Nokea
You have just received change-of-shift report about your assigned clients. In what order will you assess these clients?
- A. A 68-year-old client who has new-onset confusion after having a bilateral orchiectomy.
- B. A 44-year-old client who is receiving IV antibiotics for acute pyelonephritis.
- C. A 55-year-old client who is scheduled for discharge after having a TURP.
- D. A 77-year-old client who is receiving continuous bladder irrigation after a TURP.
Correct Answer: A
Rationale: New-onset confusion in a postoperative client could indicate complications such as infection or electrolyte imbalance.
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Failure of the ductus arteriosus to close is a common developmental defect. Which of the following would likely be present in a 12-month-old infant with patent ductus arteriosus?
- A. Below-normal arterial PO2
- B. Below-normal arterial PCO2
- C. Greater than normal arterial blood pressure
- D. Lower than normal pulmonary arterial pressure
Correct Answer: A
Rationale: The correct answer is A: Below-normal arterial PO2. In a 12-month-old infant with patent ductus arteriosus, there would likely be a left-to-right shunt causing increased blood flow to the lungs, leading to decreased systemic blood flow. This can result in decreased systemic oxygenation and below-normal arterial PO2 levels. Choices B, C, and D are incorrect because patent ductus arteriosus does not directly affect arterial PCO2, arterial blood pressure, or pulmonary arterial pressure in a way that would lead to those specific outcomes at this age.
Which of the following nursing interventions would a nurse perform to avoid maceration from irritating drainage or wound compresses in a client with a breast abscess?
- A. Apply zinc oxide to the surrounding skin.
- B. Use a binder to hold the dressing in place.
- C. Elevate the scrotum to relieve the pain.
- D. Limit alcohol intake to 2 drinks per week.
Correct Answer: A
Rationale: Zinc oxide protects the skin from moisture and irritation.
Mucous membrane partially or completely covering the vaginal orifice is called as:
- A. Clitoris
- B. Labia
- C. Hymen
- D. Vulva
Correct Answer: C
Rationale: The correct answer is C: Hymen. The hymen is a mucous membrane that partially or completely covers the vaginal orifice. It is a thin tissue located at the opening of the vagina. The hymen can vary in appearance and may partially cover the vaginal opening, making it an essential anatomical structure to consider. The other choices are incorrect because:
A: Clitoris - The clitoris is a highly sensitive sexual organ located above the vaginal opening, not covering it.
B: Labia - The labia are the folds of skin surrounding the vaginal opening, not covering it entirely.
D: Vulva - The vulva refers to the external female genitalia, including the labia, clitoris, and vaginal opening, but it does not specifically refer to the mucous membrane covering the vaginal orifice.
______________________ is the motion that extends the foot downward toward the ground as when pointing the toes or stepping on the gas pedal.
- A. Dorsiflexion
- B. Plantar flexion
- C. Rotation
- D. Flexion
Correct Answer: B
Rationale: The correct answer is B: Plantar flexion. Plantar flexion refers to the motion of extending the foot downward towards the ground, like when pointing the toes or pressing the gas pedal. This action is mainly controlled by the calf muscles, particularly the gastrocnemius and soleus. Dorsiflexion (A) is the opposite motion, where the foot is flexed upward towards the shin. Rotation (C) involves turning around an axis and is not relevant to this specific movement. Flexion (D) refers to the bending of a joint, not the extension of the foot downward. In summary, plantar flexion is the correct answer because it accurately describes the motion of extending the foot downward, while the other choices do not match the described movement.
Examples of a ball and socket joint is
- A. Interphalangeal joint
- B. Knee joint
- C. Shoulder joint
- D. Elbow joint
Correct Answer: C
Rationale: The correct answer is C: Shoulder joint. A ball and socket joint allows for multi-directional movement with a wide range of motion. The shoulder joint fits this description as it consists of the ball-shaped head of the humerus bone fitting into the socket of the scapula bone. This anatomical structure allows for movements like flexion, extension, abduction, adduction, and rotation. In contrast, the interphalangeal joint (A) is a hinge joint, the knee joint (B) is a hinge joint, and the elbow joint (D) is a pivot joint, none of which have the same range of motion as a ball and socket joint.