Nokea
What will the nurse teach parents when giving instructions for acute conjunctivitis?
- A. Apply cool compresses to the affected eye several times a day.
- B. Instill topical steroid eyedrops for 1 week.
- C. Clear drainage from the inner to the outer aspect of the eye.
- D. Keep the eye patched until the inflammation resolves.
Correct Answer: C
Rationale: Eye secretions are always cleared from the inner canthus downward and away from the opposite eye.
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What will the nurse include when documenting a grand mal seizure? (Select all that apply.)
- A. Presence of incontinence
- B. Current dose of antispasmodic medication
- C. Activity level prior to and following seizure
- D. Level of consciousness following seizure
- E. Length of seizure
Correct Answer: A,C,D,E
Rationale: Documentation on a seizure should include LOC following episode, activity prior to and following seizure, change in color, respiration, muscle tone, and length of seizure.
A child is brought to the emergency department after he fell and hit his head on the ground. Which nursing assessment suggests the child has a concussion?
- A. Sleepy but easily arousable
- B. Complaining of a stiff neck
- C. Cannot remember what happened to him
- D. Pupils react sluggishly to light
Correct Answer: C
Rationale: A concussion is a temporary disturbance of the brain that is immediately followed by a period of unconsciousness, often accompanied by a loss of memory of the events.
Which assessment finding in a child with meningitis should be reported immediately?
- A. Irregular respirations
- B. Tachycardia
- C. Slight drop in blood pressure
- D. Elevated temperature
Correct Answer: A
Rationale: Irregular respirations in conjunction with slowing heart rate and increasing blood pressure are reported immediately, because they could indicate increased intracranial pressure.
What intervention(s) would the nurse caring for a child with infectious meningitis include? (Select all that apply.)
- A. Isolation precautions
- B. Provision of brightly lit room
- C. Observation for increasing intracranial pressure
- D. Preparation for spinal tap
- E. Seizure precautions
Correct Answer: A,C,D,E
Rationale: All elements of nursing care listed in the options, except a brightly lit room, would be part of comprehensive care of a child with meningitis.
What does the nurse explain to parents of a child with febrile seizures?
- A. They occur when the body temperature exceeds 38.3?°C (101?°F).
- B. They can be prevented by anticonvulsant medication.
- C. They usually lead to the development of epilepsy.
- D. They occur when the temperature rises quickly.
Correct Answer: D
Rationale: Febrile seizures occur in response to a rapid rise in temperature, often above 38.8?°C (102?°F).