when you attempt to assess a 22 year old woman who has been sexually assaulted she orders you not to touch her your most appropriate initial action sh
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Nursing Elites

ATI LPN

LPN Pediatrics

1. When you attempt to assess a 22-year-old woman who has been sexually assaulted, she orders you not to touch her. Your MOST appropriate initial action should be to:

Correct answer: D

Rationale: In cases of sexual assault, it's important to respect the patient's wishes and provide a female EMT to attempt the assessment if the patient prefers.

2. What is the main function of the uterus?

Correct answer: B

Rationale: The main function of the uterus is to house and nurture the growing fetus for approximately 40 weeks during pregnancy. It provides the necessary environment for the fetus to develop and grow until it is ready for birth. Choice A is incorrect as the cervix, not the uterus, dilates during labor to allow the baby to pass through. Choice C is incorrect as while the uterus does provide a protective environment, its primary function is not to act as a cushion. Choice D is incorrect as the placenta, not the uterus, is responsible for providing oxygen and nutrients to the fetus.

3. What characteristic indicates that a mass on a newborn's head is a cephalohematoma?

Correct answer: A

Rationale: A cephalohematoma typically appears between the first and second days after birth, making choice A the correct answer. It results from blood vessel rupture between a cranial bone and the periosteal membrane. Choices B, C, and D are incorrect because the growth of the mass when the newborn cries, asymmetrical head appearance, or the mass being located on only one side of the head are not specific indicators of a cephalohematoma.

4. The parents of a child hospitalized with asthma who is recovering and is being prepared for discharge are receiving home care instructions from the nurse. Which statement by a parent indicates a need for further instruction?

Correct answer: D

Rationale: The statement 'We need to maintain droplet precautions and a quiet environment for at least 2 weeks' indicates a need for further instruction. Asthma management does not typically require maintaining droplet precautions. The focus should be on environmental control, medication adherence, and monitoring symptoms rather than droplet precautions, which are more relevant for contagious respiratory infections.

5. Warning signs that indicate dehydration include all EXCEPT:

Correct answer: B

Rationale: The correct answer is B. Increased urine output is not a warning sign of dehydration; it typically decreases with dehydration. Dehydration often presents with poor skin turgor, tachycardia, and an increased sensation of thirst (eager to drink) as the body tries to compensate for fluid loss. Choices A, C, and D are all correct warning signs of dehydration. Poor skin turgor is a result of decreased skin elasticity due to fluid loss. Tachycardia, an elevated heart rate, can be a compensatory mechanism to maintain cardiac output in dehydration. Feeling eager to drink is a common symptom of dehydration as the body attempts to restore fluid balance.

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