Nokea
A nurse is caring for a child who is experiencing a seizure. Which of the following actions should the nurse take?
- A. Restrain the child's arms.
- B. Insert a padded tongue blade into the child's mouth.
- C. Place the child in a side-lying position.
- D. Elevate the child's legs on a pillow.
Correct Answer: C
Rationale: This helps maintain an open airway and allows for drainage of saliva or vomit reducing the risk of aspiration.
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A nurse working at a clinic speaks on the telephone with a parent of a 2-month-old infant. The parent tells the nurse that the infant has projectile vomiting followed by hunger after meals. Which of the following responses by the nurse is appropriate?
- A. Bring your infant into the clinic today to be seen.
- B. You might want to try switching to a different formula.
- C. Give your infant an oral rehydration solution.
- D. Burp your child more frequently during feedings.
Correct Answer: A
Rationale: Projectile vomiting can be a sign of pyloric stenosis a condition that requires prompt medical evaluation.
A nurse is caring for a 2-week old Infant whose mother requests additional information about sudden infant death syndrome (SIDS). Which of the following responses should the nurse make?
- A. SIDS is directly correlated to diphtheria, tetanus, and pertussis vaccines.
- B. SIDS rates have been rising over the last 10 years.
- C. You should place your baby on her back when sleeping to decrease the risk of SIDS.
- D. Sleep apnea is the main cause of SIDS.
Correct Answer: C
Rationale: Placing a baby on their back to sleep significantly reduces the risk of SIDS.
A nurse in a family health clinic is collecting data as part of a routine physical examination of a client who is about to enter high school. The nurse observes an abnormal lateral curvature of the spine. The nurse should expect the provider to document which of the following disorders?
- A. Scoliosis
- B. Ankylosis
- C. Kyphosis
- D. Lordosis
Correct Answer: A
Rationale: Scoliosis is characterized by an abnormal lateral curvature of the spine.
A nurse is calculating the output of an infant admitted who has dehydration. When weighing the diaper, the nurse should equate 1 g of wet diaper weight to which of the following amounts of urine?
- A. 30 mL
- B. 1 mL
- C. 15 mL
- D. 5 mL
Correct Answer: B
Rationale: It is a standard practice to equate 1 gram of wet diaper weight to 1 mL of urine providing an accurate measure for fluid balance in infants.
A nurse is collecting data from a 1-year-old child who has Wilms' tumor. Which of the following findings should the nurse expect?
- A. Diarrhea
- B. Jaundice
- C. Swollen joints
- D. Abdominal mass
Correct Answer: D
Rationale: Wilms' tumor often presents as an asymptomatic abdominal mass.