Nokea
The nurse is arriving at the beginning of her shift and has taken report on four clients on a medical surgical unit. Which client should the nurse see first?
- A. A Client with pyelonephritis with nausea and vomiting
- B. A client with chronic obstructive pulmonary disease with an oxygen saturation of $90 \%$ on room air
- C. A client post vaginoplasty with bright red blood and clots in her catheter
- D. A client post-total abdominal hysterectomy with 9/10 pain
Correct Answer: C
Rationale: Bright red blood and clots post-vaginoplasty scream hemorrhage ABCs prioritize circulation, needing instant check for shock or transfusion. Pyelonephritis nags, COPD's stable at 90\%, pain's urgent but not bleeding. Nurses hit bleeding first, a life-line call in this post-op rush.
You may also like to solve these questions
Melatonin is a hormone that is involved in the regulation of the circadian rhythm. Features of melatonin include:
- A. It circulates in the cerebrospinal fluid and blood.
- B. It has a plasma elimination half-life of 4 h.
- C. It is derived from tryptophan.
- D. It activates the pituitary adenylate cyclase mechanism of circadian wakefulness.
Correct Answer: A
Rationale: Melatonin, produced by the pineal gland, regulates sleep-wake cycles. It circulates in blood and cerebrospinal fluid, crossing the blood-brain barrier to signal darkness via the suprachiasmatic nucleus (SCN). Its half-life is short, about 30-60 minutes, not 4 hours, enabling rapid response to light cues. Synthesized from tryptophan via serotonin, it's a biochemical derivative responsive to environmental triggers. It acts on melatonin receptors (MT1, MT2) in the SCN, suppressing wakefulness-promoting adenylate cyclase, not activating pituitary mechanisms for wakefulness that's a misattribution. Its role dampens alertness, promoting sleep. Circulation in bodily fluids ensures systemic distribution, aligning circadian rhythms with night, making it foundational to sleep physiology and fatigue management.
A 50-year-old male patient has been hospitalized for a wedge resection of the left lower lung lobe after a routine chest x-ray shows carcinoma. The patient is anxious and asks if he can smoke. Which statement by the nurse would be most therapeutic?
- A. Smoking is the reason you are here
- B. The doctor left orders for you not to smoke
- C. You are anxious about the surgery. Do you see smoking as helping?
- D. Smoking is OK right now, but after your surgery it is contraindicated
Correct Answer: C
Rationale: Anxiety's screaming here naming it and asking if smoking helps opens a door to his feelings, not a lecture. Blaming smoking shames him, spiking stress. Citing orders shuts down dialogue. Greenlighting it's reckless nicotine constricts vessels, risking surgical healing, especially post-lung resection. Therapeutic nursing in oncology digs into emotions, guiding patients through fear without judgment, key for pre-op calm.
The BMI that does NOT INCREASE the risk of renal disease and CKD is X. What is X?
- A. 25 or more
- B. 30 or more
- C. 35 or more
- D. 40 or more
Correct Answer: A
Rationale: Body Mass Index (BMI) correlates with chronic kidney disease (CKD) risk, with higher values linked to increased incidence due to obesity-related glomerular hypertension and inflammation. A BMI of 25 or more defines overweight and obesity, elevating CKD risk, though 18.5-24.9 is the range typically not increasing risk. The question's phrasing implies the threshold where risk begins, making 25 or more the level where renal disease risk rises, per studies like the Framingham Heart Study. Higher BMIs (30+, 35+, 40+) progressively worsen risk, with 30 marking obesity. Thus, 25 or more is the correct cutoff, guiding family physicians in counseling patients on weight management to prevent CKD onset.
A scalp block aims to stop conduction in the following nerves:
- A. Zygomaticotemporal.
- B. Infraorbital.
- C. Greater occipital.
- D. Auriculotemporal.
Correct Answer: C
Rationale: A scalp block is used in awake craniotomy to provide regional anesthesia by blocking sensory nerves innervating the scalp. The greater occipital nerve supplies the posterior scalp, making it a key target. The zygomaticotemporal nerve innervates the temple area, and the auriculotemporal nerve covers the lateral scalp and ear region both are also commonly blocked. The infraorbital nerve supplies the midface, not the scalp, and the trochlear nerve (likely a misnomer for supraorbital or supratrochlear) innervates the forehead, another typical target. However, the greater occipital stands out as essential for posterior coverage, consistently cited in scalp block techniques. The rationale hinges on anatomical innervation: effective scalp anesthesia requires blocking nerves from both trigeminal (V1, V2, V3 branches) and cervical (C2, C3) origins, with the greater occipital being a primary cervical contributor, ensuring comprehensive pain control during surgery.
The emergency management of the patient with acute asthma does not include:
- A. Performing a rapid physical examination
- B. Performing spirometry or peak flow on arrival
- C. Giving oxygen and short acting bronchodilator
- D. Close monitoring to determine efficacy of treatment and improvement or deterioration
Correct Answer: B
Rationale: Acute asthma's rush exam, O2, bronchodilators, tight watch saves breath fast. Spirometry's a no too tough mid-wheeze, delays care. Nurses skip it, a chronic flare's urgent dodge.