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The nurse has taught a patient with thrombocytopenia how to prevent bleeding. Which of the ff. is the best evidence that the teaching has been effective?
- A. The patient states that he will be careful to avoid injury.
- B. The patient can list signs and symptoms of bleeding.
- C. The patient uses an electric razor instead of his safety razor.
- D. The patient states when he should call the doctor.
Correct Answer: C
Rationale: The best evidence that the teaching has been effective is when the patient uses an electric razor instead of his safety razor. This action demonstrates understanding and application of the teaching to prevent bleeding in a practical way. By choosing the electric razor, the patient is actively taking steps to minimize the risk of injury and bleeding due to thrombocytopenia. This concrete behavior indicates that the patient has internalized the instructions provided by the nurse and is implementing them to protect his health.
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Which of the following is the most numerous type of white blood cell (WBC)?
- A. Neutrophil
- B. Basophil
- C. Eosinophil
- D. Lymphocyte
Correct Answer: A
Rationale: Neutrophils are the most numerous type of white blood cell (WBC) in the body, comprising about 60-70% of the total WBC count. They are a critical component of the immune system, playing a key role in fighting bacterial infections through phagocytosis (engulfing and destroying pathogens). Neutrophils are known for their rapid response to infections and are often the first responders to sites of inflammation. Their abundance and rapid mobilization make them essential in the body's defense against harmful pathogens.
The nurse assesses for the characteristic movement of Parkinson's disease which is a (n):
- A. Exaggerated muscle flaccidity that leads to frequent falls
- B. Hyperextension of the back and neck that alters normal movements
- C. Pronation- supination of the hand and forearm that interferes with normal hand activities
- D. Combination of all of the above
Correct Answer: D
Rationale: The characteristic movement of Parkinson's disease is the pronation-supination of the hand and forearm, also known as the "pill-rolling" tremor. This movement interferes with normal hand activities and is a common early sign of Parkinson's disease. Exaggerated muscle flaccidity leading to frequent falls and hyperextension of the back and neck are not typically associated with Parkinson's disease.
You are examining an infant with multiple cutaneous hemangiomas; you suspect involvement of internal organs. The MOST common site of visceral involvement by hemangiomas is
- A. brain
- B. heart
- C. lung
- D. liver
Correct Answer: D
Rationale: Liver is the most common site of visceral involvement by hemangiomas.
The nurse is instructed to perform preoperative preparation for the management of a client with malignant tumors. Which of the ff is the most important factor of the nursing management plan?
- A. Insertion of an ostomy pouch
- B. Assessing the symptoms of peritonitis
- C. Maintaining the integrity of the urinary
- D. Insertion of a nasogastric tube diversion procedure
Correct Answer: B
Rationale: Peritonitis is a serious and potentially life-threatening condition that can occur as a complication of malignant tumors. It is characterized by inflammation of the lining of the abdomen and can result in severe abdominal pain, tenderness, fever, and other symptoms. Prompt assessment of peritonitis symptoms is crucial for early detection and intervention to prevent further complications and improve patient outcomes. Assessing for peritonitis symptoms should be the priority in the nursing management plan to ensure timely and appropriate care for the client with malignant tumors.
The nurse is talking to a parent of an infant with severe atopic dermatitis (eczema). Which response(s) should the nurse reinforce with the parent? (Select all that apply.)
- A. "You can use warm wet compresses to relieve discomfort."
- B. "You will need to keep your infant's skin well hydrated by using a mild soap in the bath."
- C. "You should bathe your baby in a bubble bath two times a day."
- D. "You will need to prevent your baby from scratching the area by using a mild antihistamine."
Correct Answer: A
Rationale: "You can use warm wet compresses to relieve discomfort." Warm wet compresses can help soothe the affected area and provide relief from itching and discomfort associated with atopic dermatitis.