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As a result of opioid administration, a child's respirations are slow and shallow. Which should the nurse anticipate when assessing the child's arterial blood gas?
- A. Increased PCO2 and respiratory acidosis
- B. Decreased PCO2 and respiratory alkalosis
- C. Low pH and low PCO2
- D. High pH and high PCO2
Correct Answer: A
Rationale: When a child's respirations are slow and shallow due to opioid administration, it results in hypoventilation. This leads to retaining carbon dioxide, indicated by an increased PCO2 level on arterial blood gas analysis, and subsequently causes respiratory acidosis due to the buildup of CO2 in the blood.
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The age at which the infant can achieve early head control with bobbing motion when pulled to sit is
- A. 2 months
- B. 3 months
- C. 4 months
- D. 6 months
Correct Answer: A
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
The healthcare professional is preparing to administer an immunization to a four-year-old child. Which of the following actions should the professional plan to take?
- A. Place the child in a prone position for the immunization
- B. Request that the child's caregiver stay in the room during the immunization
- C. Administer the immunization using a 24-gauge needle
- D. Inject the immunization slowly without aspirating
Correct Answer: C
Rationale: When administering an immunization to a four-year-old child, it is important to use a 24-gauge needle to minimize pain and discomfort for the child. Thicker needles can cause more pain and tissue trauma. Using a thinner needle like a 24-gauge is appropriate for pediatric immunizations. The other options are not recommended practices: placing the child in a prone position is not ideal for immunization administration, it is beneficial to have the caregiver present for support, and aspirating before administering the immunization is not required for intramuscular injections in current practice.
A healthcare professional is assessing an infant who has heart failure. Which of the following findings should the healthcare professional expect?
- A. Weight gain
- B. Bounding pulses
- C. Hyperactivity
- D. Increased urine output
Correct Answer: A
Rationale: In infants with heart failure, one of the key manifestations is weight gain due to fluid retention. The heart's inability to pump effectively can lead to fluid buildup in the body, causing weight gain. Bounding pulses, hyperactivity, and increased urine output are not typically associated with heart failure in infants.
A child returns from exploratory surgery following a gunshot wound to the abdomen. Which nursing intervention should be excluded from the plan of care?
- A. Immediate initiation of oral feedings
- B. Assessment of the surgical site
- C. Administration of opioid narcotics for pain management
- D. Visitation at the bedside
Correct Answer: A
Rationale: Immediate initiation of oral feedings is contraindicated post-abdominal surgery due to the risk of bowel complications such as paralytic ileus or anastomotic leak. Starting oral feedings immediately can increase the risk of these complications and hinder the healing process. It is crucial to wait until bowel function returns and the patient shows signs of tolerance before introducing oral feedings. Assessment of the surgical site, administration of opioid narcotics for pain management, and visitation at the bedside are essential components of postoperative care and should not be excluded.
Which of the following is a key feature of the diagnosis of ASD according to the DSM V?
- A. Unusual responses to sensory input
- B. Social isolation
- C. Repetitive behaviors
- D. Delayed motor development
Correct Answer: A
Rationale: In the DSM V, one of the key diagnostic criteria for Autism Spectrum Disorder (ASD) is unusual responses to sensory input. These atypical responses can include hypersensitivity or hyposensitivity to sensory stimuli, such as sound, touch, taste, or smell. These sensory processing differences are important in the diagnosis of ASD because they can significantly impact an individual's daily functioning and behavior.