Nokea
The lower limit of pulse rate in neonate at rest is
- A. 50/min
- B. 60/min
- C. 70/min
- D. 80/min
Correct Answer: B
Rationale: The lower limit of normal pulse rate in neonates at rest is typically around 60 beats/min.
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A 70-year-old male client with type 2 diabetes mellitus (DM) is hospitalized with an infected ulcer on his great right toe. Which instruction should the nurse emphasize during discharge teaching?
- A. Check the insides and linings of all enclosed shoes before putting the shoes on
- B. Wash the feet with soap and water, then apply a topical antibiotic ointment.
- C. Trim toenails weekly to prevent injury.
- D. Avoid wearing sandals or open-toed shoes.
Correct Answer: A
Rationale: Preventing trauma to the feet is critical for clients with diabetes to avoid complications like infections and ulcers.
A 4-year-old child presents to the clinic with a history of persistent dry cough and wheezing. What is the nurse’s primary concern?
- A. Allergic reaction
- B. Asthma exacerbation
- C. Respiratory infection
- D. Acute bronchiolitis
Correct Answer: B
Rationale: Wheezing and persistent dry cough are hallmark symptoms of asthma exacerbation, which is the nurse's primary concern.
The following contribute to the natural immunity transmitted in breast milk:
- A. Macrophages
- B. Natural killer cells
- C. Lysozyme
- D. Secretory IgA
Correct Answer: D
Rationale: Secretory IgA in breast milk plays a crucial role in providing passive immunity to the infant by protecting mucosal surfaces from pathogens.
The typical radiologic configuration in tetralogy of Fallot as seen in the anteroposterior view consists of all the following EXCEPT
- A. normal heart size
- B. some elevation of the cardiac apex
- C. convexity in the region of the main pulmonary artery
- D. right-sided aortic arch
Correct Answer: A
Rationale: Normal heart size is not typical in tetralogy of Fallot.
A nurse assesses a client who is recovering after a left-sided cardiac catheterization. Which assessment finding requires immediate intervention?
- A. Urinary output less than intake
- B. Bruising at the insertion site
- C. Slurred speech and confusion
- D. Discomfort in the left leg
Correct Answer: C
Rationale: Slurred speech and confusion may indicate a neurological complication, such as a stroke, which requires immediate intervention.