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When assessing a 7-year-old child's pain after an emergency appendectomy, what is the most appropriate tool for the nurse to use?
- A. Use a visual analog scale (VAS) to assess the pain.
- B. Ask the child to rate their pain on a scale of 0 to 10.
- C. Use the Wong-Baker FACES scale to assess the pain.
- D. Ask the parents to describe the child's pain behavior.
Correct Answer: C
Rationale: The correct answer is to use the Wong-Baker FACES scale to assess the child's pain. This scale is specifically designed for children and uses facial expressions of varying intensities to help them communicate their pain levels effectively. Choices A and B may not be as suitable for a young child who may have difficulty understanding or using a numerical scale. Choice D involving parents may not provide an accurate reflection of the child's pain experience, as it is essential to assess the child's self-reporting.
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A patient with a history of venous thromboembolism is being considered for hormone replacement therapy (HRT). What should the nurse discuss with the patient regarding the risks of HRT?
- A. Discuss the potential for increased bone density.
- B. Discuss the potential for an increased risk of cardiovascular events.
- C. Discuss the potential for a reduced risk of breast cancer.
- D. Discuss the potential for improved mood and energy levels.
Correct Answer: B
Rationale: The correct answer is B because hormone replacement therapy (HRT) is associated with an increased risk of cardiovascular events, including venous thromboembolism. Patients with a history of venous thromboembolism are at higher risk, so discussing this potential risk is crucial. Choice A, increased bone density, is not a major risk of HRT. Choice C, reduced risk of breast cancer, is not a common discussion point regarding HRT risks. Choice D, improved mood and energy levels, is more related to the benefits of HRT rather than its risks.
A 44-year-old man presents with muscle weakness and fatigue. He states that he has experienced difficulty climbing stairs and even holding his arms up to comb his hair. Which test is most likely to help confirm the diagnosis?
- A. Electromyography (EMG)
- B. Nerve conduction studies
- C. Muscle biopsy
- D. Blood test for autoantibodies
Correct Answer: A
Rationale: The correct answer is Electromyography (EMG). EMG is commonly used to diagnose conditions involving muscle weakness and fatigue, such as myasthenia gravis. Nerve conduction studies primarily assess nerve function rather than muscle involvement. While a muscle biopsy can provide valuable information, EMG is more specific for evaluating muscle function in this context. A blood test for autoantibodies may be helpful in certain autoimmune conditions but is not the primary test for confirming the diagnosis based on the patient's symptoms of muscle weakness and fatigue.
When reviewing the purpose/action of neurotransmitters as they interact with different receptors, the nursing instructor gives an example using acetylcholine. When acetylcholine is released at the sinoatrial node in the right atrium of the heart, it is:
- A. positively charged.
- B. inhibitory.
- C. overstimulated.
- D. dormant.
Correct Answer: B
Rationale: Acetylcholine acts as an inhibitory neurotransmitter at the sinoatrial node. It slows down the heart rate by decreasing the firing rate of the sinoatrial node, which serves as the heart's natural pacemaker. Neurotransmitters do not have a charge, so choice A is incorrect. Choice C is wrong as overstimulation is not a characteristic of acetylcholine at the sinoatrial node. Choice D is also incorrect because acetylcholine actively influences heart rate regulation when released at the sinoatrial node.
How are antibodies produced?
- A. B cells
- B. T cells
- C. Helper cells
- D. Memory cells
Correct Answer: A
Rationale: Antibodies are produced by B cells. B cells are specialized white blood cells that generate antibodies as part of the immune response. B cells differentiate into plasma cells that secrete antibodies. T cells play a role in cell-mediated immunity, not antibody production. Helper cells, or helper T cells, assist in activating B cells but do not directly produce antibodies. Memory cells store information about previous infections but do not actively produce antibodies.
How can a colony-stimulating factor affect the patient's erythrocyte count?
- A. It stimulates the growth of red blood cells.
- B. It suppresses T-cell production.
- C. It inhibits protein synthesis.
- D. It stimulates antibody production.
Correct Answer: A
Rationale: Colony-stimulating factors are substances that stimulate the production of blood cells in the bone marrow. Erythrocytes are red blood cells, so a colony-stimulating factor would specifically stimulate the growth of red blood cells, leading to an increase in the patient's erythrocyte count. Choice B is incorrect because colony-stimulating factors do not suppress T-cell production. Choice C is incorrect because colony-stimulating factors do not inhibit protein synthesis. Choice D is incorrect because colony-stimulating factors do not stimulate antibody production; they primarily affect the production of blood cells.