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The nurse is continuing to care for the child.
Exhibits
Select the 3 priority actions that the nurse should take.

Administer Ibuprofen 200 mg PO.

Elevate the affected forearm with pillows.

Place a nonadherent dressing on the right knee abrasion.

Review cast care instructions with the child's parents.

Apply ice packs to the fingers and along the right forearm.

Explain the cast application procedure to the child.

Answer and Explanation

Correct Answer : A,B,E

Rationale:

A. Administer Ibuprofen 200 mg PO: The child reports a pain score of 5/10 and is requesting pain medication. The provider has prescribed ibuprofen PRN for this level of pain. Prompt administration supports comfort and reduces inflammation associated with fracture and swelling.

B. Elevate the affected forearm with pillows: Elevation helps reduce edema by promoting venous return and lymphatic drainage. Given the child's worsening edema in the forearm and fingers, this is a priority to minimize complications like compartment syndrome.

C. Place a nonadherent dressing on the right knee abrasion: Although dressing the abrasion is a reasonable intervention, it is not a priority at this stage. The abrasion is not actively bleeding or infected, so attention should remain on managing neurovascular risk and pain.

D. Review cast care instructions with the child's parents: This is an important educational step, but it is not a current priority since the cast has not yet been applied. Priority actions should focus on pain, swelling, and circulation while awaiting casting.

E. Apply ice packs to the fingers and along the right forearm: Ice helps manage pain and inflammation by vasoconstriction, limiting fluid accumulation in tissues. Applying it early post-injury is crucial to controlling swelling in a fractured limb.

F. Explain the cast application procedure to the child: Preparing the child for a future procedure is helpful but not immediately necessary. At this point, pain control and reduction of swelling take precedence to prevent complications and stabilize the injury.

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Correct Answer is ["A","B","C"]

Explanation

Rationale:

A. Maternal diabetes: Infants born to diabetic mothers are at increased risk for hypoglycemia due to elevated insulin levels stimulated by maternal hyperglycemia. After birth, the abrupt loss of maternal glucose can lead to a rapid drop in the infant’s blood sugar.

B. Prematurity: Premature infants have limited glycogen stores and immature metabolic systems, making them more susceptible to hypoglycemia. Their inability to effectively regulate glucose levels increases their risk after birth.

C. Hypothermia: Cold stress increases metabolic demands and glucose consumption. As the infant uses more energy to maintain body temperature, blood glucose levels can drop rapidly if not closely monitored and managed.

D. Thrombocytopenia: Low platelet counts may indicate other underlying conditions but are not directly associated with hypoglycemia. It is more relevant to clotting and bleeding risks rather than glucose regulation.

E. Anemia: Anemia affects oxygen-carrying capacity but does not have a direct link to blood glucose control. While it may indicate other health issues, it is not a recognized independent risk factor for neonatal hypoglycemia.

A. 0.45% sodium chloride B. 0.9% sodium chloride C. Lactated Ringer's D. 3% sodium chloride

Correct Answer is A

Explanation

Rationale:

A. 0.45% sodium chloride: This is a hypotonic solution that helps lower serum sodium levels by diluting extracellular sodium and promoting cellular rehydration. It is commonly used to treat hypernatremia when there is no significant fluid volume overload.

B. 0.9% sodium chloride: This isotonic solution contains the same concentration of sodium as the blood. It does not correct hypernatremia and may worsen it if sodium levels are already elevated, especially in dehydrated clients.

C. Lactated Ringer's: While this is an isotonic fluid, it contains sodium and electrolytes that do not help reduce high serum sodium levels. It is more appropriate for fluid resuscitation than for treating hypernatremia.

D. 3% sodium chloride: This hypertonic solution is used for severe hyponatremia, not hypernatremia. Administering it to someone with elevated sodium levels would further increase sodium concentration and worsen the condition.

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The nurse is continuing to care for the child.Exhibits Select the 3 priority actions that the nurse should take.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A charge nurse in a newborn nursery is providing information to a group of nurses about risk factors for hypoglycemia. Which of the following risk factors should the charge nurse include? (Select all that apply.)

Correct Answer is ["A","B","C"]

Explanation

A nurse is caring for a client who has hypernatremia. Which of the following IV solutions should the nurse plan to administer?

Correct Answer is A

Explanation

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The nurse is continuing to care for the child.
Exhibits
Select the 3 priority actions that the nurse should take.