A nurse is planning to reinforce teaching about head injuries with a group of parents of school-age children. The nurse should instruct the parents to monitor for and report which of the following manifestations?
Insomnia
Irritability
Diarrhea
Hypothermia
The Correct Answer is B
Rationale:
A) Insomnia is a sleep disorder and is not typically associated with head injuries unless there is a concurrent neurological complication.
B) Irritability can be a sign of increased intracranial pressure following a head injury and should be promptly reported for further evaluation.
C) Diarrhea is not a common manifestation of head injuries and would not typically be included in monitoring and reporting instructions.
D) Hypothermia is not typically associated with head injuries unless there is a severe injury with shock, and it is not a common manifestation requiring monitoring in the acute phase of head injury.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. The FLACC pain rating scale is appropriate for infants and young children, assessing pain based on Face, Legs, Activity, Cry, and Consolability, making it suitable for a 5-month-old infant.
B. The COMFORT pain rating scale is generally used for children who are unable to communicate their pain, typically in older children or adolescents, and is less suitable for this age group.
C. The FACES pain rating scale is designed for children aged 3 and older who can identify facial expressions but is not appropriate for a 5-month-old infant.
D. The CRIES pain rating scale is also used for infants but is more specific to neonates (0-6 months) and measures crying, oxygen requirement, increased vital signs, and facial expressions, making it less applicable than the FLACC scale for this specific postoperative context.
Correct Answer is C
Explanation
Rationale:
A. While spinal fluid analysis may be necessary in some cases, it is not typically used to confirm a diagnosis of acute lymphoid leukemia (ALL).
B. A complete blood count (CBC) may show abnormalities suggestive of leukemia, but it is not definitive for diagnosis.
C. Bone marrow biopsy is necessary to confirm the diagnosis of acute lymphoid leukemia (ALL) by examining the bone marrow for abnormal cells.
D. Bleeding time is not typically used to diagnose acute lymphoid leukemia (ALL); it assesses platelet function.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today