Nokea
In children diagnosed with sickle cell disease (SCD), tissue damage results from which of the following?
- A. Air hunger and respiratory alkalosis due to deoxygenated red blood cells.
- B. Hypersensitivity of the central nervous system (CNS) due to elevated serum bilirubin levels
- C. A general inflammatory response due to an autoimmune reaction from hypoxia
- D. Local tissue damage with ischemia and necrosis due to obstructed circulation
Correct Answer: D
Rationale: In children diagnosed with sickle cell disease (SCD), tissue damage results from local tissue damage with ischemia and necrosis due to obstructed circulation. Sickle cell disease is a genetic disorder characterized by abnormal hemoglobin that causes red blood cells to assume a sickle shape. These sickle-shaped cells can adhere to blood vessel walls, leading to vaso-occlusion and impaired blood flow. This obstruction results in tissue ischemia and eventual necrosis, causing significant pain and organ damage. The chronic vaso-occlusive events in SCD are responsible for the development of acute and chronic complications seen in affected individuals, such as painful crises, stroke, and organ damage.
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A worried mother of a 4-year-old boy describes attacks of inconsolable crying and prefers to play alone. The MOST appropriate action is
- A. reassures her that this is a normal phenomenon
- B. seek more history regarding other skills and developmental domains
- C. refer her to pediatric psychiatry
- D. investigate social issues of the family
Correct Answer: B
Rationale: Further history is needed to rule out behavioral or psychological issues.
The nurse is aware that multiple sclerosis is a progressive disease of the central nervous system characterized by:
- A. Axon degeneration
- B. Sclerosed patches of nervous system
- C. Demyelination of the brain and spinal cord
- D. All of the above
Correct Answer: D
Rationale: Multiple sclerosis (MS) is a progressive disease of the central nervous system characterized by all the given options: axon degeneration, sclerosed patches of the nervous system, and demyelination of the brain and spinal cord. Axon degeneration occurs due to the damage caused by the immune system attacking the myelin sheath. Sclerosed patches of the nervous system result from the formation of scar tissue in the central nervous system. Demyelination is the hallmark feature of MS, where the protective covering of nerve fibers (myelin) is damaged, leading to disrupted communication between the brain and the rest of the body. Collectively, these characteristics contribute to the clinical manifestations and progression of multiple sclerosis.
The LPN is caring for a patient in the preoperative period who, even after verbalizing concerns and having questions answered, states, "I know I am not going to wake up after surgery." Which of the following actions should the nurse take?
- A. Reassure patient everything will be all right
- B. Explain national surgery death rate
- C. Inform the registered nurse
- D. Ask family to comfort the patient
Correct Answer: C
Rationale: The correct action for the LPN to take in this situation is to inform the registered nurse. The patient's statement indicates a high level of fear and anxiety about the surgery and their potential outcome. It is important to involve the registered nurse, who can provide further assessment, support, and interventions to address the patient's concerns appropriately. Simply reassuring the patient or providing statistics about national surgery death rates may not address the underlying fear and may require additional support and intervention. Asking the family to comfort the patient may not be the most appropriate immediate action as the patient's concerns are specific and may require professional support. Bringing the registered nurse into the situation allows for a comprehensive approach to addressing the patient's emotional needs before the surgery.
A patient admitted with gastrointestinal tract bleeding has a hemoglobin level of 6 g/dL. She asks the nurse why she feels SOB. Which response is best?
- A. "Anemia prevents your lungs from absorbing oxygen effectively."
- B. "You do not have enough hemoglobin to carry oxygen to your tissues."
- C. ""You don't have enough blood to feed your cells."
- D. "You have lost a lot of blood, and that has damaged your lungs."
Correct Answer: B
Rationale: The best response is option B, "You do not have enough hemoglobin to carry oxygen to your tissues." Hemoglobin is the protein in red blood cells that carries oxygen from the lungs to the tissues throughout the body. With a low hemoglobin level of 6 g/dL due to gastrointestinal tract bleeding, there is a reduced capacity to carry oxygen to the body's tissues. This decreased oxygen-carrying capacity leads to symptoms of shortness of breath (SOB) because the body's cells are not receiving an adequate supply of oxygen. It is important to provide a clear and accurate explanation to the patient about the relationship between hemoglobin, oxygen transport, and symptoms of anemia like shortness of breath.
Neuroblastoma can be associated with paraneoplastic syndromes. All the following features are paraneoplastic EXCEPT
- A. uncontrollable jerking movements
- B. cerebellar ataxia and increased body coordination
- C. unilateral ptosis, myosis, and anhidrosis
- D. profound secretory diarrhea
Correct Answer: B
Rationale: Increased body coordination is not a typical feature of neuroblastoma-associated paraneoplastic syndromes.