Nokea
A 10-year-old is admitted to the orthopedic unit with a diagnosis of slipped femoral capital epiphysis (SFCE). What focus should the nurse include in this child's plan of care?
- A. Ambulation with a walking cast.
- B. Pin and incision care after surgery.
- C. Use of injections for pain control.
- D. Administration of growth hormone.
Correct Answer: B
Rationale: In the case of slipped femoral capital epiphysis, surgical intervention is often required. Post-surgery care is crucial to prevent complications such as infection and ensure proper healing. This care includes monitoring and managing pin and incision sites for signs of infection, promoting wound healing, and preventing postoperative complications. The focus on pin and incision care is essential for the child's recovery and overall well-being.
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Albumin 25% IV is prescribed for a child with nephrotic syndrome. Which assessment finding indicates to the nurse that the medication is having the desired effect?
- A. Weight gain.
- B. Reduction of fever.
- C. Improved caloric intake.
- D. Reduction of edema.
Correct Answer: D
Rationale: The correct answer is D: Reduction of edema. Albumin helps reduce edema by increasing oncotic pressure, drawing fluid back into the blood vessels. In nephrotic syndrome, there is an abnormal loss of protein in the urine, leading to decreased oncotic pressure and fluid shifting into the interstitial spaces, causing edema. Administering albumin helps restore the oncotic pressure, reducing edema, which is a desirable effect of the medication.
The LPN/LVN is preparing a client with a term pregnancy who is in active labor for an amniotomy. What equipment should the nurse have available at the client's bedside?
- A. Litmus paper.
- B. Fetal scalp electrode.
- C. A sterile glove.
- D. Needle and Thread
Correct Answer: C
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
Upon admission to the prenatal clinic, a 23-year-old woman informs the nurse that her last menstrual period began on February 15, and that previously her periods were regular. Her pregnancy test is positive. What is this client's expected date of delivery (EDD)?
- A. November 22.
- B. November 8.
- C. December 22.
- D. October 22.
Correct Answer: A
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
Just after delivery, a new mother tells the nurse, 'I was unsuccessful breastfeeding my first child, but I would like to try with this baby.' Which intervention is best for the LPN/LVN to implement first?
- A. Assess the husband's feelings about his wife's decision to breastfeed their baby.
- B. Ask the client to describe why she was unsuccessful with breastfeeding her last child.
- C. Encourage the client to develop a positive attitude about breastfeeding to help ensure success.
- D. Provide assistance to the mother to begin breastfeeding as soon as possible after delivery.
Correct Answer: D
Rationale: The correct intervention is to provide immediate assistance to the mother to begin breastfeeding as soon as possible after delivery. This approach helps initiate bonding and successful breastfeeding. Taking action promptly can address the mother's desire to breastfeed and promote positive outcomes for both the mother and the newborn.
The healthcare provider notes on the fetal monitor that a laboring client has a variable deceleration. Which action should the healthcare provider implement first?
- A. Assess cervical dilation.
- B. Change the client's position.
- C. Administer oxygen via facemask.
- D. Turn off the oxytocin infusion.
Correct Answer: B
Rationale: Changing the client's position is the priority intervention for variable decelerations as it can relieve pressure on the umbilical cord, potentially resolving the deceleration and improving fetal oxygenation. Assessing cervical dilation, administering oxygen via facemask, and turning off the oxytocin infusion are important interventions but addressing the fetal distress caused by variable decelerations takes precedence.