Nokea
Which of the following nursing actions is appropriate when a patient returns to his or her room after a bronchoscopy?
- A. Order a meal because the patient has been nil per os (NPO) for 8 hours.
- B. Encourage fluids to flush dye from the patient's system.
- C. Monitor the patient for return to consciousness.
- D. Check for a gag reflex before allowing the patient to drink.
Correct Answer: D
Rationale: After a bronchoscopy procedure, it is essential to check for the presence of a gag reflex before allowing the patient to drink. This is crucial to prevent aspiration, as the gag reflex helps protect the airway by triggering swallowing and preventing foreign material from entering the lungs. Allowing the patient to drink without assessing the gag reflex could lead to serious complications such as aspiration pneumonia. Therefore, checking for the gag reflex is an appropriate nursing action to ensure the safety and well-being of the patient after a bronchoscopy.
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The nurse understands that labyrinthitis is treated primarily with which of the ff. drug categories?
- A. Antihistamines
- B. Anti-inflammatories
- C. Antispasmotics
- D. Antiemetics
Correct Answer: A
Rationale: Labyrinthitis is an inner ear disorder that is often caused by a viral infection. Antihistamines are commonly used in the treatment of labyrinthitis to help reduce symptoms such as dizziness, nausea, and vomiting. Antihistamines work by blocking the effects of histamine, which is a chemical in the body that can cause these symptoms. Additionally, antihistamines can help alleviate any associated allergies or inflammation in the inner ear that may be contributing to the condition. Other treatment options for labyrinthitis may include vestibular rehabilitation exercises, antiemetics for nausea and vomiting, and medications to manage dizziness.
The nurse is using calipers to measure skinfold thickness over the triceps muscle in a school- age child. What is the purpose of doing this?
- A. To measure body fat
- B. To measure muscle mass
- C. To determine arm circumference
- D. To determine accuracy of weight measurement
Correct Answer: A
Rationale: Skinfold thickness measurements using calipers are commonly used in assessing body composition, specifically to estimate body fat percentage. By measuring skinfold thickness over the triceps muscle in combination with measurements from other sites on the body, healthcare professionals can estimate the amount of subcutaneous fat present. This information is valuable in evaluating an individual's overall body composition and health status. The triceps skinfold measurement is a commonly included site in body fat calculations, especially in school-age children, where it can provide insights into growth and development.
A patient has cloudy penile discharge. For which additional symptoms of urethritis should the nurse assess?
- A. Throat or rectal infection
- B. Chancres or vesicles on the genitals
- C. Painful and frequent urination
- D. Oliguria and flank pain
Correct Answer: C
Rationale: Cloudy penile discharge is a common symptom of urethritis, which is inflammation of the urethra usually caused by an infection, such as a sexually transmitted infection (STI) like gonorrhea or chlamydia. Painful and frequent urination are also classic symptoms of urethritis. Painful urination, or dysuria, may occur due to the irritation and inflammation of the urethra. Frequency of urination can be a result of the body's response to the infection or inflammation. Therefore, assessing for these additional symptoms helps in confirming the diagnosis of urethritis and determining the appropriate treatment for the patient.
ahmed 2 months old come to emergency department with epistaxis and prolong PTT, clotting and bleeding time , what you suspect ahmed have :
- A. thalassemia
- B. hemophilia
- C. leukemia
- D. sickle anemia
Correct Answer: B
Rationale: Ahmed is presenting with epistaxis (nosebleed) and prolonged PTT (partial thromboplastin time), clotting time, and bleeding time, which are indicative of a bleeding disorder. Given the symptoms and lab findings, hemophilia is the most likely cause. Hemophilia is an inherited bleeding disorder characterized by deficiency or dysfunction of clotting factors, particularly Factor VIII (hemophilia A) or Factor IX (hemophilia B). Patients with hemophilia often present with spontaneous bleeding episodes, such as nosebleeds, bruising, and prolonged bleeding after injury or surgery. Thalassemia, leukemia, and sickle cell anemia are not associated with prolonged clotting times and bleeding presentations, making hemophilia the most appropriate choice in this scenario.
Which intervention should the nurse implement to maintain the skin integrity of the preterm newborn?
- A. Cleanse skin with a gentle alkaline-based soap and water.
- B. Cleanse skin with a neutral pH solution only when necessary.
- C. Thoroughly rinse skin with plain water after bathing in a mild hexachlorophene solution.
- D. Avoid cleaning skin.
Correct Answer: B
Rationale: Preterm newborns have delicate skin that is more susceptible to damage and irritation. Using a neutral pH solution for cleansing helps to maintain the skin's natural acidity and prevent disruption of the skin barrier. It is important to avoid over-bathing or using harsh alkaline-based soaps that can strip the skin of its natural oils and cause dryness or irritation. Cleansing the skin only when necessary helps to protect the fragile skin of preterm newborns and reduce the risk of skin breakdown or injury.