Children final flash cards study 20

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A school nurse identifies that a child has pediculosis capitis and educates the child's parents about the condition. Which of the following statements by the parents indicates an understanding of the teaching? "All recently used clothing, bedding, and towels must be washed in hot water." "My child must be free from nits before returning to school." "I will treat all the family members to be on the safe side." "Toys that can't be dry cleaned or washed must be thrown out."

"All recently used clothing, bedding, and towels must be washed in hot water."

A nurse reports an incident of suspected child abuse. One of the parents of the child becomes upset and demands to know the reason for the nurse's action. Which of the following responses by the nurse is appropriate? "As a nurse, I am required by law to report suspected child abuse." "I am unable to discuss this, but I can contact my supervisor to speak with you." "The provider will be coming to explain the situation." "I reported the incident to my supervisor who decided to contact the authorities."

"As a nurse, I am required by law to report suspected child abuse."

A parent calls a clinic and reports to a nurse that his 2-month-old infant is hungry more than usual but is projectile vomiting immediately after eating. Which of the following responses should the nurse make? "Burp your baby more frequently during feedings." "Bring your baby in to the clinic today." "Give your infant an oral rehydration solution." "Try switching to a different formula."

"Bring your baby in to the clinic today."

A nurse is obtaining a health history from a child who has suspected acute rheumatic fever. Which of the following questions should the nurse ask? "Has your son had a sore throat recently?" "Was your son born with this cardiac defect?" "Has your child had any injuries recently?" "Have you given your child aspirin in the past 2 weeks?"

"Has your son had a sore throat recently?"

A nurse is teaching a parent of a child who has hemophilia how to control a minor bleeding episode. Which of the following statements by the parent indicates a need for further teaching? "I will have my child rest." "I will elevate the affected part." "I will compress the site." "I will apply heat."

"I will apply heat."

A nurse is providing teaching to the parent of an infant who has gastroesophageal reflux. Which of the following statements by the parent indicates an understanding of the teaching? "I will keep my baby in an upright position after feedings." "My baby's formula can be thickened with oatmeal." "I will have to feed my baby formula rather than breast milk." "I should position my baby side-lying during sleep."

"I will keep my baby in an upright position after feedings."

A nurse is providing teaching to a parent of a child who has Hirschsprung disease is scheduled for initial surgery. Which of the following statements by the parent indicates an understanding of the teaching? "I'm glad that my child's ostomy is only temporary." "I'm glad my child will have normal bowel movements now." "I want to learn how to use my child's feeding tube as soon as possible." "I want to learn how to empty my child's urinary catheter bag."

"I'm glad that my child's ostomy is only temporary."

The parent of a 4-year-old child tells a nurse that the child believes there are monsters hiding in the closet at bedtime. Which one of the following statements should the nurse make? "Let your child sleep in your bed with you." "Keep a night light on in your child's room." "Tell your child that monsters are not real." "Stay with your child until the child is asleep."

"Keep a night light on in your child's room."

A nurse is teaching the mother of a child who has cystic fibrosis and has a prescription for pancreatic enzymes three times per day. Which of the following statements indicates that the mother understands the teaching? "My child will take the enzymes to improve her metabolism." "My child will take the enzymes following meals." "My child will take the enzymes to help digest the fat in foods." "My child will take the enzymes 2 hours before meals."

"My child will take the enzymes to help digest the fat in foods."

A nurse is caring for a newborn whose mother voices concerns about sudden infant death syndrome (SIDS). The nurse should include which of the following statements in a discussion with the mother? "Placing your child on her back when sleeping will decrease the risk of SIDS." "SIDS is directly correlated with the diphtheria, tetanus, and pertussis vaccines." "SIDS rates have been rising over the last 10 years." "Sleep apnea is the main cause of SIDS."

"Placing your child on her back when sleeping will decrease the risk of SIDS."

A nurse is obtaining vital signs from 2-month-old infant. The infant's heart rate is 190/min and his temperature is 40° C (104° F). The father asks the nurse why the infant's heart is beating so fast. Which of the following responses by the nurse is appropriate? "This is within the expected range for your baby." "The fever is causing an increase in your baby's heart rate." "As your baby begins to fall asleep, his heart rate will decrease." "Your baby's heart is beating fast in an attempt to cool down his body."

"The fever is causing an increase in your baby's heart rate."

A nurse is teaching an assistive personnel to measure a newborn's respiratory rate. Which of the following statements indicates an understanding of why the respiratory rate should be counted for a complete minute? "Newborns are abdominal breathers." "Newborns do not expand their lungs fully with each respiration." "Activity will increase the respiratory rate." "The rate and rhythm of breath are irregular in newborns."

"The rate and rhythm of breath are irregular in newborns."

A nurse is caring for a child who was admitted with suspected rheumatic fever. The provider prescribes an anti-streptolysin O (ASO) titer. The parent asks the nurse the purpose of the test. Which of the following responses should the nurse make? "This test will indicate if your child has rheumatic fever." "This test will confirm if your child had a recent streptococcal infection." "This test will indicate if your child has a therapeutic blood level of an aminoglycoside." "This test will confirm if your child has immunity to streptococcal bacteria."

"This test will confirm if your child had a recent streptococcal infection."

A nurse is providing discharge teaching about nutrition to the parents of a child who has cystic fibrosis (CF). Which of the following responses by the parents indicates an understanding of the teaching? "We will give our child pancreatic enzymes with snacks and meals." "We will restrict the amount of salt in our child's food." "I will limit my child's fluid intake." "I will prepare low-fat meals with limited protein for my child."

"We will give our child pancreatic enzymes with snacks and meals."

A nurse is providing teaching to the parents of a newborn. Which of the following information should the nurse include? "Your baby will receive a hepatitis B vaccine prior to discharge." "Your baby should receive the pneumococcal conjugate vaccine on his first birthday." "Your baby should receive the measles, mumps, rubella vaccine at 6 months." "Your baby will receive the first diphtheria, tetanus, pertussis vaccine at the 2 week well-baby visit."

"Your baby will receive a hepatitis B vaccine prior to discharge."

A nurse is providing nutritional teaching to the mother of a preschooler and is recommending food options to provide 1 oz of grains. Which of the following foods should the nurse recommend? 1 cup ready-to-eat cereal flakes ½ slice whole wheat bread 1 cup cooked rice ½ flour tortilla

1 cup ready-to-eat cereal flakes

A nurse is admitting a 6-month-old infant who has dehydration. Which of the following amounts of urinary output should indicate to the nurse that the treatment has corrected the fluid imbalance? 0.5 mL/kg/hr 2 mL/kg/hr 7.5 mL/kg/hr 15 mL/kg/hr

2 mL/kg/hr

A nurse participating in lead screening at a community center. The nurse should instruct parents to bring their children back for rescreening in a year for which of the following laboratory values? 4 mcg/dL 10 mcg/dL 18 mcg/dL 44 mcg/dL

4 mcg/dL

A nurse is preparing to administer acetaminophen 10mg/kg/dose to a child who weighs 28 lb. The amount available is acetaminophen 120mg/ 5mL. How many mL should the nurse administer? (Round the answer to the nearest tenth).

5.3 Ml

A nurse is collecting data from an infant at a well-child visit. The nurse should understand that birth weight typically doubles by what age? 3 months 6 months 9 months 12 months

6 months

A nurse is preparing to administer digoxin to a 6-month-old infant. Prior to administering the dose, the nurse measures the apical heart rate. The nurse should withhold the dose if the infant's apical heart rate is less than what rate?

90 /min

A nurse is reviewing data for four children. Which of the following children should the nurse assess first? A 10-year-old child who has sickle cell anemia who reports severe chest pain A 7-year-old child who has diabetes insipidus and a urine specific gravity of 1.016 A 1-year-old toddler who has roseola and a temperature of 39° C (102.2° F) A 4-year-old child who has asthma and a PCO2 of 37 mm Hg

A 10-year-old child who has sickle cell anemia who reports severe chest pain

A nurse is admitting a child who has leukemia. Which of the following clients should the nurse place in the same room with this child? A child recovering from a ruptured appendix A child who has nephrotic syndrome A child who has rheumatic fever A child who has cystic fibrosis

A child who has nephrotic syndrome

A nurse is providing care to children on a general pediatric unit. Which of the following children should the nurse identify as a potential victim of abuse? A child who has frequent visitors A child who has a BMI indicating obesity A child who uses the call light frequently A child whose parents answer questions for the child

A child whose parents answer questions for the child

A nurse is collecting data from an adolescent. Which of the following should the nurse identify as the greatest risk for suicide? Availability of firearms Family conflict Homosexuality Active psychiatric disorder

Active psychiatric disorder

A nurse on an antepartum unit is caring for a client. Vital Signs Nurses Notes Diagnostic Results Vital Signs BP: 144/92 mm Hg Pulse: 108/min apical Respiratory rate: 22/min Temperature: 36.6° C (97.9° F) temporal SpO2: 97%

Administer Rh immune globulin. Perform continuous external fetal monitoring. --Placental abruption- center Hourly urine output FHR

A nurse is caring for an 8-year-old child who has acute rheumatic fever. Which of the following assessments is the nurse's priority immediately after admission? Auscultating the rate and characteristics of the child's heart sounds Using a pain-rating tool to determine the severity of the joint pain Identifying the degree of parental anxiety related to the diagnosis Assessing the client's erythematous rash

Auscultating the rate and characteristics of the child's heart sounds

A nurse is caring for a child who has pertussis. The child's parent asks the nurse what the common name for this disease is. The nurse should respond with which of the following common names? A. Chickenpox B. Whooping cough C. Mumps D. Fifth disease

B. Whooping cough

A nurse is admitting a child who has leukemia and a critically low platelet count. Which of the following precautions should the nurse initiate? Neutropenic Bleeding Contact Droplet

Bleeding

A nurse in an emergency department is caring for an infant who has a 2-day history of vomiting and an elevated temperature. Which of the following should the nurse recognize as the most reliable indicator of fluid loss? Body weight Skin integrity Blood pressure Respiratory rate

Body weight

A nurse is monitoring an infant who is 3 months old and has sneezing, coughing, nasal congestion, intermittent fever, and apneic spells. These nurse should recognize these findings are associated with which of the following diagnoses? Influenza Bronchiolitis Croup Epiglottitis

Bronchiolitis

A nurse is assessing an 11-month-old infant. Which of the following manifestations is associated with a CNS infection? Oliguria Bulging fontanel Negative Brudzinski sign Jaundice

Bulging fontanel

A nurse is caring for a client who is 36 hr postpartum. Nurses Notes Vital Signs Medical History Nurses Notes 1130: Breasts soft, warm, and tender to touch. Client denies nipple or breast discomfort. Fundus boggy, located 1 cm above umbilicus, and deviated to the right. Fundus firm with massage. Client reports abdominal cramping and rates pain as 4 on a scale of 0 to 10. Perineal pad with moderate amount of lochia rubra. Assisted client to bathroom. Voided 250 mL yellow urine. Fundus midline, 1 cm above umbilicus. Fundus firm with massage. Client given prescribed analgesic. 1230: Client continues to report cramping and rates pain as 4 on a scale of 0 to 10. Fundus boggy, midline above the umbilicus. Fundus firms with fundal massage. Perineal pad saturated with lochia rubra and small clots expressed. Provider notified.

The complication that poses the greatest risk for the client is - hemorrhage as evidenced by their - amount of lochia .

A nurse is caring for a client who is in labor. Medical History Nurses' Notes Vital Signs Medical History Gravida 2, Para 1 26 years of age 38 weeks of gestation Gestational diabetes with current pregnancy that is managed with diet and frequent blood glucose monitoring Hydramnios with current pregnancy Spontaneous vaginal delivery 1 year ago with no complications.

The complication that poses the greatest risk to the client is - uterine atony due to - hydramnios .

A nurse is caring for a newborn who is 30 min old. Medical History Nurses' Notes Vital Signs Medical History Spontaneous vaginal delivery at 42 weeks gestation Meconium-stained fluid noted during labor Apgar scores: 8 at 1 min and 9 at 5 min .

The newborn has the greatest risk for developing -Meconium aspiration syndrome due to -Amniotic fluid .

A nurse is caring for a newborn who is 4 hr old. Vital Signs Nurses Notes Diagnostic Results Medical History 0800: Axillary temperature 36.5° C (97.7° F) Heart rate 132/min Respiratory rate 52/min

The newborn is at risk for developing - jaundice as evidenced by the - indirect Coombs test results

A nurse is caring for a newborn who is 4 hr old. Medical History Vital Signs Nurses' Notes Medical History Apgar scores: 8 at 1 min; 9 at 5 min Birth weight: 4,423 gm (9 lb 12 oz) Gestational age: 41 weeks Vacuum-assisted birth for large for gestational age term newborn Maternal urine toxicology screen: positive for marijuana (negative

The newborn most likely has - a clavicle fracture as evidenced by - Moro reflex

A nurse is caring for a 22-year-old female client who reports lower abdominal and pelvic pain. Vital Signs Provider's Prescriptions Nurses Notes Diagnostic Results Medication Administration Record 0900: Temperature 36.7° C (98.1° F) Heart rate 82/min Respirations 20/min Blood pressure 120/64 mm Hg Oxygen saturation 98% on room air 1 Week After Initial Visit, 1100: Temperature 36.9° C (98.4° F) Heart rate 78/min Respirations 18/min Blood pressure 122/67 mm Hg Oxygen saturation 99% on room air

The client is at risk for developing - pelvic inflammatory disease (PID) due to - recurring STI's

A nurse is caring for a client in the labor room. Medical History Nurses Notes Vital Signs Medical HistoryGravida 2 Para 1 38 weeks gestation Pregnancy complicated by gestational diabetes and hydramnios. Spontaneous vaginal delivery 1 year ago. No significant past medical history. No history of surgeries. Spontaneous onset of labor

The client is at the greatest risk for developing (a) - Postpartum hemorrhage due to - Hydramnios .

A nurse is monitoring a child for manifestations of hemorrhage following a tonsillectomy. Which of the following findings is a manifestation of this postoperative complication? Mouth breathing Frequent swallowing Reports of thirst Reports of pain

frequent swallowing

A nurse is assessing a toddler at a well-child visit. At what point in the physical examination should the nurse examine the child's tympanic membrane? At the end At the beginning Before examining the head and neck Before auscultating the chest and abdomen

At the end

A nurse is caring for a child who has tinea pedis. The child's parent asks the nurse what this infection is commonly called. The nurse should respond with which of the following common names? Shingles Athlete's foot Fever blister Valley fever

Athlete's foot

A nurse is caring for a client who is at 34 weeks of gestation. Medical History Vital Signs Medication Administration Record Physical Examination Diagnostic Results Medical History Client is a 41-year-old Gravida 4 Para 3 .History of gestational diabetes mellitus, preeclampsia with previous pregnancy, and chronic hypertension for 5 years. Admitted to antepartum unit from provider's office with elevated blood pressure, 3 + edema in lower extremities, 3+ proteinuria.

Implement seizure precautions. Check deep tendon reflexes every hour. --Preeclampsia- Center Neurologic status Liver function studies

A nurse is assessing a 3-month-old infant. Which of the following findings should the nurse report to the provider? Inability to raise head when in prone position Inability to sit without support Inability to pick up an object with her fingers Inability to bring an object to her mouth

Inability to raise head when in prone position

A nurse is caring for a client who is 2 days postpartum. Medical History Vital Signs Medication Administration Record Physical Examination Medical History Client is a Gravida 4 Para 3 who had a forceps-assisted birth with epidural anesthesia at 40 weeks of gestation. Second degree mediolateral perineal laceration with repair. Placenta manually extracted. Estimated blood loss 600 mL.

Initiate intravenous infusion of oxytocin. Administer methylergonovine. --Subinvolution of uterus- center Hemoglobin and hematocrit Number of saturated perineal pads

A nurse is preparing to perform an abdominal assessment on a child. Identify the sequence the nurse should follow.

Inspection Auscultation Superficial palpitation Deep palpitation

A nurse is caring for a male infant who has a palpable mass in the upper right quadrant and stools mixed with blood and mucus. The nurse should recognize that which of the following diagnoses is associated with these findings? Tracheoesophageal fistula Inguinal hernia Hypertrophic pyloric stenosis Intussusception

Intussusception

A nurse is caring for a 2-month-old infant who is postoperative following surgical repair of a cleft lip. Which of the following actions should the nurse take? Encourage the parents to rock the infant. Offer the infant a pacifier. Administer ibuprofen as needed for pain. Position the infant on her abdomen.

Encourage the parents to rock the infant.

A nurse is caring for a 6-month-old infant who is postoperative following a myringotomy. Which of the following pain scales should the nurse use to determine the infant's pain level? FLACC Oucher FACES Visual Analog Scale

FLACC

A nurse is assessing a child who has nephrotic syndrome. Which of the following findings should the nurse expect? Polyuria Facial edema Smokey brown urine Hypertension

Facial Edema

A nurse is caring for a client who is in the second stage of labor. Medical History Nurse's Notes Medical History 0800: 28-year-old client; G2 P1; at 39 weeks of gestation. Client has history of insulin dependent gestational diabetes mellitus with current pregnancy. Client admitted to the facility in the latent phase of labor at 4 cm, 70% effaced, and -1 station.

Flex the client's legs against the abdomen Apply suprapubic pressure --Shoulder dystocia -- Center Maternal perineum for trauma Movement of the newborn's upper extremities

A nurse in a pediatric clinic is caring for a child who has iron deficiency anemia and a new prescription for ferrous sulfate tablets. Which of the following instructions should the nurse provide the parents regarding administration of this medication? Give with a 240 mL (8 oz) glass of milk. Administer at mealtimes. Give with orange juice. Administer at bedtime.

Give with orange juice.

A nurse is caring for an infant who has inadequate motility of part of the intestine resulting in a mechanical obstruction. The nurse should identify this finding as a manifestation of which of the following disorders? Encopresis Enterocolitis Pyloric stenosis Hirschsprung's disease

Hirschsprung's disease

A nurse is planning care for a 5-month-old infant who is scheduled for a lumbar puncture to rule out meningitis. Which of the following actions should a nurse include in the plan of care? A. Keep the infant NPO for 6 hr prior the procedure. B. Apply a eutectic mixture of lidocaine and prilocaine cream topically 15 min prior to the procedure. C. Place the infant in an infant seat for 2 hr following the procedure. D. Hold the infant's chin to his chest and knees to his abdomen during the procedure.

Hold the infant's chin to his chest and knees to his abdomen during the procedure.

A nurse is caring for a toddler who is 24 hr postoperative following a cleft palate repair. Which of the following actions should the nurse take? Offer fluids through a straw. Apply bilateral wrist restraints. Administer opioids for pain. Implement a soft diet.

Administer opioids for pain.

A nurse is caring for a newborn who is 30 min old. Medical History Nurses' Notes Vital Signs Medical History Spontaneous vaginal birth with dark brown-greenish amniotic fluid noted during labor 42 weeks gestation Apgar scores: 8 at 1 min; 9 at 5 min

After reviewing the information in the newborn's medical record, which of the following complications should the nurse identify as posing the greatest risk? The condition that poses the greatest risk to the newborn is -meconium aspiration syndrome due to -color of amniotic fluid

A nurse is providing teaching to a client who is planning on becoming pregnant about the changes she should expect. Identify the sequence of maternal changes. (Move the steps into the box on the right, placing them in the selected order of performance. Use all the steps.) 1. Quickening 2. Lightening 3. Goodell's sign 4. Amenorrhea

Amenorrhea Goodell's sign Quickening Lightening

A nurse is caring for an 18-month-old toddler who has been hospitalized for 10 days. After the toddler's mother leaves the room, the nurse observes the toddler sitting quietly in the corner of the crib, sucking her thumb. When the nurse approaches the crib, the toddler turns away from the nurse. The nurse should understand that these behaviors indicate which of the following developmental reactions? An anxiety reaction Regression Resentment toward the mother Developing autonomy

An anxiety reaction

A nurse is preparing to measure an infant's vital signs. The nurse should use which of the following sites to assess a heart rate? Carotid artery Apex of the heart Brachial artery Radial artery

Apex of the heart

A nurse is bathing a toddler and notices that she has several bruises. Which of the following actions should the nurse take first? Ask the toddler what caused the bruises. Notify the provider. Ask the parents what caused the bruises. Notify social services.

Ask the parents what caused the bruises.

A nurse is caring for a child who has a tracheostomy. After suctioning the tracheostomy, the nurse should use which of the following findings to determine that the procedure was effective? A. Increased respiratory rate B. Stable oxygen saturation C. Clear breath sounds D. Brisk capillary refill

Clear breath sounds

A nurse is assessing a 6-month-old infant at a well-child visit. Which of the following findings should the nurse expect? Closed posterior fontanel Uses thumb and index fingers in a pincer grasp Lateral incisors Sitting steadily without support

Closed posterior fontanel

A nurse is providing health promotion teaching to the parents of an infant. Which of the following conditions should the nurse identify as the leading cause of death among this age group? Congenital anomalies Respiratory distress Low birth weight Sudden infant death syndrome

Congenital anomalies

nurse at a pediatrician's office is contacted by a parent whose child just ingested half a bottle of vitamins with added ferrous sulfate. Which of the following instructions should the nurse provide to the parent? provide a high-carbohydrate meal. Give the child syrup of ipecac. Contact the poison control center. Bring the child to the office for a rapid infusion of deferoxamine.

Contact the poison control center.

A nurse is caring for an adolescent who was admitted with anorexia nervosa. Which of the following finding should the nurse expect? A. Diarrhea. B. Hypertension C. Tachycardia D. Bloating

D. Bloating

A nurse is reviewing the laboratory results of four children. Which of the following values should the nurse report to the provider? A. WBC 10,000 cells/mm³ B. Lead 2 mcg/dL C. RBC 4.9 million/mm³ D. Iron 38 mcg/dL

D. Iron 38 mcg/dL

A nurse is caring for a toddler who has acute laryngotracheobronchitis and has been placed in a cool mist tent. Which of the following findings indicates that the treatment has been effective? Barking cough Improved hydration Decreased stridor Decreased temperature

Decreased stridor

A nurse in an antepartum clinic is caring for a client who is pregnant. Vital Signs Medical History Nurses' Notes Vital Signs 0800: Temperature 36.6° C (97.9° F) Pulse 85/min Respiratory rate 20/min Blood pressure 180/99 mm Hg 0815: Pulse 88/min Respiratory rate 16/min Blood pressure 178/106 mm Hg 0830: Pulse 84/min Respiratory rate 18/min Blood pressure 174/105 mm Hg

Deep tendon reflexes Visual disturbances Blood pressure Weight

A child is admitted with a suspected diagnosis of Wilms' tumor. The nurse should place a sign with which of the following warnings over the child's bed? Do not palpate abdomen. No venipuncture or blood pressure in left arm Contact precautions Collect all urine.

Do not palpate abdomen.

A nurse is caring for a 2-month-old infant who is postoperative following repair of a cleft lip and palate. The provider prescribes restraints. The nurse should apply which of the following types of restraints for this infant? Elbow Mummy Wrist Jacket

Elbow

A nurse is caring for a 12-month-old toddler who is hospitalized and confined to a room with contact precautions in place. Which of the following toys should the nurse recommend in order to meet the developmental needs of the client? Large building blocks Hanging crib toys Modeling clay Crayons and a coloring book

Large building blocks

A nurse is preparing to administer vaccines to a 1-year-old child. Which of the following vaccines should the nurse give? (Select all that apply.) Measles, mumps rubella (MMR) Diphtheria, tetanus and acellular pertussis (DTaP) Varicella (VAR) Rotavirus (RV) Human papillomavirus (HPV4)

Measles, mumps rubella (MMR) Varicella (VAR)

A nurse is planning care for a 6-year-old child who has bacterial meningitis. Which of the following nursing interventions is unnecessary in the client's plan of care? Place the client in a semi-Fowler's position. Admit the client to a private room. Measure head circumference every shift. Implement seizure precautions.

Measure head circumference every shift.

A nurse is caring for a pre-school age child who has epiglottitis with a barking cough. Which of the following actions should the nurse take? Initiate airborne precautions. Obtain a throat culture. Use a tongue depressor to observe the epiglottis. Monitor oxygen saturation.

Monitor oxygen saturation.

A nurse is assessing a child and notes several bruises. which of the following actions should the nurse take? report the suspected abuse to the authorities. Obtain a detailed history. Ask a psychiatrist to talk with the parents. Separate the child from the parents.

Obtain a detailed history.

A nurse is providing care to a mother immediately following a stillbirth delivery. Which of the following actions should the nurse take first? Assist the client with transferring to the gynecology unit. Administer alprazolam 0.5 mg PO. Contact the health care facility's clergy. Offer mother private time with the newborn.

Offer mother private time with the newborn.

A nurse is caring for a 6-month-old infant who has a prescription for clear liquids by mouth after a repair of an intussusception. Which of the following fluids should the nurse select for the infant? Oral electrolyte solution Half-strength infant formula Half-strength orange juice Sterile water

Oral electrolyte solution

A nurse is assessing a toddler who has heart failure. Which of the following findings should the nurse expect? Weight loss Increased urine output Bradycardia Orthopnea

Orthopnea

A nurse is caring for an infant who has a congenital heart defect. Which of the following defects is associated with increased pulmonary blood flow? Coarctation of the aorta Patent ductus arteriosus Tetralogy of Fallot Tricuspid atresia

Patent ductus arteriosus

A school nurse is assessing a school-age child and notices white flakes that don't brush off the hair and a rash on the back of the child's neck. The nurse should suspect which of the following disorders? Pediculosis capitis Impetigo contagiosa Folliculitis Tinea capitis

Pediculosis capitis

A nurse is caring for a client who is at 34 weeks of gestation. Medical History Diagnostic Results Vital Signs Medical History BMI 31History of polycystic ovary syndrome (PCOS)

Perform a nonstress test. Obtain daily fasting blood glucose levels. --Gestational diabetes mellitus- center Hemoglobin A1c Fetal well-being

A nurse is planning care for a child who has suspected epiglottitis. Which of the following actions should the nurse take? Obtain a throat culture. Place the child in an upright position. Transport the child to radiology for a throat x-ray. Visualize the epiglottis with a tongue depressor.

Place the child in an upright position.

A nurse is caring for a child who has a suspected diagnosis of bacterial meningitis. Which of the following actions is the nurse's priority? Prepare the child for a lumbar puncture. Administer an intravenous antibiotic. Obtain blood cultures. Place the child in isolation.

Place the child in isolation

A nurse is admitting a child who has suspected epiglottitis. Which of the following actions should the nurse take first? Administer 0.9% sodium chloride IV solution. Place the child on droplet precautions. Initiate IV antibiotics. Assist with obtaining an x-ray of the child's neck.

Place the child on droplet precautions.

A nurse is caring for a child who is experiencing a seizure. Which of the following actions should the nurse take? Attempt to stop the seizure. Restrain the child's arms. Use a padded tongue blade. Position the child laterally.

Position the child laterally.

A nurse is teaching about safety recommendations for car seats with the parents of a 24-month-old toddler who is in the 50th percentile for height and weight. Which of the following instructions should the nurse include in the teaching? Position the toddler rear-facing in the middle of the back seat. Position a booster seat forward-facing in the middle of the back seat. Position a convertible seat rear-facing in the front passenger side. Position a convertible seat forward-facing in the front passenger side and inactivate the airbag.

Position the toddler rear-facing in the middle of the back seat.

A nurse in a clinic is assessing a 9-month-old infant. Which of the following findings requires further intervention? Positive Babinski reflex Positive Moro reflex Negative Doll's eye reflex Negative Crawl reflex

Positive Moro reflex

A nurse in a gynecology office is caring for a client. Nurses' Notes Physical Examination Nurses' Notes 1000: Client reports vaginal itching and discharge in the last week. Describes the discharge as thick and "smelly." Reports pain with urination and sexual intercourse. Verbalizes that the discharge became worse after their menstrual period this month. Reports has been treated for STIs in the past and is currently sexually active in a new relationship. Provider notified. 1035: Vaginal swab for culture and nucleic acid amplification testing (NAAT) performed.

Recommend the client's partner receive treatment Instruct client to avoid alcohol for 72 hr after treatment Administer metronidazole 2 g PO X 1 dose

A nurse is caring for a child who ingested kerosene. Which of the following assessments is the nurse's priority? Respiratory rate Burns of the mouth Bowel sounds Visual acuity

Respiratory rate

A school nurse conducting a screening for pediculosis capitis identifies several children who require treatment. Which of the following instructions should the nurse give the children's parents? Soak all combs and hairbrushes in alcohol. Inspect any dogs or cats at home for lice. Seal nonwashable items in airtight plastic bags. Spray countertops and sinks with insecticide.

Seal nonwashable items in airtight plastic bags.

A nurse is caring for a client who is in labor. Medical History Vital Signs Nurses Notes Diagnostic Results Gravida 2, Para 1 28 weeks of gestation Previous cesarean section Asthma

The client is at great risk for developing - chorioamnionitis as evidenced by the client's - leakage of vaginal fluid

A nurse is caring for a child who is admitted with suspected acute appendicitis. Which of the following manifestations should indicate to the nurse that the child's appendix is perforated? Sudden decrease in abdominal pain Absent Rovsing's sign Flaccid abdomen Low-grade fever

Sudden decrease in abdominal pain

A nurse is caring for a child who has a suspected diagnosis of cystic fibrosis. Which of the following diagnostic tests will confirm the diagnosis? Sweat chloride test A sputum culture A stool fat content analysis Pulmonary function tests

Sweat chloride test

A nurse is caring for a client. Nurses' Notes Medical History Diagnostic Results Nurses' Notes 1000: Client reports that they just recently found out they were pregnant. Client states, "Even though I've lost weight from vomiting, my clothes are tight." Abdomen round and hard. Fundus at the umbilicus. Moderate amount of dark brown vaginal discharge with some small, clear vesicles noted on the client's peri pad.

The nurse should recognize that the client is at risk for developing - anemia and - choriocarcinoma

A nurse has accepted a position on a pediatric unit and is learning about psychosocial development. Place Erikson's stages of psychosocial development in order from birth to adolescence. (Move the steps into the box on the right, placing them in the selected order of performance. Use all the steps.) autonomy vs. shame and doubt Trust vs. mistrust Initiative vs. guilt identity vs. role confusion industry vs. inferiority

Trust vs. mistrust Autonomy vs. shame and doubt Initiative vs. guilt Industry vs. inferiority Identity vs. role confusion

A nurse is caring for a child who has otitis media. Which of the following assessment findings should the nurse expect? Tugging on the affected ear lobe Clear drainage from the affected ear Pain when manipulating the affected ear lobe Erythema and edema of the affected ear

Tugging on the affected ear lobe

A nurse is caring for a 3-year-old child who was admitted with acute diarrhea and dehydration. Which of the following findings indicates that oral rehydration therapy has been effective? Heart rate 130/min Respiratory rate 24/min Urine specific gravity 1.015 Capillary refill greater than 3 seconds

Urine specific gravity 1.015

A nurse is preparing to administer a vaccine into the deltoid muscle of a preschooler. Which of the following actions should the nurse take? Use a 20-gauge needle. Use a 1.8 mm (0.5 in) needle. Insert the needle just below the acromion process. Insert the needle at a 15° angle.

Use a 1.8 mm (0.5 in) needle.

A nurse is caring for an infant who has diaper dermatitis. Which of the following actions should the nurse take? Apply a light layer of talcum powder with each diaper change. Change to cloth diapers until the skin is healed. Expose the excoriated area to hot air frequently. Use a moisturizer to wipe urine from the skin.

Use a moisturizer to wipe urine from the skin.

A nurse in a PACU is admitting a client who is postoperative following a tonsillectomy. Which of the following actions should the nurse plan to take to prevent aspiration? Place a bedside humidifier at the head of the client's bed. Suction the nasopharynx as needed. Withhold fluids until the client demonstrates a gag reflex. Perform chest physiotherapy.

Withhold fluids until the client demonstrates a gag reflex.


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