Nokea
When a child jumps out of the tub, crying and stating her feet are 'burning,' what pathophysiologic principle is responsible for this response?
- A. Pain receptors (nociceptors) have been activated in response to a thermal stimulus.
- B. The child's skin thermal receptors have undergone adaptation.
- C. The child is exhibiting a psychogenic pain response due to anxiety.
- D. The child is experiencing a conditioned pain response based on previous experiences.
Correct Answer: A
Rationale: The child's reaction is due to the activation of nociceptors, which are pain receptors that respond to thermal stimuli. This response is an immediate protective mechanism to prevent tissue damage caused by extreme temperatures. Option B is incorrect because adaptation does not explain the child's immediate and intense response. Option C is incorrect as there is a clear physical stimulus present, ruling out a psychogenic response. Option D is incorrect as the child's response is not based on previous experiences but rather on the current thermal stimulus.
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A client presents to the emergency department with complaints of chest pain and shortness of breath. The client's ECG shows ST-segment elevation. What is the priority nursing intervention?
- A. Administer aspirin as prescribed.
- B. Prepare the client for emergent coronary angiography.
- C. Administer oxygen therapy.
- D. Initiate CPR.
Correct Answer: B
Rationale: In a client presenting with chest pain, shortness of breath, and ST-segment elevation on ECG, the priority nursing intervention is to prepare the client for emergent coronary angiography. This procedure is crucial in diagnosing and treating acute myocardial infarction promptly. Administering aspirin (Choice A) is important but not the priority over emergent coronary angiography. Administering oxygen therapy (Choice C) is supportive but does not address the underlying cause of the ST-segment elevation. Initiating CPR (Choice D) is not the priority in this scenario as the client is stable and conscious.
A patient is found to have liver disease, resulting in the removal of a lobe of his liver. Adaptation to the reduced size of the liver leads to ___________ of the remaining liver cells.
- A. Metaplasia
- B. Organ atrophy
- C. Compensatory hyperplasia
- D. Physiologic hyperplasia
Correct Answer: C
Rationale: Compensatory hyperplasia is the process by which the remaining cells increase in number to adapt to the reduced size of the liver. In this case, after the removal of a lobe of the liver, the remaining cells undergo compensatory hyperplasia to compensate for the lost tissue. Metaplasia refers to the reversible change of one cell type to another, not an increase in cell number. Organ atrophy is the decrease in organ size due to cell shrinkage or loss, which is opposite to an increase in cell number seen in compensatory hyperplasia. Physiologic hyperplasia is the increase in cell number in response to a normal physiological demand, not specifically due to the removal of a portion of the organ.
A male patient is concerned about the risk of prostate cancer while receiving finasteride (Proscar) for benign prostatic hyperplasia (BPH). What should the nurse explain about this risk?
- A. Finasteride has been shown to lower the risk of developing prostate cancer.
- B. Finasteride has no effect on the risk of developing prostate cancer.
- C. Finasteride may increase the risk of developing prostate cancer, so regular screening is important.
- D. Finasteride does not affect the risk of prostate cancer, so regular screening is unnecessary.
Correct Answer: A
Rationale: The correct answer is A. Finasteride has been shown to lower the risk of developing prostate cancer. Studies have demonstrated that finasteride can reduce the incidence of prostate cancer. However, it is still recommended to have regular screening to monitor for any potential issues. Choice B is incorrect as finasteride has shown to have a positive effect on reducing prostate cancer risk. Choice C is inaccurate because finasteride decreases, not increases, the risk of prostate cancer. Choice D is incorrect as regular screening is still necessary despite the risk reduction associated with finasteride.
A patient suffers from an autoimmune disorder. Which of the following represents a potential result of a viral infection in a patient with an autoimmune disorder?
- A. Lymphocytes recognize the host's tissue as foreign.
- B. Erythrocytes destroy the T cells of the host.
- C. The involution of the thymus gland increases the risk of infection.
- D. The differential decreases the sedimentation rate.
Correct Answer: A
Rationale: In a patient with an autoimmune disorder, a viral infection can trigger an immune response where lymphocytes mistakenly recognize the host's tissue as foreign. This can lead to an exacerbation of the autoimmune condition. Choice B is incorrect because erythrocytes are not responsible for destroying T cells. Choice C is incorrect as thymus involution weakens the immune response, making the patient more susceptible to infections rather than increasing the infection risk. Choice D is unrelated to the potential effects of a viral infection in a patient with an autoimmune disorder.
The nurse is closely following a patient who began treatment with testosterone several months earlier. When assessing the patient for potential adverse effects of treatment, the nurse should prioritize which of the following assessments?
- A. Skin inspection for developing lesions
- B. Lung function testing
- C. Assessment of serum calcium levels
- D. Assessment of arterial blood gases
Correct Answer: C
Rationale: In patients receiving testosterone therapy, the nurse should prioritize assessing serum calcium levels. Testosterone therapy can lead to hypercalcemia, making the evaluation of serum calcium levels crucial. Skin inspection for developing lesions, lung function testing, and arterial blood gas assessment are not the priority assessments for potential adverse effects of testosterone therapy. Skin inspection may be relevant for dermatological side effects, lung function testing and arterial blood gas assessment are not directly related to the common side effects of testosterone therapy.