Nokea
A client with pernicious anemia is receiving parenteral vitamin B12 therapy. Which client statement indicates effective teaching about this therapy?
- A. "I will receive parenteral vitamin B12 therapy until my signs and symptoms disappear."
- B. "I will receive parenteral vitamin B12 therapy until my vitamin B12 level returns to normal."
- C. "I will receive parenteral vitamin B12 therapy monthly for 6 months to a year."
- D. "I will receive parenteral vitamin B12 therapy for the rest of my life."
Correct Answer: D
Rationale: The correct client statement indicating effective teaching about parenteral vitamin B12 therapy for pernicious anemia is, "I will receive parenteral vitamin B12 therapy for the rest of my life." Pernicious anemia is a condition in which the body cannot absorb enough vitamin B12 from food due to a lack of intrinsic factor, a protein produced in the stomach. As a result, lifelong B12 supplementation is necessary to maintain adequate levels of the vitamin. Monthly injections are typically recommended for life to ensure proper B12 levels and prevent complications associated with the deficiency.
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You are discussing failure to thrive (FTT) with medical students. You mention that FTT is most often used to describe malnutrition related to environmental or psychosocial causes. An important statement that should be included in your discussion is
- A. FTT is often diagnosed by weight that falls below the 25th percentile for age
- B. a weight crossing one major percentile lines on the growth height should be evaluated for FTT chart over time is considered abnormal
- C. a weight of less than 60 % of the median weight for the height of the child
- D. small subset of the population naturally falls below the 3rd percentile but usually have normal weight for height
Correct Answer: B
Rationale: Crossing percentile lines on a growth chart indicates a significant deviation from the child's previous growth trajectory, which is a key indicator of potential FTT.
What is the mineral necessary for chemical clotting?
- A. Iron
- B. Potassium
- C. Sodium
- D. Calcium
Correct Answer: D
Rationale: Calcium is the mineral necessary for chemical clotting. When there is a cut or injury that causes bleeding, the body's clotting process is initiated to stop the bleeding. Calcium ions play a crucial role in several steps of the clotting cascade, helping to activate various clotting factors and promoting the formation of a stable blood clot. Without sufficient calcium, the blood would not be able to clot properly, leading to potential complications with excessive bleeding.
The nurse has taught a patient with thrombocytopenia how to prevent bleeding. Which of the ff. is the best evidence that the teaching has been effective?
- A. The patient states that he will be careful to avoid injury.
- B. The patient can list signs and symptoms of bleeding.
- C. The patient uses an electric razor instead of his safety razor.
- D. The patient states when he should call the doctor.
Correct Answer: C
Rationale: The best evidence that the teaching has been effective is when the patient uses an electric razor instead of his safety razor. This action demonstrates understanding and application of the teaching to prevent bleeding in a practical way. By choosing the electric razor, the patient is actively taking steps to minimize the risk of injury and bleeding due to thrombocytopenia. This concrete behavior indicates that the patient has internalized the instructions provided by the nurse and is implementing them to protect his health.
When performing a newborn assessment, the nurse should measure the vital signs in the following sequence:
- A. Pulse, respirations, temperature
- B. Temperature, pulse, respirations
- C. Respirations, temperature, pulse
- D. Respirations, pulse, temperature
Correct Answer: A
Rationale: When performing a newborn assessment, it is important to measure the vital signs in the sequence of pulse, respirations, and temperature. This sequence is recommended because measuring the pulse first provides immediate information on the baby's cardiovascular status, followed by respirations to assess respiratory function, and ending with temperature which can be influenced by the other vital signs. This comprehensive approach helps ensure all vital signs are assessed accurately and in a logical order.
The nurse is using the FLACC scale to rate the pain level in a 9-month-old. Which is the nurse's best response to the father's question of what the FLACC scale is?
- A. It estimates a child's level of pain utilizing vital sign information.
- B. It estimates a child's level of pain based on parents' perception.
- C. It estimates a child's level of pain utilizing behavioral and physical responses.
- D. It estimates a child's level of pain utilizing a numeric scale from 0 to 5.
Correct Answer: C
Rationale: The FLACC scale uses observable behavioral and physical responses (facial expression, leg movement, activity, cry, and consolability) to estimate pain.