Nokea
When planning the client's discharge, the nurse must help the client obtain which essential piece of equipment for home care?
- A. A wheelchair
- B. A hospital bed
- C. A raised toilet seat
- D. A mechanical lift
Correct Answer: C
Rationale: A raised toilet seat prevents excessive hip flexion, reducing dislocation risk.
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Which statement to the nurse indicates a good understanding by the client of the use of methotrexate and cyclosporine?
- A. I am having an exacerbation of symptoms so two medications are needed.
- B. Cyclosporine is given to enhance the effect of the methotrexate.
- C. Methotrexate and cyclosporine together decrease unwanted side effects.
- D. My symptoms are severe enough to indicate the use of two strong medications.
Correct Answer: D
Rationale: Severe symptoms justify the use of two potent immunosuppressive drugs.
The client continues to recover following a below-the-knee amputation. What nursing action should the nurse employ to help prevent the most common complication following leg amputation?
- A. Clean the wound with hydrogen peroxide three times a day
- B. Have the client lie prone several times a day
- C. Ask the client to flex and extend the toes on the remaining leg
- D. Encourage the client to completely empty his/her bladder
Correct Answer: B
Rationale: Lying prone prevents hip flexion contractures, the most common complication post-amputation.
Which explanation by the nurse can best help this client understand the injury that has occurred?
- A. One bone end is driven into the other.
- B. One bone end is driven into the other.
- C. There is no open break in the skin.
- D. A portion of the bone is split away.
Correct Answer: C
Rationale: A comminuted fracture involves the bone breaking into multiple fragments, often without an open skin break. The description 'no open break in the skin' distinguishes it from a compound fracture, while the other options describe impacted or avulsion fractures.
Which type of seizure involves a brief loss of awareness and minor motor movements such as eye blinking?
- A. Myoclonic seizure involves muscle movement and not just loss of awareness.
- B. Febrile seizures occur when the child's temperature is excessively elevated and usually includes tonic-clonic muscle movement.
- C. An absence seizure is a generalized seizure (involving loss of awareness) that might involve minor motor movements (e.g., eye blinking). The child appears to be staring.
- D. Atonic means absence of tone and would involve loss of muscle control and not eye blinking, which requires muscle control.
Correct Answer: C
Rationale: Absence seizures are characterized by brief loss of awareness and minor motor movements like eye blinking, with the child appearing to stare.
The nurse should plan to include information about which common practice that can increase the risk for developmental dysplasia of the hip (DDH)?
- A. Carrying a child in a backpack
- B. Carrying a child in a frontpack
- C. Swaddling of a child
- D. Extended time in a car seat
Correct Answer: C
Rationale: Tight swaddling can restrict hip movement and increase the risk of DDH.