Nokea
A school-age child has peripheral edema. Which of the following assessments should the nurse perform to confirm peripheral edema?
- A. Palpate the dorsum of the child's feet
- B. Weigh the child daily using the same scale
- C. Assess the child's skin turgor
- D. Observe the child for periorbital swelling
Correct Answer: A
Rationale: To confirm peripheral edema in a child, the nurse should palpate the dorsum of the child's feet by pressing a fingertip against a bony prominence for 5 seconds. This assessment helps detect the presence of pitting edema, which is characterized by an indentation that remains after the pressure is released.
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Which factor will not promote play and playfulness in children?
- A. Novel toys
- B. Familiar peers
- C. Comfortable atmosphere
- D. Directive adults
Correct Answer: D
Rationale: Directive adults can inhibit spontaneous play and creativity, which are essential for fostering playfulness in children. When adults are too directive, children may feel constrained and less likely to engage in imaginative and free play. Encouraging independence and allowing children to explore and create their play scenarios can enhance playfulness and creativity.
Stimulant drugs are useful for hyperactivity and inattention associated with autism spectrum disorders (ASDs). Of the following, the BEST response of these drugs is seen with
- A. autism
- B. Asperger syndrome
- C. childhood disintegrative disorder
- D. Rett syndrome
Correct Answer: B
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
A female client age 66 is admitted ff a nephrolithomy. One of her laboratory tests reveals a urinary tract infection. Which would be the best nursing action in her case?
- A. Administer IV fluids and blood transfusions
- B. Administer narcotic analgesics as prescribed
- C. Encourage fluid intake of 3000ml/day
- D. Suggest taking herbs or spices to increase food palatability
Correct Answer: C
Rationale: In the case of a female client age 66 admitted for a nephrolithotomy with a urinary tract infection, the best nursing action is to encourage fluid intake of 3000ml/day. Adequate hydration helps in flushing out the bacteria causing the urinary tract infection and can prevent further complications. Increasing fluid intake also helps in preventing the formation of new kidney stones. Administering IV fluids and blood transfusions may be necessary based on the patient's overall condition, but the priority action in this case is to promote increased oral fluid intake. Administering narcotic analgesics as prescribed can help manage pain related to the nephrolithotomy procedure, but it does not directly address the urinary tract infection. Suggesting taking herbs or spices to increase food palatability is not the priority in this situation and may not contribute significantly to the management of the urinary tract infection.
Stage 1 hypertension in children is defined as:
- A. Average SBP or DBP levels <90th percentile
- B. Average SBP or DBP levels > 99th percentile
- C. BP > 120/80
- D. Average SBP or DBP levels 95-99th percentile
Correct Answer: D
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
Osteopenia begins immediately after a spinal cord injury (SCI) occurs and plateaus 6-12 mo later. Pathologic fractures occur as a consequence of loss of bone mineral density. Of the following, the MOST common site of fracture is
- A. distal tibia
- B. supracondylar region of the femur
- C. lumbosacral spine
- D. proximal humerus
Correct Answer: B
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.