Nokea
When preparing to obtain a neonatal screening test for phenylketonuria (PKU), the neonate must have received which of the following to ensure reliable results?
- A. A feeding of an iron-rich formula.
- B. Nothing by mouth for 4 hours before the test.
- C. Initial formula or breast milk at least 24 hours before the test.
- D. A feeding of glucose water.
Correct Answer: C
Rationale: PKU screening requires protein intake (breast milk or formula) for 24 hours to detect elevated phenylalanine levels. Iron-rich formula, fasting, or glucose water are inadequate.
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The parents of an 18-year-old preparing to enter college ask if their daughter should have the meningococcal (MCV4) vaccine. The nurse should tell the parents:
- A. It is only necessary to have the vaccine if your daughter will be living in a dormitory.'
- B. We recommend the vaccine, but it needs to be given as a series of three injections.'
- C. Let's review your records. The vaccine may have already been given a few years ago.'
- D. We highly recommend this vaccine, but we will need to do a pregnancy screening first.'
Correct Answer: C
Rationale: Checking vaccination records confirms whether the MCV4 vaccine, recommended for adolescents, was previously administered.
When developing a recreational therapy plan of care for a 3-year-old child hospitalized with pneumonia and cystic fibrosis, which of the following toys would be appropriate?
- A. 100-piece jigsaw puzzle.
- B. Child's favorite doll.
- C. Fuzzy stuffed animal.
- D. Scissors, paper, and paste.
Correct Answer: B
Rationale: A child's favorite doll is appropriate for a 3-year-old, providing comfort and familiarity without posing a risk of irritation or infection, unlike fuzzy stuffed animals which can harbor dust or bacteria.
After teaching the parents of a toddler about commonly aspirated foods, which of the following foods, if identified by the parents as easily aspirated, would indicate the need for additional teaching?
- A. Popcorn.
- B. Raw vegetables.
- C. Round candy.
- D. Crackers.
Correct Answer: D
Rationale: Popcorn, raw vegetables, and round candy are commonly aspirated due to their size, shape, or texture, posing a choking risk. Crackers, while a potential choking hazard, are less commonly associated with aspiration compared to the others, indicating the parents may need further clarification on specific risks.
Which statements by the mother of a toddler should lead the nurse to suspect that the child is at risk for iron deficiency anemia?
- A. He drinks over three cups of milk per day.
- B. I can't keep enough apple juice in the house; he must drink over 10 oz per day.
- C. He refuses to eat more than two different kinds of vegetables.
- D. He doesn't like meat; I don't think that he will eat small amounts of it.
- E. He sleeps 12 hours every night and takes a 2-hour nap.
Correct Answer: A,C,D
Rationale: Excess milk, limited vegetables, and low meat intake reduce iron intake, increasing anemia risk. Apple juice and sleep patterns are unrelated.
The nurse should teach the mother of a child who has a new cast for a fractured radius to do which of the following for the first few days at home?
- A. Use a hair dryer to dry the cast more quickly.
- B. Have the child refrain from strenuous activities.
- C. Check movement and sensation of the child's fingers once a day.
- D. Administer acetaminophen every 8 to 12 hours for discomfort.
Correct Answer: B
Rationale: Refraining from strenuous activities prevents damage to the cast and supports healing during the initial recovery period.