Nokea
The nurse is teaching a nursing student about standard precautions. Which statement made by the student indicates a need for further teaching?
- A. I will use precautions when I give an infant oral care
- B. I will use precautions when I change an infant's diaper
- C. I will use precautions when I come in contact with blood and body fluids
- D. I will use precautions when administering oral medications to a school-age child
Correct Answer: D
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
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An infant requires surgery for repair of a cleft lip. An important priority of the preoperative nursing care is which?
- A. Initiating discharge teaching
- B. Performing baseline physical and behavioral assessment
- C. Observing for allergic reactions to preoperative antibiotics
- D. Determining whether this defect exists in other family members
Correct Answer: B
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
An infant, age 6 months, has six teeth. The nurse should recognize that this is what?
- A. Normal tooth eruption
- B. Delayed tooth eruption
- C. Unusual and dangerous
- D. Earlier than expected tooth eruption
Correct Answer: D
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
The nurse is caring for an infant who was born 24 hr ago to a mother who received no prenatal care. The infant is a poor feeder but sucks avidly on his hands. Clinical manifestations also include hyperactive reflexes, tremors, sneezing, and a high-pitched shrill cry. What does the nurse consider as a possible diagnosis for this infant?
- A. Seizure disorder
- B. Narcotic withdrawal
- C. Placental insufficiency
- D. Meconium aspiration syndrome
Correct Answer: B
Rationale: In this case, the infant's symptoms are consistent with narcotic withdrawal. Infants exposed to drugs in utero may display withdrawal symptoms starting around 12 to 24 hours post-birth. The presentation often includes hyperactive reflexes, tremors, sneezing, high-pitched shrill cry, poor feeding, and sucking avidly on hands. Signs such as loose stools, tachycardia, fever, projectile vomiting, sneezing, and generalized sweating are common. These symptoms are not indicative of a seizure disorder. Placental insufficiency typically leads to a small-for-gestational-age child, which is not mentioned in the scenario. Meconium aspiration syndrome primarily presents with respiratory distress, not the symptoms described in this case.
As children grow and develop, their style of play changes. Which play style is descriptive of the school-age child?
- A. Plays alone but not with other children
- B. Plays games with other children and is able to follow the rules of the game
- C. Plays alone with play directed by others
- D. Plays with others in loose groups
Correct Answer: B
Rationale: The correct answer is B. School-age children are typically able to play structured games with other children and follow the rules of the game. This ability reflects their growing cognitive and social development. Choice A is incorrect as school-age children often engage in group play. Choice C is incorrect as school-age children usually have more autonomy in their play choices. Choice D is incorrect as school-age children tend to form more organized play settings rather than loose groups.
In teaching parents about appropriate pacifier selection, the nurse should recommend which characteristic?
- A. Easily grasped handle
- B. Detachable shield for cleaning
- C. Soft, pliable material
- D. Ribbon or string to secure to clothing
Correct Answer: A
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.