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The nurse is developing a teaching plan for a client diagnosed with diabetes insipidus. The nurse should include information about which hormone lacking in clients with diabetes insipidus?
- A. antidiuretic hormone (ADH).
- B. follicle-stimulating hormone (FSH).
- C. thyroid-stimulating hormone (TSH).
- D. luteinizing hormone (LH).
Correct Answer: A
Rationale: The correct answer is A: antidiuretic hormone (ADH). In diabetes insipidus, there is a deficiency of ADH, which regulates water balance by reducing urine output. Without ADH, excessive urination and thirst occur. FSH, TSH, and LH are not related to water balance regulation. FSH and LH are involved in reproductive functions, while TSH regulates thyroid hormone production. Therefore, the nurse should focus on educating the client about the importance of ADH in managing diabetes insipidus.
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Mr. Boy, a 65-year old man, has been admitted wth severe flame burns resulting from smoking in bed. The nurse can expect his room environment to include:
- A. strict isolation techniques and policies
- B. a semi-private room
- C. liberal, unrestricted visiting
- D. equipment shared between Mr. Boy and the other burn patients in the unit
Correct Answer: B
Rationale: The correct answer is B: a semi-private room. For a burn patient like Mr. Boy, a semi-private room is preferred to provide a more controlled environment for infection prevention, wound care, and privacy. Strict isolation (A) is not necessary as his burns are not infectious. Liberal visiting (C) can increase the risk of infection and compromise his recovery. Sharing equipment (D) can lead to cross-contamination and is not recommended for burn patients. In summary, a semi-private room balances infection control and patient comfort for burn patients.
Considering Mr. Franco’s conditions, which of the following is most important to include in preparing Franco’s bedside equipment?
- A. Hand bell and extra bed linen
- B. Footboard and splint
- C. Sandbag and trochanter rolls
- D. Suction machine and gloves
Correct Answer: B
Rationale: Step-by-step rationale for choice B: Footboard and splint:
1. Footboard helps prevent foot drop by maintaining proper alignment and preventing pressure ulcers.
2. Splint helps stabilize and support Franco's limbs to prevent contractures and maintain proper positioning.
3. Both items are essential for Franco's safety, comfort, and prevention of complications.
4. Hand bell and extra bed linen (Choice A) are not crucial for Franco's immediate care needs.
5. Sandbag and trochanter rolls (Choice C) are not directly relevant to Franco's specific conditions.
6. Suction machine and gloves (Choice D) are important for airway management but not the priority for bedside equipment in this case.
As the nurse cares for a patient with angioedema, differs from urticaria in that angioedema is characterized by which of the following?
- A. Angioedema is more pruritic.
- B. Angioedema has small, fluid-filled vesicles
- C. Angioedema has a deeper and more that crust.
- D. Angioedema lasts a shorter time.
Correct Answer: C
Rationale: Step-by-step rationale for choice C: Angioedema differs from urticaria as it involves deeper swelling in the dermis and subcutaneous tissue, leading to a more profound and firm texture. This contrasts with urticaria, which presents as superficial, raised wheals on the skin. Therefore, option C is correct.
Summary of other choices:
A: Angioedema is not typically associated with intense itching, so it is not more pruritic than urticaria.
B: Angioedema does not have small, fluid-filled vesicles like in allergic contact dermatitis.
D: Angioedema tends to last longer than urticaria, making this statement incorrect.
A client with anemia has been admitted to the medical-surgical unit. Which assessment findings are characteristic of iron-deficiency anemia?
- A. Night sweats, weight loss, and diarrhea
- B. Nausea, vomiting, and anorexia
- C. Dyspnea, tachycardia, and pallor
- D. Itching, rash, and jaundice A1 PASSERS TRAINING, RESEARCH, REVIEW & DEVELOPMENT COMPANY MEDICAL SURGICAL NURSING SET H
Correct Answer: C
Rationale: Rationale:
1. Anemia results in decreased oxygen-carrying capacity, leading to tissue hypoxia.
2. Dyspnea (shortness of breath) occurs due to the body's attempt to increase oxygen intake.
3. Tachycardia (rapid heart rate) compensates for decreased oxygen delivery.
4. Pallor (pale skin) is a classic sign of decreased red blood cells in iron-deficiency anemia.
Summary:
A: Night sweats, weight loss, and diarrhea are not typical manifestations of iron-deficiency anemia.
B: Nausea, vomiting, and anorexia are non-specific symptoms and not specific to iron-deficiency anemia.
D: Itching, rash, and jaundice are not commonly associated with iron-deficiency anemia.
A surgical intervention that can cause substantial remission of myasthenia gravis is:
- A. Esophagostomy
- B. Thymectomy
- C. Myomectomy
- D. Spleenectomy
Correct Answer: B
Rationale: The correct answer is B: Thymectomy. The thymus gland is often found to be abnormal in individuals with myasthenia gravis, and removing it through thymectomy can lead to substantial remission of symptoms. This is because the thymus plays a role in the development of the immune system and may be producing antibodies that attack neuromuscular junctions in myasthenia gravis.
Choice A, esophagostomy, is a surgical procedure to create an opening in the esophagus for feeding and has no direct impact on myasthenia gravis. Choice C, myomectomy, is the removal of uterine fibroids and is unrelated to myasthenia gravis. Choice D, spleenectomy, is the removal of the spleen and is not a treatment for myasthenia gravis as the spleen is not implicated in the disease process.