Nokea
To attain the goal of ambulation for the patient who is hemiplegic the initial care plan needs to be structured to first attain
- A. acceptance of his altered body image
- B. balance training
- C. adequate energy level
- D. ability to transfer from bed to chair
Correct Answer: D
Rationale: Transferring skills are foundational for ambulation.
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Which assessment finding best supports the diagnosis of dissociative amnesia with fugue? The patient states:
- A. I cannot recall why I'm living in this town.
- B. I feel as if I'm living in a fuzzy dream state.
- C. I feel like different parts of my body are at war.
- D. I feel very anxious and worried about my problems.
Correct Answer: A
Rationale: The correct answer is A because the key feature of dissociative amnesia with fugue is the inability to remember important personal information. In this case, the patient cannot recall why they are living in the current town, indicating a significant gap in memory. Choice B describes a feeling of disorientation, not memory loss. Choice C suggests dissociative identity disorder, not dissociative amnesia. Choice D focuses on anxiety, which is not a primary symptom of dissociative amnesia with fugue.
Each cerebral hemisphere is divided into ________ lobes, ________ of which have the same name as the bone over them.
- A. four, three
- B. three, two
- C. five, two
- D. five, four
Correct Answer: A
Rationale: Each cerebral hemisphere is divided into four lobes: the frontal, parietal, temporal, and occipital lobes. Three of these lobes (frontal, parietal, and temporal) share their names with the bones of the skull that overlie them. The occipital lobe is named after the occipital bone. Therefore, four, three is the correct answer as it accurately describes the division and naming of the cerebral lobes.
The nurse suspects a fat embolism rather than a pulmonary embolism from a venous thrombosis when the patient with a fracture develops what?
- A. Tachycardia and dyspnea
- B. A sudden onset of chest pain
- C. Petechiae around the neck and upper chest
- D. Electrocardiographic (ECG) changes and decreased PaO2
Correct Answer: C
Rationale: Petechiae are characteristic of fat embolism.
Which statement concerning the areas of the brain is true?
- A. The cerebellum is the center for speech and emotions.
- B. The hypothalamus controls body temperature and regulates sleep.
- C. The basal ganglia are responsible for controlling voluntary movements.
- D. Motor pathways of the spinal cord and brainstem synapse in the thalamus.
Correct Answer: B
Rationale: The correct answer is B. The hypothalamus controls body temperature and regulates sleep. The hypothalamus is a part of the brain responsible for maintaining homeostasis, including regulating body temperature and controlling sleep patterns. It acts as a thermostat for the body, adjusting temperature through various mechanisms. Additionally, it plays a crucial role in the sleep-wake cycle by influencing the production of sleep-inducing hormones.
Choices A, C, and D are incorrect:
A: The cerebellum is not the center for speech and emotions; it is primarily involved in coordination and movement control.
C: The basal ganglia are responsible for coordinating motor movements and are not directly involved in voluntary movements.
D: Motor pathways of the spinal cord and brainstem do not synapse in the thalamus; they synapse in the brainstem and spinal cord itself.
A patient with paraplegia has developed an irritable bladder with reflex emptying. What will be most helpful for the nurse to teach the patient?
- A. Hygiene care for an indwelling urinary catheter
- B. How to perform intermittent self-catheterization
- C. To empty the bladder with manual pelvic pressure in coordination with reflex voiding patterns
- D. That a urinary diversion, such as an ileal conduit, is the easiest way to handle urinary elimination
Correct Answer: C
Rationale: Manual techniques align with reflex voiding patterns.