a 13 year old boy comes to the school nurse complaining of sudden and severe scrotal pain he denies any trauma to the scrotum what is the most appropr
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Nursing Elites

ATI RN

RN Nursing Care of Children Online Practice 2019 A

1. A 13-year-old boy comes to the school nurse complaining of sudden and severe scrotal pain. He denies any trauma to the scrotum. What is the most appropriate nursing action?

Correct answer: A

Rationale: Sudden and severe scrotal pain in an adolescent male is a medical emergency and may indicate testicular torsion, which requires immediate evaluation and intervention to prevent testicular loss.

2. A mother has just given birth to a newborn with a cleft lip. Sensing that something is wrong, she starts to cry and asks the nurse, "What is wrong with my baby?" What is the most appropriate nursing action?

Correct answer: A

Rationale: Encouraging the mother to express her feelings allows her to process the situation and prepares her for receiving further information in a supportive environment.

3. Which finding suggests fluid volume deficit in an infant presenting with vomiting and diarrhea for 2 days?

Correct answer: B

Rationale: A sunken fontanel is a classic sign of dehydration in infants, indicating a fluid volume deficit. In dehydration, the fontanel sinks due to decreased fluid volume in the body. Increased blood pressure (Choice A) is not typically associated with dehydration in infants. Decreased pulse rate (Choice C) is not a common finding in fluid volume deficit, as the body tries to increase the heart rate to compensate for decreased volume. Low urine specific gravity (Choice D) may be seen in dehydration, but it is not as specific or as easily observable as a sunken fontanel.

4. Which condition is often associated with a "ground-glass" appearance on a chest x-ray in neonates?

Correct answer: B

Rationale: The correct answer is B, Respiratory distress syndrome. Respiratory distress syndrome often presents with a "ground-glass" appearance on a chest x-ray in neonates due to surfactant deficiency. Choice A, Pneumonia, typically appears as patchy infiltrates on chest x-ray. Choice C, Bronchopulmonary dysplasia, is characterized by hyperinflation and fibrosis, not a ground-glass appearance. Choice D, Congenital diaphragmatic hernia, usually shows mediastinal shift and bowel loops in the chest cavity on x-ray, not a ground-glass appearance.

5. The nurse is aware that if patients from different cultures are implied to be inferior, the emotional attitude the nurse is displaying is what?

Correct answer: B

Rationale: Ethnocentrism is the belief that one's own culture is superior to others, which can lead to bias and a lack of cultural competence in healthcare.

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