A 3-week-old infant is admited to the pediatric unit with vomiting and dehydration. The mother describes the infant as having projectile vomiting after eating. She also tells the practical nurse (PN) that the baby is always hungry. Which finding warrants immediate intervention by the PN?

Hyperactive gastric sounds.

Irregular palpable pulse.

Crying without tears.

Underweight for age.

Answer and Explanation

The Correct Answer is B

This finding may indicate a potential cardiac issue that needs immediate medical atention. Projectile vomiting and excessive hunger in a young infant may be signs of pyloric stenosis, a condition in which the muscle between the stomach and small intestine thickens, making it difficult for food to pass through.

Hyperactive gastric sounds may be present with vomiting, but it is not an immediate concern.

Crying without tears may be a sign of dehydration, but it is not an immediate concern.

Underweight for age is a concern but it is not a finding that requires immediate intervention.

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Correct Answer is B

Explanation

Acute leukemia can cause thrombocytopenia, which is a decrease in the number of platelets in the blood. Platelets are essential for blood clotting, and a low platelet count can result in heavy menstrual bleeding. Therefore, reviewing the client's platelet count is the priority in response to the client's statement. The other laboratory data may also be important to assess, but platelet count is the most relevant in this situation.

A. Ask the client if she has been experiencing constipation. B. Suggest that she should avoid citrus fruits when taking the iron. C. Recommend increasing dietary iron-rich foods. D. Explain that she should report stools that are dark green and sticky.

Correct Answer is C

Explanation

Iron supplements are often recommended for pregnant women to prevent or treat anemia and to improve the iron status of both the mother and the baby ¹. During pregnancy, you need 27 milligrams of iron a day ². Iron is also found in some foods, such as meat, beans, and leafy greens ¹. So, it is recommended to increase dietary iron-rich foods.

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A 3-week-old infant is admited to the pediatric unit with vomiting and dehydration. The mother describes the infant as having projectile vomiting after eating. She also tells the practical nurse (PN) that the baby is always hungry. Which finding warrants immediate intervention by the PN?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

An adolescent female client with acute leukemia reports that she is experiencing an unusually heavy menstrual ﬂow. Which laboratory data should the practical nurse (PN) review in response to this statement?

Correct Answer is B

Explanation

A client at 8-weeks gestation has a hemoglobin of 9.5 mg/dl. The healthcare provider prescribes an oral iron supplement. Which information should the practical nurse (PN) provide the client?

Correct Answer is C

Explanation

A highly successful businessman presents to a mental health center complaining of sleeplessness and anxiety over his financial status. Which action should the practical nurse (PN) take to assist this client in diminishing his anxiety?

The practical nurse (PN) is caring for a 3-month-old infant with a head injury who had a seizure episode. The infant has a high-pitched cry and is irritable. The caregiver reports that the infant rolled over and fell onto the carpeted ﬂoor. Which action should the PN take?

A child with cerebral palsy (CP) is taking baclofen, a relaxant. Which assessment finding indicates to the practical nurse (PN) that the drug is eﬀective?

A client with a major depressive disorder is admitted to the inpatient psychiatric unit. Which intervention should the practical nurse (PN) use to demonstrate support of the client?

A client on the mental health unit has been scowling and rapidly pacing up and down the hall for several minutes. Which behaviors are most important for the practical nurse (PN) to monitor?

The practical nurse (PN) is assisting with the admission of a 12-month-old child with a history of frequent colds and growth failure. Testing is being planned for a possible diagnosis of cystic fibrosis (CF). Which information is most important for the PN to obtain?

Another person tells the practical nurse (PN) that her 7-year-old child frequently wets the bed at night. Which information should the PN provide?

At a prenatal visit, a primigravida client confides to the practical nurse (PN) that her partner is abusive. Which information should the PN provide?