When caring for a client diagnosed with a brain tumor of the parietal lobe, the nurse expects to assess:
- A. Short-term memory impairment.
- B. Seizures.
- C. Tactile agnosia.
- D. Contralateral homonymous hemianopia. Situation: The American cancer Society recommends routine screening to detect colorectal cancer.
Correct Answer: C
Rationale: The parietal lobe is responsible for processing sensory information, including touch and spatial awareness. Tactile agnosia is a condition where individuals have difficulty recognizing objects by touch, which can result from damage or tumors in the parietal lobe. The nurse caring for a client with a brain tumor in the parietal lobe would expect to assess for signs of tactile agnosia, as this type of sensory impairment is commonly associated with lesions in this area of the brain. Short-term memory impairment, seizures, and contralateral homonymous hemianopia are more commonly associated with lesions in different areas of the brain, such as the temporal lobes for memory, the frontal or temporal lobes for seizures, and the occipital lobe for visual field deficits, respectively.
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Which of the ff factors makes it important for the nurse to provide special care to older clients with an immune system disorder?
- A. Age-related changes
- B. Use of multiple drugs (Polypharmacy)
- C. Poor diet
- D. Reduced activity levels
Correct Answer: A
Rationale: Age-related changes contribute significantly to the vulnerability of older clients with an immune system disorder. As people age, their immune system undergoes various alterations that can compromise its effectiveness in fighting off infections and diseases. These changes include thymic involution (decrease in thymus size and function), decrease in T-cell production, impaired immune response to infections, and decline in overall immune function. Older individuals are more susceptible to infections due to these age-related changes, which makes it essential for nurses to provide special care tailored to their specific needs. By understanding and considering these age-related immune system changes, nurses can develop appropriate care plans to support the health and well-being of older clients with immune system disorders.
Olympic gymnast Ms. Slovenski sufferd a great fall and suffered a great fall and fractured her femur. Approximately after 20 hours in the hospital she became dyspneic, tachypneic, and with scattered crackles in her lung fields. She is coughing up large amounts of thick, white sputum. The nurse correctly interprets this as:
- A. respiratory compromise related to inhalation of smoke
- B. pneumonia related to prolonged bedrest
- C. fat embolism syndrome related to femur fracture
- D. hypovolemic shock related to multiple trauma
Correct Answer: C
Rationale: The symptoms described in the scenario - dyspnea, tachypnea, crackles in lung fields, and coughing up thick, white sputum - are indicative of fat embolism syndrome (FES), which occurs as a complication of long bone fractures like the femur fracture in this case. FES is characterized by the release of fat droplets into the bloodstream, which can then travel to the lungs and cause respiratory distress. The onset of symptoms typically occurs within 24-72 hours after the initial injury, making it a likely cause for Ms. Slovenski's condition. This is a medical emergency that requires prompt recognition and intervention to prevent further complications. The other options (A, B, and D) do not align with the clinical picture presented in the scenario and are less likely causes of her current symptoms.
The parents of a 12-month-old child ask the nurse whether the child can eat hot dogs. The nurse's reply should be based on which statement?
- A. Child is too young to digest hot dogs.
- B. Child is too young to eat hot dogs safely.
- C. Hot dogs must be sliced into sections to prevent aspiration.
- D. Hot dogs must be cut into small, irregular pieces to prevent aspiration.
Correct Answer: D
Rationale: The correct statement to guide the parents on feeding their 12-month-old child hot dogs is that the hot dogs must be cut into small, irregular pieces to prevent aspiration. Hot dogs are a high-risk choking hazard for young children due to their shape and texture. Cutting them into small, irregular pieces decreases the risk of choking as compared to slicing them into sections. It is essential to always supervise young children while they are eating to prevent choking incidents. So, the nurse should advise the parents to cut the hot dogs into small, irregular pieces to ensure the child's safety.
Joel's parents ask if-their other children will be affected by the disorder. Which of the following statements should guide the nurse in her response? a.All the girls will be normal and the other son a carrier
- A. All the girls will be carriers and one half the boys will be affected
- B. Each son has a chance of being affected and each daughter a 50% chance of being a carrier
- C. Each son has 50% chance of being affected or a carrier, and the girls will be all carriers.
Correct Answer: B
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
A blood sample for measurement of bilirubin is required from a newborn receiving phototherapy. In what environment should this blood sample be drawn?
- A. While phototherapy lights are turned off
- B. While newborn remains under phototherapy lights
- C. When newborn is covered with a blanket
- D. When newborn has been off phototherapy for 30 to 60 minutes
Correct Answer: D
Rationale: The blood sample for measurement of bilirubin should be drawn when the newborn has been off phototherapy for 30 to 60 minutes. The reason for this is that phototherapy can alter bilirubin levels through photoisomerization, making it challenging to interpret the results accurately while the newborn is still under the lights. Allowing a period of 30 to 60 minutes for the newborn to be off phototherapy helps to ensure that the bilirubin level obtained from the blood sample reflects a more accurate baseline level. This practice helps in guiding clinical management decisions related to managing hyperbilirubinemia in newborns.