Nokea
Which of the following isoenzymes is elevated in a client who has had a myocardial infarction?
- A. CPK-BB
- B. CPK-MM
- C. CPK-MB
- D. CPK-MI
Correct Answer: C
Rationale: CPK-MB is elevated in clients who have had a myocardial infarction. CPK-BB is elevated in clients who have brain damage, and CPK-MM is elevated in clients who have skeletal muscle damage. CPK-MI does not exist.
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A client is taking hydrocodone (Vicodin) for chronic back pain. The client has required an increase in the dose and asks whether this means he is addicted to Vicodin. The nurse should base her reply on the knowledge that:
- A. the client's body has developed tolerance, requiring more drug to produce the same effect
- B. the client is preoccupied with getting the drug and is experiencing loss of control, indicating drug dependence
- C. addiction involves psychological behaviors related to substance use, not just physical dependence
- D. the client is coping with chronic back pain and requires adjustments in the medication regimen
Correct Answer: A
Rationale: When a client requires an increased dose of a drug, such as in this case with hydrocodone, it suggests that the body has developed tolerance to the medication. Tolerance means that the client needs more of the drug to achieve the same effect as before. This does not inherently indicate addiction, which involves psychological behaviors related to substance use. Choice B describes drug dependence, where the client is preoccupied with obtaining the drug and experiences loss of control, which is not the same as tolerance. Choice C correctly points out that addiction is more than just physical dependence with withdrawal symptoms and tolerance; it includes psychological factors. Choice D is irrelevant as it discusses adjusting the medication for pain management, not addressing the client's concern about addiction.
A 10-month-old child is brought to the Emergency Department because he is difficult to awaken. The nurse notes bruises on both upper arms. These findings are most consistent with
- A. wearing clothing that is too small for the child
- B. the child being shaken
- C. falling while learning to walk
- D. parents trying to awaken the child
Correct Answer: B
Rationale: The correct answer is 'the child being shaken.' Children who are shaken are frequently grasped by both upper arms, leading to bruises in that area. The presentation of a difficult-to-awaken child with bruises on the upper arms is highly concerning for non-accidental trauma, such as abusive shaking. Symptoms of brain injury associated with shaking include a decreased level of consciousness. Choices A, C, and D are less likely because the combination of a child being difficult to awaken and bruises on both upper arms is highly suggestive of non-accidental trauma rather than benign causes like ill-fitting clothing, falling while learning to walk, or parents trying to awaken the child.
What are the three major sequential maturational crises for females?
- A. puberty, pregnancy, and menopause.
- B. death of a spouse, menopause, and childbirth.
- C. rape, divorce, and menarche.
- D. dating, engagement, and separation.
Correct Answer: A
Rationale: The three major sequential maturational crises affecting females are puberty, pregnancy, and menopause. Puberty signifies the beginning of menarche, the first menstrual period. Pregnancy is a transformative experience with long-lasting effects on a woman's life. Menopause marks the end of menstrual cycles. These milestones are well-documented in research and are significant events in a woman's life. Nurses play a vital role in supporting females through these stages. Choices B, C, and D are incorrect as they do not accurately represent the recognized sequential maturational crises in a female's life.
A central venous pressure reading of 11 cm/H(2)0 of an IV of normal saline is determined by the nurse caring for the patient. The patient has a diagnosis of pericarditis. Which of the following is the most applicable:
- A. The patient has a condition of hypovolemia.
- B. Not enough fluid has been given to the patient.
- C. Pericarditis may cause pressures greater than 10 cm/H(2)0 with testing of CVP.
- D. The patient may have a condition of arteriosclerosis.
Correct Answer: C
Rationale: >10 cm/H(2)0 may indicate a condition of pericarditis.
A hospitalized client has just been informed that he has terminal cancer. He says to the nurse, 'There must be some mistake in the diagnosis.' The nurse determines that the client is demonstrating which of the following?
- A. denial
- B. anger
- C. bargaining
- D. acceptance
Correct Answer: A
Rationale: The correct answer is denial. In this scenario, the client's statement indicates denial, which is a common reaction in Kübler-Ross's Stages of Grieving. Denial involves the refusal to accept or believe that a loss, such as a terminal illness diagnosis, is happening. Choices B, C, and D are incorrect: Anger involves feelings of resentment or frustration; Bargaining is an attempt to negotiate or make deals to avoid the situation; Acceptance is the final stage where the individual comes to terms with the reality of the situation.