Nokea
Which physiological changes occur as a result of hypoxemia in congestive heart failure (CHF)?
- A. Polycythemia and clubbing
- B. Anemia and barrel chest
- C. Increased white blood cells and low platelets
- D. Elevated erythrocyte sedimentation rate and peripheral edema
Correct Answer: A
Rationale: Hypoxemia stimulates erythropoiesis, causing polycythemia, which along with chronic hypoxemia can lead to digital clubbing.
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A male client complains of pain in his right calf, and the nurse determines that his calf is edematous and deep red. What intervention has the highest priority?
- A. Tell the client to remain in bed
- B. Apply warm compresses to the affected leg.
- C. Administer pain medication as prescribed.
- D. Encourage the client to elevate the affected leg.
Correct Answer: A
Rationale: The symptoms suggest deep vein thrombosis (DVT). Bed rest prevents dislodgment of the clot, reducing the risk of pulmonary embolism.
Examples of encapsulated organisms are all except:
- A. Pseudomonas
- B. Proteus
- C. Pneumococci
- D. Salmonella
Correct Answer: A
Rationale: The correct answer is A because Pseudomonas is not an encapsulated organism. The other options (b-e) are encapsulated.
Which of the following antibodies has least association with neonatal lupus?
- A. Anti-Ro (SSA)
- B. Anti-La (SSB)
- C. Anti-RNP
- D. Anti-CCP
Correct Answer: D
Rationale: Anti-CCP antibodies have the least association with neonatal lupus compared to the other antibodies listed.
Nurse Victoria is teaching the parents of a school-age child. Which teaching topic should take priority?
- A. Prevent accidents
- B. Keeping a night light on to allay fears
- C. Explaining normalcy of fears about body integrity
- D. Encouraging the child to dress without help
Correct Answer: A
Rationale: Accident prevention is a priority for school-age children as they become more independent and engage in activities that may pose risks.
The reason that the hematocrit is so high is
- A. chronic hypoxia
- B. it was taken in a low cardiac output state
- C. it was a peripheral finger stick
- D. embolic stroke
Correct Answer: A
Rationale: Chronic hypoxia leads to secondary polycythemia as a compensatory mechanism.