Nokea
A patient's serum sodium is within normal range. The nurse estimates that serum osmolality should be:
- A. Less than 136mOsm/kg
- B. Greater than 408mOsm/kg
- C. 280 to 295mOsm/kg
- D. 350 to 544mOsm/kg
Correct Answer: C
Rationale: Normal serum osmolality typically ranges between 280 to 295mOsm/kg. Serum osmolality reflects the concentration of solute particles in the blood, including sodium, glucose, and blood urea nitrogen. Sodium is a major determinant of serum osmolality, but it is not the only factor. In this case, since the patient's serum sodium is within the normal range, the nurse can reasonably estimate that the serum osmolality would fall within the normal range of 280 to 295mOsm/kg. Options A, B, and D are outside the typical range for serum osmolality in a healthy individual.
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While obtaining a health history, the nurse learns that the client is allergic to bee stings. When obtaining the client's medication history, the nurse should determine if the client keeps which medication on hand?
- A. Diphenhydramine hydrochloride (Benadryl)
- B. Guaifenesin (Robitussin)
- C. Pseudoephedrine hydrochloride (Sudafed)
- D. Loperamide (Imodium)
Correct Answer: A
Rationale: The nurse should determine if the client keeps diphenhydramine hydrochloride (Benadryl) on hand because it is an antihistamine medication commonly used to treat allergic reactions, including those caused by bee stings. In the event of a bee sting reaction, diphenhydramine can help reduce itching, swelling, and other symptoms associated with the allergy. It is important for individuals who are allergic to bee stings to have diphenhydramine readily available for prompt treatment in case of an allergic reaction.
Although the etiology of hepatoblastoma is unknown, there are many associated risk factors for development of hepatoblastoma EXCEPT
- A. Beckwith-Wiedemann syndrome
- B. familial adenomatous polyposis syndrome
- C. prematurity
- D. low birth weight
Correct Answer: E
Rationale: Hepatitis C infection is not a recognized risk factor for hepatoblastoma.
A client is admitted for a spelenectomy. What problem is the nurse aware that could develop?
- A. Infection
- B. Urinary retention
- C. Congestive heart failure
- D. Viral hepatitis
Correct Answer: A
Rationale: Following a splenectomy (spleen removal), patients are at an increased risk of developing infections, particularly those caused by encapsulated bacteria such as Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis. The spleen plays a vital role in the immune system by filtering and clearing bacteria and viruses from the bloodstream. Without a functioning spleen, patients are more vulnerable to bacterial infections. Therefore, the nurse should be aware of the potential for infection and provide appropriate education to the client regarding infection prevention strategies, such as vaccinations and prompt medical treatment for any signs of infection.
What is the care priority for a newborn with bladder exstrophy and a malformed pelvis?
- A. Change the diaper frequently and assess for skin breakdown.
- B. Keep the exposed bladder open in a warm, dry environment.
- C. Offer formula for growth and fluid management.
- D. Cluster care to allow the child uninterrupted sleep and strength for upcoming surgical repair.
Correct Answer: D
Rationale: Minimizing disturbances (clustering care) helps prevent infection and allows the infant to conserve energy before surgical repair.
Why does emotional counselling or helping the client perform common daily activities become important nursing care interventions in clients with Parkinson's or Huntington's diseases, or even epilepsy?
- A. Because clients suffer from depression, anxiety, and inability to perform basic self care
- B. Because clients become paralytic throughout the body
- C. Because the clients bone become weak, brittle, and painful to even move
- D. Because clients generally become very aggressive and violent with other people CARING FOR CLIENTS WITH NEUROLOGIC DEFICITS
Correct Answer: A
Rationale: Emotional counseling and helping with common daily activities are important nursing care interventions for clients with neurologic diseases such as Parkinson's, Huntington's, and epilepsy because these clients often experience depression, anxiety, and difficulty performing basic self-care tasks. These diseases can have a significant impact on the client's mental health, leading to feelings of helplessness and loss of independence. Providing emotional support and assistance with daily activities can help improve the client's overall well-being and quality of life. Additionally, these interventions can also help prevent complications such as complications such as pressure sores, infections, and malnutrition that may arise from the inability to perform self-care tasks independently.