Nokea
Which individual is likely to have the best prognosis for recovery from his or her insult to the peripheral nervous system? An adult:
- A. client who developed rhabdomyolysis and ischemic injury after a tourniquet application.
- B. who suffered a bone-depth laceration to the shoulder during a knife attack.
- C. who had his forearm partially crushed by gears during an industrial accident.
- D. client who had nerves transected during surgery to remove a tumor from the mandible.
Correct Answer: C
Rationale: The correct answer is C. Crushing-type injuries to the peripheral nervous system generally have a better prognosis compared to nerve transections or lacerations. In the scenario provided, the individual who had his forearm partially crushed by gears during an industrial accident is likely to have a better chance of recovery compared to nerve transection (choice D) or laceration (choice B). Rhabdomyolysis and ischemic injury after tourniquet application (choice A) are not directly related to peripheral nerve injury and do not indicate a better prognosis for recovery.
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A patient with breast cancer is prescribed tamoxifen (Nolvadex). What key point should the nurse include in the patient education?
- A. Tamoxifen may increase the risk of venous thromboembolism.
- B. Tamoxifen may cause hot flashes and other menopausal symptoms.
- C. Tamoxifen may cause weight gain and fluid retention.
- D. Tamoxifen may decrease the risk of osteoporosis.
Correct Answer: A
Rationale: The correct answer is A: "Tamoxifen may increase the risk of venous thromboembolism." It is crucial for patients to be aware of the signs and symptoms of blood clots while taking tamoxifen. Choice B is incorrect because hot flashes and menopausal symptoms are common side effects of tamoxifen, but they are not the key point to emphasize. Choice C is incorrect as weight gain and fluid retention are potential side effects of tamoxifen but not the key point for patient education. Choice D is incorrect as tamoxifen does not decrease the risk of osteoporosis; in fact, it may increase the risk of bone loss.
Thrombocytopenia is which disorder below?
- A. Increased blood coagulation
- B. Increased platelet production
- C. Increased number of infections
- D. Decreased platelet production
Correct Answer: D
Rationale: Thrombocytopenia is a disorder characterized by a decreased platelet count or decreased platelet production, which affects blood clotting. Choice A, 'Increased blood coagulation,' is incorrect as thrombocytopenia is associated with decreased platelets, leading to impaired clotting. Choice B, 'Increased platelet production,' is incorrect as thrombocytopenia is characterized by a decrease in platelet production. Choice C, 'Increased number of infections,' is unrelated to thrombocytopenia, which primarily involves low platelet levels.
Which clients are at highest risk for pneumonia?
- A. Those in their 20s and 30s and generally healthy
- B. Those who exercise regularly and are not exposed to pathogens
- C. Those who are hospitalized and immunocompromised
- D. Those who have adequate respiratory function
Correct Answer: C
Rationale: Clients who are hospitalized and immunocompromised are at the highest risk for pneumonia due to their weakened immune systems. Choice A is incorrect as young and healthy individuals typically have stronger immune systems. Choice B is incorrect because regular exercise can actually boost the immune system and reduce the risk of infections. Choice D is incorrect as having adequate respiratory function does not necessarily correlate with the risk of developing pneumonia.
As you are walking in the park, a huge black Labrador runs up to you and places his paws on your shoulders. Immediately your heart starts racing, you feel palpitations, anxiety, and your hands become a little shaky. The nurse knows that this response is primarily caused by:
- A. cerebral cortex.
- B. somatic nervous system.
- C. limbic system.
- D. autonomic nervous system.
Correct Answer: D
Rationale: The autonomic nervous system controls involuntary bodily functions like heart rate, respiration, and sweating. In the given scenario, the 'fight or flight' response is activated, leading to increased heart rate, palpitations, anxiety, and shaky hands. The cerebral cortex is involved in conscious thought processes and decision-making, not the immediate physiological response observed here. The somatic nervous system regulates voluntary movements, while the limbic system is responsible for emotions and memory, but the autonomic nervous system is primarily responsible for the physiological responses seen in this situation.
A patient is hospitalized due to nonadherence to an antitubercular drug treatment. Which of the following is most important for the nurse to do?
- A. Observe the patient taking the medications.
- B. Administer the medications parenterally.
- C. Instruct the family on the medication regimen.
- D. Count the number of tablets in the bottle daily.
Correct Answer: A
Rationale: In this scenario, the most crucial action for the nurse to take is to observe the patient taking the medications. This ensures that the patient is actually consuming the prescribed antitubercular drugs, addressing the issue of nonadherence directly. Administering the medications parenterally (intravenously or intramuscularly) is not necessary unless there are specific medical reasons requiring this route of administration. Instructing the family on the medication regimen is important for support but may not directly address the patient's nonadherence. Counting the number of tablets in the bottle daily is not as effective as directly observing the patient taking the medications to ensure compliance.