Nokea
During an internal examination of a patient’s anus, the nurse notes that the patient has a hypertonic sphincter. What is the most relevant action for the nurse to take at this time?
- A. Ask the patient about anxiety or pain related to the examination.
- B. Inquire if the patient has had any neurologic injury that causes a hypertonic sphincter.
- C. Refer the patient to the physician for evaluation.
- D. Question the patient about a history of anal trauma.
Correct Answer: A
Rationale: Correct Answer: A
Rationale:
1. Hypertonic sphincter indicates increased muscle tone.
2. Inquiring about anxiety or pain helps assess the patient's comfort level.
3. Anxiety or pain can cause increased muscle tension.
4. Addressing emotional factors can help relax the sphincter for a more comfortable examination.
Summary:
- Option B focuses on neurologic causes, not immediate patient care.
- Option C suggests referral without addressing patient comfort.
- Option D addresses past trauma, not the current situation of hypertonic sphincter.
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As preparation for hysterectomy, Mrs. Washington is having radiation therapy for cancer of the uterus, stage IIa. To promote her self-care during recovery from irradiation, which of the following is correct?
- A. Extensive psychologic support is necessary
- B. Extensive physical care is necessary
- C. Instruction in skin care is a priority
- D. Dietary fiber and roughage should be increased
Correct Answer: C
Rationale: Proper skin care is crucial to manage and prevent radiation-induced skin reactions.
Which of the following is produced by the trophoblast cells during the first 3 weeks of pregnancy?
- A. Estrogen
- B. Luteinizing hormone
- C. Oxytocin
- D. Human chorionic gonadotropin
Correct Answer: D
Rationale: The correct answer is D: Human chorionic gonadotropin (hCG). During the first 3 weeks of pregnancy, trophoblast cells produce hCG, which is crucial for maintaining the corpus luteum and ensuring the production of progesterone to support the early pregnancy. hCG is also the hormone detected in pregnancy tests.
Rationale:
A: Estrogen is mainly produced by the ovaries, not trophoblast cells in the early stages of pregnancy.
B: Luteinizing hormone is produced by the pituitary gland to trigger ovulation, not by trophoblast cells.
C: Oxytocin is produced by the hypothalamus and released by the pituitary gland during labor and breastfeeding, not by trophoblast cells in the early stages of pregnancy.
Chronic cervicitis is treated with
- A. Antibiotics
- B. Antifungals
- C. Antivirals
- D. Anti-inflammatory drugs
Correct Answer: A
Rationale: Antibiotics are typically used to treat chronic cervicitis caused by bacterial infections.
Estrogen
- A. Facilitate the growth of ovarian follicles
- B. Cause cystic changes in the vagina
- C. Cause cervical mucous to become more alkanized
- D. Produce ductal proliferation in the breast
Correct Answer: D
Rationale: Estrogen is known to stimulate ductal proliferation in the breast tissue as part of its role in breast development and maintenance. This is crucial for preparing the breast for potential pregnancy and lactation. The other choices are incorrect because estrogen does not directly cause cystic changes in the vagina, alter the pH of cervical mucus to become more alkaline, or specifically facilitate the growth of ovarian follicles. Estrogen plays a role in ovarian follicle development, but its main function in this context is to stimulate the growth and maturation of the follicles, not just facilitate their growth.
If a radioimmunoassay is properly conducted and the amount of radioactive hormone bound to antibody is low, this would indicate which of the following?
- A. Plasma levels of endogenous hormone are high
- B. Plasma levels of endogenous hormone are low
- C. More antibody is needed
- D. Less radioactive hormone is needed
Correct Answer: A
Rationale: The correct answer is A: Plasma levels of endogenous hormone are high. When the amount of radioactive hormone bound to the antibody is low in a radioimmunoassay, it indicates that there is a high concentration of non-radioactive, endogenous hormone present in the sample competing for binding sites on the antibody. This competition results in fewer radioactive hormones binding to the antibody. Therefore, the low radioactive hormone binding suggests an abundance of non-radioactive hormone in the sample.
Choice B is incorrect because low levels of radioactive hormone binding do not indicate low plasma levels of endogenous hormone. Choice C is incorrect as more antibody wouldn't affect the binding of radioactive hormone if endogenous hormone levels are high. Choice D is incorrect because the amount of radioactive hormone needed is not related to the binding observed in the assay.