190) ANSWER

D) "My child needs an iron supplement."

RATIONALE

A child diagnosed with thalassemia who will receive multiple transfusions throughout life will need chelation therapy for excessive iron stores. An iron supplement would be inappropriate in this child. Consider which statements are appropriate for a child with thalassemia and eliminate those. That will leave only the response that indicates the need for more education.

189) ANSWER

D) Use a nitroglycerin (NTG) tablet before the activity.

RATIONALE

NTG can be taken as a preventive measure prior to activities that trigger angina. This is especially helpful with sexual activity or work-related activities that may need to be continued. Modifying such activities may be necessary, but cardiac clients should not become restricted by their condition and lead sedentary lifestyles. The question asks for a method of handling the precipitating event. Option 4 is the only option that provides a way of preventing the angina associated with exercise and stress.

188) ANSWER
D) Hard palate of the oral cavity

RATIONALE
Jaundice in the dark-skinned client can best be observed by assessing the hard palate. Normally, fat may be deposited in the layer beneath the conjunctivae that can reflect as a yellowish hue of the conjunctivae and the adjacent sclera in contrast to the dark periorbital skin. In these clients, palms and soles might appear jaundiced, but instead, calluses on the surface of their skin can make the skin appear yellow. Note that the question is referring to liver toxicity, which would appear as jaundice. Recall that assessment involves looking in the client s mouth for skin discoloration. If this was difficult, review alterations to physical assessment.

187) ANSWER
D) "My child will need to be home schooled to protect him from injury."

RATIONALE
Children with mild OI may be able to participate in sports, and many are able to participate in swimming. There are no current medications that stop this disease process. There are a variety of surgical procedures that may be done to help strengthen the bones; one is the insertion of intermedullary rods to provide for stability. The child with OI may participate in school, though care needs to be provided to protect this child from injury. The goal of treatment for all children is to promote growth and development. The one action that would limit growth and development would be home schooling.

186) ANSWER
C) The skin should always be tested for allergies by applying a small amount of oil to the area before treatment.

RATIONALE
Essential oils are distilled from flowers, roots, bark, leaves, wood, resins, citrus rinds, and more; the quality of essential oils varies. Many oils should be kept out of the sunlight and heat. Essential oils can be toxic and produce an allergic reaction in some individuals. Some essential oils are unsafe during pregnancy, so it is critical to contact the primary care provider prior to trying aromatherapy to determine which oils are safe and which are toxic. The core issue of the question is that essential oils can cause an allergic reaction in the client.

185) ANSWER
B) Inhalation of manganese dust

RATIONALE
Occupational exposure to the manganese can result from dust inhalation and can have profound neurological effects. The other options would not be applicable to this client. Critical words are mine and neurological problems. Note that options 2 and 3 contain the word inhalation, which correlates to confinement in a mind. Recall knowledge of manganese sources to be directed to option 2.

184) Answer

A. Exaggerated emotional response by the parents
B. Absent emotional response by the parents
D. Conflicting stories from the parents

Rationale

•Indications of child abuse include, but are not limited to, conflicting stories, exaggerated or absent emotional response by the parents, and a history inconsistent with the child’s developmental age.

•The parent’s appearance or use of inappropriate language are not indicators of abuse.