Reviewer 2

1. Antonio is admitted for treatment of heart failure. The physician orders an IV of 125 ml of normal saline per hour and central venous pressure (CVP) readings every 4 hours. Sixteen hours after admission, the client’s CVP reading is 3 cm/H2O. Which of the following evaluations of the client’s fluid status, if made by the nurse would be most accurate? • • • •

The client has received enough fluid. The client’s fluid status remains unaltered. The client has received too much fluid. The client needs more fluid.

The client needs more fluid. Rationale: Normal is 4-10 cm/H2O which indicates hypovolemia. 2. Nurse Olivia performs teaching with a client undergoing a paracentesis for treatment of cirrhosis. The client asks what position he will be in for the procedure. Nurse Olivia’s reply would be based on understanding that the most appropriate position for the client is: • • • •

Sitting with his lower extremities well supported. Side-lying with a pillow between his knees. Prone, with his head turned to the left side. Dorsal recumbent with a pillow at the back of his head.

Fowler’s position or sitting on side of the bed with feet on stool provide easy access to abdominal area and allows intestines to float to prevent laceration. 3. Marco returns to his room following a transurethral resection of the prostate (TURP) for benign prostatic hypertrophy (BPH). Which of the following would cause the nurse incharge to suspect postoperative hemorrhage? • • • •

Decreased blood pressure, increased pulse, increased respiration. Fluctuating blood pressure, decreased pulse, rapid respirations. Increased blood pressure, bounding pulse, irregular respirations. Increased blood pressure, irregular pulse, shallow respirations.

It is caused by decreased blood volume, as intravascular volume decreases and BP falls, heart rate increases in attempt to maintain cardiac output, respiratory increase in attempt to increase oxygenation. 4. A female client recovering from a laparoscopic laser cholecystectomy says to the nurse, “I hate the thought of eating a low-fat diet for the rest of my life.” Which of the following responses by the nurse is most appropriate? • • •

“I will ask the dietitian to come to talk to you.” “What do you think is so bad about following a low-fat diet?” “It may not be necessary for you to follow a low-fat-diet for that long.”

•

“At least you will be alive and not suffering that pain.”

Fat restriction is usually lifted as the client tolerates fat. Biliary ducts dilate sufficiently to accommodate bile volume that was held by the gallbladder. 5. Dervid returns from his room following a cardiac catheterization. Which of the following assessments, if made by the nurse would justify calling the physician? • • • •

Pain at the site of the catheter insertion. Absence of a pulse distal to the catheter insertion site. Drainage on the dressing covering the catheter insertion site. Redness at the catheter insertion site.

Decrease in blood supply and a report of change in sensation, color, pulses should be immediately alert the physician. 6. Nurse Dorothy prepares admission of a client with a perforated duodenal ulcer. Which of the following should the nurse expect to observe as the primary initial symptom? • • • •

Fever Pain Dizziness Vomiting

Sudden, sharp pain, begins mid-epigastric, boardlike abdomen. 7. Nurse Amanda plans nursing care for a client hospitalized after a cerebrovascular accident (CVA) resulting in left-sided paralysis and homonymous hentianopia. During morning care, the nurse should: • • • •

Provide care from the client’s right side. Speak loudly and distinctly when talking with the client. Reduce the level of lightning in the client’s room to prevent glare. Provide the entire client’s care to reduce his energy expenditure.

Approach the client from the side with intact vision. 8. Francis, diagnosed with chronic lymphocytic leukemia, is admitted to the hospital for treatment of hemolytic anemia. Which of the following measures, if incorporated into the nursing care plan, would best address the client’s needs. • • • •

Encourage activities with other clients in the day room. Isolate him form visitors and clients to avoid infection. Provide a diet high in vitamin C Provide a quiet environment to promote adequate rest.

In leukemia, the primary problem is activity intolerance due to fatigue. 9. Jose with lung cancer has developed an intractable, nonproductive cough that is unrelieved by non narcotic antitussive agents. The physician prescribes codeine, 10 mg P.O. every 4 hours. Which statement accurately describes codeine? • • • •

It's a centrally acting antitussive and doesn't cause dependence. It's a peripherally acting antitussive and doesn't cause dependence. It's a centrally acting antitussive and can cause dependence. It's a peripherally acting antitussive and can cause dependence.

As a centrally acting antitussive, codeine suppresses the cough reflex by directly affecting the sensitivity of the cough center in the medulla to incoming stimuli. Because codeine is a narcotic, it can cause dependence. 10. Following coronary artery bypass grafting, Richard begins having chest "fullness" and anxiety. The nurse suspects cardiac tamponade and prints a lead II electrocardiograph (ECG) strip for interpretation. In looking at the strip, the change in the QRS complex that would most support her suspicion is: • • • •

Narrowing complex. Widening complex. Amplitude increase. Amplitude decrease.

Fluid surrounding the heart such as in cardiac tamponade, suppresses the amplitude of the QRS complexes on an ECG. Narrowing and widening complexes as well as an amplitude increase aren't what is expected on the ECG of an individual with cardiac tamponade. 11. Leo comes to the emergency department with an acute myocardial infarction. An electrocardiogram shows a heart rate of 116 beats/minute with frequent premature ventricular contractions. The client experiences ventricular tachycardia and becomes unresponsive. After resuscitation, the client moves to the intensive care unit. Which nursing diagnosis is top priority? • • • •

Impaired physical mobility related to complete bed rest Deficient knowledge related to emergency interventions Social isolation related to restricted family visits Anxiety related to the threat of death

Anxiety related to the threat of death is an appropriate nursing diagnosis. Anxiety can adversely affect the client's heart rate and rhythm by stimulating the autonomic nervous system. The threat of death is an immediate and real concern for the client. The other options are valid but their priority is less urgent.

12. After having several Stokes-Adams attacks over 4 months, a client reluctantly agrees to implantation of a permanent pacemaker. Before discharge, the nurse Sheen reviews pacemaker care and safety guidelines with the client and spouse. Which safety precaution is appropriate for a client with a pacemaker? • • • •

Stay at least 2′ away from microwave ovens. Never engage in activities that require vigorous arm and shoulder movement. Avoid going through airport metal detectors. Avoid using a cellular phone.

A client with a pacemaker should avoid using cellular phones because they may disrupt the function of the pacemaker. This problem is less likely to occur with newer microwave ovens; nonetheless, the client should stay at least 5′ away from microwaves, not 2′. The client must avoid vigorous arm and shoulder movement only for the first 6 weeks after pacemaker implantation. Airport metal detectors don't harm pacemakers; however, the client should notify airport security guards of the pacemaker because its metal casing and programming magnet may trigger the metal detector. 13. Which signs and symptoms are present with a diagnosis of pericarditis? • • • •

Fever, chest discomfort, and elevated erythrocyte sedimentation rate (ESR) Low urine output secondary to left ventricular dysfunction Lethargy, anorexia, and heart failure Pitting edema, chest discomfort, and nonspecific ST-segment elevation

The classic signs and symptoms of pericarditis include fever, positional chest discomfort, nonspecific ST-segment elevation, elevated ESR, and pericardial friction rub. All other symptoms may result from acute renal failure. 14. Ramon in the emergency department complains of squeezing substernal pain that radiates to the left shoulder and jaw. He also complains of nausea, diaphoresis, and shortness of breath. What should the nurse do? • • • •

Complete the client's registration information, perform an electrocardiogram, gain I.V. access, and take vital signs. Alert the cardiac catheterization team, administer oxygen, attach a cardiac monitor, and notify the physician. Gain I.V. access, give sublingual nitroglycerin, and alert the cardiac catheterization team. Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin.

Cardiac chest pain is caused by myocardial ischemia. Administering supplemental oxygen increases the myocardial oxygen supply. Cardiac monitoring helps detect lifethreatening arrhythmias. Ensure that the client isn't hypotensive before giving sublingual nitroglycerin for chest pain. Registration information may be delayed until the client is

stabilized. Alerting the cardiac catheterization team before completing the initial assessment is premature. 15. Dave with chest pain receives nitroglycerin on the way to the acute care facility. Based on an electrocardiogram obtained on admission, the physician suspects a myocardial infarction (MI) and prescribes I.V. morphine to relieve continuing pain. A primary goal of nursing care for this client is to recognize life-threatening complications of an MI. The major cause of death after an MI is: • • • •

Cardiogenic shock. Cardiac arrhythmia. Heart failure. Pulmonary embolism.

Cardiac arrhythmias cause roughly 40% to 50% of deaths after MI. Heart failure, in contrast, accounts for 33% and cardiogenic shock for 9% of post-MI deaths. Pulmonary embolism, another potential complication of an MI, is less common. 16. Tony is hospitalized with oat cell carcinoma of the lung. To manage severe pain, the physician prescribes a continuous I.V. infusion of morphine. Which formula should the nurse use to check that the morphine dose is appropriate for the client? • • • •

1 mg/kg of body weight 5 mg/kg of body weight 5 mg/70 kg of body weight 10 mg/70 kg of body weight

The usual adult dose of morphine sulfate is based on 10 mg/70 kg of body weight when given parenterally. 17.

Which nursing intervention is most appropriate for a client with multiple myeloma? • • • •

Monitoring respiratory status Balancing rest and activity Restricting fluid intake Preventing bone injury

When caring for a client with multiple myeloma, the nurse should focus on relieving pain, preventing bone injury and infection, and maintaining hydration. Monitoring respiratory status and balancing rest and activity are appropriate interventions for any client. To prevent such complications as pyelonephritis and renal calculi, the nurse should keep the client well hydrated — not restrict his fluid intake. 18. To treat cervical cancer, Norma has had an applicator of radioactive material placed in the vagina. Which observation by the nurse indicates a radiation hazard?

• • • •

The client is maintained on strict bed rest. The head of the bed is at a 30-degree angle. The client receives a complete bed bath each morning. The nurse checks the applicator's position every 4 hours.

The client shouldn't receive a complete bed bath while the applicator is in place. In fact, she shouldn't be bathed below the waist because of the risk of radiation exposure to the nurse. During this treatment, the client should remain on strict bed rest, but the head of her bed may be raised to a 30- to 45-degree angle. The nurse should check the applicator's position every 4 hours to ensure that it remains in the proper place. 19. Malou is receiving chemotherapy has a nursing diagnosis of deficient diversional activity related to decreased energy. Which statement indicates an accurate understanding of appropriate ways to deal with this deficit? • • • •

"I'll play card games with my friends." "I'll take a long trip to visit my aunt." "I'll bowl with my team after discharge." "I'll eat lunch in a restaurant every day."

During chemotherapy, playing cards is an appropriate diversional activity because it doesn't require a great deal of energy. To conserve energy, the client should avoid such activities as taking long trips, bowling, and eating in restaurants every day. However, the client may take occasional short trips and can dine out on special occasions. 20. Andrew is recovering from an ileostomy that was performed to treat inflammatory bowel disease. During discharge teaching, the nurse should stress the importance of: • • • •

increasing fluid intake to prevent dehydration. wearing an appliance pouch only at bedtime. consuming a low-protein, high-fiber diet. taking only enteric-coated medications.

Because stool forms in the large intestine, an ileostomy typically drains liquid waste. To avoid fluid loss through ileostomy drainage, the nurse should instruct the client to increase fluid intake. The nurse should teach the client to wear a collection appliance at all times because ileostomy drainage is incontinent, to avoid high-fiber foods because they may irritate the intestines, and to avoid enteric-coated medications because the body can't absorb them after an ileostomy. 21. A male client with liver and renal failure has severe ascites. On initial shift rounds, his primary nurse finds his indwelling urinary catheter collection bag too full to store more urine. The nurse empties more than 2,000 ml from the collection bag. One hour later, she finds the collection bag full again. The nurse notifies the physician, who suspects that a bladder rupture is allowing the drainage of peritoneal fluid. The physician

orders a urinalysis to be obtained immediately. If the physician's suspicion is correct, the urine will abnormally contain: • • • •

creatinine. urobilinogen. chloride. albumin.

Albumin is an abnormal finding in a routine urine specimen. Ascites present in liver failure contain albumin; therefore, if the bladder ruptured, ascites containing albumin would drain from the indwelling urinary catheter because the catheter is no longer contained in the bladder. Creatinine, urobilinogen, and chloride are normally found in urine. 22. As a client recovers from gastric resection, nurse Zara monitors closely for complications. When the client resumes oral feedings, the nurse observes for early manifestations of dumping syndrome. The vasomotor disturbances associated with this syndrome usually occur how soon after eating? • • • •

Immediately 5 to 30 minutes 1 to 2 hours 2 to 4 hours

Early manifestations of dumping syndrome occur 5 to 30 minutes after eating. Signs and symptoms of this syndrome include vertigo, tachycardia, syncope, sweating, pallor, palpitations, diarrhea, nausea, and the desire to lie down. Manifestations of dumping syndrome don't occur immediately because food takes a few minutes to reach the jejunum. Early manifestations of vasomotor disturbances usually arise within 45 minutes. 23. Nurse Lhyzette must provide total parenteral nutrition (TPN) to a client through a triple-lumen central line. To prevent complications of TPN, the nurse should: • • • •

Cover the catheter insertion site with an occlusive dressing. Use clean technique when changing the dressing. Insert an indwelling urinary catheter. Keep the client on complete bed rest.

TPN increases the client's risk of infection because the catheter insertion site creates a port of entry for bacteria. To reduce the risk of infection, the nurse should cover the insertion site with an occlusive dressing, which is airtight. Because the insertion site is an open wound, the nurse should use sterile technique when changing the dressing. TPN doesn't necessitate placement of an indwelling urinary catheter or bed rest

24. A male client undergoes total gastrectomy. Several hours after surgery, nurse Charina notes that the client's nasogastric (NG) tube has stopped draining. How should the nurse respond? • • • •

Notify the physician Reposition the tube Irrigate the tube Increase the suction level

An NG tube that fails to drain during the postoperative period should be reported to the physician immediately. It may be clogged, which could increase pressure on the suture site because fluid isn't draining adequately. Repositioning or irrigating an NG tube in a client who has undergone gastric surgery can disrupt the anastomosis. Increasing the level of suction may cause trauma to GI mucosa or the suture line. 25. Troy is diagnosed with a hiatal hernia. Which statement indicates effective client teaching about hiatal hernia and its treatment? • • • •

"I'll eat three large meals every day without any food restrictions." "I'll lie down immediately after a meal." "I'll gradually increase the amount of heavy lifting I do." "I'll eat frequent, small, bland meals that are high in fiber."

In hiatal hernia, the upper portion of the stomach protrudes into the chest when intraabdominal pressure increases. To minimize intra-abdominal pressure and decrease gastric reflux, the client should eat frequent, small, bland meals that can pass easily through the esophagus. Meals should be high in fiber to prevent constipation and minimize straining on defecation (which may increase intra-abdominal pressure from the Valsalva maneuver). Eating three large meals daily would increase intra-abdominal pressure, possibly worsening the hiatal hernia. The client should avoid spicy foods, alcohol, and tobacco because they increase gastric acidity and promote gastric reflux. To minimize intra-abdominal pressure, the client shouldn't recline after meals, lift heavy objects, or bend. 26. What is the primary nursing diagnosis for a client with a bowel obstruction? • • • •

Deficient fluid volume Deficient knowledge Pain Ineffective tissue perfusion

Feces, fluid, and gas accumulate above a bowel obstruction. Then the absorption of fluids decreases and gastric secretions increase. This process leads to a loss of fluids and electrolytes in circulation. Options B, C, and D are applicable but not the primary nursing diagnosis.

27. An adolescent girl is admitted to an acute care facility with severe malnutrition. After a thorough examination, the physician diagnoses anorexia nervosa. When developing the plan of care for this client, nurse Michelle is most likely to include which nursing diagnosis? • • • •

Hopelessness Powerlessness Chronic low self esteem Deficient knowledge

Young women with Chronic low self esteem — are at highest risk for anorexia nervosa because they perceive being thin as a way to improve their self-confidence. Hopelessness and Powerlessness are inappropriate nursing diagnoses because clients with anorexia nervosa seldom feel hopeless or powerless; instead, they use food to control their desire to be thin and hope that restricting food intake will achieve this goal. Anorexia nervosa doesn't result from a knowledge deficit, such as one regarding good nutrition. 28. Nurse Mariner is teaching an elderly client about good bowel habits. Which statement by the client would indicate to the nurse that additional teaching is required? • • • •

"I should eat a fiber-rich diet with raw, leafy vegetables, unpeeled fruit, and whole grain bread." "I need to use laxatives regularly to prevent constipation." "I need to drink 2 to 3 liters of fluid every day." "I should exercise four times per week."

The elderly client should be taught to gradually eliminate the use of laxatives. Point out that using laxatives to promote regular bowel movements may have the opposite effect. A high-fiber diet, ample amounts of fluids, and regular exercise promote good bowel health. 29. Bea with atopic dermatitis is prescribed medication for photochemotherapy. The nurse teaches the client about the importance of protecting the skin from ultraviolet light before drug administration and for 8 hours afterward and stresses the need to protect the eyes. After administering medication for photochemotherapy, the client must protect the eyes for: • • • •

4 hours. 8 hours. 24 hours. 48 hours.

To prevent eye discomfort, the client must protect the eyes for 48 hours after taking medication for photochemotherapy. Protecting the eyes for a shorter period increases the risk of eye injury.

30. Nurse Ronald plans to administer dexamethasone cream to a client who has dermatitis over the anterior chest How should the nurse apply this topical agent? • • • •

With a circular motion, to enhance absorption With an upward motion, to increase blood supply to the affected area In long, even, outward, and downward strokes in the direction of hair growth In long, even, outward, and upward strokes in the direction opposite hair growth

When applying a topical agent, the nurse should begin at the midline and use long, even, outward, and downward strokes in the direction of hair growth. This application pattern reduces the risk of follicle irritation and skin inflammation. 31. A male client with a severe staphylococcal infection is receiving the aminoglycoside gentamicin sulfate (Garamycin) by the I.V. route. Nurse Marilyn should assess the client for which adverse reaction to this drug? • • • •

Aplastic anemia Ototoxicity Cardiac arrhythmias Seizures

The most significant adverse reactions to gentamicin and other aminoglycosides are ototoxicity (indicated by vertigo, tinnitus, and hearing loss) and nephrotoxicity (indicated by urinary cells or casts, oliguria, proteinuria, and reduced creatinine clearance). These adverse reactions are most common in elderly and dehydrated clients, those with renal impairment, and those receiving concomitant therapy with another potentially ototoxic or nephrotoxic drug. Gentamicin isn't associated with aplastic anemia, cardiac arrhythmias, or seizures. 32. Trisha with a solar burn of the chest, back, face, and arms is seen in urgent care. The nurse's primary concern should be: • • • •

Fluid resuscitation. Infection. Body image. Pain management.

With a superficial partial thickness burn such as a solar burn (sunburn), the nurse's main concern is pain management. Fluid resuscitation and infection become concerns if the burn extends to the dermal and subcutaneous skin layers. Body image disturbance is a concern that has lower priority than pain management. 33. A female client with acquired immunodeficiency syndrome (AIDS) is admitted with Pneumocystis carinii pneumonia. During a bath, the client begins to cry and says that most friends and relatives have stopped visiting and calling. What should the nurse Leng do?

• • • •

Continue with the bath and tell the client not to worry. Ask the physician to obtain a psychiatric consultation. Listen and show interest as the client expresses feelings. State that these friends' behavior shows that they aren't true friends.

The nurse should listen actively and nonjudgmentally as the client expresses feelings. Telling the client not to worry would provide false reassurance. A psychiatric consultation would be appropriate only after further assessment. Stating that the client's friends aren't true friends would discount the client's feelings. 34. Which nursing diagnosis should the nurse Dianne expect to see in a plan of care for a client in sickle cell crisis? • • • •

Imbalanced nutrition: Less than body requirements related to poor intake Disturbed sleep pattern related to external stimuli Impaired skin integrity related to pruritus Pain related to sickle cell crisis

In sickle cell crisis, sickle-shaped red blood cells clump together in a blood vessel, which causes occlusion, ischemia, and extreme pain. Therefore, option D is the appropriate choice. Although nutrition is important, poor nutritional intake isn't necessarily related to sickle cell crisis. During sickle cell crisis, pain or another internal stimulus is more likely to disturb the client's sleep than external stimuli. Although clients with sickle cell anemia can develop chronic leg ulcers caused by small vessel blockage, they don't typically experience pruritus. 35. Juan who agreed to become an organ donor is pronounced dead. What is the most important factor in selecting a transplant recipient? • • • •

Blood relationship Sex and size Compatible blood and tissue types Need

The donor and recipient must have compatible blood and tissue types. They should be fairly close in size and age. When a living donor is considered, it's preferable to have a relative donate the organ. Need is important but it can't be the critical factor if a compatible donor isn't available. 36. Which of the following cells are involved in bone resorption? • • • •

Chondrocytes Osteoblasts Osteoclasts Osteocytes

Osteoclasts carry out bone resorption by removing unwanted bone while new bone is forming in other areas. Chondrocytes are responsible for forming new cartilage. Osteoblasts are bone-forming cells that secrete collagen and other substances. Osteocytes, derived from osteoblasts, are the chief cells in bone tissue. 37. Mrs. Roda undergoes hip-pinning surgery to treat an intertrochanteric fracture of the right hip. The nurse should include which intervention in the postoperative plan of care? • • • •

Performing passive range-of-motion (ROM) exercises on the client's legs once each shift Keeping a pillow between the client's legs at all times Turning the client from side to side every 2 hours Maintaining the client in semi-Fowler's position

After hip pinning, the client must keep the affected leg abducted at all times; placing a pillow between the legs reminds the client not to cross the legs and to keep the leg abducted. Passive or active ROM exercises shouldn't be performed on the affected leg during the postoperative period because this could damage the operative site and cause hip dislocation. Most clients should be turned to the unaffected side, not from side to side. After hip pinning, the client must avoid acute flexion of the affected hip to prevent possible hip dislocation; therefore, semi-Fowler's position should be avoided. 38. Which nursing diagnosis is most appropriate for lola Luisa an elderly client with osteoarthritis? • • • •

Risk for injury related to altered mobility Impaired urinary elimination related to effects of aging Ineffective breathing pattern related to immobility Imbalanced nutrition: Less than body requirements related to effects of aging

Typically, a client with osteoarthritis has stiffness in large, weight-bearing joints, such as the hips. This joint stiffness alters functional ability and range of movement, placing the client at risk for falling and injury. Therefore, Risk for injury is the most appropriate nursing diagnosis. The other options are incorrect because osteoporosis doesn't affect urinary elimination, breathing, or nutrition. 39. A male client comes to the emergency department complaining of pain in the right leg. When obtaining the history, nurse Ron learns that the client was diagnosed with diabetes mellitus at age 12. The nurse knows that this disease predisposes the client to which musculoskeletal disorder? • • • •

Degenerative joint disease Muscular dystrophy Scoliosis Paget's disease

Diabetes mellitus predisposes the client to degenerative joint disease. It isn't a predisposing factor for muscular dystrophy, scoliosis, or Paget's disease. 40. A client who has just been diagnosed with mixed muscular dystrophy asks the nurse Cedric about the usual course of this disease. How should the nurse respond? • • • •

"You should ask your physician about that." "The strength of your arms and pelvic muscles will decrease gradually, but this should cause only slight disability." "You may experience progressive deterioration in all voluntary muscles." "This form of muscular dystrophy is a relatively benign disease that progresses slowly."

Muscular dystrophy causes progressive, symmetrical wasting of skeletal muscles, without neural or sensory defects. The mixed form of the disease typically strikes between ages 30 and 50 and progresses rapidly, causing deterioration of all voluntary muscles. Because the client asked the nurse this question directly, the nurse should answer and not simply refer the client to the physician. Limb-girdle muscular dystrophy causes a gradual decrease in arm and pelvic muscle strength, resulting in slight disability. Facioscapulohumeral muscular dystrophy is a slowly progressive, relatively benign form of muscular dystrophy; it usually arises before age 10. 41. The Milwaukee brace is used often in the treatment of scoliosis. Which the following positions best describes the placement of the pressure rods? • • • •

Laterally on the convex portion of the curve. Laterally on the concave portion of the curve. Posteriorly on the convex portion of the curve. Posteriorly along the spinal column at the exact level of the curve.

Lateral pressure applied to the convex portion of the curve will help best in reducing the curvature. Pressure pads applied posteriorly will help maintain erect pressure. Pressure applied to the concave portion of the curve will increase the kordosis. 42. The nurse is aware that congenital hip dislocation is most common found in which of the following groups? • • • •

Males Females First-born males First-born females

Studies have shown that first-born females are six times more likely to have a congenital hip dislocation than males. 43. Which of the following forms of muscular dystrophy is the most common?

• • • •

Duchenne’s Becker’s Limb girdle Myotonic

Duchenne’s accounts for 50% of all cases of muscle dystrophy. 44. The nurse is aware that the following defects involve the use of the Logan bow postoperatively? • • • •

Cleft lip or palate Esophageal atresia Hiatal hernia Tracheoesophageal fistula

Immediately after surgery for cleft lip or palate, the Logan bow, a thin arched metal device, is used to protect the suture line from tension. 45. Nurse Myrna is aware that which of the following ages would she observe a higher incidence of acute glomerulonephritis? • • • •

1 to 2 years 6 to 7 years 12 to 13 years 18 to 20 years

Acute glomerulonephritis can occur at any age, but it primarily affects early school age children with peak age of onset of 6 to 7 years. It is uncommon in children younger than 2 years old. 46. Nurse Oliver is aware that the following hormones is secreted by the anterior pituitary gland? • • • •

Corticotropin Antidiuretic hormone Cortisol Oxytocin

Corticotropin is secreted by the anterior pituitary gland. Antidiuretic hormone and oxytocin are secreted by posterior pituitary gland. Cortisol is secreted by the adrenal glands. 47. Which of the following condition is a common cause of prerenal acute renal failure? • •

Atherosclerosis Decreased cardiac output

• •

Prostatic hypertrophy Rhabdomyolysis

Prerenal refers to renal failure due to an interference with renal perfusion. Decreased cardiac output causes a decrease in renal perfusion, which leads to a lower glomerular filtration rate. 48. When the nurse provides discharge teaching for a client with uric acid calculi, the nurse should include an instruction to avoid which type of diet? • • • •

Low-calcium Low-oxalate High-oxalate High-purine

To control uric acid calculi, the client should allow to follow a low-purine diet, which excludes high-purine foods such as organ meats. A low calcium diet decreases the risk for oxalate renal calculi. Oxalate is an essential amino acid and must be included in the diet. A low-oxalate diet is used to control calcium or oxalate calculi. 49. The client with which of the following types of lung cancer has the best prognosis? • • • •

Adenocarcinoma Oat cell Squamous cell Small cell

Squamous cell carcinoma is a slow growing, rarely metastasizing type of cancer. Adenocarcinoma is the next best lung cancer to have in terms of prognosis. Oat cell and small cell carcinoma are the same. Small carcinoma grows rapidly and is quick to metastasize. 50. Which of the following conditions is an early symptom commonly seen in myasthenia gravis? • • • •

Dysphagia Fatigue improving at the end of the day Ptosis Respiratory distress

Ptosis and diplopia are the early signs of myasthenia gravis; dysphagia and respiratory distress occur later. Symptoms are typically milder in the morning and may be exacerbated by stress or lack of rest