Nokea
A nurse is assisting with the admission of a child who has pertussis. Which of the following actions should the nurse take?
- A. Initiate droplet precautions.
- B. Initiate a protective environment.
- C. Initiate contact precautions.
- D. Initiate airborne precautions.
Correct Answer: A
Rationale: Pertussis (whooping cough) is transmitted via respiratory droplets.
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A nurse is collecting data from an infant who has a large patent ductus arteriosus. Which of the following is clinical manifestations should the nurse expect?
- A. Cyanosis with crying
- B. Weak pulses
- C. Chronic hypoxemia
- D. Machine-like murmur
Correct Answer: D
Rationale: A characteristic feature of PDA is a continuous
A nurse is reviewing the medical record of an adolescent and notes a calcium level of 11.4 mEq/L. Which of the following findings should the nurse expect?
- A. Tachycardia
- B. Diarrhea
- C. Positive Chvostek's sign
- D. Muscle hypotonicity
Correct Answer: D
Rationale: Hypercalcemia can lead to muscle weakness and hypotonicity due to its effects on nerve and muscle function.
A nurse is reinforcing teaching about preventing disease transmission with the parents of a child who has a streptococcal infection. Which of the following instructions should the nurse include?
- A. I'll give him acetaminophen for the pain.
- B. I'll discard his toothbrush and buy another.
- C. I'll continue to encourage him to drink lots of fluids.
- D. I'll take his temperature every 4 hours.
Correct Answer: B
Rationale: Replacing the toothbrush after starting antibiotics helps to reduce the risk of reinfection.
A school nurse is screening an 11-year-old child for idiopathic scoliosis. Which of the following instructions should the nurse give the child for this examination?
- A. Bend forward from the waist with your head and arms downward.
- B. Lie prone on the examination table.
- C. Touch your chin to your chest, and then look up at the ceiling.
- D. Turn to the side, and remain in a relaxed position.
Correct Answer: A
Rationale: This position known as the Adam's forward bend test is commonly used to screen for scoliosis.
A nurse is reinforcing teaching with an adolescent who has type 1 diabetes mellitus. Which of the following instructions should the nurse include In the teaching?
- A. Inject insulin in the deltoid muscle.
- B. Take glyburide with breakfast.
- C. Obtain an influenza vaccine annually.
- D. Administer glucagon for hyperglycemia.
Correct Answer: C
Rationale: People with diabetes are at higher risk for complications from influenza so annual vaccination is recommended.