A 5-year-old is hospitalized with a fractured femur. Which pain assessment tool is appropriate for this child?
- A. CRIES Scale
- B. Faces Pain Rating Scale
- C. SUN Scale
- D. NIPS Scale
Correct Answer: B
Rationale: The Faces Pain Rating Scale is appropriate for assessing pain in children who can express their feelings visually. For a 5-year-old child who can communicate effectively, using a tool like the Faces Pain Rating Scale, which uses facial expressions to indicate pain levels, is more suitable than the CRIES Scale (used for neonates), the SUN Scale (used for infants), or the NIPS Scale (used for preterm and term newborns).
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Why is it difficult to assess a child's dietary intake?
- A. No systematic assessment tool has been developed
- B. Biochemical analysis for assessing nutrition is expensive
- C. Families usually do not understand much about nutrition
- D. Recall of food consumption is frequently unreliable
Correct Answer: D
Rationale: The correct answer is D. Recall of food intake, especially amounts eaten, is often unreliable. While systematic tools like the 24-hour recall and dietary history questionnaires exist, recall can still be challenging in accurately assessing a child's dietary intake. Choices A, B, and C are incorrect because systematic assessment tools do exist, biochemical analysis is not the primary method for dietary assessment, and families' understanding of nutrition may vary but is not the main reason for the difficulty in assessing a child's dietary intake.
What tool would be most useful to assess maternal and newborn attachment behaviors?
- A. Apgar
- B. Ballard scale
- C. NCAST (Nursing Child Assessment Satellite Training) Feeding Scale
- D. Brazelton Neonatal Behavioral Assessment Scale
Correct Answer: C
Rationale: The NCAST Feeding Scale is the most suitable tool to evaluate maternal and newborn attachment behaviors during feedings. It focuses on observing the interaction between the parent and infant, providing insights into their bonding. The Apgar score is used to assess a neonate's immediate transition to life outside the womb, not specifically maternal and newborn attachment behaviors. The Ballard scale is used to estimate gestational age, not to assess attachment behaviors. The Brazelton Neonatal Behavioral Assessment Scale is designed to evaluate a newborn's responses to various stimuli, not specifically maternal and newborn attachment behaviors.
The nurse is explaining different parenting styles to a group of parents. The nurse explains that an authoritative parenting style can lead to which child behavior?
- A. Shyness
- B. Self-reliance
- C. Submissiveness
- D. Self-consciousness
Correct Answer: B
Rationale: An authoritative parenting style, which balances warmth with firmness, is associated with fostering self-reliance and independence in children.
A child is admitted with renal failure. Which of these findings should the nurse expect?
- A. Decreased BUN
- B. Azotemia and oliguria
- C. Increased glomerular filtration rate (GFR)
- D. Polyuria and elevated creatinine clearance
Correct Answer: B
Rationale: Azotemia (elevated BUN and creatinine) and oliguria (reduced urine output) are classic signs of renal failure, indicating impaired kidney function. In renal failure, the kidneys are unable to effectively filter waste products, leading to an increase in BUN and creatinine levels in the blood. Additionally, oliguria occurs due to decreased kidney function. Increased GFR (Choice C) is not expected in renal failure as it signifies improved kidney function, which is not the case in renal failure. Polyuria and elevated creatinine clearance (Choice D) are not typical findings in renal failure. Polyuria is more commonly associated with conditions like diabetes insipidus, while elevated creatinine clearance would indicate increased kidney function, which is contrary to the impaired function seen in renal failure.
The nurse is describing clinical reasoning to a group of nursing students. Which is most descriptive of clinical reasoning?
- A. Purposeful and goal-directed
- B. A simple developmental process
- C. Based on deliberate and irrational thought
- D. Assists individuals in guessing what is most appropriate
Correct Answer: A
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.