Nokea
The least common late neurologic sequelae that may be encountered post craniospinal irradiation in a 9-year-old child with medulloblastoma is
- A. microcephaly
- B. learning disabilities
- C. cognitive impairment
- D. second malignancy
Correct Answer: D
Rationale: Second malignancy is a rare late effect compared to cognitive and learning impairments.
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A 36 y.o. woman who has had no prenatal care comes into the hospital in active labor for her fourth child. She has vesicles evident on her perineum. The following nursing actions are appropriate to protect the unborn baby and the staff, EXCEPT:
- A. Maintain standard precautions
- B. Prepare for the possibility that the baby may be delivered by CS.
- C. Notify the obstetrician and nurse midwife about the vesicles as soon as possible.
- D. Apply antibiotic ointment to the vesicles and place the mother in reverse isolation
Correct Answer: D
Rationale: When a woman with vesicles on her perineum comes into the hospital in active labor, it is important to take precautions to protect the unborn baby and the staff. However, applying antibiotic ointment to the vesicles and placing the mother in reverse isolation is not appropriate in this situation. This is because her condition is most likely due to herpes simplex virus (HSV) infection, which can be transmitted to the baby during birth leading to severe complications. Placing the mother in reverse isolation can increase the risk of transmission to the healthcare staff as well. Instead, notifying the obstetrician and nurse midwife about the vesicles as soon as possible is crucial for proper management and preparing for the possibility that the baby may be delivered by cesarean section is important to reduce the risk of transmission during vaginal birth. Maintaining standard precautions is essential to prevent the spread of infection.
The nurse is caring for a patient with HIV who has diarrhea. Which of the following would be most therapeutic to teach the patient to avoid in the diet to reduce diarrhea?
- A. Potassium-rich food
- B. Liquid nutritional supplements
- C. Raw fruits and vegetables
- D. Frozen products
Correct Answer: C
Rationale: Patients with HIV who have diarrhea should avoid consuming raw fruits and vegetables. Raw fruits and vegetables can be more difficult for the digestive system to break down, potentially worsening diarrhea. It is recommended to opt for cooked fruits and vegetables instead as they are easier to digest and less likely to irritate the gut. This can help reduce the frequency and severity of diarrhea in patients with HIV.
In pediatric rhabdomyosarcoma, stages are dependent on primary site whether favorable or unfavorable. Which of the following sites of involvement is considered unfavorable?
- A. vagina
- B. uterus
- C. testis
- D. paranasal sinuses
Correct Answer: D
Rationale: Paranasal sinuses are considered unfavorable sites in rhabdomyosarcoma staging.
When performing a physical examination on an infant, the nurse in charge notes abnormally low- set ears. This finding is associated with:
- A. Otogenous tetanus
- B. Tracheoesophageal fistula
- C. Congenital heart defects
- D. Renal anomalies
Correct Answer: C
Rationale: Abnormally low-set ears are often associated with certain congenital anomalies, including congenital heart defects. When a nurse notes this finding during a physical examination of an infant, it is important to consider the possibility of congenital anomalies and further assessment for associated conditions. Low-set ears alone are not diagnostic of a specific congenital heart defect, but they can serve as a clue to support the need for further evaluation to rule out any underlying cardiac issues. Other congenital anomalies that may be associated with low-set ears include renal anomalies, which makes option D a distractor in this case.
What discharge teaching is most important to help the patient who has had a splenectomy prevent infection?
- A. Avoid showering for 1 week.
- B. Sleep in a semi-fowler's position.
- C. Receive vaccines against infection.
- D. Stay on antibiotics for life.
Correct Answer: C
Rationale: Patients who have had a splenectomy are at increased risk for infections, particularly those caused by encapsulated bacteria such as Streptococcus pneumoniae. To prevent these infections, it is essential for these patients to receive vaccines against these bacteria. Vaccines recommended for patients who have had a splenectomy include the pneumococcal vaccine, meningococcal vaccine, and Hib vaccine. These vaccines help boost the body's immunity and provide protection against potentially life-threatening infections. It is important for healthcare providers to educate patients about the importance of receiving these vaccines to prevent infections post-splenectomy.