The nurse notes the first stool of a newborn is black and tarry. Which term is used to describe this type of stool?
- A. Meconium
- B. Transitional
- C. Miliaria
- D. Milk stool
Correct Answer: A
Rationale: Meconium is the term used to describe the first stool of a newborn. This stool is black and tarry in appearance. Meconium is made up of materials ingested by the fetus while in the uterus, such as mucus, amniotic fluid, and cells shed from the stomach and intestines. It is typically passed by a newborn within the first few days of life before transitioning to transitional stools, which are greenish-brown in color, and eventually to normal milk stools as the baby starts feeding on breast milk or formula.
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The BEST implication of a 6-month-old baby's visuomotor coordination is
- A. voluntary release of objects
- B. comparison ability of small objects
- C. increasing ability to explore objects
- D. autonomy of actions
Correct Answer: A
Rationale: Voluntary release is a key milestone in visuomotor coordination at this age.
If a client with increased pressure (ICP) demonstrates decorticate posturing, the nurse will observe:
- A. Flexion of both upper and lower extremities
- B. Extension of elbows and knees, plantar flexion of feet, and flexion of the wnsts
- C. Flexion of elbows, extension of the knees, and plantar flexion of the feet
- D. Extension of upper extremities, flexion of lower extremities
Correct Answer: B
Rationale: Decorticate posturing is characterized by flexion of elbows, wrists, and fingers; extension of elbows and knees; plantar flexion of the feet. This type of posturing typically indicates severe damage to the cerebral hemispheres or impairment of the corticospinal tract. When a client with increased intracranial pressure (ICP) displays decorticate posturing, it suggests significant brain injury and dysfunction. This abnormal posturing is a classic sign that requires immediate medical attention and intervention.
The nurse is preparing a client with systemic lupus erythematosus (SLE) for discharge. Which instruction should the nurse include in the teaching plan?
- A. Exposure to sunlight will help control skin rashes.
- B. There are no activity limitations between flare-ups.
- C. Monitor body temperature
- D. Corticosteroids may be stopped when symptoms are relieved.
Correct Answer: C
Rationale: Monitoring body temperature is important in clients with systemic lupus erythematosus (SLE) because fever can indicate an infection or a disease flare-up. Clients with SLE are at higher risk of infections due to their compromised immune system, and fever can be a sign of an underlying issue that needs prompt attention. It is essential for the nurse to educate the client about monitoring body temperature regularly and seeking medical advice if there is a sudden increase in temperature.
Which of the following dietary interventions prevents the precipitation of calcium renal stones?
- A. High fiber diet
- B. Increased protein intake
- C. High fluid intake
- D. Intake of zinc
Correct Answer: C
Rationale: High fluid intake is the dietary intervention that prevents the precipitation of calcium renal stones. By increasing fluid intake, particularly water, the urine gets diluted, thus reducing the concentration of substances that can lead to the formation of kidney stones, including calcium. Drinking enough water can also help to flush out any potential stone-forming minerals or substances before they have a chance to crystallize and form stones in the kidney. It is recommended to have an adequate fluid intake of around 2 to 3 liters per day to reduce the risk of calcium stone formation in the kidneys. High fiber diet, increased protein intake, and intake of zinc do not directly prevent the precipitation of calcium renal stones as effectively as maintaining high fluid intake.
Which of the ff. type of eyedrops does the nurse understand is given to constrict the pupil, permitting aqueous humor to flow around the lens?
- A. Osmotic
- B. Mydriatic
- C. Myotic
- D. Cycloplegic
Correct Answer: B
Rationale: Mydriatic eye drops are used to dilate or enlarge the pupil. By dilating the pupil, these eye drops allow more light to enter the eye and are often used before eye exams. This dilation also permits aqueous humor to flow around the lens. In contrast, myotic eye drops are used to constrict the pupil, which can increase pressure in the eye. Osmotic eye drops are used to reduce intraocular pressure by drawing fluid out of the eye. Cycloplegic eye drops are used to temporarily paralyze the muscles in the eye, affecting accommodation and pupil size.