Nokea
A 12-year-old is having surgery to repair a fractured left femur. As a part of the preoperative safety procedures, the nurse should ask the client to:
- A. Point to the area of the fracture.
- B. Mark the location of the fracture with an 'x' and sign his name.
- C. Confirm with his parents that they have signed the operative permit.
- D. State the surgery risks as understood from the surgeon.
Correct Answer: B
Rationale: Marking the surgical site with an 'x' and signing is a standard safety procedure to confirm the correct site for surgery.
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A 10-year-old child who is 5'4' (138 cm) tall with a history of asthma uses an inhaled bronchodilator only when needed. He takes no other medications routinely. His best peak expiratory flow rate is 270 L/minute. The child's current peak flow reading is 180 L/minute. The nurse interprets this reading as indicating which of the following?
- A. The child's asthma is under good control, so the routine treatment plan should continue.
- B. The child needs to start a short-acting inhaled beta-agonist medication.
- C. This is a medical emergency requiring a trip to the emergency department for treatment.
- D. The child needs to begin treatment with inhaled cromolyn sodium (Intal) for asthma control.
Correct Answer: B
Rationale: A peak flow reading of 180 L/minute is 66.7% of the child's best (270 L/minute), placing it in the yellow zone (50-80% of personal best), indicating an asthma exacerbation. A short-acting inhaled beta-agonist is needed to relieve symptoms.
While assessing a 3-year-old child who has had an injury to the leg, has pain, and refuses to walk, the nurse notes that the child's left thigh is swollen. What should the nurse do next?
- A. Assess the neurologic status of the toes.
- B. Determine the circulatory status of the upper thigh.
- C. Obtain the child's vital signs.
- D. Notify the physician immediately.
Correct Answer: D
Rationale: Swelling, pain, and refusal to walk suggest a serious injury, possibly a fracture, requiring immediate physician notification.
An adolescent with chronic renal failure is scheduled to go home with a peritoneal dialysis catheter in place. When developing the discharge teaching plan for the client and family focusing on psychosocial needs, which of the following areas should be a top priority to include?
- A. Advantages of limiting social activities and contacts for the first few months.
- B. Not disclosing information about the peritoneal dialysis to people outside the family.
- C. Possible effect on body image of the presence of an abdominal catheter.
- D. Importance of relying on parents to do the dialysis and dressing changes.
Correct Answer: C
Rationale: Body image concerns are significant.
The mother asks the nurse for advice about discipline for her 18-month-old. Which of the following should the nurse suggest that the mother use?
- A. Structured interactions.
- B. Spanking.
- C. Reasoning.
- D. Time out.
Correct Answer: D
Rationale: Time out is an effective, age-appropriate discipline method for an 18-month-old.
Which of the following, if described by the parents of a child with cystic fibrosis (CF), indicates that the parents understand the underlying problem of the disease?
- A. An abnormality in the body's mucus-secreting glands.
- B. Formation of fibrous cysts in various body organs.
- C. Failure of the pancreatic ducts to develop properly.
- D. Addition to the formation of antibodies against streptococcus.
Correct Answer: A
Rationale: Cystic fibrosis is caused by an abnormality in mucus-secreting glands, leading to thick mucus that affects multiple organs, particularly the lungs and pancreas.