Nokea
Which finding should the nursing assistant report immediately for a patient with a fractured fibula receiving skeletal traction?
- A. The patient wants to change position in bed.
- B. There is redness around the pin sites.
- C. The patient asks for a glass of water.
- D. The patient mentions feeling hungry.
Correct Answer: B
Rationale: Redness around pin sites could indicate infection or poor circulation.
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Which of these patients in the neurologic ICU will be best to assign to an RN who has floated from the medical unit?
- A. A 26-year-old patient with a basilar skull fracture who has clear drainage coming out of the nose
- B. A 42-year-old patient admitted several hours ago with a headache and diagnosed with a ruptured berry aneurysm
- C. A 46-year-old patient who was admitted 48 hours ago with bacterial meningitis and has an antibiotic dose due
- D. A 65-year-old patient with an astrocytoma who has just returned to the unit after having a craniotomy
Correct Answer: C
Rationale: A stable patient receiving antibiotics is more appropriate for an RN floating from another unit.
The fifth cranial nerve supplies
- A. Temporalis
- B. Skin of the tip of the nose via the external nasal branch of the maxillary nerve
- C. Skin of the earlobe via the auriculotemporal nerve
- D. Skin over the occiput
Correct Answer: A
Rationale: The mandibular division (V3) of the trigeminal nerve supplies motor fibers to the temporalis muscle, which is involved in mastication. It also provides sensory innervation to the lower face.
Nurse Parker is overseeing the care of a patient with Parkinson's disease who has been consistently taking carbidopa/levodopa (Sinemet) for a year. She is attentively monitoring for any potential adverse reactions associated with this specific medication. Which adverse reaction should Nurse Parker be particularly vigilant about in monitoring this patient?
- A. The occurrence of dyskinesia.
- B. The emergence of respiratory depression.
- C. The onset of glaucoma.
- D. The development of a rash or other signs of an allergic reaction.
Correct Answer: A
Rationale: Dyskinesia, or involuntary movements, is a common adverse reaction to long-term levodopa therapy in PD patients.
What advice must the nurse give to prevent recurrence of insect bites?
- A. Prevent strenuous exercises by the client when outdoors.
- B. Apply insect repellant to clothing and exposed skin.
- C. Wear thick woolen clothing to cover the skin while outdoors.
- D. Avoid giving daily baths to the client with soaps.
Correct Answer: B
Rationale: Insect repellants are effective in preventing bites.
The job of the Nervous System is:
- A. to receive stimulus as sensory input.
- B. integration of stimulus with reaction.
- C. to trigger action as a motor response or motor output.
- D. All of the above.
Correct Answer: D
Rationale: The nervous system performs three primary functions: receiving sensory input, integrating and processing this input, and triggering motor responses. Sensory input involves detecting stimuli from the environment or within the body. Integration occurs in the brain and spinal cord, where information is processed. Motor output involves sending signals to muscles or glands to produce a response. Therefore, the nervous system's job encompasses all these functions, making 'All of the above' the correct answer.