A nurse is assisting with the care of a 2-month-old infant who has a subdural hematoma. Which of the following findings should the nurse expect?
Depressed fontanels
Decreased temperature
Difficult to arouse
Weak cry
The Correct Answer is C
Choice A reason:
A subdural hematoma may not directly affect the fontanels. Depressed fontanels can be a sign of dehydration or other underlying conditions, but they are not specifically associated with a subdural hematoma.
Choice B reason:
A subdural hematoma would not typically cause a decrease in body temperature. This finding may be related to other factors, but it is not a characteristic sign of a subdural hematoma.
Choice C reason:
Correct. A subdural hematoma is a collection of blood between the dura mater and the brain. This can lead to increased intracranial pressure and result in the infant being difficult to arouse.
Choice D reason:
While a weak cry can be an indication of distress or illness in an infant, it is not a specific sign of a subdural hematoma. Other assessments, including neurological signs, are crucial in evaluating the infant's condition.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason:
Determining the child's heart rate is important for assessing overall cardiovascular health, but it is not specific to evaluating the effectiveness of dornase alfa.
Choice B reason:
Weighing the child daily is important for monitoring overall nutritional status and fluid balance, but it is not specific to evaluating the effectiveness of dornase alfa.
Choice C reason:
Dornase alfa is a medication used to help clear mucus from the airways in individuals with cystic fibrosis. Therefore, auscultating the child's breath sounds for improved air exchange and reduced adventitious lung sounds is a direct way to evaluate the effectiveness of the medication.
Choice D reason:
Monitoring the child's 180 (assuming this is a typo and referring to heart rate) is important, but it is not specific to evaluating the effectiveness of dornase alfa.
Correct Answer is A
Explanation
Choice A reason:
Using a bleach-based solution to clean the bedside table is an appropriate measure to prevent the spread of Clostridium difficile bacteria, as bleach is effective in killing spores.
Choice B reason:
While hand sanitizer is useful for killing many types of bacteria and viruses, it may not be as effective against Clostridium difficile spores. Washing hands with soap and water is preferred.
Choice C reason:
Placing the toddler in a negative-airflow room is not necessary for managing Clostridium difficile diarrhea. Standard precautions and proper hygiene are sufficient.
Choice D reason:
Loperamide is not typically recommended for managing Clostridium difficile diarrhea, as it may worsen the condition by slowing down the bowel motility. The primary treatment is discontinuing the antibiotic that caused the infection and, in some cases, using specific antibiotics to target the C. difficile bacteria.
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