Nokea
The nurse is clarifying information to a patient regarding diagnosis-related groups (DRGs). What is the nurses best response when the patient asks how DRGs reduce medical care costs?
- A. By determining payment based on diagnosis
- B. By requiring two medical opinions to confirm a diagnosis
- C. By organizing HMOs
- D. By defining a person who will require hospitalization
Correct Answer: A
Rationale: DRGs determine the amount of payment and length of hospital stay based on the diagnosis.
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A three year old child is brought to hospital by his step mother with a 2 month history of diarrhea, poor feeding and progressive leg swelling. He also has wounds on his legs and perineum. His weight is $7 \mathrm{~kg}$. When you examine him you find he is in shock and has kwashiorkor. What is your differential diagnosis?
- A. Kwashiorkor, child abuse
- B. Celiac disease, cystic fibrosis
- C. Congestive heart failure, nephrotic syndrome
- D. Tuberculosis, HIV
Correct Answer: A
Rationale: Kwashiorkor (edema, low weight) and child abuse (cigarette burns, multiple wounds) fit the clinical picture of malnutrition and trauma.
A mother is anxious about her ability to breastfeed after her child is born because of her small breast size. What would be an important point to teach this mother?
- A. Milk is produced in ducts and lobules regardless of breast size.
- B. Supplementing breastfeeding with formula allows the infant to receive adequate nutrition.
- C. Breast size can be increased with exercise.
- D. Drinking extra milk during pregnancy allows breasts to produce adequate amounts of milk.
Correct Answer: A
Rationale: Breast size does not influence the ability to secrete milk.
The nurse would explain to the father which concept of Piaget's cognitive development as the basis for the child's fear of darkness?
- A. Reversibility
- B. Animism
- C. Conservation of matter
- D. Object permanence
Correct Answer: B
Rationale: Animism, where children attribute life-like qualities to inanimate objects, can contribute to a fear of the dark.
A two month old infant is brought to the clinic for the first immunization against DPT. The nurse should administer the vaccine via what route?
- A. Oral.
- B. Intramuscular
- C. Subcutaneous
- D. Intradermal
Correct Answer: B
Rationale: The DPT vaccine is administered intramuscularly for effective absorption.
The mother tells the nurse that the child is continually telling jokes and riddles to the point of driving the other family members crazy. The nurse should explain that this behavior is a sign of...
- A. Inadequately parental attention
- B. Mastery of language ambiguities
- C. Inappropriate peer influence
- D. Excessive television watching
Correct Answer: B
Rationale: Telling jokes and riddles reflects a school-age child's mastery of language ambiguities.