Nokea
Which of the following conditions is associated with a positive Homan's sign?
- A. Deep vein thrombosis
- B. Peripheral artery disease
- C. Varicose veins
- D. Lymphedema
Correct Answer: A
Rationale: A positive Homan's sign is indicative of deep vein thrombosis. This sign is elicited by dorsiflexing the foot of a patient with the knee slightly flexed, resulting in calf pain. Peripheral artery disease (choice B) is associated with decreased blood flow to the extremities, but it does not produce a positive Homan's sign. Varicose veins (choice C) are enlarged, twisted veins that are typically not related to Homan's sign. Lymphedema (choice D) is swelling caused by a lymphatic system blockage or dysfunction and is not linked to Homan's sign.
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A 70-year-old woman has difficulty with driving, and she has been frequently getting lost. Her husband said she has also been acting strangely and seems to want to sleep a lot. He said the other night she kept saying she was seeing animals such as lions in her room. He says her memory is not too bad, but he is very concerned about her health. Physical examination reveals an alert woman with stable vital signs. Bradykinesia and limb rigidity are noted. These findings are consistent with:
- A. Alzheimer's disease.
- B. vascular dementia.
- C. dementia with Lewy bodies.
- D. frontotemporal dementia.
Correct Answer: C
Rationale: The correct answer is dementia with Lewy bodies (DLB). Hallucinations, parkinsonian symptoms (like bradykinesia and limb rigidity), and fluctuating cognition are characteristic of DLB. Alzheimer's disease (Choice A) typically presents with memory loss as a prominent feature. Vascular dementia (Choice B) is associated with a history of strokes and step-wise cognitive decline. Frontotemporal dementia (Choice D) often presents with changes in behavior and personality rather than the parkinsonian symptoms seen in this case.
Which of the following is not included in the care plan of a client with moderate cognitive impairment involving dementia of the Alzheimer's type?
- A. Daily structured schedule
- B. Positive reinforcement for performing activities of daily living
- C. Stimulating environment
- D. Use of validation techniques
Correct Answer: C
Rationale: In the care plan for a client with moderate cognitive impairment involving Alzheimer's type dementia, a stimulating environment is not included as it can potentially increase confusion. Therefore, it is important to provide a familiar, structured, and predictable environment to reduce stress and disorientation. Daily structured schedules help in maintaining routine and familiarity, positive reinforcement encourages engagement in activities, and validation techniques help in communicating effectively with the client by acknowledging their feelings and reality orientation.
A patient presents with a sudden onset of severe chest pain radiating to his back. His blood pressure is significantly higher in the right arm than in the left arm. Which of the following conditions is most likely?
- A. Acute myocardial infarction
- B. Pulmonary embolism
- C. Aortic dissection
- D. Pericarditis
Correct Answer: C
Rationale: The correct answer is C, aortic dissection. Aortic dissection is characterized by sudden, severe chest pain that can radiate to the back. The discrepancy in blood pressure between the arms (higher in the right arm) is known as a 'pulse deficit' and is a classic finding in aortic dissection. This condition involves a tear in the inner layer of the aorta, leading to the abnormal flow of blood within the aortic wall. Acute myocardial infarction (choice A) presents with chest pain but typically does not cause discrepancies in blood pressure between arms. Pulmonary embolism (choice B) usually presents with chest pain and difficulty breathing but does not cause unequal blood pressures in the arms. Pericarditis (choice D) can cause chest pain exacerbated by breathing or lying down, but it does not typically lead to differences in blood pressure between arms.
Joseph, a 12-year-old child, complains to the school nurse about nausea and dizziness. While assessing the child, the nurse notices a black eye that looks like an injury. This is the third time in 1 month that the child has visited the nurse. Each time, the child provides vague explanations for various injuries. Which of the following is the school nurse's priority intervention?
- A. Contact the child's parents and ask about the child's injuries.
- B. Encourage the child to be honest about the injuries.
- C. Question the teacher about the child's injuries.
- D. Report suspicion of abuse to the proper authorities.
Correct Answer: D
Rationale: The school nurse's priority intervention in this situation is to report suspicion of abuse to the proper authorities. Given the pattern of unexplained injuries and vague explanations provided by the child, it raises significant concerns for possible abuse. Reporting to the appropriate authorities is crucial to ensure the child's safety and well-being. Contacting the child's parents (Choice A) may not be appropriate if abuse is suspected, as it could potentially put the child at further risk. Merely encouraging the child to be honest (Choice B) does not address the immediate safety concerns. Questioning the teacher (Choice C) is not the appropriate initial action when abuse is suspected; reporting to authorities should take precedence.
A hemoglobin electrophoresis is done to evaluate for sickle cell disease. The report reveals the person has HbAS, which means the person:
- A. is normal with no sickle cell disease.
- B. is a sickle cell carrier.
- C. has sickle cell anemia.
- D. has thalassemia.
Correct Answer: B
Rationale: HbAS indicates sickle cell trait, not full-blown sickle cell anemia. Choice A is incorrect because HbAS indicates the presence of the sickle cell trait. Choice C is incorrect as sickle cell anemia is characterized by HbSS, not HbAS. Choice D is incorrect as thalassemia is a different type of hemoglobin disorder not indicated by HbAS.