Nokea
A child is upset because, when the cast is removed from her leg, the skin surface is caked with desquamated skin and sebaceous secretions. What technique should the nurse suggest to remove this material?
- A. Soak in a bathtub.
- B. Vigorously scrub the leg.
- C. Carefully pick material off the leg.
- D. Apply powder to absorb the material.
Correct Answer: A
Rationale: Soaking in a bathtub gently removes desquamated skin and secretions over days, avoiding skin damage. Scrubbing or picking risks excoriation, and powder is ineffective; oil or lotion may help comfort, not removal.
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What is the recommended drink for athletes during practice and competition?
- A. Sports drinks to replace carbohydrates
- B. Cold water for gastrointestinal tract rapid absorption
- C. Carbonated beverages to help with acid-base balance
- D. Enhanced performance carbohydrate-electrolyte drinks
Correct Answer: B
Rationale: Cold water, consumed 4-8 oz every 15-20 minutes, promotes rapid gastric and intestinal absorption for hydration. Sports drinks may cause gastrointestinal upset, carbonated beverages are discouraged, and enhanced drinks lack evidence of performance benefits.
Parents bring a 7-year-old child to the clinic for evaluation of an injured wrist after a bicycle accident. The parents and child are upset, and the child will not allow an examination of the injured arm. What priority nursing intervention should occur at this time?
- A. Send the child to radiology so radiography can be performed.
- B. Initiate an intravenous line and administer morphine for the pain.
- C. Calmly ask the child to point to where the pain is worst and to wiggle fingers.
- D. Have the parents hold the child so that the nurse can examine the arm thoroughly.
Correct Answer: C
Rationale: Gaining the child?s trust by calmly assessing pain location and finger movement is the priority to evaluate neurovascular status without increasing distress. Radiography requires initial assessment, morphine is premature, and restraining the child escalates anxiety.
Immobilization causes what effect on metabolism?
- A. Hypocalcemia
- B. Decreased metabolic rate
- C. Positive nitrogen balance
- D. Increased levels of stress hormones
Correct Answer: B
Rationale: Immobilization reduces metabolic rate, slowing systems and food intake. It causes hypercalcemia, negative nitrogen balance from muscle atrophy, and decreased stress hormone production due to reduced coping capacity.
The nurse is teaching the girls varsity sports teams about the female athlete triad. What is essential information to include?
- A. They should take low to moderate calcium to avoid hypercalcemia.
- B. They have strong bones because of the athletic training.
- C. Pregnancy can occur in the absence of menstruation.
- D. A diet high in carbohydrates accommodates increased training.
Correct Answer: C
Rationale: Pregnancy is possible despite amenorrhea in the female athlete triad, necessitating contraceptive education. High calcium (1500 mg) prevents osteoporosis, low estrogen weakens bones, and high-protein, high-calorie diets, not just carbohydrates, support intense training.
The nurse at a summer camp recognizes the signs of heatstroke in an adolescent girl. Her temperature is 40 C (104 F). She is slightly confused but able to drink water. Nursing care while waiting for transport to the hospital should include what intervention?
- A. Administer antipyretics.
- B. Administer salt tablets.
- C. Apply towels wet with cool water.
- D. Sponge with solution of rubbing alcohol and water.
Correct Answer: C
Rationale: Applying cool, wet towels and removing clothing cools the body in heatstroke, addressing thermoregulatory failure. Antipyretics are ineffective, salt tablets worsen dehydration, and rubbing alcohol is harmful and not used.