Nokea
The nurse is conducting teaching for an adolescent being discharged to home after a renal transplant. The adolescent needs further teaching if which statement is made?
- A. "I will report any fever to my primary health care provider."
- B. "I am glad I only have to take the immunosuppressant medication for two weeks."
- C. "I will observe my incision for any redness or swelling."
- D. "I won't miss doing kidney dialysis every week."
Correct Answer: B
Rationale: The statement "I am glad I only have to take the immunosuppressant medication for two weeks" indicates a misunderstanding about the long-term nature of immunosuppressant therapy following a renal transplant. In reality, individuals who undergo a renal transplant need to take immunosuppressant medications for the rest of their lives to prevent rejection of the donor kidney. Failure to adhere to this medication regimen can result in rejection of the transplanted kidney. Therefore, this statement indicates a need for further teaching to ensure the adolescent understands the importance of lifelong immunosuppressant therapy.
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A 2-mo-old male infant has a left flank mass discovered incidentally by the mother; radiological imaging reveals a left renal mass. Of the following, the MOST likely diagnosis is
- A. nephroblastoma
- B. neuroblastoma
- C. mesoblastic nephroma
- D. clear cell sarcoma
Correct Answer: A
Rationale: Nephroblastoma (Wilms tumor) is the most common renal malignancy in infants.
When testing visual fields, the nurse is assessing which of the following parts of vision?
- A. Peripheral vision
- B. Distance vision
- C. Near vision
- D. Central vision
Correct Answer: A
Rationale: When testing visual fields, the nurse is assessing the peripheral vision. Peripheral vision refers to the outer area of the visual field, away from the center of gaze. It allows individuals to detect objects, movement, and stimuli in their surroundings without needing to focus directly on them. Testing peripheral vision is important for detecting potential visual field deficits that can impede daily activities and safety, such as driving or navigating crowded spaces. By assessing the peripheral vision, healthcare professionals can identify any limitations or abnormalities that may require further evaluation or intervention.
Which of the following would the nurse evaluate as laboratory data that support the occurrence of AIDS?
- A. 900 CD 4+ cells
- B. 500 CD 4+ cells
- C. 700 CD 4+ cells
- D. 200 CD 4+ cells
Correct Answer: D
Rationale: The nurse would evaluate 200 CD 4+ cells as laboratory data that support the occurrence of AIDS. In patients with AIDS, there is a significant decrease in the CD4+ T-lymphocyte count, typically falling below 200 cells/mm³. This low CD4+ cell count increases the risk of opportunistic infections and indicates severe immune suppression, which is characteristic of AIDS. A CD4+ count of 200 or less is an important criterion for the diagnosis of AIDS according to the Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) guidelines.
A nurse is preparing to administer an angiotensin-converting enzyme (ACE) inhibitor. Which drug should the nurse administer?
- A. Captopril (Capoten)
- B. Furosemide (Lasix)
- C. Spironolactone (Aldactone)
- D. Chlorothiazide (Diuril)
Correct Answer: A
Rationale: Angiotensin-converting enzyme (ACE) inhibitors, such as captopril, work by inhibiting the conversion of angiotensin I to angiotensin II. This leads to vasodilation, reduced aldosterone secretion, and ultimately decreases blood pressure. ACE inhibitors are commonly used in the management of hypertension, heart failure, and post-myocardial infarction. In this case, the nurse should administer captopril as it is an ACE inhibitor, while the other options (B. Furosemide, C. Spironolactone, D. Chlorothiazide) are not ACE inhibitors and have different mechanisms of action.
To supplement a diet with foods high in potassium, the nurse should recommend the addition of:
- A. Fruits such as bananas
- B. Milk and yogurt
- C. Green leafy vegetables
- D. Nuts and legumes
Correct Answer: A
Rationale: Fruits such as bananas are a good source of potassium. Potassium is an essential mineral that plays a vital role in various bodily functions, including maintaining proper muscle function, nerve transmission, and fluid balance. Bananas are easy to incorporate into the diet and provide a significant amount of potassium per serving. Other fruits high in potassium include oranges, melons, and avocados. Therefore, recommending the addition of fruits such as bananas is a suitable way to supplement a diet with foods high in potassium.