Nokea
Which is the correct positioning of a child experiencing epistaxis:
- A. The child should be placed in a prone position
- B. The child should be placed in a supine position
- C. The child should be sitting with their head tilted back
- D. The child should sit up and lean forward
Correct Answer: D
Rationale: The correct positioning for a child experiencing epistaxis (nosebleed) is option D: the child should sit up and lean forward. This position helps prevent blood from flowing down the throat, reducing the risk of choking or aspiration. Sitting up also helps to reduce blood pressure in the vessels of the nose, aiding in the clotting process. Placing the child in a prone position (option A) can lead to blood flowing down the throat, causing potential airway obstruction. Placing the child in a supine position (option B) can also lead to blood going down the throat and may increase the risk of aspiration. Sitting with the head tilted back (option C) is not recommended as it can lead to blood running down the back of the throat and potentially into the airway. Therefore, option D is the correct choice for managing epistaxis in a child.
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Signs of digoxin toxicity include of the following (Select all that apply):
- A. Vomiting
- B. Poor feeding
- C. Constipation
- D. Bradycardia
Correct Answer: A,B,D
Rationale: The correct signs of digoxin toxicity are vomiting, poor feeding, and bradycardia. Vomiting is a common early sign due to the drug's effect on the gastrointestinal system. Poor feeding can occur as a result of nausea and anorexia. Bradycardia is a classic sign of digoxin toxicity due to its effect on cardiac function. Constipation is not typically associated with digoxin toxicity. In summary, A, B, and D are correct as they align with the expected symptoms of digoxin toxicity, whereas C is incorrect as constipation is not a common sign.
The nurse is caring for a school aged child in sickle cell crisis. Which interventions are appropriate for this patient? (Select all that apply)
- A. Application of a heating pad to the painful areas
- B. Start a Morphine PCA to provide pain relief for this patient
- C. Encourage patient to ambulate often to prevent pneumonia
- D. Hydrate patient with one-and-a-half-time maintenance fluid
Correct Answer: A,B,D
Rationale: Correct Answer: A, B, D
Rationale:
A: Application of a heating pad to the painful areas helps to relieve vaso-occlusive pain in sickle cell crisis by promoting vasodilation and increasing blood flow.
B: Starting a Morphine PCA is appropriate for pain management in sickle cell crisis as it provides controlled analgesia for the patient.
D: Hydrating the patient with one-and-a-half-time maintenance fluid helps prevent dehydration and maintain adequate blood flow, reducing the risk of vaso-occlusive episodes.
Incorrect Choices:
C: Encouraging the patient to ambulate often may not be suitable during a sickle cell crisis as it can increase the risk of pain and further complications.
E, F, G: No additional choices given, but typically options not directly related to pain management, hydration, or symptom relief would be incorrect in this scenario.
The nurse is caring for a child with frostbite would expect the patient to display:
- A. Redness and swelling of the hands
- B. Blisters that appear 24 to 48 hours after rewarming
- C. Itching and burning that persists after rewarming
- D. Fever
Correct Answer: B
Rationale: The correct answer is B because blisters appearing 24 to 48 hours after rewarming is a common symptom of frostbite. This occurs due to damage to the blood vessels and tissues. A: Redness and swelling are more indicative of mild frostbite. C: Itching and burning are not typical symptoms of frostbite. D: Fever is not a common symptom of frostbite.
A nurse is caring for a newborn whose mother was taking methadone during her pregnancy, which of the following findings indicates the newborn is experiencing withdrawal?
- A. Bulging fontanels
- B. Acrocyanosis
- C. Bradycardia
- D. Hypertonicity
Correct Answer: D
Rationale: The correct answer is D: Hypertonicity. Newborns exposed to opioids in utero often exhibit symptoms of withdrawal, known as Neonatal Abstinence Syndrome (NAS). Hypertonicity, or increased muscle tone, is a common sign of NAS. This occurs due to the withdrawal effects of methadone on the central nervous system. Bulging fontanels (A) are not typically associated with NAS. Acrocyanosis (B) is a common finding in newborns and not specific to NAS. Bradycardia (C) refers to a slow heart rate and is not a typical sign of NAS.
Congenital heart defects are classified as all of the following? (Select all that apply)
- A. Mixed defects
- B. Obstruction defects
- C. Decreased pulmonary blood flow
- D. Acquired defects
Correct Answer: A,B,C
Rationale: Congenital heart defects can be classified based on pathophysiology. A: Mixed defects involve combination of two types of abnormalities, B: Obstruction defects involve narrowing/blockage in blood flow, and C: Decreased pulmonary blood flow includes defects leading to decreased blood flow to lungs. D: Acquired defects result from external factors and not present at birth. E, F, G are not applicable as no information is provided. Thus, A, B, C are correct based on classification of congenital heart defects.