AQ 1535 Health Promotion

Which action by the nurse while administering human growth hormone ensures effective therapy? 1 Administration at nighttime 2 Administration via oral route 3 Administration along with meals 4 Administration by metered spray

1. Human growth hormone therapy shows best results when the hormone is administered at nighttime because the body naturally produces growth hormone at night. Therefore the normal body rhythm is being mimicked to ensure effective therapy. Subcutaneous injections of growth hormone yield effective results. Hyperpituitarism is treated by the administration of bromocriptine, which should be taken along with food to reduce side effects. Desmopressin acetate is administered either orally or intranasally with a metered spray to treat diabetes insipidus.

A 9-year-old child who is undergoing intravenous antibiotic therapy becomes bored and irritable. What activities for school-aged children should the nurse suggest? Select all that apply. 1 Playing solitaire 2 Starting a collection 3 Making a model airplane 4 Doing arithmetic puzzles 5 Watching game shows on television

2,3. School-aged children have an interest in hobbies or collections of various kinds as a means of gathering information and knowledge about the world in which they live. Children of this age are also industrious, and making a model airplane is an appropriate age-related activity. Playing solitaire is a solitary activity that will increase the child's boredom. Doing math puzzles will not interest the average 9-year-old child; nor will TV game shows.

A nurse is trying to involve a hospitalized preschooler in therapeutic play. Why is this so important? 1 The child can work out ways of coping with fears. 2 It provides an opportunity to accept the hospital situation. 3 The child can forget the reality of the situation for a little while. 4 It provides an opportunity to meet other children on the pediatric unit.

1. Because their ability to express feelings verbally is limited, preschool children act out their feelings in play. Acceptance of hospitalization will not occur until the child has coped with fears. The child needs to cope with feelings rather than forget them. Therapeutic play does not necessarily involve other children.

A 3-year-old child with nephrotic syndrome has been receiving prednisone for 1 week. The nurse reviews the child's progress record and determines that the medication has been effective. What information supports this conclusion? Select all that apply. 1 Weight loss 2 Lower blood pH 3 Decreased lethargy 4 Increased urine output 5 Decreased blood pressure

1, 3, 4. Children with nephrotic syndrome are grossly edematous. Those who have the steroid-sensitive form of nephrotic syndrome respond to corticosteroids with diuresis within 7 to 21 days after therapy is started, and the edematous weight is lost. Once the child feels better, lethargy decreases, and the activity level increases. Steroid therapy does not affect the blood pH. There is no increase in the blood pressure of a child with nephrotic syndrome and therefore no change in blood pressure when the child improves.

Which questions should the nurse ask the client when obtaining the health history? Select all that apply. 1 "Tell me about your food habits." 2 "Do you use alcohol or tobacco?" 3 "Have you sustained any personal loss recently?" 4 "Have you ever experienced any allergic reactions?" 5 "Does any family member have a long-term illness?"

1, 2, 4. The health history of a client includes the client's food habits so that the nurse can obtain an assessment of the client's nutrition status. The nurse also assesses the client's habits and lifestyle patterns. The use of alcohol and tobacco helps to determine the client's risk for diseases involving the liver or lungs. The health history includes descriptions of allergies and reactions to food, latex, drugs, or contact agents such as soap. While assessing the family history, the nurse assesses the client for stress-related problems by asking about recent personal losses. The family history provides information about family members to determine the risk for illnesses of a genetic or familial nature.

A nurse is assessing a 3-week-old infant who has been admitted to the pediatric unit with hydrocephalus. What finding denotes a complication requiring immediate attention? 1 Tense anterior fontanel 2 Uncoordinated eye/muscle movement 3 Larger head circumference than chest circumference 4 Inability to support the head while in the prone position

1. A tense or bulging fontanel is indicative of increased intracranial pressure, which is caused by the fluid accumulation associated with hydrocephalus. Conjugate gaze does not occur until 3 to 4 months of age, once the eye muscles have matured. The head is the largest part of the body at this age; the head circumference should be about 1 inch (2.5 centimeters) larger than chest circumference. An infant cannot support the head before 1 to 1½ months of age. Test-Taking Tip: If the question asks for an immediate action or response, all the answers may be correct, so base your selection on identified priorities for action.

What is the best way for a nurse to interact with a 3-year-old child sitting in the waiting room of the pediatric clinic? 1 By walking into the waiting room to greet the child 2 By calling the child by name at the waiting room door 3 By asking the receptionist to bring the child into the examining room 4 By standing at the examining room door while the child walks down the hall

1. The child may be fearful of the examining room experience. Greeting the child while in the safety of the waiting room may help make the experience less threatening. Calling the child without entering the room is an authoritarian approach that will not limit the child's anxiety. Having someone else bring the child into the examining room is an authoritarian approach that may make the child more fearful. Standing at the examining room door while the child walks down the hall is an authoritarian approach that may increase the child's anxiety. Test-Taking Tip: Multiple-choice questions can be challenging, because students think that they will recognize the right answer when they see it or that the right answer will somehow stand out from the other choices. This is a dangerous misconception. The more carefully the question is constructed, the more each of the choices will seem like the correct response.

A 10-year-old boy arrives with his mother at the emergency department after being bitten by a stray dog. He has sustained a soft tissue injury on the inner aspect of the left forearm, and it is bleeding. What is the priority nursing action? 1 Asking the mother whether her son is allergic to horse serum 2 Assessing the injury and the child's vital signs and health history 3 Inoculating the child with human rabies immunoglobulin 4 Notifying the police department to capture and test the dog

2. For effective decisions to be made, baseline information on the child's condition, extent of injury, and significant health history are required first. Hyperimmune antirabies serum is not a preferred treatment. Inoculation for establishment of short-term, passive immunity to rabies follows initial care of injuries; the priority is assessment and treatment of the injury. Authorities should be notified after the injured child has received care.

What should nursing care for a child admitted with acute glomerulonephritis be directed toward? 1 Enforcing bed rest 2 Promoting diuresis 3 Encouraging fluids 4 Removing dietary salt

2. With the reduction of edema the child's health improves, the appetite increases, and the blood pressure normalizes. Ambulation does not have an adverse effect on this disorder; most children voluntarily restrict their activities and remain in bed during the acute phase. Fluids are not encouraged because the kidneys are inflamed and cannot tolerate large amounts of fluid. Sodium intake is decreased, not eliminated; sodium restriction is not tolerated well by children and may further decrease their appetite. STUDY TIP: Establish your study priorities and the goals by which to achieve these priorities. Write them out and review the goals during each of your study periods to ensure focused preparation efforts.

A nurse is caring for a preschooler who is being prepared for surgery. What does the nurse expect to have the most influence on the child's response to hospitalization? 1 Fear of separation 2 Fear of bodily harm 3 Belief in death's finality 4 Belief in the supernatural

2. Fear of mutilation is typical of the preschooler because they have vague views of body boundaries. Toddlers are more likely to fear separation from parents. Preschoolers do not view death as final. Although preschoolers do indulge in magical thinking, they have not yet developed the concept of supernatural beliefs.

A nurse is volunteering on the community crisis hotline. What is the final objective of the counseling process? 1 Reducing anxiety 2 Exploring feelings 3 Developing constructive coping skills 4 Accomplishing the debriefing process

3. Past coping behaviors have been inadequate in resolving the current crisis; new coping skills are needed to manage anxiety-producing conflicts. Reduction of anxiety is an early objective. Exploration of feelings is an immediate objective. Accomplishment of the debriefing process is an early objective.

A 6-year-old boy is hospitalized with an exacerbation of nephrotic syndrome. The mother asks the nurse what she should bring for her son to play with during the hospitalization. What should the nurse suggest? 1 Plastic bat, cloth ball, and a hula hoop 2 Stuffed animals, large puzzles, and blocks 3 Checkers, simple card games, and crayons 4 Children's magazines, a model plane kit, and laptop computer

3. School-aged children enjoy competition, have manipulative skills, and are creative. A bat, ball, and hula hoop require too much expenditure of energy for a child in the acute phase of nephrotic syndrome. A stuffed animal, large puzzle, and blocks are appropriate for the toddler who is developing fine motor skills. Magazines, a model plane kit, and a laptop are appropriate for a child older than 6 years. Six-year-old children are not proficient readers.

After a painful exacerbation of rheumatoid arthritis, a client is scheduled to begin a walking and exercise program. Which is an expected outcome for this client? 1 Only when pain free, begin exercising as part of a formal activity program. 2 Avoid exercising when there is a moderate amount of discomfort. 3 Exercise and be active unless the discomfort becomes too great. 4 Walk and exercise even when the pain is severe.

3. Some pain is to be expected, but the activity should not be continued when the pain becomes severe, because it can further traumatize the inflamed synovial membranes. It is unrealistic to expect the client to be pain free, so exercise would never begin. Some discomfort is expected; inactivity promotes the development of muscle atrophy and joint contracture. Activity should be curtailed when pain is severe.

An 11-year-old child has gained weight. The mother tells the nurse that she is concerned that her child, who loves sports, may become obese. What is the most appropriate response by the nurse? 1 Suggesting an increase in activity 2 Encouraging a decreased caloric intake 3 Explaining that this is expected during preadolescence 4 Discussing the influence of genetics on the child's weight gain

3. There may be weight gain caused by the influence of hormones before the growth spurt. Most 10- to 12-year-old children can eat an adult-sized meal without becoming obese, especially if they are active. Before advising increased activity, the nurse should assess the child's current activity level. An adequate caloric intake is needed for the growth spurt that will occur during adolescence. Family eating patterns appear to have more effect on weight than do genetics.

A 2-year-old boy with hemophilia A is to start receiving prophylactic intravenous infusions of the recombinant form of factor VIII three times a week. The nurse will instruct the parents to administer the factor at what time on the designated days? 1 At bedtime 2 After lunch 3 Before dinner 4 Upon awakening

4. Factor VIII is administered once in the morning on designated days. The half-life of factor VIII is short. If factor VIII is administered later in the day (i.e., at bedtime, after lunch, or before dinner), protection will not be adequate during the day, when the child is most active and more vulnerable to bleeding. Test-Taking Tip: Never leave a question unanswered. Even if answering is no more than an educated guess on your part, go ahead and mark an answer. You might be right, but if you leave it blank, you will certainly be wrong and lose precious points.

A client is undergoing highly active antiretroviral therapy (HAART). From what viral disease could the client possibly be suffering? 1 Hepatitis 2 Herpes simplex virus (HSV) 3 Human papillomavirus (HPV) 4 Human immunodeficiency virus (HIV)

4. Highly active antiretroviral therapy (HAART) is a combination of antiretroviral drugs used to treat human immunodeficiency virus (HIV). Because hepatitis, herpes simplex virus (HSV), and human papillomavirus (HPV) are not retroviral, HAART is ineffective for these disorders.

What is the first nursing intervention for a newborn with a 1-minute Apgar score of 7? 1 Administering oxygen 2 Performing a brief physical assessment 3 Cutting the umbilical cord and attaching a clamp 4 Drying and placing the infant in a warm environment

4. Preventing heat loss conserves the newborn's oxygen and glycogen reserves; this is a priority. Warming the infant will reduce cyanosis if no respiratory obstruction is present. Performing a brief physical assessment is important; however, it is not a priority; assessment should be delayed until the infant is warm. Cutting the umbilical cord and attaching a clamp may be done after provisions to prevent heat loss have been made.

A nurse is assessing the developmental level of a healthy 5-month-old infant. What behavior does the nurse expect the child to exhibit? 1 Using the pincer grasp 2 Sitting without support 3 Crawling across the floor 4 Grasping objects voluntarily

4. The 5-month-old infant's neurological development has reached the stage at which objects can be grasped voluntarily; this is considered a developmental milestone. The pincer grasp appears between 9 and 12 months of age. Sitting alone without support is usually accomplished at 6 to 8 months of age. The infant begins to crawl at 8 to 10 months of age.

The student nurse compares the major developmental characteristics of vision in 12-week-old infants to those at 28-weeks-old. Which statement demonstrates that the student nurse has correct knowledge regarding the developmental milestones? 1 "The infant can recognize the feeding bottle at 12 weeks and can follow rapidly moving objects by 28 weeks." 2 "The infant develops functional tear glands for the first time at 12 weeks and starts to accommodate to near objects at 28 weeks." 3 "The infant can adjust posture to see an object at 12 weeks and develops binocular vision for the first time at around 28 weeks." 4 "The infant is able to fixate on a 1.25-cm (0.5-inch) block at 12 weeks and is able to discriminate between simple geometric forms by 28 weeks."

4. The infant is able to fixate on a 1.25-cm (0.5-inch) block between 12 and 20 weeks and is able to discriminate between simple geometric forms between 20 and 28 weeks. The infant can recognize the feeding bottle at 12 weeks; however, following rapidly moving objects first appears between 44 and 52 weeks. The infant develops functional tear glands for the first time at 4 weeks, not 12, and starts to accommodate to near objects as early as between 12 and 20 weeks. The infant can adjust posture to see an object at between 20 and 28 weeks; binocular vision develops for the first time at age 6 weeks, and it is well established by age 4 months.

The parents of a preschooler ask the nurse for advice on how to deal with the child's sleep terrors. Which intervention does the nurse recommend the parents follow? 1 "Do not make the child go back to bed." 2 "Professional counselling might be needed for recurrent episodes." 3 "Sit with the child and offer comfort, assurance, and sense of protection." 4 "It is a normal, common phenomenon that requires relatively little intervention."

4. The nurse should stress to the parents that sleep terrors are a normal, common phenomenon in preschoolers that requires relatively little intervention. The nurse may advise the parents to guide the child back to bed, if needed, after an episode of sleep terrors. In case the child has a nightmare, the parents should avoid forcing the child back to bed. Professional counselling might be needed for recurrent episodes of nightmares; sleep terrors, on the other hand, are natural in preschoolers. For episodes of nightmares, the nurse would advise the parents to sit with the child and offer comfort, assurance, and sense of protection. For episodes of sleep terrors, the parents should be instructed to intervene only if necessary to protect the child from injury.