Elsevier Adaptive Quizzing Week 2

Which term describes synovial joint movement away from the midline of the body?

Answer: Abduction Rationale: Abduction is a synovial joint movement that involves movement of a part away from the midline of the body. Inversion is turning of the sole inward toward the midline of the body. Pronation is a synovial joint movement that involves the turning of the palm downward. Extension is a synovial joint movement that involves a straightening of joint that increases the angle between two bones.

Which clinical manifestation would best indicate to the nurse that the mental status of a client with schizophrenia and paranoid delusions is improving?

Answer: Ability to function effectively in activities of daily living. Rationale: The ability to function effectively in activities of daily living would indicate improvement. A person who can handle activities of daily living and function in society is considered mentally stable. Some anxiety is necessary and unavoidable; anxiety causes problems when it is overwhelming for an extended period. Insight into one's problems is of no use if one is unable to function. Everyone uses defense mechanisms; the extent to which they are used helps determine mental health.

The nurse understands which medication is used as an ovulation stimulant but may cause multiple pregnancies?

Answer: Clomiphene Rationale: Clomiphene is used to stimulate ovulation; this medication may cause multiple pregnancies. Oxytocin stimulates uterine contractions to induce labor. Dinoprostone is used to terminate a pregnancy. Methylergonovine is used to reduce postpartum uterine hemorrhage.

Which hospital department plays a primary role in disaster preparedness?

Answer: Emergency Department Rationale: The emergency department plays a primary role in emergency disaster preparedness. Although all departments in the hospital contribute to disaster planning, the only department that plays a primary role is the emergency department.

A 2-year-old toddler is to have intravenous (IV) antibiotic therapy. Which action will the nurse take to prevent the child from pulling out the IV line?

Answer: Cover the IV site with a protective device Rationale: Restraints are a last resort; they cause more anxiety and agitation as the child attempts to get free. Verbal instructions are not sufficient for a 2-year-old child. Securing the IV site and putting protection around it decreases the likelihood that the IV line will be pulled out. Although the family should be involved in care, the staff, not the family, is responsible for preventing the child from pulling out the IV line.

Which type of needs would be placed as a low priority in the prioritization of client care?

Answer: Developmental Needs Rationale: Developmental needs and long-term care needs are low priority when prioritizing care because they are not an immediate threat to health. Potential needs in care are intermediate priority because they are best addressed before complications follow. Needs related to survival and safety are the highest priority because these are an immediate threat to client health.

Which change would the nurse expect when a child transitions from toddlerhood to the stage of preschooler?

Answer: Develops a later bedtime. Rationale: Preschoolers naturally develop later bedtimes, based on their biological sleep-wake cycles and circadian rhythm. Preschoolers have very active sleep and may appear restless rather than soundly sleeping. Daytime naps are infrequent in preschoolers. Preschoolers sleep around 12 hours each night.

Which organ is commonly affected in children with juvenile idiopathic arthritis (JIA)?

Answer: Eyes Rationale: Juvenile idiopathic arthritis can cause inflammation of the iris and ciliary body of the eyes, which may lead to blindness. The ears are not affected. The liver may become enlarged, but this does not occur as frequently as visual problems do. The brain is not affected.

Identify the stage at which an adolescent develops abstract thinking.

Answer: Formal operations period Rationale: According to Piaget's moral development theory, an adolescent develops abstract thinking during the formal operations period. According to Freud's genital stage, sexual urges reawaken and are directed to an individual outside the family circle. During the conventional reasoning stage, a person establishes his or her morals based on his or her own personal internalization of societal expectations. According to the identity versus role confusion stage, there is a marked preoccupation with appearance and body image.

Which color-tagged clients usually make up the greatest number in most large-scale multi-casualty situations, based on the disaster triage tag system?

Answer: Green Rationale: Green-tags clients usually make up the greatest number in most large-scale multicasualty situations. These clients have minor injuries and they may actually evacuate themselves from the mass casualty scene and go to the hospital in a private vehicle. Red-tagged clients have major injuries, black-tagged clients are expected and allowed to die, and yellow-tagged clients have major injuries. Clients belonging to these three categories usually do not make up the greatest number in most large-scale multicasualty situations.

During the neurological assessment of a client with a tentative diagnosis of Guillain-Barré syndrome, which clinical finding would the nurse expect the client to manifest?

Answer: Increase muscular weakness Rationale: Muscular weakness with paralysis results from impaired nerve conduction because the motor nerves become demyelinated. Diminished visual acuity usually is not a problem; motor loss is greater than sensory loss, with paresthesia of the extremities being the most frequent sensory loss. Demyelination occurs rapidly early in the disease, and the muscles will not have had time to atrophy; this can occur later if rehabilitation is delayed. Only the peripheral nerves are involved; the central nervous system is unaffected.

According to Erikson's theory, at which stage does a child start to have fantasies and an active imagination?

Answer: Initiative vs Guilt Rationale: The initiative versus guilt stage is characterized by a child having fantasies and imaginations that motivate the child to explore the environment. The stage from birth to 1 year old when an infant develops trust toward his or her parents or caregivers is known as the trust versus mistrust stage. The identity versus role confusion stage begins after adolescence; during this stage, an individual tries to figure out his or her own identity. Between the ages of 1 to 3 years old, a child starts walking, feeding, using the toilet, and handling some basic self-care activities. This stage is one of autonomy versus sense of shame and doubt.

A client with hemiparesis voices a reluctance to use a cane. Which rationale would the nurse use to explain the cane's purpose to the client?

Answer: Maintain balance to improve stability Rationale: Hemiparesis creates instability. Using a cane provides a wider base of support and therefore greater stability. Hemiparesis affects muscle strength on one side of the body; the joints are not directly affected. Activity should strengthen, not injure, weakened muscles. The use of a cane will not prevent involuntary movements if they are present.

A client with Parkinsonism takes an anticholinergic medication for morning stiffness and tremors in the right arm. During a visit to the clinic, the client complained of some numbness in the left hand. Which intervention would the nurse implement for this client?

Answer: Make immediate arrangements for further medical evaluation by the client's primary health care provider. Rationale: Numbness, a sensory deficit, is inconsistent with Parkinsonism; further medical evaluation is necessary. Numbness, even in the absence of other problems, may be indicative of an impending "brain attack" (cerebrovascular accident [CVA]). Parkinsonism does not have this symptom. Increasing the dosage of the anticholinergic medication will not be helpful. Stressing the importance of having the client call the primary health care provider as soon as possible can cause a delay in the client receiving immediate medical attention.

Which medication is unsafe to administer as an intravenous (IV) bolus?

Answer: Potassium chloride Rationale: Potassium chloride given as an IV bolus can cause cardiac arrest. It must be diluted and infused slowly through an IV infusion pump. Saline flush, naloxone, and adenosine are appropriate to be given as an IV bolus undiluted.Test-Taking Tip: Become familiar with reading questions on a computer screen. Familiarity reduces anxiety and decreases errors.

Which is the purpose of the failure mode effective analysis?

Answer: Prevent medical errors in hospital Rationale: The failure mode effective analysis is a tool designed to prevent medical errors and system failures within a health care system. It analyzes the potential failure modes and the causes of system failures, finds solutions to the problem, and evaluates the effectiveness of those solutions. The root cause analysis tool is used to analyze the cause of sentinel errors in a hospital. The efficacy of the care provided and analysis of client satisfaction are not the components of client dissatisfaction.

Which happens during the transition from infanthood to toddlerhood?

Answer: Reduced need for sleep. Rationale: As the infant enters the toddler stage, the need for sleep declines, and the activity level increases. Toddlers need less fat and more proteins. Children establish lifetime eating habits during toddlerhood, and there is increased emphasis on food choices.

A client who takes four 325-mg tablets of buffered aspirin four times a day for severe arthritis complains of dizziness and ringing in the ears. Which complication would the nurse conclude that the client probably is experiencing?

Answer: Salicylate toxicity Rationale: Aspirin is a salicylate; excessive aspirin ingestion can influence the vestibulocochlear nerve (cranial nerve VIII), causing tinnitus and dizziness. The client is experiencing symptoms of toxicity, not an allergic response. Withdrawal symptoms occur when a medication is no longer being administered. Tolerance describes a condition in which additional medication is needed to achieve an effect; it is not associated with the development of new symptoms.

Which characteristic can be observed in abusive parents? Select all that apply. One, some, or all responses may be correct.

Answer: Social isolation, poor coping skills, family authorization, feeling of no control of life, inability to seek help from others, expects child to satisfy needs for love. Rationale: Social isolation, poor coping skills, family authoritarianism, feeling of no control over life, inability to seek help from others, and expecting the child to satisfy needs for love, support, and reassurance are all characteristics of abusive parents.

At which stage of Kohlberg's theory would a child exhibit fear of punishment?

Answer: Stage 1 Rationale: According to Kohlberg's theory of moral development, at stage 1 a child is afraid of punishment. At stage 2, the child recognizes that there is more than 1 correct viewpoint. At stage 3, an individual seeks the approval of and maintains the expectations of one's immediate group. At stage 4, an individual expands focus from a relationship with others to societal concerns.

Which personnel can determine priorities for treatment in an emergency response plan?

Answer: Triage Office Rationale: The triage officer determines the priorities for treatment in an emergency preparedness and emergency response plan. The public information officer serves as a liaison between the health care facility and the media. The medical command physician decides the number, acuity, and resource needs of clients. The hospital incident commander assumes overall leadership for implementing the emergency plan.

Which activities can a child perform at 3 years of age? Select all that apply. One, some, or all responses may be correct.

Answer: Turning doorknobs, holding crayons with fingers, and eating a spoon without rotating it. Rationale: At the age of 3 years, a child can turn the pages of a book one at a time and can easily turn doorknobs. The child can now hold crayons with the fingers. A 3-year-old child can manage to eat with a spoon without rotating it. A preschooler by the age of 5 years is able to jump rope and can easily draw triangles and diamond shapes. By the age of 3 years, a child is able to drink from a cup without spilling it. A preschooler, not a toddler, is able to classify objects according to their size or color.

Which observations would indicate findings found in a child with Turner syndrome? Select all that apply. One, some, or all responses may be correct.

Answer: Webbed Neck, low position of posterior hair line, shield shaped chest with wide space between the nipples. Rationale: Turner syndrome is a chromosomal abnormality seen in females in which an X chromosome is partly or completely absent. The clinical manifestations of Turner syndrome include a webbed neck, low posterior hairline, and shield-shaped chest with wide space between the nipples. Impaired language skills are seen in clients with triple X, or superfemale syndrome. The client with Turner syndrome has short stature. Tall stature with long legs is a finding in Klinefelter syndrome.

Which pain scale would the nurse use when assessing a 4-year-old child?

Answer: Wong-Baker Rationale: The Wong-Baker method is a type of faces pain scale best used in children as young as 3 or 4 years. It contains several faces that a child can use to identify his or her pain level. CRIES and FLACC are pain scales typically used with young infants who are unable to verbalize pain. The numerical pain scales are best used in older children, teens, or adults who can accurately assign a number to represent pain level.

Which information would the nurse include when educating a group of daycare workers on infection control guidelines? Select all that apply. One, some, or all responses may be correct.

Answer: cleaning toys, hand hygiene, and food preparation. Rationale: Daycare workers must follow appropriate infection control guidelines, which include sanitizing toys and bathrooms, proper hand hygiene practiced by both employees and children, and food preparation. Child pick-up and medication administration are safety issues rather than infection control issues.

Which finding in older adult clients is associated with aging?

Answer: decrease in height Rationale: Loss of height and deformity and shortening of the trunk are common in older adults because of vertebral compression and degeneration. Rigidity in the neck, shoulders, back, hips, and knees increases with age because of loss of elasticity in ligaments, tendons, and cartilage. A decline in fine-motor dexterity occurs in the older adult because of slow impulse conduction along motor units. Range of motion (ROM) is limited in the older adult because of cartilage erosion, increased friction between the bones, and overgrowth of bone around joint margins.

The nurse is performing an assessment of fine motor skills on an infant. Which actions would the nurse observe? Select all that apply. One, some, or all responses may be correct.

Answer: holding a rattle, picking up objects, holding a baby bottle. Rationale: Holding a rattle, picking up objects, and holding a baby bottle are demonstrations of fine motor skills. Gross motor skills include crawling, creeping, and sitting erect.

While providing care for a client with a second-degree left ankle sprain, the nurse raises the injured part above heart level. Which statement provides the reason behind this nursing intervention?

Answer: prevent further edema Rationale: A client with a second-degree sprain may have a deeply torn ankle ligament with swelling and tenderness. Elevation of the injured lower limb above heart level helps mobilization of the excess fluid from the area and prevents further edema. Strengthening exercises help build bone density and muscle strength and significantly reduce the risk of sprains and strains. Cryotherapy and adequate rest help reduce pain by reducing the transmission and perception of pain impulses.

Which self-care skill would the nurse expect a 4-year-old child to be capable of performing?

Answer: putting on a shirt and buttoning it Rationale: Four-year-old children can put on a shirt and can fasten it if the buttons are large. Four-year-olds will be able to comb, but not part, their hair. Four-year-olds can handle a fork and spoon but cannot hold the meat with the fork while cutting it with the knife; children are usually 7 years old before this task is managed. Four-year-olds old can put on shoes but are usually unable to tie them until age 5.