Which type of immunity is demonstrated by the transfer of a mother's immunoglobulin across the placenta to protect the child?
- A. Natural active immunity
- B. Natural passive immunity
- C. Artificial active immunity
- D. Artificial passive immunity
Correct Answer: B
Rationale: The immunoglobulin passed from the mother to the child through the placenta is an example of natural passive immunity, making choice B the correct answer. This transfer gives the child temporary immunity to various diseases without their immune system having to work. On the other hand, natural active immunity (Choice A) occurs when the body produces its own antibodies in response to an antigen. Artificial active immunity (Choice C) is achieved through vaccinations, where the immune system is stimulated to produce antibodies against a specific disease. Artificial passive immunity (Choice D) is a temporary immunity that involves the transfer of pre-formed antibodies from another source.
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24 hours after the creation of a colostomy, what should Nurse Violy identify as the normal appearance of the stoma?
- A. Pink, moist, and slightly protruding from the abdomen
- B. Gray, moist, and slightly protruding from the abdomen
- C. Pink, dry, and slightly protruding from the abdomen
- D. Red, moist, and slightly protruding from the abdomen
Correct Answer: A
Rationale: Following colostomy surgery, a healthy stoma should appear pink, moist, and slightly protruding from the abdomen, which is why option 'A' is the correct answer. A gray stoma (choice 'B') could indicate poor blood supply or necrosis, which is a serious complication. A dry stoma (choice 'C') is also not normal as it should be moist; a dry stoma may suggest dehydration or other complications. While a stoma can appear red (choice 'D'), this is not typically the normal color; it should usually be pink. Therefore, it's important for healthcare professionals to correctly identify the normal and abnormal appearances of a stoma to ensure proper patient care.
Where should a nurse auscultate the apex beat?
- A. At the fifth intercostal space, along the midclavicular line
- B. At the mid-sternum
- C. 2 inches to the left of the lower end of the sternum
- D. 1 inch to the left of the xiphoid process
Correct Answer: A
Rationale: The correct location to auscultate the apex beat is at the fifth intercostal space, along the midclavicular line. This is where the apical impulse, also known as the point of maximal impulse (PMI), can be best heard. Choices B, C, and D are incorrect anatomical locations for auscultating the apex beat, which makes them incorrect choices. Auscultating at the correct location allows healthcare providers to assess the heart's function and detect any abnormalities in heart sounds, which is crucial for comprehensive patient care.
Which breakfast items indicate an understanding of foods high in antioxidants A and C?
- A. Fried eggs, sausage, and whole wheat toast
- B. Oatmeal with blueberries and coffee
- C. Cereal with strawberries and low-fat milk
- D. Hard-boiled eggs, cantaloupe, and orange juice
Correct Answer: D
Rationale: The correct answer is D: Hard-boiled eggs, cantaloupe, and orange juice. Cantaloupe and orange juice are rich in vitamins A and C, which are known for their antioxidant properties. Choice A is incorrect because fried eggs, sausage, and whole wheat toast do not contain high levels of antioxidants A and C. Choice B is incorrect because, while blueberries are high in antioxidants, coffee does not provide significant amounts of vitamins A and C. Choice C is incorrect because, although strawberries are a good source of vitamin C, low-fat milk does not contribute significantly to vitamins A and C.
Which of the following should a patient with a history of chronic pancreatitis avoid?
- A. Low-fat dairy
- B. Lean meats
- C. High-fiber vegetables
- D. Alcohol
Correct Answer: D
Rationale: The correct answer is D: Alcohol. Alcohol consumption can exacerbate chronic pancreatitis due to its detrimental effects on the pancreas. Conversely, options A, B, and C: Low-fat dairy, Lean meats, and High-fiber vegetables, are generally recommended for patients with chronic pancreatitis. These dietary options are easier on the pancreas and less likely to provoke symptoms. Therefore, they are incorrect choices in this context.
What is the fundamental difference between nursing diagnoses and collaborative problems?
- A. Collaborative problems are managed by nurses using physician-prescribed interventions.
- B. Collaborative problems can be addressed by independent nursing interventions.
- C. Physician-prescribed interventions are incorporated into nursing diagnoses.
- D. Nursing diagnoses include physiologic complications that nurses monitor to detect status changes.
Correct Answer: B
Rationale: The correct answer is B, as collaborative problems necessitate the collective expertise and skills of numerous healthcare professionals, including nurses. These problems can be dealt with through independent nursing interventions in cooperation with other team members. Option A is incorrect because collaborative problems aren't strictly managed with physician-prescribed interventions. Option C is incorrect because nursing diagnoses aim at identifying and treating actual or potential health issues, rather than merely integrating physician-prescribed interventions. Option D is incorrect because nursing diagnoses aim at identifying patient issues, not solely physiologic complications, and guide the necessary nursing care, not just monitor for changes.