Nokea
The nurse is caring for a child with hypernatremia. The nurse evaluates the child for which signs and symptoms of hypernatremia? (Select all that apply.)
- A. All below
- B. Lethargy
- C. Oliguria
- D. Intense thirst
Correct Answer: A
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
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Which parental statement indicates correct understanding of information presented regarding the prevention of iron deficiency anemia in infants?
- A. "We will add green leafy vegetables to our child's low-iron formula."
- B. "We will discontinue the use of vitamin C supplements by 6 months of age."
- C. "We will begin an iron-fortified infant cereal at 4 to 6 months of age."
- D. "We will introduce cow's milk by 6 months of age."
Correct Answer: C
Rationale: The correct answer is C. Introducing iron-fortified cereal between 4 to 6 months of age is a recommended practice to prevent iron deficiency anemia in infants. Iron-fortified infant cereals are a good source of iron for infants. Choices A and B are incorrect because adding green leafy vegetables to low-iron formula and discontinuing vitamin C supplements do not directly address the prevention of iron deficiency anemia. Choice D is incorrect because cow's milk should be avoided before 12 months of age as it is low in iron and can lead to intestinal blood loss, increasing the risk of iron deficiency anemia.
The nurse is preparing a 9-year-old boy before obtaining a blood specimen by venipuncture. The child tells the nurse he does not want to lose his blood. What approach is best by the nurse?
- A. Explain that it will not be painful.
- B. Suggest to him that he not worry about losing just a little bit of blood.
- C. Discuss with him how his body is always in the process of making blood.
- D. Tell the child that he will not even need a Band-Aid afterward because it is a simple procedure.
Correct Answer: C
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
A parent brings their 2-year-old son in for a well visit. The nurse assesses his growth since the last appointment. Which finding should concern the nurse?
- A. Prominent abdomen
- B. Forward curve of the spine in the sacral area
- C. Increase in height of 5 inches in the past year
- D. Total weight gain of 15 lb in the past year
Correct Answer: D
Rationale: The correct answer is D. A total weight gain of 15 lb in one year for a 2-year-old is excessive and may indicate an underlying issue such as a metabolic disorder or overfeeding. This rapid weight gain can put the child at risk for health problems. Choices A, B, and C are not typically concerning findings in a 2-year-old. A prominent abdomen can be normal at this age due to a toddler's slightly protruding belly, a forward curve of the spine at the sacral area is a typical finding in young children, and an increase in height of 5 inches in a year is within the expected range of growth for a 2-year-old.
A 13-year-old boy comes to the school nurse complaining of sudden and severe scrotal pain. He denies any trauma to the scrotum. What is the most appropriate nursing action?
- A. Refer him for immediate medical evaluation
- B. Administer analgesics and recommend scrotal support.
- C. Apply an ice bag and observe for increasing pain.
- D. Reassure the adolescent that occasional pain is common with the changes of puberty.
Correct Answer: A
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
What amount of fluid loss occurs with moderate dehydration?
- A. <50 ml/kg
- B. 50 to 90 ml/kg
- C. <5% total body weight
- D. >15% total body weight
Correct Answer: B
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.