Nokea
A patient with cancer of the bladder has just returned
- A. to the unit from the PACU after surgery to create an ileal conduit. The nurse is monitoring the patients urine output hourly and notifies the physician when the hourly output
Correct Answer: A
Rationale: The correct answer is A because after surgery to create an ileal conduit for bladder cancer, monitoring urine output is crucial to assess kidney function and ensure proper drainage. Hourly monitoring helps to detect any complications early. Choice B is incorrect as it does not provide any relevant information. Choice C is incorrect because monitoring urine output is essential postoperatively. Choice D is incorrect as it does not address the immediate postoperative care needs of a patient with an ileal conduit.
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When the nurse is performing a genital examination on a male patient, the patient has an erection. The nurse’s most appropriate action or response is to:
- A. Ask the patient if he would like someone else to examine him.
- B. Continue with the examination as though nothing has happened.
- C. Stop the examination, leave the room while stating that the examination will resume at a later time.
- D. Reassure the patient that this is a normal response and continue with the examination.
Correct Answer: D
Rationale: The correct answer is D. This is the most appropriate action because it acknowledges the patient's normal physiological response and reassures him. It helps maintain professionalism and respect for the patient's dignity. Choice A could potentially embarrass the patient further. Choice B may ignore the patient's discomfort. Choice C abruptly halts the examination without addressing the situation. Overall, choice D is the most respectful and professional response in this scenario.
A 45-year-old woman is seeking advice on contraception. She is considering using an intrauterine device (IUD). The nurse should inform her that the IUD is effective for:
- A. 5 to 10 years.
- B. 1 to 2 years.
- C. 3 to 5 years.
- D. Indefinitely.
Correct Answer: A
Rationale: The correct answer is A: 5 to 10 years. IUDs are long-acting reversible contraceptives effective for 5 to 10 years depending on the type. Hormonal IUDs last around 5 years, while copper IUDs can last up to 10 years. This extended duration provides reliable contraception for an extended period with minimal user intervention.
Choice B: 1 to 2 years is incorrect because IUDs have a longer duration of effectiveness.
Choice C: 3 to 5 years is incorrect as it falls short of the typical duration of effectiveness for most IUD types.
Choice D: Indefinitely is incorrect as IUDs do have a maximum effective period, after which they need to be removed or replaced.
Superinfections are more common with: *
- A. Use of narrow spectrum antibiotics
- B. Short courses of antibiotics
- C. Use of antibiotics that are completely absorbed from the small intestines
- D. Use of antibiotic combinations covering both gram positive and gram negative bacteria
Correct Answer: D
Rationale: The correct answer is D because using antibiotic combinations covering both gram positive and gram negative bacteria can disrupt the balance of normal flora in the body, leading to superinfections. This is due to the broad spectrum of activity of these antibiotics, which can kill off a wider range of bacteria, including the beneficial ones.
Choice A is incorrect because narrow spectrum antibiotics target specific types of bacteria, reducing the likelihood of disrupting the normal flora and causing superinfections. Choice B is incorrect because longer courses of antibiotics increase the risk of superinfections as they continue to disrupt the normal flora over a longer period. Choice C is incorrect because antibiotics that are completely absorbed from the small intestines do not necessarily increase the risk of superinfections; it is more about the spectrum of activity and the impact on normal flora.
An adhesion of the prepuce to the head of the penis, making it impossible to retract, is:
- A. Paraphimosis
- B. Phimosis
- C. Smegma
- D. Dyschezia
Correct Answer: B
Rationale: The correct answer is B: Phimosis. Phimosis is the adhesion of the prepuce to the head of the penis, leading to the inability to retract the foreskin. This condition can cause pain, difficulty urinating, and increased risk of infections. Paraphimosis (choice A) is the painful retraction of a foreskin that is stuck behind the glans. Smegma (choice C) is a buildup of dead skin cells and oils under the foreskin. Dyschezia (choice D) is difficulty in passing stools. In this case, phimosis best describes the situation of adhesion preventing foreskin retraction.
In which of the following scenarios is administration of calcium unwise with hyperkalemia?
- A. Rhabdomyolysis.
- B. Nephrotoxic ATN.
- C. Ischaemia ATN.
- D. Acute glomerulonephritis
Correct Answer: D
Rationale: The correct answer is D: Acute glomerulonephritis. In this scenario, administering calcium is unwise with hyperkalemia because acute glomerulonephritis can lead to decreased glomerular filtration rate, which impairs the excretion of potassium. Calcium administration can worsen hyperkalemia by shifting potassium out of cells and into the bloodstream.
Rhabdomyolysis (choice A) can cause hyperkalemia due to cell breakdown, and calcium may be beneficial to stabilize cell membranes. Nephrotoxic ATN (choice B) and ischemic ATN (choice C) are both conditions where calcium administration can help protect kidneys from further damage, but in acute glomerulonephritis, the risk of worsening hyperkalemia outweighs the potential benefits of calcium administration.