Nokea
In children with asthma, which of the following preoperative preparations is LEAST likely to be necessary?
- A. Increase in beta-agonist dosage
- B. Addition of systemic steroids
- C. Bronchodilator therapy
- D. None of the above
Correct Answer: D
Rationale: In stable asthmatic patients, additional interventions like systemic steroids or increased beta-agonist doses are not always necessary unless there are signs of exacerbation.
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A nurse is preparing to accompany a medical mission's team to a third world country. Marasmus is seen frequently in children 6 months to 2 years in this country. Which symptoms should the nurse expect for this condition?
- A. Loose, wrinkled skin
- B. Edematous skin
- C. Depigmentation of the skin
- D. Dermatoses
Correct Answer: A
Rationale: Marasmus is a form of severe malnutrition characterized by a significant deficiency in calories and protein intake. Symptoms of marasmus include severe wasting of muscle and fat stores, giving the appearance of loose, wrinkled skin due to the loss of subcutaneous fat. Other symptoms may include lethargy, irritability, delayed growth and development, and weakened immune function. Edematous skin is more commonly associated with kwashiorkor, another form of severe malnutrition characterized by protein deficiency with adequate caloric intake. Depigmentation of the skin and dermatoses are not typical symptoms of marasmus.
The nurse is caring for a child with persistent hypoxia secondary to a cardiac defect. The nurse recognizes that a risk exists of cerebrovascular accidents (strokes). Which is an important objective to decrease this risk?
- A. Minimize seizures
- B. Prevent dehydration
- C. Promote cardiac output
- D. Reduce energy expenditure
Correct Answer: C
Rationale: In a child with persistent hypoxia secondary to a cardiac defect, promoting cardiac output is crucial to decreasing the risk of cerebrovascular accidents (strokes). Hypoxia resulting from the cardiac defect can lead to inadequate oxygen supply to the brain, increasing the risk of strokes. By optimizing cardiac output, the body can deliver sufficient oxygen to vital organs, including the brain, reducing the likelihood of cerebrovascular accidents. It is essential to focus on supporting cardiac function to improve overall perfusion and oxygenation levels, ultimately helping to mitigate the risk of strokes in this vulnerable population.
A febrile patient's fluid output is in excess of normal because of diaphoresis. The nurse should plan fluid replacement based on the knowledge that insensible losses in an afebrile person are normally not greater than:
- A. 300ml/24hr
- B. 900ml/24hr
- C. 600ml/24hr
- D. 1200ml/24hr
Correct Answer: C
Rationale: Insensible losses are the fluid losses that occur without the individual being aware of it, such as through breathing, sweating, and through the skin. In an afebrile person, insensible losses are normally around 600ml per 24 hours. This amount can vary depending on factors such as temperature, humidity, and individual metabolism. When a patient is febrile and experiencing diaphoresis (excessive sweating), the fluid output can increase significantly due to the body's attempts to cool itself down. It is important for the nurse to consider these increased fluid losses when planning fluid replacement for a febrile patient to prevent dehydration.
While bathing an 82 y.o. man hospitalized with pneumonia, a nurse notes an ulcerated area on his penis. What action should the nurse take first?
- A. Report the ulcer to the admitting care provider.
- B. Teach the man about STD prevention.
- C. Ask the man if he has a history of syphilis.
- D. Clean the ulcer; reporting is not necessary because an STD is unlikely in a man this age.
Correct Answer: A
Rationale: The nurse should report the ulcer to the admitting care provider as the first action. An ulcerated area on the penis in an older adult may be indicative of various serious conditions, such as sexually transmitted infections (STIs) or skin breakdown. It is important for the healthcare provider to assess the ulcer, determine the cause, and initiate appropriate treatment. Reporting the finding promptly ensures timely intervention and appropriate management of the patient's condition. This initial action takes priority over teaching about STD prevention or inquiring about the patient's history of syphilis. Cleaning the ulcer without proper assessment and diagnosis by a healthcare provider can potentially worsen the patient's condition.
which of the following must be present in order for an infant with complete transposition of the great vessels to survive at birth?
- A. coarctation of aorta
- B. pulmonary stenosis
- C. patent ductus arteriosus
- D. mitral stenosis
Correct Answer: C
Rationale: In an infant with complete transposition of the great vessels, the survival at birth depends on the presence of a patent ductus arteriosus (PDA) to allow mixing of oxygenated and deoxygenated blood. In this condition, the aorta arises from the right ventricle and the pulmonary artery arises from the left ventricle, leading to separate circulatory pathways for oxygenated and deoxygenated blood. The survival of the infant is dependent on the remaining fetal shunts, such as a PDA, to maintain an adequate mixing of blood until corrective surgery can be performed. Therefore, the presence of a PDA is essential for the survival of an infant with complete transposition of the great vessels at birth.