Nokea
The parents of a young child ask the nurse for suggestions about discipline. When discussing the use of time-outs, which should the nurse include?
- A. Send the child to his or her room if the child has one.
- B. A general rule for length of time is 1 hour per year of age.
- C. Select an area that is safe and nonstimulating, such as a hallway.
- D. If the child cries, refuses, or is more disruptive, try another approach.
Correct Answer: C
Rationale: Time-outs should be in a safe, nonstimulating area, with the length typically being 1 minute per year of the child's age, not 1 hour.
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The nurse discovers welts on the back of a Vietnamese child during a home health visit. The child's mother says she has rubbed the edge of a coin on her child's oiled skin. The nurse should recognize this as what?
- A. Child abuse
- B. Cultural practice to rid the body of disease
- C. Cultural practice to treat enuresis or temper tantrums
- D. Child discipline measure common in the Vietnamese culture
Correct Answer: B
Rationale: This practice, known as "coining," is a cultural method believed to rid the body of illness and is not indicative of child abuse.
A child is admitted with renal failure. Which of these findings should the nurse expect?
- A. Decreased BUN
- B. Azotemia and oliguria
- C. Increased glomerular filtration rate (GFR)
- D. Polyuria and elevated creatinine clearance
Correct Answer: B
Rationale: Azotemia (elevated BUN and creatinine) and oliguria (reduced urine output) are classic signs of renal failure, indicating impaired kidney function. In renal failure, the kidneys are unable to effectively filter waste products, leading to an increase in BUN and creatinine levels in the blood. Additionally, oliguria occurs due to decreased kidney function. Increased GFR (Choice C) is not expected in renal failure as it signifies improved kidney function, which is not the case in renal failure. Polyuria and elevated creatinine clearance (Choice D) are not typical findings in renal failure. Polyuria is more commonly associated with conditions like diabetes insipidus, while elevated creatinine clearance would indicate increased kidney function, which is contrary to the impaired function seen in renal failure.
The nurse is conducting a teaching session for parents on nutrition. Which characteristics of families should the nurse consider that can cause families to struggle in providing adequate nutrition? (Select all that apply.)
- A. Homelessness
- B. Lower income
- C. Migrant status
- D. All of the above
Correct Answer: D
Rationale: Factors like homelessness, lower income, and migrant status can create barriers to providing adequate nutrition for children.
One of the most critical needs of the infant is control of body temperature. The nurse caring for a newborn warms all equipment that comes in direct contact with the newborn to help prevent which type of heat loss?
- A. Convection
- B. Evaporation
- C. Conduction
- D. Radiation
Correct Answer: C
Rationale: The correct answer is Conduction (choice C). Conduction heat loss occurs when the newborn's skin comes into direct contact with a cooler surface, so warming equipment helps prevent this. Choice A, Convection, is the transfer of heat through air or water currents, not direct contact. Choice B, Evaporation, is the loss of heat through moisture on the skin evaporating, not direct contact. Choice D, Radiation, is the transfer of heat in the form of waves or particles, not direct contact.
An adolescent states, "I want to be a doctor or a lawyer when I grow up because I like taking care of people." Which Eriksonian challenge is the adolescent attempting?
- A. Identity vs. role diffusion
- B. Trust vs. mistrust
- C. Industry vs. inferiority
- D. Autonomy vs. shame and doubt
Correct Answer: A
Rationale: The correct answer is A: Identity vs. role diffusion. During adolescence, individuals face the challenge of forming a cohesive sense of self and identity. In this scenario, the adolescent's desire to become a doctor or lawyer reflects the exploration of potential roles and career paths, indicating an attempt to establish a clear identity. Choices B, C, and D are incorrect. Trust vs. mistrust is a challenge experienced in infancy, industry vs. inferiority is relevant to the school-age period, and autonomy vs. shame and doubt is associated with the toddler stage, not adolescence.