ATI Custom NUR 2730 Exam 4 version 1 Part1
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Free ATI Custom NUR 2730 Exam 4 version 1 Part1 Questions
A nurse is providing teaching to a parent of a preschooler who has eczema. Which of the following instructions should the nurse include in the teaching?
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Dress the child in woolen clothes during cold months.
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Give the child a bubble baths every day.
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Apply a topical corticosteroid ointment to the affected area.
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Launder the child's clothing with fabric softener.
Explanation
Topical corticosteroids are a mainstay of eczema treatment, working to reduce the inflammation, itching, and redness of affected skin during flare-ups. Applying the prescribed corticosteroid ointment to affected areas as directed helps control symptoms and allows the skin barrier to heal.
Why the other options are incorrect:
A. Dress the child in woolen clothes during cold months. Wool is a known irritant for children with eczema, causing itching and triggering flare-ups; soft, breathable cotton clothing should be worn instead. B. Give the child a bubble baths every day. Bubble baths contain fragrances and detergents that dry and irritate the skin, worsening eczema; short, lukewarm baths with mild, fragrance-free cleansers followed by immediate moisturizing are recommended. D. Launder the child's clothing with fabric softener. Fabric softeners contain fragrances and chemicals that can irritate sensitive skin and trigger eczema flare-ups; clothing should be washed in mild, fragrance-free detergent without fabric softener.
Nurses' Notes
Day 1, 1130: The 14-year-old adolescent was brought to the ED by emergency medical services after being struck by a car while skateboarding to school. No helmet or protective gear was worn. Glasgow Coma Scale at scene was 12. Cervical collar and back board placed at scene for transport remains intact.
Reports left leg pain as 10 on a scale of 0 to 10. Open fracture noted on left anterior thigh. Dressing applied at scene is saturated with dark red blood. Left thigh is very edematous. Neurovascular status of lower extremities: Left pedal pulse 1+; R pedal pulse 2+, capillary refill is 2 seconds equal bilaterally, skin color is consistent with genetic background, warm to touch and sensation is intact equal bilaterally. Adolescent is able to slowly wiggle toes on command.
Is alert and oriented to person, place, time, and situation; reports having a headache. Reports pain as 5 on scale of 0 to 10. Doesn't recall events of the collision. States, "I woke up and was in the ambulance." Adolescent has a small, soft, raised area over the right temporal bone. Pupils are equal, round and reactive to light and accommodation (PERRLA). Hand grasps are equal and strong.
Breath sounds are equal and clear bilaterally. Abdomen is soft and nondistended with bowel sounds in all quadrants.
Day 1, 1530: The 14-year-old transferred from the postanesthesia care unit following ORIF of left open femur fracture. Drowsy but arouses easily. Oriented to time, place and person. Peripheral IV in right hand with 0.9% sodium chloride 125 mL/hr. Surgical dressing intact on left thigh; small amount of serosanguinous drainage on distal aspect of dressing.
Left foot is warm to touch, capillary refill is brisk, pedal pulse is 2+, sensation is intact and is able to wiggle toes upon command. Non-pitting edema of left toes and foot present. Adolescent reports headache pain as 3 and left leg pain as 4 on a 0 to 10 scale. Numerous abrasions are noted on face, upper and lower extremities and left hip area. Large bruise and tenderness noted in left flank area.
1730: Surgical dressing intact; moderate amount of serosanguinous drainage on distal aspect of dressing. Left foot is warm to touch, capillary refill is brisk, pedal pulse is 2+, sensation is intact and slowly wiggles toes upon command. Non-pitting edema of left toes and foot present.
Adolescent reports headache pain as 9 and left leg pain as 8 on a scale of 0 to 10. Parent reports that adolescent had a couple episode of "dry heaves." Adolescent is lethargic. Arouses briefly to tactile stimuli, is irritable and then quickly returns to sleep. PERRLA, hand grasps are equal and strong bilaterally. Abdomen is soft; nondistended with generalized tenderness upon palpation, bowel sounds are present in all four quadrants.
Day 5, 1745: Called to room by parent. Adolescent is having jerking movements of all extremities, is unresponsive, eyes are rolled upwards, mucous membranes are blue, and copious amounts of clear mucus is noted at the corners of the mouth.
Day 10, 1200: Discharge instructions provided to parent and adolescent.
Which of the following statements by the parent indicates an understanding of discharge instructions?
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"They may need to change to a keto diet if the medications don't work."
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"I should put a solid object between their teeth if they have a seizure."
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"I should avoid calling 911 unless their seizure lasts for 30 minutes."
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"They should avoid any type of anti-seizure medication with milk."
Explanation
Correct Answer: (A) "They may need to change to a keto diet if the medications don't work."
A ketogenic diet is a recognized treatment option for seizure management when anti-seizure medications alone are not adequately controlling seizure activity. This statement reflects accurate understanding that dietary therapy is a legitimate next step in managing seizures if pharmacological treatment proves insufficient, which shows the parent has a correct understanding of the broader seizure management plan.
Why the other options are incorrect:
B. "I should put a solid object between their teeth if they have a seizure." Placing any object in the mouth during a seizure is unsafe and can cause dental injury, airway obstruction, or broken teeth; nothing should ever be inserted into the mouth during a seizure.
C. "I should avoid calling 911 unless their seizure lasts for 30 minutes." Emergency services should be called if a seizure lasts longer than 5 minutes, not 30 minutes, so waiting this long delays necessary emergency care.
D. "They should avoid any type of anti-seizure medication with milk." There is no general contraindication between anti-seizure medications and milk, so this statement reflects a misunderstanding rather than accurate discharge teaching.
A nurse is caring for a child who has otitis media with effusion. The nurse should identify that which of the following manifestations indicates a tympanic membrane rupture?
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Popping sensation when swallowing
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Increased temperature
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Sudden pain relief
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Green-blue discharge in the ear canal
Explanation
Correct Answer: (C) Sudden pain relief
When the tympanic membrane ruptures, the pressure that was building up in the middle ear is suddenly released, resulting in immediate relief of ear pain. This sudden pain relief, sometimes accompanied by drainage, is a classic indicator that the eardrum has ruptured.
Why the other options are incorrect:
A. Popping sensation when swallowing A popping sensation when swallowing is more commonly associated with eustachian tube dysfunction or pressure changes, not a ruptured tympanic membrane. B. Increased temperature An increased temperature may occur with the underlying infection itself but is not a specific indicator of tympanic membrane rupture. D. Green-blue discharge in the ear canal Green-blue discharge would be more concerning for a different type of infection, such as a Pseudomonas infection; drainage following a tympanic membrane rupture is typically clear, bloody, or purulent rather than green-blue.
A nurse is providing care to a 12-year-old child diagnosed with severe iron deficiency anemia (IDA). The parents ask the nurse if IDA will affect their child at school. Which of the following statements is the most appropriate response by the nurse?
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"Your child should be able to play sports and keep up with their peers."
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"Your child may not be able to eat lunch with their peers due to dietary restrictions."
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"Your child may require additional support with schoolwork."
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"Your child may have a delay in growth, but no cognitive delays."
Explanation
Correct Answer: (C) "Your child may require additional support with schoolwork."
Severe iron deficiency anemia affects cognitive function, attention, concentration, and memory due to reduced oxygen delivery to the brain and iron's essential role in neurotransmitter synthesis. School-age children with severe IDA are at risk for difficulties with learning, attention, and academic performance, making additional educational support an appropriate and honest response.
Why Other Options are Incorrect:
A. "Your child should be able to play sports and keep up with their peers." Severe IDA causes significant fatigue, weakness, and reduced exercise tolerance, making full participation in sports unrealistic until the anemia is treated.
B. "Your child may not be able to eat lunch with their peers due to dietary restrictions." Dietary modifications for IDA involve increasing iron-rich foods and avoiding certain inhibitors, but do not require the child to eat separately from peers.
D. "Your child may have a delay in growth, but no cognitive delays." This is inaccurate. Severe IDA is well documented to cause cognitive delays, impaired attention, and learning difficulties, not merely growth delays.
A nurse is discharging a child who has sickle cell anemia after an acute crisis episode. Which of the following instructions should the nurse include in the teaching?
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"Offer fluids to your child multiple times every day."
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"Apply cold compresses when your child expresses pain."
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"Monitor your child's temperature daily."
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"Restrict outdoor play activity to 1 hour per day."
Explanation
Adequate hydration is one of the most important measures in preventing sickle cell crises, because dehydration increases blood viscosity and promotes the sickling of red blood cells, which leads to vaso-occlusion and pain. Encouraging frequent fluid intake throughout the day helps maintain hydration and reduce the risk of another crisis episode.
Why the other options are incorrect:
B. "Apply cold compresses when your child expresses pain." Cold causes vasoconstriction, which worsens sickling and vaso-occlusion; warm compresses should be used for pain relief instead. C. "Monitor your child's temperature daily." While parents should be alert for fever, which requires prompt medical attention in sickle cell disease, routine daily temperature monitoring in a well-appearing child is not the key discharge instruction compared to maintaining hydration. D. "Restrict outdoor play activity to 1 hour per day." Children with sickle cell anemia can participate in normal activities with rest periods as needed; arbitrary activity restriction is unnecessary, though extremes of temperature and overexertion should be avoided.
A nurse is performing a pre-college physical assessment on a 16-year-old adolescent. Which of the following immunizations should the nurse anticipate administering?
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Bacille Calmette-Guérin (BCG) vaccine
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Meningococcal polysaccharide vaccine
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Hepatitis B vaccine
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Pneumococcal polysaccharide vaccine
Explanation
Meningococcal vaccination is recommended for adolescents before college entry, with a booster dose at age 16 following the initial dose at 11 to 12 years. College students, particularly those living in dormitories, are at increased risk for meningococcal disease due to close living quarters, making this the anticipated immunization for a pre-college physical.
Why the other options are incorrect:
A. Bacille Calmette-Guérin (BCG) vaccine The BCG vaccine for tuberculosis is not routinely administered in the United States and is not part of the adolescent immunization schedule. C. Hepatitis B vaccine The hepatitis B vaccine series is routinely completed in infancy, so a 16-year-old would typically have already received this series unless catch-up dosing were required. D. Pneumococcal polysaccharide vaccine The pneumococcal polysaccharide vaccine is recommended for adults 65 and older and individuals with specific high-risk conditions, not routinely for healthy adolescents entering college.
A nurse is educating a parent about the contagious period of chickenpox in their child. Which statement by the nurse accurately describes when the child is no longer contagious?
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The child is no longer contagious when the rash first appears.
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The child is no longer contagious once all the blisters have crusted over.
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The child is no longer contagious once the fever subsides.
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The child is no longer contagious after five days from the onset of the rash.
Explanation
Chickenpox (varicella) remains contagious from about 1 to 2 days before the rash appears until all of the lesions have crusted over, which typically takes about 5 to 7 days after the rash onset. The crusting of all blisters is the definitive marker that the child can no longer transmit the virus, making this the accurate teaching point for when the child may safely return to school or be around others.
Why the other options are incorrect:
A. The child is no longer contagious when the rash first appears. The rash's first appearance actually marks a highly contagious period, and the child remains contagious as long as fluid-filled vesicles are present. C. The child is no longer contagious once the fever subsides. Fever resolution does not indicate the end of the contagious period, as active, uncrusted lesions can still transmit the virus. D. The child is no longer contagious after five days from the onset of the rash. The contagious period is determined by the condition of the lesions, not a fixed number of days; if any blisters have not yet crusted over after five days, the child remains contagious.
A nurse is providing education to a group of parents of children who have attention deficit hyperactivity disorder (ADHD). Which of the following interventions should the nurse include in the teaching? (Select All that Apply.)
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Teaching parents about the impact of ADHD manifestations on daily functioning.
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Providing resources to support strategies for managing the child's behaviors.
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Educating parents about ensuring the child is placed in the appropriate class in school.
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Promoting healthy habits as part of a comprehensive treatment plan for ADHD.
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Encouraging unlimited access to electronic devices to promote child engagement.
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Emphasizing the importance of strategies for promoting adequate sleep.
Explanation
Comprehensive parent education for ADHD includes helping parents understand how ADHD manifestations affect their child's daily functioning at home and school, which builds realistic expectations and empathy. Providing behavior management resources equips parents with evidence-based strategies such as consistent routines, positive reinforcement, and clear expectations. Educating parents about appropriate school placement ensures the child receives necessary academic accommodations and support services. Promoting healthy habits, including regular physical activity and balanced nutrition, supports overall treatment effectiveness. Emphasizing adequate sleep is essential because sleep deprivation can worsen ADHD symptoms such as inattention and impulsivity.
Why the other options are incorrect:
E. Encouraging unlimited access to electronic devices to promote child engagement is incorrect because excessive screen time can worsen attention difficulties, interfere with sleep, and displace beneficial activities such as physical play and social interaction; screen time should be limited and monitored for children with ADHD.
A nurse is preparing to administer digoxin to a client who has heart failure. Which of the following actions is appropriate?
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Withholding the medication if the heart rate is at the high end of normal for their age.
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Instructing the client to eat foods that are low in potassium
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Evaluating the client for nausea, vomiting, and anorexia
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Measuring apical pulse rate for 30 seconds before administration
Explanation
Nausea, vomiting, and anorexia are early signs of digoxin toxicity, which is a serious concern given the medication's narrow therapeutic range. Evaluating the client for these gastrointestinal manifestations before administration is an essential nursing safety action to detect toxicity early and prevent life-threatening complications such as dysrhythmias.
Why the other options are incorrect:
A. Withholding the medication if the heart rate is at the high end of normal for their age. Digoxin is withheld when the heart rate is too low, typically below 60/min in adults or below age-specific thresholds in children, not when the rate is at the high end of normal. B. Instructing the client to eat foods that are low in potassium Hypokalemia increases the risk of digoxin toxicity; clients taking digoxin should maintain adequate potassium intake, not restrict it. D. Measuring apical pulse rate for 30 seconds before administration The apical pulse must be counted for a full 60 seconds before administering digoxin to accurately assess the heart rate and rhythm.
A nurse is caring for a 2-month-old infant who is postoperative following surgical repair of a cleft lip. Which of the following actions should the nurse take?
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Administer ibuprofen as needed for pain.
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Position the infant on her abdomen.
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Offer the infant a pacifier.
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Encourage the parents to rock the infant.
Explanation
Correct Answer: (D) Encourage the parents to rock the infant.
After cleft lip repair, keeping the infant calm and comfortable is essential to protect the surgical site, since crying places tension on the suture line and can compromise healing. Encouraging the parents to rock and soothe the infant is a safe, effective comfort measure that reduces crying and stress on the incision while also promoting parent-infant bonding.
Why the other options are incorrect:
A. Administer ibuprofen as needed for pain. Ibuprofen is not recommended for infants younger than 6 months of age; acetaminophen is the appropriate analgesic for a 2-month-old. B. Position the infant on her abdomen. Prone positioning places direct pressure on the surgical site and risks damaging the repair; the infant should be positioned supine or upright to protect the suture line. C. Offer the infant a pacifier. Pacifiers and other objects placed in the mouth create suction and pressure that can disrupt the suture line and are avoided following cleft lip repair.
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