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The nurse is caring for an adolescent with scoliosis who is recovering after a surgical spinal instrumentation. Which technique should the nurse use when moving the client?
- A. Flex the knees.
- B. Raise the hips.
- C. Cross the arms and legs.
- D. Perform a log roll.
Correct Answer: D
Rationale: Log rolling maintains spinal alignment, protecting the surgical site during movement.
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A nurse is providing care for a toddler diagnosed with autism spectrum disorder and failure to thrive. What strategy should the nurse employ?
- A. Propose food even if the child shows no interest.
- B. Integrate play activities during meal times.
- C. Establish regular meal times.
- D. Permit a variety of food options.
Correct Answer: C
Rationale: Regular meal times provide structure, aiding nutrition in autism spectrum disorder.
The parents of a child who is diagnosed with Wilm's tumor ask the nurse why surgery is necessary before a biopsy is performed. What information should the nurse provide?
- A. The surgery provides a visualization of other pathology and dysfunction of the kidney.
- B. Surgery is necessary to stage the tumor and determine metastasis to other sites.
- C. Metal clips are surgically applied at the tumor site for exact marking for radiation.
- D. Biopsy may rupture the encapsulated tumor and cause the cancer cells to spread.
Correct Answer: D
Rationale: Biopsy risks rupturing the tumor, potentially spreading cancer cells.
The nurse is evaluating a preschool-aged child who is presenting with symptoms of flank pain, dysuria, and a low-grade fever. What additional information should the nurse obtain from the parent to determine if the child might have a urinary tract infection?
- A. Frequency of urination
- B. Any recent changes in diet
- C. Presence of any unusual odors in the urine
- D. Any changes in the color of the urine
Correct Answer: A
Rationale: Increased urination frequency is a common UTI symptom in children, aiding diagnosis.
During a routine clinic visit, a nurse finds that a 5-year-old girl's systolic blood pressure is above the 90th percentile. What should be the nurse's subsequent action?
- A. Refer the child to the healthcare provider and schedule a blood pressure evaluation in two weeks.
- B. Perform a comprehensive assessment and avoid repeated blood pressure measurements during the examination.
- C. Take the child's blood pressure three times during the visit and record the highest reading.
- D. Measure the blood pressure twice more during the visit and calculate the average of the three readings.
Correct Answer: D
Rationale: Averaging three readings ensures accuracy of elevated blood pressure findings.
The nurse is planning care for a 16-year-old, who has juvenile idiopathic arthritis (JIA). The nurse includes activities to strengthen and mobilize the joints and surrounding muscle. Which physical therapy regimen should the nurse encourage the adolescent to implement?
- A. Exercise in a swimming pool.
- B. Begin a training program lifting weights and running.
- C. Perform passive range of motion exercises twice daily.
- D. Splint affected joints during activity.
Correct Answer: A
Rationale: Exercising in a swimming pool is low-impact, reduces joint stress, and improves strength and mobility, making it ideal for JIA.