Which finding is an early indicator of bladder cancer?
- A. Painless hematuria
- B. Nocturia
- C. Occasional polyuria
- D. Dysuria
Correct Answer: A
Rationale: Painless hematuria, which is the presence of blood in the urine without any associated pain, is an early indicator of bladder cancer. This symptom is often one of the first signs of this type of cancer and should be promptly evaluated by a healthcare provider. It is crucial not to ignore the presence of blood in the urine, as it can indicate various underlying conditions, including bladder cancer. While other symptoms like Nocturia (waking up at night to urinate), Occasional polyuria (increased urination), and Dysuria (painful urination) can also occur with bladder cancer, painless hematuria is a significant red flag for the disease.
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Prenatal changes associated with maternal diabetes include all the following EXCEPT
- A. shorter birth length
- B. lower neonatal neurodevelopmental status
- C. reduced milk production of the most times
- D. increased neonatal learning problems
Correct Answer: C
Rationale: Reduced milk production is not directly associated with maternal diabetes.
The nurse is assigned to a client with polymyositis. Which expected outcome in the plan of care relates to a potential problem associated with polymyositis?
- A. "Client will lose 2lb per week on a calorie-restricted diet."
- B. "Client will exhibit no signs or symptoms of aspiration."
- C. "Client will exhibit bowel and bladder continence."
- D. "Client will exhibit alertness and orientation to person, place, and time."
Correct Answer: B
Rationale: Polymyositis is a condition that involves inflammation of the muscles, including the muscles involved in swallowing (dysphagia) and breathing. This can lead to a higher risk of aspiration, where food or fluids go into the airway instead of the esophagus. Therefore, monitoring for signs and symptoms of aspiration and ensuring the client exhibits no signs of aspiration are crucial in the care of a client with polymyositis. The other options are not directly related to the potential problems associated with polymyositis and are more general aspects of nursing care.
A 5-year-old girl is having a checkup before starting kindergarten. The nurse asks her to do the "finger-to-nose" test. What is the nurse testing for?
- A. Deep tendon reflexes
- B. Cerebellar function
- C. Sensory discrimination
- D. Ability to follow directions
Correct Answer: B
Rationale: The nurse is testing the girl's cerebellar function by asking her to do the "finger-to-nose" test. The cerebellum is the part of the brain that plays a crucial role in coordinating movement, balance, and posture. In the finger-to-nose test, the child is asked to touch her own nose and then the nurse's finger repeatedly. A properly functioning cerebellum helps control and coordinate these precise movements. If there are issues with the cerebellar function, the child might have difficulty performing this task accurately, indicating a potential problem with motor coordination and balance.
A baby is born temporarily immune to the diseases to which the mother is immune. The nurse understands that this is an example of which of the following types of immunity?
- A. Naturally acquired passive immunity
- B. Naturally acquired active immunity
- C. Artificially acquired passive immunity
- D. Artificially acquired active immunity
Correct Answer: A
Rationale: In the scenario described, the baby is born with temporary immunity to diseases that the mother is immune to. This is an example of naturally acquired passive immunity, where the baby receives preformed antibodies from the mother, providing immediate protection against certain diseases. This type of immunity is passive because the baby did not produce the antibodies themselves, and it is naturally acquired as it occurs through the transfer of antibodies from the mother to the baby during pregnancy.
A hospitalized client has the following blood lab values: WBC 3,000/ul, RBC 5.0 (X 106), platelets 300, 000, what would be a priority nursing intervention?
- A. Preventing infection
- B. Alleviating pain
- C. Controlling infection
- D. Monitoring blood transfusion reactions
Correct Answer: A
Rationale: With a WBC count of 3,000/ul (indicating leukopenia or low white blood cell count), the priority nursing intervention should be preventing infection. Leukopenia puts the client at a higher risk of developing infections due to a compromised immune system. Nurses should focus on implementing strict infection control measures, such as hand hygiene, maintaining a sterile environment, and promoting vaccination compliance to reduce the risk of infection for the hospitalized client. This intervention is crucial for ensuring the client's safety and well-being during their hospital stay. Alleviating pain, controlling infection, and monitoring blood transfusion reactions are important aspects of care but in this scenario, preventing infection takes precedence due to the client's low WBC count.