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Mrs. Diwa has been diagnosed with systemic lupus erythematosus, the nurse upon assessment can expect to find which of the following?
- A. dysphagia
- B. dryness or itching of genitalia
- C. decreased visual acuity or blindness
- D. abnormal lung sounds
Correct Answer: D
Rationale: The correct answer is D because systemic lupus erythematosus can lead to inflammation in the lungs, causing abnormal lung sounds. Dysphagia (choice A) is not typically associated with lupus. Dryness or itching of genitalia (choice B) is more characteristic of conditions like yeast infections or dermatitis. Decreased visual acuity or blindness (choice C) is not a common manifestation of lupus. Abnormal lung sounds (choice D) are commonly seen in lupus patients due to inflammation and possible lung involvement.
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Clinical manifestations of Huntington’s disease include:
- A. Abnormal involuntary movements (chorea)
- B. Intellectual decline
- C. Emotional disturbances
- D. All of the above
Correct Answer: D
Rationale: The correct answer is D because Huntington's disease is a neurodegenerative disorder that presents with a triad of symptoms: abnormal involuntary movements (chorea), intellectual decline, and emotional disturbances. Abnormal involuntary movements are a hallmark feature, while cognitive decline and emotional disturbances are also commonly observed. Therefore, all three manifestations are typically present in individuals with Huntington's disease. Choices A, B, and C are incorrect because each of these symptoms alone does not encompass the full spectrum of clinical manifestations seen in Huntington's disease.
Which of the ff values pertaining to different clients shows the normal range of plasma pH?
- A. 7.35-7.45
- B. 8-Jul
- C. 6.35-6.45
- D. 8.35-8.45
Correct Answer: A
Rationale: The correct answer is A: 7.35-7.45. Plasma pH typically falls within this range for normal clients. A pH of 7.35-7.45 indicates a slightly alkaline to neutral environment, which is essential for various physiological processes to function optimally. Choices B, C, and D have pH values outside the normal range, indicating either acidic (B and C) or highly alkaline (D) conditions, which would be abnormal and potentially harmful to the body's functioning. Therefore, the normal range for plasma pH is crucial to maintain homeostasis and support overall health.
A patient who is being tested for HIV asks what tests are used. The nurse would correct in stating that the tests used to confirm HIV infection are which of the following?
- A. CD 4+ cell count and thymus function.
- B. ELISA and Western Blot
- C. B-cell and T-cell count.
- D. CD 4+, viral load, and ELISA
Correct Answer: B
Rationale: The correct answer is B: ELISA and Western Blot. The rationale is as follows: ELISA (enzyme-linked immunosorbent assay) and Western Blot are specific tests used to confirm HIV infection by detecting antibodies or antigens related to the virus. ELISA is the initial screening test, while Western Blot is the confirmatory test. These tests are highly sensitive and specific for HIV detection.
Choice A is incorrect because CD4+ cell count and thymus function are not tests used to confirm HIV infection. They are used to monitor disease progression and immune function in HIV-positive individuals.
Choice C is incorrect because B-cell and T-cell count are also not tests used to confirm HIV infection. They are indicators of immune system health but not specific for HIV diagnosis.
Choice D is incorrect because while CD4+ and viral load tests are used in monitoring HIV progression, ELISA is the main confirmatory test for HIV diagnosis, and viral load is not typically used for initial
Mr. Mendres asks Nurse Rose what causes peptic ulcer to develop. Nurse Rose responds that recent research indicates that peptic ulcers are the result of which of the following?
- A. genetic defect in the gastric mucosa
- B. helicobacter pylori infection
- C. high fat diet
- D. work related stress
Correct Answer: B
Rationale: The correct answer is B: helicobacter pylori infection. This bacterium is a major cause of peptic ulcers by weakening the protective mucous layer of the stomach and duodenum. Research has shown a strong association between H. pylori infection and peptic ulcer development. Genetic defects in the gastric mucosa (choice A) are not a proven cause of peptic ulcers. While a high-fat diet (choice C) can exacerbate symptoms, it is not the primary cause. Work-related stress (choice D) may exacerbate symptoms but is not a direct cause of peptic ulcers. Therefore, choice B is the most supported and logical answer based on current research findings.
The physician orders cystoscopy and random biopsies of the bladder for a client who reports painless hematuria. Test results reveal carcinoma in situ in several bladder regions. To treat bladder cancer, the client will have a series of intravesical instillations of bacillus Calmette-Guerin (BCG), administered 1 week apart. When teaching the client about BCG, the nurse should mention that this drug commonly causes:
- A. Renal calculi
- B. Delayed ejaculation
- C. Hematuria
- D. Impotence
Correct Answer: C
Rationale: The correct answer is C: Hematuria. Bacillus Calmette-Guerin (BCG) is a type of immunotherapy used to treat bladder cancer by stimulating the immune system to attack cancer cells. One common side effect of BCG instillations is hematuria, which is the presence of blood in the urine. This occurs because BCG irritates the bladder lining, leading to inflammation and bleeding. It is important for the nurse to educate the client about this potential side effect so they are aware and can report any excessive bleeding to their healthcare provider promptly.
Other choices are incorrect:
A: Renal calculi - BCG therapy is not known to cause renal calculi.
B: Delayed ejaculation - BCG therapy is not associated with delayed ejaculation.
D: Impotence - BCG therapy is not linked to impotence.