Nokea
During a funduscopic examination of a school-age child, the nurse notes a brilliant, uniform red reflex in both eyes. The nurse should recognize that this is which?
- A. A normal finding
- B. A sign of a possible visual defect and a need for vision screening
- C. An abnormal finding requiring referral to an ophthalmologist
- D. A sign of small hemorrhages, which usually resolve spontaneously
Correct Answer: A
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
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The nurse is presenting a staff development program about understanding culture in the healthcare encounter. Which components should the nurse include in the program? (Select all that apply.)
- A. Cultural humility
- B. All are applicable
- C. Cultural sensitivity
- D. Cultural competency
Correct Answer: B
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
What is the most critical physiological change required of newborns at birth?
- A. Transition from fetal to neonatal breathing
- B. Body temperature maintenance
- C. Stabilization of fluid and electrolytes
- D. Closure of fetal shunts in the heart
Correct Answer: A
Rationale: The correct answer is A: Transition from fetal to neonatal breathing. The most critical physiological change required of newborns at birth is the initiation of breathing. This transition is crucial for the newborn to start exchanging oxygen and carbon dioxide outside the womb, marking the beginning of their independent respiratory function. Choices B, C, and D are important aspects of newborn care but are not as immediately critical as the establishment of breathing for oxygenation and removal of carbon dioxide, which is essential for the newborn's survival and adaptation to extrauterine life.
The nurse is caring for a child with the following order: Methylprednisolone (Solu-Medrol) 20 mg IV, every 6 hours. The nurse has Methylprednisolone 100 mg in 2 mL available. How many mL should the nurse administer with each dose?
- A. 0.4 mL
- B. 0.2 mL
- C. 0.5 mL
- D. 0.6 mL
Correct Answer: A
Rationale: The correct dosage to administer 20 mg is 0.4 mL, calculated by dividing the dose (20 mg) by the concentration (100 mg in 2 mL). This calculation ensures the accurate administration of the prescribed medication. Choices B, C, and D are incorrect as they do not reflect the correct calculation based on the provided concentration of the medication.
Which is the single most important factor to consider when communicating with children?
- A. Presence of the child's parent
- B. Child's physical condition
- C. Child's developmental level
- D. Child's nonverbal behaviors
Correct Answer: C
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
The caregiver asks why the 6-month-old infant needs to have solid foods when breast milk is such a good source of nutrition. What would be the best response by the nurse?
- A. Solid foods, especially iron-fortified cereals, are introduced to meet the infant's increased nutritional needs, including iron, which breast milk alone may not provide adequately.
- B. The extrusion reflex must be developed and feeding solid foods will help the infant to develop this reflex.
- C. Breastfeeding will become painful when the infant gets more teeth, so the infant needs to eat solid foods.
- D. By this age the infant becomes interested in trying new skills.
Correct Answer: A
Rationale: The correct response is A. Solid foods, especially iron-fortified cereals, are introduced to meet the infant's increased nutritional needs, including iron, which breast milk alone may not provide adequately. Choice B is incorrect because the extrusion reflex is related to the tongue-thrust reflex, not the nutritional needs of the infant. Choice C is incorrect as breastfeeding does not become painful when the infant gets more teeth, and it is not a reason for introducing solid foods. Choice D is incorrect as the infant's interest in trying new skills is not a primary reason for introducing solid foods at this age.