The nurse is continuing to care for the child.

Exhibits

After reviewing the discharge instructions with the family, which of the following statements by a parent indicate an understanding of the teaching?
For each statement by the parent, click to specify if the statement reflects an understanding or indicates a need for reinforcement of the discharge teaching.

"We should notify the provider if the cast becomes loose over time."

"We should expect the swelling and tingling to worsen before it gets better."

"We need to be very careful about how we handle the cast for the first 2 days while it dries."

"It is important that our child avoids placing anything inside the cast.

"We should prop the casted arm on pillows for the next 24 hours."

Answer and Explanation

The Correct Answer is {"A":{"answers":"A"},"B":{"answers":"B"},"C":{"answers":"A"},"D":{"answers":"A"},"E":{"answers":"A"}}

Rationale:

• "We should notify the provider if the cast becomes loose over time.": A loose cast can fail to immobilize the fracture properly, risking displacement or delayed healing. Recognizing this and contacting the provider demonstrates proper understanding of cast care.

• "We should expect the swelling and tingling to worsen before it gets better.": While mild swelling and tingling may occur, increasing or worsening neurovascular symptoms can indicate complications such as compartment syndrome. The parent needs reinforcement that any worsening sensation or cold fingers should prompt immediate provider notification rather than being expected.

• "We need to be very careful about how we handle the cast for the first 2 days while it dries.": Handling a wet cast improperly can deform it and compromise fracture stabilization. Awareness of this indicates correct knowledge of initial cast care.

• "It is important that our child avoids placing anything inside the cast.": Inserting objects into the cast can cause skin irritation, pressure ulcers, or infection. Avoiding this demonstrates understanding of safe cast management.

• "We should prop the casted arm on pillows for the next 24 hours.": Elevation of the casted limb reduces swelling and promotes comfort. This reflects correct knowledge of post-cast care.

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Correct Answer is B

Explanation

Calculation:

Identify the client's weight in kilograms (kg) and height in meters (m).

Weight = 75 kg

Height = 1.8 m

Calculate the square of the height in meters (m squared).

Height squared = 1.8 m x 1.8 m

= 3.24 m squared.

Calculate the BMI.

BMI = Weight (kg) / Height (m squared)

= 75 kg / 3.24 m squared

= 23.148

Round the answer to the nearest tenth.

= 23.1

A. Perform a vaginal examination every 12 hr. B. Administer betamethasone. C. Provide a low-stimulation environment. D. Maintain bed rest. E. Obtain a 24-hr urine specimen. F. Give antihypertensive medication. G. Monitor intake and output hourly.

Correct Answer is ["B","C","D","E","F","G"]

Explanation

Rationale

A. Perform a vaginal examination every 12 hr: Vaginal examinations should be avoided in a client with severe preeclampsia unless delivery is imminent, as they can stimulate uterine activity and increase the risk of placental abruption. Continuous monitoring and noninvasive assessments are prioritized instead.

B. Administer betamethasone: Betamethasone promotes fetal lung maturity by stimulating surfactant production when preterm delivery before 34 weeks is anticipated. This reduces the risk of neonatal respiratory distress syndrome and intraventricular hemorrhage.

C. Provide a low-stimulation environment: A quiet, dimly lit environment helps minimize CNS stimulation, reducing the risk of seizure activity in clients with severe preeclampsia. Environmental stressors such as bright lights and loud noises should be avoided.

D. Maintain bed rest: Bed rest, particularly in the left lateral position, improves uteroplacental perfusion and reduces blood pressure by minimizing pressure on the vena cava. It also helps limit activity that could elevate BP further.

E. Obtain a 24-hr urine specimen: Collecting a 24-hour urine specimen allows accurate assessment of total protein excretion, which confirms the severity of preeclampsia. Proteinuria greater than 300 mg/24 hr indicates significant renal involvement.

F. Give antihypertensive medication: Antihypertensives such as labetalol or hydralazine help prevent maternal complications like stroke or heart failure from sustained severe hypertension while avoiding excessive BP reduction that could impair uteroplacental blood flow.

G. Monitor intake and output hourly: Close monitoring of intake and output detects early signs of renal compromise or fluid overload, which are common in preeclampsia. Accurate measurement helps guide safe fluid management and prevent pulmonary edema.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is calculating the BMI of a client who has a weight of 75 kg (165.3 lb) and a height of 1.8 m (5 ft 9 in). Which of the following values should the nurse calculate as the client's BMI?

Correct Answer is B

Explanation

The nurse is continuing to care for the client. Exhibits The nurse is initiating the client's plan of care. Which of the following interventions should the nurse plan to implement? Select all that apply.

Correct Answer is ["B","C","D","E","F","G"]

Explanation

A charge nurse is supervising a newly hired nurse who is instructing a client about how to use a walker. For which of the following actions should the charge nurse intervene?

A nurse is caring for a client who is in the latent phase of labor and has decided to have a natural childbirth. Which of the following coping mechanisms should the nurse suggest?

A nurse is assessing self-management skills for a client who has preeclampsia without severe features. Which of the following client statements should the nurse recognize as an indication the client is coping effectively?

A nurse is caring for a client who has type 1 diabetes mellitus. The client reports that she is not feeling well. Which of the following findings should indicate to the nurse that the client is hypoglycemic? (Select all that apply.)

A nurse is caring for an infant who has gastroenteritis. Which of the following assessment findings should the nurse report to the provider?

A nurse is caring for a client who is postpartum and requests information about contraception. Which of the following instructions should the nurse include?

A nurse in a community health clinic is caring for a client who expresses plans to quit smoking within the next 2 weeks and requests a prescription for a nicotine patch. Which of the following stages of health behavior change is the client in?

A nurse is discussing antidepressants with a newly licensed nurse. Which of the following clients should the nurse identify as being a candidate for antidepressant therapy?