Nokea
The client is suspected of having myasthenia gravis. Edrophonium (Tensilon) 2 mg is administered intravenously to determine the diagnosis. Which of the following indicates that the client has myasthenia gravis?
- A. Joint pain following administration of the medication
- B. Feelings of faintness, dizziness, hypotension, and signs of flushing in the client
- C. A decrease in muscle strength within 30 to 60 seconds following administration of the medication.
- D. An increase in muscle strength within 30 to 60 seconds following administration of the medication
Correct Answer: D
Rationale: Edrophonium (Tensilon) is a short-acting cholinesterase inhibitor used in the Tensilon test to aid in the diagnosis of myasthenia gravis. In patients with myasthenia gravis, there is a deficiency of acetylcholine at the neuromuscular junction, leading to muscle weakness. By inhibiting the breakdown of acetylcholine, edrophonium temporarily increases the availability of acetylcholine at the neuromuscular junction.
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Patient S is a sexually active adolescent; which of the following instructions would be included in the preventive teaching plan about urinary tract infections?
- A. Drinking acidic juices
- B. Avoiding urinating before intercourse
- C. Wearing nylon underwear
- D. Wiping back to front
Correct Answer: A
Rationale: Drinking acidic juices, such as cranberry juice, can help make the urine more acidic, which can potentially prevent bacteria from sticking to the urinary tract walls and reduce the risk of urinary tract infections. It is important to note that while acidic juices can be beneficial in some cases, they should not be relied upon as the sole preventive measure for UTIs. Other important preventive measures include staying hydrated, practicing good hygiene, and urinating before and after intercourse.
A 10-mo-old boy has a left suprarenal mass. Surgery is accomplished with complete removal of the mass as well as the non-adherent lymph nodes; surgical biopsies are taken during surgery. The histology reveals poorly differentiated neuroblastoma with microscopic ipsilateral lymph nodes involvement. The contralateral lymph nodes are negative. Of the following, the BEST therapeutic approach for this infant is
- A. chemotherapy
- B. radiotherapy
- C. concomitant chemo-radiotherapy
- D. chemotherapy followed by radiotherapy
Correct Answer: A
Rationale: Complete resection with microscopic residual disease typically warrants adjuvant chemotherapy.
Which type of leukemia has been MOST likely developed in a 2-year-old child with Down syndrome in the neonatal period?
- A. ALL
- B. CML
- C. AML M1
- D. AML M6
Correct Answer: D
Rationale: Transient myeloproliferative disorder in neonates with Down syndrome can evolve into AML M6.
A 36-year-old man is scheduled for a unilateral orchiectomy for treatment of testicular cancer. He is withdrawn and does not interact with the nurse. Which action is most appropriate?
- A. Identify the problem with a nursing diagnosis of impaired communication related to the diagnosis of cancer
- B. Set a patient outcome that the patient will verbalize his concerns about his diagnosis
- C. Ask the patient whether he is worried about future sexual functioning
- D. Say, "You seem quiet. Are you feeling concerned about your diagnosis or treatment?"
Correct Answer: D
Rationale: Option D is the most appropriate action in this scenario because it demonstrates empathy and opens the door for the patient to express his concerns. By acknowledging the patient's withdrawn behavior and directly inquiring about his feelings regarding the diagnosis or treatment, the nurse creates an opportunity for the patient to share his thoughts and concerns. This open-ended question allows the patient to express himself without any assumptions or judgments. It shows that the nurse is attentive, supportive, and willing to listen to the patient's emotional needs during this challenging time.
Mrs. Baker was instructed by the nurse on foods to encourage her child's diet concerning the latter's iron deficiency anemia; which of the following if stated by the mother would indicate the need for further instruction?
- A. Fish
- B. Lean meats
- C. Whole-grain breads
- D. Yellow vegetables
Correct Answer: D
Rationale: Yellow vegetables do not contain a significant amount of iron compared to the other options provided (fish, lean meats, and whole-grain breads). Therefore, if Mrs. Baker indicates that she plans to focus on yellow vegetables to address her child's iron deficiency anemia, further instruction would be necessary to help her choose more iron-rich sources of food to improve her child's condition.