A nurse is caring for a preschooler with a partial-thickness burn on her right forearm. Which of the following findings should the nurse expect? (Select all that apply.).

Intact epidermis.

Dry surface.

Sensitive to touch.

Wound blanches with pressure.

Blisters.

Answer and Explanation

Correct Answer : C,D,E

The correct answers are C, D, and E.

Choice A rationale: Intact epidermis would not be expected with a partial-thickness burn as the burn extends into the dermis.

Choice B rationale: A dry surface is not characteristic of partial-thickness burns, which typically have a moist surface.

Choice C rationale: Partial-thickness burns are sensitive to touch due to the damage to nerve endings in the dermis.

Choice D rationale: Wound blanches with pressure because the blood vessels are damaged, allowing blanching on pressure.

Choice E rationale: Blisters are a common feature of partial-thickness burns, as the damage to the dermis causes fluid to accumulate.

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Correct Answer is D

Explanation

This is the recommended technique for chest compressions on an infant, as it provides adequate blood ﬂow without causing injury12.
Choice A.
Deliver compressions just above the nipple line is incorrect, as this is not the correct location for chest compressions on an infant.
The correct location is below the nipple line, at the center of the chest.
Choice B.
Deliver compressions with the heel of one hand is incorrect, as this is the technique for chest compressions on a child, not an infant. For an infant, two ﬁngers are used instead of one hand13.
Choice C.
Deliver compressions at a depth of 5 cm (2 in) is incorrect, as this is too deep for an infant’s chest.
The correct depth for an infant is about 4 cm (1.5 in) or 1/3 the depth of the
chest12.
Therefore, choice D is the best answer.

A. "I do wheelchair exercises while watching TV.". B. "I carry a water bottle with me because I drink a lot of water.". C. "I use a suppository every night to have a bowel movement.". D. "I only need to catheterize myself twice every day.".

Correct Answer is D

Explanation

Individuals with spina biﬁda who are paralyzed from the waist down may have difficulty emptying their bladder completely and may need to perform intermittent catheterization.
The frequency of catheterization can vary depending on the individual’s needs, but it is typically performed every 3-6 hours or 4-6 times per day.
Choice A, “I do wheelchair exercises while watching TV,” is a positive statement because exercise is important for overall health and well-being.
Choice B, “I carry a water bottle with me because I drink a lot of water,” is also a positive statement because staying hydrated is important for overall health.
Choice C, “I use a suppository every night to have a bowel movement,” is not necessarily an indication for further teaching because some individuals with spinal biﬁda may need to use bowel management techniques such as suppositories to help regulate bowel movements.

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A nurse is caring for a preschooler with a partial-thickness burn on her right forearm. Which of the following findings should the nurse expect? (Select all that apply.).

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is preparing to begin chest compressions on an infant. The nurse should perform compressions using which of the following techniques?

Correct Answer is D

Explanation

A nurse is caring for an adolescent who has spina bifida and is paralyzed from the waist down. Which of the following statements by the client should indicate to the nurse a need for further teaching?

Correct Answer is D

Explanation

A nurse is caring for a child who has been physically abused by a family member. Which of the following statements should the nurse say to the child?

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A school nurse is performing a routine health assessment for a school-age child. Which of the following findings indicates the nurse should investigate further for pediculosis capitis?