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Renal failure is the second cause of death in patients with diabetes mellitus. Question: What is the end (histological) stage in the development of diabetic nephropathy?
- A. Arteriolar hyalinosis
- B. GBM thickening
- C. Kimmerstiel Wilson lesions
- D. Mesangial matrix expansion
Correct Answer: C
Rationale: Diabetic nephropathy's end Kimmerstiel Wilson nodules scar kidneys, past thickening or expansion. Nurses dread this, a chronic renal doom mark.
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A 60-year-old patient with a diagnosis of prostate cancer is scheduled to have an interstitial implant for high-dose radiation (HDR). What safety measure should the nurse include in this patient's subsequent plan of care?
- A. Limit the time that visitors spend at the patient's bedside
- B. Teach the patient to perform all aspects of basic care independently
- C. Assign male nurses to the patient's care whenever possible
- D. Situate the patient in a shared room with other patients receiving brachytherapy
Correct Answer: A
Rationale: HDR implants (brachytherapy) emit radiation limiting visitor time (e.g., 30 min) cuts exposure risk. Self-care's nice but not safety-driven. Gender's irrelevant pregnant staff avoid, not males. Shared rooms up exposure, not safety. Nurses in oncology enforce this, shielding others while the source's active, a radiation rule of thumb.
Early Goal Directed Therapy in severe sepsis and septic shock (Rivers et al) does NOT recommend:
- A. hydrocortisone 100 mg QID
- B. maintaining mixed venous oxygen saturation measurement >70%
- C. maintaining CVP between 8-12 mmHg
- D. using inotropes to keep MAP >65 mmHg<90 mmHg
Correct Answer: A
Rationale: Rivers' sepsis hydrocortisone's out, SvO2, CVP, MAP, dobutamine hold. Nurses skip this chronic steroid sidestep.
A patient has been assigned the nursing diagnosis of imbalanced nutrition: less than body requirements related to painful oral ulcers. Which nursing action will be most effective in improving oral intake?
- A. Offer the patient frequent small snacks between meals.
- B. Assist the patient to choose favorite foods from the menu.
- C. Provide teaching about the importance of nutritional intake.
- D. Apply prescribed anesthetic gel to oral lesions before meals.
Correct Answer: D
Rationale: Painful oral ulcers from cancer or chemo kill appetite anesthetic gel (e.g., lidocaine) numbs them pre-meal, making eating bearable. Snacks and favorites tempt but don't dull pain. Teaching informs, not fixes. Nurses in oncology prioritize this pain relief drives intake, tackling the root of this nutrition nosedive.
During the teaching session for a patient who has a new diagnosis of acute leukemia, the patient is restless and looks away without making eye contact. The patient asks the nurse to repeat the information about the complications associated with chemotherapy. Based on this assessment, which nursing diagnosis is appropriate for the patient?
- A. Risk for ineffective adherence to treatment related to denial of need for chemotherapy
- B. Acute confusion related to infiltration of leukemia cells into the central nervous system
- C. Deficient knowledge: chemotherapy related to a lack of interest in learning about treatment
- D. Risk for ineffective health maintenance related to possible anxiety about leukemia diagnosis
Correct Answer: D
Rationale: New leukemia diagnosis plus restlessness and repeat requests scream anxiety risk for ineffective health maintenance' fits, as it ties to coping, not denial , brain infiltration , or disinterest . Nurses in oncology spot this fear fogs learning, needing slower, calmer teaching to stick.
The nurse is caring for a 4-year-old child following surgical removal of a stage I neuroblastoma. Which of the following interventions will be most appropriate for this child?
- A. Applying aloe vera lotion to irradiated areas of skin
- B. Administering antiemetics as prescribed for nausea
- C. Giving medications as ordered via least invasive route
- D. Maintaining isolation as prescribed to avoid infection
Correct Answer: C
Rationale: Post-surgical care for a stage I neuroblastoma (localized, surgically resected) focuses on recovery with minimal invasiveness, making giving medications via the least invasive route preferably oral most appropriate for a 4-year-old. This reduces trauma, anticipates needs like pain relief, antiemetics, or steroids (e.g., dexamethasone for swelling), and suits a stable post-op child without chemotherapy or radiation yet, as stage I often requires surgery alone. Aloe vera implies radiation, not indicated here post-surgery. Antiemetics are useful but too narrow broader medication needs apply. Isolation isn't standard for stage I post-op unless immunosuppression emerges later. This intervention balances efficacy and comfort, aligning with pediatric nursing's goal to minimize distress while ensuring effective postoperative management.