When assessing a client with autoimmune disorder, what signs should the nurse look for in the client?

Correct Answer: B

Rationale: When assessing a client with an autoimmune disorder, the nurse should look for signs such as hives or rashes. Autoimmune disorders can manifest with various skin manifestations, including hives or rashes, which may be indicative of an autoimmune response. These skin manifestations may occur due to the immune system mistakenly attacking the body's own tissues. Observing and monitoring these skin changes can help in assessing and managing the autoimmune disorder in the client. Additionally, localized inflammation may also be present in autoimmune disorders, but hives or rashes are more commonly associated with these conditions.

Correct Answer: B

Rationale: Type 2 diabetes mellitus (DM) most likely results from heterogeneous risk factors, such as obesity, unhealthy diet, sedentary lifestyle, genetic predisposition, and other lifestyle factors. By addressing these risk factors through lifestyle modifications, such as maintaining a healthy diet and regular exercise, the development of Type 2 DM can often be prevented or delayed. On the other hand, Type 1 diabetes is primarily an autoimmune condition where the body mistakenly attacks insulin-producing cells in the pancreas, and it is not preventable. Gestational diabetes occurs during pregnancy and is influenced by hormonal changes during pregnancy and other factors, making it less preventable through lifestyle changes alone. Thus, Type 2 diabetes is the type that is most preventable through lifestyle modifications.

Correct Answer: B

Rationale: Hyperdiploidy is associated with a better prognosis in neuroblastoma.

Correct Answer: C

Rationale: When suctioning a patient, it is important to limit the suctioning time to avoid hypoxia and tissue trauma. The maximum recommended time for suctioning an adult patient is usually around 10-15 seconds. However, in some cases, such as when dealing with thick or excessive secretions, the maximum time can be extended up to 30 seconds. In this particular case, where James is likely experiencing respiratory distress due to his symptoms, it would be appropriate for Wilma to suction him for a maximum of 30 seconds to effectively clear his airways while minimizing the risk of complications.

Correct Answer: C

Rationale: Developmental dysplasia of the hip (DDH) is a condition where the hip joint does not develop normally. In infants, one of the signs of DDH is the presence of asymmetry of gluteal (buttock) and thigh folds. This is due to the dislocated or subluxed hip being positioned differently than the healthy hip. The nurse should look for this sign during the assessment of a 2-week-old infant to help identify potential hip joint problems early on. Excessive hip abduction, femoral lengthening of an affected leg, and pain when lying prone are not typical signs of DDH in a 2-week-old infant.