Nokea
For a patient with gastroesophageal reflux symptoms, the purpose of esophageal pH monitoring is to evaluate for:
- A. esophagitis from the reflux.
- B. frequency of the reflux.
- C. gastric emptying delays.
- D. possible obstructions.
Correct Answer: B
Rationale: Esophageal pH monitoring measures the frequency and duration of acid exposure in the esophagus, helping diagnose GERD.
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Primary amenorrhea should be considered for any female adolescent who has not reached menarche by
- A. 13 years or has not done so within 3 years of thelarche
- B. 14 years or has not done so within 2 years of thelarche
- C. 14 years or has not done so within 3 years of thelarche
- D. 15 years or has not done so within 3 years of thelarche
Correct Answer: D
Rationale: Primary amenorrhea is suspected if menarche has not occurred by age 15 or within 3 years of thelarche.
For a client newly diagnosed with radiation-induced thrombocytopenia, the nurse should include which intervention in the plan of care?
- A. Administering aspirin if the temperature exceeds 102â—‹1 F (38.8â—‹0 C)
- B. inspecting the skin for petechiae once every shift
- C. providing for frequent rest periods
- D. Placing the client in strict isolation
Correct Answer: C
Rationale: Providing for frequent rest periods is the most appropriate intervention for a client newly diagnosed with radiation-induced thrombocytopenia. Thrombocytopenia is characterized by a decreased number of platelets, which are essential for blood clotting. Clients with thrombocytopenia are at an increased risk for bleeding and bruising. Therefore, it is important to prevent activities that may lead to injury or bleeding. Providing frequent rest periods allows the client to conserve energy and minimize the risk of trauma that could lead to bleeding complications. This intervention helps manage the symptoms associated with thrombocytopenia and promotes the client's safety and well-being.
A 1-year-old child develops right eye ptosis, miosis, and loss of sweating; you suspect neuroblastoma. The MOST valuable investigation to confirm the diagnosis is
- A. CT scan of the neck and chest
- B. CT scan of the abdomen
- C. CT scan of the brain
- D. magnetic resonance imaging (MRI) of the brain
Correct Answer: A
Rationale: CT scan of the neck and chest can help identify a primary neuroblastoma mass in the adrenal gland or sympathetic chain.
A male client is prescribed medications that depress thrombocytes. The nurse should monitor for which of the ff signs and symptoms in the client?
- A. Sore throat and swollen glands
- B. Pernicious anemia with weakness
- C. Bleeding gums and dark tarry tools
- D. Thickening of blood and bruising
Correct Answer: C
Rationale: Thrombocytes, also known as platelets, play a crucial role in blood clotting. Medications that depress thrombocytes can lead to decreased clotting ability and an increased risk of bleeding. Therefore, monitoring for signs and symptoms of bleeding is essential. Bleeding gums and dark tarry stools are indicative of bleeding in the oral cavity and gastrointestinal tract, respectively, and are key indicators to watch for in a client taking medications that depress thrombocytes. Options A, B, and D are not directly related to the impact of thrombocyte depression on clotting function.
Newborns are highly susceptible to infection as a result of:
- A. excessive levels of immunoglobulin A (IgA) and immunoglobulin M (IgM).
- B. diminished nonspecific and specific immunity.
- C. increased humoral immunity.
- D. overwhelming anti-inflammatory response.
Correct Answer: B
Rationale: Newborns are highly susceptible to infection due to their diminished nonspecific and specific immunity. Nonspecific immunity includes physical barriers such as intact skin and mucous membranes, as well as components of the innate immune system like phagocytes and complement proteins. Specific immunity refers to the adaptive immune response involving B and T cells. In newborns, both these arms of the immune system are not fully developed or mature, leading to increased susceptibility to infections. Additionally, newborns have lower levels of immunoglobulins like IgA and IgM compared to adults, further contributing to their vulnerability to infections.