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A patient is having difficulty swallowing following a stroke, and a swallowing evaluation is ordered. The ff. nursing interventions might be recommended to help prevent aspiration during eating except:
- A. Provide clear liquids only until the patient can swallow solid foods.
- B. Have the patient swallow twice after each bite
- C. Place food on the unaffected side of the patient's mouth
- D. Check if the patient's mouth for pocketing of food
Correct Answer: A
Rationale: Providing clear liquids only until the patient can swallow solid foods is not recommended as it restricts the patient's diet unnecessarily. In the case of difficulty swallowing after a stroke, it is important to modify the food consistency and provide appropriate techniques to support safe swallowing. Limiting the patient to clear liquids only could lead to inadequate nutrition and hydration. Instead, it is important to modify the diet consistency and use strategies such as altering the food presentation, having the patient swallow twice after each bite, placing food on the unaffected side of the mouth, and checking for pocketing of food to help prevent aspiration.
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Which of the ff vessels is often used for grafting?
- A. The basic and cephalic veins in the arm
- B. The internal mammary and internal thoracic arteries in the chest
- C. The saphenous vein in the leg
- D. The radial artery in the arm
Correct Answer: B
Rationale: The internal mammary and internal thoracic arteries in the chest are often used for grafting in procedures such as coronary artery bypass surgery. These arteries have been found to have good long-term patency rates when used as grafts to bypass blocked coronary arteries. The internal mammary artery, in particular, is commonly used for this purpose due to its accessibility and long-term durability. The use of these arteries for grafting helps to improve blood flow to the heart muscle, relieving symptoms of coronary artery disease and reducing the risk of heart-related complications.
The nurse is aware that a healthy newborn's respirations are:
- A. Regular, abdominal, 40-50 per minute, deep
- B. Irregular, abdominal, 30-60 per minute, shallow
- C. Irregular, initiated by chest wall, 30-60 per minute, deep
- D. Regular, initiated by the chest wall, 40-60 per minute, shallow
Correct Answer: B
Rationale: A healthy newborn's respirations are typically irregular, abdominal, with a rate of 30-60 per minute, and tend to be shallow. Newborns have immature respiratory centers in their brain, leading to irregular breathing patterns compared to adults. Their breathing is usually abdominal due to their diaphragmatic breathing pattern. The normal respiratory rate for a newborn can fluctuate between 30-60 breaths per minute, with shallow breathing being characteristic of their physiology. Regular shallow breathing with occasional periods of apnea is considered normal in newborns and should not be a cause for concern.
Which finding on a newborn assessment should the nurse recognize as suggestive of a clavicle fracture?
- A. Negative scarf sign
- B. Asymmetric Moro reflex
- C. Swelling of fingers on affected side
- D. Paralysis of affected extremity and muscles
Correct Answer: C
Rationale: A newborn with a clavicle fracture may present with swelling of the fingers on the affected side. This is due to the injury disrupting the nerves and blood vessels that supply the arm, leading to edema and swelling in the fingers. The other signs mentioned in the options are not typically associated with a clavicle fracture. A negative scarf sign relates to positioning of the arm and is not specific to a clavicle fracture. Asymmetric Moro reflex can be a normal finding in newborns and not indicative of a fracture. Paralysis of the affected extremity and muscles would be more suggestive of a nerve injury rather than a clavicle fracture.
Which is the causative agent of scarlet fever?
- A. Enteroviruses
- B. Corynebacterium organisms
- C. Scarlet fever virus
- D. Group A b-hemolytic streptococci (GABHS)
Correct Answer: D
Rationale: Scarlet fever is caused by Group Aß-hemolytic streptococci (GABHS), particularly Streptococcus pyogenes. This bacteria produces erythrogenic exotoxins that cause the characteristic rash seen in scarlet fever. These toxins also contribute to the other symptoms associated with scarlet fever, such as high fever, sore throat, and a red, bumpy tongue (strawberry tongue). Therefore, the correct causative agent of scarlet fever is Group Aß-hemolytic streptococci (GABHS).
You are meeting with parents of a 12-year-old girl who recently diagnosed with papillary thyroid carcinoma (PTC). The statement that should be included in your discussion is
- A. PTC has a grim overall prognosis
- B. FTC do not require radioactive iodine therapy
- C. supraphysiologic levothyroxine therapy is required during long-term follow-up
- D. calcitonin/carcinogenic antigen monitoring is required during the course of treatment
Correct Answer: C
Rationale: Levothyroxine suppression therapy is standard in differentiated thyroid cancer.