Nokea
The client with epilepsy is taking the prescribed dose of phenytoin (Dilantin) to control seizures. Results of a phenytoin blood level study reveal a level of 35 mcg/ml. Which of the following symptoms would be expected as a result of this laboratory result?
- A. Nystagmus
- B. No symptoms, because this is normal
- C. Tachycardia therapeutic level
- D. Slurred speech
Correct Answer: A
Rationale: A phenytoin blood level of 35 mcg/ml is considered to be above the therapeutic range (usually 10-20 mcg/ml for phenytoin). At this elevated level, the client is at risk for phenytoin toxicity. Symptoms of phenytoin toxicity include nystagmus (rapid, involuntary eye movements), as well as other symptoms such as confusion, slurred speech, ataxia, and tremors. Tachycardia is not typically associated with phenytoin toxicity. Therefore, the expected symptom in this case would be nystagmus.
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You are discussing failure to thrive (FTT) with medical students. You mention that FTT is most often used to describe malnutrition related to environmental or psychosocial causes. An important statement that should be included in your discussion is
- A. FTT is often diagnosed by weight that falls below the 25th percentile for age
- B. a weight crossing one major percentile lines on the growth height should be evaluated for FTT chart over time is considered abnormal
- C. a weight of less than 60 % of the median weight for the height of the child
- D. small subset of the population naturally falls below the 3rd percentile but usually have normal weight for height
Correct Answer: B
Rationale: Crossing percentile lines on a growth chart indicates a significant deviation from the child's previous growth trajectory, which is a key indicator of potential FTT.
Children with high-risk neuroblastoma have poor survival. Current treatment consists of all the following EXCEPT
- A. surgery
- B. intensive chemotherapy
- C. radiation
- D. allogenic bone marrow transplantation
Correct Answer: E
Rationale: Differentiating agents like 13-cis-retinoic acid are used instead of allogenic bone marrow transplantation in high-risk neuroblastoma.
When administering oxygen to a client, under which of the ff situations should the nurse discontinue the administration and notify the physician?
- A. When the client's color does not improve
- B. When the client level of consciousness decreases
- C. When the client is in a state of respiratory arrest
- D. When the client cannot effectively use the diaphragm
Correct Answer: C
Rationale: When a client is in a state of respiratory arrest, it means their breathing has stopped. This is a life-threatening emergency situation that requires immediate action. The nurse should discontinue administering oxygen and promptly notify the physician for further intervention, such as initiating CPR or advanced airway management. Prompt recognition and timely response to respiratory arrest are crucial in saving the client's life.
The client is a type II DM patient. The client asks the nurse what is the primary reason a type II diabetic does not usually develop diabetic ketoacidosis?
- A. there is no insulin available for the state of hyperglycemia
- B. the type II diabetic has no protein of fat reserves
- C. there is no sufficient insulin to prevent the breakdown of protein and fatty acid for metabolic needs
- D. there is insufficient serum glucose concentrations
Correct Answer: C
Rationale: The primary reason a type II diabetic does not usually develop diabetic ketoacidosis is that there is no sufficient insulin to prevent the breakdown of protein and fatty acids for metabolic needs. In type II diabetes, the body still produces some insulin, unlike in type I diabetes where there is a complete lack of insulin. However, the insulin that is produced in type II diabetes may not be enough to effectively lower blood sugar levels and prevent the breakdown of protein and fatty acids for energy. This imbalance can lead to high blood sugar levels, known as hyperglycemia, but not to the extent of causing diabetic ketoacidosis, which typically occurs in the absence of sufficient insulin to prevent the breakdown of fats into ketones.
Which of the following instructions would Nurse Courtney include in a teaching plan that focuses on initial prevention for Sheri who is diagnosed with rheumatic fever?
- A. Treating streptococcal throat infections with an antibiotic
- B. Giving penicillin to patients with rheumatic fever
- C. Using corticosteroid to reduce inflammation
- D. Providing an antibiotic before dental work
Correct Answer: A
Rationale: The most appropriate instruction in a teaching plan focusing on initial prevention for Sheri, who is diagnosed with rheumatic fever, would be treating streptococcal throat infections with an antibiotic (Choice A). Rheumatic fever is often preceded by a group A streptococcal infection, such as strep throat. Prompt treatment of streptococcal infections with antibiotics can help prevent the development of rheumatic fever and its complications. Therefore, this instruction emphasizes the importance of treating the initial infection to prevent the occurrence of rheumatic fever in individuals like Sheri who are at risk. Choices B, C, and D are not specific to the initial prevention of rheumatic fever but may be more related to the management or treatment of established cases.