NR 328 CMS Exam Practice Questions with Complete Solutions

NR 328 CMS Exam Practice Questions with Complete Solutions The school nurse is caring for a boy with hemophilia who fell on his arm during recess. What supportive measures should the nurse use until factor replacement therapy can be instituted? a. Applying pressure for at least 1 minute b. Beginning passive range-of-motion exercise unless the pain is severe c. Elevating the area above the level of the heart d. Applying warm, moist compresses Answer: C Rationale: The initial response should include elevation of the arm to minimize bleeding. Cold should be applied to the arm. This will aid in vasoconstriction, which will in turn minimize blood loss. Pressure is effective in small areas but would not be as effective for an extremity. Passive range-of-motion exercise is not recommended. The child may perform active range-of-motion exercise after the bleeding episode has resolved A child with sickle cell anemia is brought to the hospital with pain in the lower limbs. On examination the child's skin and tongue are pale and the PaO2 is 98%. What measure should the nurse take to prevent sickling of red blood cells in this patient? a. Give intravenous fluids. b. Restrict drinking of water. c. Administer oxygen. d. Give oral analgesics. Answer: A Rationale: Prevention of sickling is an important measure in the management of sickle cellLinks to an external site. crisis. Hydration of the body either through oral or intravenous fluids helps to prevent the sickling phenomenon. The PaO2 of the patient indicates that oxygen saturation is optimal, and therefore oxygen administration is not required. Analgesics are given to reduce pain; however they cannot prevent sickling. Drinking of water should be encouraged. A child with sickle cell disease is brought to the hospital reporting right knee pain. On examination, the nurse finds localized swelling and immediately applies a cold compress to the right knee, massages the knee, and administers ibuprofen for pain relief. The nurse informs the mother that the child may need a high dose of an opioid if there is no relief from pain. Which of the measures taken by the nurse need to be corrected? a. Giving ibuprofen to the child for pain relief b. Giving cold compression to the affected area c. Informing the parent that the child needs a high dose of an opioid d. Massaging the affected area for pain relief Answer: B Rationale: Localized swelling over a joint with arthralgia can occur in some children with sickle cell disease. In such situations a nurse should avoid applying a cold compress to the affected area, as it promotes vasoconstriction leading to sickling of cells. Therefore the nurse should apply heat, massage the affected area, and give analgesics such as ibuprofen for pain relief. Parents should be informed that the child may require a high dose of an opioid if the pain is not relieved and that it is completely safe. For a postoperative patient 6 hours after brain surgery, which potential complications can result from improper positioning? Select all that apply. a. Increased risk for aspiration b. Pressure on the surgical site c. Infection d. Skin breakdown e. Increased intracranial pressure