Nokea
The nurse is caring for a school-age boy with Kawasaki's Disease. She knows the medication the child will receive includes:
- A. Immunoglobulin G and aspirin
- B. Immunoglobulin G and ACE inhibitors
- C. Immunoglobulin E and heparin
- D. Immunoglobulin E and ibuprofen
Correct Answer: A
Rationale: Rationale: Kawasaki's Disease is treated with Immunoglobulin G to reduce inflammation and aspirin to prevent blood clots and coronary artery abnormalities. Immunoglobulin E is not used in this condition, and heparin and ibuprofen are not part of the standard treatment. ACE inhibitors are not indicated in Kawasaki's Disease. So, choice A is correct due to its adherence to the standard treatment guidelines.
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A nurse is caring for an infant who has gastroenteritis. Which of the following assessment findings should the nurse report to the provider?
- A. Pale and a 24-hr fluid deficit of 30 mL
- B. Sunken fontanels and dry mucous membranes
- C. Decreased appetite and irritability
- D. Temperature 38° C (100.4° F) and pulse rate 124/min
Correct Answer: B
Rationale: The correct answer is B: Sunken fontanels and dry mucous membranes. These findings indicate severe dehydration in the infant with gastroenteritis. Sunken fontanels suggest significant fluid loss, while dry mucous membranes also indicate dehydration. Dehydration in infants can lead to serious complications, so it is crucial for the nurse to report these findings to the provider promptly.
The other choices are not as concerning as choice B. Choice A indicates a fluid deficit but does not suggest severe dehydration. Choice C could be expected in a sick infant and does not require immediate provider notification. Choice D shows signs of fever and tachycardia, which are common in gastroenteritis and may not be as urgent as severe dehydration.
The nurse is caring for a child with frostbite would expect the patient to display:
- A. Redness and swelling of the hands
- B. Blisters that appear 24 to 48 hours after rewarming
- C. Itching and burning that persists after rewarming
- D. Fever
Correct Answer: B
Rationale: The correct answer is B because blisters appearing 24 to 48 hours after rewarming is a common symptom of frostbite. This occurs due to damage to the blood vessels and tissues. A: Redness and swelling are more indicative of mild frostbite. C: Itching and burning are not typical symptoms of frostbite. D: Fever is not a common symptom of frostbite.
The doctor has ordered Synthroid 75 mcg oral daily. The available Synthroid is 0.15 mg tablets. How many tablets will the nurse administer?
- A. 1 tablet
- B. 0.5 tablet
- C. 2 tablets
- D. 1.5 tablets
Correct Answer: B
Rationale: The correct answer is B: 0.5 tablet. To determine the number of tablets needed, convert 75 mcg to mg by dividing by 1000 (75 mcg = 0.075 mg). Then, divide the prescribed dose (0.075 mg) by the tablet strength (0.15 mg) to find the number of tablets needed (0.075 mg / 0.15 mg = 0.5 tablet). This calculation ensures the patient receives the correct dosage. Choice A is incorrect as it does not account for the tablet strength. Choices C and D are incorrect as they result in a higher dose than prescribed.
Which is the most accurate genetic explanation for a family with hemophilia?
- A. It is an X-linked recessive disorder
- B. It is an autosomal recessive disorder
- C. It is equally distributed among males and females
- D. It is a Y-linked dominant disorder
Correct Answer: A
Rationale: The correct answer is A: It is an X-linked recessive disorder. Hemophilia is caused by a mutation in genes located on the X chromosome. Males inherit the disorder from their mothers, as they only inherit one X chromosome. Females can be carriers if they inherit one mutated X chromosome. Autosomal recessive disorders (choice B) require both parents to pass on the mutated gene. Hemophilia is not equally distributed among males and females (choice C) because males are more likely to exhibit symptoms. Y-linked disorders (choice D) are inherited only by males and are passed from father to son.
When preparing your pediatric patient for his cardiac assessment, which element would you start with for the assessment?
- A. Assess peripheral pulses
- B. Auscultate heart rate and rhythm
- C. Evaluate chest rise
- D. Palpate liver margins
Correct Answer: B
Rationale: The correct answer is B: Auscultate heart rate and rhythm. This is the first step in a pediatric cardiac assessment because it provides crucial information about the heart's function. Listening to the heart helps identify any abnormalities in heart sounds, such as murmurs or irregular rhythms, which can indicate underlying cardiac issues. Assessing peripheral pulses (choice A) may be important but comes after evaluating the heart. Evaluating chest rise (choice C) is important for respiratory assessment, not specifically for cardiac assessment. Palpating liver margins (choice D) is more relevant for assessing hepatomegaly, not typically the initial step in a cardiac assessment.