a nurse is caring for an 8 month old infant who screams when the parent leaves the room the parent begins to cry and says i dont understand why my chi
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Nursing Elites

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1. A nurse is caring for an 8-month-old infant who screams when the parent leaves the room. The parent begins to cry and says, 'I don't understand why my child is so upset. I've never seen my child act this way around others before.' Which of the following statements should the nurse make?

Correct answer: A

Rationale: The correct answer is 'This is a normal, expected reaction for a child of this age.' Separation anxiety typically peaks around 8-10 months of age, leading to distress when separated from caregivers. Choice B is incorrect because the infant's behavior is more likely due to separation anxiety rather than overstimulation. Choice C is incorrect as the infant's behavior is not related to overexposure to caregivers but rather a natural developmental stage. Choice D is incorrect as the infant's behavior is not indicative of illness but rather a normal emotional response.

2. A client with a large lower-leg ulcer needs protein for wound healing. Which of the following foods should the nurse suggest?

Correct answer: B

Rationale: Grilled salmon is the best choice for providing high-quality protein for wound healing. Salmon is rich in essential amino acids, omega-3 fatty acids, and vitamin D, which can help promote tissue repair and reduce inflammation. Kidney beans, peanut butter, and raw spinach are good protein sources but do not offer the same level of high-quality protein and nutrients needed specifically for wound healing.

3. A nurse is providing nutritional education to a client who is obese. The nurse should include in the information that which of the following gastrointestinal disorders is commonly associated with obesity?

Correct answer: B

Rationale: Gastroesophageal reflux disease (GERD) is commonly associated with obesity due to increased abdominal pressure and other factors. Peptic ulcer disease (Choice A) is not commonly associated with obesity. Celiac disease (Choice C) is an autoimmune disorder triggered by gluten consumption and is not directly linked to obesity. Crohn’s disease (Choice D) is a type of inflammatory bowel disease and is not specifically associated with obesity.

4. An adolescent client has bloodshot eyes, a voracious appetite, and dry mouth. Which drug abuse would the nurse most likely suspect?

Correct answer: A

Rationale: The symptoms described, including bloodshot eyes, a voracious appetite, and dry mouth, are consistent with marijuana use. Bloodshot eyes are a common side effect of marijuana due to its effect on blood vessels in the eyes. Marijuana also often causes an increase in appetite (known as 'the munchies') and can result in dry mouth. Amphetamines typically cause symptoms like increased alertness, energy, and decreased appetite. Barbiturates and anxiolytics would not typically cause bloodshot eyes, a voracious appetite, and dry mouth as described in the scenario. Therefore, the most likely drug abuse the nurse would suspect in this case is marijuana.

5. A client with a body mass index of 28 is seeking dietary advice. Which of the following actions should the nurse take?

Correct answer: D

Rationale: Referring the client to a weight-loss support group is the most appropriate action for a client with a body mass index of 28. This action can provide the necessary support, guidance, and motivation to help the client achieve their weight loss goals. Encouraging the client to continue their current daily caloric intake (Choice A) may not address the need for weight loss. Recommending a total fiber intake of 12g per day (Choice B) is important for overall health but may not directly address weight loss. Advising the client to add 500 calories per day to their diet (Choice C) would not be beneficial for weight loss in this scenario.

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