Nursing assessment for a patient with metabolic alkalosis includes evaluation of laboratory data for all of the following except:
- A. Hypocalcemia
- B. Hypokalemia
- C. Hypoglycemia
- D. Hypoxemia
Correct Answer: C
Rationale: Nursing assessment for a patient with metabolic alkalosis includes evaluation of laboratory data for hypocalcemia, hypokalemia, and hypoxemia as these are commonly associated with this acid-base imbalance. Hypoglycemia, on the other hand, is not typically linked with metabolic alkalosis and is not commonly assessed in this context. Therefore, hypoglycemia would not be a key focus of nursing assessment in a patient with metabolic alkalosis.
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A child has a postoperative appendectomy incision covered by a dressing. The nurse has just completed a prescribed dressing change for this child. Which description is an accurate documentation of this procedure?
- A. Dressing change to appendectomy incision completed, child tolerated procedure well, parent present
- B. No complications noted during dressing change to appendectomy incision
- C. Appendectomy incision non-reddened, sutures intact, no drainage noted on old dressing, new dressing applied, procedure tolerated well by child
- D. No changes to appendectomy incisional area, dressing changed, child complained of pain during procedure, new dressing clean, dry and intact
Correct Answer: C
Rationale: Option C provides a thorough and accurate documentation of the dressing change procedure for the postoperative appendectomy incision. This documentation includes essential details such as the condition of the incision site (non-reddened, sutures intact, no drainage noted on old dressing), the action taken (new dressing applied), and the outcome (procedure tolerated well by the child). It covers all the necessary aspects of the dressing change procedure and clearly indicates the status of the incision site before and after the intervention. Options A, B, and D do not provide as comprehensive and detailed information about the dressing change procedure and its outcomes, making option C the most appropriate choice for accurate documentation.
A worried mother of a 4-year-old boy describes attacks of inconsolable crying and prefers to play alone. The MOST appropriate action is
- A. reassures her that this is a normal phenomenon
- B. seek more history regarding other skills and developmental domains
- C. refer her to pediatric psychiatry
- D. investigate social issues of the family
Correct Answer: B
Rationale: Further history is needed to rule out behavioral or psychological issues.
All the following are true about infant sleep between 2-6 months EXCEPT
- A. total sleep hours are about 14-16 hr/24 hr
- B. sleeps about 9-10 hr concentrated at night
- C. sleeps 2 naps/day
- D. the sleep cycle time is similar to that of adults
Correct Answer: D
Rationale: Infant sleep cycles differ significantly from adult patterns.
For children receiving steroid therapy, which of the following regimens is most appropriate for perioperative management?
- A. Prednisone 1 mg/kg given 24 and 12 hours before surgery
- B. Dexamethasone 0.6 mg/kg IV given 24 and 12 hours before surgery
- C. Hydrocortisone 5 mg/kg IV given 24 and 12 hours before surgery
- D. Methylprednisolone 10 mg/kg IV given 24 and 12 hours before surgery
Correct Answer: C
Rationale: Hydrocortisone is commonly used for perioperative steroid coverage due to its mineralocorticoid and glucocorticoid effects.
During a routine checkup, the nurse assesses a client with acquired immunodeficiency syndrome (AIDS) for signs and symptoms of cancer. What is the common AIDS-related cancer?
- A. Squamous cell carcinoma
- B. Leukemia
- C. Multiple myeloma
- D. Kaposi's sarcoma
Correct Answer: D
Rationale: Kaposi's sarcoma is the most common AIDS-related cancer. It is a type of cancer that usually appears as lesions on the skin, mouth, or internal organs. Kaposi's sarcoma is caused by human herpesvirus 8 (HHV-8) and is more likely to develop in individuals with weakened immune systems, such as those with AIDS. The risk of developing Kaposi's sarcoma is higher in people with HIV/AIDS due to the weakened immune system's inability to fight off infections and certain cancers. Regular assessment for signs and symptoms of Kaposi's sarcoma is important in people living with AIDS in order to detect and treat it early.