One of the following is not a feature of attention deficit/hyperactivity disorder (ADHD)
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Rationale
Option D: Lead intoxication is not a recognized feature of attention deficit/hyperactivity disorder (ADHD). While lead exposure can have various neurodevelopmental effects, it is not considered a direct cause or characteristic of ADHD itself.
Option A: ADHD is multifactorial in origin, involving genetic, environmental, and neurobiological factors, which is a well-established understanding in the field of psychiatry.
Option B: The female to male ratio for ADHD is typically reported as 1:3 to 1:5, not 2 to 6:1, indicating a higher prevalence in males compared to females.
Option C: Prenatal exposure to nicotine has been shown to increase the risk of developing ADHD, making this a recognized contributing factor in its etiology.
Takeaways: Understanding that lead intoxication does not contribute to ADHD highlights the importance of recognizing multifactorial origins and risk factors, including prenatal exposure to substances like nicotine, which can influence development and behavior in children. For more information on ADHD risk factors, refer to CDC guidelines on ADHD.
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Question 2 of 101
Barbiturate anticonvulsants are effective in treating all of these seizure types, except:
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Rationale
Option D: Absence seizures are not effectively treated with barbiturate anticonvulsants, as these medications primarily target generalized tonic-clonic and partial seizures. Absence seizures respond better to ethosuximide or other agents specifically indicated for this type of seizure activity.
Option A: Partial seizures can be effectively managed with barbiturates, which help in controlling focal seizure activity by enhancing GABAergic transmission.
Option B: Febrile seizures, which are typically self-limiting, can be treated with barbiturates if necessary, although they are often managed with supportive care and antipyretics.
Option C: Tonic-clonic seizures are well-managed with barbiturate anticonvulsants, as they are effective in suppressing the generalized seizure activity associated with this type.
Takeaways: Barbiturate anticonvulsants are not effective for absence seizures, which require different treatment approaches; understanding the specific seizure types and their appropriate management is crucial for effective patient care, including the use of [appropriate medications for seizure types](https://...).
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Question 3 of 101
Primary amenorrhea should be considered for any female adolescent who has not reached menarche by
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Rationale
Option D: Primary amenorrhea should be considered for any female adolescent who has not reached menarche by 15 years or has not done so within 3 years of thelarche. This aligns with clinical guidelines, which define primary amenorrhea based on these age thresholds, indicating the need for further evaluation if these milestones are not met.
Option A: The age of 13 years is too early to define primary amenorrhea, as the standard threshold is 15 years. Additionally, thelarche typically occurs before menarche, so this option does not meet the established criteria.
Option B: The age of 14 years is also too early for diagnosing primary amenorrhea. The accepted age for concern is 15 years, making this option insufficient for proper evaluation.
Option C: While this option correctly states the 3-year timeframe from thelarche, the age of 14 years does not meet the standard threshold of 15 years for diagnosing primary amenorrhea, thus failing to align with clinical guidelines.
Takeaways: Understanding the criteria for diagnosing primary amenorrhea is essential, as it requires consideration of age and thelarche timing, specifically noting that evaluation is warranted if menarche has not occurred by 15 years or within 3 years of [thelarche onset](https://...).
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Question 4 of 101
The child who walks backward, scribbles, and uses spoon and fork has achieved the developmental age of
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Rationale
Option D: The child who walks backward, scribbles, and uses a spoon and fork has achieved the developmental age of 18 months. At this stage, children typically demonstrate increased motor skills, including walking independently and beginning to use utensils, which aligns with the described behaviors.
Option A: Developmental milestones at 9 months include crawling and sitting up, but not walking backward or using utensils.
Option B: At 12 months, children may walk with assistance and start to show interest in self-feeding, but they do not typically walk backward or use a spoon and fork proficiently.
Option C: By 15 months, children may walk independently and begin to scribble, but using utensils like a spoon and fork is generally not consistent until 18 months.
Takeaways: Mastery of walking backward, scribbling, and using utensils indicates a developmental age of 18 months, highlighting the progression of fine and gross motor skills in toddlers, which is essential for [understanding child development milestones](https://...).
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Question 5 of 101
The kidneys regulate acid-base balance by all of the following mechanisms except:
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Rationale
Option B: Reabsorbing carbon dioxide into the blood is not a mechanism by which the kidneys regulate acid-base balance. The kidneys primarily manage acid-base homeostasis through the excretion of hydrogen ions and the reabsorption or excretion of bicarbonate (HCO3). This process helps maintain the pH of the blood within a narrow range.
Option A: Excreting hydrogen ions (H ) is a key mechanism for the kidneys in regulating acid-base balance. By removing excess hydrogen ions, the kidneys help to prevent acidosis and maintain a stable pH level in the body.
Option C: Reabsorbing or excreting HCO3 into the blood is a critical function of the kidneys in acid-base regulation. Bicarbonate acts as a buffer, and its reabsorption or excretion directly influences blood pH levels.
Option D: Retaining hydrogen ions would lead to acidosis, which is contrary to the kidneys' role in maintaining acid-base balance. The kidneys aim to excrete excess hydrogen ions to keep the body's pH stable.
Takeaways: The kidneys regulate acid-base balance primarily through excreting hydrogen ions and managing bicarbonate levels, while reabsorbing carbon dioxide into the blood does not contribute to this process. Understanding these mechanisms is essential for [managing acid-base disorders](https://...) in clinical practice.
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Question 6 of 101
The spouse of a client with gastric cancer expresses concern that the couple's children may develop this type of cancer when they're older. When reviewing risk factors for gastric cancer with the client and family, the nurse explains that a certain blood type increases the risk by 10%. The nurse is referring to:
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Rationale
Option A: Type A blood is associated with an increased risk of gastric cancer, with studies indicating that individuals with this blood type have a 10% higher likelihood of developing the disease compared to other blood types. This information is crucial for understanding familial risk factors and guiding patient education regarding genetic predispositions.
Option B: Type AB blood does not have a significant association with an increased risk of gastric cancer, making it less relevant in discussions about hereditary risk factors for this condition.
Option C: Type B blood has not been shown to increase the risk of gastric cancer, and thus does not contribute to the concerns regarding the hereditary nature of this disease.
Option D: Type O blood is not linked to an increased risk of gastric cancer; in fact, it is often considered to have a lower risk compared to other blood types.
Takeaways: Understanding that individuals with [Type A blood have a higher risk of gastric cancer](https://...) is essential for assessing familial risk factors and providing appropriate counseling to affected families.
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Question 7 of 101
Dr. Jones prescribes corticosteroids for a child with nephritic syndrome. What is the primary purpose of administering corticosteroids to this child?
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Rationale
Option B: To reduce inflammation is the primary purpose of administering corticosteroids to a child with nephritic syndrome. Corticosteroids act by suppressing the immune response and decreasing inflammatory processes, which are crucial in managing the symptoms and complications associated with nephritic syndrome, such as edema and hypertension.
Option A: To increase blood pressure does not align with the therapeutic goals of corticosteroid treatment in nephritic syndrome, as the focus is on reducing inflammation and managing symptoms rather than elevating blood pressure.
Option C: To decrease proteinuria is a secondary effect of corticosteroids, as their primary action is to reduce inflammation. While proteinuria may improve with inflammation reduction, it is not the main purpose of corticosteroid therapy.
Option D: To prevent infection is not a primary goal of corticosteroid therapy. In fact, corticosteroids can increase the risk of infections due to their immunosuppressive effects, making this option misleading in the context of nephritic syndrome treatment.
Takeaways: The administration of corticosteroids in nephritic syndrome primarily aims to [reduce inflammation](https://...) and manage symptoms, which can subsequently lead to decreased proteinuria as a secondary benefit.
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Question 8 of 101
Which nursing diagnosis is most appropriate for a client with Addison's disease?
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Rationale
Option C: Excessive fluid volume is the most appropriate nursing diagnosis for a client with Addison's disease due to the adrenal insufficiency leading to inadequate aldosterone production. This results in sodium loss and potential dehydration, making fluid volume management a critical nursing consideration.
Option A: Risk for infection does not directly relate to Addison's disease, as the primary concern is not an increased susceptibility to infections but rather the management of fluid and electrolyte balance.
Option B: Urinary retention is not typically associated with Addison's disease. The condition primarily affects fluid and electrolyte balance rather than urinary function directly.
Option D: Hypothermia is not a common nursing diagnosis for Addison's disease. While patients may experience temperature regulation issues, the primary focus remains on fluid volume and electrolyte management.
Takeaways: Understanding the implications of adrenal insufficiency in Addison's disease highlights the priority for [fluid volume management and electrolyte balance](https://...) in nursing care to prevent complications related to dehydration.
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Question 9 of 101
Baby Ellie is diagnosed with gastroesophageal reflux (GER); which of the following nursing diagnoses would be inappropriate?
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Rationale
Option B: Impaired oral mucous membrane is not a relevant nursing diagnosis for a baby diagnosed with gastroesophageal reflux (GER). GER primarily affects the gastrointestinal system and does not typically lead to direct impairment of the oral mucous membranes, making this diagnosis inappropriate in this context.
Option A: Risk for aspiration is a valid nursing diagnosis for infants with GER, as the reflux can lead to aspiration of gastric contents, posing a significant risk to the airway and respiratory function.
Option C: Deficient fluid volume can be a concern in infants with GER if vomiting occurs frequently, leading to dehydration. Monitoring fluid intake and output is essential in this population.
Option D: Imbalanced nutrition: Less than body requirements is applicable as GER can affect feeding patterns and nutrient intake, potentially leading to inadequate nutrition in infants.
Takeaways: Understanding the implications of gastroesophageal reflux in infants is crucial for nursing care, particularly regarding the priority for [airway obstruction and ventilation](https://...) before addressing nutritional needs and fluid balance.
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Question 10 of 101
A college student goes to the college clinic and asks the best way to avoid contracting an STD. The nurse provides the clinic's standard STD teaching. Which statement by the student indicates the need for additional instruction?
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Rationale
Option D: If I question my partner about past sexual encounters, I can avoid STDs. This statement reflects a misunderstanding of STD transmission, as questioning alone does not guarantee safety. Individuals may not disclose accurate information, and STDs can be asymptomatic, making it essential to use protective measures regardless of partner history.
Option A: There is no guarantee that I won't contract an STD if I choose to be sexually active. This statement accurately reflects the reality of sexual activity and STD risk, emphasizing the importance of safe practices.
Option B: Abstinence is the only sure way to avoid an STD. This statement is factually correct, as abstaining from sexual activity eliminates the risk of contracting STDs.
Option C: If I use a condom with spermicide, I will be safer than if I don't use one. This statement is true, as condoms significantly reduce the risk of STD transmission when used correctly, and spermicide can provide additional protection.
Takeaways: Understanding that questioning a partner's sexual history does not ensure safety highlights the need for consistent use of protection, as the only sure way to avoid STDs is through [abstinence or proper condom use](https://...) during sexual activity.
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Question 11 of 101
For a patient with gastroesophageal reflux symptoms, the purpose of esophageal pH monitoring is to evaluate for:
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Rationale
Option B: The purpose of esophageal pH monitoring is to evaluate the frequency of gastroesophageal reflux episodes. This assessment helps determine the severity and impact of reflux symptoms on the patient, guiding treatment decisions and management strategies.
Option A: Esophagitis from reflux may be a consequence of frequent reflux episodes, but pH monitoring specifically measures reflux frequency rather than directly diagnosing esophagitis.
Option C: Gastric emptying delays are assessed through different tests, such as gastric emptying studies, rather than esophageal pH monitoring, which focuses solely on reflux events.
Option D: Possible obstructions in the esophagus would require imaging studies or endoscopy for evaluation, as pH monitoring does not provide information on structural abnormalities.
Takeaways: Understanding the purpose of esophageal pH monitoring is crucial for evaluating the frequency of reflux episodes, which is essential for [managing gastroesophageal reflux disease](https://...) effectively and tailoring appropriate treatment plans.
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Question 12 of 101
Alveolar type of rhabdomyosarcoma accounts for approximately 1/3 of all cases of pediatric RMS and carries the poorest prognosis. Of the following, the MOST common site of involvement by alveolar type RMS is
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Rationale
Option C: The extremities are the most common site of involvement by alveolar rhabdomyosarcoma (RMS), accounting for a significant proportion of cases. This type of RMS typically presents in the muscles of the arms and legs, leading to a higher incidence in these areas compared to other sites.
Option A: The orbit, while a known site for RMS, is less commonly affected by the alveolar type compared to the extremities.
Option B: The middle ear is not a typical site for alveolar RMS, which primarily affects soft tissues rather than structures like the ear.
Option D: The bladder is associated with embryonal RMS rather than alveolar RMS, making it a less likely site for this specific type of tumor.
Takeaways: Understanding that the extremities are the most common site of involvement by alveolar rhabdomyosarcoma highlights the need for early detection and intervention, especially in pediatric cases where [timely diagnosis can significantly impact outcomes](https://...).
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Question 13 of 101
To provide safe care for Mrs. Zeno, it is important for the nurse to check the bedside for the presence of:
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Rationale
Option B: A hypothermia blanket is essential for providing safe care to Mrs. Zeno, particularly if she is at risk for hypothermia during labor or postpartum. Maintaining normothermia is crucial for both maternal and neonatal health, preventing complications such as hypoglycemia and respiratory distress in the newborn.
Option A: A tracheostomy set is not routinely required for Mrs. Zeno unless there is a specific indication of airway compromise, which is not mentioned in the scenario.
Option C: An intravenous set-up may be necessary for fluid administration or medication delivery, but it does not specifically address the immediate safety concern of maintaining body temperature.
Option D: A syringe and edrophonium HCl (Tensilon) are used for diagnosing myasthenia gravis and are not relevant to the care of Mrs. Zeno unless there is a known history of this condition, which is not indicated.
Takeaways: Ensuring the presence of a hypothermia blanket is a priority for [maintaining normothermia during labor](https://...) to prevent complications for both the mother and the newborn.
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Question 14 of 101
Just as the nurse was entering the room, the patient who was sitting on his chair begins to have a seizure. Which of the following must the nurse do first?
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Question 15 of 101
A client has had heavy menstrual bleeding for 6 months. Her gynecologist diagnoses microcytic hypochromic anemia and prescribes ferrous sulfate (Feosol), 300mg PO daily. Before initiating iron therapy, the nurse reviews the client's medical history. Which condition would contraindicate the use of ferrous sulfate?
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Rationale
Option D: Severely impaired liver function contraindicates the use of ferrous sulfate due to the risk of iron overload and potential hepatic toxicity. The liver is crucial for iron metabolism, and impaired function can exacerbate the adverse effects of iron supplementation, leading to serious complications.
Option A: Pregnancy does not contraindicate ferrous sulfate; in fact, iron supplementation is often recommended during pregnancy to prevent anemia due to increased blood volume and iron demands.
Option B: Ulcerative colitis does not directly contraindicate iron therapy. However, caution is warranted due to the potential for gastrointestinal irritation and absorption issues associated with iron supplements in patients with inflammatory bowel disease.
Option C: Asthma does not contraindicate the use of ferrous sulfate. While some patients may experience respiratory symptoms related to iron supplements, it is not a general contraindication and can be managed with appropriate monitoring.
Takeaways: Iron supplementation, such as ferrous sulfate, is contraindicated in patients with severely impaired liver function due to the risk of iron overload and hepatic toxicity, necessitating careful assessment of liver health before initiating therapy. For more information on iron therapy and contraindications, refer to this resource on iron supplementation.
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Question 16 of 101
The beta subunit of human chorionic gonadotropin (HCG) is a useful surface marker in some malignant germ cell tumors (GCTs); it is secreted by syncytiotrophoblasts. In which of the following GCTs this surface marker is characteristically elevated?
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Rationale
Option D: Embryonal carcinoma characteristically elevates the beta subunit of human chorionic gonadotropin (HCG), as it is a germ cell tumor that often produces this hormone due to the presence of syncytiotrophoblast-like cells. This marker is crucial for diagnosis and monitoring treatment response.
Option A: Teratomas can contain various tissue types but do not typically produce elevated levels of HCG, making them less relevant for this specific marker.
Option B: Germinomas primarily produce alpha-fetoprotein (AFP) and do not significantly elevate HCG levels, distinguishing them from embryonal carcinoma.
Option C: Endodermal sinus tumors are associated with increased AFP rather than HCG, which limits their relevance in this context.
Takeaways: The beta subunit of human chorionic gonadotropin (HCG) is specifically elevated in embryonal carcinoma, a malignant germ cell tumor, which requires monitoring of tumor markers for effective management during treatment.
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Question 17 of 101
Which of the ff are the symptoms of basilar skull fracture? Choose all that apply
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Rationale
Option A: Raccoon eyes are a classic sign of a basilar skull fracture, indicating periorbital ecchymosis due to blood tracking from the fracture site. This symptom is significant in assessing head trauma and potential complications.
Option B: Amnesia is not a direct symptom of basilar skull fractures; it may occur due to traumatic brain injury but is not specific to this type of fracture.
Option C: The halo sign, which indicates cerebrospinal fluid leakage, is associated with skull base fractures but is not exclusive to basilar skull fractures, making it less definitive for this specific question.
Option D: Paresthesia is not a recognized symptom of basilar skull fractures. It may occur with nerve injury but does not specifically indicate a skull fracture.
Takeaways: Raccoon eyes are a definitive symptom of basilar skull fractures, indicating potential complications from trauma. Understanding these signs is crucial for effective assessment and management of head injuries, which requires prompt evaluation and intervention to prevent further complications.
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Question 18 of 101
The clinical manifestations of Parkinson's disease (bradykinesia rigidity and tremors) is directly related to a decreased level of:
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Rationale
Option C: Dopamine levels are decreased in Parkinson's disease, leading to the hallmark symptoms of bradykinesia, rigidity, and tremors. This neurotransmitter is crucial for coordinating smooth and controlled movements, and its deficiency directly contributes to the motor symptoms observed in this condition.
Option A: Acetylcholine levels do not decrease in Parkinson's disease; rather, the balance between acetylcholine and dopamine is disrupted. Increased acetylcholine activity relative to dopamine contributes to some symptoms but is not the primary deficit.
Option B: Serotonin is not primarily involved in the motor symptoms of Parkinson's disease. While it plays a role in mood regulation and can affect motor function indirectly, it is not the main neurotransmitter affected in this condition.
Option D: Phenylalanine is an amino acid and does not have a direct relationship with the pathophysiology of Parkinson's disease. It is not a neurotransmitter and does not influence the motor symptoms associated with the disease.
Takeaways: The clinical manifestations of Parkinson's disease are primarily linked to decreased levels of dopamine, which is essential for motor control. Understanding this relationship requires knowledge of neurotransmitter functions in movement disorders.
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Question 19 of 101
A male client is suspected of an immune system disorder. Which of the ff important factors will the nurse document while assessing the client?
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Rationale
Option D: The client's ability to produce antibodies is crucial in assessing immune system function, as it directly reflects the immune response capability. Antibody production is a key indicator of the immune system's health and effectiveness in combating infections and diseases.
Option A: The client's diet, while important for overall health, does not specifically indicate immune system function or disorders. Nutritional status can influence immunity but is not a direct measure of immune capability.
Option B: The client's family member's history of chronic diseases may provide context for genetic predispositions but does not directly assess the current state of the client's immune function.
Option C: The client's drug history can impact immune function, particularly with immunosuppressive medications, but it does not directly assess the client's ability to produce antibodies.
Takeaways: Assessing a client's ability to produce antibodies is vital in evaluating immune system disorders, as it indicates the immune response's effectiveness. Understanding these factors requires knowledge of immunology and patient assessment techniques.
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Question 20 of 101
A nurse is assessing for jaundice in a dark-skinned newborn. Where is the best place to assess for jaundice in this newborn?
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Rationale
Option C: Sclera, conjunctiva, and oral mucosa are the best areas to assess for jaundice in a dark-skinned newborn. These areas are less pigmented and allow for clearer observation of yellowing, which indicates elevated bilirubin levels.
Option A: Buttocks are not an optimal site for assessing jaundice as they are typically more pigmented, making it difficult to detect subtle changes in skin color.
Option B: The tip of the nose and sclera can be assessed, but the sclera alone is insufficient for a comprehensive evaluation of jaundice in newborns, particularly in darker-skinned infants.
Option D: Palms of hands and soles of feet are also not ideal for jaundice assessment in newborns, as these areas may not exhibit yellowing until bilirubin levels are significantly elevated, potentially delaying diagnosis.
Takeaways: Assessing jaundice in dark-skinned newborns requires careful evaluation of areas like the sclera, conjunctiva, and oral mucosa to accurately identify elevated bilirubin levels, which necessitates appropriate clinical assessment techniques for effective monitoring.
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Question 21 of 101
The nurse is aware that the shift of body fluids associated with the intravenous administration of albumin occurs by the process of:
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Rationale
Option B: Osmosis describes the movement of water across a semipermeable membrane from an area of lower solute concentration to an area of higher solute concentration. When albumin is administered intravenously, it increases the oncotic pressure in the vascular space, drawing fluid from the interstitial compartments into the bloodstream, thus facilitating fluid shift by osmosis.
Option A: Filtration involves the movement of fluid and solutes through a membrane due to hydrostatic pressure differences, not osmotic gradients. This process does not accurately describe the mechanism by which albumin affects fluid distribution.
Option C: Diffusion refers to the movement of solutes from an area of higher concentration to one of lower concentration. This process does not account for the osmotic effects of albumin on fluid movement within the body.
Option D: Active transport requires energy to move substances against their concentration gradient. The administration of albumin does not involve this energy-dependent process; rather, it relies on osmotic principles.
Takeaways: The administration of albumin affects fluid distribution through osmosis, where water moves to balance solute concentrations, highlighting the importance of oncotic pressure in fluid management.
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Question 22 of 101
Which bite causes Rocky Mountain spotted fever?
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Rationale
Option B: Tick bites are the primary vectors for Rocky Mountain spotted fever, a serious illness caused by the bacterium Rickettsia rickettsii. Understanding the transmission route is crucial for prevention and early diagnosis, as timely treatment can significantly reduce morbidity and mortality associated with this disease.
Option A: Fleas do not transmit Rocky Mountain spotted fever; they are primarily associated with other diseases such as murine typhus and plague.
Option C: Mosquitoes are not vectors for Rocky Mountain spotted fever; they are more commonly linked to diseases like West Nile virus and Zika virus.
Option D: Mouse or rat bites are not related to Rocky Mountain spotted fever transmission; rodents are more associated with hantavirus and leptospirosis.
Takeaways: Understanding that tick bites are the primary cause of Rocky Mountain spotted fever is essential for effective prevention and management strategies, which requires awareness of tick-borne diseases and their prevention.
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Question 23 of 101
All the following are Test results seen in JRA EXCEPT :
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Rationale
Option D: Positive CA 9 is not a test result typically associated with Juvenile Rheumatoid Arthritis (JRA). JRA is characterized by inflammatory markers and autoantibodies, but CA 9 is not relevant in this context.
Option A: Increase ESR is a common finding in JRA, reflecting systemic inflammation and is used to monitor disease activity.
Option B: Positive RF (Rheumatoid Factor) can be seen in some cases of JRA, particularly in the polyarticular form, indicating autoimmune activity.
Option C: Positive IgM & IgG antibodies may indicate an immune response, which can be present in JRA as part of the autoimmune process.
Takeaways: Understanding the specific test results associated with JRA, such as elevated ESR and possible positive RF, is crucial for accurate diagnosis and management. For more information on JRA and its laboratory findings, see Juvenile idiopathic arthritis overview on the NCBI website.
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Question 24 of 101
Which is most likely to encourage parents to talk about their feelings related to their child's illness?
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Rationale
Option C: Use open-ended questions. This approach encourages parents to express their feelings and thoughts in a more expansive manner, fostering a supportive environment for dialogue about their child's illness. Open-ended questions facilitate deeper conversations and allow parents to share their emotional experiences more freely.
Option A: Be sympathetic. While sympathy can provide emotional support, it does not actively encourage parents to articulate their feelings. Sympathy may lead to passive responses rather than open discussion.
Option B: Use direct questions. Direct questions often lead to yes or no answers, which can limit the depth of conversation and may not encourage parents to explore their feelings thoroughly.
Option D: Avoid periods of silence. Silence can be uncomfortable, but it can also provide space for reflection. Avoiding silence does not inherently promote discussion of feelings; instead, it may rush the conversation and inhibit genuine expression.
Takeaways: Open-ended questions are essential for facilitating meaningful conversations, particularly in sensitive contexts like discussing a child's illness, as they encourage parents to share their feelings and thoughts more openly. For effective communication, healthcare providers should utilize strategies for effective communication with families.
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Question 25 of 101
A client is diagnosed with metastatic adenocarcinoma of the stomach. The physician prescribes mitomycin (Mutamycin) with other chemotherapeutic agents for palliative treatment. How mitomycin does exert its cytotoxic effects?
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Rationale
Option A: Mitomycin exerts its cytotoxic effects primarily by inhibiting deoxyribonucleic acid (DNA) synthesis. It forms cross-links in DNA, preventing replication and transcription, which is crucial for cancer cell proliferation. This mechanism is vital in the treatment of metastatic adenocarcinoma, as it targets rapidly dividing cells effectively.
Option B: Mitomycin is not cell cycle-phase specific; it acts on DNA synthesis regardless of the cell cycle phase, making it effective against both dividing and non-dividing cells.
Option C: Mitomycin does not inhibit ribonucleic acid (RNA) synthesis. Its primary action is on DNA, not RNA, which is essential for protein synthesis and cellular function.
Option D: Mitomycin does not inhibit protein synthesis directly. Its mechanism of action focuses on disrupting DNA processes rather than targeting the protein synthesis pathway.
Takeaways: Mitomycin inhibits DNA synthesis by forming cross-links in DNA, which is a critical mechanism in chemotherapy for cancer treatment. Understanding this action is essential for effective palliative care in oncology, as it requires knowledge of chemotherapeutic agents and their mechanisms to optimize patient outcomes.
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Question 26 of 101
A 3-week-old neonate is brought to the emergency department because of a three-day history of intermittent vomiting. His mother reports that he has not urinated for eight hours. On physical examination, his eyes are sunken. Which of the following will MOST likely require correction before surgery is performed?
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Rationale
Option A: Hypochloremia is a common electrolyte imbalance in neonates, particularly in the context of vomiting and dehydration. Correcting hypochloremia is crucial before surgery to prevent complications such as metabolic alkalosis and to ensure proper physiological function during the procedure.
Option B: Hyperkalemia can be a concern in dehydrated patients; however, it is not the most immediate electrolyte imbalance requiring correction prior to surgery in this scenario. The focus is on addressing hypochloremia first.
Option C: Hypernatremia indicates dehydration and may need correction, but it is not the primary electrolyte imbalance that requires immediate attention before surgery in this case. Hypochloremia takes precedence due to its direct impact on metabolic stability.
Takeaways: Proper management of electrolyte imbalances, particularly addressing hypochloremia before surgical procedures, is essential in neonates to prevent complications and ensure safe anesthesia and surgery.
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Question 27 of 101
The twelve-year-old boy has fractured his arm because of a fall from his bike. After the injury has been casted, the nurse knows it is most important to perform all of the following assessments on the area distal to the injury except:
Select an option. Use Strike to cross one out.
Rationale
Option B: Radial and ulnar pulse assessment is not the most critical evaluation after a fracture casting, as the primary focus should be on distal circulation and neurological function rather than specific pulse points.
Option A: Capillary refill is essential for assessing perfusion to the distal extremity, indicating blood flow adequacy.
Option C: Finger movement is crucial for evaluating motor function and potential nerve injury, making it a key assessment after casting.
Option D: Skin integrity is important to monitor for signs of pressure or irritation from the cast, which can lead to complications.
Takeaways: Assessing distal circulation and function after a fracture is vital, focusing on capillary refill, movement, and skin integrity, while specific pulse checks may be less critical in this context. For more information on fracture management, see fracture care guidelines.
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Question 28 of 101
The nurse is assessing a 6-month-old healthy infant who weighed 7 pounds at birth. The nurse should expect the infant to now weigh approximately how many pounds?
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Option C: The infant should weigh approximately 20 pounds by 6 months of age, as it is expected for infants to double their birth weight by 5 to 6 months. Since this infant weighed 7 pounds at birth, doubling that weight results in an expected weight of around 14 pounds, but the typical range can extend to 20 pounds for healthy growth.
Option A: The weight of 10 pounds is below the expected weight range for a 6-month-old infant who weighed 7 pounds at birth, as they typically should weigh more than this.
Option B: A weight of 15 pounds is also below the expected weight for a 6-month-old infant, as they should ideally weigh closer to 14 pounds or more, depending on growth patterns.
Option D: A weight of 25 pounds significantly exceeds the expected weight for a 6-month-old infant, as this would indicate excessive weight gain beyond normal growth parameters.
Takeaways: Infants typically double their birth weight by 5 to 6 months, so a healthy infant weighing 7 pounds at birth should weigh around 14 to 20 pounds at 6 months, requiring regular growth assessments to monitor development.
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Question 29 of 101
After general anesthesia, elective procedures should generally be avoided in children with a URI for how long?
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Option B: 2-4 weeks is the recommended duration to avoid elective procedures in children with a URI after general anesthesia due to the increased risk of respiratory complications. This timeframe allows for the resolution of symptoms and reduces the likelihood of perioperative respiratory events, which can be particularly concerning in pediatric patients.
Option A: 1-2 weeks is insufficient, as it may not allow enough time for the URI symptoms to fully resolve, increasing the risk of complications during anesthesia and surgery.
Option C: 4-6 weeks extends beyond the generally accepted timeframe, which may unnecessarily delay elective procedures that could be performed safely once the child has recovered from the URI.
Option D: 6-8 weeks is excessive and not supported by current clinical guidelines, which recommend a shorter waiting period to minimize delays in necessary surgical interventions while ensuring patient safety.
Takeaways: Understanding the appropriate waiting period after a URI before elective procedures is crucial for minimizing risks associated with anesthesia. This requires consideration of the child's health status and URI resolution to ensure safe surgical outcomes.
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Question 30 of 101
A male client is prescribed medications that depress thrombocytes. The nurse should monitor for which of the ff signs and symptoms in the client?
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Option C: Bleeding gums and dark tarry stools are indicative of thrombocytopenia, a condition characterized by decreased platelet levels, leading to increased bleeding risk. Monitoring for these symptoms is crucial in clients receiving medications that depress thrombocytes, as they signal potential complications such as gastrointestinal bleeding or oral hemorrhage.
Option A: Sore throat and swollen glands are more associated with infections or immune responses rather than thrombocyte depression. These symptoms do not directly relate to the effects of decreased platelet counts.
Option B: Pernicious anemia with weakness is linked to vitamin B12 deficiency and does not directly stem from thrombocytopenia. This condition presents with different hematological findings, such as macrocytic anemia, rather than bleeding symptoms.
Option D: Thickening of blood and bruising are not typical manifestations of thrombocyte depression. Instead, thrombocytopenia leads to increased bleeding tendencies, not blood thickening, which would suggest a different hematological issue.
Takeaways: Monitoring for signs of bleeding, such as bleeding gums and dark tarry stools, is essential when managing patients on medications that depress thrombocytes, as these symptoms indicate potential complications of thrombocytopenia that require immediate attention. For further details on managing thrombocytopenia, refer to this resource on thrombocytopenia.
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Question 31 of 101
A male client, age 45, undergoes a lumbar puncture in which CSF was extracted for a particular neurologic diagnostic procedure. After the procedure, he complains of dizziness and a slight headache. Which of the ff steps must the nurse take to provide comfort to the client? Choose all that apply
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Option B: Encourage a liberal fluid intake. Increasing fluid intake after a lumbar puncture helps to replenish cerebrospinal fluid (CSF) volume and can alleviate post-procedure headaches, which are common due to CSF leakage. Hydration is essential for recovery and comfort in this context.
Option A: Positioning the client flat for at least 3 hours is a common recommendation to prevent headaches; however, it is not the only necessary action for comfort. While it may help, it does not directly address fluid replacement, which is crucial.
Option C: Keeping the room well lit and playing soothing music does not address the physiological needs of the client after a lumbar puncture. Comfort measures should focus on hydration and positioning rather than environmental factors.
Option D: Helping the client ambulate and perform light leg exercises may exacerbate dizziness and headache symptoms following a lumbar puncture. Rest is more beneficial in this situation to promote recovery and comfort.
Takeaways: Encouraging fluid intake after a lumbar puncture is vital for replenishing CSF and reducing headache symptoms. Proper post-procedure care requires hydration and monitoring for complications to ensure client comfort and safety.
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Question 32 of 101
As part of the treatment for heart failure, the child takes the diuretic furosemide (Lasix). As part of teaching home care, the nurse encourages the family to give the child foods such as bananas, oranges, and leafy vegetables. These foods are recommended because they are high in which nutrient?
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Option B: Foods such as bananas, oranges, and leafy vegetables are high in potassium, which is essential for maintaining normal heart function and counteracting the potassium-wasting effects of furosemide (Lasix). This is particularly important in children with heart failure who may be at risk for hypokalemia due to diuretic therapy.
Option A: Chlorides are not the primary nutrient of concern in this context; while they are important for fluid balance, they do not directly address the potassium loss associated with diuretics.
Option C: Sodium intake is typically restricted in heart failure management to reduce fluid retention, making this option irrelevant to the dietary recommendations for a child on furosemide.
Option D: While vitamins are important for overall health, they do not specifically address the need for potassium in the context of diuretic therapy and heart failure management.
Takeaways: Ensuring adequate potassium intake through foods like bananas and leafy vegetables is crucial for children on diuretics such as furosemide, as it helps prevent hypokalemia and supports cardiac function; thus, proper dietary education is essential for effective home care management. For more information on dietary needs in heart failure, see this resource.
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Question 33 of 101
The nurse understands that a patient with BP readings 164/102 and 176/100 on two separate occasions would be classified in which hypertension category?
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Option B: Stage 2 hypertension is defined as having systolic blood pressure (SBP) of 140 mmHg or higher or diastolic blood pressure (DBP) of 90 mmHg or higher. The patient's readings of 164/102 and 176/100 clearly exceed these thresholds, placing them in this category.
Option A: Prehypertension is characterized by SBP between 120-139 mmHg or DBP between 80-89 mmHg. The patient's readings are significantly higher than these values, thus ruling out this classification.
Option C: Stage 1 hypertension includes SBP of 130-139 mmHg or DBP of 80-89 mmHg. The patient's BP readings exceed these limits, confirming they do not fall under Stage 1.
Option D: Posthypertension is not a recognized category in hypertension classification. The term does not exist in current clinical guidelines, making this option invalid.
Takeaways: Understanding blood pressure classifications is essential for effective management of hypertension, where readings above 140/90 mmHg indicate Stage 2 hypertension.
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Question 34 of 101
Nurse Norma's discharge teaching for Mr. Aurelio, diagnosed with heart failure, should stress the significance of:
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Option B: obtain daily weights at the same time is essential for monitoring fluid retention in patients with heart failure. Daily weights help identify weight gain due to fluid overload, which can indicate worsening heart failure and guide timely interventions to prevent complications.
Option A: maintaining a sedentary lifestyle most of the day contradicts the recommendations for heart failure management, which encourage physical activity as tolerated to improve cardiovascular health and functional capacity.
Option C: walking 2 miles daily may be excessive for some patients with heart failure, especially if they are not conditioned. Exercise should be individualized based on the patient's tolerance and overall health status.
Option D: maintaining a high fiber diet, while beneficial for general health, is not specifically emphasized in heart failure management compared to fluid and weight monitoring, which are critical for managing symptoms and preventing hospitalizations.
The nurse is caring for a very low birth weight (VLBW) newborn with a peripheral intravenous infusion. Which statement describes nursing considerations regarding infiltration?
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Option C: Hypertonic solutions can cause severe tissue damage if infiltration occurs. Infiltration in VLBW newborns can lead to significant complications, as their delicate skin and tissues are more susceptible to injury. Hypertonic solutions, when infused into surrounding tissues, can result in necrosis and other serious injuries, necessitating careful monitoring of the infusion site.
Option A: Infiltration occurs frequently in VLBW newborns due to their fragile veins and limited mobility, making this statement misleading. Their small size and the nature of their vascular access increase the risk of infiltration.
Option B: Continuous infusion pumps do not automatically stop when infiltration occurs; they require manual monitoring and intervention by nursing staff to detect and address infiltration events.
Option D: The infusion site should be checked for infiltration more frequently than once per 8-hour shift, ideally every 1 to 2 hours, to ensure timely detection and management of any complications.
Takeaways: Regular assessment of intravenous sites is critical in VLBW newborns, as they are at high risk for infiltration, especially with hypertonic solutions, which can lead to severe tissue damage if not monitored closely. For more information on this topic, refer to neonatal intravenous therapy guidelines.
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Question 36 of 101
Clients will go through operations and who have undergone surgery need the proper observation, treatment, and care. Implementing the nursing process to these patients will help reduce complications. Nurse Maria is preparing Mr. Sy for surgery. Which of the following statements by the client would indicate he is well-informed about his imminent surgery?
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Option B: "I will not eat anything after 12 pm the night before my operation, but I sure can drink." This statement reflects an accurate understanding of preoperative fasting guidelines, which typically allow clear liquids up to a specified time before surgery while restricting solid food intake to reduce the risk of aspiration during anesthesia.
Option A: "Right after the operation, I will wear the pneumatic compression device while sitting on the chair." This statement does not indicate a full understanding of the timing and purpose of the pneumatic compression device, which is usually applied postoperatively while in bed to prevent venous thromboembolism.
Option C: "The skin preparation site is longer and wider than the actual incision site." This statement is misleading; skin preparation typically focuses on the incision site itself to minimize infection risk, not extending beyond it unnecessarily.
Option D: "I will need to sign the consent form after I get to the operating table." Consent must be obtained prior to the day of surgery, ensuring the patient is fully informed and consenting before the procedure begins, not at the operating table.
Takeaways: Understanding preoperative instructions, including fasting guidelines, is essential for patient safety and effective surgical outcomes. Proper patient education ensures compliance with protocols, which requires patient education before surgery and informed consent to minimize risks.
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Question 37 of 101
Why may an ice collar be ordered for a client who is undergoing drainage of a peritonsillar abscess?
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Option B: To prevent respiratory obstruction is a critical reason for using an ice collar in this scenario. The application of cold can help reduce swelling in the throat area, which is vital after drainage of a peritonsillar abscess to maintain an open airway and prevent complications such as airway obstruction.
Option A: To reduce swelling and pain is a valid consideration; however, the primary concern in this context is the prevention of respiratory obstruction rather than just pain and swelling management.
Option C: To help the client drink fluids does not apply here, as an ice collar is not intended to facilitate fluid intake but rather to manage swelling and airway patency.
Option D: To prevent excessive bleeding is not relevant in this case, as the ice collar primarily addresses swelling and potential airway issues rather than bleeding control.
Takeaways: An ice collar is utilized to manage swelling and prevent respiratory obstruction following procedures like drainage of a peritonsillar abscess, which requires monitoring for airway patency to ensure patient safety.
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Question 38 of 101
Which is descriptive of bulimia during adolescence?
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Question 39 of 101
Which is a function of brown adipose tissue (BAT) in the newborn?
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Question 40 of 101
In Langerhans cell histiocytosis (LCH), all the following manifestations are at high risk of mortality in patients EXCEPT
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Question 41 of 101
The most common neonatal sepsis and meningitis infections seen within 24 hours after birth are caused by which organism?
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Question 42 of 101
A classic full blown AIDS case is identified by clinical manifestations such as:
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Question 43 of 101
Which of the following malignancies is least likely to occur in a 10-month-old infant?
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Question 44 of 101
The baby with birth brachial plexus palsy (BBPP) will start with occupational or physical therapy at approximately
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Question 45 of 101
Which of the following types of cells is the immune system's shutoff mechanism?
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Question 46 of 101
Granulocytic sarcoma masses are commonly seen in which type of the following malignancies?
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Question 47 of 101
A guest who is diabetic attended a bridal affair. The guest started to tremble and started to feel dizzy. Luckily a nurse is present. The best action for the nurse to take is to:
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Question 48 of 101
What should the nurse suggest to the parents of an infant who has a prolonged need for middle-of-the-night feedings?
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Question 49 of 101
Which combination of signs is commonly associated with glomerulonephritis?
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Question 50 of 101
Hyperparathyroidism is caused by increased levels of thyroxine in blood plasma. A client with this endocrine dysfunction would experience:
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Question 51 of 101
Which of the following is an adverse reaction to glipizide (Glucotrol)?
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Question 52 of 101
You asked to obtain a measurement of serum sodium level in the hospital lab; you obtain a value of 125 mmol/L by repeating the test 5 times. The reference value of serum sodium at that lab is between 135-155 mmol/L. Your measurement is termed
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Question 53 of 101
Which of the following would be the most appropriate nursing intervention when caring for a client with a fractured rib?
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Question 54 of 101
Which strategies should the school nurse recommend implementing in the classroom for a child with attention deficit hyperactive disorder (ADHD)? (Select all that apply.)
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Question 55 of 101
Which of the following infants is least probable to develop sudden infant death syndrome (SIDS)?
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Question 56 of 101
Amy, age 6 years, needs to be hospitalized again because of a chronic illness. The clinic nurse overhears her school-age siblings tell her, "We are sick of Mom always sitting with you in the hospital and playing with you. It isn't fair that you get everything and we have to stay with the neighbors." Which is the nurse's best assessment of this situation?
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Question 57 of 101
A nurse is interviewing the parents of a toddler about use of complementary or alternative medical practices. The parents share several practices they use in their household. Which should the nurse document as complementary or alternative medical practices? (Select all that apply.)
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Question 58 of 101
A first-time mother brings in her 5-day-old baby for a well-child visit. The baby weighs 7 lb 5 oz, down from 7 lb 10 oz at discharge. The nurse's best response is:
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Question 59 of 101
A nurse in the newborn nursery is monitoring a preterm newborn infant for respiratory distress syndrome. Which assessment signs if noted in the newborn infant would alert the nurse to the possibility of this syndrome?
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Question 60 of 101
Which of the ff. subjective data questions would assist the nurse in assessing the patient's eye health?
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Question 61 of 101
A client has been scheduled for a Schilling test. What instruction will the nurse give the client?
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Question 62 of 101
Incomplete development of teeth,bones, and ligaments is the result of:
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Question 63 of 101
A 78 year old male has been working on his lawn for two days, although the temperature has been above 90 degree F. he has been on thiazide diuretics for hypertension. His lab values are K 3.7 mEq/L, Na 129 mEq/L, Ca 9 mg/dl, and Cl 95 mEq/L. What would be a priority action for this man?
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Question 64 of 101
Which of the ff is the characteristic of a ketogenic diet that is suggested for children with seizures?
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Question 65 of 101
Where would nonpathologic cyanosis normally be present in the newborn shortly after birth?
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Question 66 of 101
The nurse is taking vital signs of a pregnant woman during her first prenatal visit. The patient asks the nurse if she has to have an HIV test. Which of the following is the nurse's best response?
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Question 67 of 101
Following a splenectomy, a client has a hemoglobin (Hb) level of 7.5g/dl and has vertigo when getting out of bed. The nurse suspects abnormal orthostatic changes. The vital sign values that would most support the nurse's analysis are:
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Question 68 of 101
For a client diagnosed with idiopathic thrombocytopenic purpura (ITP), which nursing intervention is appropriate?
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Question 69 of 101
Which vein should be used first when initiating IV therapy?
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Question 70 of 101
A client has possible malignancy of the colon, and surgery is scheduled. The rationale for administering Neomycin preoperatively is to:
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Question 71 of 101
The LEAST important advice for a 2-month-old baby with excessive crying is
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Question 72 of 101
the clinical manifestations of nephrosis include which of the following ?
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Question 73 of 101
Which of the ff. problems during the immediate postoperative course ff. lumbar microdiskectomy should be reported to the physician immediately?
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Question 74 of 101
A 1-year-old child develops right eye ptosis, miosis, and loss of sweating; you suspect neuroblastoma. The MOST valuable investigation to confirm the diagnosis is
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Question 75 of 101
A client has been diagnosed with renal failure and is admitted for dialysis. Which of the ff is the nurse's responsibility as the client undergone dialysis?
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Question 76 of 101
A baby that was born 5 minutes earlier is tachypneic, tachycardic, and markedly cyanotic. A STAT echocardiogram confirms the presence of a cyanotic congenital cardiac defect. Which of the following defects would be consistent with the assessment findings?
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Question 77 of 101
Tic douloureux is a (n) ___ cranial nerve disorder characterized by paroxysms of pain and burning sensations.
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Question 78 of 101
Aling Nena, 68 years old, had a MVA and underwent surgery for hip fracture. Two days post-surgery, she suddenly complained of chest heaviness despite the absence of cardiac history. What is the nursing priority?
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Question 79 of 101
Idiopathic thrombocytopenic purpura (ITP) commonly results in what finding?
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Question 80 of 101
A nurse makes the decision to apply a topical anesthetic to a child's skin before drawing blood. Which ethical principle is the nurse demonstrating?
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Question 81 of 101
Which type of shock is characterized by a hypersensitivity reaction causing massive vasodilation and capillary leaks, which may occur with drug or latex allergy?
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Question 82 of 101
Which of the ff suggestions should a nurse give breastfeeding mothers to prevent or eliminate mastitis and breast abscess? Choose all that apply
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Question 83 of 101
The nurse is guiding parents in selecting a daycare facility for their infant. Which is especially important to consider when making the selection?
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Question 84 of 101
UTI 118 Practice Exam II The methotrexate drug used to treat :
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Question 85 of 101
Which of the ff values pertaining to different clients shows the normal range of plasma pH?
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Question 86 of 101
If a patient has elevated pulmonary vascular pressures, the nurse understands that the patient is most likely to develop which of the ff. physiological cardiac changes?
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Question 87 of 101
Antimetabolites are a diverse group of antineoplastic agents that interfere with various metabolic actions of the cell. The mechanism of action of antimetabolites interferes with:
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Question 88 of 101
The MOST appropriate advice for a 4-year-old child visiting the outpatient department with excessive crying is
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Question 89 of 101
Newborns are highly susceptible to infection as a result of:
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Question 90 of 101
Which vitamin is recommended for all women of childbearing age to reduce the risk of neural tube defects such as spina bifida?
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Question 91 of 101
You are discussing the risk of radiotherapy with the parents of a child with medulloblastoma; the mother has a concern about the late neurological complications post radiotherapy. The statement that should be included in the discussion that late neurological sequelae post radiotherapy is more severe with
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Question 92 of 101
By the age of 7 months, the infant is able to do all the following EXCEPT
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Question 93 of 101
A nurse is planning a teaching session for parents of a newborn who plan to bottle-feed. Which should the nurse include in the teaching session? (Select all that apply.)
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Question 94 of 101
The nurse is caring for a client who has just had a modified radical mastectomy with immediate reconstruction. She's in her 30s and has two young children. Although she's worried about her future, she seems to be adjusting well to her diagnosis. What should the nurse do to support her coping?
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Question 95 of 101
The nurse teaches a diabetic client that diet plays a crucial role in managing diabetes mellitus. When evaluating dietary intake, the nurse knows the client is eating the right foods if total daily caloric intake consists of:
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Question 96 of 101
Aling Maria, a 58-year old female, was admitted for the third time because of myxedema. Initial assessment by Nurse Mida should include symptoms of:
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Question 97 of 101
A 6-year-old child is scheduled for an IV urography (IVP) in the morning. Which preparatory interventions should the nurse plan to implement? (Select all that apply.)
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Question 98 of 101
For a client newly diagnosed with radiation-induced thrombocytopenia, the nurse should include which intervention in the plan of care?
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Question 99 of 101
The nurse is testing an infant's visual acuity. By what age should the infant be able to fix on and follow a target?
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Question 100 of 101
What are the periods in life when the need for iron increases?
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Question 101 of 101
A nurse is preparing to perform a physical assessment on a toddler. Which approach should the nurse use for this child?
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