Pinoy Blog Machine (Beta)

Erin's been quite talkative these days. Her speech is not limited anymore to just cooing. She gurgles a lot and I think an emerging "Ba" is on the way as she loves making bubbles with her saliva. "Gi" is also now part of her vocal gymnatics repertoire.

The other day, J reckons he heard her say "Daddy." Now, that can't be really true, right? I spend almost the entire day (24/7) with this kid and her first word is "daddy" ?! Maybe J heard something else, like the "gi" syllable which does sound like the last syllable of daddy. Anyway, whatever it is, I have yet to hear it for myself to believe it. So far, nada! :P

-o-

Yesterday was Erin's cousin C's 18th birthday. Lunch was held at the second floor of the Canberra Football Club in Deakin. It was eat-all-you-can Yum Cha at AU$15 per person. The food was delicious but their service was terrible. :( The place was packed at 12 noon. And since our tables were located in the farthest corner from the kitchen, the food couldn't get to us. I think we were able to start really eating at past one when some of the other customers had left.

While waiting for the food, the little girl got passed around to other family members and friends. And she did not cry! :) Looks like this kid is turning into one social butterfly! And she doesn't cry anymore in her car seat (except of course, when she's already tired). Thanks to endless playing of nursery rhymes and toys dangling everywhere. ;)

-o-

The three of us haven't been getting much sleep these days. Erin's eczema still flares up every now and then. What's worse is that these episodes occur late at night or at early dawn when we're all supposed to be sleeping. We know it's occuring when she suddenly wakes up, rubs her face and starts screaming. J and I don't have eczema so we don't have the slightest clue as to how she's really feeling. But I reckon it's so damn itchy judging from her terribly loud cries. After applying creams, the most that we can do is just wait for the rashes to subside. And it's only then can we go back to getting some shut-eye, which isn't easy, by the way.

I realise eczema is actually pretty common in kids, especially after talking to family and friends. Extreme weather temperatures (either the cold or the heat), I think, are majorly the culprits. So I'm guessing this'll be back to haunt us in the summer time. Oh dear... :(

-o-

Shameless Plugs
Thanks to my brother D for 'photoshopping' one of Erin's photos. He's a graduating Fine Arts student at the UP in Diliman and he's trying to build up his portfolio. Here's his 'Erin' project:

And here's one more of his works:

Couldn't be any prouder. :D

And while we're on the subject of family and the arts, my brother-in-law is currently exhibiting his artwork at The Art Hall, Tower 2, The Enterprise Center in Makati City. The exhibit runs from the 23rd of July to the 5th of August. Access to his works is also available online at his site.

SITUATION : Aling Martha, a 32 year old fish vendor from baranggay matahimik came to see you at the prenatal clinic. She brought with her all her three children. Maye, 1 year 6 months; Joy, 3 and Dan, 7 years old. She mentioned that she stopped taking oral contraceptives several months ago and now suspects she is pregnant. She cannot remember her LMP. 1. Which of the following would be useful in

I was browsing on technorati earlier and started to notice on my blog reactions the title of my most recent post about my week 1 earnings. It was from PinoyBlogMachine and then, that was one of those times when a lightbulb flashes above your head "twing!". My Post Got Featured on PinoyBlogMachine! As i continued to think about it, i had train of thoughts spinning on my mind. Traffic, Visitors, Traffic, Readers, traffic, more clicks, traffic, more friends , and. . . well, you know whats next. . .hehe

Read my post here.

Kidding aside, i was really delighted to find this out. Not only will this get my blog more visitors, but it will be known to more people around the blogsphere and on the internet in general. As i have said in my previous post, i will try hard to help people earn on the internet; this being said, i need as much eyeballs on my blog as possible. This, i hope is one of them. . .

Like this post? Add me to your tech faves.

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Does this story remind you of our local celebrity news anchors?

"The world of the news anchor, born of the idea that the news is a public trust, is in free fall," says this story. "Today's news presenters like the much-criticised Katie Couric of CBS News and the idolised Anderson Cooper of CNN, are the creation of the media campaigns that old Hollywood studios once used to manufacture their stars."

"Dan Rather complained that the decision to bring in Katie Couric as his replacement to anchor The CBS Evening News represented a desire 'to dumb it down, tart it up'.

Starting with a story on a journalist who slept with her source and very much part of the controversy she reported, the story said: "The old world that Rather represents is long gone. With his prematurely grey head of hair and steel blue eyes, the newest star, Anderson Cooper, gazes from the cover of June's issue of Vanity Fair. No bad dye jobs for the man People magazine has named one of the 'sexiest men alive'."

Click here for the story which I got from the New Zealand Herald.

Yey! Sizzle wins in Move! Now back to work.

Got lots of things to do but I have to stop for now. I'm watching the final episode of Move. Oh boy, I hope Sizzle gets in.

• Why my First week of blogging is 'SuccessFULL'
  my first week on my journey to earn online. See what i did.

Read and post comments | Send to a friend

It has been a little over a week since yours truly started blogging to earn money. And so far, so good. At least i would like to think so. .

As far as I can recall, here are the things i did the past week on my blog.

For Money-maKing. . .

• Signed up for a number of Ads Providers. . . Bidvertiser, AffiliateBot, AdBrite (just earlier)
• Signed up for a MyLot account.
• Signed up for SlashMySearch
  

For Traffic. . .

• Submitted to quite a number of blog directories.
  
• Added myself to Blogcatalog, MyblogLog and bumpzee.
• Submitted Stories to Digg.com
• Signed up for Associated content which i am yet to write my first article.
• Had Link exchanges with several bloggers.
  

For any Other:

• I added a WeekLy FreEbie feature on my blog which for this week, Harry Potter E-Book is up for Grabs! get your copy now!
  

These, among others were done by my own initiative, dictations, or any other guidance from other people. I did have friends whom i value their advises. And guys, for that, Thanks you! You know who you are. I hope i can make more friends and expand my Horizons.


My Earnings So Far. . .
-Expect not to see thousands, hundreds or even tens for that matter. Hey, afterall, im still starting out. Here's what i Got.

• SlashmySearch - $.246 (this i havent done anything. "Hulog ng langit" as we say. . .)
  
• AffiliateBot - $.91 (Lucky i got a few Clicks. . . Great! )
• Squidoo - $.25 ( Havent updated my Squidoo for ages! )
  
• MyLot -$.06 (I made 6 comments this week. I dont really got time as of now. If you could post/make comments more, You can earn Way More than i could. register here.
• Bidvertiser -$.08 (As you can see, I only have a single add unit. A single snippet. This figure means i need to tweak, tweak, tweak. )
  

Total Money Earned So Far - $1.7

This figure is qutie humble but ill take this as a challenge. I see this as an obstacle that needs to be surpassed. i just bear in mind that success is 1% inspiration and 99% perspiration. Expect more of this to come your way.

Culture Shiok!'s contribution to the "Reflective Thinking - Taking the 8th Habit Challenge: The Top 10 Emerging Influential Blogs in 2007" writing project... (in no particular order)

Project Manila
CokskiBlue
An Apple a Day
Make Money Online with a 13-Year Old
Kubiertos
Nice4Rice
Fruity Oaty
The Anitokid Chronikos
Culture Shiok!
HappySlip

The struggle between online and print journalism continues. I don't really know whether we have a similar memo issued among the papers in the Philippines, but the US-based The Washington Post issued a memo to its staff to avoid misunderstandings between the two departments. Got the info here.

"The Washington Post and its dot-com operation have always had a tricky relationship. Newsroom staffers always complain that their stuff doesn’t get good enough play on the site," writes Erik Wemple here. "Dot-commers reply that the newsies don’t really get the Web. The bitching—er, dialogue—volleys back and forth between Post HQ at 15th and L and the post.com HQ in Arlington." He also posted the full memo in his piece.

Ten Principles for Washington Post Journalism on the Web

1. The Washington Post is an online source of local, national and international news and information. We serve local, national and international audiences on the Web.
2. We will be prepared to publish Washington Post journalism online 24/7. Web users expect to see news as it happens. If they do not find it on our site they will go elsewhere.
3. We will publish most scoops and other exclusives when they are ready, which often will be online.
4. The originality and added value of Post journalism distinguishes us on the Web. We will emphasize enterprise, analysis, criticism and investigations in our online journalism.
5. Post journalism published online has the same value as journalism published in the newspaper. We embrace chats, blogs and multimedia presentations as contributions to our journalism.
6. Accuracy, fairness and transparency are as important online as on the printed page. Post journalism in either medium should meet those standards.
7. We recognize and support the central role of opinion, personality and reader-generated content on the Web. But reporters and editors should not express personal opinions unless they would be allowed in the newspaper, such as in criticism or columns.
8. The newsroom will respond to the rhythms of the Web as ably and responsibly as we do to the rhythms of the printed newspaper. Our deadline schedules, newsroom structures and forms of journalism will evolve to meet the possibilities of the Web.
9. Newsroom employees will receive training appropriate to their roles in producing online journalism.
10. Publishing our journalism on the Web should make us more open to change what we publish in the printed newspaper. There is no meaningful division at The Post between “old media” and “new media.”

Whew. Just had my longest sleep in years. Okay, maybe that's an overstatement. Make that my longest sleep in more than three months.

If I only have all the time in the world, I would probably do this.



White Water Rafting for Indigenous Peoples' Education

Take a thrilling adventure and make it worth a lifetime for a child!

Cartwheel Foundation invites you to experience the renowned Cagayan de Oro River white water rapids and raft for indigenous peoples' education, together with The Red Rafts and Men's Health Magazine. Starting this June until October 2007, raft with The Red Rafts, Cagayan de Oro's premier outfitter, and part of the proceeds of your trip will benefit the educational programs of Cartwheel.

There are an estimated 12 million indigenous peoples (IPs) in the Philippines and they have little or no access to quality education. Cartwheel is committed to bridging the gap and ensuring that they enjoy their right to education that is best suited to their culture and life experience. You, too, can lend your support and have a blast while you're at it-- you might just discover the ride of your life!

Go with your friends or even take the whole office for an outing (special teambuilding activities are included). Reserve your trip now!

Call/text: (0922)454-0021 or (0919)204-3534
Email: action@cartwheelfoundation.org

Note: Cebu Pacific promo of P99 fare to CDO available from June 21 to 27!

About Cartwheel:

Cartwheel Foundation is committed to bringing education to indigenous peoples (IPs), one of the most vulnerable sectors of the Philippines. IPs have long been neglected, isolated, and overtaken by development and suffer from a severe lack of access to basic services, including education. Cartwheel strives to bridge this gap by providing education that is culturally sensitive, appropriate, and relevant to their realities. Through the Pre-School, Alternative Learning, and College Scholarship Programs, Cartwheel works hand in hand with IP communities in allowing them to thrive in their rich culture and equipping them with tools necessary for community leadership and development.

my fellow blogger kirbitz tagged me on his 8 random facts game. each player will write 8 little known facts about himself and in the end will choose 8 bloggers to be tagged. so here it is.

1. i kill roaches the easy way. instead of doing the disgusting slipper splat, i just use a lighter and a flammable spray (perfume, lysol, etc.) and viola. problem solved.

2. i hate spiders. small or big, black or brown, dead or alive, i freak out whenever i see one.

3. i have a crush on shaira luna. nope, she ain't the nerd anymore and she's damn pretty!

4. i don't wear the same jacket on the next day. i have a fetish for jackets.

5. i always name my gadgets. i named my ipod "donna", my videocam "fantasia", my fone "jodie", and my digicam "twinkie".

6. i have a green thumb. yes i have hands that are colored green... no you silly goose, it means i have the passion for gardening.
7. i have never ever purchased a single audio cd. i'm an mp3 junkie.

8. i daydream a lot. and if you could only see it, you'd probably think i'm insane.

here are the ones that i tag:
2. kellecker
3. paper tiger
4. uncle oli
5. jumble-jan
6. rachi
7. twisted banana
8. thunker and keep

RESPIRATORY – 5 items

1. Mr. A., a patient with status asthmaticus, becomes less responsive. Arterial blood gas analysis reveals a partial pressure of carbon dioxide in arterial blood (PaCO2) of 60mmHg and PaO2 of 55mmHg. The data most likely indicate acute:

A. Pneumonitis
B. Respiratory failure
C. Pulmonary edema
D. Pulmonary embolism

Rationale:
B. A patient with status asthmaticus occasionally develops acute respiratory failure late in attack. This may occur with infections or pulmonary air leak, but it commonly occurs without evident complications. Exhaustion, coma, and deteriorating pulmonary function indicate a lack of response to therapy or deterioration. ; altered arterial blood gas levels ( partial pressure of carbon dioxide in arterial blood [PaCO2] below 50mmHg, partial pressure of oxygen in arterial blood [PaO2] below 50mmHg on 50% oxygen) indicate acute respiratory failure. The patient may need intubation or supportive ventilation. Acute pulmonary embolism causes initial sharp pain, hyperinflation, and respiratory alkalosis followed by respiratory acidosis. Acute pulmonary edema causes orthopnea, crackles, paroxysmal dyspnea, and pink, frothy sputum. Pneumonitis causes temperature elevation and purulent sputum.


M., a 19-year-old college student, is on the varsity football team. During a game, he is tackled and sustains fractured ribs on the right side of the chest. He is taken to the emergency department in a local hospital.

2. Which initial manifestation should the nurse expect with this patient?

A. Shallow, painful breathing
B. Diminished breath sounds on the affected side
C. A clicking sensation during inspiration
D. Paradoxical respirations

Rationale:
A. Initial assessment to a patient with fractured ribs reveals a shallow breathing to minimize pain accompanying any movement. Paradoxical respirations, in which the chest expands on expiration and contracts on inspiration, would be present only if the ribs sustain multiple fractures. Diminished breath sounds on affect side, would be present only if the patient has pneumothorax. A clicking sensation would be present only with costochondrial separation.


3. Which condition would most likely indicate that M.’s chest tube should be removed?

A. Lung reexpansion on chest x-ray
B. 120 ml of chest tube drainage in 24 hours
C. Cessation of pain and dyspnea
D. Absence of fluid fluctuation in the water-seal chamber

Rationale:
A. A chest x-ray must confirm lung reexpansion before chest tubes can be removed. The amount of chest tube drainage and the cessation of pain and dyspnea are not indications for removal. The presence of chest tubes itself may be irritating and painful; the pain may increase the patient’s dyspnea. Absence of fluid fluctuation in the water-seal chamber indicates lung reexpansion, but it could also mean that the chest tubes are obstructed or the drainage system is not working.


4. Which method would best prevent the air from entering the pleural cavity after removal of M.’s chest tubes?

A. Breathing with an open mouth
B. Breathing through pursed lips
C. Performing Valsalva maneuver
D. Breathing quickly and shallowly (panting)

Rationale:
C. Valsalva’s maneuver causes bearing-down effect, increasing pressure through the cavity and preventing air from entering the pleural cavity. Breathing through pursed lips, quickly and shallowly, or with an open mouth will not prevent air from entering when chest tubes are removed.


Mr. S., a 65-year-old retired steel mill worker, is admitted to the unit with dyspnea upon exertion. He has a long history of smoking. Initial assessment includes barrel chest, ankle edema, persistent cough with copious sputum production, and variable wheezing on expiration. Laboratory test results include a hematocrit greater than 60% and a partial pressure of carbon dioxide in arterial blood gas (PaCO2) of 65mmHg. The physician diagnosed chronic obstructive pulmonary disease (COPD).

5. Mr. S.’s, ankle edema and respiratory problem would make the nurses suspect hypertrophy of the which heart chamber?

A. Left ventricle
B. Right ventricle
C. Right atrium
D. Left atrium

Rationale:
B. Chronic obstructive pulmonary disease (COPD) can cause hypoxemia and pulmonary hypertension. Hypoxemia causes increased production of red blood cells, making the blood more viscous. The increased viscosity combined with increased pressure forces the right side of the heart to work harder than usual, resulting in right ventricular hypertrophy. Ankle edema is a common assessment finding in this situation. The right atrium may decompensate as the hypertrophy worsens; the left atrium and left ventricle are not affected.

CARDIAC SYSTEM

1 Intermittent claudication is an indication of which condition?

A. Mitral regurgitation
B. Venous insufficiency
C. Arterial insufficiency
D. Phlebitis

Rationale:
C. Intermittent claudication typically is the first symptom of arterial insufficiency. It is not associated with phlebitis, venous insufficiency, or mitral regurgitation.


2 Which statement does not accurately describe Raynaud’s disease?

A. It is precipitated by exposure to cold air or by emotional stress
B. Its is characterized by episodic digital vasospasm associated with skin color changes
C. It usually occurs in men ages 40 to 60
D. It is typically seen in fingers and toes

Rationale:
C. Raynaud’s disease usually occurs in woman ages 16 to 40, not older men. Intermittent constriction of cutaneous blood vessels, precipitated by exposure to cold or by emotional stress, produces cyanosis and pallor of the fingers or toes; reactive hyperemia after vasoconstriction causes redness.

Mr. S., age 36, is admitted to the hospital with a diagnosis of congestive heart failure (CHF). The

3 When assessing Mr. S., for signs and symptoms of digoxin toxicity, the nurse should watch all of the following except:

A. Anorexia, nausea and vomiting, diarrhea, and abdominal pain
B. Bradycardia, tachycardia, bigeminy, ectopic beats, and pulse deficits
C. Abdominal distention, weakness, paralysis, apathy, depression, and hallucinations
D. Headache, double or blurred vision, drowsiness, confusion, restlessness, and muscle weakness.

Rationale:
C. Abdominal distention, weakness, apathy, paralysis, depression and hallucinations are signs of potassium and calcium overdose, not digoxin toxicity. The rest are all signs and symptoms of digoxin toxicity.


Mrs. J., a 58-year-old patient with long standing hypertension, is admitted for shortness of breath. During morning rounds the nurse notices that Mrs. J. has developed an S4 gallop, crackles, and diminished breath sounds, which indicate CHF.
4 Mrs. J., is admitted a year later with a diagnosis of malignant hypertension.

Which drug is commonly used to treat this disorder?

A. ACE inhibitors and diuretics administered orally
B. Vasodilators and diuretics administered intravenously
C. Beta blockers and angiotensin converting enzymes (ACE) inhibitors administered orally
D. Adrenergic blockers and vasodilators administered intravenously

Rationale:
B. Malignant hypertension-rapid progression of primary or secondary hypertension-commonly is treated with potent vasodilator and loop diuretic. Nitroprusside (Nipride), the vasodilator of choice, can be titrated for pressure reduction when monitoring is available; diazoxide (Hyperstat), which acts directly on the peripheral arteriolar smooth muscle, may be given instead. Treatment must include a loop diuretic, usually furosemide. These drugs are given IV; their onsets of action are extremely fast. ACE inhibitors (which reduces peripheral arterial resistance without affecting heart rate or cardiac workload) and alpha-adrenergic blockers (which block peripheral vascular adrenergic receptors an cause vessel wall relaxation, resulting in peripheral vasodilation) as well as beta-adrenergic blockers (which decrease sympathetic stimulation and rennin secretion by the kidneys) may be used to treat primary or essential hypertension but not medical emergency like malignant hypertension.


Mr. T., a 57-year-old steelworker with a history of angina, has been having more frequent attacks of chest pain. He is admitted to the ED with chest pain unrelieved by three nitroglycerin tablets. The physician diagnosis Prinzmetal’s variant angina.

5 Mr.T.’s MI extends, and begins to show signs of left ventricular failure. Which sign would appear first?

A. An S3 heart sound
B. An S4 heart sound
C. Pink, frothy sputum
D. Crackles an cough

Rationale:
A. The third heart sound (S3) is the first objective sign of left ventricular failure. Crackles and cough and pink, frothy sputum are late signs, signifying congestion from heart failure and pulmonary edema. A fourth heart sound (S4) is not a sign of left ventricular failure.


NEUROSENSORY SYSTEM 5 ITEMS

1. Which medication is not appropriate for a patient with a craniotomy?

A. Phenytoin (Dilantin)
B. Codeine
C. Meperidine (Demerol)
D. Dexamethasone (decadron)

Rationale:
C. Meperine (Demerol) is not given postoperatively to a craniotomy patient because it may mask the neurologic problems, such as changes in level of consciousness and abnormal pupillary reactions or size; the drug may also cause respiratory depression. Dexamethasone (Decadron) is given to control cerebral edema. Phenytoin (Dilantin) is given to prevent generalized tonic-clonic seizures. Codeine is used as an analgesic for severe headache; this mild narcotic’s activity does not interfere with neurologic assessment.

2. All of the following signs indicate increased intracranial pressure except:

A. Decreased level of consciousness
B. Papilledema
C. Vomiting
D. Tachycardia

Rationale:
D.Bradycardia, not tachycardia, accompanied by hypertension is a sign of increased intracranial pressure (ICP). Other signs include nausea and vomiting, decreased level of consciousness, and headache; papilledema is a late sign.


3. Which assessment most strongly suggest Meniere’s disease?

A. Vertigo
B. Nausea
C. Neurosensory hearing loss
D. Tinnitus

Rationale:
A. The strongest indication of Meniere’s disease is vertigo, a sensation of irregular or whirling motion of oneself or of surrounding objects. Nausea commonly accompanies vertigo, but nausea by itself may be caused by many disease. Tinnitus (a buzzing sound in the eras) and neurosensory hearing loss occur in Meniere’s disease because of cochlear labyrinth disturbances (although hearing loss may not occur early in the disease); however, these findings also could result from other diseases. Vertigo accompanied tinnitus and neurosensory hearing loss confirms the diagnosis of Meniere’s disease.


4Characteristic clinical manifestation of ALS do not include:

A. Uncontrolled outburst of crying
B. Aphagia and dysarthria
C. Loss of bowel and urine control
D. Fasciculation of the involved muscles

Rationale:
C. The patient with ALS usually does not lose urinary and bowel sphincter control because the disease does not affect the spinal nerves controlling these muscles. However, other muscles that control the neck, pharynx, larynx, trunk, and legs atrophy from the gradual degeneration of motor neurons; this can lead to aphagia, dysarthria, uncontrolled outburst of laughing or crying, and fasciculation of the involved muscles.


5. rs. D.’s physician orders myelogram using a water-soluble contrast medium. Which nursing activity is most appropriate for Mrs.D after his procedure?

A. Monitoring level of consciousness
B. Restricting fluids for 6 to 10 hours
C. Placing the patient in a recumbent position for 12 to 24 hours
D. Elevating the head of the bed 15 to 30 degrees

Rationale:
D. After the patient has had a myelogram using a water-soluble contrast medium, the nurse should elevate the head of the bed 15 to 30 degrees to reduce the medium’s rate of upward dispersion, preventing such complications, such as seizures and transient encephalopathy. The nurse should encourage high fluid intake after myelogram to replenish CSF leakage and to maintain adequate hydration. Monitoring the patient’s level of consciousness is not necessary because myelogram will not alter it. The physician may specify a recumbent position for 12 to 24 hours after the procedure if oil-based iodine is used; this position helps prevent headache and may help reduce CSF leakage.


(Musculo) 5 items

1. A 15-year-old is treated in the emergency room for a fractured right ankle. A plaster walking cast is applied and the client is instructed to walk with the aid of crutches once the cast has dried. While instructing the client to ambulate with crutches the nurse most appropriately teaches the client to:

A. Move both crutches and the right foot forward simultaneously followed by the left foot
B. Move the right foot and the left foot forward together followed by the left foot and right crutch
C. Move crutches and feet in the following sequence: right crutch, left foot, left crutch, right foot
D. Place the crutches under the arms, bear weight on the axilla, and position both crutches 8-10 inches in front of the body

Rationale:
A. This is the three point gait, which is used when one leg is injured or weak and the other leg is capable of supporting the client’s full body weight. Most of the body weight is placed on the crutches when the fractured rib is moved forward.


2. The nurse is assisting a client who has broken ankle with crutch walking. The nurse knows the client understands the instructions when the client:

A. Leans on the crutch pads to relieve pressure on the affected foot
B. Advances both crutches and the affected leg at the same time
C. Puts partial weight on the affected side
D. Advances both crutches and the unaffected leg at the same time

Rationale:
B. The three point gait is the appropriate gait for someone with a broken ankle as it allows no weight bearing on the affected leg. The client advances both crutches and the affected leg at the same time. The client then swings the involved extremity to the crutches while the body’s weight is supported by the crutches and the unaffected leg.


3. A 2-day-old infant is diagnosed as having congenital hip dysplasia of the right hip. The infant is fitted with a Pavlick harness. Which of the following would not be included in the instructions for home care of the patients?

A. Turn her every 3-4 hours
B. Watch for signs of skin breakdown
C. Keep her off the affected side
D. Give her sponge baths, not tub baths

Rationale:
C. The infant in a Pavlick harness can be turned from back to abdomen but should not be positioned to other side.


Mrs. D., a 32-year-old homemaker, is admitted to the hospital with a history of urine retention. Her physician suspects multiple sclerosis (MS).

4 Which diagnostic tool helps confirm the diagnosis of MS?

A. Skull x-rays
B. Cerebrospinal fluids
C. Electromyography
D. Electroencephalography

Rationale:
B. Cerebrospinal fluid (CSF) analysis showing increased lymphocytes and oligoclonal immunoglobulin G helps confirm the diagnosis of MS. Other helpful diagnostic procedures include CT, nuclear magnetic resonance, and magnetic resonance imaging. Skull x-rays, electroencephalography, and electromyography do not diagnose MS.


Mr. C., a 65-year-old retired assembly line worker, is admitted to the hospital with a diagnosis of Parkinson’s disease.

5 The physician orders 1 mg of benztropine mesylate (Cogentin) P.O. daily for Mr. C., which finding suggests a favorable effect from this medication?

A. Decreased tremors
B. Decreased muscle rigidity
C. Decreased confusion
D, Decreased dizziness

Rationale:
A. Anticholinergics, such as benztropine mesylate (Cogentin), reduce the cholinergic activity caused by decreased dopamine levels and decrease tremors. Muscle rigidity typically is treated with amantadine (Symmetrel) or carbodopa-levodopa (Sinemet). Possible adverse effect of anticholinergic drugs includes increased dizziness and confusion; benztropine therapy will not decrease this symptoms.





GASTROINTESTINAL SYSTEM

1. A client who is experiencing ascites is admitted to the hospital and will be undergoing a paracentesis. What should be included in the nursing care plan?

A. Place client in Trendelenberg position for the procedure
B. Monitor client closely for evidence of vascular collapse
C. Have client remain on bed rest for 24 hours following the procedure
D. Encourage the client to drink plenty of fluids to distend the bladder prior to procedure

Rationale:
B. Removing large amounts of fluids may cause hypotension leading to vascular collapse. The client should be monitored closely for decrease in blood pressure, increase in pulse and pallor.

2. A woman is admitted for a suspected duodenal ulcer. The nurse is interviewing her for an admission history. Which description of her pain would be most characteristic of duodenal ulcer?

A. Right upper quadrant that increases after meals
B. Aching in the epigastric area that wakens her from sleep
C. A sensation of painful pressure in the midsternal area
D. Sharp pain in the epigastric area that radiates to the right shoulder

Rationale:
B. Pain from a duodenal ulcer is often aching or burning in character. Pain occurs when the stomach is empty. In addition, in persons who develop duodenal ulcers often hyper secrete gastric acid during REM sleep, with a resulting increase in pain that wakens them from sleep.


Mr. F., age 60, is admitted to the hospital with ascites and jaundice to rule out cirrhosis of the liver.

3 The physician schedules Mr.F., for a liver biopsy to confirm the diagnosis of cirrhosis. Which crucial information should the nurse tell Mrs.F before the procedure?

A. The procedure is painless
B. He should hold his breath on exhalation when biopsy needle is inserted
C. Pressure will be applied to his right side after the procedure
D. He must maintain a side-lying position after the procedure

Rationale:
B. to prevent puncture of the diaphragm, the nurse should tell the patient to hold his breath on exhalation when the needle is inserted. Because the patient may feel discomfort during needle insertion, he should not be told that the procedure is painless. After the procedure, the patient should lie in his right side on a pillow or a sandbag to arrest bleeding; however, this information is not crucial for the patient to know before the procedure.


Mr. M., a 42-year-old accountant, is admitted to the hospital with intestinal obstruction. A flat-plate x-ray of the abdomen shows a mass, which may be malignant.

4 Which type of tube will Mr. M.’s physician require for intestinal decompression?

A. Levin
B. Salem sump
C. Ewald
D. Miller-Abbott

Rationale:
D. The physician will use the Miller-Abbott tube, a double-lumen tube with an inflatable balloon, to decompress the patient’s intestine. The Levin tube is a single-lumen nasogastric tube used to decompress the stomach. The Salem sump tube is a double-lumen tube used for stomach decompression. The Ewald tube is a large-bore tube used to evacuate the stomach.



Mr. O., a 50-year-old postal worker, is admitted to the hospital with acute pancreatitis.

5 If Mr. O., begins to exhibit muscle twitching and irritability, the nurse should:

A. Call the physician because the patient may have hypocalcemia
B. Administer analgesics because the symptoms may be caused by pain
C. Check his serum amylase level
D. Reassure the patient that this is common among people who abuse alcohol

Rationale:
A. The nurse should call the physician immediately, because muscle twitching and irritability are signs of hypocalcemia, which commonly accompanies acute pancreatitis; other signs and symptoms include tetany, jerking, and positive Trousseau’s sign and Chvostek’s signs. Hypocalcemia results from the fixation of calcium by the fatty acids where fat necrosis has occurred and from the increased calcium loss in the urine.


ENDOCRINE and ONCOLOGY

1. Which medication is not an oral hypoglycemic agent?

A. Glipizide (Glucotrol)
B. Tolbutamide (Orinase)
C. Chlorpropamide (Diabinese)
D. Diazoxide (Hyperstat)

Rationale:
D. Diazoxide (Hyperstat) is a benzothiadiazide that causes hyperglycemia by inhibiting insulin secretions; it is used to treat hypoglycemia by excessive insulin production. Chlorpropamide (Diabinase), Glipizide (Glucotrol), and Tolbutaline (Orinase) are oral hypoglycemic agents used to treat type II (non-insulin-dependent) diabetes mellitus. Chlorpropamide and tolbutamide are first-generation sulfonylureas that have been extensively used since 1965. Glipizide is a second-generation sulfonylurea approved for use in the United States in 1984; this medication is more potent than the first-generation ones and is associated with fewer complications.


2. When caring for Mrs. B., a diabetic patient starting prednisone (Deltasone) therapy for severe arthritis, the nurse should expect:

A. Worsened diabetes control
B. No effect on diabetes control
C. Improved diabetes control
D. Frequent hypoglycemic reactions

Rationale:
A. Diabetes control worsens with the use of prednisone (Deltasone), a glucocorticoids and insulin antagonist. This drug increases glucose production by the liver and inhibits glucose use by the peripheral tissues; therefore, it increases the blood glucose level in diabetic patients and impairs diabetic control. Prednisone therapy may cause frequent hyperglycemic, not hypoglycemic, reactions by increasing blood glucose levels.

3. Parenteral injections of cortisol for patients with Addison’s disease should be injected:

A. After the patient eats
B. Deep into the deltoid muscle
C. Deep into the gluteal muscle
D. Into the subcutaneous tissue

Rationale:
C. Because sufficient muscle mass is necessary for acute injection of Parenteral cortisol preparations, the nurse should inject them deep into the gluteal muscle. Cortisol should not be injected subcutaneously, because it may cause sterile abscesses, tissue atrophy, and pigmentation abnormalities. Steroid therapy causes GI disturbances with oral administration, not IM injection; therefore, the patient does not need to have food in his stomach before administration.


4 According to current American Cancer Society recommendations, women age 50 and over should have a routine mammography:

A. Every 2 years
B. Every year
C. Only if symptomatic
D. Every 5 years

Rationale:
B. Because the risk of breast cancer begins to rise at age 40 and progressively increases through age 80, all women age 50 and over should follow the American Cancer Society recommendation for yearly mammography examinations.


5 Which assessment finding to a patient with prostatic cancer indicates metastasis?

A. Pus in urine
B. Urinary frequency and decreased urinary stream
C. Decrease serum alkaline phosphatase level
D. A complaint of lumbosacral pain

Rationale:
D. A complaint of lumbosacral pain indicates metastasis; the most common form of metastasis by the hematogenous route is osseous, and the most common sites are the pelvis, lumbar spine, and ribs. Pus in the urine indicates urinary tract infection, not metastasis. Urinary frequency and decreased urinary stream are caused by urinary obstruction, not metastasis. The serum alkaline phosphatase level would be elevated, not decreased, with metastasis as a result of increased bone activity.


Mr. V., age 55, is admitted to the hospital with a diagnosis of chronic lymphocytic leukemia

6.During routine care, the patient asks the nurse,”How can I be anemic if this disease causes increased white cell production?” the nurse’s response would be that increased number of white blood cells (WBC):

A. Are not responsible for the anemia
B. Crowd out red blood cells
C. Have an abnormally short life span
D. Use nutrients from other cells

Rationale:
B. Uncontrolled proliferation of granulocytes and monocytes causes leukemia, in which WBC’s are produced at a rapid rate, crowding out RBC’s. this reduces the amount of oxygen-transporting hemoglobin, resulting in anemia. The WBC’s do not use nutrients from other cells ar have abnormal life span.

7. Diagnostic assessment of Ms. V., would probably not reveal:

A. Leukocytois with a shift from the left
B. Abnormal blast cells in the marrow
C. An elevated thrombocyte count
D. A predominance of lymphocytes

Rationale:
C. Assessment of the patient with leukemia typically reveals thrombocytopenia, rather than elevated thrombocyte count; with leukemia, an increase number in immature WBC’s are produced, crowding out platelets and RBC’s. Another common clinical manifestation of leukemia is an increased WBC count with increased release of band (immature) cells by the bone marrow-leukocytosis with a shift to the left. Blast cells, which are precursors of WBC’s, accumulate in the bone marrow with leukemia.

8. Several days after admission Mr.V., becomes disoriented and complains of frequent headaches. The nurse first action would be to:

A. Raise the rails of the bed
B. Call the physician
C. Document the patient’s status on detail in her chart
D. Prepare oxygen equipment

Rationale:
A. Leukemia causes disorientation and headaches in the patient through WBC infiltration of the central nervous system (CNS); the nurse should raise the bed’s side rails to prevent falls. The nurse should document the assessment finding after taking action to prevent injury. Administering oxygen will not remove WBC’s from the CNS. The nurse should notify the physician of the patient’s condition change after ensuring her safety.


9. Which statement about bone marrow transplantation-the treatment of choice for patients under age 40 with leukemia-is not correct?

A. The bone marrow aspirated is mixed with heparin
B. The patient is under local anesthesia
C. The recipient receives cyclophosphasmide (cytoxan) for 4 consecutive days
D. The aspiration site is the posterior or anterior iliac crest

Rationale:
B. The patient is under general or spinal anesthesia during bone marrow transplantation. The procedure involves the aspiration of approximately 600ml of bone marrow from the iliac crest; the marrow is mixed with heparin or frozen until given intravenously to the patient. Recipients are “primed” to prevent rejection by receiving cyclophosphasmide (cytoxan0 for 4 days before the transplant. The drug’s exact action is unknown; it has been found to have an immunosuppressive effect.


Mrs. R., age 53 has been experiencing bone pain, recurrent infections and abdominal pain for the past 5 years. After ordering a battery of tests, including x-ray studies, the physician diagnosed multiple myeloma.

10.The physician orders the administration of melphalan (Alkeran) for Mrs.R., because this drug causes pancytopenia, the nurse should assess the patient for:

A. Decreased WBC count
B. Alopecia
C. Skin pigmentation
D. Thrombophlebitis

Rationale:
A. Pancytopenia refers to depression in all blood’s cellular elements; the patient on melphalen (Alkeran) therapy would probably have a reduced WBC count. Skin pigmentation is governed by melanocytes, which are controlled by pituitary gland; because melphalan affects bone marrow production of blood cells, the drug would cause skin pigmentation changes. Temporary alopecia and mild thrombophlebitis at the infusion site are adverse effects of melphalen therapy, but they are not related to pancytopenia.




HEMATOLOGIC AND INFECTIOUS 5 items


Ms. X., age25, complains of chronic fatigue, particularly after menstrual periods, which she says sometimes last for 6 days; her sanitary pads often are saturated in 2 hours. After a general prescribed oral ferrous sulfate (Feosol) therapy, Ms. X., remained fatigued and pale, and tiny bruises appear on her arms. An internist refers her then to a hematologist, who diagnosed idiopathic thrombocytopenic purpura (ITP) and admitted her to the hospital.

1. Which assessment finding is not typical of ITP?

A. Prolonged activated partial thromboplastin time
B. Prolonged bleeding
C. Decreased platelet count
D. Increased capillary fragility

Rationale:
A. Prolonged partial thromboplastin time is not a typical of ITP. Thrombocytopenia refers to platelet count below 100,000/mm3, which is caused by premature platelet destruction. Normally, platelets survive 9 to 10 days; with thrombocytopenia, the survival rate is 2 to 3 days. Bone marrow aspiration reveals normal or increased megakaryocytes (precursor to platelets). Platelets form temporary clots, release incomplete thromboplastin, and maintain capillary integrity; they help close opening in the capillary