Nokea
A school-age child has peripheral edema. Which of the following assessments should the nurse perform to confirm peripheral edema?
- A. Palpate the dorsum of the child's feet
- B. Weigh the child daily using the same scale
- C. Assess the child's skin turgor
- D. Observe the child for periorbital swelling
Correct Answer: A
Rationale: To confirm peripheral edema in a child, the nurse should palpate the dorsum of the child's feet by pressing a fingertip against a bony prominence for 5 seconds. This assessment helps detect the presence of pitting edema, which is characterized by an indentation that remains after the pressure is released.
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A 6-month-old infant is receiving digoxin (Lanoxin). The nurse should notify the practitioner and withhold the medication if the apical pulse is less than _______ beats/min.
- A. 60
- B. 70
- C. 90 to 110
- D. 110 to 120
Correct Answer: A
Rationale: Digoxin is a medication commonly used to treat infants with heart conditions. One of the primary concerns with digoxin therapy is the risk of toxicity, which can lead to serious cardiac arrhythmias. Bradycardia, or a heart rate less than 60 beats per minute, is a common sign of digoxin toxicity. Therefore, if a 6-month-old infant receiving digoxin has an apical pulse rate of less than 60 beats/min, the nurse should notify the practitioner and withhold the medication to prevent further complications.
Which feature is NOT characteristic of autistic spectrum disorder?
- A. Defective social communication
- B. Fixated interests
- C. Highly restricted routines
- D. Stereotyped absence of motor use
Correct Answer: D
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
All the following are recognizable teratogens EXCEPT
- A. ethanol
- B. antiepileptic medications
- C. toxoplasmosis
- D. hypothermia
Correct Answer: D
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
The parents of a 12-month-old child ask the nurse if the child can eat hot dogs as do their other children. The nurse's reply should be based on which of the following?
- A. Child is too young to digest hot dogs.
- B. Child is too young to eat hot dogs safely.
- C. Hot dogs must be sliced into sections to prevent aspiration.
- D. Hot dogs must be cut into small, irregular pieces to prevent aspiration.
Correct Answer: D
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
A 35-year-old female client is requesting information about mammograms and breast cancer. She isn't considered at high risk for breast cancer. What should the nurse tell this client?
- A. She should have had a baseline mammogram before age
Correct Answer: D
Rationale: According to the American Cancer Society guidelines, women with average risk for breast cancer should start getting mammograms every 2 years starting at age 40. Since the client is not considered at high risk for breast cancer, this recommendation applies to her. Regular mammograms are important for early detection of breast cancer, even in those at average risk. It is also important for the client to perform monthly breast self-exams and report any changes or concerns to her healthcare provider.