A nurse is caring for a 10-year-old boy who has a new diagnosis of diabetes mellitus and is eager to return to school and participate in social events. The mother tells the nurse she is afraid to let him take part in physical activities at school. Which of the following responses should the nurse make?

You sound overwhelmed. Let’s talk about this some more.

I agree. His well-being is the most important.

Tell me more about how you are feeling about your son’s activities.

You might want to use tutors to home-school him.

Answer and Explanation

The Correct Answer is C

Choice A reason: You sound overwhelmed. Let’s talk about this some more. This response acknowledges the mother’s feelings and opens the door for further discussion. However, it does not directly address her specific concerns about physical activities. While it is empathetic, it lacks the focus needed to explore her worries about her son’s participation in school activities.

Choice B reason: I agree. His well-being is the most important. This response validates the mother’s concern but may inadvertently reinforce her fears without providing a balanced perspective. It does not encourage a discussion about the benefits of physical activity for children with diabetes or how to manage his condition safely during such activities.

Choice C reason: Tell me more about how you are feeling about your son’s activities. This response is the most appropriate as it invites the mother to express her specific concerns and feelings. It shows empathy and a willingness to understand her perspective, which can lead to a more productive conversation about managing her son’s diabetes while allowing him to participate in physical activities.

Choice D reason: You might want to use tutors to home-school him. This response suggests an alternative that may not be necessary or beneficial. Home-schooling might isolate the child and prevent him from enjoying social interactions and physical activities that are important for his overall development. It does not address the mother’s concerns directly and may not be the best solution.

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Correct Answer is ["A","B","D","E"]

Explanation

Choice A reason: Apply intermittent ice to the affected ankle for the first 48 hours

Applying ice intermittently to the affected ankle for the first 48 hours helps reduce swelling and inflammation. Ice should be applied for 15-20 minutes every 2-3 hours during the initial phase of injury management. This practice is part of the RICE (Rest, Ice, Compression, Elevation) protocol commonly used for sprains and strains.

Choice B reason: Wrap the affected ankle with an elasticized compression bandage

Wrapping the affected ankle with an elasticized compression bandage helps to minimize swelling and provide support to the injured area. Compression bandages should be snug but not too tight to avoid restricting blood flow. This is another component of the RICE protocol.

Choice C reason: Apply full weight-bearing on the affected ankle

Applying full weight-bearing on the affected ankle is not recommended immediately after a second-degree sprain. The ankle needs time to heal, and weight-bearing should be gradually reintroduced as pain and swelling decrease. Initially, the client should avoid putting weight on the injured ankle to prevent further damage.

Choice D reason: Elevate the affected ankle above the level of the heart

Elevating the affected ankle above the level of the heart helps reduce swelling by promoting venous return and decreasing fluid accumulation in the injured area. This is an essential part of the RICE protocol and should be done as much as possible during the first 48 hours.

Choice E reason: Apply a heating pad intermittently to the affected ankle after 48 hours

Applying a heating pad intermittently to the affected ankle after 48 hours can help increase blood flow and promote healing. Heat therapy should be used after the initial acute phase (first 48 hours) when swelling has subsided. Heat can help relax muscles and reduce stiffness in the injured area.

A. Sleepy, but arousing when her name is called. B. Respiratory rate 8/min. C. Pain level of 6 on a scale from 0 to 10.

Correct Answer is B

Explanation

Choice A reason:

Being sleepy but arousing when her name is called is a common side effect of morphine, which is a potent opioid analgesic. Morphine can cause drowsiness and sedation, but this is not necessarily an adverse effect unless it progresses to a state where the patient cannot be easily aroused. Therefore, while this is a side effect, it is not as concerning as respiratory depression.

Choice B reason:

A respiratory rate of 8/min is an adverse effect of morphine. Opioids like morphine can depress the respiratory center in the brain, leading to a decreased respiratory rate. Normal respiratory rates for adults are typically between 12 and 20 breaths per minute. A rate of 8 breaths per minute indicates significant respiratory depression, which can be life-threatening and requires immediate intervention.

Choice C reason:

A pain level of 6 on a scale from 0 to 10 indicates that the morphine has not fully alleviated the client’s pain. While this is important to address, it is not an adverse effect of the medication. The primary concern with morphine administration is monitoring for serious side effects like respiratory depression.

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Naxlex Comprehensive Predictor Exams

A nurse is teaching a client who has a new second-degree ankle sprain. Which of the following instructions should the nurse include in the teaching? Select all that apply.

Correct Answer is ["A","B","D","E"]

Explanation

A nurse is assessing a client 15 minutes after administering morphine sulfate 2 mg via IV push. The nurse should identify which of the following findings as an adverse effect of the medication?

Correct Answer is B

Explanation

A nurse is caring for a client who is postoperative following a laminectomy. Exhibits Select the 3 findings that require immediate follow-up:

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A nurse is teaching a female client who has a new prescription for transdermal sumatriptan to treat migraine headaches. Which of the following instructions should the nurse include?

A nurse is providing teaching to the parent of a toddler about appropriate snacks. Which of the following foods should the nurse include?

A nurse is providing teaching about dietary recommendations to a client who has iron deficiency anemia. Which of the following dietary recommendations should the nurse include as a food that enhances iron absorption when consumed with nonheme iron?

A nurse is assessing a client who is taking oxacillin to treat an infection. The nurse should recognize which of the following findings is a manifestation of an allergic reaction?

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