Nokea
When the nurse performs the initial assessment of an adolescent with depression, what is the most important question to ask?
- A. What is making you depressed?
- B. Have you ever thought about suicide?
- C. What could we do to make you happy?
- D. Would you like your friends to visit?
Correct Answer: B
Rationale: Ask direct questions about suicidal thoughts. The discovery of whether the person has an actual plan is an indicator of the seriousness of the situation.
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Following surgical repair of a cleft palate, what should be used to prevent injury to the suture line?
- A. Straw
- B. Spoon
- C. Syringe
- D. Cup
Correct Answer: D
Rationale: When feeding a child with a repaired cleft palate, the nurse should avoid utensils, straws, droppers, and syringes.
A teenage girl has been placed in a brace for the treatment of scoliosis, the most common skeletal deformity of adolescence. The family asks what they can do to be more supportive. What suggestion of the nurse is the most appropriate?
- A. Enrolling her in a health club
- B. Taking her to the mall in a wheelchair
- C. Purchasing clothes to disguise the cast
- D. Spending a majority of their time with her
Correct Answer: C
Rationale: The adolescent is trying to fit in with peers and has concerns about body image.
What should the nurse caring for a 6-year-old child with acute glomerulonephritis anticipate as the most difficult part of the care to implement?
- A. Forced fluids
- B. Increased feedings
- C. Bed rest
- D. Frequent position changes
Correct Answer: C
Rationale: During the acute phase of glomerulonephritis, bed rest is usually recommended. A diet of restricted fluid, sodium, potassium, and phosphate is initially required. Bed rest can be very hard to implement with an active 6-year-old child.
When performing an assessment of a child with recurrent abdominal pain (RAP), the nurse recognizes the child will most likely experience what symptom?
- A. Increased temperature
- B. Constipation
- C. Right quadrant pain
- D. Exercise-associated pain
Correct Answer: B
Rationale: The child may be constipated with periumbilical pain unrelated to eating, defecation, or exercise.
The nurse explains to the parents of a child with developmental hip dysplasia that the application of a Pavlik harness is necessary. In what position will the harness hold the child's femurs?
- A. Abduction
- B. Adduction
- C. Flexion
- D. Extension
Correct Answer: A
Rationale: The use of the Pavlik harness maintains the hips in abduction for 4 to 6 months.