Nokea
A two month old infant is brought to the clinic for the first immunization against DPT. The nurse should administer the vaccine via what route?
- A. Oral.
- B. Intramuscular
- C. Subcutaneous
- D. Intradermal
Correct Answer: B
Rationale: The DPT vaccine is administered intramuscularly for effective absorption.
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Immediately on the arrival of a premature baby to the neonatal intensive care unit, the nurse should do which of the following:
- A. Take temperature rectally
- B. Examine for anomalies
- C. Check airway for patency
- D. Cleanse skin of vernix
Correct Answer: C
Rationale: Ensuring airway patency is the immediate priority in a premature infant to support respiration, critical due to their immature respiratory system.
Which of the following would the nurse expect to assess in a child with celiac disease having a celiac crisis secondary to an upper respiratory infection?
- A. Respiratory distress
- B. Lethargy
- C. Watery diarrhea
- D. Weight gain
Correct Answer: C
Rationale: Episodes of celiac crises are precipitated by infections, ingestion of gluten, prolonged fasting, or exposure to anticholinergic drugs. Celiac crisis is typically characterized by severe watery diarrhea.
A mother of a 2 year old has just left the hospital to check on her other children. Which of the following would best help the 2 year old who is now crying inconsolably?
- A. Taking a nap
- B. Peer play group
- C. Large cuddly dog
- D. Favorite blanket
Correct Answer: D
Rationale: A favorite blanket provides comfort and security, reducing separation anxiety.
The nurse notes a swelling on the neonate's scalp that crosses the suture line. The nurse documents this condition as...
- A. Cephallic hematoma.
- B. Caput succedaneum.
- C. Hemorrhage edema.
- D. Perinatal caput.
Correct Answer: B
Rationale: Caput succedaneum is a swelling that crosses the suture line due to pressure during delivery and resolves spontaneously.
A mother tells the nurse that she is very worried because her 2-years old child does not finish his meals. What should the nurse advise the mother?
- A. Make the child sit with the family in the dining room until he finishes his meal
- B. Provide quiet environment for the child before meals
- C. Do not give snacks to the child before meals
- D. Put the child on a chair and feed him
Correct Answer: C
Rationale: Toddlers often have variable appetites; avoiding snacks before meals helps ensure hunger at mealtime, promoting better eating without forcing or disrupting the child’s autonomy.