Nokea
Elderly persons with pernicious anemia should be instructed:
- A. to increase their dietary intake of foods high in B12.
- B. that they do not need to return for follow-up for at least a month after initiation of treatment.
- C. that oral B12 is safer and less expensive than parenteral replacement.
- D. that diarrhea can be a transient side effect of B12 injections.
Correct Answer: D
Rationale: Pernicious anemia is a megaloblastic, macrocytic, normochronic anemia caused by a deficiency of the intrinsic factor produced by the stomach. This results in malabsorption of vitamin B12, which is necessary for DNA synthesis and maturation of RBC. Education should include side effects of Vitamin B12, which can include pain and burning at the injection site, peripheral vascular thrombosis, and transient diarrhea.
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Two staff nurses were considered for promotion to head nurse. The promotion is announced via a memo on the unit bulletin board. The nurse who was not promoted tells a friend, 'Oh, well, I really didn't want the job anyway.' This is an example of:
- A. rationalization.
- B. denial.
- C. projection.
- D. compensation.
Correct Answer: A
Rationale: This is called the sour grapes form of rationalization. Rationalization is an unconscious form of self-deception in which excuses are made.
The nurse should make which of the following responses when questioned by a client about the role of leptin in the body?
- A. It increases food intake in clients, thereby promoting obesity.
- B. It assists in the regulation of steroids.
- C. It increases the total fat mass of people who are obese.
- D. It might decrease the total fat mass in the bodies of people who are obese.
Correct Answer: D
Rationale: Leptin (recessive obesity gene-protein hormone) is expressed in fat cell coding for the protein that reacts to the percentage of fat cells in the body. Leptin is associated with increased energy expenditure and decreased food intake via hypothalamic control. Obese clients might have insensitivity or resistance to the effects of leptin. Leptin can affect other body hormones such as insulin. Genetic factors include leptin, uncoupling proteins, and the amount of brown/white fat in the body.
Neural tube defects in the fetus have been primarily associated with which deficiency in the mother?
- A. iron
- B. folic acid
- C. vitamin B12
- D. vitamin E
Correct Answer: B
Rationale: Folic acid is essential for the development of the neural tube and might prevent the defect or failure of the tube to close (congenital anomalies).
An 8-year-old Asian child is being examined during a school screening. The nurse notices small bruises on the anterior and posterior ribs. The nurse should ask the child:
- A. If the family practices coining
- B. Who hit him
- C. If the child has fallen
- D. How long the abuse has been occurring
Correct Answer: A
Rationale: Coining, a cultural practice in some Asian communities, can cause bruising and should be assessed to differentiate from abuse. Other options assume abuse prematurely.
With a breech presentation, the nurse must be particularly alert for which of the following?
- A. quickening
- B. ophthalmia neonatorum
- C. pica
- D. prolapsed umbilical cord
Correct Answer: D
Rationale: Prolapsed umbilical cord is the descent of the umbilical cord into the vagina before the fetal presenting part and compression of the cord between the presenting part and the maternal pelvis, compromising or completely cutting off fetoplacental perfusion. This is an emergency situation; immediate delivery should be attempted to save the fetus.