Nokea
Signs of digoxin toxicity include of the following (Select all that apply):
- A. Vomiting
- B. Poor feeding
- C. Constipation
- D. Bradycardia
Correct Answer: A,B,D
Rationale: The correct signs of digoxin toxicity are vomiting, poor feeding, and bradycardia. Vomiting is a common early sign due to the drug's effect on the gastrointestinal system. Poor feeding can occur as a result of nausea and anorexia. Bradycardia is a classic sign of digoxin toxicity due to its effect on cardiac function. Constipation is not typically associated with digoxin toxicity. In summary, A, B, and D are correct as they align with the expected symptoms of digoxin toxicity, whereas C is incorrect as constipation is not a common sign.
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A 15-year-old with type 1 diabetes mellitus presents with a fever and 48-hour history of vomiting. As the nurse, you note the child's breath has a fruity odour, his breathing is deep and rapid, and mom states he has become less arousable. You recognize these are the signs of:
- A. Acute Hypoglycemia
- B. Diabetic Ketoacidosis
- C. Hyperglycemia
- D. Polydipsia
Correct Answer: B
Rationale: The correct answer is B: Diabetic Ketoacidosis (DKA). The fruity odor of breath, deep and rapid breathing (Kussmaul breathing), and altered mental status are classic signs of DKA. In DKA, the body produces excess ketones due to lack of insulin, leading to metabolic acidosis. Acute Hypoglycemia (A) presents with low blood sugar levels, not high as in DKA. Hyperglycemia (C) is a general term for high blood sugar without the specific ketone production seen in DKA. Polydipsia (D) refers to excessive thirst, not the symptoms described in the scenario.
Which actions by the school nurse is important in the prevention of rheumatic fever?
- A. Encourage routine cholesterol screenings
- B. Conduct routine blood pressure screenings
- C. Refer children with sore throats for throat cultures
- D. Recommend aspirin instead of acetaminophen for minor discomforts
Correct Answer: C
Rationale: The correct answer is C: Refer children with sore throats for throat cultures. This is important in preventing rheumatic fever as it helps identify and treat streptococcal infections promptly, which can lead to rheumatic fever if left untreated. Encouraging routine cholesterol screenings (A) and conducting routine blood pressure screenings (B) are not directly related to preventing rheumatic fever. Recommending aspirin instead of acetaminophen (D) can actually be harmful in children with viral infections, increasing the risk of Reye's syndrome.
A 14-year-old was brought to the school nurse's office due to a reported suicide threat. Which one of the following findings puts the patient at the greatest risk for suicide completion?
- A. History of suicide attempt
- B. History of drug and alcohol use
- C. History of divorced parents
- D. Bisexual orientation
Correct Answer: A
Rationale: The correct answer is A: History of suicide attempt. This finding puts the patient at the greatest risk for suicide completion because individuals with a history of suicide attempts are more likely to attempt suicide again. This indicates underlying mental health issues and distress, increasing the risk of completing suicide. Choice B is incorrect as drug and alcohol use is a risk factor but not as strong as a previous suicide attempt. Choices C and D are not direct risk factors for suicide completion.
A 36 pound almost 3-year-old arrives to the ED with dehydration. The provider orders an IV fluid bolus, 15 ml/kg over 30 minutes. How many ml will the nurse administer?
- A. 164 ml
- B. 246 ml
- C. 460 ml
- D. 640 ml
Correct Answer: B
Rationale: The correct answer is B: 246 ml. To calculate the IV fluid bolus amount, first, we need to determine the child's weight in kilograms: 36 lbs ÷ 2.2 = 16.36 kg. Next, multiply the weight in kg by the ordered dose of 15 ml/kg: 16.36 kg x 15 ml/kg = 245.4 ml. Since it is recommended to round up in pediatric dosing, the nurse will administer 246 ml. Choice A is incorrect as it underestimates the dose. Choices C and D are incorrect as they overestimate the dose.
The nurse is providing education to the parents of an infant with cradle cap. Which of the following statements by the parents indicates their understanding?
- A. We should use hydrogen peroxide as shampoo for my child until it is resolved
- B. We should expect that my child will probably have asthma & allergies too
- C. We should brush the loosened crusts out of the hair after shampooing
- D. We should decrease the frequency that I wash my child's hair to once a week
Correct Answer: C
Rationale: The correct answer is C: "We should brush the loosened crusts out of the hair after shampooing." This statement indicates understanding as brushing the loosened crusts helps to remove the scales and prevent further build-up. Hydrogen peroxide (A) is not recommended for cradle cap as it can irritate the skin. Asthma and allergies (B) are not directly related to cradle cap. Decreasing hair wash frequency to once a week (D) can worsen cradle cap by allowing build-up of oils and dead skin cells.