Nokea
An adolescent who sustained a tibia fracture in a motor vehicle accident has a cast. What should the nurse do to help relieve the itching?
- A. Apply cool air under the cast with a blow-dryer
- B. Use sterile applicators to scratch the itch
- C. Apply cool water under the cast
- D. Apply hydrocortisone cream under the cast using sterile applicator
Correct Answer: A
Rationale: Cool air helps relieve itching without damaging the cast or introducing moisture, which can lead to skin breakdown.
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The nurse explained how to position an infant with tetralogy of Fallot if the infant suddenly becomes cyanotic. Which statement by the father leads the nurse to determine he understood the instructions?
- A. If the baby turns blue, I will hold him against my shoulder with his knees bent up toward his chest.
- B. If the baby turns blue, I will lay him down on a firm surface with his head lower than the rest of his body.
- C. If the baby turns blue, I will immediately put the baby upright in an infant seat.
- D. If the baby turns blue, I will put the baby in supine position with his head elevated.
Correct Answer: A
Rationale: In the event of a paroxysmal hypercyanotic or tet spell, the infant should be placed in a knee-chest position.
Down syndrome and VSD
- A. Doesn't close spontaneously as in children without downs
- B. Inaudible murmur is a characteristic feature / Murmur is not audible
- C. Pulmonary Hypertension is a late complication
- D. If no murmur, condition need not be investigated
Correct Answer: C
Rationale: Pulmonary hypertension is a known late complication in Down syndrome with VSD.
Hypertrophic obstructive cardiomyopathy
- A. Causes LV outflow tract obstruction
- B. Occurs after adenoviral infection
- C. Commonly occurs in infancy
- D. Double apical impulse
Correct Answer: A
Rationale: Hypertrophic obstructive cardiomyopathy primarily causes left ventricular outflow tract obstruction.
The clinic nurse is reviewing strategies for blood glucose monitoring with a client who is newly diagnosed with diabetes mellitus. When helping the client select a blood glucose meter, which client assessments should the nurse complete?
- A. Manual dexterity and visual acuity
- B. Capillary refill time and radial pulse volume
- C. Deep tendon reflexes and skin color
- D. Skin elasticity and hand grip strength
Correct Answer: A
Rationale: Manual dexterity and visual acuity are important for the client to properly use the glucose meter.
Ventricular tachycardia (VT) is defined as at least 3 premature ventricular contractions PVCs at >120 beats/min. Hemodynamically unstable patients with VT should be immediately treated with
- A. catheter ablation
- B. ICD implantation
- C. DC cardioversion
- D. amiodarone
Correct Answer: C
Rationale: DC cardioversion is the immediate treatment for hemodynamically unstable VT.