A nurse is caring for a 9-year-old child at a clinic.
Vital Signs.
1000:. Temperature 36.8°C (98.2 °F). Heart rate 102/min.
Respiratory rate 22/min.
BP 100/60 mm Hg. Oxygen saturation is 98% on room air.
Nurses' Notes.
1000:.The child has been brought to the clinic by their parent due to a. report of right arm pain.
The parent states that several hours.
ago the child tripped and fell onto the sidewalk while playing.
outside.
The child states, "I was running when we were playing,and I tripped over a curb." The child is supporting their arm across.
their body.
Assessment.
1000:The child is alert and appears developmentally appropriate for their.
age and well nourished.
Respirations are easy and unlabored.
Abdomen nondistended.
The right forearm and fingers are edematous.
Ecchymotic area.
noted on the outer aspect of the forearm.
Radial pulse +2. Fingers.
slightly cool to the touch.
A child can move fingers and reports a mild.
"tingling" sensation.
The child verbalizes a pain level of 4 on a scale.
of 0 to 10. Abrasion noted on the right knee.
No active bleeding.
Multiple areas of bruising were noted on the lower extremities in various.
stages of healing.
The nurse should determine that the assessment findings are consistent with.
which of the following conditions? For each potential condition, click to specify if the assessment findings are.
consistent with a sprain, a fracture, or dislocation.
Each finding may support this.
more than 1 condition.
Sensation
Edema
Pain level
Ecchymosis
The Correct Answer is {"A":{"answers":"B,C"},"B":{"answers":"A,B,C"},"C":{"answers":"A,B,C"},"D":{"answers":"A,B,C"}}
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
The correct answer is B. The taking-in phase of maternal adjustment is characterized by the passive and dependent behavior of the mother, who focuses on her own needs and relies on others for assistance. The mother is eager to review the birth experience and share her feelings with others, which helps her process and integrate what happened. The other options are incorrect because they describe manifestations of other phases of maternal adjustment: tolerating physical discomforts and performing self-care independently are typical of the taking-hold phase while beginning reconnecting with their partner is typical of the letting-go phase.
Correct Answer is ["A","E"]
Explanation
Choice A rationale:
Contractures are a risk for this client due to the lack of movement and constant positioning on one side. Contractures occur when the muscles, tendons, or ligaments shorten and tighten, limiting range of motion and flexibility. This can be a result of prolonged immobility or lack of use of the muscles.
Choice B rationale:
Calcium resorption is not a risk for this client. Calcium resorption refers to the process where bone tissue is broken down and calcium is released into the bloodstream. This process is not directly related to immobility or multiple sclerosis.
Choice C rationale:
Hypocalcemia, or low calcium levels in the blood, is also not a direct risk for this client. While immobility can lead to bone loss over time, it does not directly cause hypocalcemia.
Choice D rationale:
Diarrhea is not a risk for this client based on the information provided. Diarrhea can be a symptom of many conditions but there is no indication in the scenario that this client is at risk.
Choice E rationale:
Urinary stasis is a risk for this client due to their immobility. When a person is immobile, urine can pool in the bladder, creating an environment where bacteria can grow, potentially leading to urinary tract infections.
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