Nokea
The nurse is teaching a class to pregnant teenagers. Which information is most important when discussing ways to prevent osteoporosis?
- A. Take at least 1,200 mg of calcium supplements a day.
- B. Eat foods low in calcium and high in phosphorus.
- C. Osteoporosis does not occur until around age 50 years.
- D. Remain as active as possible until the baby is born.
Correct Answer: D
Rationale: Staying active (weight-bearing exercise) during pregnancy builds bone density, preventing future osteoporosis. Calcium supplements are secondary, low-calcium diets are harmful, and age misconception ignores prevention.
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The client is taken to the emergency department with an injury to the left arm. Which intervention should the nurse implement first?
- A. Assess the nailbeds for capillary refill time.
- B. Remove the client's clothing from the arm.
- C. Call radiology for a STAT x-ray of the extremity.
- D. Prepare the client for the application of a cast.
Correct Answer: A
Rationale: Assessing capillary refill evaluates neurovascular status, the priority in arm injury to detect compromise. Clothing removal, x-rays, and casting follow assessment.
What is the expected Glasgow Coma Scale score for a child with a mild head injury?
- A. A score of 0 is not possible on the Glasgow Coma Scale. The lowest possible score is 3.
- B. A score of 3 on the Glasgow Coma Scale indicates that the child has an absent eye opening, verbal, and motor response. This score is not expected with a mild head injury.
- C. A score of 10 on the Glasgow Coma Scale indicates an altered eye opening, verbal, or motor response and would not be expected with a mild head injury.
- D. Glasgow Coma Scale scores range from 3 (no response) to 15 (normal response). A score of 15 indicates that brain function is intact. A child with a mild head injury should have intact neurological function.
Correct Answer: D
Rationale: A score of 15 on the Glasgow Coma Scale indicates intact neurological function, expected in a mild head injury.
Which statement by the client diagnosed with a fractured ulna indicates to the nurse the client needs further teaching?
- A. I need to eat a high-protein diet to ensure healing.'
- B. I need to wiggle my fingers every hour to increase circulation.'
- C. I need to take my pain medication before my pain is too bad.'
- D. I need to keep this immobilizer on when lying down only.'
Correct Answer: D
Rationale: Immobilizers must be worn continuously to stabilize a fractured ulna, not just when lying down. High-protein diet, finger movement, and proactive pain management are correct.
The nurse would be correct to request a consultation with a dietitian if the client chooses a meal that includes which food?
- A. Nuts
- B. Milk
- C. Eggs
- D. Liver
Correct Answer: D
Rationale: Liver is high in purines, which increase uric acid levels, worsening gout. Nuts, milk, and eggs are low-purine foods, suitable for a gout diet, necessitating a dietitian consultation for education.
Which information should the nurse teach the client regarding sports injuries?
- A. Apply heat intermittently for the first 48 hours.
- B. An injury is not serious if the extremity can be moved.
- C. Only return to the health-care provider if the foot becomes cold.
- D. Keep the injury immobilized and elevated for 24 to 48 hours.
Correct Answer: D
Rationale: Immobilization and elevation reduce swelling in sports injuries. Heat worsens swelling, movement does not rule out severity, and cold feet are a late sign.