Nokea
An African client has been diagnosed with Osteomyelitis. The nurse expects to assess which of the following?
- A. pale, cool, tender skin at site
- B. decreased white blood cell count
- C. positive wound cultures
- D. decreased erythrocyte sedimentation rate
Correct Answer: C
Rationale: The correct answer is C: positive wound cultures. Osteomyelitis is an infection of the bone that is typically diagnosed through wound cultures. This assessment helps to identify the causative organism and guide appropriate treatment. Choices A and D are not typical findings in osteomyelitis. Choice A describes symptoms of poor circulation which are not specific to osteomyelitis. Choice B, decreased white blood cell count, is typically not seen in the presence of an infection like osteomyelitis.
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Immunity to a disease after recovery is possible because the first exposure to the pathogen has stimulated the formation of which of the following?
- A. Antigens
- B. Complement
- C. Memory cells
- D. Natural killer cells
Correct Answer: C
Rationale: The correct answer is C: Memory cells. After recovery from a disease, memory cells are formed as part of the adaptive immune response. These memory cells "remember" the pathogen and can mount a quicker and stronger immune response upon re-exposure. This results in immunity to the disease. Antigens (choice A) are substances that trigger the immune response but do not provide immunity on their own. Complement (choice B) is a group of proteins that enhance the immune response but do not directly lead to immunity. Natural killer cells (choice D) are part of the innate immune system and are not responsible for the specific memory response needed for immunity.
Management of the foregoing patient should include:
- A. Regular diet with extra fruits and green vegetables
- B. Potassium-sparing diuretics
- C. Discontinuance of any oral magnesium salts
- D. All of the above measures
Correct Answer: D
Rationale: The correct answer is D because a regular diet with extra fruits and green vegetables can provide essential nutrients for overall health, potassium-sparing diuretics can help manage potassium levels in the body, and discontinuing oral magnesium salts can prevent further complications in the patient. Option A focuses on promoting a healthy diet, B addresses specific medication for potassium management, and C avoids potential interactions with magnesium salts. Therefore, all of the measures (A, B, and C) are necessary for comprehensive management of the patient's condition.
A client who reports increasing difficulty swallowing, weight loss, and fatigue is diagnosed with esophageal cancer. Because this client has difficulty swallowing, the nurse should assign highest priority to:
- A. Helping the client cope with body image
- B. Maintaining a patent airway.
- C. Preventing injury.
- D. Ensuring adequate nutrition.
Correct Answer: B
Rationale: The correct answer is B: Maintaining a patent airway. This is the highest priority because the client with esophageal cancer is at risk for airway obstruction due to difficulty swallowing. Maintaining a patent airway ensures adequate oxygenation and ventilation, which are vital for the client's survival. Without a clear airway, the client may experience respiratory distress or failure. Body image, preventing injury, and ensuring adequate nutrition are important aspects of care but do not take precedence over maintaining a patent airway in this situation.
Once admitted to hospital the physician indicates that Mr. Gubatan is a paraplegic. The family asks the nurse what that means. The nurse explains that:
- A. Upper extremities are paralyzed
- B. Both lower and upper extremities are
- C. Lower extremities are paralyzed paralyzed
- D. One side of the body is paralyzed
Correct Answer: C
Rationale: Rationale for Correct Answer (C):
1. Paraplegia is a condition where both lower extremities are paralyzed.
2. The prefix "para-" means alongside or beside, indicating that both legs are affected.
3. The nurse would explain to the family that Mr. Gubatan has paralysis in his lower extremities only.
4. This aligns with the medical definition of paraplegia.
Summary of Incorrect Choices:
A. Upper extremities being paralyzed is not indicative of paraplegia, as paraplegia specifically refers to lower extremity paralysis.
B. Both lower and upper extremities being paralyzed is suggestive of quadriplegia, not paraplegia.
D. One side of the body being paralyzed describes hemiplegia, not paraplegia.
At the present time, the best treatment for cancer is complete __________ before metastasis occurs:
- A. Chemotherapy
- B. Radiation
- C. Surgical removal
- D. All of the above
Correct Answer: C
Rationale: The correct answer is C: Surgical removal. Surgical removal of the cancerous tumor is the best treatment before metastasis because it physically removes the cancer cells. Chemotherapy and radiation are used to treat cancer after it has spread, not as the primary treatment. Choice D is incorrect because not all types of cancer can be effectively treated with all three options.