Nokea
Bennett was rushed to the emergency department with possible increased intracranial pressure (ICP); which of the following is an early clinical manifestation of increased ICP in older children? (Select all that apply.)
- A. Macewen's sign
- B. Setting sun sign
- C. Papilledema
- D. Diplopia
Correct Answer: C
Rationale: Papilledema is a common early clinical manifestation of increased intracranial pressure (ICP) in older children. Papilledema is defined as optic disc swelling due to increased ICP transmitted to the optic nerve sheath. This can be visualized during a fundoscopic examination. It is important to identify papilledema promptly as it may signify increased ICP, which requires urgent evaluation and management to prevent potential complications. While other signs like Macewen's sign, Setting sun sign, and Diplopia can also indicate increased ICP, papilledema is a more specific sign seen in older children.
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Which of the following hormones retains sodium in the body?
- A. Antidiuretic hormone
- B. Aldosterone
- C. Thyroid hormone
- D. Insulin
Correct Answer: B
Rationale: Aldosterone is a hormone produced by the adrenal glands that plays a crucial role in regulating the balance of sodium and potassium in the body. One of its primary functions is to retain sodium in the body, leading to increased reabsorption of sodium in the kidneys. This retention of sodium helps to maintain blood pressure and fluid balance. In contrast, other hormones like antidiuretic hormone (ADH) primarily regulate water reabsorption, while thyroid hormone and insulin do not have a direct role in retaining sodium in the body.
Which of the ff is the primary sign of breast cancer?
- A. A bloody discharge from the nipple
- B. A retraction of the nipple
- C. A dimpling of the skin over the lesion
- D. A painless mass in the breast CLIENT IN BIOLOGICAL CRISIS MANAGEMENT of PATIENTS with COMPLICATIONS from HEART DISEASE
Correct Answer: D
Rationale: The primary sign of breast cancer is usually a painless mass or lump in the breast. This mass or lump may feel hard, irregularly shaped, and different from the surrounding breast tissue. It is important to note that not all breast lumps are cancerous, but it is crucial to seek medical evaluation if you notice any new or unusual changes in your breast tissue. Other signs such as a bloody discharge from the nipple, retraction of the nipple, or dimpling of the skin over the lesion can also be associated with breast cancer, but the presence of a painless mass in the breast is typically the most common initial indication of the disease.
The nurse is assessing a child after a cardiac catheterization. Which complication should the nurse be assessing for?
- A. Cardiac arrhythmia
- B. Hypostatic pneumonia
- C. Heart failure
- D. Rapidly increasing blood pressure
Correct Answer: A
Rationale: After a cardiac catheterization, the nurse should be assessing for the development of cardiac arrhythmias, as this is a potential complication associated with the procedure. Cardiac arrhythmias can occur due to irritation of the heart during the catheterization, changes in electrolyte levels, or other factors related to the procedure. Monitoring the child's cardiac rhythm closely allows for early detection and management of arrhythmias to prevent serious complications. While other complications such as hypostatic pneumonia, heart failure, and rapidly increasing blood pressure can also occur, cardiac arrhythmia is the most important complication to assess for immediately post-cardiac catheterization.
Assume you are going to estimate the prevalence of amoebic dysentery in a small country which harbors a total number of population of 530,000; you find that 57,000 of the population are infected by the disease. The prevalence of this disease is closest to
- A. 5.33%
- B. 7.45%
- C. 10.75%
- D. 20.22%
Correct Answer: C
Rationale: Prevalence = (Number of infected / Total population) * 100 = (57,000 / 530,000) * 100 ≈ 10.75%.
A client with hyperglycemia, which assessment finding best supports a nursing diagnosis of Deficient fluid volume?
- A. Cool, clammy skin
- B. Increased urine osmolarity
- C. Distended neck veins
- D. serum sodium level
Correct Answer: B
Rationale: Increased urine osmolarity would best support the nursing diagnosis of Deficient fluid volume in a client with hyperglycemia. Hyperglycemia can lead to osmotic diuresis, where the body excretes excessive amounts of water to help eliminate glucose. This results in concentrated urine with a higher osmolarity. A high urine osmolarity indicates that the kidneys are conserving water due to decreased fluid volume in the body, supporting the diagnosis of Deficient fluid volume. The other assessment findings (cool, clammy skin, distended neck veins, serum sodium level) are not specific to the diagnosis of Deficient fluid volume in this context.