Nokea
What should the nurse plan to teach about to a patient with Crohn's disease who has megaloblastic anemia?
- A. Iron dextran infusions
- B. Oral ferrous sulfate tablets
- C. Routine blood transfusions
- D. Cobalamin (B ) supplements
Correct Answer: D
Rationale: The correct answer is D: Cobalamin (B ) supplements. Patients with Crohn's disease often have malabsorption issues leading to megaloblastic anemia due to vitamin B12 deficiency. Cobalamin supplements are essential for treating such anemia. Iron dextran infusions (A) and oral ferrous sulfate tablets (B) are used to treat iron deficiency anemia, not megaloblastic anemia. Routine blood transfusions (C) do not address the underlying cause of megaloblastic anemia in Crohn's disease.
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A two-week-old boy develops persistent projectile vomiting. The most likely diagnosis is:
- A. pyloric stenosis
- B. esophageal atresia
- C. annular pancreas
- D. incomplete rotation of the gut
Correct Answer: A
Rationale: The correct answer is A: pyloric stenosis. In pyloric stenosis, there is hypertrophy of the pyloric sphincter muscle, leading to gastric outlet obstruction and projectile vomiting. This typically presents in infants around 2-6 weeks of age. Other choices (B) esophageal atresia presents with difficulty feeding and choking, (C) annular pancreas with duodenal obstruction, and (D) incomplete rotation of the gut with volvulus or obstruction due to malrotation. Pyloric stenosis is the most likely diagnosis in this scenario based on the age of the infant and the symptom of projectile vomiting.
To evaluate the effect of nutritional interventions for a patient with protein-calorie malnutrition, what is the best indicator for the nurse to use?
- A. Height and weight
- B. Weight in relation to ideal body weight
- C. Body mass index (BMI)
- D. Mid-upper arm circumference and triceps skinfold
Correct Answer: D
Rationale: The correct answer is D. Mid-upper arm circumference and triceps skinfold are commonly used indicators to assess muscle and fat reserves in individuals with protein-calorie malnutrition. Mid-upper arm circumference reflects muscle mass, while triceps skinfold measures body fat. These indicators provide a comprehensive assessment of the patient's nutritional status, making them the best choice for evaluating the effectiveness of nutritional interventions.
A: Height and weight do not provide a specific assessment of muscle and fat reserves and may not accurately reflect changes in nutritional status.
B: Weight in relation to ideal body weight does not differentiate between muscle and fat mass, making it less specific for assessing protein-calorie malnutrition.
C: BMI is a general indicator of weight status and does not specifically measure muscle and fat reserves, making it less suitable for evaluating nutritional interventions in patients with protein-calorie malnutrition.
In planning a treatment and prevention program of chronic fecal incontinence for an elderly client, which intervention should you try first?
- A. Administer a glycerin suppository 15 minutes before evacuation time.
- B. Insert a rectal tube at specified intervals each day.
- C. Assist the client to the bedpan or toilet 30 minutes after meals.
- D. Use incontinence briefs or adult-sized diapers.
Correct Answer: C
Rationale: The correct answer is C: Assist the client to the bedpan or toilet 30 minutes after meals. This intervention is appropriate as it aligns with the natural physiological process of bowel movements after meals, increasing the likelihood of successful evacuation. This timing can help establish a routine and promote regular bowel movements, potentially reducing episodes of fecal incontinence.
Choice A is incorrect because administering a glycerin suppository may not address the underlying cause of fecal incontinence and may not promote regular bowel movements. Choice B is incorrect as inserting a rectal tube is an invasive intervention that should only be considered after less invasive methods have been exhausted. Choice D is incorrect as using incontinence briefs or adult-sized diapers only manages the symptoms without addressing the root cause or promoting bowel regularity.
Which enzyme is responsible for breaking down proteins in the stomach?
- A. Amylase
- B. Protease
- C. Lipase
- D. Pepsin
Correct Answer: D
Rationale: Pepsin is the correct answer as it is the enzyme specifically produced by gastric chief cells in the stomach to break down proteins into peptides. It works optimally in the acidic environment of the stomach. Amylase (choice A) breaks down carbohydrates, protease (choice B) refers to a general term for enzymes that break down proteins, and lipase (choice C) breaks down fats, making them incorrect for this question.
Which female patient is most likely to have metabolic syndrome?
- A. BP 128/78 mm Hg, triglycerides 160 mg/dL, fasting blood glucose 102 mg/dL
- B. BP 142/90 mm Hg, high-density lipoproteins 45 mg/dL, fasting blood glucose 130 mg/dL
- C. Waist circumference 36 in, triglycerides 162 mg/dL, high-density lipoproteins 55 mg/dL
- D. Waist circumference 32 in, high-density lipoproteins 38 mg/dL, fasting blood glucose 122 mg/dL
Correct Answer: B
Rationale: The correct answer is B because the patient's blood pressure, HDL levels, and fasting blood glucose levels all indicate a higher likelihood of metabolic syndrome. High blood pressure, low HDL levels, and elevated blood glucose are key components of metabolic syndrome.
Option A has normal blood pressure and slightly elevated triglycerides and blood glucose, but not as concerning as choice B.
Option C has a normal blood pressure, slightly elevated triglycerides, and good HDL levels, which lowers the likelihood of metabolic syndrome.
Option D has a normal blood pressure, very low HDL levels, and slightly elevated blood glucose, but the blood pressure is not in the hypertensive range as in choice B.