The following are causes of cyanosis in the presence of 60% oxygen:
- A. Haemoglobin concentration < 5 g%
- B. Methaemoglobinaemia
- C. Thalassaemia
- D. Right to left shunt
Correct Answer: D
Rationale: A right-to-left shunt can cause cyanosis even in the presence of high oxygen levels. Methaemoglobinaemia and severe anemia (Hb < 5 g%) can also cause cyanosis.
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Two days after a nephrectomy, the client reports abdominal pressure and nausea, which assessment should the nurse implement?
- A. Palpate the abdomen
- B. Measure hourly urine output
- C. Ambulate client in hallway
- D. Auscultate bowel sounds
Correct Answer: D
Rationale: Auscultating bowel sounds helps assess for any bowel obstruction or ileus, which could be contributing to abdominal pressure.
Exposure to which illness should be a cause to discontinue therapy and substitute dipyridamole (Persantine) in a child receiving aspirin therapy for Kawasaki disease (KD)?
- A. Chickenpox or influenza
- B. E. coli or staphylococcus
- C. Mumps or streptococcus A
- D. Streptococcus A or staphylococcus
Correct Answer: A
Rationale: Both chickenpox and influenza are viral; during these illnesses, aspirin (a salicylate) is typically discontinued due to the risk of Reye syndrome.
An older adult woman with a long history of chronic obstructive pulmonary disease (COPD) is admitted with progressive shortness of breath and a persistent cough. She is anxious and is complaining of a dry mouth. Which intervention should the nurse implement?
- A. Administer a prescribed sedative
- B. Encourage client to drink water
- C. Apply a high-flow venturi mask
- D. Assist her to an upright position
Correct Answer: D
Rationale: An upright position improves lung expansion and oxygenation, which is crucial for a client with COPD.
The Duke criterion for the diagnosis of endocarditis is a major
- A. new regurgitant flow by echocardiography
- B. Osler nodes
- C. single positive blood culture
- D. serologic evidence of infection
Correct Answer: C
Rationale: A single positive blood culture is one of the major criteria for diagnosing endocarditis.
The following statements are true regarding a screening test:
- A. Sensitivity indicates the proportion of true positives
- B. Specificity indicates the proportion of true negatives
- C. Sensitivity is inversely related to specificity
- D. Prevalence affects predictive value
Correct Answer: D
Rationale: Prevalence affects predictive value