Nokea
How can the nurse assist the patient and family in coping with the long-term effects of a stroke?
- A. Informing family members that the patient will need assistance with almost all ADLs
- B. Explaining that the patient's prestroke behavior will return as improvement progresses
- C. Encouraging the patient and family members to seek assistance from family therapy or stroke support groups
- D. Helping the patient and family to understand the significance of residual stroke damage to promote problem solving and planning
Correct Answer: C
Rationale: Support groups and understanding residual damage aid in long-term adaptation to stroke effects
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Immediately after an action potential is propagated, which one of the following ions rapidly diffuses out of the cell into the tissue fluid:
- A. sodium
- B. chloride
- C. calcium
- D. potassium
Correct Answer: D
Rationale: After an action potential, potassium ions rapidly diffuse out of the cell to restore the resting membrane potential. Sodium ions enter the cell during depolarization, while chloride, calcium, and magnesium ions play different roles in cellular processes. Thus, D is the correct answer.
Acetylcholine is a neurotransmitter that provides for communication between muscles and nerves. When there is a problem with the interaction between acetylcholine and the acetylcholine receptor sites on the muscles, which condition(s) can occur?
- A. Myasthenia gravis
- B. Botulism
- C. Multiple sclerosis
- D. A and B
Correct Answer: D
Rationale: Myasthenia gravis and botulism are conditions that result from impaired acetylcholine function. Myasthenia gravis is an autoimmune disorder that blocks acetylcholine receptors, while botulism prevents acetylcholine release. Multiple sclerosis affects the myelin sheath, not acetylcholine. Understanding these conditions highlights the importance of acetylcholine in neuromuscular communication.
Which finding should the nursing assistant report immediately for a patient with a fractured fibula receiving skeletal traction?
- A. The patient wants to change position in bed.
- B. There is redness around the pin sites.
- C. The patient asks for a glass of water.
- D. The patient mentions feeling hungry.
Correct Answer: B
Rationale: Redness around pin sites could indicate infection or poor circulation.
A patient is brought to the emergency department with an injured lower left leg following a fall while rock climbing. The nurse identifies the presence of a fracture based on what cardinal sign of fracture?
- A. Muscle spasms
- B. Obvious deformity
- C. Edema and swelling
- D. Pain and tenderness
Correct Answer: B
Rationale: Obvious deformity is a clear indicator of a fracture.
The following occur in response to a major surgery:
- A. increased potassium loss
- B. increased protein breakdown
- C. sodium and water retention
- D. all above
Correct Answer: D
Rationale: Major surgery triggers a stress response, leading to potassium loss, protein catabolism, and sodium/water retention due to hormonal changes.