Nokea
A father of a child with a urinary tract infection calls the clinic and explains, "My wife and I are concerned because our child refuses to obey us concerning the preventions you told us about. Our child refuses to take the medication unless we buy a present. We don't want to use discipline because of the illness, but we're worried about the behavior." Which response by the nurse is best?
- A. I sympathize with your difficulties
- B. but just ignore the behavior for now.
- C. I understand it's hard to discipline a child who is ill
- D. but things need to be kept as normal as possible.
- E. I understand that things are difficult for you right now
- F. but your child is ill and deserves special treatment.
- G. I understand your concern
Correct Answer: B
Rationale: Maintaining routines is essential.
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A child is admitted with a fracture of the femur and placed in skeletal traction. What should the nurse assess first?
- A. The pull of traction on the pin.
- B. The Ace bandage.
- C. The pin sites for signs of infection.
- D. The dressings for tightness.
Correct Answer: C
Rationale: Assessing pin sites for infection is the priority, as infection can lead to serious complications in skeletal traction.
When caring for an infant post-repair of an anorectal malformation, which of the following should the nurse monitor to prevent complications?
- A. Skin integrity around the surgical site.
- B. Frequency of oral feedings.
- C. Daily weight gain.
- D. Parental bonding behaviors.
Correct Answer: A
Rationale: Monitoring skin integrity prevents infection and breakdown at the surgical site.
When obtaining the initial health history from a 10-year-old child with abdominal pain and suspected appendicitis, which of the following questions would be most helpful in eliciting data to help support the diagnosis?
- A. Where did the pain start?
- B. What did you do for the pain?
- C. How often do you have a bowel movement?
- D. Is the pain continuous, or does it let up?
Correct Answer: A
Rationale: Pain starting near the umbilicus and migrating to the right lower quadrant is characteristic of appendicitis.
An adolescent complains of chest pain and goes to the school nurse. The nurse determines that the teenager has a history of asthma but has had no problems for years. Which of the following should the nurse do next?
- A. Call the adolescent's parent.
- B. Have the adolescent lie down for 30 minutes.
- C. Obtain a peak flow reading.
- D. Give two puffs of a short-acting bronchodilator.
Correct Answer: C
Rationale: Obtaining a peak flow reading is the next step to objectively assess the adolescent's respiratory status, given the history of asthma and new chest pain, which could indicate an asthma exacerbation.
The nurse judges that the mother understands the term cerebral palsy when she describes it as a term applied to impaired movement resulting from which of the following?
- A. Injury to the cerebrum caused by viral infection.
- B. Malformed blood vessels in the ventricles caused by inheritance.
- C. Nonprogressive brain damage caused by injury.
- D. Inflammatory brain disease caused by metabolic imbalances.
Correct Answer: C
Rationale: Cerebral palsy is characterized by nonprogressive brain damage from injury, often occurring before, during, or shortly after birth, leading to impaired movement.