Nokea
Discharge care planning has begun for a seriously injured patient who is Asian. The patient's parents have refused routine home health visits. The pediatric nurse understands the family may:
- A. believe that health outcomes are predetermined.
- B. feel health is a personal responsibility and maintenance of family reputation is paramount.
- C. regard health as a family responsibility, seeking outside aid only when resources are exhausted.
- D. none of the above.
Correct Answer: C
Rationale: In some cultures, families may prefer to handle health matters internally, viewing outside assistance as a last resort.
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The nurse is conducting an admission assessment on a school-age child with acute renal failure. Which are the primary clinical manifestations the nurse expects to find with this condition?
- A. Oliguria and hypertension
- B. Hematuria and pallor
- C. Proteinuria and muscle cramps
- D. Bacteriuria and facial edema
Correct Answer: A
Rationale: Acute renal failure is characterized by a sudden decrease in kidney function, resulting in the reduced ability to excrete waste products and maintain fluid balance. The primary clinical manifestations typically seen in acute renal failure include oliguria (low urine output) due to decreased kidney function, and hypertension (high blood pressure) as the body retains excess fluid and waste products. These symptoms indicate impaired kidney function and the need for immediate medical intervention to prevent further complications. Hematuria, proteinuria, muscle cramps, bacteriuria, and facial edema are not typically primary clinical manifestations of acute renal failure.
The nurse notices that a 10-month-old infant being seen in the clinic is wearing expensive, inflexible, high-top shoes. The nurse should explain that:
- A. soft and flexible shoes are generally better.
- B. high-top shoes are necessary for support.
- C. inflexible shoes are necessary to prevent in-toeing and out-toeing.
- D. this type of shoe will encourage the infant to walk sooner.
Correct Answer: A
Rationale: Soft and flexible shoes are generally better for infants who are learning to walk. Infants have soft and pliable bones in their feet that are still developing, so it is important for them to wear shoes that allow natural movement and flexibility. High-top shoes and inflexible shoes may restrict the natural movement of the foot and can hinder the infant's ability to develop balance and coordination while learning to walk. It is important for infants to wear shoes that are comfortable, lightweight, and provide some protection without restricting their foot movements.
Assume you are going to estimate the prevalence of amoebic dysentery in a small country which harbors a total number of population of 530,000; you find that 57,000 of the population are infected by the disease. The prevalence of this disease is closest to
- A. 5.33%
- B. 7.45%
- C. 10.75%
- D. 20.22%
Correct Answer: C
Rationale: Prevalence = (Number of infected / Total population) * 100 = (57,000 / 530,000) * 100 ≈ 10.75%.
Which occurs in septic shock?
- A. Hypothermia
- B. Increased cardiac output
- C. Vasoconstriction
- D. Angioneurotic edema
Correct Answer: C
Rationale: In septic shock, vasoconstriction is a common phenomenon. This occurs as part of the body's response to the infection, where blood vessels constrict in an attempt to maintain blood pressure and perfusion to vital organs. The vasoconstriction leads to increased systemic vascular resistance and contributes to the hypotension seen in septic shock. The body's natural response to infection also involves a release of inflammatory mediators, which can cause vasodilation in some areas while concurrent vasoconstriction occurs in others, resulting in uneven blood flow distribution and contributing to organ dysfunction. Therefore, vasoconstriction is a key factor in the pathophysiology of septic shock.
A nurse is admitting a toddler to the hospital. The toddler is with both parents and is currently sitting comfortably on a parent's lap. The parents state they will need to leave for a brief period. Which type of nursing diagnosis should the nurse formulate for this child?
- A. Risk for anxiety
- B. Anxiety
- C. Readiness for enhanced coping
- D. Ineffective coping
Correct Answer: A
Rationale: The appropriate nursing diagnosis for the toddler in this scenario would be "Risk for anxiety." The child is currently comfortable sitting on a parent's lap but may experience increased anxiety when the parents leave for a brief period. Since the parents' departure has not yet occurred and the child's reaction is uncertain, it is more appropriate to identify the potential risk of anxiety rather than stating the child is already experiencing anxiety. This diagnosis focuses on the potential for a negative emotion, providing an opportunity for nursing interventions to prevent or reduce anxiety in the child's upcoming situation.