The nurse notices that a child is increasingly apprehensive and has tachycardia after heart surgery. The chest tube drainage is now $8 \mathrm{ml} / \mathrm{kg} / \mathrm{hr}$. Which of the following should be the nurse’s initial intervention?

Correct Answer: B

Rationale: The correct initial intervention is to notify the practitioner of the child's increased apprehension, tachycardia, and increased chest tube drainage. This is important because these signs could indicate a potential complication post-heart surgery that requires immediate medical attention. Applying warming blankets (choice A) may not address the underlying issue, giving additional pain medication (choice C) without practitioner approval could mask symptoms, and encouraging coughing and deep breathing (choice D) may not be appropriate in this situation. It is crucial to involve the practitioner promptly for further evaluation and management.

Correct Answer: B

Rationale: Correct Answer: B (erythroid progenitor: megakaryocyte) Rationale: Erythroid progenitors differentiate into red blood cells, not megakaryocytes. Megakaryocytes arise from megakaryocyte-erythroid progenitors. The mismatch lies in the differentiation pathway. Summary: A: Monocyte progenitor differentiates into macrophages. C: Myeloid progenitor gives rise to neutrophils. D: Lymphoid progenitor differentiates into natural killer cells.

Correct Answer: A

Rationale: The correct answer is A: Gloves only. Monitoring gloves is not relevant when a patient is taking NSAIDs. - B: CNS adverse effects should be monitored due to potential risks such as headaches or dizziness. - C: Cardiac adverse effects should be monitored as NSAIDs can increase the risk of heart attacks or stroke. - D: Renal adverse effects should be monitored because NSAIDs can lead to kidney damage. In summary, monitoring gloves is not necessary when a patient is taking NSAIDs, whereas monitoring CNS, cardiac, and renal adverse effects is essential for patient safety.

Correct Answer: A

Rationale: The correct answer is A because pernicious anemia is caused by a deficiency in vitamin B12, which can occur after gastric bypass surgery due to malabsorption. Excessive fatigue is a common symptom of pernicious anemia. B: Hematuria is associated with kidney or bladder issues, not pernicious anemia. C: Pancytopenia is a decrease in all three blood cell types, not specific to pernicious anemia. D: Epistaxis is nosebleeds, which are not typically associated with pernicious anemia.

Correct Answer: A

Rationale: The correct answer is A because liver enlargement is typically assessed by measuring the number of centimeters it can be palpated below the ribcage. This method helps determine if the liver is enlarged without the need for imaging. The other choices are incorrect because lymph node assessment usually starts in the neck, the spleen size is assessed by palpating the left upper quadrant of the abdomen, and petechiae are tiny red or purple spots that appear on the skin, not the sclera.