Nokea
The child's parents ask for information on hemodialysis. Which of the following statements should the nurse make?
- A. Hemodialysis uses your child's abdominal cavity as a membrane to clean their blood.
- B. Hemodialysis uses an electrolyte solution to clean your child's blood.
- C. Hemodialysis uses an artificial membrane outside the body to clean your child's blood.
- D. Hemodialysis slowly filtrates your child's blood continuously.
Correct Answer: C
Rationale: The correct answer is C. Hemodialysis uses an artificial membrane outside the body to clean the child's blood. This is because hemodialysis involves the process of blood being filtered through a machine that uses a synthetic membrane to remove wastes and excess fluids. This process mimics the function of the kidneys in filtering the blood.
Choice A is incorrect because hemodialysis does not use the abdominal cavity as a membrane, it uses an external artificial membrane. Choice B is incorrect as hemodialysis does not involve the use of an electrolyte solution to clean the blood. Choice D is incorrect because hemodialysis is not a continuous filtration process, it is done intermittently during treatment sessions.
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For which of the following adverse effects should the nurse monitor?
- A. Hypotension
- B. Prolonged wound healing
- C. Stevens-Johnson syndrome
- D. Bradypnea
Correct Answer: C
Rationale: The correct answer is C: Stevens-Johnson syndrome. This is a severe adverse reaction characterized by blistering and peeling of the skin, mucous membranes involvement, and flu-like symptoms. It is potentially life-threatening and requires immediate medical intervention. The nurse should monitor for early signs such as rash, fever, and mucosal lesions. Choices A, B, and D are not typically associated with the medication's adverse effects. Hypotension is a common side effect of some medications but not the focus of monitoring for this specific drug. Prolonged wound healing is more related to factors like nutrition and comorbidities. Bradypnea (slow breathing) is not commonly associated with adverse effects of medications but could signify respiratory distress.
7 year old with UTI intervention?
- A. Monitor salicylic acid?
- B. Monitor Pain s fever
Correct Answer: B
Rationale: The correct answer is B: Monitor Pain and Fever. In a 7-year-old with a UTI, monitoring pain and fever is crucial as these symptoms indicate the severity of the infection and response to treatment. Pain and fever can also help in assessing the effectiveness of antibiotics. Monitoring salicylic acid is not relevant as it is not commonly used in UTI management in children due to the risk of Reye's syndrome. The other choices are not provided, but they would likely be incorrect as they are unrelated to UTI management in a 7-year-old.
Which of the following findings should the nurse report to the provider?
- A. Unable to roll from back to abdomen
- B. Exhibits head lag when pulled to a sitting position
- C. Unable to hold a bottle
- D. Absent grasp reflex
Correct Answer: B
Rationale: The correct answer is B: Exhibits head lag when pulled to a sitting position. This finding indicates poor head control, a developmental milestone typically achieved around 4 months. Reporting this to the provider is crucial for further assessment and intervention. Choice A is incorrect as rolling from back to abdomen is typically achieved around 5-6 months. Choice C is incorrect as holding a bottle is a milestone around 6-10 months. Choice D is incorrect as the grasp reflex typically disappears around 3-4 months. The key is to identify the finding that deviates significantly from the expected developmental milestone, which is demonstrated by choice B.
The nurse is planning care for the adolescent. Select the 5 interventions the nurse should include.
- A. Instruct the parent to ensure the pneumococcal vaccine is current.
- B. Administer folic acid as prescribed.
- C. Monitor oxygen saturation continuously.
- D. Place the client on strict bed rest.
- E. Apply cold compresses to the affected joints.
- F. Administer meperidine IV for pain.
Correct Answer: B,C,E,F,H
Rationale: The correct interventions for the adolescent are B, C, E, F, and H. Administering folic acid (B) is important for growth and development. Monitoring oxygen saturation (C) ensures respiratory function. Applying cold compresses (E) helps reduce inflammation in affected joints. Administering meperidine IV (F) addresses pain management. The rationale for excluding other choices: A is irrelevant for adolescent care, D may worsen joint symptoms, and G is incomplete.
Which of the following actions should the nurse take first?
- A. Check the pH of the gastric secretions.
- B. Set the administration rate on the feeding pump.
- C. Flush the tube with water.
- D. Attach the feeding bag tubing to the end of the NG tube.
Correct Answer: C
Rationale: The nurse should first flush the tube with water to ensure patency and prevent clogging. This step clears any residual medication or debris, allowing for safe and effective administration of feedings. Checking the pH of gastric secretions (A) is important but can be done after ensuring tube patency. Setting the administration rate (B) and attaching the feeding bag tubing (D) are premature without confirming tube patency. The correct order prioritizes patient safety and optimal feeding delivery.