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During surgery, the anesthesia personnel notice the client is having a steady rise in end-tidal carbon dioxide level. At this time, the nurse anesthetist begins to assess the client for malignant hyperthermia. The initial (priority) assessment for this disorder may include:
- A. measuring serum potassium levels.
- B. monitoring for muscle rigidity.
- C. evaluating renal function.
- D. checking arterial blood gases.
Correct Answer: B
Rationale: The correct answer is B: monitoring for muscle rigidity. Muscle rigidity is a hallmark sign of malignant hyperthermia, a life-threatening condition triggered by certain anesthetics. Monitoring for this sign is critical in the early identification of the condition. Choices A, C, and D are not the initial priority assessments for malignant hyperthermia. Measuring serum potassium levels, evaluating renal function, and checking arterial blood gases are not specific initial assessments for malignant hyperthermia and would not aid in its early identification.
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A patient with breast cancer is prescribed tamoxifen (Nolvadex). What important information should the nurse provide during patient education?
- A. Tamoxifen may increase the risk of venous thromboembolism, so patients should be educated about the signs and symptoms of blood clots.
- B. Tamoxifen may cause weight gain, so patients should monitor their diet.
- C. Tamoxifen may decrease the risk of osteoporosis, so patients should ensure adequate calcium intake.
- D. Tamoxifen may increase the risk of breast cancer, so regular mammograms are essential.
Correct Answer: A
Rationale: The correct answer is A. Tamoxifen increases the risk of venous thromboembolism, a serious side effect, so patients should be educated about the signs and symptoms of blood clots. This information is crucial as early recognition and prompt treatment of blood clots can prevent complications. Choices B, C, and D are incorrect because tamoxifen is not associated with causing weight gain, decreasing the risk of osteoporosis, or increasing the risk of breast cancer. Providing accurate information is essential for patient safety and understanding.
A patient is prescribed zanamivir (Relenza) to treat influenza B. The patient has a history of asthma. For which of the following symptoms should the nurse assess?
- A. Bradycardia
- B. Pneumonia
- C. Bronchospasm
- D. Pulmonary embolism
Correct Answer: C
Rationale: The correct answer is C: Bronchospasm. Zanamivir (Relenza) is an inhaled medication used to treat influenza by reducing the severity and duration of symptoms. Patients with a history of asthma are at risk of bronchospasm as a potential side effect of zanamivir. Assessing for bronchospasm is crucial in this case to ensure the patient's safety and well-being. Choices A, B, and D are incorrect. Bradycardia, pneumonia, and pulmonary embolism are not commonly associated with zanamivir use in the treatment of influenza B, especially in a patient with a history of asthma.
When the body produces antibodies against its own tissue, the condition is called:
- A. Alloimmunity
- B. Opsonization
- C. Autoimmunity
- D. Hypersensitivity
Correct Answer: C
Rationale: Autoimmunity is the correct term for a condition where the body's immune system mistakenly targets its own tissues. Alloimmunity (Choice A) refers to an immune response against foreign tissue. Opsonization (Choice B) is a process where pathogens are marked for destruction by immune cells. Hypersensitivity (Choice D) involves an exaggerated immune response against antigens.
How should the nurse respond to a 72-year-old patient diagnosed with benign prostatic hypertrophy (BPH) who is skeptical about tamsulosin (Flomax) for symptom relief?
- A. "Flomax can increase the amount of urine your kidneys produce, resulting in better urine flow."
- B. "Flomax can relax your prostate and your bladder neck, making it easier to pass urine."
- C. "Flomax makes your urine less alkaline, reducing the irritation that makes your prostate swell."
- D. "Flomax increases the strength of your bladder muscle and results in a stronger flow of urine."
Correct Answer: B
Rationale: The correct response is choice B because it explains the mechanism of action of Flomax, which helps the patient understand how the medication works. By stating that Flomax relaxes the prostate and bladder neck, making it easier to pass urine, the nurse is addressing the patient's concerns about symptom relief. Choices A, C, and D provide inaccurate information about Flomax's mechanism of action and do not directly address the patient's skepticism or concerns.
The nurse is caring for a client with an astrocytoma. The client asks, 'What do astrocytes do in the brain?' What is the nurse's best response?
- A. Astrocytes help to nourish and support neurons in the brain.
- B. Astrocytes are a type of neuron that transmit electrical signals.
- C. Astrocytes are involved in immune responses in the brain.
- D. Astrocytes help regulate blood flow in the brain.
Correct Answer: A
Rationale: Astrocytes play a crucial role in supporting and nourishing neurons by providing metabolic support, maintaining the blood-brain barrier, and regulating the chemical environment of the brain. While astrocytes are essential for brain function, they are not neurons and do not transmit electrical signals (Choice B). Astrocytes are not primarily involved in immune responses in the brain (Choice C) or in regulating blood flow in the brain (Choice D), although they indirectly influence blood flow through their support functions.