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Mr. Reyes is extremely confused. The nurse provide new information slowly and in small amounts because;
- A. Confusion or delirium can be a defense against further stress
- B. Destruction of brain cells has occurred, interrupting mental activity
- C. Teaching based on information progressing from the simple to the complex
- D. A minimum of information should be given, since he is unaware of surrounding
Correct Answer: A
Rationale: Providing new information slowly and in small amounts to a confused individual, like Mr. Reyes, is important because confusion or delirium can be a defense mechanism against further stress. By giving information gradually, it allows the individual to better absorb and process the information without becoming overwhelmed, which can further exacerbate their confusion. This approach also helps reduce the risk of causing additional stress or agitation in the individual, thus promoting a more conducive environment for cognitive processing and understanding.
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You are discussing physical child abuse with medical students; you state that fractures are common presentation and those that should raise suspicion for abuse include fractures that are unexplained, occurring in young, non-ambulatory children, or involve multiple bones. Of the following, the site of the fracture that is LESS specific for abuse is
- A. rib
- B. scapula
- C. skull
- D. vertebra
Correct Answer: D
Rationale: Fractures of the vertebrae are less specific for abuse compared to other sites like ribs, scapula, or skull, which are more characteristic of inflicted trauma.
About 500 children have just been exposed to radiation from a nuclear power plant accident. The most appropriate first step in your treatment of these children should be to
- A. prescribe potassium iodide to protect the thyroid
- B. order thyroid function tests
- C. order complete blood counts (CBCs)
- D. do nothing acutely; evaluate in 4-6 weeks
Correct Answer: A
Rationale: Potassium iodide can protect the thyroid from radioactive iodine exposure, which is a critical first step in radiation exposure.
The parent of a 3-year-old with suspected Wilms tumor says, 'How could I have missed a lump this big?' Which is the best response?
- A. Don't be hard on yourself; it's easy to miss something growing slowly.
- B. I understand you're upset; earlier detection might have improved prognosis.
- C. It takes a trained professional to notice such a lump.
- D. This tumor grows rapidly and may not have been noticeable just a few days ago.
Correct Answer: D
Rationale: Wilms tumor can grow very quickly, so a lump that was not evident previously may become noticeable in a short period.
The nurse is conducting teaching for an adolescent being discharged to home after a renal transplant. The adolescent needs further teaching if which statement is made?
- A. "I will report any fever to my primary health care provider."
- B. "I am glad I only have to take the immunosuppressant medication for two weeks."
- C. "I will observe my incision for any redness or swelling."
- D. "I won't miss doing kidney dialysis every week."
Correct Answer: B
Rationale: The statement "I am glad I only have to take the immunosuppressant medication for two weeks" indicates a misunderstanding about the long-term nature of immunosuppressant therapy following a renal transplant. In reality, individuals who undergo a renal transplant need to take immunosuppressant medications for the rest of their lives to prevent rejection of the donor kidney. Failure to adhere to this medication regimen can result in rejection of the transplanted kidney. Therefore, this statement indicates a need for further teaching to ensure the adolescent understands the importance of lifelong immunosuppressant therapy.
The patient is having difficulty coping with her new diagnosis of lymphoma. Which response by the nurse is most helpful?
- A. "Don't worry. You'll be okay."
- B. "The treatments you are receiving will make you feel better very soon."
- C. "Who do you usually go to when you have a problem?"
- D. "Have you made end-of-life decisions?"
Correct Answer: C
Rationale: Option C, "Who do you usually go to when you have a problem?" is the most helpful response by the nurse in this situation. This response allows the patient to identify her support system and opens up a conversation about coping mechanisms and sources of emotional support. It helps the nurse understand who the patient leans on during difficult times and enables the nurse to involve these individuals in providing support and encouragement to the patient as she copes with her new diagnosis of lymphoma. By exploring the patient's typical sources of support, the nurse can assist in strengthening her coping mechanisms and emotional well-being during this challenging time.