RN exams medical-surgical practice questions set 30

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Urinary incontinence is a common complication associated with prostatectomy for the treatment of benign prostatic hyperplasia (BPH). Prostate surgery, such as a prostatectomy, can disrupt the sphincter muscle that controls the flow of urine from the bladder, leading to temporary or even long-term urinary incontinence in some patients. This usually improves over time with pelvic floor exercises and other treatment options, but it is an important consideration when discussing the potential risks and benefits of prostate surgery with patients. While erectile dysfunction and retrograde ejaculation can also be potential side effects of prostate surgery, urinary incontinence is specifically associated with issues related to bladder control following the procedure. Urethral stricture, although it can occur post prostate surgery, is less common compared to urinary incontinence.

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In the case of a woman in active labor with placenta previa, the priority nursing intervention is to prepare for an immediate cesarean section. Placenta previa is a condition in which the placenta covers part or all of the cervix, which can lead to severe bleeding during labor and delivery. The risk of hemorrhage is significant, making a cesarean section the safest option for both the mother and the baby in this situation. It is crucial to act promptly to prevent complications and ensure the well-being of both the mother and the baby. Administering intravenous oxytocin to augment labor or inserting a Foley catheter to monitor urine output would not address the immediate risk of hemorrhage associated with placenta previa. Implementing bed rest and continuous fetal monitoring may be part of the overall care plan but not the priority intervention in this urgent situation.

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Rationale: A: Correct. The nurse should advise the patient to discuss her desire to start a family with her healthcare provider. By doing so, the provider can assess the risks, adjust the medication regimen if necessary, and provide guidance on how to proceed safely during pregnancy. B: Incorrect. Discontinuing immune modulating drugs abruptly can have negative consequences on the patient's health. It is important to have a healthcare provider manage any necessary adjustments to the medication. C: Incorrect. While some immune modulating drugs may have potential risks during pregnancy, not all are highly teratogenic. Each drug should be evaluated individually. D: Incorrect. While pregnancy may require adjustments to the medication regimen, it is not necessarily ruled out as an option. Adoption is a personal choice and should not be presented as the only alternative.

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The correct answer is A: '5 mL PO BID.' To calculate the child's daily dose requirement, you multiply the child's weight (10 kg) by the prescribed dosage per kg, which is 8 mg for TMP and 40 mg for SMX. This results in a total daily requirement of 80 mg of TMP and 400 mg of SMX. To divide this into two doses, each dose should contain half of the total daily requirement, which is 40 mg TMP and 200 mg SMX. Since the liquid preparation contains 40 mg of TMP and 200 mg of SMX per 5 mL, the correct dose per administration is 5 mL. Therefore, 5 mL PO BID is the correct order. Choice B, '5 mL PO daily,' is incorrect as the total daily dose needs to be divided into two doses. Choices C and D, '10 mL PO BID' and '10 mL PO daily,' respectively, are incorrect as they do not align with the calculated dosage requirements based on the child's weight and the prescribed dosage per kg.

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According to the Health Belief Model, the most effective event to increase compliance with the prescribed diet for a middle-aged male client with diabetes is experiencing a significant consequence related to the disease. In this case, visiting his diabetic brother who just had surgery to amputate an infected foot would serve as a strong 'cue to action,' increasing the client's perceived seriousness of the disease. This event is likely to have a more immediate and impactful effect on the client than other options. Option B provides valuable information but may not have the same personal and emotional impact as witnessing a severe consequence firsthand. Option C involves indirect exposure to prevention messages, which might not be as compelling as a direct experience. Option D, while supportive, does not present a direct consequence of non-compliance like option A does.

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Skin fibers, primarily collagen in the dermis, are arranged in bundles called lines of cleavage (or Langer's lines). These parallel alignments reflect the natural tension and orientation of collagen and elastic fibers in the reticular dermis, giving skin strength and flexibility. Surgeons use these lines for incisions, as cuts along them heal with less scarring due to minimal fiber disruption. The zone of hyperaemia is a region of increased blood flow, not a fiber structure. Epidermal ridges, on the epidermis, form fingerprints from dermal papillae, not fiber bundles. The stratum lucidum, an epidermal layer in thick skin, consists of dead cells, not fibers. Lines of cleavage are a dermal feature, visible in histological sections as organized collagen, critical for skin's mechanical properties and surgical outcomes, distinguishing them from epidermal or vascular terms.

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In a patient with acute kidney injury (AKI) secondary to hypovolemic shock, the priority intervention to manage the patient's renal function is to administer intravenous fluids to restore circulating volume. Hypovolemic shock leads to decreased blood flow to the kidneys, resulting in hypoperfusion and ischemic damage to the renal tubules. Prompt correction of hypovolemia with intravenous fluids helps improve renal perfusion and function by increasing blood flow to the kidneys. Adequate fluid resuscitation can potentially prevent further kidney damage and support kidney function recovery. It is crucial to address the underlying cause of AKI (hypovolemia in this case) to prevent complications and improve patient outcomes. Initiating renal replacement therapy or recommending nephrotoxic medications would not be the initial interventions for managing AKI in this scenario.

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Sebaceous glands, found in the dermis near hair follicles, produce sebum, an oily substance. Sebum, a mix of lipids like triglycerides and wax esters, lubricates hair and skin, preventing dryness and offering minor antimicrobial protection. It's secreted via a holocrine process cells disintegrate to release it into follicles, then to the skin surface. Milk is produced by mammary glands, modified sweat glands, not sebaceous ones. Sweat comes from eccrine and apocrine glands, distinct from sebaceous function, with water and salts, not oil. Cerumen (earwax) is made by ceruminous glands in the ear canal, a specialized sebaceous type, but not typical skin sebaceous glands. Sebum's oily nature distinguishes it, supporting skin flexibility and waterproofing, a role confirmed by histological and physiological studies of gland activity, setting it apart from other secretions.

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Patients prescribed proton pump inhibitors (PPIs) for the treatment of GERD should be closely monitored for the development of osteoporosis. PPIs have been associated with an increased risk of developing osteoporotic fractures, particularly in long-term users. This risk is thought to be due to decreased calcium absorption as stomach acidity is reduced by PPIs, leading to potential alterations in bone metabolism and density. Therefore, it is important for healthcare providers to assess bone health, educate patients on calcium and vitamin D supplementation, and consider other risk factors for osteoporosis in individuals taking PPIs long-term. While hypoglycemia, hyperkalemia, and Clostridium difficile infection may be seen as adverse effects with other medications or conditions, osteoporosis is the adverse effect most closely monitored in patients taking PPIs for GERD.

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Von Willebrand disease is a hereditary bleeding disorder that results from a deficiency or dysfunction of von Willebrand factor (vWF), a protein that plays a key role in platelet adhesion and the initiation of primary hemostasis. The clinical manifestations of von Willebrand disease include recurrent mucocutaneous bleeding, such as nosebleeds, easy bruising, and gum bleeding. Laboratory findings typically show a prolonged bleeding time due to impaired platelet function, while platelet count, PT (prothrombin time), and aPTT (activated partial thromboplastin time) are usually normal. This distinguishes von Willebrand disease from other bleeding disorders such as hemophilia A (Factor VIII deficiency), which would show abnormal PT and aPTT due to deficiencies in specific clotting factors. Thrombocytopenia, on the other hand, would be characterized by a low platelet count