An 8-year-old girl asks the nurse how the blood pressure apparatus works. The most appropriate nursing action is which?
- A. Ask her why she wants to know.
- B. Determine why she is so anxious.
- C. Explain in simple terms how it works.
- D. Tell her she will see how it works as it is used.
Correct Answer: C
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
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The nurse is aware that skin turgor best estimates what?
- A. Perfusion
- B. Adequate hydration
- C. Amount of body fat
- D. Amount of anemia
Correct Answer: B
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
The nurse is testing an infant's visual acuity. By which age should the infant be able to fix on and follow a target?
- A. 1 month
- B. 1 to 2 months
- C. 3 to 4 months
- D. 6 months
Correct Answer: C
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
The nurse is preparing to administer a prescribed, as-needed antiemetic drug for a child diagnosed with cancer. Which action by the nurse is most appropriate?
- A. Administering the drug only if the child is nauseated.
- B. Administering the drug prophylactically before the next dose of chemotherapy.
- C. Administering the drug after the next dose of chemotherapy.
- D. Administering the drug only if the child is experiencing diarrhea.
Correct Answer: B
Rationale: Administering the antiemetic prophylactically before the next dose of chemotherapy is the most appropriate action. This approach helps prevent nausea and vomiting associated with chemotherapy. Waiting until the child is already nauseated, as stated in option A, is less effective as it is reactive rather than proactive. Administering the drug after chemotherapy, as in option C, may not be as beneficial in preventing chemotherapy-induced nausea and vomiting. Option D, administering the drug only if the child is experiencing diarrhea, is not relevant to the prevention of chemotherapy-induced nausea.
What is the appropriate method for measuring the temperature of a 2-day-old neonate?
- A. Tympanic
- B. Oral
- C. Axillary
- D. Rectal
Correct Answer: C
Rationale: For a 2-day-old neonate, the most suitable method to measure temperature is the axillary method. This approach is considered safe and appropriate for neonates, minimizing the risk of injury. Tympanic temperature measurement may not be as accurate in neonates due to their small ear canals. Oral temperature measurement is not recommended for neonates as they may not be able to hold a thermometer properly in their mouths. Rectal temperature measurement is invasive and carries a higher risk of injury and should be avoided unless absolutely necessary.
Which muscle is contraindicated for the administration of immunizations in infants and young children?
- A. Deltoid
- B. Dorsogluteal
- C. Ventrogluteal
- D. Anterolateral thigh
Correct Answer: B
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
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