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What is the pathophysiologic mechanism of cystic fibrosis leading to obstructive lung disease?
- A. Fibrosis of mucous glands and destruction of bronchial walls
- B. Destruction of lung parenchyma from inflammation and scarring
- C. Production of secretions low in sodium chloride and therefore thickened mucus
- D. Increased serum levels of pancreatic enzymes that are deposited in the bronchial mucosa
Correct Answer: C
Rationale: Cystic fibrosis (CF) is caused by mutations in the CFTR gene, leading to altered transport of sodium and chloride ions in and out of epithelial cells. This results in the production of secretions that are low in sodium chloride, leading to thickened mucus. The abnormally thick, abundant secretions from mucous glands in the respiratory tract can obstruct the airways, leading to chronic, diffuse obstructive pulmonary disease in almost all patients with CF. This process impairs mucociliary clearance, predisposing individuals to recurrent lung infections, inflammation, and ultimately bronchiectasis. This mechanism is a key factor in the pathophysiology of cystic fibrosis-associated obstructive lung disease.
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Which of the following signs indicates to the nurse that digoxin (Lanoxin) has been effective for a patient?
- A. Urine output decreases
- B. Heart rate higher than 95
- C. Urine output increases
- D. Heart rate lower than 50
Correct Answer: C
Rationale: Digoxin is a medication commonly used to treat heart failure and certain types of irregular heart rhythms. One of the therapeutic effects of digoxin is an improvement in cardiac output, leading to better tissue perfusion. As the heart's pumping ability improves, blood flow to the kidneys also increases, resulting in an increase in urine output. Therefore, an increase in urine output is a positive indication that digoxin is effective for the patient. Monitoring urine output can be a valuable way for nurses to assess the response to digoxin therapy and the overall cardiac function of the patient.
A nurse is assessing a preterm newborn for the possibility of necrotizing enterocolitis (NEC). Which assessment findings should the nurse expect to find if NEC is confirmed? (Select all that apply.)
- A. Minimal gastric residual
- B. Abdominal distention
- C. Apnea
- D. Urinary output at 2 ml/kg/hr
Correct Answer: B
Rationale: Abdominal distention: NEC is characterized by abdominal distention due to gas and fluid accumulation in the intestines, leading to a bloated appearance of the abdomen.
A 6-year-old male child presented with a cerebellar mass; after undergoing complete surgical resection of the mass, the histology of the mass reveals pilocytic astrocytoma. Of the following, the MOST appropriate next step in the management is
- A. radiotherapy
- B. chemotherapy
- C. observation
- D. concomitant chemo-radiotherapy
Correct Answer: C
Rationale: Pilocytic astrocytomas are generally low-grade tumors, and observation is often sufficient after complete resection.
Mrs. Santos, a 75-year old patient with type II diabetes is in emergency department with signs of hyperglycemic, hyperosmolar nonketotic (HHNK) coma. What assessment finding should the nurse expect?
- A. Fruity odor of the breath
- B. shallow, deep respirations
- C. severe dehydration
- D. profuse sweating
Correct Answer: C
Rationale: In a patient with hyperglycemic, hyperosmolar nonketotic coma (HHNK), the high blood glucose levels lead to osmotic diuresis, causing excessive urination and subsequent dehydration. Dehydration can manifest as symptoms such as dry mucous membranes, poor skin turgor, decreased urine output, increased heart rate, and low blood pressure. Therefore, the nurse should expect to find signs of severe dehydration in a patient with HHNK coma. The other options listed are not typical assessment findings associated with HHNK coma.
What does nursing care of the newborn with oral candidiasis (thrush) include?
- A. Avoiding use of pacifier
- B. Removing characteristic white patches with a soft cloth
- C. Continuing medication for a prescribed number of days
- D. Applying medication to oral mucosa, being careful that none is ingested
Correct Answer: D
Rationale: Nursing care of the newborn with oral candidiasis (thrush) includes applying medication to the oral mucosa, being careful that none is ingested. This is because oral candidiasis is a fungal infection caused by Candida fungus, and treating it requires antifungal medication to effectively clear the infection. It is crucial to apply the medication directly to the affected oral mucosa to target and eliminate the fungus. Care must be taken to ensure that none of the medication is accidentally ingested by the newborn during the application process. This approach helps provide direct treatment to the affected area and promotes quicker resolution of oral thrush.