Nokea
Discharge care planning has begun for a seriously injured patient who is Asian. The patient's parents have refused routine home health visits. The pediatric nurse understands the family may:
- A. believe that health outcomes are predetermined.
- B. feel health is a personal responsibility and maintenance of family reputation is paramount.
- C. regard health as a family responsibility, seeking outside aid only when resources are exhausted.
- D. none of the above.
Correct Answer: C
Rationale: In some cultures, families may prefer to handle health matters internally, viewing outside assistance as a last resort.
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After the surgical incision has been clised and the anesthesia has wear-off, the patient is extubated and transferred to the postanesthesia care unit (PACU). Who is responsible for transferring the patient?
- A. Circulating nurse
- B. scrub nurse
- C. surgeon
- D. anesthesiologist
Correct Answer: D
Rationale: The anesthesiologist is responsible for transferring the patient to the postanesthesia care unit (PACU) after the surgical incision has been closed and the anesthesia has worn off. The anesthesiologist ensures that the patient is stable and ready for transfer, including assessing vital signs and overall condition. Due to their specialized training in anesthesia and perioperative care, the anesthesiologist is best equipped to manage the transition of care from the operating room to the PACU, where the patient will continue to be monitored closely during the immediate postoperative period.
Which of the following types of translocation of childhood AML that typically associated with granulocytic sarcoma mass?
- A. inv(16)
- B. t(8;21)
- C. t(6;9)
- D. inv(3)
Correct Answer: A
Rationale: The inv(16) translocation is strongly associated with granulocytic sarcoma in AML.
A client with neuromuscular disorder is receiving intensive nursing care. The client is likely to face the risk for impaired skin integrity. Which of the ff must the nurse ensure to prevent skin breakdown in the client?
- A. Prevent strenuous exercises by the client
- B. Use pressure relieving devices when the client is in bed
- C. Place the client in Fowler's position
- D. Avoid giving daily baths with soaps to the client
Correct Answer: B
Rationale: Using pressure relieving devices when the client is in bed is essential to prevent skin breakdown. Clients with neuromuscular disorders are at higher risk for impaired skin integrity due to limited mobility and sensation. Pressure relieving devices such as specialized mattresses, cushions, or pads help distribute pressure evenly and reduce the risk of pressure ulcers. Maintaining good skin integrity is crucial in preventing complications and promoting the overall well-being of the client. It is important for the nurse to assess the client's risk factors, implement preventive measures like using pressure relieving devices, and monitor the client's skin regularly to prevent skin breakdown.
Which of the following tests would the nurse use as an initial screening test to determine hearing loss?
- A. Romberg test
- B. Caloric test
- C. Otoscopic examination
- D. Whisper voice test
Correct Answer: D
Rationale: The nurse would use the whisper voice test as an initial screening test to determine hearing loss. This test involves the nurse whispering a series of words or numbers from a distance behind the patient to assess their ability to hear and repeat the whispered words accurately. This test is quick, easy, and can be performed in a quiet environment without the need for special equipment, making it an effective initial screening tool for hearing loss. The Romberg test assesses balance, the caloric test evaluates vestibular function, and the otoscopic examination is used to assess the external ear canal and eardrum, but none of these tests specifically assess hearing loss.
A mother of a term neonate asks what the thick, white, cheesy coating is on his skin. Which correctly describes this finding?
- A. Lanugo
- B. Milia
- C. Nevus flammeus
- D. Vernix 6
Correct Answer: D
Rationale: The thick, white, cheesy coating on the skin of a newborn baby is called vernix caseosa. It is a substance produced by the fetal sebaceous glands and is meant to protect the baby's skin while in the amniotic fluid. Vernix helps to maintain the skin's hydration, provides a barrier against infection, and aids in the transition from the wet intrauterine environment to the dry extrauterine world. It is usually found on the skin of term newborns but can be present in preterm babies as well. As the baby is exposed to air and dries off, the vernix will naturally diminish.