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Another girl was bitten by a poisonous snake. All of the following are true except
- A. The victim of a snake bite should be made to exercise the bitten extremity to hasten circulation
- B. The bite of a poisonous snake is distinguished by two fang marks
- C. Immediate severe pain and swelling distinguished the bite of a poisonous snake
- D. The tourniquet should be tight enough to prevent superficial circulation of blood thus stopping absorption of the poison
Correct Answer: A
Rationale: When it comes to snake bites, one should not exercise the bitten extremity as it can increase the spread of venom in the body. Moving the affected limb can potentially lead to the venom spreading more quickly through the lymphatic system and into the bloodstream. Therefore, it is essential to keep the victim as calm and still as possible to minimize the effects of the venom. Proper first aid for snake bites includes keeping the victim calm, immobilizing the bitten limb, and seeking immediate medical attention.
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A nurse is assigned to four children of different ages. In which age group should the nurse understand that body integrity is a concern? TestBankWorld.org
- A. Toddler
- B. Preschooler
- C. School-age child
- D. Adolescent
Correct Answer: D
Rationale: Body integrity becomes a concern in adolescence, which is the period of development marked by rapid physical changes and self-awareness. Adolescents may experience body image issues, peer pressure, and the desire to conform to societal standards, which can lead to behaviors that compromise their body integrity, such as risky behaviors, eating disorders, self-harm, or seeking cosmetic procedures. By understanding the concerns surrounding body integrity in adolescents, the nurse can provide appropriate support, education, and guidance to promote healthy body image and self-esteem.
Which of the following IV solutions is hypertonic?
- A. Normal saline
- B. 0.45% NaCl
- C. 5% dextrose in 0.9% NaCl
- D. 0.225% NaCl
Correct Answer: C
Rationale: A hypertonic solution has a higher concentration of solutes compared to the intracellular fluid. In this case, 5% dextrose in 0.9% NaCl is hypertonic because it has a higher osmolarity due to the combined effect of dextrose and sodium chloride. The dextrose contributes to the hypertonicity, making the overall solution more concentrated than the intracellular fluid.
The nurse interprets this as?
- A. Respiratory acidosis
- B. Metabolic acidosis
- C. Respiratory alkalosis
- D. Metabolic alkalosis
Correct Answer: C
Rationale: Respiratory alkalosis is a condition where there is a decrease in carbon dioxide levels in the blood due to hyperventilation, leading to an increase in pH. In respiratory alkalosis, the body is expelling too much carbon dioxide, causing the blood to become more alkaline. The nurse's interpretation of the situation as respiratory alkalosis suggests that the patient may be breathing rapidly or deeply, resulting in the elimination of excess carbon dioxide and a shift towards alkalosis.
what is an appropriate nursing intervention while the child with nephrotic syndrome is confined to bed?
- A. restrain child as necessary.
- B. change position frequently.
- C. discourage parents from holding child.
- D. do passive rang-of-motion exercises once a day.
Correct Answer: B
Rationale: While a child with nephrotic syndrome is confined to bed, changing their position frequently is an appropriate nursing intervention to prevent complications associated with immobility. Constant pressure on certain areas of the body can lead to skin breakdown, discomfort, and decreased circulation which can exacerbate the child's condition. Changing positions frequently helps prevent these complications and promotes circulation and comfort. Restraints should only be used when necessary for the safety of the child or others, passive rang-of-motion exercises should be done more frequently than once a day to prevent contractures, and discouraging parents from holding their child can have negative emotional and psychological effects on the child's well-being.
The nurse is caring for an infant with congestive heart disease (CHD). The nurse should plan which intervention to decrease cardiac demands?
- A. Organize nursing activities to allow for uninterrupted sleep.
- B. Allow the infant to sleep through feedings during the night.
- C. Wait for the infant to cry to show definite signs of hunger.
- D. Discourage parents from rocking the infant
Correct Answer: A
Rationale: Organizing nursing activities to allow for uninterrupted sleep is the most appropriate intervention to decrease cardiac demands in an infant with congestive heart disease (CHD). Providing a peaceful and quiet environment will help in conserving the infant's energy and reducing stress on the heart, ultimately decreasing cardiac demands. Interrupted sleep or inadequate rest can place additional strain on the infant's heart, leading to increased cardiac demands and potential complications. Prioritizing uninterrupted sleep will benefit the infant's overall cardiac function and well-being.