Nokea
Which of the following meals would be most appropriate for a 15-year-old with glomerulonephritis with severe hypertension?
- A. Egg noodles, hamburger, canned peas, milk.
- B. Baked ham, baked potato, pear, canned carrots, milk.
- C. Baked chicken, rice, beans, orange juice.
- D. Hot dog on a bun, corn chips, pickle, cookie, milk.
Correct Answer: C
Rationale: Low-sodium diet is recommended.
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After a plaster cast has been applied to the arm of a child with a fractured right humerus, the nurse completes discharge teaching. The nurse should evaluate the teaching as successful when the mother agrees to seek medical advice if the child experiences which of the following?
- A. Inability to extend the fingers on the right hand.
- B. Vomiting after the cast is applied.
- C. Coolness and dampness of the cast after 5 hours.
- D. Fussiness with complaints that the cast is heavy.
Correct Answer: A
Rationale: Inability to extend fingers suggests possible nerve or circulatory compromise, requiring immediate medical attention.
A 10-year-old with scoliosis has to wear a brace. The nurse should develop a teaching plan with the client to include which of the following instructions?
- A. Wear the brace during waking hours.
- B. Wear the brace only during sleep.
- C. Wear a form-fitting, sleeveless T-shirt under the brace.
- D. Bathe the skin under the brace once per week.
Correct Answer: A,C
Rationale: The brace should be worn during waking hours for maximum effectiveness, and a form-fitting T-shirt helps protect the skin and improve comfort.
An adolescent is on the football team and practices in the morning and afternoon before school starts for the year. The temperature on the field has been high. The school nurse has been called to the practice field because the adolescent is now reporting that he has muscle cramps, nausea, and dizziness. Which of the following actions should the school nurse do first?
- A. Administer cold water with ice cubes.
- B. Take the adolescent's temperature.
- C. Have the adolescent go to the swimming pool.
- D. Move the adolescent to a cool environment.
Correct Answer: D
Rationale: The symptoms suggest heat exhaustion, and the first priority is to move the adolescent to a cool environment to prevent further heat-related complications.
The toddler with nephrotic syndrome exhibits generalized edema. Which of the following measures should the nurse institute for this child with a nursing diagnosis of Impaired skin integrity related to edema?
- A. Ambulate every shift while awake.
- B. Apply lotion on opposing skin surfaces.
- C. Apply powder to skinfolds.
- D. Separate opposing skin surfaces with soft cloth.
Correct Answer: D
Rationale: Prevent skin breakdown.
The nurse manager on a pediatric floor is reviewing national sentinel event alerts and preparing recommendations for the unit. Which strategy would help reduce pediatric medication errors? Select all that apply.
- A. Eliminate the pediatric satellite pharmacy.
- B. Increase the steps in the medication administration procedure.
- C. Utilize only oral syringes to administer oral medication.
- D. Limit the size of I.V. fluid bags that can be hung on small children.
- E. Reduce the available concentrations or dose strengths to the minimum.
Correct Answer: C,D,E
Rationale: Oral syringes ensure accurate dosing, smaller IV bags prevent fluid overload, and fewer concentrations reduce dosing errors.