ATI RN
Burns Pediatric Primary Care 7th Edition Test Bank Questions
Question 1 of 5
A community nurse will perform chest physiotherapy for Mrs. Dy every 3 hours. It is important for the nurse to:
Correct Answer: C
Rationale: Performing chest physiotherapy (CPT) at least two hours after meals is important to prevent potential risks such as vomiting and aspiration. This timing allows for better tolerance of the procedure and decreases the likelihood of complications. By waiting at least two hours after meals, the nurse ensures that the patient's stomach is not full, reducing the risk of regurgitation during the chest physiotherapy session. This practice promotes the safety and well-being of the patient while undergoing this treatment.
Question 2 of 5
The adrenal cortex is responsible for producing which substances?
Correct Answer: A
Rationale: The adrenal cortex is the outer portion of the adrenal glands and is responsible for producing hormones known as corticosteroids. Within the corticosteroids, the adrenal cortex produces glucocorticoids (such as cortisol) which are involved in regulating metabolism and the immune response. Additionally, the adrenal cortex produces androgens which are male sex hormones, although they are present in both males and females. Therefore, the correct substances produced by the adrenal cortex are glucocorticoids and androgens (Choice A).
Question 3 of 5
A client is diagnosed with diabetes mellitus. Which assessment finding best supports a nursing diagnosis of Ineffective individual coping related to diabetes mellitus?
Correct Answer: D
Rationale: Crying whenever diabetes is mentioned indicates a maladaptive coping mechanism, which can be a sign of ineffective individual coping related to diabetes mellitus. Coping with a chronic condition like diabetes can be overwhelming, and excessive emotional distress may hinder the client's ability to effectively manage their disease. It is important for the nurse to identify maladaptive coping strategies in order to provide appropriate interventions and support for the client.
Question 4 of 5
During the physical assessment, the nurse recalls that the areas most frequently affected by multiple sclerosis are the:
Correct Answer: C
Rationale: Multiple sclerosis (MS) is a disease that primarily affects the central nervous system (CNS) by causing inflammation, damage, and scarring in the myelin sheath that covers nerve fibers. The optic nerve and chiasm are common areas affected by MS, leading to symptoms such as blurred or double vision, loss of color vision, and pain with eye movement. This involvement is known as optic neuritis, a common early symptom of MS. While MS can affect various parts of the CNS, the optic nerve and chiasm are among the most frequently involved areas, making choice C the correct answer in this case.
Question 5 of 5
Which of the following statements would be the nurse's response to a famiiy member asking questions about a client's transient ischemic attack (TIA)?
Correct Answer: C
Rationale: The correct response would be: "It is a temporary interruption in the blood flow to the brain." This response provides a clear and accurate explanation of a transient ischemic attack (TIA), which is commonly known as a "mini-stroke." A TIA is indeed a temporary episode where there is a brief interruption in the blood flow to the brain, leading to symptoms similar to those of a stroke, but without lasting damage. This response would give the family member a better understanding of what a TIA is and help alleviate concerns about permanent brain damage.