Nokea
A four-week-old infant with symptoms of pyloric stenosis is brought to the outpatient clinic by his mother. Which of the following statements would the nurse expect the mother to make about her son's symptoms?
- A. My son's bowel movements have turned black and sticky.
- B. I really have to encourage my son to suck the bottle.
- C. My son is fussy and seems hungry all the time.
- D. My son spits up green liquid after feeding.
Correct Answer: C
Rationale: becomes lethargic, dehydrated, and malnourished
You may also like to solve these questions
An elderly man is admitted to a medical unit with shortness of breath and is diagnosed with an upper respiratory infection (URI). He is placed on droplet precautions. The nurse has just finished giving him his PO medications. As the nurse leaves his room, the nurse should
- A. wash hands, remove the gown and mask, and throw the trash in a container outside of the room.
- B. remove the mask, wash hands, and throw the trash in a container inside the room.
- C. wash hands, remove the mask, and throw the trash in a container inside the room.
- D. remove the gown and gloves, wash hands, remove the mask, and throw the trash in a container inside the room.
Correct Answer: C
Rationale: hands should be washed before removing mask to prevent transfer of microbes to face
The nurse is caring for an 11-year-old girl being treated for a fractured right femur with balanced suspension traction with a Thomas ring and Pearson attachment. The physician orders 2 liters to be instilled with a dwell time of 40 minutes. The nurse measures the outflow and finds it to be 1,800 cc. During the nurse's shift, the client drinks 700 cc of fluids and voids 400 cc. The nurse should record which of the following on the client's intake and output sheet?
- A. Intake: 2,700 cc; output: 400 cc.
- B. Intake: 2,700 cc; output: 2,200 cc.
- C. Intake: 700 cc; output: 400 cc.
- D. Intake: 2,700 cc; output: 1,800 cc.
Correct Answer: B
Rationale: intake and output
The nurse is preparing to administer insulin to a client with type I diabetes.
- A. Which action should the nurse take first before administering insulin to a client with type I diabetes?
- B. Verify the insulin dose with another nurse.
- C. Check the client’s blood glucose level.
- D. Cleanse the injection site with alcohol.
- E. Rotate the injection site from the previous dose.
Correct Answer: B
Rationale: Checking the client’s blood glucose level is the first step to ensure the insulin dose is appropriate, preventing hypo- or hyperglycemia. Verifying the dose, cleansing the site, and rotating sites are important but follow glucose confirmation.
A 68-year-old woman comes to the outpatient clinic for a routine health screening. The nurse learns the client is a retired teacher who lives alone on a limited income. A history indicates the client drinks about 1,500 cc a day and her diet consists primarily of starches. It is MOST important for the nurse to encourage the client to
- A. increase her intake of protein.
- B. increase her intake of vitamins.
- C. reduce her caloric intake.
- D. reduce her fluid intake.
Correct Answer: A
Rationale: protein needed to slow down degeneration process of aging
A young child is placed on droplet precautions. The nurse is caring for which of the following clients?
- A. A child with cystic fibrosis.
- B. A child with tonsillitis.
- C. A child with bronchitis.
- D. A child with pertussis.
Correct Answer: D
Rationale: droplet precautions required, private room, maintain spatial separation of 3 feet between patient and visitors