Nokea
Clinitest is used to assess urine for
- A. Protein
- B. Sugar
- C. Phenylketones
- D. Bilirubin
Correct Answer: B
Rationale: Clinitest detects sugar e.g., glucose in diabetes via tablet reaction, unlike acetic (protein), PKU tests (phenylketones), or bilirubin assays. Nurses use e.g., bedside for quick checks, per diagnostics.
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The nurse is caring for a client with a suspected myocardial infarction. Which laboratory value is most specific for confirming the diagnosis?
- A. Troponin I
- B. Creatine kinase (CK)
- C. Myoglobin
- D. Lactic dehydrogenase (LDH)
Correct Answer: A
Rationale: Troponin I is the most specific marker for myocardial infarction, rising within hours and staying elevated for days CK and myoglobin are less specific, LDH is outdated. Nurses monitor this, correlating with ECG and symptoms, aiding rapid diagnosis and treatment.
The coronary vessels, unlike any other blood vessels in the body, respond to sympathetic stimulation by
- A. Vasoconstriction
- B. Vasodilatation
- C. Decreases force of contractility
- D. Decreases cardiac output
Correct Answer: B
Rationale: The coronary vessels are unique because they respond to sympathetic stimulation with vasodilatation, unlike most other blood vessels which constrict. Sympathetic stimulation activates the fight-or-flight response, increasing heart rate and oxygen demand. To meet this demand, the coronary arteries dilate to supply more blood to the heart muscle. Vasoconstriction (A) is incorrect as it would reduce blood flow, countering the heart's needs during stress. Decreases in force of contractility (C) or cardiac output (D) are unrelated to the vascular response and pertain more to myocardial function, not the coronary vessels' behavior. This vasodilatation is mediated by beta-adrenergic receptors, ensuring adequate perfusion during heightened activity, making B the correct choice.
The nurse raised her fist to Mr. Gary who refused his medication. This is an example of?
- A. Malpractice
- B. Negligence
- C. Assault
- D. Battery
Correct Answer: C
Rationale: Raising a fist to Mr. Gary is assault (C) intentional threat, per law. Malpractice (A) and negligence (B) are care failures, battery (D) requires touch. C fits the threatening act, making it correct.
What equipment would be necessary to complete an evaluation of cranial nerves 9 and 10 during a physical assessment?
- A. A cotton ball
- B. A penlight
- C. An ophthalmoscope
- D. A tongue depressor and flashlight
Correct Answer: D
Rationale: Cranial nerves 9 and 10 (glossopharyngeal and vagus) are assessed with a gag reflex, requiring a tongue depressor and light.
What stress response can you expect from a patient with blood sugar of 50 mg/dl?
- A. Body will try to decrease the glucose level
- B. There will be a halt in release of sex hormones
- C. Client will appear restless
- D. Blood pressure will increase
Correct Answer: C
Rationale: A blood sugar level of 50 mg/dl indicates hypoglycemia, a stress state triggering the body's fight-or-flight response. The client will appear restless due to the brain's reliance on glucose; low levels cause agitation as a protective mechanism to signal distress. The body attempts to increase glucose via glycogenolysis and gluconeogenesis (opposite of A), so decreasing glucose further is incorrect. Halting sex hormone release (B) occurs in chronic stress, not acute hypoglycemia. Blood pressure may rise (D) due to catecholamine release, but restlessness is the most immediate and observable response in this acute scenario, aligning with early stress symptoms. Thus, C is correct as it directly reflects the patient's presentation during a hypoglycemic crisis.