Q&A Hero

Q: The correct response of the nurse who is asked if Florence Nightingale had any impact on the role of the nurse in psychiatric"mental health nursing should be which of the following? 1. "No, Nightingale focused her ideas on nursing education rather than direct client care." 2. "Yes, Nightingale was among the first to note that the influence of nurses has psychological components." 3. "No, Nightingale emphasized the physical environment for healing." 4. "Yes, Nightingale developed the idea of the therapeutic relationship."

Q: The nurse is admitting a client to the psychiatric unit. Which nursing action is correct? 1. Instruct the client that all information gathered during the assessment will be shared with the mental health team. 2. Alert the client that the psychiatrist will do all the intake assessment to maximize the efficiency of the team. 3. Discuss with the client information that is to be shared with family members and the mental health team. 4. Instruct the client that the mental health team will decide what the client needs to do in treatment.

Q: The nurse is planning activities to enhance collaboration within the mental health care team. Which activities will be helpful toward this goal? Standard Text: Select all that apply. 1. Identification of ways to minimize diversity among team members 2. Discussion of decisions that require team unity 3. Identification of ways to ignore individual power bases 4. Review of interpersonal communication skills 5. Discussion of decisions that can be made autonomously

Q: Observation of the behavior of the mental health team seems to indicate that one team member is primarily interested in client progress as a measure of their knowledge and expertise. Given the nurse's knowledge of game theories, this team member might be functioning as which of the following? 1. Rivalist 2. Leader 3. Enabler 4. Maximizer

Q: The nurse reflecting on the nursing role within the mental health team, understands that the main purpose of delivering care using a multidisciplinary team is to do which of the following? 1. Maximize the efficiency of the health care team with each team member learning from the others. 2. Increase the opportunity for interpersonal interaction among the client, family, and team members. 3. Facilitate the case management process by delivering care using a multidisciplinary health care team. 4. Make the best use of the different abilities of mental health team members in order to facilitate client progress.

Q: The mental health team nurse is having some role issues regarding how best to facilitate client progress toward therapeutic goals. What is the priority action by the nurse in order to aid the team as they assist the client? 1. Acknowledge the diversity of the mental health team. 2. Recognize that conflict is natural and expected. 3. Determine personal values, biases, and goals. 4. Attend all mental health team meetings.

Q: The client's treatment plan includes teaching related to possible side effects of psychotropic medications. Which member of the mental health team should plan to implement the teaching? 1. The psychosocial rehabilitation worker 2. The primary therapist 3. The psychiatrist 4. The nurse

Q: Due to a staff member's absence, the nurse is reviewing staff assignments for the day. Which task can the nurse delegate to the psychosocial rehabilitation worker? 1. Conflict resolution teaching to a small group of clients 2. Comparison of physician's orders with the medication records 3. Routine medication administration to a stable client 4. Assessment of a long-term client

Q: Upon arrival on the psychiatric unit this morning, which activity should be the nurse's focus? The nurse should do which of the following? 1. Review psychological testing results for all clients. 2. Schedule the individual therapy sessions for all clients. 3. Identify community resources for clients to be discharged this morning. 4. Assess each client for whom the nurse will be providing care.

Q: The nurse assesses that the mental health client has problems choosing productive, safe leisure activities. Which member of the mental health team should the nurse consult with? 1. Recreational therapist 2. Occupational therapist 3. Attending psychiatrist 4. Clinical psychologist

Q: The client asks the nurse if certain changes can be made in the unit milieu. Which action by the nurse indicates understanding of the nursing role in the therapeutic milieu? 1. The nurse refers the client's requests to the psychiatric social worker. 2. The nurse discusses the desired changes with the client. 3. The nurse refers the client's requests to the psychosocial rehabilitation worker. 4. The nurse instructs the client that no changes can be made.

Q: The client on the psychiatric unit is asking questions about prevention of sexually transmitted diseases. Given the Psychiatric"Mental Health Nursing Standards of Practice, which action would be most appropriate for the nurse to take at this time? 1. Consult with the mental health care team. 2. Teach safer sexual practices. 3. Investigate the questions in individual psychotherapy. 4. Notify the attending psychiatrist.

Q: The psychiatric"mental health nurse is working with the new graduate nurse who is orienting to the psychiatric unit. Which comment by the new graduate indicates further clarification of the generalist-nursing role is needed? 1. "I would feel better if you would look at my documentation that addresses progress toward treatment goals." 2. "I will spend time each day evaluating the effectiveness of the therapeutic milieu." 3. "I am a little nervous about conducting psychotherapy with clients." 4. "I am doing some reading on how to incorporate complementary interventions into treatment plans."

Q: The psychiatric"mental health nurse reflecting on professional role activities is referred to the standards of professional performance by a colleague. To which organization should the nurse look for guidance? 1. North American Nursing Diagnosis Association 2. American Nurses Credentialing Center 3. National League for Nursing 4. American Nurses Association

Q: The nurse is serving on a committee charged with reviewing the roles and responsibilities of the nurses on the psychiatric unit. Which publication should the nurse bring to the first meeting? 1. Diagnostic and Statistical Manual of Mental Disorders 2. American Nurses Credentialing Center certification requirements 3. American Nurses Association, Code of Ethics 4. Psychiatric"Mental Health Nursing Standards of Practice

Q: The nurse's new job description at the generalist level of practice reflects the definition of psychiatric"mental health nursing and the Psychiatric"Mental Health Nursing Standards of Practice (ANA, APNA, ISPN). In which of the following areas might the nurse plan programs and intervention to fulfill employment expectations?Standard Text: Select all that apply.1. Stress management strategies2. Early diagnosis of psychiatric disorders3. Parenting classes for new parents4. Family and group psychotherapy5. Medication teaching for anti-anxiety medications

Q: The nurse educator is teaching a group of students about stigma. The educator states that stigma can affect the judgment of which of the following people about the person who is labeled as mentally ill? 1. God or other higher powers 2. Family 3. Health care providers 4. Co-workers 5. Friends

Q: A nurse is teaching a group of students about the stigma that is often associated with mental illness. The nurse tells the group that stigma associated with mental illness is about which of the following? 1. Disrespect 2. Intelligence 3. Respect 4. Appreciation

Q: The psychiatric nurse states that today's nursing practice is based on contemporary theories concerning the etiology of mental disorder. Given this theoretical basis, the nurse would most likely give priority to which of the following assessments? Standard Text: Select all that apply. 1. Family communication patterns 2. Psychotropic medications 3. Family history of mental disorder 4. Early childhood interactions 5. PET and CT scans of the brain

Q: The psychiatric nurse is asked to explain the primary focus in the assessment and treatment of mental illnesses during the mid-20th century. Given this request, the nurse would emphasize beliefs and actions related to which of the following? 1. Faulty life habits and interactions 2. Decay of intellect or of the nervous system 3. Classification of symptoms 4. Social dimension and drug treatment

Q: The psychiatric nurse is reflecting on the treatment and care of the mentally ill throughout history. Which of the following philosophical beliefs most guided treatment of the mentally ill during 17th century Europe? 1. The mentally ill were divinely inspired and should be treated with care and benevolence. 2. The body's humors were responsible; blood, bile, and phlegm must be balanced. 3. Madness was best overcome by discipline and brutality. 4. The mentally ill were possessed by evil spirits that inflicted emotional suffering.

Q: The nursing assistant asks the psychiatric nurse the location of the first asylum for the mentally ill. Which response by the nurse is most appropriate? 1. "The first asylum for the mentally ill was in Morocco." 2. "This is not part of your role on this unit." 3. "The first asylum for the mentally ill was St. Mary of Bethlehem (Bedlam)." 4. "Why do you want to know this?"

Q: The nurse is teaching a group of students the various historical explanations of mental illness. Which statement by the students indicates understanding of the nurse's teaching regarding the era of magico-religious explanations? 1. "The insane were believed to be divinely inspired and care was generally benevolent and kindly." 2. "Mental illnesses were caused by imbalances in body humors: blood, bile, and phlegm." 3. "Mental and physical illness were the result of superhuman forces that inflicted suffering." 4. "Mental illnesses were influenced by the moon; hence, the term lunacy."

Q: The nurse is assessing a client in the home. Given the nurse's knowledge of the top 10 causes of disability worldwide, choose the priority area for data collection. 1. Social interactions and history of abuse 2. Irrational fears and quality of communication 3. Memory and childhood history 4. Mood and patterns of alcohol usage

Q: During the evaluation of the effectiveness of the nurse's discharge teaching, which client report would indicate to the nurse that the client understands the leading cause of disability and decrement in health? The client reports a need to incorporate strategies to prevent: 1. Obesity. 2. Anxiety. 3. Depression. 4. Cancer.

Q: The home health nurse is caring for a number of clients with chronic illnesses. Given World Health Organization (WHO) research, the nurse realizes that the client with which of the following is at greatest risk for mental disability? 1. Bipolar disorder 2. Panic disorder 3. Psychotic disorders 4. Anxiety disorders

Q: The nurse plans to implement health promotion activities at the local senior citizen center. To meet the goal of promoting knowledge related to maximizing mental health and functional ability, the nurse's teaching is guided by World Health Organization research and should include discussion of which priority area specific to the leading causes of mental disability? 1. Social isolation 2. Dementia 3. Alcohol 4. Over-the-counter medications

Q: The nurse is planning care for the client who presents with frequent reports of multiple physical complaints. Given knowledge of the leading causes of mental disability, the nurse should plan to include further data collection in which of the following priority areas? 1. Relationships with others 2. History of family violence 3. Alcohol usage 4. Clarity of thought processes

Q: The nurse is researching statistics of the five psychiatric disorders that comprise the top 10 causes of disability worldwide. Given this information, the nurse chooses which of the following as a priority screening for clients? 1. Bipolar disorder 2. Depression 3. Schizophrenia 4. Alcohol abuse

Q: The client has frequently presented to the clinic with multiple physical complaints. The multiple physical complaints would warrant the nurse to screen the client for: 1. A chronic illness. 2. Deviant behavior. 3. Hospitalization. 4. A mental disorder.

Q: The nurse is asked to provide traits of a mentally healthy individual at a hospital in-service. The nurse knows that mentally healthy individuals are: 1. Physically healthy and dependent. 2. Middle-aged and physically ill. 3. Dependent and needy. 4. Independent and autonomous.

Q: A nurse educator is teaching a group of students the definition of a mentally healthy individual. The nurse educator knows that an individual is considered mentally healthy when which of the following concepts give evidence to psychological, emotional, and social health? 1. Behavior 2. Intrapersonal relationships 3. Gender 4. Age 5. Interpersonal relationships

Q: The new nurse is working with a preceptor on a medical-surgical unit. The nurse has just assessed a client and states to the preceptor, "This client has many odd notions regarding several common health practices. He seems like a deviant to me." In planning a response, the preceptor is guided by: 1. A definition of deviance that covers all clinical situations. 2. The knowledge that beliefs and behaviors are only deviant if the client thinks there is a problem. 3. The knowledge that beliefs and behaviors are judged by cultural and social considerations. 4. The need for further assessment to determine the duration of the beliefs and actions.

Q: The nurse is caring for a client who was recently admitted to the unit. During the nursing assessment of the client, the nurse finds the client's beliefs and actions related to many health practices to stray from the norm. Which action would be most appropriate for the nurse to take at this time? 1. Repeat the assessment later in the day. 2. Write a nursing diagnosis to address the "bizarre" beliefs and actions. 3. Inquire as to the culture with which the client identifies. 4. Communicate the findings to the health care team.

Q: During an admission assessment on an adult unit, the nurse is thinking that the client's beliefs and actions regarding commonly accepted health practices are "bizarre." To help establish the presence of a mental disorder, the nurse should first collect information about the client's: Standard Text: Select all that apply. 1. Occupational history. 2. Psychiatric history. 3. Culture. 4. Age. 5. Family history.

Q: The nurse is told that the client most likely has the diagnosis of obsessive-compulsive disorder. The nurse is not sure of the assessment data and behaviors that accompany this disorder. Which action would be most appropriate for the nurse to take? 1. Document all subjective and objective data provided by the client. 2. Ask the primary health provider to identify needed subjective and objective assessment data. 3. Research obsessive-compulsive disorder in the medical dictionary. 4. Consult the Diagnostic and Statistical Manual of Mental Disorders for diagnostic criteria.

Q: The nurse is teaching staff at a community mental health clinic about what constitutes a mental disorder. Which comment by staff indicates to the nurse the need for further teaching? 1. "Experiencing distressful symptoms may imply a mental disorder." 2. "Experiencing pain and suffering may imply a mental disorder." 3. "Being unable to function in everyday life is consistent with a mental disorder." 4. "Grieving after a loss may signal a mental disorder."

Q: The nurse is teaching the client regarding the concept of mental disorders. In instructing the client, what areas should be covered in the explanation of what impacts the determination of a mental disorder? Standard Text: Select all that apply. 1. Social conditions 2. Biochemistry 3. Mother"child interactions 4. Brain structure 5. Culture

Q: The nursing assistant verbalizes to the psychiatric nurse that normal people don"t have mental disorders. Which approach by the nurse would be best? 1. Instruct the nursing assistant that anyone can have a mental health problem. 2. Alert the nursing manager of the nursing assistant's remark. 3. Refer the nursing assistant back to the psychiatric orientation materials. 4. Ignore the comment; the nurse has no responsibility in this situation.

Q: The nurse is sharing client assessment data with the multidisciplinary health care team. Which comment by the nurse is irrelevant and indicates a misunderstanding of the concept of a mental disorder? 1. "The client reports significant emotional distress about the current situation." 2. "The client reports a loss of interest in usual pleasurable activities and commitments." 3. "The client denies thoughts of harming self or others." 4. "The client has some very inappropriate religious ideas and spiritual beliefs."

Q: The psychiatric mental health nursing student is preparing to attend a meeting of the psychiatric mental health care team to discuss possible updates to clients' diagnoses. In preparing for this meeting, the nursing student should consult which of the following references? 1. Standards of Psychiatric Nursing Practice 2. Psychiatric nursing care plan manual 3. Diagnostic and Statistical Manual of Mental Disorders 4. Dictionary of common mental disorders

Q: During the shift report, a nurse describes a client as "crazy." Which approach by the nurse would be best? 1. Ask the staff what terminology they wish to use. 2. Say nothing. 3. Suggest that staff use the term "mentally ill." 4. Role model using the term "nervous breakdown."

Q: There has been an outbreak of tinea pedis among the high school football team. The school nurse meets with the team and discusses preventative activities to reduce spread of the organism. The nurse will instruct the team members to: Standard Text: Select all that apply. 1. Wear 100% white cotton socks, changed twice a day. 2. Use talc on feet daily. 3. Use an over-the-counter corticosteroid cream to treat the area. 4. Wear foot covers such as flip flops in the locker room and shower. 5. Apply heat to the area twice a day.

Q: A three-year-old is admitted to the hospital unit with cellulitis of the neck. The nurse will expect medical treatment to include: 1. Topical antibiotics. 2. Intravenous antibiotics. 3. Incision and drainage. 4. Intravenous corticosteroids.

Q: The clinic nurse has completed teaching the teenager about skin care and acne prevention. Which statement by the teenager indicates the need for additional teaching? 1. "I shouldn"t squeeze my blackheads or pimples." 2. "I need to watch my diet and cut out all chocolates." 3. "I should avoid applying drying materials, such as astringents, to my face" 4. "I should wash my hands frequently and avoid touching my face."

Q: The mother of several children is talking with the nurse. She asks the nurse why her younger child seems to sunburn easier than her older children. The nurse would explain that the skin of younger children: 1. Is thinner than that of adolescents. 2. Has less melanin. 3. Has smaller, nonfunctional apocrine sweat glands. 4. More readily absorbs chemicals.

Q: While preparing for the day in the integument clinic, the nurse notices that a number of the patients being seen that day have conditions with a genetic component. Which skin conditions have a genetic or inherited component? Standard Text: Select all that apply. 1. Atopic dermatitis 2. Seborrheic dermatitis 3. Epidermolysis bullosa 4. Molluscum contagiosum 5. Psoriasis

Q: Following an automobile accident, a teenager is left paraplegic. The child is being prepared for discharge. The nurse is reviewing instructions to avoid decubitus ulcers on the buttocks and instructs the teenager to: 1. Contract the buttock muscles five times every two hours. 2. Increase fat in the diet to provide a protective coating over the boney prominences. 3. Do wheelchair push-ups every 15 to 30 minutes. 4. Avoid use of sheepskin as it prevents air from reaching the area.

Q: The nurse is teaching strategies to prevent insect bites and stings to the parents of a small child. Which statement made by the parents indicates a need for further teaching? 1. "If my child wears bright colors and floral prints when outdoors, she will blend in with the surroundings, and the stinging insects will not sting her." 2. "We should remove any items with standing water from our yard and surrounding area to prevent mosquito reproduction." 3. "My child can use insect repellent containing DEET of 10% or less." 4. "My child should avoid heavy colognes, perfumes, and soaps so that insects are not attracted to them."

Q: Nursing care of the child with a snake bite involves assessment of the child for initial and progressive signs of envenomation. Which is the priority nursing action at this time? 1. Measure the circumference of the extremity containing the bite every 20 to 30 minutes. 2. Assess immunization status. 3. Assess the need for emergency breathing interventions. 4. Assess neurovascular status and vital signs. 5. Assess pain and the child's response to pain medication.

Q: The nurse explains to the parents of a child with a severe burn that wearing an elastic pressure garment (Jobst stocking) during the rehabilitative stage can help prevent which complication? 1. Pain 2. Hypertrophic scarring 3. Poor circulation 4. Formation of thrombus in the burn area

Q: The toddler pulled a pot of boiling water off the stove and suffered partial and full thickness burns to the chest. EMS arrived, stabilized the child, and transported him to the hospital burn unit. The child is now in the recovery-management phase of burn treatment. Which is the most common complication seen in this period? 1. Asphyxia 2. Metabolic acidosis 3. Shock 4. Burn-wound infection

Q: Which would be the priority nursing diagnosis during the acute phase of burn injury for a child who has a third-degree circumferential burn of the right arm? 1. Altered tissue perfusion, risk for 2. Infection, risk for 3. Impaired physical mobility 4. Altered nutrition: less than body requirements, risk for

Q: A child has sustained a minor burn. Which of the following should be included in increased amounts in the child's diet? 1. Protein 2. Minerals 3. Carbohydrates 4. Fats

Q: A nurse is applying a 5% permethrin lotion to a toddler with scabies. Which instruction describes the best way to apply this lotion? 1. Apply the lotion over the entire body from the chin down, as well as on the scalp and forehead. 2. Apply the lotion only on the areas with evidence of scabies activity. 3. Apply the lotion only to the hands. 4. Apply the lotion to the scalp only.

Q: Parents understand the teaching a nurse has done with regard to care of their child with tinea capitis (ringworm of the scalp) if they state: 1. "We will give the griseofulvin with milk or peanut butter." 2. "We're glad ringworm isn't transmitted from person to person." 3. "Once the lesion is gone, we can stop the griseofulvin." 4. "Well, at least we don"t have to worry about the family cat getting the ringworm."

Q: An infant has a severe case of oral thrush (Candida albicans). Which is the priority nursing diagnosis for this infant? 1. Ineffective infant feeding pattern related to discomfort 2. Ineffective breathing pattern related to oral thrush 3. Activity intolerance related to oral thrush 4. Ineffective airway clearance related to mucus

Q: The nurse is planning care for a three-month-old infant with eczema. Which intervention would take top priority in this infant's care? 1. Applying antibiotics to lesions 2. Keeping the baby content 3. Maintaining adequate nutrition 4. Preventing infection of lesions

Q: A child had an appendectomy and was discharged home at 48 hours postoperative. A week later the child is readmitted for delayed wound healing. Which causes of delayed wound healing will the nurse review prior to assessing the child? Standard Text: Select all that apply. 1. Infection 2. Predisposing chronic condition, such as diabetes 3. Hypervolemia 4. Inadequate nutrition 5. Hypoxemia 6. Corticosteroid therapy

Q: The 10-year-old child is admitted to the hospital following an accident at school that resulted in a puncture wound of the abdomen. Two days after the injury, the child continues in the inflammation phase of healing. What would the nurse expect to see while changing the child's dressing and assessing the wound? 1. The wound is contracting, and the edges are growing together. 2. A blood clot has formed, sealing the wound. 3. Epithelial cells are growing into the wound. 4. The wound is pale and weepy.

Q: The school nurse is conducting pediculosis capitis (head lice) checks. Which finding would indicate a "positive" head check? 1. White, flaky particles throughout the entire scalp region 2. Lesions on the scalp that extend to the hairline or neck 3. Maculopapular lesions behind the ears 4. Silver/white sacs attached to the hair shafts in the occipital area

Q: The nurse is examining a 12-month-old who was brought to the clinic for persistent diaper rash. The nurse finds perianal inflammation with bright red, scaly plaques and small papules. Satellite lesions are also present. This is most likely caused by which of the following? 1. Candida albicans (yeast) 2. Impetigo (staph) 3. Infrequent diapering 4. Urine and feces

Q: An infant returns to the unit following casting of the leg for talipes equinovarus. Standing orders include monitoring the neurovascular status. In addition to color, for what will the nurse monitor the infant's foot? Standard Text: Select all that apply. 1. Warmth 2. Capillary refill 3. Pedal pulse 4. Sensation 5. Movement of the toes

Q: An 18-month-old child is admitted to the hospital unit for weakness of the lower extremities. Duchenne muscular dystrophy is suspected. Which assessment finding on the admission history and physical is indicative of this disorder? 1. Infant was post-mature by almost two weeks. 2. The child seems very muscular. 3. The child walked early and without support at 10 months. 4. The child's older sister developed scoliosis in the fourth grade.

Q: While at recess, a child falls and hurts his arm. The school nurse is called and suspects a fractured arm. The nurse will apply a splint before transporting the child to the hospital. The nurse will ensure that: 1. The splint is applied firmly enough to prevent swelling. 2. The arm is fully extended in the splint. 3. The splint is fully padded to prevent skin damage. 4. The joints above and below the suspected fracture are immobilized.

Q: When assigned to the patient on complete bed rest for spinal fusion secondary to scoliosis, the nurse will want to intervene to prevent common complications of immobility. Nursing interventions will include: Standard Text: Select all that apply. 1. Encouraging use of the spirometer every two hours while the child is awake. 2. Log-rolling the patient every two hours while awake. 3. Increasing intake of milk to maintain bone calcium. 4. Increasing fruit and grains in the diet. 5. Limiting fluid intake to reduce the need to void.

Q: A two-year-old child is placed in balanced Bryant's traction for a fractured right femur. Which finding by the nurse should be reported to the surgeon? 1. The child keeps trying to turn and lay on his belly. 2. The ropes are unequal in length. 3. The child's buttocks are resting on the bed. 4. The ace bandage wrapping the legs is wrinkled.

Q: A six-year-old boy is admitted to the hospital with a diagnosis of osteomyelitis of the left femur. The plan of care includes a two-week round of intravenous antibiotics. The father questions why the child must be hospitalized and why the child cannot receive oral antibiotics. The nurse explains: 1. The antibiotic of choice is not available in oral form. 2. Blood flow to bones is limited, and parenteral administration is necessary to get appropriate blood levels. 3. Because the child is older now, it is harder to get the child to cooperate with oral antibiotics. 4. Because two weeks of therapy is necessary, the intravenous route will produce fewer side effects.

Q: A nurse is assessing a child after an open reduction of a fractured femur. Which signs indicate that compartment syndrome could be occurring? Standard Text: Select all that apply. 1. Pink, warm extremity 2. Dorsalis pedis pulse present 3. Prolonged capillary refill time 4. Pain not relieved by pain medication 5. Paresthesia of the leg

Q: A child has experienced a sprain of the right ankle. The school nurse should: 1. Leave the ankle open to the air and avoid compressing the area to allow tissue swelling as necessary. 2. Perform passive range-of-motion to the extremity. 3. Lower the extremity below the level of the heart. 4. Apply ice to the extremity.

Q: The nurse is teaching a family how to care for their infant in a Pavlik harness to treat congenital developmental dysplasia of the hip. Which instruction is appropriate for the nurse to include in parental education in relation to the Pavlik harness? 1. Apply lotion or powder to minimize skin irritation. 2. Check at least two or three times a day for red areas under the straps. 3. Put clothing over the harness for maximum effectiveness of the device. 4. Place a diaper over the harness, preferably using a thin, superabsorbent, disposable diaper.

Q: An infant has just returned from surgery for correction of bilateral congenital clubfeet. The infant has bilateral long-leg casts. The toes on both feet are edematous, but there is color, sensitivity, and movement to them. What should the nurse do first? 1. Apply a warm, moist pack to the feet. 2. Elevate the infant's legs on pillows. 3. Encourage movement of the toes. 4. Call the physician to report the edema.

Q: Which of the following would take priority when teaching the family how to care for an infant with osteogenesis imperfecta? 1. Teaching the family how to care for an infant in a cast 2. Teaching the family that the trunk and extremities should always be supported when moving this infant 3. Teaching the family how to care for an infant postop spinal surgery 4. Teaching the family how to care for an infant in traction

Q: The nurse has completed discharge teaching for the family of a child diagnosed with Legg-Calv-Perthes disease. The nurse knows further teaching is needed about the condition if the family states: 1. "We're glad this will only take about six weeks to correct." 2. "We understand abduction of the affected leg is important." 3. "We know to watch for areas on the skin that the brace might rub." 4. "We understand swimming is a good sport for Legg-Calv-Perthes."

Q: An adolescent has just returned from surgery after spinal fusion surgery. Which assessment finding would take priority at this time? 1. Sleeps when not bothered but arouses easily with stimuli 2. Impaired color, sensitivity, and movement to lower extremities 3. Nausea 4. Pain

Q: A child must wear a brace for correction of scoliosis. Which nursing diagnosis takes priority at this time? 1. Impaired gas exchange, risk for 2. Altered growth and development, risk for 3. Impaired skin integrity, risk for 4. Impaired mobility, risk for

Q: The nurse has completed parent education related to treatment for a child with congenital clubfoot. The nurse knows that parents need further teaching when they state: 1. "We're getting a special car seat to accommodate the casts." 2. "We'll watch for any swelling of the feet while the casts are on." 3. "We'll keep the casts dry." 4. "We're happy this is the only cast our baby will need."

Q: A school health nurse is screening for scoliosis. For what assessment findings would the nurse look? Standard Text: Select all that apply. 1. Lordosis 2. Prominent scapula 3. Pain 4. A one-sided rib hump 5. Uneven shoulders and hips

Q: The nurse in the newborn nursery is doing the admission assessment on a neonate. Which assessment finding would lead the nurse to suspect unilateral congenital hip dysplasia? 1. Lordosis 2. Trendelenburg sign 3. Asymmetry of the gluteal and thigh fat folds 4. Telescoping of the affected limb

Q: A mother brings her 22-month-old child to the well-child clinic for an evaluation. The mother states that this child does not seem to be developing like her sister's child of the same age. The nurse will perform which screening test that may provide information about the child's development? 1. MRI of the head 2. An EEG 3. A Denver II 4. Chromosomal study