Nokea
Before finishing the check up, which of the following principles is NOT included among the principles of guidance in handling Richard?
- A. Controlling temper tantrums
- B. Basing her expectations within the child's limitations.
- C. Acceptance of masturbation as a normal phenomenon to be discouraged in public.
- D. Reinforcing the correct use of language.
Correct Answer: D
Rationale: The principles of guidance in handling Richard involve understanding and addressing the behaviors and needs of the child, such as controlling temper tantrums, basing expectations within the child's limitations, and acceptance of certain behaviors like masturbation as normal but to be discouraged in public. However, reinforcing the correct use of language is not typically included as a principle specifically in handling Richard. Therefore, this choice is NOT included among the principles of guidance in this context.
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A patient with a history of coronary artery disease is prescribed aspirin for secondary prevention. Which adverse effect is a potential concern with long-term aspirin therapy?
- A. Thrombocytopenia
- B. Gastrointestinal bleeding
- C. Hypercholesterolemia
- D. Hypertension
Correct Answer: B
Rationale: Long-term aspirin therapy, especially at higher doses, can increase the risk of gastrointestinal bleeding. Aspirin irreversibly inhibits cyclooxygenase enzyme, which is essential for the production of prostaglandins involved in mucosal protection of the gastrointestinal tract. Without these protective prostaglandins, the stomach lining becomes more susceptible to damage from gastric acid, leading to potential ulcer formation and bleeding. Patients with a history of coronary artery disease may be on aspirin for secondary prevention, and it is crucial to monitor for signs of bleeding such as black, tarry stools or abdominal pain. The benefits of aspirin in preventing cardiovascular events need to be weighed against the risk of adverse effects like gastrointestinal bleeding, especially in patients on long-term therapy.
A patient presents with a pruritic, erythematous rash with edematous plaques and vesicles on the hands and fingers. The patient reports a history of exposure to detergents and frequent hand washing. Which of the following conditions is most likely responsible for this presentation?
- A. Atopic dermatitis
- B. Contact dermatitis
- C. Psoriasis
- D. Pityriasis rosea
Correct Answer: B
Rationale: The presentation of a pruritic, erythematous rash with edematous plaques and vesicles on the hands and fingers in a patient with a history of exposure to detergents and frequent hand washing is most indicative of contact dermatitis. Contact dermatitis can be caused by direct contact with irritants such as detergents or chemicals, leading to skin irritation and inflammation. In this case, the history of exposure to detergents and hand washing suggests that the rash is likely due to irritant contact dermatitis. Atopic dermatitis, psoriasis, and pityriasis rosea do not typically present with the same pattern of rash in response to irritant exposure.
A patient with a history of chronic obstructive pulmonary disease (COPD) is prescribed tiotropium (Spiriva) inhaler. Which instruction should the nurse include in patient education about tiotropium inhaler use?
- A. "Use the inhaler only when you experience symptoms."
- B. "Rinse your mouth with water after each use."
- C. "Exhale forcefully before inhaling the medication."
- D. "Store the inhaler in the refrigerator between uses."
Correct Answer: B
Rationale: Tiotropium (Spiriva) is an anticholinergic bronchodilator used for the management of COPD. A common side effect of anticholinergic medications is dry mouth. Rinsing the mouth with water after using the inhaler can help reduce the risk of developing oral thrush or other mouth infections due to dryness. This instruction helps promote good oral hygiene and decreases the potential side effects associated with tiotropium inhaler use. This teaching is important for patients to follow to ensure their overall health and well-being while using the medication.
A patient presents with fatigue, pallor, and exertional dyspnea. Laboratory tests reveal severe anemia, low serum iron, low transferrin saturation, and elevated total iron-binding capacity (TIBC). Which of the following conditions is most likely to cause these findings?
- A. Iron deficiency anemia
- B. Anemia of chronic disease
- C. Sideroblastic anemia
- D. Thalassemia
Correct Answer: A
Rationale: The clinical presentation of fatigue, pallor, exertional dyspnea along with the laboratory findings of severe anemia, low serum iron, low transferrin saturation, and elevated TIBC are consistent with iron deficiency anemia. In iron deficiency anemia, there is inadequate iron available for erythropoiesis leading to microcytic hypochromic anemia. The low serum iron and transferrin saturation, along with the elevated TIBC, indicate decreased iron stores and increased iron-binding capacity as the body tries to compensate for the deficiency by increasing absorption and recycling of iron. Anemia of chronic disease typically presents with mild to moderate anemia, normal to low TIBC, and low transferrin saturation due to iron sequestration in macrophages. Sideroblastic anemia usually has elevated serum iron, high saturation, and normal to low TIBC. Thalassemia presents with microcytic hyp
A patient presents with sudden-onset severe scrotal pain, swelling, and erythema. Physical examination reveals a tender, swollen, and high-riding testicle. What is the most likely diagnosis?
- A. Testicular torsion
- B. Epididymitis
- C. Testicular trauma
- D. Testicular tumor
Correct Answer: A
Rationale: Given the sudden-onset severe scrotal pain, swelling, and erythema, along with the physical examination findings of a tender, swollen, and high-riding testicle, the most likely diagnosis is testicular torsion. Testicular torsion occurs when the spermatic cord twists, leading to compromised blood flow to the testicle, causing ischemia and severe pain. It is considered a surgical emergency that requires prompt diagnosis and intervention to salvage the affected testicle. Prompt surgical detorsion is necessary to prevent irreversible testicular damage. While epididymitis, testicular trauma, and testicular tumors can also present with scrotal pain and swelling, the presence of a high-riding testicle in this context is highly suggestive of testicular torsion.