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The nurse instructs a parent regarding the appropriate actions to take when the toddler has a temper tantrum. Which statement by the parent indicates a successful outcome of the teaching?
- A. I will ignore the tantrums as long as there is no physical danger.
- B. I will give frequent reminders that only bad children have tantrums.
- C. I will send my child to a room alone for 10 minutes after every tantrum.
- D. I will reward my child with candy at the end of each day without a tantrum.
Correct Answer: A
Rationale: Ignoring a negative attention-seeking behavior is considered the best way to extinguish it, provided that the child is safe from injury. Option 2 is untrue and negative. Option 3 gives attention to the tantrum and also exceeds the recommended time of 1 minute per year of age for a time-out. Providing candy for rewards is unhealthy and unlikely to be effective at the end of the day.
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A client has begun medication therapy with betaxolol. The nurse determines that the client is experiencing the intended effect of therapy if which observation is noted?
- A. Edema present at 3+
- B. Weight loss of 5 pounds within 2 days
- C. Pulse rate increased from 58 to 74 beats/min
- D. Blood pressure decreased from 142 / 94mmHg to 128 / 82mmHg
Correct Answer: D
Rationale: Betaxolol is a beta-adrenergic blocking agent used to lower blood pressure, relieve angina, or eliminate dysrhythmias. Side/adverse effects include bradycardia and symptoms of heart failure, such as weight gain and increased edema.
The nurse is assessing a client with gestational hypertension who was admitted to the hospital 48 hours ago. Which current assessment data would indicate that the condition has not yet resolved?
- A. Urinary output is increased.
- B. Presence of trace urinary protein
- C. Client complaints of blurred vision
- D. Blood pressure reading at prenatal baseline
Correct Answer: C
Rationale: Client complaints of headache or blurred vision indicate a worsening of the condition and warrant immediate further evaluation. The remaining options are all signs that the gestational hypertension is being resolved.
A client is seen in the health care clinic, and a diagnosis of conjunctivitis is made. The nurse provides instructions to the client regarding the care of the disorder while at home. Which statement by the client indicates the need for further instruction?
- A. I can use an ophthalmic analgesic ointment at night if I have eye discomfort.
- B. I do not need to be concerned about spreading this infection to others in my family.
- C. I should apply warm compresses before instilling antibiotic drops if purulent discharge is present in my eye.
- D. I should perform saline eye irrigation before instilling the antibiotic drops into my eye if purulent discharge is present.
Correct Answer: B
Rationale: Conjunctivitis is highly contagious. Antibiotic drops are usually administered four times a day. Ophthalmic analgesic ointment or drops may be instilled, especially at bedtime because discomfort becomes more noticeable when the eyelids are closed. When purulent discharge is present, saline eye irrigations or applications of warm compresses to the eye may be necessary before instilling the medication.
A client has received a dose of an as-needed medication loperamide. The nurse evaluates the client after administration to determine if the client has relief of which sign/symptom?
- A. Diarrhea
- B. Tarry stools
- C. Constipation
- D. Abdominal pain
Correct Answer: A
Rationale: Loperamide is an antidiarrheal agent, and it is commonly administered after loose stools. It is used for the management of acute diarrhea and also for chronic diarrhea, such as with inflammatory bowel disease. It can also be used to reduce the volume of drainage from an ileostomy. It is not intended to treat any of the other options.
The nurse is providing instructions to the mother of a child with a diagnosis of strabismus of the left eye. Which statement by the mother indicates that the mother understands the procedure for patching?
- A. I will place the patch on both eyes.
- B. I will place the patch on the left eye.
- C. I will place the patch on the right eye.
- D. I will alternate the patch from the right eye to the left eye every hour.
Correct Answer: C
Rationale: Patching may be used for the treatment of strabismus to strengthen the weak eye. With this treatment, the good eye is patched; this encourages the child to use the weaker eye. The treatment is most successful when it is performed during the preschool years. The schedule for patching is individualized and prescribed by the ophthalmologist.