Nokea
The MOST appropriate age of a child who helps to undress; puts 3 words together (subject, verb, object); and handles spoon well is
- A. 15 months
- B. 18 months
- C. 24 months
- D. 30 months
Correct Answer: C
Rationale: These milestones are typically achieved around 24 months.
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A 14-year-old boy is being admitted to the hospital for an appendectomy. Which roommate should the nurse assign with this patient?
- A. A 4-year-old boy post-appendectomy surgery
- B. A 6-year-old boy with pneumonia
- C. A 15-year-old boy admitted with a vasoocclusive sickle cell crisis
- D. A 12-year-old boy with cellulitis
Correct Answer: C
Rationale: The nurse should assign the 14-year-old boy recovering from an appendectomy to Roommate C, the 15-year-old boy admitted with a vasoocclusive sickle cell crisis. This decision is based on providing similar age groups and conditions for mutual support and understanding. Both patients are teenagers and are experiencing health challenges that involve pain management and supportive care. This pairing can offer emotional and social benefits as they navigate their hospital stay together. It is important to consider factors like age, condition, and potential social interactions when assigning roommates in a healthcare setting to promote a positive environment for healing and recovery.
The nurse is assessing a 3-day-old, breastfed newborn who weighed 7 pounds, 8 ounces at birth. The newborn's mother is now concerned that the newborn weighs 6 pounds, 15 ounces. Which is the most appropriate nursing intervention?
- A. Recommend supplemental feedings of formula.
- B. Explain that this weight loss is within normal limits.
- C. Assess child further to determine cause of excessive weight loss.
- D. Encourage mother to express breast milk for bottle feeding the newborn.
Correct Answer: B
Rationale: It is normal for newborns to lose weight in the first few days of life, typically up to 10% of their birth weight. In this case, the newborn's weight loss from 7 pounds, 8 ounces to 6 pounds, 15 ounces is within the expected range. It is important for the nurse to reassure the mother that this weight loss is normal and to encourage continued breastfeeding on demand to support newborn hydration and nutrition. There is no need for supplemental feedings at this point unless there are other signs of feeding issues or concerns.
In embryonic period, formation of all of the following occur by the given time EXCEPT
- A. 8 days - blastocyst formation
- B. 6 weeks - ectoderm formation
- C. 8 weeks - crown-rump length about 3 cm
- D. 10 weeks - endoderm formation
Correct Answer: D
Rationale: Endoderm formation occurs much earlier than 10 weeks in the embryonic period.
A 15-month-old toddler was able to do all the following EXCEPT
- A. walks alone
- B. makes tower of 3 cubes
- C. inserts raisin in a bottle
- D. responds to his/her name
Correct Answer: D
Rationale: Responding to name usually occurs earlier, around 6-9 months.
An adult had a total thyroidectomy. Which statement by the client demonstrates to the nurse an adequate understanding of long term care?
- A. "I will need to take replacement hormones for the rest of my life."
- B. " I should try to avoud stress and be alert for signs of recurrent hyperthyroidism."
- C. "Thank goodness, this is over! I will never have to worry about throid problems again."
- D. " I should increase my caloric intake to replace what I lost during the surgery."
Correct Answer: A
Rationale: An adult who had a total thyroidectomy will no longer be able to produce thyroid hormones naturally. Therefore, the client will need to take replacement hormones for the rest of their life to maintain normal bodily functions and prevent complications associated with hypothyroidism. This statement demonstrates an adequate understanding of the long-term care needed after a total thyroidectomy. The other options do not accurately reflect the necessary long-term care for someone who has undergone a total thyroidectomy.