PrActice questions to review

A nurse is assessing the six month old infant infant during a well child visit. Which of the following findings should the nurse report to the provider?

A. Presence of a central incisor tooth. B. Presence of strabismus. C. Presence of an open anterior fontanelle. D. Presence of external cerumen. B. Presence of strabismus. Strabismus, or crossing of the eyes typically disappeared, and 3 to 4 months of age. If not corrected early, this can lead to blindness. The presence of a central incisor tooth is an expected, finding of a six month old infant. And the nurse recognized the anterior fontanelle. Generally closes around 12 months of age. The nurse should recognize that Cerrone is an expected buying for six month, which is just earwax.

A nurse is reviewing the laboratory report of a school age child who is experiencing fatigue. Which of the following findings should the nurse recognize as an indication of anemia?

A. Hematocrit 28% B. hemoglobin, 13.5. C. WBC count 8000. D. platelets 250,000 A. The nurse recognize that hematocrit level is below the expected reference range of 32% to 42% for a school age child. Hemoglobin is within the expected reference range of 9.5 to 14.

A nurse is caring for a one month old infant infant, who is breast-feeding and requires a heel stick. Which of the following actions should the nurse take to minimize the infants pain?

A. User manual lancer to obtain the heel blood sample. B. Applying ice pack to the infants he'll prior to obtain in the sample. C. Allow the mother to breast-feed while the sample has been obtained. D. Apply topical lidocaine cream prior to obtain in the sample. C. EBP indicates that breast-feeding or non-nutritive, sucking with a pacifier can provide non-pharmacological pain management in infants. Evidence based practice recommends using an automatic lancet to obtain heal samples because it is safer and less traumatic. The nurse should recognize that applying an ice pack will reduce circulation and make it harder to obtain blood sample. Therefore, they should use heat to increase blood flow to the site . Lidocaine is not an effective use of pain management infants.

A nurse, and a provider's office is preparing to administer immunizations to a toddler during a well-child visit. Which of the following actions should the nurse plan to take? (Click on the exhibit button for additional information about the client. There are three tabs that contain separate categories of data.)

A. With all the measles, Mom's, and rubella vaccine. B. Withhold the diphtheria, tetanus, and pertussis vaccine. C. Withhold the influenza vaccine. D. Withhold the tuberculin skin test. A. The nurse should recognize that an allergy to Neil myosin with an anaphylactic reaction is a contra indication for receiving the MMR vaccine. Clients who have a severe allergy to eggs or gelatin, should not receive this vaccine.

A nurse is providing teaching to the parents of a preschooler who is heart failure a new prescription for digoxin twice daily. Which of the following instructions should the nurse include in the teaching?

A. Use the kitchen spoon to measure the medication. B. Brush the child's teeth after giving the medication. C. Double the next dose if the child misses it does. D. Repeat the dose if the child vomits. B. The nurse instructed parents to brush the child's teeth after administering the Jackson to prevent tooth. Decay caused by the medication, which comes as a sweetened liquid to enhance the taste. The nurse should instruct the parents to use the calibrated device that comes with the medication while measuring the medication to avoid accidental overdose. Never doubled the dose or repeat a dose of a child vomits.

A nurse is providing anticipatory guidance to the parent of a toddler. Which of the following expected behavior characteristics of toddlers should the nurse include?

A. Controls impulsive feelings. B. Understands right from wrong. C. Easily separate from parents for long periods of time. D. Expresses likes and dislikes. D. I. The nurse should include that expressing likes and dislikes is an expected behavior of toddlers. This is the time in life when a toddler is developing autonomy and self-concept. They will try to assert themselves and frequently refuse to comply. The parent should allow the child to have some control, but also set limits for them so they learn from their behavior and learn to control their actions. Toddlers tend to have a great deal of curiosity and ask many questions, but are not able to fully understand what behaviors are right or wrong. A toddler might be able to separate from the parents for a short period of time where is more likely to experience acute separation anxiety when separated from the parents were an extended period of time .

A nurse is caring for a school age child, who is diabetes mellitus, and was admitted with a diagnosis of diabetic keto acidosis. When performing the respiratory assessment, which of the following findings should the nurse expect?

A. Deep respirations of 32/min B. Shallow respirations of 10/min C. Paradoxical respirations of 26/min D. Periods of Apnea lasting for 20 seconds A. The nurse should expect Kussmaul, respirations in a child who is diabetic keto acidosis. These deep and rapid respirations are the bodies attempt to eliminate excessive carbon dioxide and achieve a state of homeostasis. The nurse expect shallow, respirations in a child who has respiratory depression related to opioid administration. The nurse should expect paradoxical respirations in a child who has flail chest. The nurse should expect. Apnea lasting 20 seconds or more in a child who has sleep apnea.

A nurse is providing teaching to the family of a school age child who has juvenile idiopathic arthritis. Which of the following instructions should the nurse include in the teaching?

A. Limit movement of the child large joints. B. Encourage the child to perform independent self-care. C. Provide the child with a soft mattress for sleeping. D. Schedule a 2-hour daily nap for the child in the afternoon. B.. the nurse should teach the family the importance of encouraging the child perform independent self-care. This will minimize the child's pain well maximize mobility. Large joints should be exercise regularly to maintain mobility and strengthen muscle mass. Children who have juvenile idiopathic arthritis should sleep on a firm mattress to provide support in maintaining joints in a functional position. Daytime naps are discouraged, because deafness can easily occur within activity.

A nurse is planning care for a school age child who has a tunneled central venous access device. Which of the following interventions should the nurse include in the plan?

A. Use sterile scissors to remove the dressing from the site. B. Irrigate each lumen weekly with 10 ML of 0.9% sodium chloride solution when not in use. C. Access the site using an noncoring angled needle. D. Use a semi permeable transparent dressing to cover the site. D. The nurse should cover the site with a semi permeable transparent dressing to reduce the risk of infection.

A nurse in an emergency department is caring for a school age child who has sustained minor superficial burn from fireworks on their forearms. Which of the following actions should the nurse take?

A. Administer the tetanus toxoid vaccine, if more than one year since the prior dose. B apply antimicrobial I went to the affected area C. Leave the burnt area open to air. D. Place an ice pack on the affected area. B. The nurse should apply antimicrobial appointment to the burned area to prevent infection. The nurse should apply a clean dry dressing, a fine match guys and a light gods dressing that restricts movement to prevent injury to the wound. Applying ice to the affected area can impair circulation to the area and increase tissue damage. The nurse administer the tetanus toxoid vaccine if it has been more than five years since the prior dose.

What is the function of sodium polystyrene sulfonate?

It is used to treat excessive levels of potassium in the blood

A nurse in emergency department is assessing a three month old infant who has rotavirus and is experiencing acute vomiting and diarrhea. Which of the following manifestations should the nurse identify an indication that the infant has moderate to severe dehydration?

A. HR 124 per minute. B. Increased tear production C. Sunken anterior fontanelle. D. Capillary refill two seconds. C. The nurses recognize that a sunken anterior funnel is an indication of moderate to severe dehydration due to the acute loss of fluid. The heart rate is within the expected reference range. The nurse would expect decreased tear production. Cap refill would be greater than two seconds.

A nurse is reviewing the laboratory result of the school age child who is one week postoperative following an open fracture repair. Which of the following findings should the nurse identify as an indication of a potential complication?

A. Erythrocyte sedimentation rate 18 MM per hour. B. WBC count 6200. C. See reactive protein, 1.4 mg/dL. D. RBC count 4.7 mm A. ESR is above the prescribed rate of 10 MM, and indicates osteomyelitis. C-reactive protein is within the expected reference range of less than 10 mg/L. RBC count is within the expected reference range of 4.0 to 5.5.

A nurse is assessing the pain level of a three year old toddler. Which of the following pain assessment scales should the nurse use?

A. FACES B. Numeric C.CRIES D. Visual analog A. The nurse should use the faces pain rating scale for a pediatric clients who are three years and older. The scale allows the toddler to point the face that depicts their current level of pain. CRIES: the nurse should use the cries, pain assessment scale, when assessing the need for pain management in infants, who are less than 40 weeks of age Visual analog: the nurse should use the visual analog scale to assess pain for a child who is greater than eight years of age the scale allows the child to mark their pain on a centimeter ruler. Numeric: the nurse should use the numeric pain reading scale when assessing the need for pain management, and pediatric clients who were eight years and older.

A nurse is providing teaching to an adolescent about how to manage tinea pedis. Which of the following statements by the adolescent indicates an understanding of the teaching?

A. I should buy plastic shoes to wear the swimming pool. B. I should wear sandals as much as possible. C. I should place permethrin cream between my toes daily. D. I should seal my non-washable shoes in a plastic bag for a couple of weeks. B. Sandals, allow air to circulate around the feet, decreasing perspiration and eliminating the medium for bacteria and fungus to grow. The nurse should inform the adolescent that wearing sandals, open toed, or well ventilated shoes, or promote healing a fungal infection. - The use of plastic shoes increases the occurrence of tinea pedis. The nurse should instruct the adolescent to avoid wearing plastic shoes. Permethrin 5% cream is a scabacide used to treat scabies is treatment is not indicated for tinea pedis and sealing non-washable items in a plastic bag for 14 days is recommended practice for clients who have pediculosis.

A nurse is creating a plan of care for a newly admitted adolescent who has bacterial meningitis. How long should the nurse plan to maintain the adolescent in droplet precautions?

A. Until the adolescent is afebrile. B. 47 days following admission to the facility. C. Until the adolescent has a negative blood culture. D. For 24 hours, following initiation of antimicrobial therapy. D. For 24 hours follow initiation of antimicrobial therapy the nurse should plan to maintain the adolescent and drop the precautions for at least 24 hours following initiation of antimicrobial therapy.

A nurse is caring for a 10 year old child following a head injury. Which of the following findings should the nurse identify an indication of the child is developing diabetes insipidus?

A. Urine specific gravity B. Sodium 155 mEq. C. Blood glucose 45 mg/dL. D. Urine output 35 mL per hour. B. As a result of the two Teri hypofunction leading to deficiency of ADH. Under excretion of ADH leads to polyuria polydipsia and possibly dehydration. With the excessive loss of free water, sodium levels rise above the expected reference range. Diabetes insipidus has normal levels of blood glucose, polyuria, and a urine specific gravity below the expected reference range