Nokea
Which finding indicates a properly functioning ileal conduit?
- A. Clear urine output.
- B. Mucus in the urine.
- C. Dry stoma site.
- D. No urine output.
Correct Answer: B
Rationale: Mucus in the urine is normal due to the intestinal segment used in the conduit.
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Peripheral blood flow is dependent on which of the following variables?
- A. Blood viscosity and diameter of vessels
- B. Diameter and resistance of vessels
- C. Force of contraction of the heart and resistance of vessels
- D. Pressure differences in the arterial and venous systems and resistance
Correct Answer: D
Rationale: Peripheral blood flow depends on pressure differences between the arterial and venous systems (driving force) and vascular resistance (opposing force). This relationship is governed by Poiseuille's law and Ohm's law for fluid flow, where flow is proportional to the pressure gradient and inversely proportional to resistance. The other options are incomplete or incorrect combinations of factors.
A 70-year-old female is scheduled to undergo mitral valve replacement for severe mitral stenosis and mitral regurgitation. Although the diagnosis was made during childhood, she did not have symptoms until 4 years ago. Recently, she noticed increased symptoms, despite daily doses of digoxin and furosemide. During the initial interview with the client, the nurse would most likely learn that the client's childhood health history included:
- A. Chickenpox.
- B. Poliomyelitis.
- C. Rheumatic fever.
- D. Meningitis.
Correct Answer: C
Rationale: Rheumatic fever in childhood is a common cause of mitral valve disease, leading to stenosis or regurgitation later in life.
The client's wife asks the nurse whether the I.V. infusion is meeting her husband's nutritional needs because he has vomited several times. The nurse's response should be based on the knowledge that 1 L of 5% dextrose in normal saline solution delivers:
- A. 170 calories.
- B. 250 calories.
- C. 340 calories.
- D. 500 calories.
Correct Answer: A
Rationale: One liter of 5% dextrose provides 50 g of dextrose, yielding approximately 170 calories, insufficient for full nutritional needs.
The nurse explains to the client that a biopsy of the enlarged lymph node is important because, if Hodgkin's disease is present, the histologic examination will reveal which of the following?
- A. Tay-Sachs cells.
- B. Reed-Sternberg cells.
- C. Duchenne's cells.
- D. None of the above
Correct Answer: B
Rationale: Hodgkin's disease is diagnosed by the presence of Reed-Sternberg cells, large multinucleated cells, in the lymph node biopsy. Tay-Sachs and Duchenne's cells are unrelated to Hodgkin's.
A client who was in a motor vehicle accident has a fractured mandible. Surgery has been performed to immobilize the injury by wiring the jaw. In the immediate postoperative phase, the nurse should:
- A. Prevent nausea and vomiting.
- B. Maintain a patent airway.
- C. Provide frequent oral hygiene.
- D. Establish a way for the client to communicate.
Correct Answer: B
Rationale: Maintaining a patent airway is the priority in the immediate postoperative phase for a client with a wired jaw, as swelling or secretions could obstruct the airway. While the other interventions are important, airway management is the most critical.