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Which of these individuals would the nurse suspect as having the greatest risk of contracting Hepatitis B?
- A. A sexually active 45-year-old man who has Type 1 Diabetes
- B. A 75-year-old woman who lives in a crowded nursing home
- C. A child who lives in a country with poor sanitation and hygiene standards
- D. A sexually active 23-year-old man who works in a hospital
Correct Answer: D
Rationale: The correct answer is a sexually active 23-year-old man who works in a hospital. This individual is at the highest risk of contracting Hepatitis B due to exposure in a healthcare setting where potential bloodborne pathogens are present. Being sexually active also increases the risk of transmission through sexual contact. Choice A, a 45-year-old man with Type 1 Diabetes, is not directly associated with an increased risk of Hepatitis B. Choice B, a 75-year-old woman living in a crowded nursing home, is at risk for other infections due to the living environment but not specifically for Hepatitis B. Choice C, a child in a country with poor sanitation, is more at risk for water or foodborne illnesses rather than Hepatitis B transmission.
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Which of the following factors may alter the level of consciousness in a patient?
- A. Alcohol
- B. Electrolytes
- C. Infection
- D. All of the above may cause altered level of consciousness
Correct Answer: D
Rationale: Various factors can lead to altered levels of consciousness in a patient. Alcohol consumption can depress the central nervous system and cause changes in consciousness. Electrolyte imbalances, such as hyponatremia or hypernatremia, can disrupt brain function and affect consciousness. Infections, especially those affecting the brain like encephalitis, can also lead to alterations in consciousness. Therefore, all of the choices provided - Alcohol, Electrolytes, and Infection - can potentially cause changes in the level of consciousness. Remember the acronym AEIOU-TIPPS to recall common causes of decreased level of consciousness, including Alcohol, Electrolytes, and Infection, among others.
What drives respiration in a patient with advanced chronic respiratory failure?
- A. Hypoxemia
- B. Hypocapnia
- C. Hypercapnia
- D. None of the above
Correct Answer: A
Rationale: In patients with advanced chronic respiratory failure, such as those with chronic obstructive pulmonary disease (COPD), the respiratory drive shifts from being primarily stimulated by high levels of carbon dioxide (hypercapnia) to being driven by low oxygen levels (hypoxemia). This shift is due to the body's adaptation to chronic respiratory acidosis and hypoxemia. As a result, hypoxemia becomes the primary stimulus for respiration in these patients. Hypocapnia, a low level of carbon dioxide, is not a common driver of respiration in patients with advanced chronic respiratory failure. Therefore, the correct answer is hypoxemia.
While planning care for a 2-year-old hospitalized child, which situation would the nurse expect to most likely affect the behavior?
- A. Strange bed and surroundings
- B. Separation from parents
- C. Presence of other toddlers
- D. Unfamiliar toys and games
Correct Answer: B
Rationale: The correct answer is 'Separation from parents.' Separation anxiety is most evident from 6 months to 30 months of age and is the greatest stress imposed on a toddler by hospitalization. If separation is avoided, young children have a tremendous capacity to withstand other stress. The other choices, such as 'Strange bed and surroundings,' 'Presence of other toddlers,' and 'Unfamiliar toys and games,' may also have an impact on the child, but separation from parents is typically the most significant factor affecting behavior in a hospitalized 2-year-old.
The nurse is performing a neurological assessment on a client post right cerebrovascular accident. Which finding, if observed by the nurse, would warrant immediate attention?
- A. Decrease in level of consciousness
- B. Loss of bladder control
- C. Altered sensation to stimuli
- D. Emotional lability
Correct Answer: A
Rationale: A decrease in the level of consciousness is a critical finding that would warrant immediate attention in a client post right cerebrovascular accident. This change may indicate an increase in intracranial pressure, leading to inadequate oxygenation of the brain. It could also reveal the presence of a transient ischemic attack, which may signal an impending thrombotic cerebrovascular accident. Loss of bladder control (choice B) can be managed and monitored but does not indicate an immediate threat to the client's life. Altered sensation to stimuli (choice C) can be a concerning finding but may not require immediate attention unless it affects the client's safety. Emotional lability (choice D) may be distressing for the client but does not pose an immediate risk to their health compared to a decrease in the level of consciousness.
The clinic nurse reviews the record of an infant and notes that the primary healthcare provider has documented a diagnosis of suspected Hirschsprung's disease. The nurse reviews the assessment findings documented in the record, knowing that which sign most likely led the mother to seek healthcare for the infant?
- A. Diarrhea
- B. Projectile vomiting
- C. Regurgitation of feedings
- D. Foul-smelling, ribbon-like stools
Correct Answer: D
Rationale: Hirschsprung's disease, also known as congenital aganglionosis or aganglionic megacolon, is a congenital anomaly characterized by an absence of ganglion cells in the rectum and other areas of the affected intestine. A key clinical manifestation of Hirschsprung's disease is chronic constipation that starts in the first month of life, leading to pellet-like or ribbon-like stools that have a foul smell. Another sign is the delayed passage or absence of meconium stool in the neonatal period. In addition to foul-smelling, ribbon-like stools, bowel obstruction (especially in the neonatal period), abdominal pain and distention, and failure to thrive are also common clinical manifestations of this disorder. Options A, B, and C are not typically associated with Hirschsprung's disease, making them incorrect choices in this scenario.