Nokea
The nurse reviews the record of a newborn infant and notes that a diagnosis of esophageal atresia with tracheoesophageal fistula is suspected. The nurse expects to note which most likely sign of this condition documented in the record?
- A. Incessant crying
- B. Coughing at nighttime
- C. Choking with feedings
- D. Severe projectile vomiting
Correct Answer: C
Rationale: In esophageal atresia and tracheoesophageal fistula, the esophagus ends before it reaches the stomach, forming a blind pouch, and there is an abnormal connection (fistula) with the trachea. Any child who exhibits the '3 Cs'"?coughing and choking with feedings and unexplained cyanosis"?should be suspected to have tracheoesophageal fistula. Option A, 'Incessant crying,' is not a typical sign of esophageal atresia with tracheoesophageal fistula. Option B, 'Coughing at nighttime,' is not a specific sign associated with this condition. Option D, 'Severe projectile vomiting,' is not a common sign of esophageal atresia with tracheoesophageal fistula.
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The nurse is collecting data on a child recently diagnosed with glomerulonephritis. Which question to the mother should elicit data associated with the cause of this disease?
- A. Has your child had any nausea or diarrhea?''
- B. Have you noticed any rashes on your child?''
- C. Did your child recently complain of a sore throat?''
- D. Did your child sustain any injuries to the kidney area?''
Correct Answer: C
Rationale: The correct answer is 'Did your child recently complain of a sore throat?' Group A beta-hemolytic streptococcal infection is a known cause of glomerulonephritis. In this condition, the child typically becomes ill with streptococcal infection of the upper respiratory tract, and then after 1 to 2 weeks, symptoms of acute poststreptococcal glomerulonephritis can develop. This question aims to gather crucial information related to a potential trigger for glomerulonephritis. Choices A, B, and D are incorrect because they do not pertain to a common cause or associated symptom of glomerulonephritis.
The healthcare provider assesses a patient suspected of having an asthma attack. Which of the following is a common clinical manifestation of this condition?
- A. Audible crackles and orthopnea
- B. An audible wheeze and use of accessory muscles
- C. Audible crackles and use of accessory muscles
- D. Audible wheeze and orthopnea
Correct Answer: B
Rationale: Choice B, 'An audible wheeze and use of accessory muscles,' is the correct answer. In asthma, patients commonly present with wheezing due to airway constriction and the use of accessory muscles to aid in breathing. Audible crackles (rales) are more commonly associated with conditions like pneumonia, congestive heart failure, or pulmonary fibrosis. Orthopnea, which is difficulty breathing while lying flat, is typically seen in conditions like heart failure or chronic obstructive pulmonary disease, rather than asthma. Choice C is incorrect as crackles are not a typical finding in asthma. Choice D is incorrect as orthopnea is not a common clinical manifestation of asthma.
A nurse is educating a patient about bimatoprost (Lumigan) eyedrops for the treatment of Glaucoma.
Which of the following indicates that the patient has a correct understanding of the expected outcomes
following treatment?
- A. "I should be experiencing less blurriness in my central field of vision"
- B. "This medication won't help my vision at all, but will keep it from getting worse."
- C. "My peripheral vision should be increasing back to its normal state, but will take a few weeks to do so."
- D. "This medication will help my eye restor intraocular fluid and increase intraocular pressure"
Correct Answer: B
Rationale: Glaucoma cannot be cured, just treated. Treatment revolves around preventing further deterioration.
A 7-year-old child is seen in a clinic, and the pediatrician documents a diagnosis of nighttime (nocturnal) enuresis. What information should the nurse provide to the parents?
- A. Nighttime (nocturnal) enuresis does not respond to treatment.
- B. Nighttime (nocturnal) enuresis is caused by a psychiatric problem.
- C. Nighttime (nocturnal) enuresis requires surgical intervention to improve the problem.
- D. Nighttime (nocturnal) enuresis is usually outgrown without therapeutic intervention.
Correct Answer: D
Rationale: Nighttime (nocturnal) enuresis is common in children and is characterized by a child who has never been dry at night for extended periods. Most children eventually outgrow bedwetting without therapeutic intervention. This condition is due to the child being unable to sense a full bladder and not awakening to void, often related to delayed maturation of the central nervous system. It is important for parents to understand that nighttime (nocturnal) enuresis is not caused by a psychiatric problem, does not typically require surgical intervention, and usually resolves on its own over time.
A nurse is caring for a client who was recently diagnosed with breast cancer. The oncologist uses the TNM staging system to classify this case as T2, N2, M0. The nurse understands that TNM stands for:
- A. Tumor, Necrosis, Metastasis
- B. Tumor, Node Involvement, Mastectomy
- C. Tumor, Node Involvement, Metastasis
- D. Therapy, Necrosis, Metastasis
Correct Answer: B
Rationale: The TNM staging system is a classification system for determining the size and extent of cancerous tissue. The TNM system helps providers to identify the most accurate forms of treatment. The T stands for tumor, the N stands for node involvement, and the M stands for metastasis. Choice A, 'Tumor, Necrosis, Metastasis,' is incorrect because it does not include the node involvement component. Choice B, 'Tumor, Node Involvement, Mastectomy,' is incorrect as it erroneously includes the treatment approach 'Mastectomy' instead of 'Metastasis.' Choice D, 'Therapy, Necrosis, Metastasis,' is incorrect because it includes 'Therapy' instead of the correct component 'Node Involvement.'