Nokea
During a routine examination of a 10-mo-old male infant, you find a white pupillary reflex of the right eye; the eye movements are normal. You suspect retinoblastoma. Of the following, the BEST confirmatory diagnostic evaluation of this infant is
- A. indirect ophthalmoscopy with slit-lamp examination
- B. examination under general anesthesia by an experienced ophthalmologist
- C. orbital ultrasonography
- D. brain MRI
Correct Answer: B
Rationale: Examination under anesthesia by an experienced ophthalmologist is the gold standard for diagnosing retinoblastoma.
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In growing children, growth hormone deficiency results in short stature and very slow growth rates. Short stature may result from which of the following?
- A. Anterior pituitary gland hypofunction
- B. Posterior pituitary gland hyperfunction
- C. Parathyroid gland hyperfunction
- D. Thyroid gland hyperfunction
Correct Answer: A
Rationale: Short stature due to growth hormone deficiency commonly occurs as a result of anterior pituitary gland hypofunction. The anterior pituitary gland is responsible for releasing growth hormone, which is crucial for proper growth and development, especially during childhood. When there is a deficiency of growth hormone, children may experience slowed growth rates and ultimately result in short stature. Other gland dysfunctions mentioned in the choices, such as posterior pituitary gland hyperfunction, parathyroid gland hyperfunction, and thyroid gland hyperfunction, do not directly impact growth hormone production and are not associated with growth hormone deficiency-related short stature in children.
Calcium carbonate is given with meals to a child with chronic renal disease. What is the purpose of administering calcium carbonate?
- A. Prevent vomiting
- B. Bind phosphorus
- C. Stimulate appetite
- D. Increase absorption of fat-soluble vitamins
Correct Answer: B
Rationale: In chronic renal disease, the kidneys are not functioning properly, leading to an accumulation of phosphorus in the body. High levels of phosphorus can be harmful and contribute to bone and mineral disorders. Calcium carbonate is often given with meals to bind phosphorus in the gut and prevent its absorption. By binding with phosphorus, calcium carbonate helps lower the levels of phosphorus in the blood, thereby managing complications associated with chronic renal disease, such as renal osteodystrophy. It is an essential part of the treatment plan for patients with chronic kidney disease to help maintain appropriate phosphorus balance in the body and prevent further complications.
The laboratory results of a patient with disseminated intravascular coagulation are likely to include:
- A. decreased levels of fibrin split products.
- B. increased levels of fibrinogen.
- C. increased platelet counts.
- D. prolonged prothrombin and partial thromboplastin times.
Correct Answer: D
Rationale: DIC leads to prolonged clotting times due to consumption of clotting factors and platelets.
An adult has and IV line in the right forearm infusing D5 ½ NS with 20 mEq of potassium at 75 ml/h. which statement would be a correct report from the RN?
- A. The potassium bag is piggybacked into the dextrose at 75ml/h
- B. The clamp should be closed below the D5 ½ NS bag
- C. Potassium is on the secondary line
- D. 75 ml infuse in one hour
Correct Answer: A
Rationale: The correct report from the RN in this situation would be option A. This report accurately describes the situation by mentioning that the potassium bag is piggybacked into the dextrose at 75 ml/h, stating that the clamp should be closed below the D5 ½ NS bag, and clarifying that potassium is on the secondary line. Additionally, the statement that 75 ml will infuse in one hour is also correct based on the infusion rate provided in the question. Therefore, option A is the most appropriate and accurate report to provide in this scenario.
Ms. CC's laboratory values indicate hemoconcentration secondary to fluid loss. Which of the following intravenous solutions would be most appropriate during initial fluid replacement therapy?
- A. 10% dextrose and saline
- B. 5% dextrose and water
- C. 5% dextrose and water with 60 mEq
- D. Distilled water KCl
Correct Answer: A
Rationale: In hemoconcentration due to fluid loss, the primary goal is to rapidly expand the intravascular volume and correct the deficit. The most appropriate intravenous solution for initial fluid replacement therapy in this case is 10% dextrose and saline. This solution is isotonic, which means it has an osmolarity close to that of blood and is effective in quickly restoring intravascular volume without causing significant shifts in electrolytes. The saline component helps to replenish lost electrolytes while the dextrose provides energy and helps prevent hypoglycemia. The combination of dextrose and saline is beneficial for addressing both intravascular volume depletion and dehydration causing hemoconcentration.