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Extract:


Question 1 of 5

A 3-year-old female client is brought into the pediatric clinic because she limps. She has not been to the clinic since she was 9 months old. The nurse practitioner describes the limp as a 'Trendelenburg gait.' This gait is characteristic of:

Correct Answer: B

Rationale: (A, C,
D) A Trendelenburg gait is not characteristic of any of these disorders. The downward slant of one hip is a positive sign of dislocation in the weight-bearing hip. If one hip is dislocated, the child walks with a characteristic limp known as the Trendelenburg gait.

Question 2 of 5

A 3-year-old female client is brought into the pediatric clinic because she limps. She has not been to the clinic since she was 9 months old. The nurse practitioner describes the limp as a 'Trendelenburg gait.' This gait is characteristic of:

Correct Answer: B

Rationale: (A, C,
D) A Trendelenburg gait is not characteristic of any of these disorders. The downward slant of one hip is a positive sign of dislocation in the weight-bearing hip. If one hip is dislocated, the child walks with a characteristic limp known as the Trendelenburg gait.

Question 3 of 5

A 24-hours' postpartum client complains of discomfort at the episiotomy site. On assessment, the nurse notes the episiotomy is without signs of infection. To relieve the discomfort, the nurse should first:

Correct Answer: A

Rationale: Warm, moist heat will promote circulation and provide comfort. A sitz bath should be tried before medication is given. Pain medication can be given when other comfort measures such as a sitz bath and topical applications are ineffective. Kegel exercises facilitate sitting by decreasing tension on the episiotomy. They will not be effective for pain control or sustained comfort level. Ice packs are appropriate to apply in the first 12 hours post-delivery to produce vasoconstriction and to reduce edema to the area.

Question 4 of 5

A client in labor has an order for Demerol (meperidine) 75 mg. IM to be administered 10 minutes before delivery. The nurse should:

Correct Answer: B

Rationale: Meperidine given close to delivery can cause neonatal respiratory depression due to its sedative effects crossing the placenta. The nurse should question the timing of the order.

Question 5 of 5

The physician has ordered a lumbar puncture for a client with suspected Guillain-Barre syndrome. The spinal fluid of a client with Guillain-Barre syndrome typically shows:

Correct Answer: B

Rationale: Guillain-Barre syndrome is characterized by elevated protein levels in cerebrospinal fluid with a normal cell count, reflecting nerve root inflammation.

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