Nokea
The initial neurological symptom of Guilain-Barre Syndrome is:
- A. Absent tendon reflex
- B. Paresthesia of the legs
- C. Dysrhythmias
- D. Transient hypertension
Correct Answer: B
Rationale: The initial neurological symptom of Guillain-Barre Syndrome (GBS) is typically paresthesia, which is a tingling or numbness sensation in the legs. GBS is an autoimmune disorder that affects the peripheral nervous system, leading to muscle weakness and paralysis. As the condition progresses, symptoms may worsen and may include absent tendon reflexes, weakness in the arms and legs, and difficulty breathing. However, paresthesia is often one of the earliest and most common symptoms of GBS.
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A nurse is assessing a newborn infant who was born to a mother who is addicted to drugs. Which of the following assessment findings would the nurse expect to note during the assessment of this newborn?
- A. Sleepiness
- B. Cuddles when being held
- C. Lethargy
- D. Incessant crying
Correct Answer: C
Rationale: Newborn infants born to mothers who are addicted to drugs are at risk for neonatal abstinence syndrome (NAS) due to drug withdrawal. Lethargy is a common finding in newborns with NAS. This is characterized by excessive sleepiness, decreased responsiveness, and lack of energy or enthusiasm for activities. Lethargy is often seen as a result of the withdrawal symptoms experienced by the newborn due to exposure to drugs in utero. It is important for the nurse to monitor the newborn closely for signs of withdrawal and provide appropriate care and interventions to manage NAS symptoms.
When caring for a patient with AIDS, which of the following nursing actions would be the most appropriate for infection control?
- A. Wear gloves at all times
- B. Wear gown and mask at all times
- C. Wear gloves for blood/body fluid contact
- D. Wear a mask during patient contact times
Correct Answer: C
Rationale: The most appropriate nursing action for infection control when caring for a patient with AIDS is to wear gloves for blood/body fluid contact. HIV, the virus that causes AIDS, is primarily spread through exposure to infected blood or body fluids. Therefore, wearing gloves when there is a potential for blood or body fluid contact is crucial in preventing the transmission of the virus. Wearing gloves at all times may not be necessary if there is no direct contact with blood or body fluids, and wearing a gown and mask at all times may not be indicated unless there is a specific need based on the situation. Wearing a mask during patient contact times may also not be necessary unless there is a risk of exposure to respiratory secretions.
In children with asthma, which of the following preoperative preparations is LEAST likely to be necessary?
- A. Increase in beta-agonist dosage
- B. Addition of systemic steroids
- C. Bronchodilator therapy
- D. None of the above
Correct Answer: D
Rationale: In stable asthmatic patients, additional interventions like systemic steroids or increased beta-agonist doses are not always necessary unless there are signs of exacerbation.
After the surgical incision has been clised and the anesthesia has wear-off, the patient is extubated and transferred to the postanesthesia care unit (PACU). Who is responsible for transferring the patient?
- A. Circulating nurse
- B. scrub nurse
- C. surgeon
- D. anesthesiologist
Correct Answer: D
Rationale: The anesthesiologist is responsible for transferring the patient to the postanesthesia care unit (PACU) after the surgical incision has been closed and the anesthesia has worn off. The anesthesiologist ensures that the patient is stable and ready for transfer, including assessing vital signs and overall condition. Due to their specialized training in anesthesia and perioperative care, the anesthesiologist is best equipped to manage the transition of care from the operating room to the PACU, where the patient will continue to be monitored closely during the immediate postoperative period.
A client is in isolation after receiving an internal radioactive implant to treat cancer. Two hours later, the nurse discovers the implant in the bed linens. What should the nurse do first?
- A. Stand as far away from the implant as possible and call for help.
- B. Pick up the implant with long-handled forceps and place it in a lead-lined container.
- C. Leave the room and notify the radiation therapy department immediately.
- D. Put the implant back in place, using forceps and a shield for self-protection, and call for help.
Correct Answer: B
Rationale: The nurse should first pick up the internal radioactive implant with long-handled forceps and place it in a lead-lined container. This action ensures the safety of the nurse and prevents further exposure to radiation. Handling the implant with forceps helps minimize direct contact, and placing it in a lead-lined container containing the radiation will effectively shield any further exposure. Once the implant is secured, proper authorities should be notified to take further action and ensure the client's safety.