Nokea
Decreasing level of consciousness is a symptom of which of the following physiological phenomena?
- A. Increased ICP
- B. Parasympathetic response
- C. Sympathetic response
- D. Increased cerebral blood flow
Correct Answer: A
Rationale: A decreasing level of consciousness is a symptom often associated with increased intracranial pressure (ICP). When the pressure inside the skull rises, it can compress and damage the brain, leading to a deterioration in consciousness. Common causes of increased ICP include traumatic brain injury, brain tumors, and infections. As ICP continues to rise, it can result in serious consequences such as brain herniation, which can be life-threatening if not promptly managed. Therefore, a decreasing level of consciousness should raise concerns about increased ICP and warrant immediate medical evaluation and intervention.
You may also like to solve these questions
Which patient is most at risk for fluid volume overload?
- A. The 40-year-old with meningitis
- B. The 60-year-old with psoriasis
- C. The 35-year-old with kidney failure
- D. The 2-year-old with influenza
Correct Answer: C
Rationale: The patient with kidney failure is most at risk for fluid volume overload because the kidneys are responsible for regulating fluid balance in the body. In kidney failure, the kidneys are unable to effectively filter and excrete excess fluids, leading to an accumulation of fluid in the body. This can result in fluid volume overload, which can be dangerous and lead to complications such as pulmonary edema, congestive heart failure, and hypertension. It is important to monitor this patient closely for signs and symptoms of fluid overload and manage their fluid intake carefully.
What are the nursing interventions for a client with thalassemia?
- A. Maintain the client on bed rest and protect him or her from infections
- B. Ambulate the client frequently
- C. Advise drinking 3 quarts (L) of fluid per day
- D. Instruct the client to elevate the lower extremities as much as possible
Correct Answer: A
Rationale: Thalassemia is a genetic blood disorder that results in the reduced production of hemoglobin and red blood cells. Nursing interventions for a client with thalassemia aim to manage symptoms and prevent complications. Maintaining the client on bed rest helps conserve energy and prevent fatigue, which is commonly experienced due to anemia. Protecting the client from infections is crucial because individuals with thalassemia are at a higher risk of infections due to their weakened immune system. By minimizing the risk of infections, nurses can help prevent further complications in clients with thalassemia.
In children diagnosed with sickle cell disease (SCD), tissue damage results from which of the following?
- A. Air hunger and respiratory alkalosis due to deoxygenated red blood cells.
- B. Hypersensitivity of the central nervous system (CNS) due to elevated serum bilirubin levels
- C. A general inflammatory response due to an autoimmune reaction from hypoxia
- D. Local tissue damage with ischemia and necrosis due to obstructed circulation
Correct Answer: D
Rationale: In children diagnosed with sickle cell disease (SCD), tissue damage results from local tissue damage with ischemia and necrosis due to obstructed circulation. Sickle cell disease is a genetic disorder characterized by abnormal hemoglobin that causes red blood cells to assume a sickle shape. These sickle-shaped cells can adhere to blood vessel walls, leading to vaso-occlusion and impaired blood flow. This obstruction results in tissue ischemia and eventual necrosis, causing significant pain and organ damage. The chronic vaso-occlusive events in SCD are responsible for the development of acute and chronic complications seen in affected individuals, such as painful crises, stroke, and organ damage.
Building a tower by a 22-month-old child requires
- A. visual-motor coordination
- B. uses visual and motor skills in combination
- C. gross and fine motor coordination
- D. symbolic thought
Correct Answer: A
Rationale: Tower building primarily involves visual-motor coordination.
The most common type of CP is :
- A. Athetoid
- B. B.Spastic
- C. Ataxic
- D. None Of The Above
Correct Answer: B
Rationale: Spastic cerebral palsy is the most common type of cerebral palsy, accounting for around 70-80% of cases. Spastic CP is characterized by stiff, tight muscles that can affect movement and coordination. This type of CP is caused by damage to the motor cortex of the brain, leading to increased muscle tone and difficulty with voluntary movements. Symptoms of spastic CP can vary in severity and may affect one or multiple limbs.