Nokea
Not realizing that its surface was hot, a woman has quickly withdrawn her hand from the surface of a bowl that she was removing from a microwave. Which phenomena has facilitated the rapid movement of her hand in response to the painful stimulus?
- A. Crossed-extensor reflex
- B. Flexor reflex
- C. Withdrawal reflex
- D. Stretch reflex
Correct Answer: C
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
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Which scenario would be an example of a child born with congenital insensitivity to pain?
- A. A child who does not cry when injured and fails to respond to painful stimuli.
- B. A child who cries excessively and has a heightened response to pain.
- C. A child who experiences pain but has difficulty expressing it.
- D. A child who is sensitive to minor stimuli but has a delayed response to severe pain.
Correct Answer: A
Rationale: The correct scenario depicting a child with congenital insensitivity to pain is when the child does not cry when injured and fails to respond to painful stimuli. This condition is characterized by the inability to feel and react to pain, resulting in a lack of typical responses such as crying or withdrawal when hurt. Choice B is incorrect as it describes a child with heightened pain sensitivity, opposite to the insensitivity seen in the condition. Choice C is incorrect as it suggests the child feels pain but struggles to communicate it, which is not the case with congenital insensitivity to pain. Choice D is incorrect as it describes a child who is sensitive to minor stimuli and has delayed responses to severe pain, which is not indicative of congenital insensitivity to pain.
A client with cystic fibrosis is admitted with a pulmonary exacerbation. Which intervention should the nurse prioritize?
- A. Administer a high-calorie, high-protein diet.
- B. Initiate airway clearance techniques.
- C. Encourage the client to maintain an active lifestyle.
- D. Monitor for signs of respiratory distress.
Correct Answer: B
Rationale: During a pulmonary exacerbation in cystic fibrosis, the priority intervention is to initiate airway clearance techniques. These techniques help clear mucus from the airways, improving ventilation and reducing the risk of respiratory complications. Administering a high-calorie, high-protein diet is beneficial for overall nutrition but is not the priority during an exacerbation. Encouraging an active lifestyle is important for long-term health but does not address the immediate need for managing exacerbations. Monitoring for signs of respiratory distress is important, but initiating airway clearance techniques takes precedence in the management of pulmonary exacerbations in cystic fibrosis.
A hospital client is at a high risk of developing bacterial endocarditis. Which of the following prophylactic measures is likely to be most effective?
- A. Avoiding exposure to individuals known to carry the streptococcus bacterium
- B. Daily administration of low-dose corticosteroids
- C. Prophylactic antimicrobial therapy before any invasive procedure
- D. Routine vaccinations against meningococcal and pneumococcal infections
Correct Answer: C
Rationale: Prophylactic antimicrobial therapy before any invasive procedure is the most effective measure in preventing bacterial endocarditis in at-risk individuals. This measure helps to reduce the risk of bacterial infection during invasive procedures, which can lead to endocarditis. Choice A is incorrect as avoiding exposure to individuals with streptococcus does not address the primary preventive measure needed. Choice B is incorrect as corticosteroids do not prevent bacterial endocarditis, and daily administration is not the recommended prophylactic measure. Choice D is incorrect as routine vaccinations against meningococcal and pneumococcal infections are important for other conditions but not specifically for preventing bacterial endocarditis.
A patient is being treated with amphotericin B. Which of the following statements indicates that the patient has understood the patient teaching?
- A. "The medication may cause diabetes."
- B. "The medication will cause liver necrosis."
- C. "The medication may cause kidney damage."
- D. "The medication will cause pancreatitis."
Correct Answer: C
Rationale: The correct answer is C: 'The medication may cause kidney damage.' Amphotericin B is known for its potential to cause nephrotoxicity, which can manifest as kidney damage. It is crucial for the patient to be aware of this possible adverse effect. Choices A, B, and D are incorrect because amphotericin B is not typically associated with causing diabetes, liver necrosis, or pancreatitis. Therefore, these statements do not reflect an accurate understanding of the medication's side effects.
A patient is taking alendronate (Fosamax) for the treatment of osteoporosis. What instructions should the nurse provide to ensure the effectiveness of the medication?
- A. Take the medication with food to avoid gastrointestinal upset.
- B. Take the medication in the morning with a full glass of water and remain upright for at least 30 minutes.
- C. Take the medication before bed to ensure absorption during sleep.
- D. Take the medication with milk to enhance calcium absorption.
Correct Answer: B
Rationale: The correct answer is B. Alendronate should be taken in the morning with a full glass of water and the patient should remain upright for at least 30 minutes. This is important to prevent esophageal irritation and ensure proper absorption of the medication. Choice A is incorrect because alendronate should not be taken with food as it can decrease its absorption. Choice C is incorrect as taking the medication before bed increases the risk of esophageal irritation and reduces absorption due to lying down. Choice D is also incorrect because taking alendronate with milk or other calcium-rich foods can decrease its absorption.