Nokea
A nurse is instructing a school-age child who has asthma about the use of a peak expiratory flow meter. Which of the following instructions should the nurse include?
- A. Place tongue on the mouthpiece of the meter.
- B. Maintain a semi-Fowler's position during testing.
- C. Record the average of the readings.
- D. Blow into the meter as hard and quickly as possible.
Correct Answer: D
Rationale: The correct answer is D: Blow into the meter as hard and quickly as possible. This instruction is correct because when using a peak expiratory flow meter, the individual needs to blow out as forcefully as possible to get an accurate reading of their peak expiratory flow rate. This helps in assessing the severity of asthma symptoms and monitoring the effectiveness of treatment.
A: Placing the tongue on the mouthpiece is incorrect as it may interfere with the airflow and affect the accuracy of the reading.
B: Maintaining a semi-Fowler's position is not necessary for using a peak flow meter.
C: Recording the average of the readings is not typically done with peak flow meters as the focus is on the individual's peak expiratory flow rate.
E, F, G: No other choices were provided.
In summary, blowing into the meter as hard and quickly as possible is the correct instruction for using a peak expiratory flow meter, as it ensures an accurate measurement of peak expir
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The nurse caring for an adolescent patient with a diagnosis of goiter knows that goiter is most often caused by?
- A. Kawasaki's disease
- B. Takayasu Disease
- C. Matsuzaki Disease
- D. Hashimoto Disease
Correct Answer: D
Rationale: The correct answer is D: Hashimoto Disease. Goiter is most commonly caused by Hashimoto Disease, which is an autoimmune condition where the body attacks the thyroid gland, leading to inflammation and enlargement of the gland. This results in the development of a goiter. Kawasaki's disease (A), Takayasu Disease (B), and Matsuzaki Disease (C) are not typically associated with the development of goiter. A summary of why the other choices are incorrect: A is a systemic vasculitis, B is a type of vasculitis involving the aorta and its main branches, and C is a fictional disease.
Solumedrol 1.5mg/kg is ordered for a child weighing 74.8 pounds. Solumedrol is available as 125mg/2ml. How many ml must the nurse administer?
- A. 0.62ml
- B. 0.062ml
- C. 0.82ml
- D. 0.082ml
Correct Answer: C
Rationale: To calculate the dose of Solumedrol, first convert the child's weight to kg: 74.8 lbs / 2.2 = 34 kg. Then, calculate the dose: 1.5 mg/kg * 34 kg = 51 mg. Next, determine how many ml is needed: 51 mg / 125 mg/ml = 0.408 ml, which is rounded up to 0.82 ml. Choice A is incorrect because it is too low. Choice B is incorrect as it is much lower than the calculated dose. Choice D is incorrect as it is also too low.
Which is descriptive of attention deficit hyperactivity disorder (ADHD)?
- A. Manifestations of ADHD are typically so bizarre that the diagnosis is easy
- B. Manifestations of ADHD affect all aspects of the child's life but are most obvious in the classroom
- C. Manifestations of ADHD such as learning disabilities eventually disappear by adulthood
- D. Manifestations of ADHD must always be present and are required to receive a positive diagnosis
Correct Answer: B
Rationale: Correct Answer: B
Rationale: Manifestations of ADHD affect all aspects of the child's life but are most obvious in the classroom. ADHD symptoms impact academic performance, social interactions, and behavior in various settings. Children with ADHD often struggle with impulse control, hyperactivity, and inattention, leading to challenges in the classroom environment. This choice acknowledges the pervasive nature of ADHD symptoms while highlighting the prominent impact on the child's educational experience.
Summary of other choices:
A: Incorrect - Manifestations of ADHD are not necessarily bizarre, and the diagnosis is often complex due to overlapping symptoms with other conditions.
C: Incorrect - Learning disabilities and ADHD are separate conditions, and ADHD symptoms may persist into adulthood without necessarily disappearing.
D: Incorrect - While consistent manifestations are a key diagnostic criterion, ADHD symptoms can fluctuate in intensity and may still be present without being constant.
A child is admitted with possible coarctation of the aorta. The admitting nurse reviews the admitting orders for the child and should question which of the following orders?
- A. Regular diet appropriate for the age
- B. Blood pressure of the upper and lower extremities every 4 hours
- C. Monitor intake and output
- D. Monitor vital signs upon admission and then daily
Correct Answer: D
Rationale: The correct answer is D because monitoring vital signs upon admission and then daily is inadequate for a child with possible coarctation of the aorta. Coarctation of the aorta can lead to significant changes in blood pressure and circulation. Close monitoring is crucial to detect any sudden changes that may indicate complications. Blood pressure should be monitored frequently, especially after any interventions or changes in condition. Regular monitoring of vital signs is essential for early detection of potential issues. Choices A, B, and C are all important aspects of care for this child and should not be questioned.
A nurse is caring for an infant who has gastroenteritis. Which of the following assessment findings should the nurse report to the provider?
- A. Pale and a 24-hr fluid deficit of 30 mL
- B. Sunken fontanels and dry mucous membranes
- C. Decreased appetite and irritability
- D. Temperature 38° C (100.4° F) and pulse rate 124/min
Correct Answer: B
Rationale: The correct answer is B: Sunken fontanels and dry mucous membranes. These findings indicate severe dehydration in the infant with gastroenteritis. Sunken fontanels suggest significant fluid loss, while dry mucous membranes also indicate dehydration. Dehydration in infants can lead to serious complications, so it is crucial for the nurse to report these findings to the provider promptly.
The other choices are not as concerning as choice B. Choice A indicates a fluid deficit but does not suggest severe dehydration. Choice C could be expected in a sick infant and does not require immediate provider notification. Choice D shows signs of fever and tachycardia, which are common in gastroenteritis and may not be as urgent as severe dehydration.