During a home care visit for an infant diagnosed with gastroesophageal reflux, which parental action observed requires intervention by the nurse?
- A. The infant's formula is mixed with rice cereal.
- B. The mother positions the infant in a high Fowler position while feeding.
- C. After feeding, the infant is placed in a car seat.
- D. The mother administers ranitidine (Zantac) to the infant using a syringe.
Correct Answer: C
Rationale: Placing an infant diagnosed with gastroesophageal reflux in a car seat after feeding can increase the risk of reflux and aspiration. The semi-upright or high Fowler position is recommended to help reduce reflux symptoms during feeding. Adding rice cereal to formula can help thicken it and reduce reflux episodes. Administering ranitidine using a syringe is a common method of oral medication administration.
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A 4-year-old hospitalized with failure to thrive (FTT) has orders for daily weights, strict I&O, and calorie counts. Which action by the nurse is a concern?
- A. Weighing the child every morning after breakfast.
- B. Weighing the child with only undergarments on.
- C. Sitting with the child while she eats her meals.
- D. Weighing the child after she has been fed.
Correct Answer: A
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
Ava is a 6-year-old girl with spina bifida who is generally happy to be at occupational therapy. On this day, she comes to therapy looking sad and tearful. She tells the therapist that she had a fight with her best friend at recess. What type of characteristic is described in this scenario?
- A. Mode Change
- B. Social
- C. Enduring
- D. Situational
Correct Answer: D
Rationale: The scenario describes a temporary change in Ava's emotional state due to a specific event - the fight with her friend. This aligns with the definition of a situational characteristic, which is influenced by specific circumstances or events. Ava's sadness and tearfulness in this situation are not reflective of a permanent trait but rather a response to a particular situation.
All the following are parasomniac disorders EXCEPT
- A. sleepwalking
- B. sleepterror
- C. confusional arousal
- D. nightmare
Correct Answer: D
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
Which statement should the nurse include in the teaching plan for a patient being started on levodopa/carbidopa (Sinemet) for newly diagnosed Parkinson’s disease?
- A. Take medication on a full stomach
- B. Change positions slowly
- C. The drug may cause the urine to be very dilute
- D. Carbidopa has many adverse effects
Correct Answer: B
Rationale: Postural hypotension is common early in treatment, so the patient should be instructed to change positions slowly. Administration with meals should be avoided, if possible, because food delays the absorption of the levodopa component. If the patient is experiencing side effects of nausea and vomiting, administration with food may be considered. The levodopa component may darken urine. Carbidopa has no adverse effects of its own.
A nurse is planning care for a school-age child who has thrombocytopenia. Which of the following interventions should the nurse include in the plan?
- A. Administer aspirin as needed for fever.
- B. Avoid venipunctures whenever possible.
- C. Encourage the child to participate in contact sports.
- D. Administer ibuprofen for pain.
Correct Answer: B
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
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