Nokea
The nurse caring for a child diagnosed with kidney disease is analyzing the child's laboratory results and notes a sodium level of 148 mEq/L (148 mmol/L). On the basis of this finding, which clinical manifestation should the nurse expect to note in the child?
- A. Lethargy
- B. Diaphoresis
- C. Cold, wet skin
- D. Dry, sticky mucous membranes
Correct Answer: D
Rationale: Hypernatremia occurs when the sodium level is more than 145 mEq/L (145 mmol/L). Clinical manifestations include intense thirst, oliguria, agitation, restlessness, flushed skin, peripheral and pulmonary edema, dry and sticky mucous membranes, nausea, and vomiting. None of the remaining options are associated with the clinical manifestations of hypernatremia.
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A child was diagnosed with acute poststreptococcal glomerulonephritis and renal insufficiency. Which laboratory result should the nurse expect to note in the child?
- A. Urine positive for glucose and negative for protein
- B. Urine specific gravity of 1.020 and negative for red blood cells
- C. White blood cell count 18,000 mm^3 (18 × 10^9/L) and platelets 355,000 mm^3 (355 × 10^9/L)
- D. Blood urea nitrogen (BUN) 22 mg/dL (7.92 mmol/L) and creatinine levels of 2.1 mg/dL (185 mcmol/L)
Correct Answer: D
Rationale: With poststreptococcal glomerulonephritis, a urinalysis will reveal hematuria with red cell casts. Proteinuria is also present. If renal insufficiency is severe, the BUN and creatinine levels will be elevated. The WBC is usually within normal limits, and mild anemia is common. Platelets would be lower, whereas glucose is not related.
A pregnant client diagnosed with mitral valve prolapse is prescribed anticoagulant therapy during pregnancy. The nurse reviews the client's medical record, expecting to note that which medication therapy is prescribed daily?
- A. Oral warfarin
- B. Intravenous infusion of heparin sodium
- C. Subcutaneous administration of terbutaline
- D. Subcutaneous administration of heparin sodium
Correct Answer: D
Rationale: Pregnant women with mitral valve prolapse are frequently given anticoagulant therapy during pregnancy because they are at greater risk for thromboembolic disease during the antenatal, intrapartal, and postpartum periods. Heparin, which does not pass the placental barrier, is a safe anticoagulant therapy during pregnancy, and it would be administered by the subcutaneous route. Warfarin is contraindicated during pregnancy because it passes the placental barrier and causes potential fetal malformations and hemorrhagic disorders. Terbutaline is a medication that is indicated for preterm labor management.
A client diagnosed with myasthenia gravis is reporting vomiting, abdominal cramps, and diarrhea. The nurse notes that the client is hypotensive and experiencing facial muscle twitching. Which possible situation does this assessment data support?
- A. Myasthenic crisis
- B. Cholinergic crisis
- C. Systemic infection
- D. Reaction to plasmapheresis
Correct Answer: B
Rationale: Signs and symptoms of cholinergic crisis include nausea, vomiting, abdominal cramping, diarrhea, blurred vision, pallor, facial muscle twitching, pupillary miosis, and hypotension. It is caused by overmedication with cholinergic (anticholinesterase) medications, and it is treated by withholding medications. Myasthenic crisis is an exacerbation of myasthenic symptoms caused by undermedication with anticholinesterase medications. There are no data in the question to support the remaining options.
A child is admitted to the hospital with a suspected diagnosis of idiopathic thrombocytopenic purpura (ITP) and diagnostic studies are performed. Which diagnostic result is indicative of this disorder?
- A. An elevated platelet count
- B. Elevated hemoglobin and hematocrit levels
- C. Bone marrow exam showing increased megakaryocytes
- D. Bone marrow exam indicating increased immature white blood cells
Correct Answer: C
Rationale: The laboratory manifestations of ITP include the presence of a low platelet count of usually less than 20,000 mm^3 (20 × 10^9/L). Thrombocytopenia is the only laboratory abnormality expected with ITP. If there has been significant blood loss, there is evidence of anemia in the blood cell count. If a bone marrow examination is performed, the results with ITP show a normal or increased number of megakaryocytes, which are the precursors of platelets. Option 4 indicates the bone marrow result that would be found in a child with leukemia.
The nurse interprets that which observation is related to the dysfunction of cranial nerve III (oculomotor nerve)?
- A. Mild drowsiness
- B. Unilateral ptosis
- C. Diminished mental acuity
- D. Less frequent spontaneous speech
Correct Answer: B
Rationale: Ptosis of the eyelid is caused by pressure on and the dysfunction of cranial nerve III, the oculomotor nerve. The remaining options identify early signs of a deteriorating level of consciousness.