Nokea
An 18-month old has been hospitalized six times for upper airway infections. Diagnostic studies including sweat analysis confirm the diagnosis of cystic fibrosis. Which of the following statements describes the inheritance pattern for cystic fibrosis?
- A. An affected gene is inherited from both the father and mother, who remain symptom free.
- B. Males are at risk at twice the rate as females.
- C. Autosomal recessive disorders tend to skip generations, so the children of affected parents will have children with the disorder.
- D. The disorder is transmitted by an affected gene on one of the six chromosomes.
Correct Answer: A
Rationale: Cystic fibrosis is an autosomal recessive disorder, requiring a mutated gene from both parents, who are carriers but asymptomatic.
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The nurse is teaching an adult who has a broken ankle that has been casted how to climb stairs. The nurse knows that the client understands how to climb up stairs when she does which of the following?
- A. While bearing weight on the unaffected leg, the client moves the crutches up to the next step followed by the affected leg and then the unaffected leg.
- B. While bearing weight on the unaffected leg, the client moves affected leg to the next step followed by the unaffected leg and the crutches.
- C. While bearing weight on crutches, the client moves the affected leg to the next step followed by the unaffected leg and the crutches.
- D. While bearing weight on crutches, the client moves the unaffected leg to the next step followed by the affected leg and the crutches.
Correct Answer: D
Rationale: To climb stairs, weight is borne on crutches, moving the unaffected leg first, then the affected leg and crutches, ensuring stability and safety using the stronger leg.
The home health nurse is caring for a 6-year-old client who has a tracheostomy and is being mechanically ventilated when the ventilator's apnea alarm sounds. The nurse determines the client is unresponsive and pulseless, and there are no other caregivers present. Which of the following actions should the nurse take next?
- A. Deliver 30 chest compressions.
- B. Activate the emergency response system.
- C. Locate an automated external defibrillator.
- D. Deliver 2 breaths using a bag valve device connected to the tracheostomy.
Correct Answer: B
Rationale: Activating the emergency response system ensures rapid assistance for a pulseless child, initiating the chain of survival in pediatric cardiac arrest.
Which of these tests would the nurse expect to monitor for the evaluation of clients aged 18 and older with poor glycemic control?
- A. A glycosylated hemoglobin (A1c) should be performed during an initial assessment and during follow-up assessment, which should occur in longer than 3-month intervals
- B. A glycosylated hemoglobin is to be obtained at least two years
- C. A fasting glucose and a glycosylated hemoglobin is to be obtained at 3 months intervals after the initial assessment
- D. A glucose tolerance test, a fasting glucose and a glycosylated hemoglobin should be obtained at 6-month intervals after the initial assessment
Correct Answer: A
Rationale: The American Diabetes Association (ADA) recommends obtaining a glycosylated hemoglobin during an initial assessment and then routinely as part of continuing care for clients with poor glycemic control.
The nurse is preparing to administer the fourth dose of IV vancomycin to a client. Which set of laboratory values would alert the nurse to hold the vancomycin and notify the health care provider?
- A. Vancomycin trough 10 mg/L (6.9 umol/L), creatinine 1.1 mg/dL (97.2 umol/L), BUN 6 mg/dL (2.1 mmol/L)
- B. Vancomycin trough 14 mg/L (9.7 umol/L), creatinine 1.2 mg/dL (106.1 umol/L), BUN 10 mg/dL (3.6 mmol/L)
- C. Vancomycin trough 18 mg/L (12.4 umol/L), creatinine 0.6 mg/dL (53 umol/L), BUN 18 mg/dL (6.4 mmol/L)
- D. Vancomycin trough 23 mg/L (15.9 umol/L), creatinine 1.5 mg/dL (132.6 umol/L), BUN 24 mg/dL (8.6 mmol/L)
Correct Answer: D
Rationale: A vancomycin trough of 23 mg/L is above the therapeutic range (10-20 mg/L), indicating potential toxicity. Elevated creatinine (1.5 mg/dL) suggests renal impairment, which increases the risk of vancomycin accumulation and nephrotoxicity.
The client has just returned from having a cast placed on the right forearm and is found putting a lead pencil in the cast to 'reach the itch.' What is the nurse's priority action?
- A. Offer the client a straw to reach the itch instead of a lead pencil
- B. Perform a peripheral neurovascular check of the casted extremity
- C. Pour a generous amount of baby powder or corn starch in the cast to reach the itch
- D. Review appropriate itch relief technique using the cool setting of a hair dryer
Correct Answer: D
Rationale: Using a hair dryer on a cool setting is a safe and effective way to relieve itching without risking skin damage or cast integrity, unlike inserting objects or powders.