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A young child has coarctation of the aorta. What does the nurse expect to identify when taking the child's vital signs?
- A. A weak radial pulse
- B. An irregular heartbeat
- C. A bounding femoral pulse
- D. An elevated radial blood pressure
Correct Answer: A
Rationale: In coarctation of the aorta, there is narrowing of the aorta leading to decreased blood flow distal to the constriction. This results in a weak or delayed femoral pulse and a relatively weaker radial pulse compared to the femoral pulse. An irregular heartbeat (choice B) is not a typical finding in coarctation of the aorta. A bounding femoral pulse (choice C) would not be expected due to the decreased blood flow beyond the constriction. An elevated radial blood pressure (choice D) is not a common characteristic of coarctation of the aorta; instead, blood pressure may be higher in the upper extremities compared to the lower extremities due to the constriction.
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A parent receives a note from the school that a student in class has head lice. The parent calls the school nurse to ask how to check for head lice. What instructions should the nurse provide?
- A. Ask the child where it itches.
- B. Check to see if your dog has ear mites.
- C. Look along the scalp line for white dots.
- D. Observe between the fingers for red lines.
Correct Answer: C
Rationale: The correct answer is to look along the scalp line for white dots (nits) when checking for head lice. White dots are indicative of head lice infestation. Itching alone, as mentioned in choice A, is not a reliable indicator of head lice. Choice B is irrelevant as it refers to checking for ear mites in a dog, not head lice in a human. Observing between the fingers for red lines, as in choice D, is not a method to check for head lice.
A 2-year-old child with a diagnosis of hemophilia is admitted to the hospital. What should the nurse include in the care plan?
- A. Encourage participation in contact sports
- B. Use a soft toothbrush for oral care
- C. Administer nonsteroidal anti-inflammatory drugs
- D. Administer aspirin for pain
Correct Answer: B
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
A child with juvenile idiopathic arthritis (JIA) is under the care of a nurse. What is the priority nursing intervention?
- A. Encouraging a diet high in protein
- B. Administering nonsteroidal anti-inflammatory drugs (NSAIDs)
- C. Applying heat to affected joints
- D. Providing range-of-motion exercises
Correct Answer: B
Rationale: The priority nursing intervention for a child with juvenile idiopathic arthritis (JIA) is administering nonsteroidal anti-inflammatory drugs (NSAIDs) to manage pain and inflammation. NSAIDs are commonly used in the treatment of JIA to help alleviate symptoms. While encouraging a diet high in protein, applying heat to affected joints, and providing range-of-motion exercises are essential components of care, addressing pain and inflammation with NSAIDs is the priority intervention. This is because controlling pain and inflammation is crucial in improving the child's comfort and quality of life, which takes precedence over other supportive measures.
A parent asks a nurse how to tell the difference between measles (rubeola) and German measles (rubella). What should the nurse tell the parent about rubeola that is different from rubella?
- A. High fever and Koplik spots
- B. Rash on the trunk with pruritus
- C. Nausea, vomiting, and abdominal cramps
- D. Characteristics of a cold, followed by a rash
Correct Answer: A
Rationale: Rubeola (measles) is characterized by a high fever and the presence of Koplik spots, which are not seen in rubella (German measles). Therefore, the correct answer is A. Choice B, rash on the trunk with pruritus, is more indicative of rubella rather than rubeola. Choice C, nausea, vomiting, and abdominal cramps, are not specific differentiating symptoms between rubeola and rubella. Choice D, characteristics of a cold followed by a rash, does not specifically distinguish between rubeola and rubella.
The nurse is admitting a newborn with hypospadias to the nursery. The nurse expects which finding in this newborn?
- A. absence of a urethral opening
- B. penis appears shorter than usual for age
- C. the urethral opening is along the dorsal surface of the penis
- D. the urethral opening is along the ventral surface of the penis
Correct Answer: D
Rationale: Hypospadias is a congenital condition where the urethral opening is located along the ventral surface of the penis, not the dorsal surface (Choice C) or absent (Choice A). This leads to the characteristic appearance of a ventrally displaced urethral meatus. The penis may appear normal in size but with the urethral opening positioned abnormally (Choice D), rather than being shorter than usual (Choice B). Therefore, the correct expectation for a newborn with hypospadias is that the urethral opening is along the ventral surface of the penis, making Choice D the correct answer.