Nokea
A woman sees her primary care provider because of extreme fatigue for the past 2 months; she difficulty lifting even light objects. Her physician suspects myasthenia gravis. Which of the ff. tests should the nurse anticipate to confirm this diagnosis?
- A. Mestinon test
- B. Pulmonary function studies
- C. Quinine tolerance test
- D. Tensilon test
Correct Answer: D
Rationale: The Tensilon test is used to confirm the diagnosis of myasthenia gravis, a condition characterized by muscle weakness and fatigue. In this test, the medication Tensilon (also known as edrophonium) is administered intravenously. If the patient has myasthenia gravis, there will be a rapid but temporary improvement in muscle strength after the Tensilon injection. This response helps to differentiate myasthenia gravis from other causes of muscle weakness. The other options mentioned (Mestinon test, pulmonary function studies, and quinine tolerance test) do not specifically confirm the diagnosis of myasthenia gravis.
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The nurse is conducting a staff in-service on newborn defects of the genitourinary system. Which describes the narrowing of the preputial opening of the foreskin?
- A. Chordee
- B. Phimosis
- C. Epispadias
- D. Hypospadias
Correct Answer: B
Rationale: Phimosis is the term used to describe the narrowing of the preputial opening of the foreskin in males. This condition does not allow the foreskin to be fully retracted over the head of the penis, which can cause issues with hygiene and potentially lead to infections. Phimosis can occur in newborns and also persist into adulthood if not treated. It is important for healthcare providers, including nurses, to be aware of this condition in order to provide appropriate education and intervention when needed.
Which of the ff nursing interventions should a nurse perform when caring for a client with congestive heart failure who has decreased cardiac output?
- A. Encourage activities that engage the Valsalva maneuver
- B. Encourage the client to perform exercises
- C. Assess apical heart before administering digitalis
- D. Offer small frequent feedings
Correct Answer: C
Rationale: Decreased cardiac output is a serious concern in clients with congestive heart failure. By assessing the apical heart rate before administering digitalis, the nurse can monitor the client's cardiac status and prevent possible complications such as digitalis toxicity. Digitalis is a medication commonly used to improve cardiac output in clients with heart failure, but it can also cause harm if given inappropriately, especially if the client's heart rate is already low. Monitoring the client's apical heart rate before giving digitalis helps ensure that the medication is safely administered and that the client's cardiac status is closely monitored. This intervention is crucial in the care of clients with congestive heart failure to optimize patient safety and outcomes.
A nurse is teaching parents about caring for their child with chickenpox. The nurse should let the parents know that the child is considered to be no longer contagious when which occurs?
- A. When fever is absent
- B. When lesions are crusted
- C. 24 hours after lesions erupt
- D. 8 days after onset of illness
Correct Answer: B
Rationale: The child with chickenpox is considered to be no longer contagious when the lesions are crusted over. This usually occurs around 7-10 days after the rash first appears. At this stage, the fluid-filled blisters have dried up and formed scabs, indicating that the infectious stage of the illness has passed. The child can then safely return to school or daycare without posing a risk of spreading the infection to others. It is important for parents and caregivers to continue practicing good hygiene and ensuring that the child does not scratch the scabs to prevent complications and scarring.
Miss OB's malignant tumor in her left breast was discovered to be spreading all over the surrounding and adjacent tissue and not entering the blood stream, it would be:
- A. Malignant
- B. Non-malignant
- C. Benign
- D. B and C
Correct Answer: C
Rationale: A malignant tumor is characterized by its ability to spread to surrounding tissues and potentially enter the bloodstream to form secondary tumors in distant organs (metastasis). In the scenario provided, the tumor in Miss OB's left breast is described as spreading all over the surrounding and adjacent tissue but specifically noted not to be entering the bloodstream. This behavior is more indicative of a benign tumor that is growing locally but is not capable of metastasis. Therefore, the tumor is best classified as benign in this case.
the frontal fontanell is protruding when a child suffering from:
- A. meningitis
- B. hydrocepalus
- C. subdural hematoma
- D. all the answers are correct
Correct Answer: D
Rationale: The protrusion of the frontal fontanelle in a child can be a concerning sign and can be seen in various conditions such as meningitis, hydrocephalus, and subdural hematoma. In meningitis, the inflammation of the meninges can lead to increased intracranial pressure, which may cause the fontanelle to bulge. Hydrocephalus, which is the buildup of fluid in the brain, can also result in the fontanelle being more pronounced. Additionally, a subdural hematoma, which is a collection of blood between the brain and its outermost covering, can lead to pressure on the brain and consequent fontanelle protrusion. Therefore, all the provided choices (A, B, C) are correct as they can lead to the protrusion of the frontal fontanelle in a child.