Nokea
A nurse is reinforcing appropriate interventions with the parent of an infant who had a febrile seizure. Which instruction is appropriate to review?
- A. Give acetaminophen or ibuprofen every 6-8 hours to control fever.
- B. Give the infant frequent tepid sponge baths to control the fever.
- C. If the infant develops another seizure, wait 15 minutes to see if it subsides.
- D. Place ice bags under the arms and around the neck to control fever.
Correct Answer: A
Rationale: Administering acetaminophen or ibuprofen every 6-8 hours helps control fever, reducing the risk of recurrent febrile seizures in infants.
You may also like to solve these questions
A home health nurse is at the home of a client with diabetes and arthritis. The client has difficulty drawing up insulin. It would be most appropriate for the nurse to refer the client to
- A. A social worker from the local hospital
- B. A physical therapist to improve fine motor coordination
- C. An activity therapist from the community center
- D. Another client with diabetes mellitus and takes insulin
Correct Answer: B
Rationale: A physical therapist can assist a client to improve the fine motor skills needed to prepare an insulin injection.
The nurse enters a client's room and finds that the client and spouse are crying. The spouse states that the health care provider just diagnosed the client with Alzheimer disease. What is the best response by the nurse?
- A. Do you have any questions about the diagnosis?
- B. There are medications available to treat Alzheimer disease.
- C. This new diagnosis must be frightening for you.
- D. We can help you make decisions about your care.
Correct Answer: C
Rationale: Acknowledging the emotional impact of the diagnosis validates the client's and spouse's feelings, fostering therapeutic communication and trust.
The nurse has assigned a nursing assistant to give the client a bath. Which observation reported by the nursing assistant requires immediate attention by the nurse?
- A. A red area on the back that disappears after it is massaged
- B. A red area on the hip that does not go away after the area is massaged
- C. The client's insistence on doing most of the bath
- D. The indwelling urethral catheter is draining clear, amber urine.
Correct Answer: B
Rationale: A non-blanching red area on the hip suggests a pressure injury, requiring immediate nursing intervention to prevent progression.
The nurse is teaching a client who has a hip prosthesis following total hip replacement. Which of the following should be included in the instructions for home care?
- A. Avoid climbing stairs for 3 months
- B. Ambulate using crutches only
- C. Sleep in a supine position only
- D. Do not cross your legs
Correct Answer: D
Rationale: Do not cross your legs. Crossing legs can exceed the 90-degree hip flexion limit, risking dislocation.
In reviewing the assessment data of a client suspected of having diabetes insipidus, the nurse expects which of the following after a water deprivation test?
- A. Increased edema and weight gain
- B. Unchanged urine specific gravity
- C. Rapid protein secretion
- D. Decreased blood potassium
Correct Answer: B
Rationale: Unchanged urine specific gravity. When fluids are restricted, the client continues to excrete large amounts of dilute urine. This finding supports the diagnosis. Normally, urine is more concentrated with reduced fluid intake.