Nokea
The MOST appropriate advice for a 4-year-old child visiting the outpatient department with excessive crying is
- A. reassures her that this is a normal phenomenon
- B. seek more history regarding other skills and developmental domains
- C. refer her to pediatric psychiatry
- D. investigate for child abuse
Correct Answer: B
Rationale: Further history may help differentiate normal behavior from developmental concerns.
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Nurse Norma's discharge teaching for Mr. Aurelio, diagnosed with heart failure, should stress the significance of:
- A. maintaining a sedentary lifestyle most of the day
- B. obtain daily weights at the same time
- C. walking 2 miles daily
- D. maintaining a high fiber die
Correct Answer: B
Rationale: Nurse Norma's discharge teaching for Mr. Aurelio, diagnosed with heart failure, should stress the significance of obtaining daily weights at the same time. Daily weights help monitor fluid retention, a key indicator of worsening heart failure. Sudden weight gain may signal fluid buildup in the body, while weight loss may indicate dehydration or treatment effectiveness. By obtaining daily weights at the same time each day, Mr. Aurelio can track changes and provide valuable information for his healthcare team to adjust his treatment plan accordingly. This practice is crucial in managing heart failure and preventing exacerbations.
Dr. Jones prescribes corticosteroids for a child with nephritic syndrome. What is the primary purpose of administering corticosteroids to this child?
- A. To increase blood pressure
- B. To reduce inflammation
- C. To decrease proteinuria
- D. To prevent infection
Correct Answer: B
Rationale: Corticosteroids are commonly used to reduce inflammation in various conditions, including nephritic syndrome. In nephritic syndrome, there is inflammation in the glomeruli of the kidneys, leading to symptoms such as proteinuria, hematuria, and reduced kidney function. Corticosteroids work by suppressing this inflammatory response, which helps alleviate the symptoms and improve kidney function in patients with nephritic syndrome. Administering corticosteroids to this child aims to reduce the inflammation in the kidneys, thereby improving their condition.
Which nursing diagnosis is most appropriate for a client with Addison's disease?
- A. Risk for infection
- B. Urinary retention
- C. Excessive fluid volume
- D. Hypothermia
Correct Answer: C
Rationale: Addison's disease is a condition characterized by adrenal insufficiency, resulting in a deficiency of aldosterone and cortisol. Without aldosterone, the body is unable to regulate fluid and electrolyte balance properly, leading to sodium loss and potassium retention. This imbalance can result in excessive fluid volume, as the kidneys retain water and sodium. Symptoms of excessive fluid volume in Addison's disease can include edema, weight gain, and hypertension. Therefore, the most appropriate nursing diagnosis for a client with Addison's disease would be Excessive Fluid Volume.
For a patient with gastroesophageal reflux symptoms, the purpose of esophageal pH monitoring is to evaluate for:
- A. esophagitis from the reflux.
- B. frequency of the reflux.
- C. gastric emptying delays.
- D. possible obstructions.
Correct Answer: B
Rationale: Esophageal pH monitoring measures the frequency and duration of acid exposure in the esophagus, helping diagnose GERD.
Where would nonpathologic cyanosis normally be present in the newborn shortly after birth?
- A. Feet and hands
- B. Bridge of nose
- C. Circumoral area
- D. Mucous membranes
Correct Answer: D
Rationale: Nonpathologic cyanosis in newborns shortly after birth is typically seen in the mucous membranes, such as the lips and oral mucosa. This transient cyanosis is caused by the normal physiologic response of the newborn's immature circulatory system adjusting to extrauterine life. As oxygenation improves and blood circulation stabilizes, the cyanosis will usually resolve within the first few days after birth. It is important for healthcare providers to distinguish between pathologic and nonpathologic cyanosis in newborns to ensure appropriate management and monitoring.