Question

A nurse is preparing to administer medication to a preschooler and must convert the child's weight from pounds to kilograms. The child weighs 30 lb. How many kilograms does the child weigh?(Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)

Answer 1

Correct Answers:

13.6

Rationale :

✴ To convert pounds to kilograms,

🔺Divide the weight in pounds by 2.2.

✔️ 30 lb ÷ 2.2 = 13.636 [rounding off)

👉🏻= 13.6 kg.

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Answer 2

Correct Answers:

Turn off the faucet with a clean paper towel after drying hands.

Rationale :

🟢 After washing and drying hands, the faucet should be turned off using a clean paper towel to avoid recontamination.

🟢 Touching the faucet with bare hands can transfer bacteria back onto clean skin.

🟢 This is a critical infection control measure in all healthcare settings.

🟢 Proper hand hygiene is the first line of defense against healthcare-associated infections (HAIs).

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Answer 3

Correct Answers:

A piston syringe.

Rationale :

🔵 A piston syringe (35-mL) with an appropriate gauge catheter is recommended for wound irrigation, especially in stage 3 pressure injuries.

🔵 This method provides adequate pressure (8–15 psi) to cleanse the wound without causing trauma.

🔵 Barrier ointments, cotton balls, and chilled solutions are not appropriate for irrigation of open wounds.

🔵 Wound irrigation helps reduce infection risk and remove exudate and debris.

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Answer 4

Correct Answers:

Client states, "I started to itch after taking that medication."

Rationale :

When documenting, nurses must use the client’s own words in quotation marks to record subjective data.

🟡 This ensures the documentation is accurate, clear, and legally appropriate.

🟡 Avoid making assumptions or interpretations (e.g., “rash from medication”) unless confirmed.

🟡 Clear documentation helps in identifying potential allergic reactions or adverse drug effects.

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Answer 5

Correct Answers:

"I will remove all stuffed animals from my baby's crib.”

Rationale :

🔴 Soft bedding, toys, and stuffed animals pose a suffocation and SIDS risk and should be removed from the infant's sleep area.

🔴 The safest sleep environment is a firm mattress with a fitted sheet only, and the baby should be placed on their back to sleep.

🔴 Pacifier use is actually protective against SIDS, and blankets should be avoided in favor of sleep sacks or wearable blankets.

🔴 This answer demonstrates the parent's understanding of safe sleep practices.

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Answer 6

Correct Answers:

Pallor with scaly skin.

Rationale :

🔹 Pallor and scaly skin are classic indicators of malnutrition, especially deficiencies in protein, vitamins A, C, and zinc.

🔹 These symptoms reflect poor skin integrity and nutrient absorption, often seen in clients who are undernourished.

🔹 The skin may become dry, rough, or flaky due to lack of essential fatty acids and hydration.

🔹 Malnutrition also reduces wound healing capacity and increases infection risk.

🔹 Pink mucous membranes and a BMI of 23 are within normal limits and do not indicate malnutrition.

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Answer 7

Correct Answers:

Headache.

Rationale :

🟢 Headache is a common adverse effect following a lumbar puncture due to leakage of cerebrospinal fluid at the puncture site.

🟢 The headache typically worsens when sitting or standing and improves when lying down.

🟢 This occurs because of changes in intracranial pressure after CSF loss.

🟢 Clients may need increased oral fluids, caffeine, or even a blood patch to seal the leak.

🟢 The nurse should monitor and report it if persistent or severe.

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Answer 8

Correct Answers:

Use warm water when bathing the client.

Rationale :

🔵 Using warm water (not hot) for bathing helps maintain skin moisture and prevents drying and irritation.

🔵 Clients with limited mobility are at increased risk of skin breakdown, especially over bony prominences.

🔵 Harsh scrubbing, hot water, and improper positioning can damage fragile skin tissue.

🔵 Reddened areas should never be massaged, as this could worsen tissue damage.

🔵 Regular gentle hygiene promotes skin integrity and comfort.

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Answer 9

Correct Answers:

The client has tenderness and warmth in their calf.

Rationale :

🟡 Tenderness and warmth in the calf suggest deep vein thrombosis (DVT), a potentially life-threatening complication.

🟡 DVT can lead to pulmonary embolism if the clot dislodges, making it the highest priority to report.

🟡 While fever and nausea are also concerning, DVT presents immediate risk of sudden decompensation.

🟡 Pain alone is expected postoperatively, but signs of vascular compromise are urgent.

🟡 Prompt diagnosis and treatment (e.g., anticoagulation) are essential.

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Answer 10

Correct Answers:

"It must be difficult facing this type of surgery.”

Rationale :

🔴 This statement uses therapeutic communication by acknowledging the client’s feelings and encouraging expression.

🔴 It shows empathy and invites the client to discuss their fears and anxiety without minimizing their experience.

🔴 Statements like “others have done fine” or offering a sleeping pill immediately can dismiss the client’s emotions.

🔴 Addressing emotional needs is essential for holistic preoperative care.

🔴 The nurse’s role includes listening and supporting psychological well-being.

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QLexNursing

1 :
A nurse is preparing to administer medication to a preschooler and must convert the child's weight from pounds to kilograms. The child weighs 30 lb. How many kilograms does the child weigh?(Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)

2 :
A nurse is preparing to obtain a client's vital signs. Which of the following actions should the nurse take when washing their hands?

3 :
A nurse is preparing to perform a wound irrigation for a client who has a stage 3 pressure injury. Which of the following supplies should the nurse plan to use?

4 :
A nurse is caring for a client who reports itching 30 min after receiving a newly prescribed medication. Which of the following data should the nurse document in the client's medical record?

5 :
A nurse is reinforcing teaching with a new parent who is concerned about sudden infant death syndrome (SIDS). Which of the following statements by the client indicates an understanding of the teaching?

6 :
A nurse is assisting with the admission of a client to a medical-surgical unit. Which of the following findings should the nurse identify as an indication that the client is malnourished?

7 :
A nurse is collecting data from a client following a lumbar puncture. The nurse should identify which of the following findings as a potential adverse effect of this procedure?

8 :
A nurse is caring for a client who has limited mobility. Which of the following actions should the nurse take to maintain the client's skin integrity?

9 :
A nurse is collecting data from a client who is 1 day postoperative following abdominal surgery. Which of the following findings is the priority for the nurse to report to the provider?

10 :
A nurse is caring for a client who is scheduled for surgery the following day. During the night, the client is unable to sleep and is restless. Which of the following statements should the nurse make?

QLexNursing

1 : A nurse is preparing to administer medication to a preschooler and must convert the child's weight from pounds to kilograms. The child weighs 30 lb. How many kilograms does the child weigh?(Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)

2 : A nurse is preparing to obtain a client's vital signs. Which of the following actions should the nurse take when washing their hands?

3 : A nurse is preparing to perform a wound irrigation for a client who has a stage 3 pressure injury. Which of the following supplies should the nurse plan to use?

4 : A nurse is caring for a client who reports itching 30 min after receiving a newly prescribed medication. Which of the following data should the nurse document in the client's medical record?

5 : A nurse is reinforcing teaching with a new parent who is concerned about sudden infant death syndrome (SIDS). Which of the following statements by the client indicates an understanding of the teaching?

6 : A nurse is assisting with the admission of a client to a medical-surgical unit. Which of the following findings should the nurse identify as an indication that the client is malnourished?

7 : A nurse is collecting data from a client following a lumbar puncture. The nurse should identify which of the following findings as a potential adverse effect of this procedure?

8 : A nurse is caring for a client who has limited mobility. Which of the following actions should the nurse take to maintain the client's skin integrity?

9 : A nurse is collecting data from a client who is 1 day postoperative following abdominal surgery. Which of the following findings is the priority for the nurse to report to the provider?

10 : A nurse is caring for a client who is scheduled for surgery the following day. During the night, the client is unable to sleep and is restless. Which of the following statements should the nurse make?

1 :
A nurse is preparing to administer medication to a preschooler and must convert the child's weight from pounds to kilograms. The child weighs 30 lb. How many kilograms does the child weigh?(Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)

2 :
A nurse is preparing to obtain a client's vital signs. Which of the following actions should the nurse take when washing their hands?

3 :
A nurse is preparing to perform a wound irrigation for a client who has a stage 3 pressure injury. Which of the following supplies should the nurse plan to use?

4 :
A nurse is caring for a client who reports itching 30 min after receiving a newly prescribed medication. Which of the following data should the nurse document in the client's medical record?

5 :
A nurse is reinforcing teaching with a new parent who is concerned about sudden infant death syndrome (SIDS). Which of the following statements by the client indicates an understanding of the teaching?

6 :
A nurse is assisting with the admission of a client to a medical-surgical unit. Which of the following findings should the nurse identify as an indication that the client is malnourished?

7 :
A nurse is collecting data from a client following a lumbar puncture. The nurse should identify which of the following findings as a potential adverse effect of this procedure?

8 :
A nurse is caring for a client who has limited mobility. Which of the following actions should the nurse take to maintain the client's skin integrity?

9 :
A nurse is collecting data from a client who is 1 day postoperative following abdominal surgery. Which of the following findings is the priority for the nurse to report to the provider?

10 :
A nurse is caring for a client who is scheduled for surgery the following day. During the night, the client is unable to sleep and is restless. Which of the following statements should the nurse make?