Nokea
What findings on physical assessment of a neonate would indicate the need for further evaluation?
- A. Nystagmus
- B. Epstein pearls
- C. Low-set ears
- D. Positive Babinski reflex
Correct Answer: C
Rationale: Low-set ears in a neonate suggest major abnormalities and should prompt further evaluation. The correct alignment of the top of the pinnae of the ear with the outer canthus of the eye is crucial. Nystagmus, an involuntary eye movement, is common in newborns and often resolves on its own. Epstein pearls, small cysts on the hard palate, are insignificant and disappear over time. A positive Babinski reflex is normal in infants up to 1 year of age. Therefore, the presence of low-set ears is the most concerning finding that requires immediate attention.
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During a well-child checkup, the parent of a 5-year-old child reports the child seems much smaller than the 2 older siblings did at this same age. A review of the medical record reveals that the child is 44 inches tall and weighs 42 pounds. What information should be included in the response by the nurse?
- A. The weight of your child at this time is within normal limits for this age but the child is moderately taller than other children this age.
- B. Your child is within the acceptable range for height but the child is significantly smaller in weight for this age.
- C. Your child is within normal limits for weight but the child is slightly shorter in stature than other children this age.
- D. Your child is slightly taller than other children this age but the child's weight is normal.
Correct Answer: D
Rationale: The correct answer is D. The child is slightly taller than average, but the weight is within normal limits. This information should be reassuring to the parent and provides insights into normal growth patterns. Choice A is incorrect as it inaccurately states that the child is taller than other children this age. Choice B is incorrect because the child's weight is actually within normal limits. Choice C is incorrect as it inaccurately states that the child is shorter in stature than other children this age.
What statement is an advantage of peritoneal dialysis compared with hemodialysis?
- A. Protein loss is less extensive.
- B. Dietary limitations are not necessary.
- C. It is easy to learn and safe to perform.
- D. It is needed less frequently than hemodialysis.
Correct Answer: C
Rationale: Peritoneal dialysis is generally easier to learn and can be safely performed at home. Although dietary limitations still apply, this method offers greater flexibility in treatment scheduling compared to hemodialysis, which often requires multiple weekly visits to a dialysis center.
What major complication is associated with a child with chronic renal failure?
- A. Hypokalemia
- B. Metabolic alkalosis
- C. Water and sodium retention
- D. Excessive excretion of blood urea nitrogen
Correct Answer: C
Rationale: Water and sodium retention is a major complication in chronic renal failure, leading to hypertension and edema. Hypokalemia and metabolic alkalosis are less common, and while BUN levels rise, retention rather than excretion is problematic in chronic renal failure.
The physician tells the parents of a 2-year-old that the child probably has RSV. The parents ask how the diagnosis will be confirmed. How should the nurse respond?
- A. We will swab your child's nose and send the secretions for testing.
- B. There is no specific test for RSV. The diagnosis is based on symptoms.
- C. We will send a viral culture to an outside lab for testing.
- D. There is no specific test for RSV. The diagnosis is based on symptoms.
Correct Answer: A
Rationale: The correct answer is A. RSV is typically diagnosed by swabbing the nose and testing the secretions. This method helps confirm the presence of the respiratory syncytial virus. Choice B is incorrect because while symptoms are important in diagnosis, specific tests like swabbing for RSV do exist. Choice C is incorrect as sending a viral culture to an outside lab is not the primary method for diagnosing RSV. Choice D is a duplicate of choice B and is incorrect for the same reasons.
Which finding suggests fluid volume deficit in an infant presenting with vomiting and diarrhea for 2 days?
- A. Increased blood pressure
- B. A sunken fontanel
- C. Decreased pulse rate
- D. Low urine specific gravity
Correct Answer: B
Rationale: A sunken fontanel is a classic sign of dehydration in infants, indicating a fluid volume deficit. In dehydration, the fontanel sinks due to decreased fluid volume in the body. Increased blood pressure (Choice A) is not typically associated with dehydration in infants. Decreased pulse rate (Choice C) is not a common finding in fluid volume deficit, as the body tries to increase the heart rate to compensate for decreased volume. Low urine specific gravity (Choice D) may be seen in dehydration, but it is not as specific or as easily observable as a sunken fontanel.