Nokea
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.
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According to developmental theories, which event is essential to toddler development?
- A. Learning to feed oneself.
- B. Developing friendships.
- C. Learning to walk.
- D. Being potty-trained.
Correct Answer: D
Rationale: The mastery of toilet training is considered a key developmental milestone during the toddler period.
A surgical intervention that can cause substantial remission of myasthenia gravis is:
- A. Esophagostomy
- B. Thymectomy
- C. Myomectomy
- D. Spleenectomy
Correct Answer: B
Rationale: Thymectomy is a surgical procedure that involves the removal of the thymus gland. The thymus is a key component of the immune system and is believed to play a role in the development of myasthenia gravis (MG). In some cases, particularly in younger patients with early onset MG or with thymoma (a tumor of the thymus), thymectomy can lead to substantial remission of MG symptoms or even a cure. By removing the thymus gland, the abnormal immune response in MG may be reduced, resulting in improved muscle strength and decreased symptoms. It is worth noting that thymectomy is not always indicated for all patients with MG and should be considered on a case-by-case basis in consultation with a healthcare provider specialized in neuromuscular diseases.
The LPN is caring for a patient in the preoperative period who, even after verbalizing concerns and having questions answered, states, "I know I am not going to wake up after surgery." Which of the following actions should the nurse take?
- A. Reassure patient everything will be all right
- B. Explain national surgery death rate
- C. Inform the registered nurse
- D. Ask family to comfort the patient
Correct Answer: C
Rationale: The correct action for the LPN to take in this situation is to inform the registered nurse. The patient's statement indicates a high level of fear and anxiety about the surgery and their potential outcome. It is important to involve the registered nurse, who can provide further assessment, support, and interventions to address the patient's concerns appropriately. Simply reassuring the patient or providing statistics about national surgery death rates may not address the underlying fear and may require additional support and intervention. Asking the family to comfort the patient may not be the most appropriate immediate action as the patient's concerns are specific and may require professional support. Bringing the registered nurse into the situation allows for a comprehensive approach to addressing the patient's emotional needs before the surgery.
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.
Mrs. Silang, a 52-year old female, is experiencing advanced hepatic cirrhosis now complicated by hepatic encephalopathy. She is confused, restless, and demonstrating asterixis. The nurse has formulated the nursing diagnosis: Altered thought processes related to which of the following?
- A. massive ascites formation
- B. fluid volume excess
- C. increased serum ammonia levels
- D. altered clotting mechanism
Correct Answer: C
Rationale: Hepatic encephalopathy is a neuropsychiatric complication of advanced liver disease, such as cirrhosis, where the liver's ability to metabolize ammonia is impaired. As a result, there is an increase in serum ammonia levels, leading to alterations in brain function and neurotransmission. Symptoms such as confusion, restlessness, and asterixis (flapping tremor) are characteristic of hepatic encephalopathy caused by increased ammonia levels affecting the brain. Therefore, altered thought processes in Mrs. Silang are primarily related to the increased serum ammonia levels rather than other factors like massive ascites formation, fluid volume excess, or altered clotting mechanism.