Nokea
Pulses can be graded according to certain criteria. Which is a description of a normal pulse?
- B. 1
- C. 2
- D. 3
Correct Answer: B
Rationale: In grading pulses, the normal pulse is typically designated as +1. This indicates a pulse that is easily felt, normal in strength, and corresponds to a healthy pulse rate. A +1 pulse is considered regular, not too weak or too strong, and is indicative of good cardiovascular health. Any abnormalities in pulse strength or rate would be graded differently.
You may also like to solve these questions
A patient with a history of haemophilia A arrives in the emergency department complaining of a "funny feeling" in his elbow. The patient states that he thinks he is bleeding into the joint. Which response by the nurse is correct?
- A. Palpate the patient's elbow to assess for swelling.
- B. Notify the physician immediately and expect an order for factor VIII.
- C. Prepare the patient for an x-ray examination to determine whether bleeding is occurring.
- D. Apply heat to the patient's elbow and wait for the physician to examine the patient.
Correct Answer: B
Rationale: For a patient with a history of hemophilia A complaining of a "funny feeling" in the elbow, suspecting bleeding into the joint, the correct response by the nurse is to notify the physician immediately and expect an order for factor VIII. Hemophilia A is a genetic disorder characterized by a deficiency in clotting factor VIII, leading to prolonged bleeding. In this case, immediate medical intervention in the form of factor VIII replacement therapy is crucial to control and manage the bleeding episode. Urgent treatment aims to prevent complications such as joint damage and to promote hemostasis in patients with hemophilia. Palpating the elbow, preparing for an x-ray, or applying heat are not the appropriate initial actions when managing a suspected bleeding episode in a patient with hemophilia.
A 9-mo-old infant is recently diagnosed with bilateral retinoblastoma; examination under anesthesia reveals bilateral multifocal involvement of the retina. An important next step in the management is
- A. radiotherapy of both eyes
- B. retinal examination of 1st degree relatives
- C. orbital ultrasonography
- D. bilateral enucleation
Correct Answer: B
Rationale: Retinal examination of first-degree relatives is crucial to identify hereditary forms of retinoblastoma.
A nursing intervention for anemia is:
- A. Medical therapy
- B. High protein, vitamin and iron diet
- C. Fluid therapy
- D. Chemotherapy
Correct Answer: B
Rationale: Anemia is a condition characterized by a low red blood cell count or insufficient hemoglobin levels, resulting in decreased oxygen-carrying capacity in the blood. One of the nursing interventions for anemia is to promote a high protein, vitamin, and iron diet. Iron is essential for the production of hemoglobin, which carries oxygen in the blood. Including foods rich in iron, such as lean meats, dark leafy greens, beans, and fortified cereals, can help boost iron levels in the body. Additionally, consuming foods high in vitamin C can also aid in iron absorption. Protein is crucial for overall health and plays a role in red blood cell production. By encouraging a nutrient-rich diet, nurses can help support the body's ability to replenish its red blood cell supply and improve the symptoms associated with anemia.
A preterm newborn, after spending 8 weeks in the NICU, is being discharged. The parents of the newborn express apprehension and worry that the newborn may still be in danger. How should the nurse interpret these statements?
- A. Normal
- B. A reason to postpone discharge
- C. Suggestive of maladaptation
- D. Suggestive of inadequate bonding
Correct Answer: A
Rationale: It is normal for parents of preterm newborns who have spent time in the NICU to express apprehension and worry upon discharge. The NICU experience can be stressful and overwhelming for families, and it is common for parents to feel anxious about taking their newborn home. The nurse should provide support and education to help alleviate the parents' concerns and ensure a smooth transition from the hospital to home. It is important to acknowledge the parents' feelings, offer reassurance, and reinforce the importance of follow-up care and monitoring.
Cow's milk allergy (CMA) is diagnosed in a 6-month-old infant. Which should the nurse recommend as a substitute formula?
- A. Nutramigen
- B. Goat's milk
- C. Similac
- D. Enfamil
Correct Answer: A
Rationale: Nutramigen is a hypoallergenic formula specifically designed for infants with cow's milk allergy (CMA). It is extensively hydrolyzed, which means the cow's milk proteins are broken down into smaller pieces, making it easier for babies with CMA to digest without triggering an allergic reaction. Other options such as goat's milk, Similac, and Enfamil are not suitable substitutes for an infant with CMA as they may still contain proteins that can cause an allergic response in these infants. Therefore, Nutramigen is the most appropriate recommendation for a 6-month-old infant diagnosed with cow's milk allergy.