Nokea
Which of the following types of restraints is best for the nurse to use for a child in the immediate postoperative period after cleft palate repair?
- A. Safety jacket.
- B. Elbow restraints.
- C. Wrist restraints.
- D. Body restraints.
Correct Answer: B
Rationale: Elbow restraints are most appropriate post-cleft palate repair to prevent the child from touching or damaging the surgical site while allowing some mobility.
You may also like to solve these questions
The nurse assesses the assigned clients for the shift. Of the following assigned clients, which client is at greatest risk for falling?
- A. A 22-year-old man with three fractured ribs and a fractured left arm.
- B. A 70-year-old woman with episodes of syncope.
- C. A 50-year-old man with angina.
- D. A 30-year-old woman with a fractured ankle.
Correct Answer: B
Rationale: Syncope increases fall risk due to sudden loss of consciousness, particularly in an elderly client with potential comorbidities.
The nurse is assessing an infant diagnosed with bacterial meningitis. The nurse should ask the parent if the infant has which of the following? Select all that apply.
- A. Fever.
- B. Vomiting.
- C. Diarrhea.
- D. Poor feeding.
- E. Abdominal pain.
Correct Answer: A,B,D
Rationale: Bacterial meningitis in infants commonly presents with fever, vomiting, and poor feeding. Diarrhea and abdominal pain are less typical symptoms in this age group.
Which of the following terms is used to describe the sound, timely, smooth, unfragmented and seamless transition of the client from one level of acuity to another?
- A. Case management
- B. Continuity of care
- C. Medical necessity
- D. Critical pathway
Correct Answer: B
Rationale: Continuity of care refers to the seamless, coordinated transition of a client across different levels of care, ensuring consistent and effective treatment.
The nurse is ready to administer a partial fill of imipenem-cilastatin (Primaxin) in the I.V. pump when a full partial fill bag of imipenem-cilastatin is found hanging at the client's bedside. Which of the following is not appropriate to do by the nurse when recognizing that the previous dose was not administered 8 hours ago to the client with pneumonia?
- A. Discard the full partial fill of imipenem-cilastatin found hanging at the client's bedside.
- B. Check the identifying information of the full partial fill of imipenem-cilastatin found hanging at the client's bedside.
- C. Follow up on the legal documentation of the client's previous administration of imipenem-cilastatin.
- D. Administer the new partial fill of imipenem-cilastatin.
Correct Answer: A
Rationale: Discarding the medication without investigation is inappropriate; the nurse should verify, document, and address the error appropriately.
The nurse is reviewing the laboratory results of a client with hypothyroidism. An expected finding is:
- A. Decreased thyroxine (T4) and increased thyroid-stimulating hormone (TSH) levels
- B. Decreased TSH and increased T4 levels
- C. Decreased creatine phosphokinase levels
- D. Absence of antithyroid antibodies
Correct Answer: A
Rationale: Hypothyroidism is characterized by decreased thyroxine (T4) and increased TSH as the pituitary attempts to stimulate the thyroid. Other options are inconsistent with hypothyroidism.