Practice Questions

A 12-year-old patient has a diagnosis of hyperthyroidism and is hospitalized for the manifestations of a thyroid storm. Which home-care concept will the nurse include in the care of the patient during hospitalization? 1. Provide a low-stress, low-pressure environment. 2. Ensure medications are given on the home schedule. 3. Limit intake of caffeine and carbonated fluids. 4. Increase intake of foods high in calcium and vitamin K.

1

A 13-year-old male patient is diagnosed with hypopituitarism and is prescribed to begin growth hormone replacement therapy. Which patient teaching information will best optimize the replacement therapy outcomes for the patient? 1. Clear communication about side effects of therapy and how they are managed 2. The chemical makeup and differences between the brands of somatotropin 3. How much and how quickly the patient will see the effects of the therapy 4. Psychotherapy for the family to deal with emotional problems of the condition

1

A 4-year-old who had a broken arm is preparing to have the cast removed after 4 weeks. The child's parent states, "I had a cast on my arm a lot longer than that for it to heal. Are you sure the cast has been on long enough?" Which is the best response to the parent? 1. "Children's bones heal faster than adults, so they don't need to wear a cast as long as an adult." 2. "Children's bones are different, but the cast should be on about as long as yours was." 3. "You're right. The cast hasn't been on nearly as long as an adult. I'll recheck with the health-care provider." 4. "We don't worry about children's bones as much; they will remodel well on their own."

1

A teenaged patient arrives in the emergency department where the physician diagnoses a dislocated shoulder. It is the patient's first dislocation. Which should the nurse prepare for treatment of the dislocation? 1. Make sedative medication available. 2. Prepare a minimally invasive surgery room. 3. Anticipate a physical therapist consultation. 4. Get portable radiology equipment.

1

An 11-year-old child who had been treated for a broken leg is having his cast removed. After removal, the child asks the nurse about playing basketball for his local league. Which should be included in the response to the child? 1. The child should avoid playing basketball for up to 4 weeks but can then resume playing. 2. The child can play basketball as soon as the stiffness in this leg subsides, which is typically within 3 to 5 days. 3. The child should avoid playing basketball until he has stopped growing due to risk of reinjury. 4. The child may play basketball immediately, but should stop if the extremity develops swelling and pain.

1

The mother of a 3-month-old returns for a visit with the physician who is caring for the infant's hip dysplasia. However, the nurse notes that upon arrival, the infant is not wearing the prescribed Pavlick harness. The mother indicates she thought the infant was uncomfortable so she removed it. Which is the best response by the nurse? 1. Inform the mother how to check for capillary refill in the toes. 2. Assess the infant for trauma or swelling to the lower extremities. 3. Report the findings to the physician before entering the examination room. 4. Ask the mother to demonstrate how to place the Pavlick harness.

1

The nurse is assessing a 4-month-old infant who has a diagnosis of hypoparathyroidism. In which manner will the nurse assess the infant for pain related to the diagnosis? 1. Tap on a facial nerve and note the response. 2. Monitor closely for signs of seizure activity. 3. Assess for hyperreflexia of the muscles. 4. Carefully monitor cardiovascular status.

1

The nurse is providing care to a 7-year-old child who has been diagnosed with avascular necrosis. The patient's guardians ask the nurse what to expect due to this diagnosis. Which would be appropriate information to provide to the parents? 1. The child will be hospitalized and placed in traction. 2. The child will be treated by surgically placing a femoral screw. 3. The child will be placed in a Pavlik harness for several weeks. 4. The child will be given medication while on bedrest.

1

The nurse on a pediatric unit is admitting a 6-week-old infant. Symptoms include a wet daily diaper count of 10 to 12 a day, irritability, constipation, and dehydration. For which medical prescription does the nurse contact the physician? 1. Limit oral intake of water to 200 mL per shift. 2. Weigh diapers to measure 24-hour urine output. 3. Check urine-specific gravity every 8 hours. 4. Allow the mother to continue breastfeeding.

1

The school nurse is teaching a middle-school class about the hormones that regulate body functions. Which information provided by the nurse is accurate? 1. Hormones are chemicals secreted by endocrine glands. 2. Hormones act specifically on the glands that produce them. 3. Hormones react with negative feedback as levels decline. 4. Hormones are made from proteins, fats, and carbohydrates.

1

The nurse is discussing a child's diagnosis of autism (ASD) with the child's parents. The parents tell the nurse the child is completely resistant to any type of stimulation. The nurse suspects sensory processing disorder and will recommend which intervention? 1. Make a rocking horse or trampoline available to the child. 2. Place colored lights and automated toys in the child's room. 3. Set specific times of day when the child is held and cuddled. 4. Child-appropriate music is played throughout the day.

1 This is correct. Children with ASD often have a sensory processing disorder, which makes them highly sensitive to sensory stimuli. The nurse recommends short periods of exposure to increasing stimuli to build tolerance. The child is most receptive to items that cause motion, such as a rocking horse or trampoline.

A parent of an adolescent tells the nurse, "He had some bad habits as a child, but now he is in trouble with the law for destruction of property, stealing, and hurting animals. I think his ODD is getting worse." Which comment by the nurse is accurate? 1. "Your son has developed conduct disorder." 2. "Increasing his ADHD medication may help." 3. "Right now he needs your feedback and support." 4. "There are lawyers that specifically help troubled teens."

1 This is correct. Children with conduct disorder (CD) generally also present with a history of developmental delays, ADHD, and ODD. Adolescents are often hostile, sarcastic, defensive, and provocative toward others. This comment by the nurse is most accurate.

The nurse is presenting a program to the parents of school-age children about prescription drug abuse among adolescents. Which information does the nurse provide to parents about preventing their children from abusing prescription drugs? 1. Most drugs are obtained cost free from friends or family members. 2. The abused drugs are not commonly found in the normal household. 3. Adolescents are at great risk for life-threatening effects from these drugs. 4. Withdrawal from this type of drug can be managed by the adolescent's family.

1 This is correct. It is true that most prescription drugs are available at no cost from friends or family members. When this source is no longer available, the abuser will turn to opiates from street sources.

The nurse at a pediatric clinic is gathering assessment information on a school age patient who is 9 years of age. The mother expresses concern about a recent habit of handwashing to "get rid of germs." Which recommendation by the nurse is appropriate? 1. Allow the child to complete each session of handwashing. 2. Assign tasks to the child that involves putting hands in water. 3. Interrupt the handwashing by moving the child away from the sink. 4. During the handwashing, ask the child about worries and concerns.

1 This is correct. Obsessive-compulsive disorder (OCD) is characterized by severe obsessions (unwanted, reoccurring thoughts) and/or compulsions (repetitive behaviors) that interfere with quality of life. Obsessions create anxiety, and compulsions are performed to reduce anxiety. The child is allowed to complete the compulsive behavior; interrupting the behavior will increase anxiety.

A teacher in an elementary school voices concerns to the school nurse about a student in her second-grade class. The student has recently become withdrawn from adults but constantly tries to please the teacher. Today the teacher saw bruises around his neck. Which plan does the school nurse develop and implement? Select all that apply. 1. Talk to child alone in the school clinic about any pain or concerns. 2. Inspect the back, chest, and legs in the presence of the principal. 3. Report possible child abuse with assessment findings to proper authorities. 4. Call the parents and report that authorities have been notified of abuse. 5. Develop a trusting rapport with the child.

1,2,3,5 This is correct. Evaluation of the child should be done in a safe, supportive environment. 2. This is correct. Signs of physical abuse include bruises or lacerations, especially on areas that are not exposed by clothing; marks from objects such as belts, ropes, hands, or cords; bite marks from adults; and bald spots on hair. Involving a witness to the assessment is professionally and legally appropriate. 3. This is correct. Nurses are required by law to report any suspected abuse or neglect to child protective agencies. 5. This is correct. Developing a trusting relationship will provide support to the child.

A 19-year-old patient has a history of hyperthyroidism that is managed with medication. The patient recently moved into an apartment and is living independently. Which behavior indicates to the nurse the patient is continuing appropriate health management? Select all that apply. 1. The patient called for refills of antithyroid medications and beta-blocking agents. 2. The patient went to an urgent care facility over the weekend for a sore throat and fever. 3. The patient reports experiencing tachycardia, restlessness, and tremors for a week. 4. The patient's last laboratory results indicates a high level of T4. 5. The patient stops the medication for 1 month once a year to promote hair regrowth.

12

The nurse is preparing a teaching plan for a patient and family. The patient is diagnosed with hyperpituitarism. Which teaching information will optimize therapy outcomes for the patient? Select all that apply. 1. Education about home administration of medications 2. Education about the disorder and treatment options 3. Explanations of long-term complications for noncompliance 4. Signs of excess bone growth and other features of gigantism 5. The impact of a tumor on or near the hypothalamus or pituitary gland

1233

The pediatric nurse is preparing a community education program for parents and children who have endocrine disorders. With which normal regulatory functions does the nurse begin the presentation before covering endocrine disorders? Select all that apply. 1. Growth and development 2. Sexual development 3. Energy use and storage 4. An individual's response to stress 5. Levels of glucose, fluid, and sodium in the blood

12345

The family of an infant is present in the hospital when the diagnosis of osteogenesis imperfecta is given to the infant. The nurse is responsible for care of the infant and family. Which hospital care is appropriate? Select all that apply. 1. Avoid excessive force when monitoring blood pressure. 2. Consult a social worker for concerns of child abuse. 3. Teach the parents how to gently handle the infant. 4. Inform ancillary staff about handling precautions. 5. Prepare for the use of a riser cast for treatment.

134

A 10-year-old patient is diagnosed with type 2 diabetes mellitus. Which medical history finding will help the nurse identify alternative interventions for managing the patient's condition? 1. The patient's ethnicity group is African American. 2. The patient's BMI is greater than 85th percentile for age and weight. 3. The patient's mother had gestational diabetes during her pregnancy. 4. The patient's extended family exhibits a high incidence of diabetes.

2

A 15-year-old female asks the pediatric nurse how tall she may be as an adult. The adolescent's father is 6 feet 0 inches tall; her mother is 5 feet 4 inches tall. Which calculation will the nurse use to provide a probable answer? 1. Add the parents' heights in inches together; divide by 2; add 2.5 inches. 2. Add the parents' heights in inches together; divide by 2; subtract 2.5 inches. 3. Add the parents' heights in inches together and divide the total by 4. 4. Add the parents' heights in inches together; divide by 4; add 2.5 inches.

2

A 2-year-old child is being evaluated for a musculoskeletal disorder. The child's laboratory results indicate hypophosphatemia, a normal erythrocyte sedimentation rate, and negative rheumatoid factor. Which disorder is the child likely experiencing? 1. Juvenile arthritis 2. Genu varum (bowlegs) 3. Septic arthritis 4. Avascular necrosis

2

A child is being treated with a hip Spica cast and preparing to be discharged home. Which statement by the parents demonstrates effective education and readiness to care for the child? 1. "We will turn our daughter every day and watch for skin irritation." 2. "Placing the absorbent part of the diaper toward the skin is best." 3. "We will let our daughter chose her own snacks to help her be happy." 4. "If our daughter is in pain, we will use only oxycodone to treat pain."

2

The nurse is caring for a 13-year-old patient diagnosed with adolescent idiopathic scoliosis. The curve in her back was treated by spinal fusion with rod insertion. Which is the priority nursing intervention in the postoperative period? 1. Promote adequate oral fluid intake. 2. Keep oxygen saturation within normal limits. 3. Ensure placement of indwelling urinary catheter. 4. Maintain a straight back, no bending.

2

The nurse is providing care for a 14-year-old patient who is within the first 24 hours postoperative for scoliosis treatment. Which intervention, if performed, would demonstrate appropriate care measures? 1. Removing the indwelling urinary catheter immediately upon arrival to the care unit 2. Repositioning the patient every 2 to 4 hours while in bed during the recovery period 3. Encouraging the patient to walk postoperatively once daily during pain-free periods 4. Monitoring oxygen levels and bowel sounds once daily until patient is discharged to home

2

The nurse is providing care for a child who is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). Which laboratory result does the nurse expect with this condition? 1. Low urine-specific gravity 2. High urine and low serum osmolarity 3. High serum sodium level 4. Increase in the hematocrit level

2

The nurse is providing care to a preschool-aged child who has been placed in a hip Spica cast for treatment of a femur fracture. The child is given narcotic pain medication for the first 48 hours before being sent home. When providing discharge instructions to the child's parents, which is the most important? 1. Assist the child to find ways to play while in the cast. 2. Ensure the cast is not too tight around the abdomen. 3. Keep the cast clean by using absorbent pads when toileting. 4. Avoid giving the child sugary snacks while being treated.

2

The nurse is providing care for a female adolescent at an in-patient facility for persons with eating disorders. The adolescent's current weight is less than 85% of ideal body weight. The adolescent appears to be unexpectedly agreeable with the interventions being implemented for weight gain. Which is an important intervention for the nurse to perform? 1. Eat with the client in order to demonstrate adequate intake. 2. Closely monitor the adolescent's bathroom behavior. 3. Allow the adolescent to select the flavor of nasogastric (NG) tube feedings. 4. Provide information about the effects of malnutrition on the body.

2 This is correct. Because the adolescent seems to be unexpectedly agreeable with the interventions implemented for weight gain, the nurse needs to carefully monitor the adolescent's bathroom behavior. Patients with anorexia nervosa are likely to attempt to dispose of food in the toilet. Vomiting and pocketing of food is common.

The nurse is performing a routine pediatric assessment on an 11-year-old student who is being medicated for ADHD. The parent reports disruptive behavior and acting out both at school and at home. The parent asks about a possible medication increase. Which information is the most important for the nurse to acquire? 1. Whether the student is having problems sleeping 2. How often the student is getting medication 3. The student's weight and level of appetite 4. The student's perception of medication effects

2 This is correct. The nurse needs to ascertain how often the student is receiving the medication, which should be every day. In addition, ADHD medication has street value and may be sold by the parent instead of given to the student.

Parents of an adolescent female are concerned about the adolescent's recent, rapid weight loss. Nursing assessment reveals the adolescent to be below the ideal weight for her height and age. Which questions will the nurse ask to help identify an eating disorder? Select all that apply. 1. "How much weight have you lost in the past 3 months?" 2. "What words would you use to describe your body right now?" 3. "Do you have a sports activity causing you to exercise excessively?" 4. "Can you tell me some of your daily thoughts about food?" 5. "Would you consider yourself to be a good student at school?"

2,3,4 This is correct. Asking the adolescent to describe her body will allow the nurse to assess the adolescent's physical perception and relate to her body image. 3. This is correct. Inquiring about the amount of exercise related to a sports activity will allow the nurse to determine whether the adolescent's current exercise regimen is excessive. 4. This is correct. Adolescents with eating disorders, whether anorexia, bulimia, or overeating, may find themselves thinking obsessively about food: when they will eat; what they will eat; the amount they will eat; and how they will deal with the effects eating will have on their body.

The nurse at a pediatric clinic notices a female high school student has had extensive dental work and is currently exhibiting additional dental caries. The nurse also identifies the bilateral existence of Russell's sign. Based on these findings, for which comorbid manifestation will the nurse assess the student? Select all that apply. 1. Frequent absenteeism from school 2. Issues with overspending 3. Thoughts of suicide 4. Presence of cutting activity 5. Casual sexual encounters

2,3,4,5 This is correct. The nurse recognizes some physiological manifestations related to bulimia nervosa. It is important for the nurse to assess for comorbid conditions and behaviors that exist with the condition, such as issues with overspending or shoplifting. 3. This is correct. The nurse recognizes some physiological manifestations related to bulimia nervosa. It is important for the nurse to assess for comorbid conditions and behaviors that exist with the condition, such as suicidal thoughts. 4. This is correct. The nurse recognizes some physiological manifestations related to bulimia nervosa. It is important for the nurse to assess for comorbid conditions and behaviors that exist with the condition, such as cutting, an example of deliberate self- harm. 5. This is correct. The nurse recognizes some physiological manifestations related to bulimia nervosa. It is important for the nurse to assess for comorbid conditions and behaviors that exist with the condition, such as casual sexual encounters.

The nurse is providing care for a preschool child who is 4 years of age. The child is being treated for horrific abuse that occurred in the home since the child was an infant. Which comments by the child indicate to the nurse a possible dissociative disorder? Select all that apply. 1. "Someday I will live with grandma." 2. "If it hurts, I will just go away." 3. "I have a friend who always stays with me." 4. "I want a really big lunch and dinner." 5. "I can be invisible if they get mad at me."

2,3,5 This is correct. The nurse will recognize that voicing the ability of "going away" if something hurts is a possible indication of dissociative disorder and is probably related to magical thinking. 3. This is correct. The nurse is aware that the child's belief that there is a friend who always stays with the child alerts the nurse to an imaginary friend and magical thinking, which can indicate dissociative thinking in an abused child. This is correct. The magical thinking of a child prompts the child to mentally become invisible if "they" are mad. This is indicative of dissociative thinking.

A 14-year-old student reports to the school nurse that he has a persistent pain and soreness in his legs. The student is part of the football team. There is no evidence of injury to the student. Which information should the nurse provide to the student? Select all that apply. 1. Continue to practice despite tiredness and pain. 2. Do stretching exercises before playing or being active. 3. Ask the coach to sit out of practice for a week. 4. Ensure shoes and equipment fit properly and are stable. 5. Learn proper body mechanics for the activities.

245

A 3-year-old, well-known to the nursing staff, is admitted to the hospital frequently for fracture treatment secondary to osteogenesis imperfecta. It is known by staff and parents that the child is fragile. The nurse develops a long-term care plan to review with the parents. Which is the priority intervention for this child's plan of care? 1. Observe the child's height and weight growth. 2. Monitor for bluish colored sclera development. 3. Teach methods to prevent falls and injury. 4. Inform parents about the OI foundation.

3

A school-aged child is refusing to use her right hand to write or type in the classroom. The child states that her wrist hurts. There is no apparent deformity, but the wrist is swollen. The child reports crashing her bike and landing on her hand 2 days prior. If fractured, which type of fracture does the child likely suffer from? 1. Greenstick fracture 2. Elbow fracture 3. Torus fracture 4. Toddler fracture

3

The child is visiting the clinic for a pre-sports-participation physical. Which should be included as part of the patient education to prevent musculoskeletal injury during participation? 1. Manage any pain with acetaminophen 2. Consume extra fluids during warm weather 3. Perform stretching exercises before play 4. Seek emergency treatment for injuries

3

The nurse at a pediatric clinic is assessing a 12-year-old female. The patient ask the nurse, "I am scared about what's happening to my body. How does it happen?" Which information from the nurse is most appropriate? 1. The ovaries are located on each side of the uterus. 2. The ovaries secrete hormones that regulate the menstrual cycle. 3. The ovaries play a role in the regulation of puberty and fertility. 4. The body changes will indicate the patient is a woman and not a child.

3

The nurse in a NICU nursery is providing care for a newborn diagnosed with congenital hypothyroidism. During hospitalization, which home-care concept will the nurse include in the newborn's care? 1. Mix thyroid replacement hormone medication in a bottle of milk. 2. Increase dietary fiber with a soy-based formula to prevent constipation. 3. Ask the breastfeeding mother to bring breastmilk to the hospital. 4. Administer hormone replacement medication using a medicine dropper.

3

The nurse is caring for a child who reports he has pain in his ankle after "twisting" it during play. Which would be the most appropriate follow-up assessment to this report? 1. Color and temperature of the skin around the ankle 2. The patient's gait and range-of-motion of all extremities 3. Swelling and deformity of the ankle joint 4. Palpation of the joints proximal to the ankle

3

The nurse is planning a teaching session for a 10-year-old patient and the patient's parents. The patient is newly diagnosed with type 1 diabetes mellitus. Which is the most important topic for the nurse to cover? 1. Methods for preventing hypoglycemia during exercise 2. The purpose of setting up a dietary consult for the patient 3. All procedures involved in insulin administration 4. Instructions for blood glucose and urine ketone testing

3

The nurse is preparing to complete assessments on children in a homeless shelter. Which assessment will assist the nurse to identify possible musculoskeletal conditions each child? 1. Eating and sleeping patterns 2. Height and weight growth patterns 3. Motor development patterns 4. Sensory development patterns

3

The nurse is providing care for a 12-month-old patient who is experiencing poor weight gain. Physical assessment reveals an open anterior fontanel and open cranial sutures. To differentiate between a decrease in growth hormone and a congenital thyroid problem, which laboratory test does the nurse expect to be ordered? 1. Serum calcium 2. CBC 3. TSH 4. FSH

3

The nurse works in a facility where treatment of adolescents with addiction issues is the focus. A 14-year-old patient is being admitted for treatment of cocaine dependence. Which information does the nurse provide relative to the patient's withdrawal? 1. Acute symptoms of withdrawal last for 2 to 3 weeks. 2. The patient will be sedated throughout most of the process. 3. After acute withdrawal some symptoms may become chronic. 4. Close monitoring is important due to life-threatening symptoms.

3 This is correct. After withdrawal from cocaine, some withdrawal symptoms may become chronic and may include fatigue, depression, anhedonia (lack of pleasure), mood disturbance, and cravings.

The nurse in a pediatric emergency department is providing care for a school- age child with first- and second-degree burns to the hands and arms. The parent states, "She is so fascinated with the color and movement of the flames; she just got too close." For which reason does the nurse recommend psychotherapy for this child? 1. The child is exhibiting an inability to recognize danger. 2. The child does not obey instructions to stay away from matches. 3. The child may have excessive interest in or attraction to fire. 4. The child is likely to repeat the behavior and cause worse injuries.

3 This is correct. The nurse may suspect the child is exhibiting manifestations of pyromania because of fascination and interest in a fire that led to burns. The nurse recognizes the child may benefit from psychotherapy or psychoanalysis.

The school nurse is called to attend to a child who is 10 years of age. The teacher reports the child panicked when asked to present a verbal book report to the class. Which intervention will the nurse initiate with the child? 1. Take the child to the clinic and report the event to the parents. 2. Place the child on a clinic bed and allow some alone time. 3. Walk with the child in the hallway and provide reassurance. 4. Join the teacher in attempting to find the source of panic.

3 This is correct. The nurse's initial intervention is to assist the patient to an environment with minimal stimulation, such as a hallway. Walking with the patient will provide a physical outlet for panic.

The nurse is providing family teaching for a child diagnosed with hypoparathyroidism. Which additional teaching will the nurse include related to alternative dietary management? Select all that apply. 1. Avoiding caffeine and limiting the intake of carbonated beverages 2. Encouraging foods high in calcium and vitamin K 3. Including dietary supplements such as magnesium and boron 4. Giving calcium and vitamin D with acidic substances 5. Providing green leafy vegetables as the primary source of calcium

3,4

The nurse is performing a well-baby check on an infant at 6 months of age. The mother shares that the infant sometimes seems unhappy. Which question is most important for the nurse to ask the mother? 1. "Is it easy to make the baby laugh if he seems unhappy?" 2. "Can you cheer him up by playing with his favorite toys?" 3. "Do you ever remember feelings of being depressed or sad?" 4. "Are you noticing any problems with him eating or sleeping?"

3. This is correct. The most important question for the nurse to ask is related to the moods of the mother. There is an increased risk of depression in infants of depressed mothers.

The nurse on a pediatric unit is providing care for a preschool child with syndrome of inappropriate antidiuretic hormone (SIADH). The parents brought the child to the hospital to receive IV therapy. Which statements by the parents indicate to the nurse that the child is receiving appropriate care? Select all that apply. 1. "We were getting concerned about her loving salt." 2. "Popsicles have become a favorite daytime snack." 3. "We recognized the symptoms of sodium depletion." 4. "The confusion, headache, and irritability are unusual." 5. "She loves her new little bracelet and shows it to everyone."

345

A 12-year-old girl is noted to walk with an uneven gait, and her shoulders appear uneven. The left shoulder sits lower than the right shoulder, and her waist appears to be tilted from side to side. Which condition is the girl most likely experiencing? 1. Internal femoral torsion 2. Hip dysplasia 3. Club foot 4. Scoliosis

4

A 16-year-old adolescent has Addison's disease. The adolescent's current medication involves corticosteroid and mineralocorticoid replacement therapy. During sports practice, the adolescent collapses and loses consciousness with sudden, penetrating pain in the lower back and legs. Which action is taken by the school nurse? 1. Administer the glucagon kept for the adolescent in the clinic. 2. Place the adolescent in side-lying position in case vomiting occurs. 3. Notify the parents of the incident and request permission to transport to the hospital. 4. Give IM Solu-Cortef and call the paramedics for emergency IV infusion.

4

The mother of a 6-week-old patient calls the physician's office and reports her infant is irritable, running a fever, holds his hip in an "unusual" position, and was recently given antibiotics for an ear infection. Which response by the nurse is most appropriate? 1. "Administer acetaminophen every 4 hours for the fever and call back if he still has a fever in 24 hours." 2. "This can easily be managed at home and will most likely resolve on its own." 3. "The antibiotics need more time to work. Finish the antibiotics prescribed and call back if the symptoms continue." 4. "You need to take him to the walk-in clinic or emergency room for evaluation."

4

The nurse in a pediatric emergency department is providing care for a 1-year-old patient with a history of congenital adrenal hyperplasia (CAH). The patient is exhibiting the manifestations of a febrile illness. Which medical intervention does the nurse expect to be prescribed? 1. Laboratory testing for elevated serum 17-OHP level 2. Cultures and testing for the cause of the febrile illness 3. A quiet, cool environment for the patient 4. Administration of corticosteroids by injection

4

The nurse in a pediatrician's office is assessing a 9-year-old male patient who is being monitored for the possible diagnosis of hypopituitarism. Which assessment finding does the nurse recognize specifically as an indication of growth hormone deficiency? 1. High weight-to-height ratio 2. Large hands and feet for body size 3. Severe aching in knees and ankles 4. Height increase of 1.75 inches in 12 months

4

The nurse is caring for a child in the emergency department. The child's arm is abnormally positioned, and the child is holding the arm near that area and is crying with pain. The child's parents explain that the child fell off the bicycle when riding on the streets of this subdivision. Which is the priority care to provide to the child? 1. Apply ice to the painful area. 2. Elevate the child's arm. 3. Encourage the child to rest. 4. Protect the child from more injury.

4

A middle-school teacher notifies the school nurse of a student who sleeps in class, smells of alcohol, and exhibits behavior impairment. The student tells the nurse, "I drink too much and want to quit, but I keep failing." Which recommendation does the nurse make to the student? 1. "You may be the perfect candidate for attending AA meetings." 2. "Many young people benefit from individual and group therapy." 3. "Maybe you need a few days at home to see if you can quit on your own." 4. "I am suggesting you and your parents see a doctor who can help."

4 This is correct. Because the student shares unsuccessful attempts to stop drinking independently, the nurse needs to recommend the assistance of a physician or medical facility that can help the student quit. Because the student is most likely a minor, the parents will need to participate and be financially responsible.

The nurse is providing care for a student who was involved in a school violence incidence. The student becomes agitated and angry on the anniversary of the event. Which action by the nurse is most helpful to the student? 1. Administer the physician-prescribed dose of propranolol (Inderal). 2. Gently and quietly try to verbally and physically soothe the student. 3. Call for a psychotherapist to come and assist the student with PTSD. 4. Offer verbal support and encourage the student to express feelings.

4 This is correct. If the possibility of a flashback passes or resolves, the nurse needs to offer the student verbal support and ask the student to talk about feelings.

A parent brings a toddler to a pediatric clinic for advice about dealing with a fear of water. The parent shares that the toddler screams and throws a tantrum if anyone attempts to get him into a pool. The nurse also learns of an incident when the toddler was pushed into a pool. Which recommendation will the nurse make to help the toddler overcome this phobia? 1. Make sure the toddler has a safe flotation device. 2. Talk calmly as the toddler is taken slowly into the pool. 3. Plan recreation activities that do not involve water. 4. Allow the toddler to decide his own approach to the pool.

4 This is correct. The best advice by the nurse is to allow the toddler to decide his own approach to the pool. Initial behavior may involve playing in the kiddy pool, placing his feet in the shallow end of the pool, or sitting on the pool steps. The parents should encourage any positive behavior and protect the toddler from additional negative experiences.

The school nurse in a middle school is aware of a student who takes lithium for a bipolar disorder type 1. Which observation by the nurse will indicate a need for a laboratory test? 1. The student is exhibiting multiple signs of mania. 2. The student gets a bathroom pass during every class. 3. The student shoved other students at lunch and in the hall. 4. The student is exhibiting signs of a respiratory infection.

4 This is correct. The greatest concern for a patient taking lithium is the possibility of toxicity. The student appears to have signs of a respiratory infection but may actually be exhibiting signs of lithium toxicity. Signs of toxicity include runny nose, coughing, chest congestion, and fever. The nurse will seek a prescription for a laboratory test.

The nurse is counseling a parent of a child diagnosed with ADHD. The parent states, "He is now also diagnosed with oppositional defiant disorder (ODD). I don't know what to do." Which information does the nurse provide for the parent? 1. The fact that 40% to 60% of children with ADHD also have ODD. 2. The importance of not showing emotional reactions to the behaviors. 3. How to remain consistent with consequences related to ODD behaviors. 4. The need and availability of parent training for behavior management.

4 This is correct. The nurse needs to provide information to the parent about how to learn how to manage ODD behavior. The parent needs to know about and how to access a parent training program.

The nurse is attending a high school sports event when a student suddenly stands and shouts, "I need to get out of here—get me out!" Which intervention by the nurse is most appropriate at this time? 1. Attempt to calm the student with quiet breathing and relaxation. 2. Identify the events that led to the student's behaviors. 3. Look for the student's parents and ask about the behavior. 4. Assist the student to a quiet place and remain with the student.

4 This is correct. The nurse's best intervention at this time is to move the student to a quiet environment to reduce stimuli and to remain with the student until the anxiety passes and the student is calm.