Which should the nurse recommend for the diet of a child with chronic renal failure?
- A. High in protein
- B. Low in vitamin D
- C. Low in phosphorus
- D. Supplemented with vitamins A, E, and K
Correct Answer: C
Rationale: For a child with chronic renal failure, it is important to recommend a diet that is low in phosphorus. In chronic renal failure, the kidneys have difficulty filtering phosphorus from the blood, leading to high levels of phosphorus in the body. High phosphorus levels can contribute to bone problems and other complications in renal failure patients. By recommending a diet low in phosphorus, the nurse can help manage the child's condition and reduce the risk of further complications. It is also important to monitor other electrolyte levels such as calcium, potassium, and sodium, and adjust the diet accordingly to maintain proper balance.
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Tara is an 11-year-old girl diagnosed with type 1 diabetes mellitus (DM). She asks her attending nurse why she can't take a pill rather than shots like her grandmother does. Which of the following would be the nurse's best reply?
- A. "If your blood glucose levels are controlled, you can switch to using pills."
- B. "The pills correct fat and protein metabolism, not carbohydrate metabolism."
- C. "Your body does not make insulin, so the insulin injections help to replace it."
- D. "The pills work on the adult pancreas, you can switch when you are 18."
Correct Answer: C
Rationale: The nurse's best reply would be option C, "Your body does not make insulin, so the insulin injections help to replace it." This response directly addresses Tara's question about why she needs insulin injections instead of pills. In type 1 diabetes mellitus, the body's immune system mistakenly attacks the beta cells in the pancreas that produce insulin. As a result, individuals with type 1 DM do not produce insulin, so they require insulin injections to replace the missing hormone. Unlike type 2 diabetes where oral medications can be used to manage the condition, individuals with type 1 diabetes rely on insulin injections to regulate their blood glucose levels.
A 9-mo-old infant is recently diagnosed with bilateral retinoblastoma; examination under anesthesia reveals bilateral multifocal involvement of the retina. An important next step in the management is
- A. radiotherapy of both eyes
- B. retinal examination of 1st degree relatives
- C. orbital ultrasonography
- D. bilateral enucleation
Correct Answer: B
Rationale: Retinal examination of first-degree relatives is crucial to identify hereditary forms of retinoblastoma.
All the following are features of rapid eye movement (REM) EXCEPT
- A. polysomnography
- B. EEG
- C. fibro-optic nasopharngeal examination
- D. CT scan of head and neck
Correct Answer: D
Rationale: CT scan of head and neck is not a feature of REM sleep; it is an imaging study unrelated to the physiological characteristics of REM sleep.
During thoracentesis, which of the following nursing intervention will be most crucial?
- A. Place patient in a quiet and cool room
- B. Maintain strict aseptic technique
- C. Advice patient to sit perfectly still during needle insertion until it has been withdrawn from the chest
- D. Apply pressure over the puncture site as soon as the needle is withdrawn
Correct Answer: B
Rationale: Maintaining strict aseptic technique during thoracentesis is the most crucial nursing intervention. Thoracentesis is a procedure where a needle is inserted into the pleural space to obtain a sample of fluid for diagnostic purposes or to drain excess fluid for therapeutic relief. It is essential to prevent the introduction of pathogens or contaminants into the pleural space, as this can lead to serious complications such as infection. By following strict aseptic technique, the risk of complications can be minimized, ensuring the safety and well-being of the patient undergoing the procedure.
During preoperative teaching for a client who will undergo subtotal thyroidectomy, the nurse should include which statement?
- A. "The head of your bed must remain flat for 24 hours after surgery."
- B. "You should avoid deep breathing and coughing after surgery."
- C. "You won't be able to swallow for the first day or two."
- D. "You must avoid hyperextending your neck after surgery."
Correct Answer: D
Rationale: The correct statement to include during preoperative teaching for a client undergoing subtotal thyroidectomy is "You must avoid hyperextending your neck after surgery." This is important because hyperextending the neck can put strain on the suture line and may lead to dehiscence (wound opening). It is crucial for the client to avoid any activities or positions that could compromise the surgical site and hinder proper healing.