Nokea
Which is an important nursing consideration when chest tubes will be removed from a child?
- A. Explain that it is not painful.
- B. Explain that only a Band-Aid will be needed.
- C. Administer analgesics before the procedure.
- D. Expect bright red drainage for several hours after removal.
Correct Answer: C
Rationale: It is appropriate to prepare the child for the removal of chest tubes with analgesics. Short-acting medications can be used that are administered through an existing IV line. A sharp, momentary pain is felt. This should not be misrepresented to the child. A petroleum gauze, air-tight dressing will be needed, but it is not a pain-free procedure. Little or no drainage should be found on removal.
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Closure of the ductus will worsen following conditions
- A. Transposition of great vessels
- B. Tricuspid Atresia
- C. Hypoplastic Left heart syndrome
- D. Tetrology of Fallots
Correct Answer: C
Rationale: Closure of the ductus arteriosus worsens hypoplastic left heart syndrome by removing the only source of systemic circulation.
Toxoplasma gondii infection in humans causes:
- A. Oral ulcers
- B. Cervical lymphadenopathy
- C. Microcephaly
- D. Chorioretinitis
Correct Answer: D
Rationale: Chorioretinitis is a hallmark of congenital toxoplasmosis, leading to vision impairment.
Nurse Betina should begin screening for lead poisoning when a child reaches which age?
- A. 6 months
- B. 12 months
- C. 18 months
- D. 24 months
Correct Answer: B
Rationale: Screening for lead poisoning typically begins at 12 months, as children at this age are more likely to be exposed to lead through crawling and hand-to-mouth activities.
The parents of a young child with heart failure tell the nurse that they are “nervous†about giving digoxin (Lanoxin). The nurse’s response should be based on which statement?
- A. It is a safe, frequently used drug.
- B. It is difficult to either overmedicate or undermedicate with digoxin.
- C. Parents lack the expertise necessary to administer digoxin.
- D. Parents must learn specific, important guidelines for administration of digoxin.
Correct Answer: D
Rationale: Digoxin has a narrow therapeutic range. The margin of safety between therapeutic, toxic, and lethal doses is very small. Specific guidelines are available for parents to learn how to administer the drug safely and to monitor for side effects. Digoxin is a frequently used drug, but it has a narrow therapeutic range. Small amounts of the liquid are given to infants, making it easy to overmedicate or undermedicate. Parents may lack the necessary expertise to administer the drug at first, but with discharge preparation, they should be prepared to administer the drug safely.
A nurse assesses an older adult client who is experiencing a myocardial infarction. Which clinical manifestation should the nurse expect?
- A. Excruciating pain on inspiration
- B. Left lateral chest wall pain
- C. Disorientation and confusion
- D. Numbness and tingling of the arm
Correct Answer: C
Rationale: Older adults may present with atypical symptoms of myocardial infarction, such as confusion or disorientation, rather than classic chest pain.