Nokea
Which withdrawal symptom is the nurse most likely to note while observing the newborn of a mother who used heroin during pregnancy?
- A. Tremors
- B. Lethargy
- C. Poor feeding
- D. High-pitched cry
Correct Answer: A,C,D
Rationale: Tremors, poor feeding, and high-pitched cry are common symptoms of neonatal opioid withdrawal.
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What is the best guidance the nurse can give the mental health technician caring for the anorectic client?
- A. Blend the food and administer it by tube feeding.
- B. Remind the client that the intake is being recorded.
- C. Review the treatment goals with the client again.
- D. Remove the food without making any comments.
Correct Answer: D
Rationale: Removing food without comment avoids power struggles and maintains neutrality.
Which nursing approach is most appropriate to encourage the maximum level of independence possible?
- A. Allowing the teen to select the foods for his or her diet
- B. Answering all the teen's medical questions
- C. Exaggerating the teen's accomplishments
- D. Assuming blame for the teen's condition
Correct Answer: A
Rationale: Allowing food choices promotes autonomy within safe boundaries.
Which information is most appropriate for the nurse to collect at this time?
- A. The infant's weight and length
- B. The infant's breath and heart sounds
- C. The infant's head and chest circumference
- D. The infant's sucking and grasp reflexes
Correct Answer: A
Rationale: Weight and length assess growth and potential failure to thrive, relevant to the mother's concern.
When planning care for an autistic child, which nursing intervention is most appropriate?
- A. Providing interactive play activities
- B. Applying soft restraints while in bed
- C. Using a consistent caregiver
- D. Rocking the child as a calming technique
Correct Answer: C
Rationale: Consistency reduces anxiety in autistic children.
Which statement regarding hospital admittance is most accurate?
- A. The client cannot be committed involuntarily unless the client is uncooperative at this time.
- B. The client cannot be committed involuntarily unless the client poses harm to self or others.
- C. The client cannot be committed involuntarily unless the client cancels office appointments.
- D. The client cannot be committed involuntarily unless the client refuses to take medications.
Correct Answer: B
Rationale: Involuntary commitment requires evidence of harm to self or others.