Nokea
Mrs. Zeno continues to become a weaker despite .treatment with neostigmine. Edrophonium HCL is ordered:
- A. For its synergestic effect
- B. Because of the client's resistance to
- C. To rule out cholinergic crisis Neostigmine
- D. To confirm the diagnosis of myasthenia
Correct Answer: C
Rationale: Edrophonium HCL is ordered to rule out cholinergic crisis caused by possible overdose of neostigmine. In myasthenia gravis, patients are normally given neostigmine to help improve muscle strength by prolonging the effect of acetylcholine at the neuromuscular junction. However, if too much neostigmine is given, it can lead to a cholinergic crisis characterized by excess stimulation at the neuromuscular junction. Edrophonium HCL is a fast-acting drug that can help differentiate between a myasthenic crisis (worsening of symptoms due to under-dosing of anti-cholinesterase medication like neostigmine) and a cholinergic crisis (worsening of symptoms due to over-dosing). By administering edrophonium HCL, the healthcare provider can observe the patient's response and determine if the weakness is due to under-treatment or over-treatment with
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Which screening test is a neonatal nurse likely to use to detect developmental dysplasia of the hip (DDH)?
- A. Barlow's maneuver
- B. Pavlik's maneuver
- C. Gower's maneuver
- D. Allis's maneuver
Correct Answer: B
Rationale: Neonatal nurses are likely to use Pavlik's maneuver to detect developmental dysplasia of the hip (DDH) in newborns. Pavlik's maneuver is a technique used to diagnose, treat, and manage DDH in infants. It involves positioning the infant's hips in a flexed and abducted position to help stabilize the hip joint and promote proper development. This technique is gentle and non-invasive, making it suitable for screening infants for hip dysplasia. Other maneuvers listed, such as Barlow's, Gower's, and Allis's maneuvers, are different techniques used to assess hip stability or alignment and are not specific to DDH screening in newborns.
Which of the ff nursing interventions would a nurse perform to avoid maceration from irritating drainage or the wound compresses in a client with breast abscess?
- A. Apply zinc oxide to the surrounding skin
- B. Use a binder to hold the dressing in place
- C. Support the arm and the shoulder with pillows
- D. Instruct the client not to shave the axillary hair on the side with abscess
Correct Answer: A
Rationale: Applying zinc oxide to the surrounding skin can help protect it from becoming macerated due to irritating drainage or wound compresses. Zinc oxide acts as a barrier that helps prevent moisture from affecting the skin, thus reducing the risk of maceration. It provides a protective layer and promotes healing by keeping the affected area dry and free from further irritation. It is an effective intervention to maintain skin integrity and promote optimal wound healing in clients with a breast abscess.
An adult who has gastroenteritis and is on digitalis ha lab values of: K 3.2 mEq/L, Na 136 mEq/L, Ca 8.8 mg/dl, and Cl 98 mEq/L. the nurse puts which of the following on the client's plan of care?
- A. Stop digitalis therapy
- B. Observe for trousseau's and chovestek's
- C. Avoid foods rich in potassium signs
- D. Observe for digitalis toxicity
Correct Answer: C
Rationale: The client's low potassium level (K 3.2 mEq/L) is a cause for concern, especially in a patient on digitalis therapy. Digitalis (such as digoxin) can potentiate the effects of hypokalemia, leading to an increased risk of digitalis toxicity. Therefore, in this scenario, it is important to avoid foods rich in potassium to prevent further lowering of the potassium level. It is essential to address the electrolyte imbalance promptly to prevent potential complications related to digitalis therapy.
A client with type 1 diabetes mellitus asks the nurse about taking an oral antidiabetic agent. The nurse explains that these medications are only effective if the client:
- A. prefers to take insulin orally.
- B. has type 1diabetes.
- C. has type 2 diabetes.
- D. is pregnant and has type 2 diabet
Correct Answer: C
Rationale: Oral antidiabetic agents are medications designed specifically for the management of type 2 diabetes mellitus. They work by improving insulin sensitivity, increasing insulin production, or reducing glucose production in the liver. Type 1 diabetes mellitus is characterized by an absolute deficiency of insulin production, requiring lifelong insulin therapy. Therefore, oral antidiabetic agents are not effective for individuals with type 1 diabetes like the client in this scenario.
The nurse provides care for a client with deep partial-thickness burns. What could cause a reduced hematocrit (Hct) in this client?
- A. Hypoalbuminemia with hemoconcentration
- B. Volume overload with hemodilution
- C. Metabolic acidosis
- D. Lack of erythropoeitin factor
Correct Answer: B
Rationale: A reduced hematocrit (Hct) in a client with deep partial-thickness burns can be primarily caused by volume overload with hemodilution. In patients with burns, there is an initial shift of fluid from the intravascular space to the interstitial space, leading to a decreased intravascular volume. In response to this hypovolemia, there is an increased release of antidiuretic hormone (ADH) and aldosterone, resulting in retention of water and sodium. This volume overload leads to hemodilution, where the proportion of red blood cells to plasma decreases, causing a reduction in hematocrit levels. This scenario is a common occurrence in clients with burn injuries and helps explain the reduced hematocrit in this client.