Nokea
The nurse mentions that a group meeting for mothers of mentally retarded children is to be held soon. 'Not retarded!' the child's mother angrily blazes, 'Exceptional.' When responding to this outburst, which of the following replies by the nurse would be most appropriate?
- A. Retarded' is the commonly used and accepted term.'
- B. I'm sorry if I offended you by my thoughtless remark.'
- C. No matter what it's called, the condition is still the same, isn't it?'
- D. I'd like to hear more of your thoughts and feelings on that.'
Correct Answer: D
Rationale: Inviting the mother to share her feelings promotes therapeutic communication and addresses her emotional response sensitively.
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When teaching the parents of an infant how to perform back slaps to dislodge a foreign body, which of the following should the nurse tell the parents to use to deliver the blows?
- A. Palm of the hand.
- B. Heel of the hand.
- C. Fingertips.
- D. Entire hand.
Correct Answer: B
Rationale: The heel of the hand is used to deliver back slaps in infants to effectively dislodge a foreign body without causing injury.
A 15-year-old has been diagnosed with acute glomerulonephritis and has been in the hospital for 1 day. Which of the following findings requires immediate action?
- A. Large amount of generalized edema.
- B. Urine specific gravity of 1.030.
- C. Large amount of albumin in the urine.
- D. 24-hour output of 1,500 mL.
Correct Answer: A
Rationale: Severe edema could indicate worsening condition.
When discussing the onset of adolescence with parents, the nurse explains that it occurs at which of the following times?
- A. Same age for both boys and girls.
- B. 1 to 2 years earlier in boys than in girls.
- C. 1 to 2 years earlier in girls than in boys.
- D. 3 to 4 years later in boys than in girls.
Correct Answer: C
Rationale: Girls typically enter puberty 1-2 years earlier than boys, around ages 10-12.
When explaining to the parents of a child with a hydrocele about the possible cause of the condition, the nurse bases this explanation on the interpretation that a hydrocele is most likely the result of which condition?
- A. Blockage in the inguinal canal that allows fluid to accumulate in epididymis and ductus deferens.
- B. Failure of the upper part of the processus vaginalis to atrophy, allowing accumulation of fluid in the testicle and the peritoneal cavity.
- C. A patent processus vaginalis that results in the collection of fluid along the spermatic cord or tunica vaginalis of the testicle.
- D. An obliterated processus vaginalis that allows fluid to accumulate in the scrotal sac.
Correct Answer: C
Rationale: Patent processus vaginalis leads to fluid collection.
A 10-year old child is admitted to the hospital with complications related to chickenpox. The nurse should do which of the following to prevent the transmission of the infection to other children on the unit? Select all that apply.
- A. Place the child on contact isolation.
- B. Wear a gown, mask, and gloves before entering the room.
- C. Place the child in a room with a 10-year-old who has had chickenpox.
- D. Place the child in a negative air-flow room.
- E. Maintain isolation until lesions have disappeared.
Correct Answer: A,B,C,E
Rationale: Chickenpox requires contact and airborne precautions (gown, mask, gloves) and isolation until lesions crust. Rooming with an immune child reduces risk. Negative airflow is for diseases like tuberculosis.