9 - Nursing Competitive Exams QAs - NORCET, ESIC

 

Question 6081) 

When planning emergent care for a patient with a suspected MI, what should the nurse anticipate administering ? 

A. Oxygen, nitroglycerin, aspirin and morphine 

B. Oxygen, furosemide (lasix), nitroglycerin and meperidine 

C. Aspirin, nitroprusside (Nipride), dopamine (intropin), and oxygen 

D. Nitroglycerin, lorazepam (Ativan), oxygen and warfarin (Coumadin) 

Answer: A 

Explanation: Oxygen,nitroglycerin, aspirin and morphine. The American Heart Association's guidelines for emergency care of the patient with chest pain include the administration of oxygen, nitroglycerin, aspirin and morphine. These interventions serve to relieve chest pain, improve oxygenation, decrease myocardial workload and prevent further platelet aggregation. The other medications my be used later in the patient's treatment. 

Question 6082) 

One week after being hospitalized for an acute myocardial infarction, a patient reports loss of appetite and feeling nauseated which of the following prescribed medication next dose should be withheld? 

A. Digoxin 

B. Furosemide 

C. Propranolol 

D. Spironolactone 

Answer: A 

Explanation: Opioids decrease peristalsis, which may precipitate constipation, straining at stool should be avoided to prevent the Valsalva maneuver, which increases demands on the heart. 

Question 6083) 

The patient with CHF is placed in a High Fowler's position. What is the rationale for placing the patient in this position? 

A. To increase the volume of blood returning to heart 

B. To increase cardiac output and stroke volume 

C. To reduce the volume of blood returning to heart 

D. To reduce ankle edema and prevent dysrhythmia 

Answer: C 

Explanation: To reduce the volume of blood returning to heart 

Question 6084) 

Which among the following clinical indicator is most likely to be assessed when taking the admission history of a patient with right ventricular failure? 

A. Dyspnea 

B. Vertigo 

C. Polyuria 

D. Palpitation 

Answer: A 

Explanation: Dyspnea due to heart failure from other causes of dyspnea. If myocardial infarction is suspected, various cardiac markers may be used. BNP is a better indicator than N-terminal pro-BNP (NTproBNP) for the diagnosis of symptomatic heart failure and left ventricular systolic dysfunction. 

Question 6085) 

Which of the following symptoms is most commonly associated with lift sided heart failure? 

A. Crackles 

B. Arrhythmias 

C. Hepatic engorgement 

D. Hypotension 

Answer: A 

Explanation: Pulmonary edema may cause crackling sounds in your lungs. People with congestive heart failure (CHF) often have pulmonary edema. CHF occurs when the heart cannot pump blood effectively. 

Question 6086) 

The inability of the left ventricle to fill or pump sufficient blood to meet the needs of the tissues for oxygen and nutrients is: 

A. Decompensated heart failure 

B. Congestive heart failure 

C. Left ventricular failure 

D. Right ventricular failure 

Answer: C 

Explanation: Left-sided heart failure (left ventricular failure): inability of the left ventricle to fill or pump sufficient blood to meet the needs of the tissues for oxygen and nutrients, traditional term used to describe patient's symptoms of heart failure 

Question 6087) 

What is MOST effective at removing the corona virus from your hands

 A. Alcohol-based hand sanitiser 

B. Soap and water 

C. Sodium Hypochlorite 

D. Chlorhexitidine 

Answer: B 

Explanation: Soap and water Soap loosens the lipids in the virus membrane, causing its structure to collapse and making the virus inactive. Alcohol-based hand sanitiser is still useful for removing the virus if soap and warm water is unavailable, but it is not as effective 

Question 6088) 

The nurse says, "If you do not let me do this dressing change, I will not let you eat dinner with the other residents in the dining room." What legal term is related to this statement? 

A. Battery 

B. Assault 

C. Negligence 

D. Malpractice 

Answer: B 

Explanation: This statement is an unjust threat. Assault is the threat to harm another person without cause 

Question 6089) 

A patient who is receiving mechanical ventilation is anxious and is "fighting" the ventilator. Which action should the nurse take FIRST? 

A. Ventilate the patient with a manual resuscitation bag. 

B. erbally coach the patient to breathe with the ventilator. 

C. Sedate the patient with the ordered PRN lorazepam (Ativan). 

D. Increase the rate for the ordered propofol (Diprivan) infusion. 

Answer: B 

Explanation: The initial response by the nurse should be to try to decrease the patient's anxiety by coaching the patient about how to coordinate respirations with the ventilator. The other actions also may be helpful if the verbal coaching is ineffective in reducing the patient's anxiety. 

Question 6090) 

With which placental anomaly is the placenta deeply attached to the uterus? 

A. Battledore placenta 

B. Placenta succenturiata 

C. lacenta accreta 

D. Placenta circumvallata 

Answer: C 

Explanation: A --- battledore placenta occurs when cord inserts at the placental margin instead of centrally B---- Placenta Sucenturiata is a Placenta w/ 1 or more accessory lobes connected to the main placenta via blood vessels (Causes uterine bleeding due to retentions) D----Placenta Circumvallata, the Placenta's fetal side is partially covered w/chorion --> Making delivery a little difficult Abnormal Attachment of the Placenta to the uterus 1. Accreta: "Against the myometrium" 2. Increta: "Into the myometrium" 3. Percreta: "Perforates out into the serosa" .. and can attach to the bladder What is the presentation of placenta accreta? A woman who has a normal 1st and 2nd stage of labor but the placenta does not deliver. The woman usually has C-section or myomectomy, creating a uterine scar where the placenta implanted. What are the risk factors for placenta accreta? - prior C section - CURRENT (not necessarily prior) placenta previa - prior myomectomy - fetal Down syndrome - advanced maternal age Which placental position, posterior or anterior, is associated with a greater risk of placenta accreta? Anterior placenta = greater risk of accreta Mnemonic: "A" is for "Accreta" Does numerous C-sections increase the risk of accreta, or is your risk stable following the first C-section onward? It increases with every C-section

8 - Nursing Competitive Exams QAs - NORCET, ESIC

 

Question 6071) 

ECG change in myocardial infarction is: 

A. ST segment elevation 

B. Wide QRS complex 

C. Presence of U wave 

D. Prolonged PR interval 

Answer: A 

Explanation: ECG changes in myocardial infarction. In the first few hours the T waves become abnormally tall and the ST segments begin to rise. In the first 24 hours the T wave will become inverted, as the ST elevation begins to resolve. Pathological Q waves may appear within hours or may take greater than 24 hour. 

Question 6072) 

The nurse is administering a calcium channel blocker to the client diagnosed with a myocardial infarction. Which assessment data would cause the nurse to question administering this medication? 

A. The client's apical pulse is 64 

B. The client's calcium level is elevated 

C. The client's telemetry shows occasional PVC's 

D. The client's blood pressure is 90/62 

Answer: D 

Explanation: The client's blood pressure is low, and a calcium channel blocker could cause the blood pressure to bottom out. 

Question 6073) 

In acute myocardial infarction which enzyme is raised first? 

A. CPK-MB 

B. SGPT 

C. SGOT 

D. Troponin - T 

Answer: A 

Explanation: Myocardial muscle creatine kinase (CK-MB) is found mainly in the heart. -> CK-MB levels increase within 3-12 hours of onset of chest pain, reach peak values within 24 hours, and return to baseline after 48-72 hours. -> Sensitivity and specificity are not as high as for troponin levels. 

Question 6074) 

The enzyme level which is found elevated after myocardial infarction is : 

A. Serum creatine 

B. Alkaline phosphatase 

C. Phosphokinase 

D. Creatine kinase 

Answer: D 

Explanation: Myocardial muscle creatine kinase (CK-MB) is found mainly in the heart.CK-MB levels increase within 3- 12 hours of onset of chest pain, reach peak values within 24 hours, and return to baseline after 48-72 hours. Sensitivity and specificity are not as high as for troponin levels. 

Question 6075) 

The procedure that has to be performed in order to shift the high pressure from the right ventricle to the left ventricle in Transposition of the Great Arteries (TGA) is: 

A. Rashkind Procedure 

B. Rastelli Procedure 

C. Pulmonary Artery Banding 

D. Jatene Procedure 

Answer: D 

Explanation: The Jatene procedure,arterial switch operation or arterial switch, is an open-heart surgical procedure used to correct dextro-transposition of the great arteries (d-TGA). 

Question 6076) 

Along with persistent, crushing chest pain, which signs/symptoms would make the nurse suspect that the client is experiencing a myocardial infarction? 

A. Mid-epigastric pain and pyrosis 

B. Diaphoresis and cool clammy skin 

C. Intermittent claudication and pallor 

D. Jugular vein distention and dependent edema 

Answer: B 

Explanation: Diaphoresis is a systemic reaction to the MI. The body vasoconstricts to shunt blood from the periphery to the trunk of the body this in turn leads to cold,clammy skin. 

Question 6077) 

The lack of oxygen supply to myocardium of heart leads to 

A. Fibrillation 

B. Heart failure 

C. Angina 

D. Infarction 

Answer: C 

Explanation: Angina pectoris is the medical term used to describe chest pains related to heart disease, particularly due to myocardial ischemia. The lack of adequate oxygen (ischemia) in the heart muscles (myocardium) due to a reduced blood supply brought about by disease produces symptoms of: -> Chest tightness, discomfort or heaviness. -> Squeezing, constricting or crushing pains behind the breastbone or sternum -> Prickling, stabbing or burning chest pain -> Choking sensation 

Question 6078) 

Blood pressure in the systemic circulation is highest in the: 

A. Arterioles 

B. Capillaries. 

C. Aorta 

D. Venules 

Answer: C 

Explanation: Blood pressure is the highest in the aorta as the blood is being ejected out of the left ventricle into the aorta. The pressure declines as the blood flows through the arteries, capillaries, arterioles, veins, capillaries and venules. The force of the contraction of the heart and resistance of vessels influence flow, however it is the pressure differences that control blood flow. 

Question 6079) 

Which of the following classes of medication maximizes cardiac performance in client with heart failure by increasing ventricular contractility? 

A. Beta-adrenergic blockers 

B. Diuretics 

C. Calcium channel blockers 

D. Inotropic agents 

Answer: D 

Explanation: Inotropic agents, drugs that increase the force of contraction of cardiac muscle.(for example, digitalis glycosides, amrinone, and epinephrine) 

Question 6080) 

The client admitted with peripheral vascular disease (PVD) asks the nurse why her legs hurt when she walks. The nurse bases a response on the knowledge that the main characteristic of PVD is: 

A. Decreased blood flow 

B. Increased blood flow 

C. Slow blood flow. 

D. Thrombus formation. 

Answer: A 

Explanation: Decreased blood flow is a common characteristic of all PVD. When the demand for oxygen to the working muscles becomes greater than the supply, pain is the outcome. Slow blood flow throughout the circulatory system may suggest pump failure. Thrombus formation can result from stasis or damage to the intima of the vessels. 

7 - Nursing Competitive Exams QAs - NORCET, ESIC

 

Question 6061)

The nurse in the postpartum unit is caring for a client who has just delivered a newborn infant following a pregnancy with placenta previa. The nurse reviews the plan of care and prepares to monitor the client for which risk associated with placenta previa? 

A. Infection 

B. Hemorrhage 

C. Chronic hypertension 

D. Disseminated intravascular coagulation

Answer: B 

Explanation: In placenta previa, the placenta is implanted in the lower uterine segment. The lower uterine segment does not contain the same intertwining musculature as the fundus of the uterus, and this site is more prone to bleeding. 

Question 6062) 

The nurse in a labor room is preparing to care for a client with hypertonic uterine contractions. The nurse is told that the client is experiencing uncoordinated contractions that are erratic an their frequency, duration and intensity. What is the priority nursing action? 

A. Provide pain relief measures. 

B. Prepare the client for an amniotomy. 

C. Promote ambulation every 30 minutes. 

D. Monitor the oxytocin infusion closely. 

Answer: A 

Explanation: Hypertonic uterine contractions are painful, occur frequently and are uncoordinated. Management of hypertonic labor depends on the cause. Relief of pain is the primary intervention to promote a normal labor pattern. An amniotomy and oxytocin infusion are not treatment measures for hypertonic contractions, however, these treatments may be used in clients with hypertonic dysfunction. A client with hypertonic uterine contraction would not be encouraged to ambulate every 30 minutes but would be encouraged to rest. 

Question 6063) 

Pregnant client tells the clinic nurse that she wants to know the sex of her baby as soon as it can be determined. The nurse informs the client that she should be able to find out the sex at 12 weeks gestation because of which factor? 

A. The appearance of the fetal external genitalia 

B. The beginning of differentiation in the fetal groin 

C. The fetal testes are descended into the scrotal sac 

D. The internal differences in males and females become apparent 

Answer: A 

Explanation: By the end of the twelfth week, the external genitalia of the fetus have developed to such a degree that the sex of the fetus can be determined visually. Differentiation of the external genitalia occurs at the end of the ninth week. Testes descend into the scrotal sac at the end of the thirty-eight week. Internal differences in the male and female occur at the end of the seventh week. 

Question 6064) 

A couple comes to the family planning clinic and asks about sterilization procedures. Which question by the nurse should determine whether this method of family planning would be most appropriate? 

A. "Did you ever had surgery?" 

B. "Do you plan to have any other children?" 

C. "Do either of you have diabetes mellitus?" 

D. "Do either of you have problems with high blood pressure?" 

Answer: B 

Explanation: Sterilization is a method of contraception for couples who have completed their families. It should be considered a permanent end to fertility because reversal surgery is not always successful. The nurse would ask the couple about their plans for having children in the future. 

Question 6065) 

The nurse is performing an assessment on a client with a suspected diagnosis of cataract. Which clinical manifestation is NOT observed in cataract? 

A. Decrease color perception 

B. Blurred vision 

C. Dizziness 

D. Opaque 

Answer: C 

Explanation: Cataract Vision starts as slightly blurred vision an decreased color perception (pt may think contacts or glasses dirty); then blurred and double vision occur and may have difficulty with ADLs; can progress to blindness w/o surgery; no pain or eye redness is associated with age-related cataracts The eye becomes progressively opaque (not transparent) -> resulting in blurred vision - Progressive opacity of the crystalline lens - It is loss of transparency of the lens -> causes decreased transmission of light to retina - Usually not treated until there is visual loss that interferes with ADLs - Occurs in patients > 50 years old Signs & Symptoms of Cataract - Painless - Progressive -- in early stages vision is minimally distorted -- there is gradual decrease in visual acuity - Hazy vision - b/c of light scattering - cloudy vision - b/c of light scattering - Blurry, blurred vision - b/cof light scattering - Decrease in color perception - Decrease in night vision -- pts who drive at night may notice cataracts more - Pt ll see glare from lights - specially from other cars' headlights when driving at night - Photophobia = sensitivity to light, light can cause headache - Decrease in depth perception - On eye exam you will see pt's pupils change colors -- Pupils goes from Cloudy -> Yellow -> Grey -> Milky White --Once pupils are milky white - it is mature cataract - Opthalmoscope - will show the opacity -- may not be able to see retina - due to the opacity - Once the cataracts are mature & interferes with ADLs - it is treated with eye surgery 

Question 6066) 

What is the priority problem in the client diagnosed with congestive heart failure? 

A. Fluid volume overload 

B. Decreased cardiac output 

C. Activity intolerance 

D. Knowledge deficit 

Answer: A 

Explanation: Fluid volume overload. 

Question 6067) 

Which laboratory data confirm the diagnosis of congestive heart failure? 

A. Chest X-ray (CXR) 

B. Liver function tests 

C. Blood Urea Nitrogen (BUN) 

D. Beta-type natriuteric peptide (BNP) 

Answer: A 

Explanation: A chest X-ray may show features of heart failure such as an increased cardiothoracic ratio, lung interstitial oedema or bilateral pleural effusions. 17 A systematic review including five studies that estimated the accuracy of an abnormal chest X-ray in detecting a diagnosis of heart failure found considerable variation between studies. 24 Sensitivity was 68% and specificity 83%.

Question 6068) 

The newer drug given to interfere with the production of angiotensin II in heart failure is:

A. Isordil 

B. Enoximone 

C. Esmolol 

D. Captopril 

Answer: C 

Explanation: Esmolol hydrochloride injection is indicated for the short-term treatment of tachycardia and hypertension that occur during induction and intubation, during surgery, on emergency from anesthesia and in the postoperative period, when in the physician's judgment such specific intervention is considered indicated. 

Question 6069) 

What are the signs of shock 

A. Sweating and forgetfulness 

B. Cold clammy skin, unconsciousness and rapid pulse rate 

C. Rapid pulse rate and unconsciousness 

D. Lethargy and slow pulse rate 

Answer: B 

Explanation: Eyes appear to stare. Cold clammy skin, Rapid pulse -> Anxiety or agitation. -> Seizures. ->Confusion or unresponsiveness. -> Low or no urine output. 

Question 6070) 

The client is diagnosed with neurogenic shock which sign/symptoms would the nurse assess in this client: 

A. Cool moist skin 

B. Bradycardia 

C. Wheezing 

D. Decreased bowel sounds 

Answer: B 

Explanation: The client will have bradycardia instead of tachycardia, which is seen in other forms of shock. 

6 - Nursing Competitive Exams QAs - NORCET, ESIC

 

Question 6051) 

The nurse is planning care for a newborn of a mother with diabetes mellitus. What is the priority nursing consideration for this newborn? 

A. Developmental delays because of excessive size 

B. Maintaining safety because of low blood glucose levels 

C. Choking because of impaired suck and swallow reflexes 

D. Elevated body temperature because of excess fat and glycogen 

Answer: B 

Explanation: The newborn of a diabetic mother is at risk for hypoglycemia, so maintaining safety because of low blood glucose levels would be a priority. The newborn would also be at risk for hyperbilirubinemia, respiratory distress, hypocalcemia and congenital anomalies. Developmental delays, choking and an elevated body temperature are not expected problems. 

Question 6052) 

Rho(D) immune globulin is prescribed for a client after delivery and the nurse provides information to the client about the purpose of the medication. The nurse determines that the woman understands the purpose if the woman states that it will protect her next baby from which condition? 

A. Having Rh-positive blood 

B. Developing a rubella infection 

C. Developing physiological jaundice 

D. Being affected by Rh incompatibility 

Answer: D 

Explanation: Rh incompatibility can occur when an Rh-negative mother becomes sensitized to the Rh antigen. Sensitization may develop when an Rh-negative woman becomes pregnant with a fetus who is Rh positive. During pregnancy and at delivery, some of the fetus's Rh-positive blood can enter the maternal circulation, causing the mother's immune system to form antibodies against Rh-positive blood. Administration of Rho(D) immune globulin prevents the mother from developing antibodies against Rh-positive blood by providing passive antibody protection against the Rh antigen. 

Question 6053) 

The nurse is monitoring a postpartum client who received epidural anesthesia for delivery for the presence of a vulvar hematoma. Which assessment findings would best indicate the presence of a hematoma? 

A. Change in vital signs 

B. Signs of heavy bruising 

C. Complaints of intense pain 

D. Complaints of tearing sensation 

Answer: A 

Explanation: Because the client has had epidural anesthesia and is anesthetized, she cannot feel pain, pressure or tearing sensation. Changes in vital signs indicate hypovolemia in an anesthetized postpartum client with vulvar hematoma. 

Question 6054) 

The nurse is providing instructions about measures to prevent postpartum mastitis to a client who is breastfeeding her newborn. Which client statement would indicate a need for further instruction? 

A. "I should breastfeed every 2 to 3 hours." 

B. "I should change the breast pads frequently." 

C. "I should wash my hands well before breastfeeding." 

D. "I should wash my nipples daily with soap and water." 

Answer: D 

Explanation: Mastitis is inflammation of the breast as a result of infection. It generally is caused by an organism that enters through an injured area of the nipples, such as a crack or blister. Measures to prevent the development of mastitis include changing nursing pads when they are wet and avoiding continuous pressure on the breasts. Soap is drying and could lead to cracking of the nipples and the client should be instructed to avoid using soap on the nipples. The mother is taught about the importance of hand washing and that she should breastfeed every 2 to 3 hours. 

Question 6055) 

The nurse is monitoring a client in the immediate postpartum period for signs of hemorrhage. Which sign if noted would be an early sign of excessive blood loss? 

A. A temperature of 100.4 degree F (38 degree C) 

B. An increase in the pulse rate from 88 to 102 beats/minute 

C. A blood pressure change from 130/88 to 124/80 mm Hg 

D. An increase in the respiratory rate from 18 to 22 breaths/minute 

Answer: B 

Explanation: During the fourth stage of labor, the maternal blood pressure, pulse, and respiration should be checked every 15 minutes during the first hour. An increasing pulse is an early sign of excessive blood loss because the heart pumps faster to compensate for reduced blood volume. A slight increase in temperature is normal. The blood pressure decreases as the blood volume diminishes, but a decreased blood pressure would not be the earliest sign of hemorrhage. The respiratory rate is slightly increased from normal. 

Question 6056) 

The nurse is assessing a client in the fourth stage of labor and notes that the fundus in firm, but that bleeding is excessive. Which should be the initial nursing action?

A. Record the findigs. 

B. Massage the fundus. 

C. Notify the health care provider. 

D. Place the client in Trendelenburg's position. 

Answer: C 

Explanation: If bleeding is excessive, the cause may be laceration of the cervix or birth canal. Massaging the fundus if it is firm would not assist in controlling the bleeding. Trendelenburg's position should be avoided because it may interfere with cardiac and respiratory function. Although the nurse would record the findings, the initial nursing action would be to notify the HCP. 

Question 6057) 

The nurse is monitoring the amount of lochia drainage in a client who is 2 hours postpartum and notes that the client has saturated a perineal pad in 15 minutes. How should the nurse respond to this finding initially? 

A. Document the finding. 

B. Encourage the client to ambulate. 

C. Encourage the client to increase fluid intake 

D. Contact the health care provider and inform the HCP of this finding. 

Answer: D Explanation: Lochia is the discharge from the uterus in the postpartum period, it consists of blood from the vessels of the placental site and debris from the decidua. The following can be used as a guide to determine the amount of flow:scant less than 2.5 cm(<1 inch) on menstrual pad in 1 hour, light less than 10 cm (<4 inches) on menstrual pad in 1 hour, moderate less than 15 cm (<6 inches) on menstrual pad in 1 hour, heavy saturated menstrual pad in 1 hour, excessive menstrual pad saturated in 15 minutes. If the client is experiencing excessive bleeding, the nurse should contact the HCP in the event that postpartum hemorrhage is occurring. It may be appropriate to encourage increased fluid intake, but this is not the initial action. It is not appropriate to encourage ambulation at this time. Documentation should occur once the client has been stabilized. 

Question 6058) 

The nurse is caring for four 1-day postpartum clients. Which client assessment requires the need for follow-up? 

A. The client with mild after pains 

B. The client with a pulse rate of 60 beats/minute 

C. The client with colostrum discharge from both breasts D. The client with lochia that is red and has a foul smelling odor 

Answer: D 

Explanation: Lochia, the discharge present after birth, is red for the first 1 to 3 days and gradually decreases in amount. Normal lochia has a fleshy odor or an odor similar to menstrual flow. Foul smelling or purulent lochia usually indicates infection, and these findings are not normal. The other options are normal findings for a 1-day postpartum client. 

Question 6059) 

The postpartum nurse is providing instructions to a client after birth of a healthy newborn. Which time frame should the nurse relay to the client regarding the return of bowel function? 

A. 3 days postpartum

B. 7 days postpartum 

C. On the day of birth 

D. Within 2 weeks postpartum 

Answer: A 

Explanation: After birth, the nurse should auscultate the client's abdomen in all 4 quadrants to determine the return of bowel sounds. Normal bowel elimination usually returns 2 to 3 days postpartum. Surgery, anesthesia and the use of opioids and pain control agents also contribute to the longer period of altered bowel functions. 

Question 6060) 

The postpartum nurse is taking the vital signs of a client who delivered a healthy newborn 4 hours ago. The nurse notes that the client's temperature is 100.2 degree F. What is the priority nursing action? 

A. Document the findings. 

B. Retake the temperature in 15 minutes. 

C. Notify the health care provider. 

D. Increase hydration by encouraging oral fluids. 

Answer: D 

Explanation: The client's temperature should be taken every 4 hours while she is awake. Temperatures up to 100.4 degree F in the first 24 hours after birth often are related to the dehydrating effects of labor. The appropriate action is to increase hydration by encouraging oral fluids, which should bring the temperature to a normal reading. Although the nurse also would document the findings, the appropriate action would be to increase hydration. Taking the temperature in another 15 minutes is an unnecessary action. Contacting the HCP is not necessary. 

5 - Nursing Competitive Exams QAs - NORCET, ESIC

 

Question 6041) 

A nurse is teaching breast care to a client who is breastfeeding. Which client statement indicates that the teaching was effective? 

A. "I should air dry my nipples after each feeding." 

B. "Mild soap is appropriate for washing my breasts." 

C. "My breast pads should be lined with plastic shields." 

D. "I will remove my brassiere before I go to bed at night." 

Answer: A 

Explanation: Air-drying nipples after feeding limits irritation and disruption of skin integrity. 

Question 6042) A nurse is teaching breast care to a client who is breastfeeding. Which client statement indicates that the teaching was effective? 

A. "I should air dry my nipples after each feeding." 

B. "Mild soap is appropriate for washing my breasts." 

C. "My breast pads should be lined with plastic shields." 

D. "I will remove my brassiere before I go to bed at night." 

Answer: A 

Explanation: Air-drying nipples after feeding limits irritation and disruption of skin integrity. 

Question 6043) 

At what time during prenatal development should the nurse expect the greatest fetal weight gain? 

A. Third trimester 

B. Second trimester 

C. First eight weeks 

D. Implantation period 

Answer: A 

Explanation: This is the period in which the fetus stores deposits of fat 

Question 6044) What should be included in a plan of care to limit the development of hyperbilirubinemia in the breastfed neonate? 

A. Encouraging more frequent breastfeeding during the first 2 days 

B. Instituting phototherapy for 30 minutes every 6 hours for 3 days 

C. Substituting breastfeeding with formula feeding on the second day 

D. Supplementing breastfeeding with glucose-water during the first day 

Answer: A 

Explanation: More frequent breastfeeding stimulates more frequent evacuation of meconium, thus preventing resorption of bilirubin into the circulatory system. 

Question 6045) 

At 12 weeks gestation, a client who is Rh negative expels the total products of conception.What is the nursing action after it has been determined that she has not been previously sensitized? 

A. Administer RhoGAM within 72 hours. 

B. Make certain that RhoGAM is administered at the first clinic visit. 

C. Withhold the RhoGAM, because the gestation lasted only 12 weeks. 

D. Withhold the RhoGAM,because it is not used after the birth of a stillborn. 

Answer: A 

Explanation: RhoGAM must be given within 72 hours postpartum if the client has not been sensitized previously, irrespective of the length of the gestation. 

Question 6046) 

The nurse is differentiating between cephalohematoma and caput succedaneum. What finding is unique to caput succedaneum? 

A. Scalp over the area is tender. 

B. Edema crosses the suture line. 

C. Edema increases during the first day. 

D. Scalp over the area becomes echymosed. 

Answer: B 

Explanation: This is the sign that differentiate between these two conditions, cephalohematoma does not extend beyond the suture line. 

Question 6047) 

A newborn has an asymmetric Moro reflex. What does a nurse identify as a cause of this problem? 

A. Down syndrome 

B. Cranial nerve damage 

C. Cerebral or cerebellar birth injuries 

D. Brachial plexus, calvicular or humeral birth injuries 

Answer: D 

Explanation: Injury to the brachial plexus,clavicle or humerus during birth prevents abduction and adduction movements of an upper extremity. 

Question 6048) 

What should the care of a newborn infant whose mother has had untreated syphilis since the second trimester of pregnancy include? 

A. Examining for a cleft palate 

B. Testing for congenital syphilis 

C. Assessing for muscle hypotonicity 

D. Observing for maculopapular lesions of the soles 

Answer: B 

Explanation: Because physical signs of congenital syphilis are difficult to detect at birth, the infant should be screened immediately to determine if treatment is necessary. 

Question 6049) The postpartum nurse is providing instructions to the mother of a newborn with hyperbilirubinemia who is being breastfed. The nurse should provide which instruction to the mother? 

A. Feed the newborn less frequently. 

B. Continue to breastfeed every 2 to 4 hours. 

C. Switch to bottle-feeding the infant for 2 weeks. 

D. Stop breastfeeding and switch to bottle-feeding permanently. 

Answer: B 

Explanation: Hyperbilirubinemia is an elevated serum bilirubin level. At any serum bilirubin level, the appearance of jaundice during the first day of life indicates a pathological process. Early and frequent feeding hastens the excretion of bilirubin. Breastfeeding should be initiated within 2 hours after birth and every 2 to 4 hours thereafter. The infant should not be fed less frequently. Switching to bottle-feeding for 2 weeks or stopping breastfeeding permanently is necessary. 

Question 6050) 

The nurse notes hypotonia, irritability and a poor sucking reflex in a full-term newborn on admission to the nursery. The nurse suspects fetal alcohol syndrome and is aware that which additional sign would be consistent with this syndrome? 

A. Length of 19 inches 

B. Abnormal palmar creases 

C. Birth weight of 6 lb, 14 oz (3120 g) 

D. Head circumference appropriate for gestational age 

Answer: B Explanation: Fetal alcohol syndrome, a diagnostic category of fetal alcohol spectrum disorders, is caused by maternal alcohol use during pregnancy. Features of newborns diagnosed with fetal alcohol syndrome includes craniofacial abnormalities, intrauterine growth restriction, cardiac abnormalities, abnormal palmar creases and respiratory distress.

4 - Nursing Competitive Exams QAs - NORCET, ESIC

 

Question 6031) 

What is the safest position for a woman in labor when a nurse observes a prolapsed cord? 

A. Prone 

B. Fowler 

C. Lithotomy 

D. Trendelenburg 

Answer: D 

Explanation: A position in which the mother's head is below the level of the hips helps decrease compression of the cord and therefore maintains the blood supply to the fetus. 

Question 6032) 

What should a nurse anticipate about the insulin requirements of a client with diabetes on her first postpartum day? 

A. A rapid increase 

B. Will remain unchanged 

C. A sharp and sudden decrease 

D. Will decrease slowly and steadily 

Answer: C

Explanation: Insulin requirements may fall suddenly during the first 24 to 48 postpartum hours because the endocrine changes of pregnancy are reversed. 

Question 6033) 

How should a nurse screen a newborn of a diabetic mother for hypoglycemia? 

A. Test for glucose tolerance. 

B. Draw blood for a serum glucose level. 

C. Arrange for a fasting blood glucose level. 

D. Test heel blood with a glucose-oxidase strip. 

Answer: D 

Explanation: Glucose-oxidase strips are used by nurses to screen infants for hypoglycemia. 

Question 6034) 

An infant is born with a bilateral cleft palate. Plans are made to begin reconstruction immediately. What nursing intervention should be included to promote parentinfant attachment? 

A. Demonstrating a positive acceptance of the infant 

B. Placing the infant in a nursery away from view of the general public 

C. Explaining to the parents that the infant will look normal after the surgery 

D. Encouraging the parents to limit contact with the infant until after the surgery 

Answer: A 

Explanation: By demonstrating acceptance of the infant, without regard for the defect, the nurse acts as a role model for the patents, thus enhancing their acceptance. 

Question 6035) 

A nurse who is assessing a newborn 3 minutes after birth takes into consideration that the heart rate of a healthy, alert neonate may range between: 

A. 120 and 180 beats/min. 

B. 130 and 170 beats/min. 

C. 110 and 160 beats/min. 

D. 100 and 130 beats/min. 

Answer: C 

Explanation: The newborn's heart rate varies with activity, crying can increase it to 180 beats/min., whereas deep sleep may lower it to 80 to 100 beats/min., a rate between 110 and 160 beats/min is the average. 

Question 6036) 

At the beginning of the first formula feeding a newborn begins to cough and choke, and the lips become cyanotic. What is the immediate nursing action? 

A. Stimulate crying. 

B. Suction and then oxygenate. 

C. Substitute the formula with sterile water. 

D. Stop the feeding momentarily and then restart. 

Answer: B 

Explanation: Cyanosis, choking and coughing are signs of aspiration and hypoxia. Suctioning and oxygenation are needed. 

Question 6037) 

Which behavior should a nurse identify as the Moro reflex response? 

A. Extension and adduction of the arms 

B. Abduction and then adduction of the arms 

C. Adduction of the arms and fanning of the toes 

D. Extension of the arms and curling of the fingers 

Answer: B 

Explanation: The Moro reflex is a sudden extension and abduction of the arms at the shoulders and spreading of the fingers. This is followed by flexion and adduction of the arms with the index finger and thumb forming the letter "C", the infant may cry. 

Question 6038) 

An infant's intestines are sterile at birth, thus lacking the bacteria necessary for the synthesis of: 

A. bilirubin 

B. bile salts 

C. prothrombin 

D. intrinsic factor 

Answer: C 

Explanation: Bacteria, especially Escherichia coli, produce substances necessary to synthesize prothrombin. 

Question 6039) 

A nurse teaches a group of postpartum clients that all their newborns will be screened for phenylketonuria (PKU)to : 

A. assess protein metabolism. 

B. reveal potential retardation. 

C. detect chromosomal damage. 

D. identify thyroid insufficiency. 

Answer: A 

Explanation: Phenylalanine is an essential amino acid necessary for growth that may be absent in infants with phenylketonuria (PKU), testing is done on all neonates born in the United States. 

Question 6040) 

Which newborn assessment identified immediately after birth will probably necessitate prolonged follow-up care? 

A. Apgar score of 5 

B. Weight of 3500 grams 

C. Blood glucose level of 50 mg/dL 

D. Umbilical cord with 2 blood vessels 

Answer: D 

Explanation: The congenital absence of a blood vessel in the umbilical cord is often associated with life-threatening congenital anomalies. There should be two arteries and one vein. 

3 - Nursing Competitive Exams QAs - NORCET, ESIC

Question 6021) 

A client is receiving magnesium sulfate therapy for severe pre-eclampsia. What initial sign of toxicity should alert the nurse to intervene? 

A. Hyperactive sensorium 

B. Increase in respiratory rate 

C. Lack of the knee-jerk reflex 

D. Development of a cardiac dysrhythmia 

Answer: C 

Explanation: Magnesium sulfate has a CNS depressant effect,toxic levels will be reflected by the loss of the kneejerk reflex. 

Question 6022) 

A client is admitted to the high-risk unit in preterm labor. A loading dose of 6 g of magnesium sulfate over 20 minutes is prescribed to be followed by 2 g/hr. Premixed stock is available with 40 grams of magnesium sulfate in 100 mL of D5W. At how many milliliters should a nurse set the infusion pump to complete the loading dose? 

A. 150 

B. 200 

C. 450 

D. 350 

Answer: C 

Explanation: 450 ml. Use the "Desire over Have" formula to solve the problem by using ratio and proportion. Desire / have = 6g/40g = xml/100ml -> 40x = 6000, X = 6000/40, X = 150. An infusion pump is set at milliliters per hour. 150 mL is needed in 20 minutes. There are 60 minutes in an hour, therefore , 3 x 150 = 450 mL/hr. Question 

6023) 

A nurse is assessing a client with a tentative diagnosis of hydatidiform mole. Which clinical finding should the nurse anticipate? 

A. Hypotension 

B. Decreased fetal heart rate 

C. Unusual uterine enlargement 

D. Painless, heavy vaginal bleeding 

Answer: C 

Explanation: The proliferation of trophoblastic tissue filled with fluid causes the uterus to enlarge more quickly than if a fetus were in the uterus. 

Question 6024) 

An expectant couple ask the nurse about the cause of low back pain in labor. The nurse replies that this pain occurs most often when the position of the fetus is: 

A. Breech 

B. Transverse 

C. Occiput anterior. 

D. Occiput posterior 

Answer: D 

Explanation: A persistent occiput posterior position causes intense back pain because of fetal compression of the maternal sacral nerves. 

Question 6025) 

itz baths are ordered for a client with an episiotomy during the postpartum period. A nurse encourages her to take the sitz baths because they aid the the healing process by: 

A. promoting vasodilation 

B. cleansing perineal tissue 

C. softening the incision site. 

D. tightening the rectal sphincter 

Answer: A Explanation: Heat causes vasodilation and an increased blood supply to the area. 

Question 6026) 

An infant is born precipitously in the emergency department. What should the nurse do first? 

A. Tie and cut the umbilical cord. 

B. Establish an airway for the newborn. 

C. Ascertain the condition of the uterine fundus. 

D. Arrange transport for mother and infant to the birthing unit. 

Answer: B 

Explanation: The nurse should position the newborn with head slightly lower than the chest to allow mucus to flow by gravity and then rub the back to stimulate crying, which promotes oxygenation. 

Question 6027) 

Why does a nurse encourage continued health care supervision for a pregnant woman with pyelonephritis? 

A. Preeclampsia frequently occurs after pyelonephritis. 

B. Antibiotic therapy should be administered until the urine is sterile. 

C. Pelvic inflammatory disease can occur with untreated pyelonephritis. 

D. Nutritional needs change to accommodate the prescribed low-protein diet. 

Answer: B 

Explanation: Healthcare supervision requires treatment with an appropriate antibiotic until two cultures of urine are negative, recurring pyelonephritis often leads to preterm birth. 

Question 6028) 

A client arrives at the hospital at 38 weeks gestation with profuse vaginal bleeding. She states that it occurred suddenly without any contractions. Which condition may the client be experiencing that requires immediate notification of the health care provider? 

A. Placenta previa 

B. Placenta accreta 

C. Ruptured uterus 

D. Concealed abruptio 

Answer: A 

Explanation: Placenta previa is classically painless bleeding, the placenta partially or completely covers the cervical os, and the cervix dilates, the placenta separates and bleeds. 

Question 6029) 

A client in the prenatal clinic is diagnosed with pre-eclampsia. What clinical findings support this diagnosis? 

A. Elevated blood pressure of 150/100 mm Hg 

B. Elevated blood pressure that is accompanied by a headache 

C. Blood pressure above the baseline while fluctuating at each reading 

D. Blood pressure more than 140 mm Hg systolic accompanied by proteinuria 

Answer: D 

Explanation: A blood pressure more than 140 mm Hg systolic and 90 mm Hg diastolic along with proteinuria is diagnostic of preeclampsia, assessments should be done twice 4 to 6 hours apart. 

Question 6030) 

When does a nurse caring for a client with eclampsia determine that the risk for another seizure has subsided? 

A. After birth occurs 

B. After labor begins 

C. 48 hours postpartum 

D. 24 hours postpartum 

Answer: C 

Explanation: The danger of a seizure in a woman with eclampsia subsides when postpartum diuresis has occurred, usually 48 hours after birth, however, the risk for seizures may remain for up to 2 weeks postpartum.

2 - Nursing Competitive Exams QAs - NORCET, ESIC

 

Question 6011) 

A client's membranes spontaneously rupture during active labor. The nurse inspects the perineum and determines that the umbilical cord is not visible. What is the next nursing action? 

A. Auscultate the FHR. 

B. Time the contractions. 

C. Call the health care provider. 

D. Obtain the maternal vital signs. 

Answer: A 

Explanation: When the membranes rupture, there is always the possibility of a prolapsed cord leading to fetal compromise, which will manifest itself in a slow FHR. 

Question 6012) 

A client is admitted to the birthing unit in active labor. What should the nurse expect after an amniotomy is performed? 

A. Diminished bloody show 

B. Increased and more variable FHR 

C. Less discomfort with contractions 

D. Progressive dilation and effacement 

Answer: D 

Explanation: Artificial rupture of the membranes (amniotomy) allows for more effective pressure of the fetal head on the cervix, enhancing dilation and effacement. 

Question 6013) Why should a nurse withhold food and oral fluids as a laboring client approaches the second stage of labor? 

A. The mechanical and chemical digestive processes require energy that is needed for labor.

 B. Undigested food and fluid may cause nausea and vomiting and limit the choice of anesthesia. 

C. The gastric phase of digestion stimulates the release of hydrochloric acid and may cause dyspesia. 

D. Food and fluid will further aggravate gastric peristalsis, which is already increased because of the stress of labor. 

Answer: B 

Explanation: Gastric peristalsis often ceases during periods of stress. Abdominal contractions put pressure on the stomach and can cause nausea and vomiting, increasing the risk for aspiration. 

Question 6014) When a client's legs are placed in stirrups for birth, the nurse confirms that both legs are positioned simultaneously to prevent: 

A. venous stasis in the legs. 

B. pressure on the perineum. 

C. excessive pull on the fascia. 

D. trauma to the uterine ligaments. 

Answer: D 

Explanation: As the uterus rises into the abdominal cavity, the uterine ligaments become elongated and hypertrophied, raising both legs at the same time limits the tension placed on these ligaments. 

Question 6015) A laboring client is to have a pudendal block. What should a nurse teach the client about the effects of the pudendal block? 

A. Bladder sensation may be lost. 

B. She will not feel an episiotomy. 

C. She may lose the ability to push. 

D. Contractions will no longer be felt. 

Answer: B 

Explanation: A pudendal block provides anesthesia to the perineum. 

Question 6016) 

A primigravida who is at 35 weeks gestation is diagnosed with hydraminos. For what should the nurse assess the newborn? 

A. Cardiac defect 

B. Kidney disorder

C. Diabetes mellitus 

D. Esophageal atresia 

Answer: D 

Explanation: Esophageal atresia is associated with hydramnios. 

Question 6017) 

A nurse examines a client who had a cesarean birth. It is 3 days since the birth and the client is about to be discharged. Where does the nurse expect the fundus to be located? 

A. 1 finger breadth below the umbilicus 

B. 2 finger breadth below the umbilicus 

C. 3 finger breadth below the umbilicus 

D. 4 finger breadth below the umbilicus 

Answer: C 

Explanation: The fundus descends one finger breadth per day from the first postpartum day. 

Question 6018) 

A nurse is caring for a postpartum client who is formula feeding. What should the nurse teach her about minimizing breast discomfort? 

A. Apply covered ice packs to her breasts. 

B. Gently apply cocoa butter to her nipples. 

C. Place warm, wet washcloths on her nipples. 

D. Manually express colostrum from her breasts. 

Answer: A 

Explanation: Covered ice packs promote comfort by decreasing vasocongestion. 

Question 6019) 

A teenager at 32 weeks gestation is hospitalized with preeclampsia. She is anorexic and appears depressed. Which comment indicates to the nurse that further exploration of the client's emotional status is indicated. 

A. "I'm tired of feeling so clumsy." 

B. "I'll be glad when I can sleep all night." 

C. "I dreamed my baby had only one arm." 

D. "I was really happy before I got pregnant." 

Answer: D 

Explanation: This indicates failure to resolve conflicting feelings about pregnancy that should have been resolved in the first trimester. 

Question 6020) 

A client at 38 weeks gestation is admitted for induction of labor. Her membranes ruptured 12 hours ago. There are no other signs of labor. Which medication does the nurse anticipate will be prescribed? 

A. Oxytocin (Pitocin) 

B. Estrogen (Premarin) 

C. Ergonovine (Ergotrate) 

D. Progesterone (Prometrium) 

Answer: A 

Explanation: Oxytocin (Pitocin) is a small polypeptide hormone synthesized in the hypothalamus and secreted from the neurohypophysis (posterior pituitary gland) during parturition or suckling, it promotes powerful uterine contractions and thus is used to induce labor.

1- Nursing Competitive Exams QAs - NORCET, ESIC

Question 6001) 

A pregnant client is making her first antepartum visit. She has a 2-year-old son born at 40 weeks, a 5-year-old daughter born at 38 weeks, and 7-year-old twin daughters born at 35 weeks. She had a spontaneous abortion 3 years ago at 10 weeks. Using the GTPAL format, what does the nurse document about the client's obstetric history?

A. G4 T3 P2 A1 L4 

B. G5 T2 P2 A1 L4 

C. G5 T2 P1 A1 L4 

D. G4 T3 P1 A1 L4

Answer: C 

Explanation: The acronym GTPAL reflects G-gravidity, T-term birth, P-preterm births, A-abortions,and L-living children, G5 T2 P1 A1 L4 indicates that there were 5 pregnancies, twins count as 1 pregnancy and the present pregnancy counts as 1.

Question 6002) A client at 8 weeks gestation reports having to urinate more often. The nurse explains that urinary frequency often occurs because bladder capacity during pregnancy is diminished by: 

A. atony of the detrusor muscle. 

B. compression by the enlarging uterus. 

C. compromise of the autonomic reflexes. 

D. narrowing of the ureteral entrance at the trigone

Answer: B 

Explanation: The uterus and bladder occupy the pelvic cavity and lie closely together, as the uterus enlarges with the growing fetus, it impinges on the space occupied by the bladder and thereby diminishes bladder capacity.

Question 6003) 

A nurse who is caring for a mother and her newborn infant reviews their record. Using the data below, which nursing intervention is required? 

A. Neonatal blood transfusion 

B. Maternal rubella vaccination 

C. Maternal RhoGam injection 

D. Neonatal 50% glucose infusion 

Answer: B 

Explanation: A 

rubella titer of 1:2 is inadequate immunization. A titer of 1:8 is considered immune. Rubella immunization protects the fetus of future pregnancies from significant birth defects caused by a rubella infection. These laboratory results are borderline for pregnancy but were taken during the prenatal period and do not represent the woman's current status.

Question 6004) 

What recommendation should a nurse give to clients who have fluid retention during pregnancy? 

A. Decrease fluid intake. 

B. Maintain a low-sodium diet. 

C. Elevate the lower extremities. 

D. Ask the health care provider for a diuretic 

Answer: C 

Explanation: Elevation of the extremities several times daily is recommended to decrease the dependent edema.

Question 6005) 

During the postpartum period, a client tells a nurse she is having leg-cramps. Which foods should the nurse encourage the client to eat? 

A. Liver and raisins 

B. Cheese and broccoli 

C. Eggs and lean meats 

D. Whole wheat breads and cereals 

Answer: B 

Explanation: The leg cramps may be related to low calcium intake, cheese and broccoli both have a high calcium content. 

Question 6006) 

A nurse is caring for a primigravida during labor. At 7 cm dilation a prescribed pain medication is administered. Which medication requires monitoring of the newborn for the side effect of respiratory depression? 

A. Butorphanol (Stadol) 

B. Hydroxyzine (Vistaril) 

C. Promethazine (Phenergam) 

D. Diphenhydramine (Benadryl) 

Answer: A 

Explanation: Respiratory depression may occur in the newborn because the duration of action of Butorphanol (Stadol) is 3 to 4 hours and circulating blood levels will be high if birth occurs within that time.

Question 6007) 

At a prenatal visit a client who is at 36 weeks gestation states that she is having uncomfortable irregular contractions. What should the nurse recommend?

A. "Lie down until they stop." 

B. "Walk around until they subside." 

C. "Time the contractions for 30 minutes." 

D. "Take 2 extra-strength aspirins if the discomfort persists." 

Answer: B 

Explanation: Ambulation relieves the discomfort of preparatory (Braxton Hicks) contractions.

Question 6008) 

Why should a nurse teach pregnant women the importance of conserving the "spurt of energy" before labor? 

A. Energy helps to increase the progesterone level. 

B. Fatigue may influence the need for pain medication. 

C. Energy is needed to push during the first stage of labor. 

D. Fatigue will increased the intensity of the uterine contractions 

Answer: B 

Explanation: Fatigue will influence other coping strategies, such as distraction.

Question 6009) 

A primigravida is admitted to the birthing unit in early labor. A pelvic examination reveals that her cervix is 100% effaced and 3 cm dilated. The fetal head is at +1 station. In what area of the client's pelvis is the fetal occiput? 

A. Not yet engaged 

B. Below the ischial spines 

C. Entering the pelvic inlet 

D. Visible at the vaginal opening 

Answer: B 

Explanation: A station of +1 indicates that the fetal head is 1 cm below the ischial spines. 

Question 6010) 

A nurse assesses the frequency of a client's contractions by timing them from the beginning of a contraction:
A. until the uterus starts to relax. 

B. to the end of a second contraction. 

C. until the uterus completely relaxes. 

D. to the beginning of the next contraction. 

Answer: D 

Explanation: This is the accepted way to determine the frequency of the contractions.

PARKINSON'S DISEASE

                            PARKINSON'S DISEASE

Introduction:

 Parkinson disease is named for the English doctor James Parkinson. In 1817 he described a chronic, slowly progressive disease of the nervous system characterized by a combination of tremor, rigidity, and stooped posture. 11 April is considered as World Parkinson day on the birthday of James Parkinson. Red tulip is the symbol of this disease.

Definition:

It is a progressive brain disorder characterized by loss of neurons in an area of midbrain known as substantia nigra.

Pathophysiology:

Etiogical causes leads to degeneration of monamine containg cell population in brain stem & basal ganglia particularly dopamine affecting to brain & spinal cord  causing neurotoxicity causing cell death

Etiology & risk factors:

• Idiopathic Parkinsonism
• Secondary Parkinsonism:

1. Drug induced: Neuroleptics, antiemetics, lithium
2. Hydrocephalus
3. Hypoxia
4. Toxins: carbon monoxide, cyanide, methanol
5. Infections: AIDS
6. Metabolic: Hypo/Hyper calcemia, Wilson's disease, chronic hepatocerebral brain degeneration
7. Psychogenic
8. Trauma
9. Vascular causes
10. Parkinson plus syndromes:
11. Multiple system atrophy
12. Progressive supranuclear palsy
13. Corticobasal ganglionic degeneration
14. Progrssive pallidial atrophy
15. Lytico-Bodig : It is referred to by neuroscientists as amyotrophic lateral sclerosis-parkinsonism-dementia.

• Heredodegenerative disease:

1. Alzheimer's disease
2. Dementia with lewy bodies
3. Pick's disease
4. Huntington's disease
5. X linked dystonia parkinsonism

• Genetic factors:

1. Alanine 53- threonine mutation
2. The parkin gene dominant

Sign & Symptoms:

Cardinal features:

Bradykinesia:

• It means decreased movements characterized by delay in initiation & execution of willed movements & a general reduction of automatic movements.
• It manifests:

1. Facial Hypomania
2. Reduced blinking
3. Impaired ocular convergence
4. Bradylalia
5. Anarthria
6. Drooling of saliva
7. Micrographia
8. Slow shuffling gait with reduced associated movements

Muscle Rigidity:

1. It is characterized by resistance to passive movements that affects flexion, extension, pronation & supination.
2. Axial & proximal limb muscles rigidity will be present.
3. Cogwheel Rigidity: It is characterized by periodic modification of muscle tone due to superimposed tremor that can be seen & felt when passively moving the extremity.
4. Akinetic rigid syndrome is the characteristic of PD which is seen in due to abnormal dopaminergic input in to brain.

Resting tremors: 

1. It is characterized by pill rolling between thumb & index finger
2. Illegible writing
3. Tremors may increase due to emotional response, fatigue, stress, anxiety & disturbed sleep pattern.
4. It typically affects the distal appendicular muscles causing:

• Abduction- adduction movemen ts of thumb [pill rolling]
• Pronation-supination movements of wrist
• Often unilateral involving thumb & fingers
• Lower limp of same side will be affected before involving opposite side of body.
• Tremors of lips, head & jaw may be seen

Disorder of postural fixation:

1. May affect head, trunk & limbs causing:
2. Instability of trunk
3. Forward displacement of head
4. Difficulty in maintaining erect posture
5. Slight leaning forward while standing
6. Parkinson's gait

Freezing phenomenon:

1. Motor act stucks in place lasting for seconds
2. The voluntary acts are halted as agonist & antagonist muscles are spontaneously contracting.
3. This phenomenon include:
4. Freezing when initiating gait [start hesitation]
5. Freezing when turning [turn hesitation]
6. Freezing when approaching the target [destination hesitation]
7. Freezing when obstacle is encountered 
8. Repetition of first syllable
9. Apraxia of eye opening
10. Freezing of limbs [during writing & brushing teeth]

Other features:

1. Parkinson Posture: Forward flexion of trunk, flexion of elbows & partial flexion of knees
2. Prkinsonian hand: Dorsiflexion of wrist, extensoion & adduction of fingers, slight ulnar deviation, flexion of metacarpophalangeal joints
3. Dystonic foot posture: Extension of great toe, flexion of toes, arching of sole & inversion of foot
4. Hpokinetic dysarthria
5. Palilalia
6. Bradyphrenia
7. Hypophonia

Behavioural Signs:

1. Depression 
2. Sudden onset of sleep
3. Bent spine syndrome

Medical & Nursing Management:

• Antiparkinsonian drug: Levadopa, carbidopa levadopa
• Dopamine receptor agonists: Pergolide, Bromocriptine, Pramipexole
• Selegiline
• Catchechol O- methyltranferase: entocapone, tolcapne
• Acetylcholine blocking drugs: Biperiden, Procyclidine
• Monitor neurological status
• Encourage respiratory changes
• Encourage exercise
• Passive ROM 
• Weight Patient
• Advice patient to take medicines & reduces risk of falls
• Encourage diet high in protein & calories
• Encourage soft diet

Distinctive facts:

• Ix: CSF analysis shows decrease in dopamine levels
• Sx: Thalomotomy, pallidotomy, deep brain stimulation
• Cx: Dementia
• Dopamine level will decrease 
• Occurs between 45-65 years
• Lewy bodies may be absent
• Autosomal dominant & autosomal recessive gene inheritance may be identified

Prognosis:

It is progressive disorder with no cure. symptoms may be managed with medicines & may come off when medicine stops.

DISEASES & DRUGS

                               DISEASES & DRUGS

• It is one of the important responsibilities of the medical personnel especially doctors to prescribe drug as per the symptoms & diagnosis of the patient.
• A basic idea about the use of drugs & its effectiveness is mandatory.

• Here are some of the infections & their choice of drugs:

1. Drug of choice for cryptoccocus: Flucanazole
2. Drug of choice for systemic fungal infection: Amphotericin B
3. Drug of choice for vulvovaginal candidiasis: Flucanazole
4. Drug of choice for Pyrazinamide induced hyperuricemia: Aspirin
5. Drug of choice for relapsing fever: Tetracycline
6. Drug of choice for cholera: Doxycycline
7. Drug of choice for tick typhus: Tetracycline
8. Drug of choice for syphilis: Penicillin G
9. Drug of choice for toxoplasmosis: Cotrimoxazole
10. Drug of choice for spotted mountain fever: Tetracycline
11. Drug of choice for scrub typhus: Tetracycline
12. Drug of choice for surgical prophylaxis: Cefazolin
13. Drug of choice for community acquired pneumonia: Clarithromycin
14. Drug of choice for Tapeworm: Praziquentel
15. Drug of choice for thread worm: Ivermectin
16. Drug of choice for filarial worm: Ivermectin
17. Drug of choice for hook worm: Albendazole
18. Drug of choice for guinea worm: Albendazole
19. Drug of choice for round worm: Albendazole
20. Drug of choice for pin worm: Albendaole
21. Drug of choice for aspergillosis: Amphotrecin B
22. Drug of choice for leshmaniasis: Amphotrecin B
23. Drug of choice for Toxoplasmosis in pregnancy: Spiramycin
24. Drug of choice for Enterococcus fecalis: Ampicillin
25. Drug of choice for listeria monocytogenes: Ampicillin
26. Drug of choice for Filariasis: Diethyl Carbamazine [DEC]
27. Drug of choice for scabies: Ivermectin / Permethrine
28. Drug of choice for Leptospirosis: Penicillins
29. Drug of choice for typhoid: Ceftriaxone
30. Drug of choice for influenza: Oseltamivir
31. Drug of choice for herpes simplex: Acyclovir
32. Drug of choice for herpes zoster: Valacyclovir
33. Drug of choice for leprosy: Dapsone/ Rifampicin
34. Drug of choice for actinomycosis: Penicillin G
35. Drug of choice for brucella: Streptomycin
36. Drug of choice for plague: Streptomycin
37. Drug of choice for kala azar: Miltefosine / Sodium stibogluconate
38. Drug of choice for lymphogranuloma venereum: Azithromycin
39. Drug of choice for dysuria: Phenazopyridine
40. Drug of choice for gonorrhea: Procaine Penicillin
41. Drug of choice for anthrax: Doxycycline
42. Drug of choice for Haemophilus influenza type B: Rifampicin
43. Drug of choice for prophylaxis TB: Isoniazide
44. Drug of choice for diarrhea in HIV patient: Octreotide
45. Drug of choice for Hepatitis B: Limuvidine
46. Drug of choice for Hepatits C: Ribavarine & Interferron 2 alpha
47. Drug of choice for salmonella: Ceftriaxone
48. Drug of choice for meningitis: Ceftriaxone
49. Drug of choice for gonorrhea: Ceftriaxone
50. Drug of choice for Trichomoniasis: Metronidazole
51. Drug of choice for bacterial lactamase extended spectrum: Carbapenem
52. Drug of choice for otitis media: Amoxicillin
53. Drug of choice for nocardia: Sulfonamides
54. Drug of choice for Neurosyphillis: Aqueous penicillin
55. Drug of choice for MDR strains for TB patients: Amikacin
56. Drug of choice for accidental exposure og HIV health care workers: Zodovudine with Lamivudine
57. Drug of choice for neisseria: Ceftriaxone
58. Drug of choice for cellulitis: oxacillin
59. Drug of choice for microspora: Albendazole
60. Drug of choice forhistoplasmosis: Amphotrecin B
61. Drug of choice for dermatitis herpetiformis: Aspirin
62. Drug of choice for post splenectomy sepsis: Ceftraixone
63. Drug of choice for impetigo: Penicillin G
64. Drug of choice for animal bite: Ampicillin
65.  Drug of choice for toxic shock syndrome: Penicillin with clindamycin
66. Drug of choice for dirty wound prophylaxis: Cefazoline
67. Drug of choice for lice infection: 1% Permethrin
68. Drug of choice for dental prophylaxis for endocarditis: Clarithromycin
69. Drug of choice for UTI: Aminoglycosides
70. Drug of choice for cholera in children: Cotrimoxazole
71. Drug of choice for MRSA: Vancomycin
72. Drug of choice for trench mouth: Metronidazole
73. Drug of choice for whooping cough: Erythromycin
74. Drug of choice for candida: Flucanazole
75. Drug of choice for trachoma: Azithromycin
76. Drug of choice for giardiasis: Metronidazole
77. Drug of choice for tetanus: Metronidazole
78. Drug of choice for cerebral malaria: Artesunate
79. Drug of choice for plasmodium vivax: Chloroquine
80. Drug of choice for Plasmodium falciparum: Artesunate + Pyrimethamine + Sulfadoxine

Types of IV solutions:

Isotonic: 

• 0.9% NS
• 5% Dextrose in water
• 5% Dextrose in 0.2255 saline
• Ringer lactate

Hypotonic:

• 0.45% NS
• 0.225% NS
• 0.33% NS

Hypertonic:

• 3% NS
• 5% NS
• 10% Dextrose in water
• 5% Dextrose in 0.9% NS
• 5% Dextrose in 0.45% NS
• 5% Dextrose in RL

Colloids:

• Dextran
• Albumin

FETAL SKULL

                                    FETAL SKULL

Introduction:

Fetal skull is the bony part which protects the fetal brain & has to pass through the maternal pelvis to be born.

Parts of fetal skull:

• Vault
• Face 
• Base

Bones of vault:

• Frontal bones-2
• Parietal bones-2
• Occipital bone-1
• Temporal bones-2

Sutures of vault:

• Frontal suture: Between 2 frontal bones
• Coronal suture: Between frontal & parietal bone
• Saggital suture: Between 2 parietal bones
• Lamdoidal suture: Between parietal & occipital bone
• Squamous suture: Between Temporal & parietal bone on either side.

Regions of fetal skull:

• Vertex: A quadrangular area bounded anteriorly by bregma & coronal suture Posteriorly by lamda & lamdoidal sutures & laterally by parietal eminence.
• Brow: An area bounded by bregma & coronal sutures on one side & root of nose & supra orbital ridges on either side.
• Face: Area bounded by root of nose & supra orbital ridges on one side & by the junction of floor of mouth with neck on the other side.
• Sinciput: An area lying in front of anterior fontanel & corresponds to area of brow.
• Occiput: Area limited to occipital bone.

Landmarks of fetal skull:

• Vertex
• Face
• Brow
• Glabella
• Occiput
• Sinciput
• Mentum
• Parietal eminence

Fontanelles of fetal skull:

Wide gap in the suture line is called fontanel.

ANTERIOR FONTANEL:

• Also called as bregma
• Shape: diamond
• Bounded by:
• Anteriorly- Frontal bone
• Posteriorly- Saggital suture
• Laterally- Coronal suture
• Floor is made by membrane
• Measures- 3-4 * 1.5-2.5 cm.
• Ossification  at 18 months

Importance of anterior fontanel:

• Denotes degree of flexion by palpation during vaginal examination.
• Facilitates moulding
• Helps in accommodating fetal brain growth as the brain becomes almost double in size at the first year of life.
• Palpation of it reflects intracranial status: 
• Depressed- Dehydration 
• Elevated: Raised intracranial tension
• Blood collection or exchange transfussion in case of scalp infusion.
• Withdrawal of CSF .

POSTERIOR FONTANEL:

• Formed by junction of 3 sutures
• bounded by:
• Anteriorly- saggital suture
• Laterally- lamdoidal suture
• Shape- Triangular
• Measures about- 1.2 * 1.2 cm
• Ossification- 3 months.

Saggital fontanelle & Posteriolateral fontanelle both on either side have no clinical implications.

Moulding:

• Sliding of bones under each other thereby reducing diameters of fetal skull is called as moulding.
• During normal delivery an moulding of 4 mm diameter is common.
• Grade 1- Bones are not touching each other & no overlapping.
• Grade 2- Overlapping but easily separated.
• Grade 3-  Fixed overlapping

Diameters of fetal skull:

1] Anterioposterior diameters

2] Transverse diameters

1] Anterio-posterior diameters:

• Suboccipito bregmatic diameter: Below the occipital protuberance to the center of bregma- 9.5 cm
• Subocciputo frontal diameter: Below the occipital protuberance to the center of frontal suture- 10 cm
• Occipito frontal diameter: From occipital protuberance to glabella- 11.5 cm
• Mento vertical diameter: Loingest diameter. From the midpoint of chin to highest point of vertex- 14cm
• Submento vertical diameter: From the point where chin joints the neck to highest point of vertex- 11.5cm.
• Submento bregmatic diameter: From the point where chin joints the neck to the center of bregma-     9.5cm.

2] Transverse diameters:

• Biparietal diameter: Longest transverse diameter. distance between to parietal eminences- 9.5 cm.
• Bitemporal diameter: Distance between 2 farthest point of coronal suture- 8 cm.
• Supra-sub parietal diameter: From the point below 1 parietal eminence to the point placed above the other parietal eminence on opposite side - 8.5 cm.
• Bimastoid diameter: Distance between 2 mastoid process- 7.5 cm.

Clinical Implications:

• The sutures & fontanels are used for identification of presentation & position of fetus.
• The engaging diameter is an important factor that determines the progress of labor.