Nokea
The nurse understands that a patient with status asthmaticus will likely initially evidence symptoms of:
- A. metabolic acidosis.
- B. metabolic alkalosis.
- C. respiratory acidosis.
- D. respiratory alkalosis.
Correct Answer: C
Rationale: In status asthmaticus, a severe and prolonged asthma attack can lead to inadequate ventilation due to airway obstruction. This results in retention of carbon dioxide (CO2) in the blood, leading to respiratory acidosis. As the CO2 levels rise, it combines with water in the blood to form carbonic acid, lowering the blood pH levels. Symptoms of respiratory acidosis can include shortness of breath, confusion, lethargy, and potentially life-threatening complications. Treatment for status asthmaticus aims to improve ventilation and restore normal blood gas levels to alleviate respiratory acidosis.
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The nurse is caring for a preterm newborn who requires mechanical ventilation for the treatment of respiratory distress syndrome. What is the preterm newborn at increased risk of due to the mechanical ventilation?
- A. Alveolar rupture
- B. Meconium aspiration
- C. Transient tachypnea
- D. Retractions and nasal flaring
Correct Answer: A
Rationale: Preterm newborns who require mechanical ventilation are at increased risk of developing alveolar rupture. The pressure from mechanical ventilation can lead to overdistension of the alveoli, causing damage to their delicate structure. This can result in the rupture of the alveolar walls, leading to a condition known as pulmonary interstitial emphysema. Alveolar rupture can contribute to the development of other complications such as pneumothorax and air leaks, which can further compromise the newborn's respiratory status. Therefore, close monitoring and adjustment of ventilation parameters are crucial in the care of preterm newborns on mechanical ventilation to minimize the risk of alveolar rupture and its associated complications.
Which of the following is disease process characterized by a chronic progressive inflammation of the sacroiliac and costovertebral joints and adjacent soft tissue?
- A. Rheumatoid arthritis
- B. Scoliosis
- C. Kyphosis
- D. Ankylosing spondylitis
Correct Answer: D
Rationale: Ankylosing spondylitis is a chronic inflammatory disease primarily affecting the sacroiliac joints and the spine. It leads to progressive inflammation of the sacroiliac and costovertebral joints, which can cause pain, stiffness, and eventually lead to fusion of the affected joints. This condition is also characterized by inflammation of other joints, tendons, and ligaments, as well as extra-articular manifestations such as uveitis and cardiac involvement. Ankylosing spondylitis is more common in young males and is associated with the presence of the HLA-B27 genetic marker. It is important to diagnose and manage ankylosing spondylitis early to help prevent complications and improve quality of life for affected individuals.
Although most relapses in children with Wilms tumor occur early (within 2 yr of diagnosis) and have a favorable outcome, about 15% suffer relapse. Relapse includes all the following EXCEPT
- A. low stage (I/II) at diagnosis
- B. no prior radiotherapy
- C. anaplastic histology
- D. more than 12 mo from nephrectomy
Correct Answer: C
Rationale: Anaplastic histology is associated with a poorer prognosis and is not typically associated with favorable relapse outcomes.
An infant with bladder exstrophy has had a continent urinary reservoir placed. Which discharge instruction should be included?
- A. Allow your child to sleep on the abdomen for comfort.
- B. Avoid contact with latex-containing surfaces (e.g., playgrounds with rubber) to prevent allergic reactions.
- C. Encourage a varied diet to prevent allergies.
- D. Provide brightly colored objects to stimulate development.
Correct Answer: B
Rationale: Children with urologic malformations are prone to latex allergies; parents should be advised to avoid latex exposure.
When caring for Mr. Reyes, the nurse should assess for
- A. Decreased carotid pulses
- B. Altered level of consciousness
- C. Bleeding from oral cavity
- D. Absence of deep tendon-reflexes
Correct Answer: B
Rationale: When caring for Mr. Reyes, the nurse should assess for an altered level of consciousness as it is a crucial indicator of his overall neurological status. Changes in consciousness can signify multiple underlying issues such as neurological, metabolic, or circulatory problems. It is important for the nurse to monitor Mr. Reyes closely for any signs of confusion, disorientation, agitation, drowsiness, or changes in behavior that could indicate a decline in his neurological function. Assessing and addressing alterations in consciousness promptly is essential for providing appropriate care and preventing further complications.