Prep U Questions for Unit 5 Exam

A nurse is teaching the parent of a 5-month-old infant diagnosed with bronchiolitis. Which statement by the mother indicates that teaching has been effective?

"I know that this disease is serious and can lead to asthma." By saying that bronchiolitis places the child at risk for developing asthma, the parent demonstrates understanding of the infant's condition. If diagnosed and treated promptly, most infants recover from the illness and return home. Infants typically don't have recurrences of bronchiolitis. Infants diagnosed with bronchiolitis rarely require mechanical ventilation.

A 2-year-old child brought to the clinic by her parents is uncooperative when the nurse tries to look in her ears. What should the nurse try first?

Allow a parent to assist. Parents can be asked to assist when their child becomes uncooperative during a procedure. Most commonly, the child's difficulty in cooperating is caused by fear. In most situations, the child will feel more secure with a parent present. Other methods, such as asking another nurse to assist or waiting until the child calms down, may be necessary, but obtaining a parent's assistance is the recommended first action. Restraints should be used only as a last resort, after all other attempts have been made to encourage cooperation.

A 4-year-old child is admitted for an appendectomy. What is the most appropriate way for the nurse to prepare the child for surgery?

Permit the child to play with the blood pressure cuff, electrocardiogram (ECG) pads, and a face mask. The best way to teach a child about surgery is through play. The nurse can let the child handle the items that will be used for monitoring, such as the blood pressure cuff and the ECG pads. The child will become more familiar with the face masks he sees the surgical team wearing in the operating room after playing with one and wearing it before surgery. A child of this age-group does not understand detailed explanations of how to use equipment, such as a PCA, a VAS, or even a video. The pain scale that should be used for children is the FACES scale.

A client diagnosed with an empyema is scheduled for a thoracentesis. The nurse should prepare the client for this procedure with which action?

Position the client sitting upright on the edge of the bed and leaning forward. This procedure can be done at the bedside. The nurse should help to position the client correctly. The best position for the procedure is to place the client in a sitting position with arms raised and resting on an overbed table. This position helps to spread out the spaces between the ribs for needle insertion. It is not necessary for the client to receive a sedative or be sent to the catheterization lab. The client does not have to be NPO for this procedure.

A nurse is teaching a client with chronic bronchitis about breathing exercises. Which instruction should the nurse include in the teaching?

Use diaphragmatic breathing. In chronic bronchitis the diaphragm is flat and weak. Diaphragmatic breathing helps to strengthen the diaphragm and maximizes ventilation. Exhalation should be longer than inhalation to prevent collapse of the bronchioles. The client with chronic bronchitis should exhale through pursed lips to prolong exhalation, keep the bronchioles from collapsing, and prevent air trapping. Diaphragmatic breathing — not chest breathing — increases lung expansion.

Which interview strategy contributes to a poor nurse-adolescent relationship?

interviewing adolescents with their parents present When possible, adolescents should be interviewed without their parents present to ensure confidentiality and privacy. Interviewing adolescents with their parents present hinders the formation of the nurse-adolescent relationship. Avoiding assumptions, judgments, and lectures will increase the adolescents' comfort in disclosing sensitive information. Begin with less-sensitive questions so the adolescents won't feel threatened and uncomfortable and become uncooperative during the interview. Ask open-ended questions to give adolescents opportunities to share their psychosocial context.

The nurse should refer the parents of an 8-month-old child to a health care provider (HCP) if the child is unable to demonstrate which gross motor ability?

sit without support for long periods of time According to the Denver Developmental Screening Examination, a child of 8 months should sit without support for long periods of time. An 8-month-old child does not have the ability to stand without hanging onto a stationary object for support. His muscles are not developed enough to support all his weight without assistance. His balance has not developed to the point that he can stand and stoop over to reach an object

The nurse is prioritizing care for several clients. Which client should the nurse assess first?

the client with stridor who just received the first dose of an antibiotic The highest priority client is the client with stridor who started an antibiotic. Stridor is an assessment finding indicating an extremely narrowed airway. This may indicate an anaphylactic reaction to the antibiotic. The nurse must intervene to prevent anaphylactic shock. The airway is the top priority. Next, the nurse should assess the client with wheezing. Finally, the clients with improving chest pain and elevated blood pressure should be assessed.

ODD behavior meds

there is little to no evidence that meds improve ODD. If pt also has conditions such as ADHD, meds can be given that may improve their ODD in turn, but nothing directly for the disorder.

Which diet would be most appropriate for a client with chronic obstructive pulmonary disease (COPD)?

high-calorie, high-protein diet The client should eat high-calorie, high-protein meals to maintain nutritional status and prevent weight loss that results from the increased work of breathing. The client should be encouraged to eat small, frequent meals. A low-fat, low-cholesterol diet is indicated for clients with coronary artery disease. The client with COPD does not necessarily need to follow a sodium-restricted diet, unless otherwise medically indicated. There is no need for the client to eat bland, soft foods.

A client has a sucking stab wound to the chest. Which action should the nurse take first?

Apply a dressing over the wound and tape it on three sides. The nurse should immediately apply a dressing over the stab wound and tape it on three sides to allow air to escape and to prevent tension pneumothorax (which is more life-threatening than an open chest wound). Only after covering and taping the wound should the nurse draw blood for laboratory tests, assist with chest tube insertion, and start an I.V. line.

A client with a tracheostomy tube coughs and dislodges the tracheostomy tube. What should the nurse do first?

Attempt reinsertion of tracheostomy tube. The nurse's first action should be to attempt to replace the tracheostomy tube immediately so that the client's airway is reestablished. Although the nurse may also call for assistance, there should be no delay before attempting reinsertion of the tube. The client is placed in a supine position with the neck hyperextended to facilitate reentry of the tube. The obturator is inserted into the replacement tracheostomy tube to guide insertion and is then removed to allow passage of air through the tube.

The parent of a 2-week-old infant brings the child to the clinic for a checkup. The parent expresses concern about the baby's breathing because the infant breathes quickly for a while and then breathes slowly. The nurse interprets this finding as an indication of what factor?

a normal pattern in infants of this age

A nurse discussing injury prevention with a group of workers at a daycare center is focusing on toddlers. When discussing this age-group, the nurse should stress that

accidents are the leading cause of death among toddlers. The leading cause of death in toddlers is accidents, so it's important for parents, family members, and childcare providers to understand the importance of accident prevention. Toddlers don't have the highest risk for homicide. Toddlers are just beginning to understand right from wrong, but don't understand the consequences of their actions. Although many children will chase balls or toys into the street, not all children will do so.

The nurse is instructing the client with chronic obstructive pulmonary disease to do pursed-lip breathing. What is the expected outcome of this exercise?

better elimination of carbon dioxide Pursed-lip breathing prolongs exhalation and prevents air trapping in the alveoli, thereby promoting carbon dioxide elimination. By prolonging exhalation and helping the client relax, pursed-lip breathing helps the client learn to control the rate and depth of respiration. Pursed-lip breathing does not promote the intake of oxygen, strengthen the diaphragm, or strengthen intercostal muscles.

To prevent oral complications when using a fluticasone metered-dose inhaler, a nurse should instruct the client to do what? Select all that apply.

Rinse out the mouth after using the inhaler. Add a spacer to the metered dose inhaler. Keep the mouthpiece from becoming contaminated. To prevent mouth sores, the nurse should teach the client to rinse the mouth after use. Yeast in the mouth/throat is a common side effect when using this medication. The use of a spacer will assist the client in getting more of the medication and keeping the mouthpiece clean will decrease the chance of infections. Fluticasone is for scheduled use and not for PRN use. Use before meals should be avoided to prevent bad taste.

What teaching will the nurse include about methylphenidate?

Ritalin is a stimulant medication that is effective for 70% to 80% of children with ADHD by decreasing hyperactivity and impulsivity and improving the child's attention. Ritalin can cause appetite suppression and should be given after meals to encourage proper nutrition. Substantial, nutritious snacks between meals are helpful. Giving the medication in the daytime helps avoid the side effect of insomnia. Parents should notice improvements in a day or two. Notify the physician or return to the clinic if no improvements in behavior are noted.

The parent of a 2-year-old is concerned because the child's right eye seems to turn in toward the nose when the child is tired. The nurse should:

Test the child with the cover-uncover test and refer the parent and child to an ophthalmologist if the test is abnormal. Strabismus is diagnosed through observation and use of the corneal light reflex test. The cover-uncover test will reveal movement of the affected eye when the unaffected eye is covered, indicating abnormal fixation of the affected eye. The child should be referred to an ophthalmologist as soon as possible so that the correct vision in the affected eye can be restored. It is never normal for one eye to turn inward or outward even if the child is tired. If this condition is not corrected early, blindness can result in the unaffected eye due to the brain suppressing the double vision. Thus, telling the parent to watch the child and call later with concerns is not an appropriate response. The child will not grow out of this type of condition and may need surgery, an eye patch, daily exercises, or a combination of these interventions.

Which desired outcome demonstrates effective parent teaching about disciplining a toddler?

The parents will call immediate attention to undesirable behavior. Calling immediate attention to undesirable behavior reflects effective teaching. This approach helps the child learn socially acceptable behavior and maintain self-esteem and a positive self-concept while learning to adapt to the rules of the larger group and society. Rules should be established clearly and enforced consistently. To reinforce desirable behavior, parents should voice requests for behavior in positive terms and use a normal speaking voice and tone when talking to or reprimanding the child. Screaming and shouting should be minimized.

A home health nurse sees a client with end-stage chronic obstructive pulmonary disease (COPD). An outcome identified for this client is preventing infection. Which finding indicates that this outcome has been met?

decreased oxygen requirements A client who is free from infection will most likely have decreased oxygen requirements. A client with infection will display increased sputum production, fever, shortness of breath, decreased activity tolerance, and increased oxygen requirements. Elevated white blood cell count may be indicative of infection.

After undergoing a left thoracotomy, a client has a chest tube in place. When caring for this client, the nurse must

encourage coughing and deep breathing

When teaching a client with chronic obstructive pulmonary disease to conserve energy, what instruction should the nurse give the client about breathing when lifting heavy objects? Lift the object by:

exhaling through pursed lips. Exhaling requires less energy than inhaling. Therefore, lifting while exhaling saves energy and reduces perceived dyspnea. Pursing the lips prolongs exhalation and provides the client with more control over breathing. Lifting after exhaling but before inhaling is similar to lifting with the breath held. This should not be recommended because it is similar to the Valsalva maneuver, which can stimulate cardiac arrhythmias.

Intermittent explosive disorder (IED) meds

fluoxetine, lithium, & anticonvulsant mood stabilizers such as valproic acid

A nurse is assessing the growth and development of a 10-year-old. What is the expected behavior of this child?

has a strong sense of justice and fair play School-age children are concerned about justice and fair play. They become upset when they think someone is not playing fair. Physical affection makes them embarrassed and uncomfortable. They are concerned about others and are cooperative in play and school

The nurse is instructing a client with acute asthma who is taking short-term corticosteroid therapy. The nurse should tell the client that steroids will have which expected outcome? Steroids will:

have an anti-inflammatory effect. Corticosteroids have an anti-inflammatory effect and act to decrease edema in the bronchial airways and decrease mucus secretion. Corticosteroids do not have a bronchodilator effect, act as expectorants, or prevent respiratory infections

A client with bacterial pneumonia is coughing up tenacious, purulent sputum. Which action would help liquefy these viscous secretions?

Breathe humidified air. Humidified air helps to liquefy respiratory secretions, making them easier to raise and expectorate. Postural drainage may be helpful for respiratory hygiene but will not affect the nature of secretions. Vibration and percussion of the chest wall may be helpful for respiratory hygiene but will not affect the nature of secretions. Coughing and deep-breathing exercises may be helpful for respiratory hygiene but will not affect the nature of secretions.

Assessment of a 6-week-old infant reveals weight and length in the 50th percentile for his age and a head circumference at the 95th percentile. What should the nurse do first?

Examine the fontanels and sutures. Head circumference usually parallels the percentile for length. The discrepancy found requires close and immediate attention because it could indicate hydrocephalus with its potential for brain damage. Therefore, the nurse should examine the fontanels and sutures. In an infant, bulging fontanels and widening cranial sutures are signs of increasing intracranial pressure related to increased cerebrospinal fluid in the cranial space.Assessing motor and sensory function of the legs would be done if the fontanel or sutures were abnormal.Since the infant requires immediate attention, follow-up in 1 month is inadequate.Transillumination is a noninvasive procedure used to assess hydrocephalus. It does not require a written consent and would be performed after examining the fontanel and sutures.

The nurse is evaluating an infant for auditory ability. What is the expected response in an infant with normal hearing?

blinking and stopping body movements when sound is introduced In response to hearing a noise, normally hearing infants blink or startle and stop body movements. Shy and withdrawn behaviors are characteristic of older children with hearing impairment. Squealing occurs in 90% of infants by age 4 months. Most infants can say "da-da" by age 9 months.

Oxygen at the rate of 2 liters per minute through nasal cannula is prescribed for a client with chronic obstructive pulmonary disease (COPD). Which of the following statements best describes why the oxygen therapy is maintained at a relatively low concentration?

The client's respiratory center is so used to high carbon dioxide and low oxygen levels that changing these levels may eliminate his stimulus for breathing. Relatively low concentrations of oxygen are administered to clients with COPD so as not to eliminate their respiratory drive. Carbon dioxide content in the blood normally regulates respirations. Clients with COPD, though, are often accustomed to high carbon dioxide levels; the low oxygen blood level is their stimulus to breathe. If they receive excessive oxygen and experience a drop in the blood carbon dioxide level, they may stop breathing. Oxygen flow rate is not diminished at high levels when administered through a nasal cannula. The client's ability to absorb oxygen administered at a higher level is not affected. Increased oxygen levels and decreased carbon dioxide levels cannot cause cells to burst.

A client has just undergone a bronchoscopy. Which nursing interventions are appropriate after this procedure? Select all that apply.

Withhold food and fluids until the client's gag reflex returns. Assess for hemoptysis and frank bleeding. Monitor the client's vital signs To prevent aspiration, the client should not receive food or fluids until the gag reflex returns. Although a small amount of blood in the sputum is expected if a biopsy was performed, frank bleeding indicates hemorrhage and should be reported to the physician immediately. Vital signs should be monitored after the procedure, because a vasovagal response may cause bradycardia, laryngospasm can affect respirations, and fever may develop within 24 hours of the procedure. To reduce the risk of aspiration, the client should be placed in a semi-Fowler's or side-lying position after the procedure until the gag reflex returns. The client does not lose the voice after a bronchoscopy, so voice should not be used as a gauge for resuming food and fluid intake.