. 25 gauge
- C. 22 gauge
- D. 20 gauge
Correct Answer: C
Rationale: The correct answer is 22 gauge. A 22-gauge needle is recommended for school-age children, toddlers, and adolescents due to their muscle mass and tolerance. In infants, a smaller gauge (23-25) is preferred as their muscles are less developed and more sensitive. Choice A, 27 gauge, is too thin for an intramuscular injection in a 12-year-old boy. Choice B, 25 gauge, is more suitable for infants than for a 12-year-old. Choice D, 20 gauge, is too thick and not typically used for intramuscular injections in children.