What is an appropriate nursing intervention to minimize separation anxiety in a hospitalized toddler?
- A. Provide for privacy
- B. Encourage parents to room in
- C. Explain procedures and routines
- D. Encourage contact with children the same age
Correct Answer: B
Rationale: Encouraging parents to room in with the hospitalized toddler is an appropriate nursing intervention to minimize separation anxiety. This allows the child to maintain a sense of security and familiarity by having their primary caregivers close by. Having parents present can provide comfort, reassurance, and emotional support for the child during their hospital stay, which can help alleviate separation anxiety. Additionally, parents can continue to provide their usual care and routines for the child, further promoting a sense of stability and security.
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Which characteristic is representative of the newborn's gastrointestinal tract?
- A. Stomach capacity is approximately 90 ml.
- B. Peristaltic waves are relatively slow.
- C. Overproduction of pancreatic amylase occurs.
- D. Intestines are shorter in relation to body size.
Correct Answer: D
Rationale: The characteristic representative of the newborn's gastrointestinal tract is that the intestines are shorter in relation to the body size. This is because a newborn's gastrointestinal tract is still developing and adapting to the digestion and absorption of nutrients. The proportion of the intestines to the body size is smaller in newborns compared to adults. Over time, as the newborn grows and matures, the intestines will also lengthen and increase in capacity to efficiently process food and absorb nutrients.
An adult who has gastroenteritis and is on digitalis ha lab values of: K 3.2 mEq/L, Na 136 mEq/L, Ca 8.8 mg/dl, and Cl 98 mEq/L. the nurse puts which of the following on the client's plan of care?
- A. Stop digitalis therapy
- B. Observe for trousseau's and chovestek's
- C. Avoid foods rich in potassium signs
- D. Observe for digitalis toxicity
Correct Answer: C
Rationale: The client's low potassium level (K 3.2 mEq/L) is a cause for concern, especially in a patient on digitalis therapy. Digitalis (such as digoxin) can potentiate the effects of hypokalemia, leading to an increased risk of digitalis toxicity. Therefore, in this scenario, it is important to avoid foods rich in potassium to prevent further lowering of the potassium level. It is essential to address the electrolyte imbalance promptly to prevent potential complications related to digitalis therapy.
A client is undergoing a diagnostic work-up for suspected testicular cancer. When obtaining the client's history, the nurse checks for known risk factors for this type of cancer. Testicular cancer has been linked to:
- A. Testosterone therapy during childhood
- B. Early onset of puberty
- C. Sexually transmitted disease
- D. Cryptorchidism
Correct Answer: D
Rationale: Cryptorchidism, also known as undescended testicle, is a known risk factor for testicular cancer. Men who had cryptorchidism, a condition where one or both testicles fail to descend into the scrotum before birth, have a higher risk of developing testicular cancer compared to those without this condition. The abnormal positioning of the testicle outside the scrotum may disrupt normal testicular development and increase the likelihood of malignant transformation. Therefore, clients with a history of cryptorchidism are at increased risk for testicular cancer and warrant close monitoring and follow-up.
Which of the ff statements justifies the administration of the prescribed anticonvulsant phenytoin to a client before the intracranial surgery?
- A. To reduce the risk of seizures before and after surgery
- B. To avoid intraoperative complications
- C. To reduce cerebral edema
- D. To prevent postoperative vomiting
Correct Answer: A
Rationale: The correct statement justifying the administration of the prescribed anticonvulsant phenytoin to a client before intracranial surgery is "To reduce the risk of seizures before and after surgery." Patients undergoing intracranial surgery are at an increased risk of seizures due to the manipulation of the brain tissue and the potential for increased intracranial pressure during the procedure. Administering an anticonvulsant like phenytoin before surgery helps reduce the risk of seizures both during the surgery and in the postoperative period. This proactive approach not only protects the patient from the potential harm associated with seizures but also contributes to a smoother recovery process.
Why should the nurse wake up a client who is to undergo an EEG at midnight?
- A. Because excess sleep may make the client lazy and nervous for the EEG
- B. Because optimum sleep helps regulate the breathing patterns during the EEG
- C. Because it helps the client to fall asleep naturally during the EEG
- D. Because it reduces the chances of getting a headache when electrodes are fixed to the scalp of the client
Correct Answer: B
Rationale: The nurse should wake up a client who is to undergo an EEG at midnight to ensure that the client receives optimum sleep before the procedure. Optimum sleep helps regulate the client's breathing patterns during the EEG, resulting in more accurate readings. Adequate rest is essential for brain activity monitoring to be as normal as possible. Waking the client at midnight allows for enough time for the client to fall back asleep before the EEG is conducted, ensuring the best possible conditions for the procedure.