Nokea
The nurse is admitting a school-age child in acute renal failure with reduced glomerular filtration rate. Which urine test is the most useful clinical indication of glomerular filtration rate?
- A. pH
- B. Osmolality
- C. Creatinine
- D. Protein level
Correct Answer: C
Rationale: Creatinine is a waste product produced by muscle metabolism that is normally filtered by the glomerulus in the kidneys and excreted in urine. The level of creatinine in the urine is a direct reflection of the glomerular filtration rate (GFR). As GFR decreases in conditions such as acute renal failure, the amount of creatinine excreted in the urine also decreases. Therefore, measuring creatinine levels in the urine is a useful clinical indication of the glomerular filtration rate and kidney function. pH, osmolality, and protein level may provide additional information but are not as directly linked to GFR as creatinine levels.
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What type of breath sound is normally heard over the entire surface of the lungs except for the upper intrascapular area and the area beneath the manubrium?
- A. Vesicular
- B. Bronchial
- C. Adventitious
- D. Bronchovesicular
Correct Answer: A
Rationale: Vesicular breath sounds are normal, low-pitched sounds heard over the majority of the lung surface. They are usually soft and rustling with a longer inspiratory phase than expiratory phase. Vesicular breath sounds are produced by air moving through smaller bronchioles and alveoli. These sounds can be heard over the entire lung surface except for the upper intrascapular area and the area beneath the manubrium, where bronchovesicular breath sounds are typically heard.
An infant with gastroschisis is MORE likely than one with an omphalocele to have which of the following conditions?
- A. Congenital heart disease
- B. History of prematurity
- C. Imperforate anus
- D. N/A
Correct Answer: B
Rationale: Infants with gastroschisis are more likely to have a history of prematurity compared to those with omphalocele, though neither condition is strongly associated with congenital heart disease or imperforate anus.
A patient's serum sodium is within normal range. The nurse estimates that serum osmolality should be:
- A. Less than 136mOsm/kg
- B. Greater than 408mOsm/kg
- C. 280 to 295mOsm/kg
- D. 350 to 544mOsm/kg
Correct Answer: C
Rationale: Normal serum osmolality typically ranges between 280 to 295mOsm/kg. Serum osmolality reflects the concentration of solute particles in the blood, including sodium, glucose, and blood urea nitrogen. Sodium is a major determinant of serum osmolality, but it is not the only factor. In this case, since the patient's serum sodium is within the normal range, the nurse can reasonably estimate that the serum osmolality would fall within the normal range of 280 to 295mOsm/kg. Options A, B, and D are outside the typical range for serum osmolality in a healthy individual.
The nurse is caring for a newborn who was born 24 hours ago to a mother who received no prenatal care. The newborn is a poor feeder but sucks avidly on his hands. Clinical manifestations also include loose stools, tachycardia, fever, projectile vomiting, sneezing, and generalized sweating. Which should the nurse suspect?
- A. Seizure disorder
- B. Narcotic withdrawal
- C. Placental insufficiency
- D. Meconium aspiration syndrome
Correct Answer: B
Rationale: The clinical manifestations described in the scenario are classic signs of neonatal abstinence syndrome (NAS), which occurs in newborns who were exposed to drugs, particularly narcotics, in utero. The newborn's symptoms of poor feeding, sucking on his hands, tachycardia, fever, projectile vomiting, loose stools, sneezing, and generalized sweating are consistent with NAS. These symptoms occur as the newborn experiences withdrawal from the drugs to which they were exposed during pregnancy. In this case, the lack of prenatal care suggests that the mother may have used narcotics during pregnancy, leading to NAS in the newborn. It is essential for healthcare providers to recognize these signs and provide appropriate care and support for infants experiencing NAS.
Coarctation of the aorta causes all of the following signs except:
- A. higher B/P in the upper extremities
- B. right ventricular hypertrophy
- C. legs cooler than arms
- D. nosebleeds
Correct Answer: D
Rationale: Coarctation of the aorta is a congenital heart defect characterized by a narrowing of the aorta, the main artery carrying blood from the heart to the body. The signs of coarctation of the aorta include higher blood pressure in the upper extremities (Choice A) due to the narrowing of the aorta causing increased pressure proximal to the constriction. Right ventricular hypertrophy (Choice B) occurs as the heart works harder to overcome the obstruction in the aorta. Legs being cooler than arms (Choice C) is a result of decreased blood flow to the lower body due to the aortic narrowing. Hemodilution (Choice E) can occur as a compensatory mechanism in response to the increased blood pressure in the upper body. Nosebleeds (Choice D) are not typically associated with coarctation of the aorta but may occur due to other factors unrelated to this condition.