Clinical manifestations of sodium excess (hypernatremia) include which signs or symptoms?
- A. Hyperreflexia
- B. Abdominal cramps
- C. Cardiac dysrhythmias
- D. Dry, sticky mucous membranes
Correct Answer: D
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
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What is an approximate method of estimating output for a child who is not toilet trained?
- A. Have parents estimate output.
- B. Weigh diapers after each void.
- C. Place a urine collection device on the child.
- D. Have the child sit on a potty chair 30 minutes after eating.
Correct Answer: B
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
The nurse is teaching the family of a child with a long-term central venous access device about signs and symptoms of bacteremia. What finding indicates the presence of bacteremia?
- A. Hypertension
- B. Pain at the entry site
- C. Fever and general malaise
- D. Redness and swelling at the entry site
Correct Answer: C
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
Picking up a pencil demonstrates the ability to use which of the following?
- A. Pincer grasp
- B. Prehension
- C. Parachute reflex
- D. Grasp reflex
Correct Answer: A
Rationale: Picking up a pencil requires the use of the pincer grasp, which involves the coordination of the thumb and forefinger to hold small objects. The pincer grasp is a fine motor skill essential for tasks that necessitate precision and dexterity. Choices B, C, and D are incorrect. Prehension refers to the act of grasping or holding an object, parachute reflex is a protective response to sudden movement or loss of support, and grasp reflex is an automatic closing of the hand when an object is placed in the palm, none of which specifically relate to the action of picking up a pencil.
The nurse has completed an education program on normal communication abilities in the preschool-age child. Which statement by a participant indicates a need for further education?
- A. When my child counts numbers, it is only to 10 and we are slowly working on counting higher.
- B. I am glad to know that my 4-year-old child asking so many questions is normal.
- C. Stating his name and address is too hard for my 5-year-old child; it will be another year before he can do that.
- D. My child is finally talking in a way that most of my friends can understand her speech.
Correct Answer: C
Rationale: The correct answer is C. By age 5, children should be able to state their name and address. If a child cannot do this, it may indicate a developmental delay that requires further assessment. Choices A, B, and D do not indicate a need for further education as they reflect typical developmental milestones for preschool-age children, such as gradually improving counting skills, asking many questions, and improving speech clarity over time.
The nurse is admitting a child with severe isotonic dehydration. Which intravenous fluid should the nurse anticipate the doctor to order initially to replace fluids?
- A. 0.9% normal saline
- B. D5 0.2% (1/4) normal saline
- C. D5W
- D. Albumin
Correct Answer: A
Rationale: In the case of severe isotonic dehydration, the initial fluid of choice is 0.9% normal saline. This solution is preferred because it helps to restore both fluids and electrolytes effectively. Options B, C, and D are not suitable for the initial management of severe isotonic dehydration. D5 0.2% (1/4) normal saline (Choice B) is a hypotonic solution and might worsen the imbalance. D5W (Choice C) is a hypotonic solution that does not contain electrolytes essential for rehydration. Albumin (Choice D) is a colloid solution used for specific indications like hypoproteinemia or hypoalbuminemia, not for initial rehydration in severe dehydration.