Nokea
A healthy 4-year-old child has a left flank mass. Computerized tomography (CT) scan of the abdomen shows a localized renal mass. Radical nephrectomy is performed; the histology shows clear cell sarcoma of the kidney. The MOST appropriate next step in the management is
- A. CT scan of the chest
- B. CT scan of the brain
- C. bone scan
- D. magnetic resonance imaging (MRI) of the brain
Correct Answer: C
Rationale: Clear cell sarcoma of the kidney has a propensity to metastasize to bones, making a bone scan essential.
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In planning safe care for the older adult, which of the ff. conditions does the nurse recognize would not cause visual problems?
- A. Glaucoma
- B. Macular degeneration
- C. Cataracts
- D. Arcus senilis
Correct Answer: D
Rationale: Arcus senilis is a condition characterized by a white or gray ring forming around the cornea and does not typically cause visual problems. It is a common and benign condition often seen in older adults. On the other hand, glaucoma, macular degeneration, and cataracts are all eye conditions that can significantly affect vision and lead to visual impairments in older adults. Therefore, in planning safe care for the older adult, the nurse should recognize that Arcus senilis would not cause visual problems unlike the other conditions mentioned.
A client is receiving chemotherapy to treat breath cancer. Which assessment finding indicates a fluid and electrolyte imbalance induced by chemotherapy?
- A. A Urine output of 400 ml in 8 hours
- B. B. Serum potassium level of 3.6 mEq/L
- C. C. Blood pressure of 120/64 to 130/72 mm Hg
- D. D. Dry oral mucous membranes and cracked lips
Correct Answer: A
Rationale: Chemotherapy can cause fluid and electrolyte imbalances in the body, leading to potential kidney damage and altered urinary output. A low urine output of 400 ml in 8 hours could indicate dehydration or impaired renal function, both of which can be induced by chemotherapy. Monitoring urine output is crucial in assessing the patient's fluid balance and kidney function during chemotherapy. It is essential to identify and address such imbalances promptly to prevent complications.
What is the first action the nurse should take?
- A. Start an IV lines for fluids
- B. Get an ECG
- C. Place a Foley catheter
- D. Check for neurologic status
Correct Answer: D
Rationale: The first action the nurse should take is to check for neurologic status. This is essential in assessing the patient's level of consciousness, orientation, motor function, and pupil responses. It helps determine if the patient is experiencing neurological issues such as a stroke, which would require immediate medical attention. Checking neurologic status is a priority because it guides the nurse in identifying the next steps for the patient's care.
The ductus arteriosus is another fetal structure that is important in the intrauterine life. It functions to:
- A. Shunts the combined cardiac output from the pulmonary artery to the aorta going to the lungs
- B. Shunts the combined cardiac output from the pulmonary artery to the systemic circulation
- C. Shunts the combined cardiac output from the aorta to the pulmonary artery and later to the pulmonary veins
- D. Shunts the combined cardiac output from the aorta to the pulmonary artery to the right ventricle 48
Correct Answer: B
Rationale: The ductus arteriosus is a fetal blood vessel that connects the pulmonary artery to the aorta. Its main function is to bypass the non-functional fetal lungs by shunting blood from the pulmonary artery (which carries deoxygenated blood) directly to the systemic circulation, specifically the aorta. This allows oxygenated blood from the placenta to be distributed to the body's organs and tissues without having to first pass through the lungs for oxygen exchange. After birth, when the baby begins to breathe and oxygenate its blood through the lungs, the ductus arteriosus normally closes within the first few days to weeks of life.
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.