A nurse is caring for an adolescent in an emergency department who was brought to the emergency department by their parent. The adolescent reports intermittent low-grade fever and anorexia. Manifestations presented a few days after having dental work performed. Now they are worse. The adolescent noticed shortness of breath with exertion today. The nurse reports the 2400 assessment findings to the provider. Which of the following should the nurse anticipate the provider will prescribe? For each potential provider's prescription, click to specify if the potential prescription is anticipated or contraindicated for the client.

Administer antibiotic therapy

Obtain an echocardiogram

Obtain blood cultures x3

Restrict dental hygiene

Perform strenuous exercise regimen twice a day

Answer and Explanation

The Correct Answer is A

Choice A reason: Administering antibiotic therapy is an anticipated prescription for the client, as it can treat the possible bacterial infection that is causing the fever, anorexia, and shortness of breath. The client may have developed infective endocarditis, a serious condition that affects the heart valves and can lead to heart failure or stroke. Antibiotic therapy can help prevent further complications and reduce the risk of mortality.

Choice B reason: Obtaining an echocardiogram is an anticipated prescription for the client, as it can help diagnose the presence and severity of infective endocarditis. An echocardiogram is a noninvasive test that uses sound waves to create images of the heart and its structures. It can show if there is any damage to the heart valves, vegetation (clumps of bacteria and cells) on the valves, or signs of heart failure.

Choice C reason: Obtaining blood cultures x3 is an anticipated prescription for the client, as it can help identify the causative organism of the infection and guide the appropriate antibiotic therapy. Blood cultures are samples of blood that are taken from different sites and times and tested for the presence of bacteria or other microorganisms. They can confirm the diagnosis of infective endocarditis and determine the sensitivity and resistance of the bacteria to different antibiotics.

Choice D reason: Restricting dental hygiene is a contraindicated prescription for the client, as it can worsen the oral health and increase the risk of infection. Dental hygiene is important for preventing plaque and tartar buildup, which can harbor bacteria and cause dental caries, gingivitis, or periodontitis. These conditions can increase the risk of bacteremia (bacteria in the blood) and infective endocarditis. The nurse should teach the client to maintain good oral hygiene and use a soft-bristled toothbrush and gentle flossing.

Choice E reason: Performing a strenuous exercise regimen twice a day is a contraindicated prescription for the client, as it can increase the cardiac workload and exacerbate the symptoms of infective endocarditis. Strenuous exercise can cause tachycardia (fast heart rate), dyspnea (difficulty breathing), chest pain, and fatigue, which can worsen the condition of the heart and the valves. The nurse should advise the client to avoid strenuous exercise and limit physical activity to a level that does not cause symptoms.

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Correct Answer is B

Explanation

Choice A reason: Acidic odors are not a sign of a perforated appendix, but rather a possible indication of gastroesophageal reflux disease (GERD), which is a condition that causes stomach acid to flow back into the esophagus¹.

Choice B reason: Sudden decrease in abdominal pain is a sign of a perforated appendix, which is a serious complication of acute appendicitis. When the appendix ruptures, the pressure inside the abdomen is released, causing a temporary relief of pain. However, this is followed by severe inflammation and infection of the peritoneum, which is the membrane that lines the abdominal cavity². This can lead to sepsis, shock, and death if not treated promptly.

Choice C reason: Narrow fever is not a term that is commonly used in medicine. Fever is a general sign of infection or inflammation, and it can be present in both acute appendicitis and perforated appendix. However, fever alone is not a reliable indicator of the severity or location of the problem³.

Choice D reason: Rigid abdomen is a sign of peritonitis, which is a possible consequence of a perforated appendix. Peritonitis causes the abdominal muscles to contract and become stiff, making the abdomen hard and tender to touch². However, rigidity can also occur in other conditions that cause intra-abdominal inflammation, such as pancreatitis or cholecystitis⁴.

Choice E reason: Nausea is a common symptom of acute appendicitis, but it is not specific to a perforated appendix. Nausea can be caused by irritation of the stomach or the nerves that control vomiting. It can also occur in other gastrointestinal disorders, such as gastritis or gastroenteritis⁵.

A. Headaches B. Bleeding C. Tearing D. Swelling

Correct Answer is D

Explanation

Choice A reason: Headaches are not a specific finding for rhabdomyosarcoma of the nasopharynx, as they can be caused by many other conditions. Headaches may occur if the tumor compresses the cranial nerves or the brain, but this is not a common manifestation.

Choice B reason: Bleeding is not a specific finding for rhabdomyosarcoma of the nasopharynx, as it can be caused by many other conditions. Bleeding may occur if the tumor erodes the blood vessels or the mucosa, but this is not a common manifestation.

Choice C reason: Tearing is not a specific finding for rhabdomyosarcoma of the nasopharynx, as it can be caused by many other conditions. Tearing may occur if the tumor affects the lacrimal duct or the eye, but this is not a common manifestation.

Choice D reason: Swelling is an expected finding for rhabdomyosarcoma of the nasopharynx, as it indicates the presence of a mass in the nasal cavity or the pharynx. Swelling may cause nasal obstruction, difficulty breathing, or facial asymmetry. Swelling may also be palpable or visible on imaging studies.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a child who is admitted with suspected acute appendicitis. Which of the following manifestations should indicate to the nurse that the child's appendix is perforated?

Correct Answer is B

Explanation

A nurse is assessing a child who has rhabdomyosarcoma of the nasopharynx. What is an expected finding for this malignancy?

Correct Answer is D

Explanation

A nurse is caring for a toddler whose parent states that while bathing the child, she noticed a mass in his abdominal area and that his urine is a pink color. Which of the following actions is the nurse's priority?

A nurse is planning care for a preschooler who has leukemia. After reviewing the child's information, which of the following potential issues should the nurse identify that the child is at risk for developing? (Select all that apply.)

A nurse is providing teaching to a parent of a child who has Hirschsprung disease and is scheduled for initial surgery. Which of the following statements by the parent indicates an understanding of the teaching?

A nurse is caring for a 17-year-old client who is experiencing a relapse of leukemia and is refusing treatment. The client's mother insists that the client receive treatment. Which of the following actions should the nurse take?

A nurse is preparing to develop a plan of care for a school-aged child who has been hospitalized due to peptic ulcer disease. The nurse should identify that the child has developed a complication of peptic ulcer disease based on which of the following findings?

A nurse is caring for a male infant who has a palpable mass in the upper right quadrant and stools mixed with blood and mucus. The nurse should recognize that which of the following diagnoses is associated with these findings?

A nurse is caring for an infant who has a congenital heart defect. Which of the following defects is associated with increased pulmonary blood flow?

A nurse in a pediatric clinic is caring for a child who has iron deficiency anemia and is prescribed ferrous sulfate. Which of the following instructions should the nurse provide the parents regarding administration of this medication?