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VERSION 1/ACTUAL EXAM WITH CORRECT
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DETAILED ANSWERS WITH RATIONALES/A+
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GRADE ll
A nurse is caring for an adolescent following a lumbar puncture. which
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ll of the followingactions should the nurse take?
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- initiate llNPO llstatus llfor llthe lladolescent
- place llthe lladolescent llin lla llsupine llposition
- place lla llmoist, llwarm llpack llon llthe lladolescents lllower llback
- apply lla lleutectic llmixture llof lllocal llanesthetics llto llthe lladolescent's
ll puncture site -ANSWER>>Place the adolescent in supine
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ll position
RATIONALE:(The nurse should place the adolescent in a supine position ll ll ll ll ll ll ll ll ll
ll for 30 minutes to an 1 hourfollowing a lumbar puncture to decrease the
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risk of a post Dural puncture headache)
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A nurse is assessing a child who is receiving IV chemotherapy.
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ll assessment findingsinclude extravasation of the tissues surrounding
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ll the IV insertion site. In which order should the nurse take the
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ll following actions? ll
-Remove IV line ll ll
-Elevate the extremity ll ll
-Stop the infusion ll ll
-Notify the provider - ANSWER>>Stop ll ll ll ll
ll the infusionElevate the extremity
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, Notify the ll
ll provider
ll Remove the IV ll ll
line
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A nurse is discussing the causes of chronic diarrhea with a client. which
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ll of the followingconditions is caused by malabsorption
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-Celiac disease ll
-Ulcerative colitis ll
-Hirschsprung's disease ll
-Crohn's disease - ANSWER>>Celiac Disease
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RATIONALE:( (the nurse should recognize that celiac disease causes ll ll ll ll ll ll ll ll
ll chronic diarrhea due to malabsorption. other malabsorption conditions
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include short bowel syndrome, lactoseintolerance, and congenital enzyme
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ll deficiency)
A nurse is caring for an 8 year old child who has sickle cell anemia.
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which of thefollowing actions should the nurse take?
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-Apply cool compresses to the painful area
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-Initiate contact isolation precautions
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-Give the child flavored popsicles
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-Administer phytonadione - ANSWER>>Give the child flavored popsicles
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RATIONALE:( (Maintaining hydration with a child who has sickle cell ll ll ll ll ll ll ll ll ll
anemia is important to preventsickling. children often accept flavored
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