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A charge nurse in an emergency department is preparing an in-service for a
group of newly licensed nurses on the clinical manifestations of child
maltreatment. Which of the following clinical manifestations should the charge
nurse include as suggestive of potential physical abuse?
A- Recurrent urinary tract infections
B- symmetric Burns of the lower extremities
C- growth failure
D- lack of subcutaneous fat - Correct Answers-B- symmetric Burns of the lower extremities; The
nurse should include in the teaching that symmetric burns of the lower
extremities are a suggestive clinical manifestation of physical abuse. The patterns
are usually characteristic of the method or object used, such as cigar or cigarette
burns, or burns in the shape of an iron.
A charge nurse in an emergency department is preparing an in-service for a
group of newly licensed nurses on the clinical manifestations of child
maltreatment. Which of the followingclinical manifestations should the charge
nurse include as suggestive of potential physical abuse?
A- Recurrent urinary tract infections
B- symmetric Burns of the lower extremities
C- growth failure
D- lack of subcutaneous fat - Correct Answers-B- symmetric Burns of the lower extremities; The
nurse should include in the teaching that symmetric burns of the lower
extremities are a suggestive clinical manifestation of physical abuse. The patterns
are usually characteristic of the method or object used, such as cigar or cigarette
,burns, or burns in the shape of an iron.
A newly admitted client who has major depressive disorder states to the nurse, "I'm a failure, I can't even
cope with the little things anymore." Which of the following responses should the nurse provide?
A) "What happened in your life to make you feel like such a failure?"
B) "It sounds as if you are feeling pretty overwhelmed right now"
C) "Do you feel like you don't deserve to feel good about yourself?"
D) "I know you feel like that now, but you'll feel differently when you get better" - Correct Answers-
C) "Do you feel like you don't deserve to feel good about yourself?"
A newly licensed nurse is preparing to administer medications to a client. The nurse notes that the
provider has prescribed a medication that is unfamiliar to him. Which of the following actions should the
nurse take?
A) Consult the medication reference book available on the unit
B) Ask a more experienced nurse for information about the medication
C) Call the clients provider and verify the prescription
D) Ask the client if she takes this medication at home - Correct Answers-A) Consult the medication
reference book available on the unit
A nurse at an urgent care clinic is assessing an adolescent client who has an
upper respiratory tract infection. Which of the following findings should the
nurse recognize as a manifestation of pertussis?
A- Inflamed throat with exudate
B- purulent eye drainage
C- dry, hacking cough
D- koplik spots on buccal mucosa - Correct Answers-C- dry, hacking cough; The nurse should
recognize that a dry, hacking cough is a manifestation of
pertussis. This disease usually begins with indications of an upper respiratory
tract infection, which includes a dry, hacking cough that is sometimes more
severe at night.
A nurse at an urgent care clinic is assessing an adolescent client who has an
upper respiratory tract infection. Which of the following findings should the
nurse recognize as a manifestation of pertussis?
A- Inflamed throat with exudate
,B- purulent eye drainage
C- dry, hacking cough
D- koplik spots on buccal mucosa - Correct Answers-C- dry, hacking cough; The nurse should
recognize that a dry, hacking cough is a manifestation of
pertussis. This disease usually begins with indications of an upper respiratory
tract infection, which includes a dry, hacking cough that is sometimes more
severe at night.
A nurse has received a prescription for dextran to administer to a client. The nurse should recognize that
dextran belongs in which of the following functional classifications
A) Skeletal muscle relaxants
B) Beta-adrenergic blockers
C) Broad-spectrum anti-infective agents
D) Plasma volume expanders - Correct Answers-D) Plasma volume expanders
A nurse in a provider's office is caring for a school-age child who has
varicella. The parent askthe nurse when her child will no longer be
contagious. Which of the following responses should the nurse make?
A- When your child no longer has an increased temperature
B- three days after you first noticed the rash appear on your child
C- when your child lesions are crusted, 6 days after they appear
D- 2 - 3 weeks, when your child's lesions completely disappear - Correct Answers-C- when your child
lesions are crusted, 6 days after they appear; The nurse should inform the parent that the child is
contagious 1 day prior to lesion eruption and until the vesicles have crusted over, which usually takes
about
6 days.
A nurse in a provider's office is caring for a school-age child who has
varicella. The parent askthe nurse when her child will no longer be
contagious. Which of the following responses should the nurse make?
A- When your child no longer has an increased temperature
B- three days after you first noticed the rash appear on your child
C- when your child lesions are crusted, 6 days after they appear
D- 2 - 3 weeks, when your child's lesions completely disappear - Correct Answers-C- when your child
lesions are crusted, 6 days after they appear; The nurse should inform the parent that the child is
, contagious 1 day prior to lesion eruption and until the vesicles have crusted over, which usually takes
about
6 days.
A nurse in a provider's office is preparing to administer immunizations to a
toddler during awell-child visit. Which of the following actions should the
nurse plan to take?
Prescriptions:
-tuberculin skin test (TST)
-measles mumps rubella
vaccine
-inactivated influenza vaccine
-diphtheria, tetanus, and pertussis (DTaP vaccine)
Vital signs
-respiratory rate 24/minute
-heart rate 115/minute
-temperature 37.4 degrees Celsius or 99.3 degrees Fahrenheit
History and physical
-Age 12 months 9 days
-height 71.1cm/28-in
allergies
neomycin - anaphylactic reaction
caregiver reports:
-rhinitis with clear nasal drainage for 2days
-occasional non productive cough for 2 days
-history of asthma
A- Withhold the measles mumps and rubella MMR vaccine
B- withhold the DTaP vaccine
C- withhold the influenza vaccine