A nurse in an emergency department is assessing an adolescent who reports inhalation of gasoline.
Which of the following findings should the nurse expect?
Pinpoint pupils
Hypothermia
Ataxia
Hyperactive reflexes
The Correct Answer is C
Choice A rationale
Pinpoint pupils are not a typical finding in an adolescent who has inhaled gasoline. Pinpoint pupils are more commonly associated with opioid use.
Choice B rationale
Hypothermia is not a typical finding in an adolescent who has inhaled gasoline. Inhalation of gasoline can cause central nervous system depression, leading to symptoms such as dizziness, confusion, and ataxia.
Choice C rationale
Ataxia, or lack of muscle coordination, can occur after inhaling gasoline. The gasoline vapors can depress the central nervous system, leading to symptoms such as dizziness, confusion, and ataxia.
Choice D rationale
Hyperactive reflexes are not a typical finding in an adolescent who has inhaled gasoline. Inhalation of gasoline can cause central nervous system depression, leading to symptoms such as dizziness, confusion, and ataxia.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Regular tuberculosis testing is recommended for children with HIV as they have a higher risk of developing tuberculosis due to their weakened immune system.
Choice B rationale
Doubling the child’s medications for the next 6 months is not a standard practice in HIV treatment. The dosage and regimen of antiretroviral therapy are carefully determined by healthcare providers based on the child’s specific needs and condition.
Choice C rationale
The risk of HIV transmission does not decrease after 2 weeks of zidovudine treatment. Antiretroviral therapy can reduce the viral load to undetectable levels, significantly reducing the risk of transmission, but this usually takes longer than 2 weeks to achieve.
Choice D rationale
Children with HIV do not need to repeat their childhood immunizations once they are in remission. The standard immunization schedule is generally followed for children with HIV, with some additional vaccines recommended due to their increased risk of certain infections.
Correct Answer is A
Explanation
The correct answer is Choice A.
Choice A rationale: Increased restlessness in a toddler with a full-thickness burn may indicate hypoxia, pain, or shock. These conditions require immediate medical attention to prevent further complications and ensure proper management of the burn injury.
Choice B rationale: A respiratory rate of 25/min is within the normal range for toddlers (20-30 breaths per minute). This finding does not indicate an immediate concern that requires reporting to the provider.
Choice C rationale: Bowel sounds of 20/min are within the normal range (5-30 sounds per minute). This finding does not indicate any gastrointestinal complications that need to be reported to the provider.
Choice D rationale: Urinary output of 35 mL/hr is within the normal range for toddlers (1-2 mL/kg/hr). This finding indicates adequate kidney function and hydration status, so it does not require immediate reporting.
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