Nokea
A child is admitted with suspected pyloric stenosis. Which of the following should be included in the plan of care?
- A. Monitor for signs of metabolic acidosis
- B. Observe for projectile vomiting
- C. Provide large, infrequent feedings to allow for rest
- D. Place the infant in a supine position after feeding
Correct Answer: B
Rationale: The correct answer is B: 'Observe for projectile vomiting.' Projectile vomiting is a classic sign of pyloric stenosis, caused by obstruction at the pylorus. Choice A is incorrect as metabolic alkalosis, not acidosis, often occurs due to the loss of hydrochloric acid from persistent vomiting. Choice C is incorrect as frequent, small feedings are preferred to prevent overloading the stomach. Choice D is incorrect as placing the infant in an upright position after feeding can help reduce reflux.
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The nurse is teaching the mother of a 9-month-old infant about administering liquid iron preparation. Which information should be included in the teaching?
- A. Adequate dosage will turn the stools a tarry, black color.
- B. Give Vitamin D to enhance absorption.
- C. Allow the liquid iron to mix with saliva before swallowing.
- D. Give the liquid iron with meals.
Correct Answer: A
Rationale: The correct answer is A. Iron supplements can cause stools to turn black, which is a normal and harmless side effect. Iron is best absorbed on an empty stomach, although it can be given with food if gastrointestinal upset occurs. Vitamin C, not D, enhances iron absorption. Choice B is incorrect because Vitamin C enhances iron absorption, not Vitamin D. Choice C is incorrect as there is no need to mix liquid iron with saliva before swallowing. Choice D is incorrect because iron is best absorbed on an empty stomach.
The nurse is taking a sexual history on an adolescent girl. Which is the best way to determine whether she is sexually active?
- A. Ask her, "Are you sexually active?"
- B. Ask her, "Are you having sex with anyone?"
- C. Ask her, "Are you having sex with a boyfriend?"
- D. Ask both the girl and her parent if she is sexually active
Correct Answer: A
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
The nurse is discussing parenting in reconstituted families with a new stepparent. The nurse is aware that the new stepparent understands the teaching when which statement is made?
- A. "I am glad there will be no disruption in my lifestyle."
- B. "I don't think children really want to live in a two-parent home."
- C. "I realize there may be power conflicts bringing two households together."
- D. "I understand contact between grandparents should be kept to a minimum."
Correct Answer: C
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
Which drug is usually the best choice for patient-controlled analgesia (PCA) for a child in the immediate postoperative period?
- A. Codeine sulfate (Codeine)
- B. Morphine (Roxanol)
- C. Methadone (Dolophine)
- D. Meperidine (Demerol)
Correct Answer: B
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
According to Piaget, which principle supports a nine-year-old child's understanding that an arm will look the same when the IV is removed?
- A. The principle of conservation
- B. The principle of transductive reasoning
- C. The principle of identity
- D. The principle of reflex abilities
Correct Answer: A
Rationale: The correct answer is A, the principle of conservation. Piaget's principle of conservation relates to a child's ability to understand that certain properties of objects remain unchanged despite modifications in their appearance. In this case, the child's understanding that an arm will look the same after the IV is removed demonstrates conservation of appearance. Choice B, transductive reasoning, involves making faulty generalizations based on specific instances and does not apply in this context. Choice C, the principle of identity, pertains to recognizing objects as the same even if they undergo transformations, which is not directly relevant to the scenario. Choice D, reflex abilities, refers to automatic responses to stimuli and is unrelated to the child's understanding of the arm's appearance post-IV removal.