Week 4

Mr. Lopez has a 7-year-old son with growth hormone (GH) deficiency. He shares to the nurse the desire of his son to play ball games. However, his wife feels the child will be in danger since he is smaller than the other children. In planning anticipatory guidance for these parents, the nurse should keep in mind which of the following? A The child should be allowed to play because doing so can foster healthy self-esteem. B The risk for fractures is increased because a GH deficiency results in fragile bones. C Activity could aggravate insulin sensitivity, causing hyperglycemia. D Activity would aggravate the child's joints, already over tasked by obesity.

A The child should be allowed to play because doing so can foster healthy self-esteem. Engaging in peer-group activities can aid foster a sense of belonging and a positive self-concept. T-ball is a good sport to choose because physical stature is not an important consideration in the ability to participate, unlike some other sports, such as basketball and football. B: Hypopituitarism does not affect calcium and phosphorus homeostasis and demineralization of bone. So the risk for fractures is not increased. C: Although rare, physical activity without adequate carbohydrate intake can cause hypoglycemia. D: Moderate physical activity increases caloric use and reduces weight without undue strain on weight-bearing joints.

The nurse is preparing a teaching plan for a 10-year-old girl with hyperthyroidism. What information would the nurse include in the plan? A) Describing surgery to remove an anterior pituitary tumor B) Teaching her parents to give injections of growth hormone C) Explaining about the radioactive iodine procedure D) Showing her parents how to give DDAVP intranasally

C) Explaining about the radioactive iodine procedure

A child with growth hormone deficiency is receiving growth hormone. What result would the nurse interpret as indicating effectiveness of this therapy? A) Rapid weight gain B) Complaints of headaches C) Height increase of 4 inches D) Growth plate closure

C) Height increase of 4 inches Effectiveness of growth hormone therapy is indicated by at least a 3- to 5-inch increase in linear growth in the first year of treatment. Rapid weight gain and headaches are adverse reactions of this therapy. The drug is stopped when the epiphyseal growth plates close.

Which exercise would the nurse suggest as most helpful to maintain mobility in a child with juvenile idiopathic arthritis? A) Jogging every other day B) Using a treadmill C) Swimming D) Playing basketball

C) Swimming Swimming is a particularly useful exercise to maintain joint mobility without placing pressure on the joints. Jogging, using a treadmill, and playing basketball would place pressure on the joints of the lower extremities.

The nurse is assessing a 13-year-old boy with type 2 diabetes mellitus. What would the nurse correlate with disorder? A) The parents report that their child had "a cold or flu" recently. B) Blood pressure is decreased when checking vital signs. C) The parents report that their son "can't drink enough water." D) Auscultation reveals Kussmaul breathing.

C) The parents report that their son "can't drink enough water." 3 P's!

The nurse is administering a hepatitis B vaccine to a child. What is the classification of this type of vaccine? A) Killed vaccines B) Toxoid vaccines C) Conjugate vaccines D) Recombinant vaccines

D) Recombinant vaccines Recombinant vaccines use genetically engineered organisms. The hepatitis B vaccine is produced by splicing a gene portion of the virus into a gene of a yeast cell. The yeast cell is then able to produce hepatitis B surface antigen to use for vaccine production. Killed vaccines contain whole dead organisms; they are incapable of reproducing but are capable of producing an immune response. Toxoid vaccines contain protein products produced by bacteria called toxins. The toxin is heat-treated to weaken its effect, but it retains its ability to produce an immune response. Conjugate vaccines are the result of chemically linking the bacterial cell wall polysaccharide (sugar-based) portions with proteins.

What finding would the nurse expect to assess in a child with hypothyroidism? A) Nervousness B) Heat intolerance C) Smooth velvety skin D) Weight gain

D. Weight gain Hypothyroidism is manifested by weight gain, fatigue, cold intolerance, and dry skin. Nervousness, heat intolerance, and smooth velvety skin are associated with hyperthyroidism.

An adolescent client with type 1 diabetes mellitus is admitted to the emergency department for treatment of diabetic ketoacidosis. Which assessment findings should the nurse expect to note? 1.Sweating and tremors 2.Hunger and hypertension 3.Cold, clammy skin and irritability 4.Fruity breath odor and decreasing level of consciousness

Fruity breath odor and decreasing level of consciousness

A child who is 4 years old is seen for a well-child checkup. He has been regularly receiving immunizations. Which immunizations should the child receive at this visit? Select all that apply. 1.Varicella vaccine 2.Rotavirus vaccine 3.Inactivated polio vaccine 4.Meningococcal conjugate vaccine 5.Haemophilus influenzae type B vaccine 6.Measles, mumps, rubella (MMR) vaccine

1.Varicella vaccine 3.Inactivated polio vaccine 6.Measles, mumps, rubella (MMR) vaccine

The nurse should expect to administer the first dose of the measles, mumps, and rubella (MMR) vaccine at which age? 1. 2 years 2. 4 years 3. 12 months 4. 22 months

3. 12 months

The nurse is preparing to administer an MMR (measles, mumps, and rubella) vaccine to a 15-month-old child. Before administering the vaccine, which question should the nurse ask the mother of the child? 1."Has the child had any sore throats?" 2."Has the child been eating properly?" 3."Is the child allergic to any antibiotics?" 4."Has the child been exposed to any infections?"

3."Is the child allergic to any antibiotics?" MMR is used with caution in a child with a history of an allergy to gelatin, eggs, or neomycin because the live measles vaccine is produced by chick embryo cell culture and because MMR also contains a small amount of the antibiotic neomycin.

The clinic nurse prepares to administer a measles, mumps, and rubella (MMR) vaccine to a 5-year-old child. The nurse should administer this vaccine by which method? 1.Subcutaneously in the gluteal muscle 2.Intramuscularly in the deltoid muscle 3.Subcutaneously in the outer aspect of the upper arm 4.Intramuscularly in the anterolateral aspect of the thigh

3.Subcutaneously in the outer aspect of the upper arm

The nurse is developing a plan of care for a 7-year-old boy with diabetes insipidus. What is the priority nursing diagnosis? A) Deficient fluid volume related to dehydration B) Excess fluid volume related to edema C) Deficient knowledge related to fluid intake regimen D) Imbalanced nutrition, more than body requirements related to excess weight

A) Deficient fluid volume related to dehydration The priority nursing diagnosis most likely would be deficient fluid volume related to dehydration, due to a deficiency in the secretion of antidiuretic hormone (ADH). Excess fluid would result from a disorder that leads to water retention, such as syndrome of inappropriate antidiuretic hormone (SIADH). Deficient knowledge related to fluid intake regimen is a nursing diagnosis for this child, but a secondary one. Imbalanced nutrition, more than body requirements related to excess weight would be inappropriate for this child since he probably has lost weight secondary to the fluid loss.

After teaching the mother about follow-up immunizations for her daughter, who received the varicella vaccine at age 14 months, the nurse determines that the teaching was successful when the mother states that a follow-up dose should be given at which time? A) When the child is 20 to 36 months of age B) When the child is 4 to 6 years of age C) When the child is 11 to 12 years of age D) When the child is 13 to 15 years of age

B) When the child is 4 to 6 years of age

Which type of shock is characterized by a hypersensitivity reaction causing massive vasodilation and capillary leaks, which may occur with drug or latex allergy? a. Neurogenic b. Cardiogenic c. Hypovolemic d. Anaphylactic

d. Anaphylactic

The nurse is teaching the parents of a child with growth hormone deficiency about preparing synthetic growth hormone and administering it to the child. Which statement, if made by the parents, would indicate an understanding of the procedure? 1."We will rotate injection sites." 2."We will give the injection weekly on Monday." 3."We will administer the injection every morning." 4."We will store the mixed growth hormone in the medicine cabinet."

1."We will rotate injection sites." Synthetic growth hormone comes in a powdered form that must be diluted for administration. It is given as a subcutaneous injection six or seven times per week as prescribed at bedtime. Parents are taught that, once diluted, the hormone preparation is to be stored at 36° to 46° F (refrigerated). Injection sites should be rotated, which will direct you to the correct option.

Several children have contracted rubeola (measles) in a local school, and the school nurse conducts a teaching session for the parents of the schoolchildren. Which statement made by a parent indicates a need for further teachingregarding this communicable disease? 1."Small blue-white spots with a red base may appear in the mouth." 2."The rash usually begins on the face and spreads downward toward the feet." 3."The disease can be spread to others from 10 days before any sign of the disease appears to 15 days after the rash appears." 4."Respiratory symptoms such as a profuse runny nose, cough, and fever occur before the development of a rash."

3."The disease can be spread to others from 10 days before any sign of the disease appears to 15 days after the rash appears." The communicable period for rubeola ranges from 4 days before to 5 days after the rash appears, mainly during the prodromal stage. All other options are accurate descriptions of rubeola, so they would not indicate a need for further teaching. The small blue-white spots found in this communicable disease are called Koplik's spots. The incorrect option describes the incubation period for rubella, not rubeola.

The home health nurse visits a child with infectious mononucleosis and provides home care instructions to the parents. Which instruction should the nurse give to the parents? 1.Maintain the child on bed rest for 2 weeks. 2.Maintain respiratory precautions for 1 week. 3.Notify the health care provider (HCP) if the child develops a fever. 4.Notify the HCP if the child develops abdominal pain or left shoulder pain.

4.Notify the HCP if the child develops abdominal pain or left shoulder pain. Infectious mononucleosis is caused by Epstein-Barr virus. The parents need to be instructed to notify the HCP if abdominal pain, especially in the left upper quadrant, or left shoulder pain occurs because this may indicate splenic rupture. Children with enlarged spleens also are instructed to avoid contact sports until splenomegaly resolves. Bed rest is unnecessary, and children usually self-limit their activity. Respiratory precautions are not required, although transmission can occur via direct intimate contact or contact with infected blood. Fever is treated with acetaminophen or ibuprofen per HCP preference.

In growing children, growth hormone deficiency results in short stature and very slow growth rates. Short stature may result from which of the following? A Anterior pituitary gland hypofunction B Posterior pituitary gland hyperfunction C Parathyroid gland hyperfunction D Thyroid gland hyperfunction

A Anterior pituitary gland hypofunction Short stature usually results from diminished or deficient growth hormone, which is released from the anterior pituitary gland.

Katie is admitted to the intensive care unit of Nurseslabs Medical Center for diabetic ketoacidosis; which of the following is of primary importance when caring for the child? A Giving I.V. NPH insulin in high doses B Evaluating the child for cardiac abnormalities C Limiting fluids to prevent aggravating cerebral edema D Monitoring and recording the child's vital signs for hypertension

B Evaluating the child for cardiac abnormalities

After teaching the parents of a daughter with central precocious puberty about medication therapy, which statement by the parents indicates successful teaching? A) "She needs to use the nasal spray once every day." B) "She'll start puberty again when the medication stops." C) "This medication will slow down the changes but not reverse them." D) "Once therapy is done, she'll need surgery."

B) "She'll start puberty again when the medication stops." Treatment for central precocious puberty involves administering a gonadotropin-releasing hormone (GnRH) analog. When it is stopped, puberty resumes according to the appropriate developmental stages. This analog can be given by depot injection every 3 to 4 weeks, a daily subcutaneous injection, or an intranasal spray two or three times per day. With GnRH analog treatment, secondary sexual development stabilizes or regresses. Surgery is indicated only if there is a tumor.

The nurse is discussing vaccination for Haemophilus influenzae type B (Hib) with the mother of a 6-month-old child. Which comment provides the most compelling reason to get the vaccination? A) "These bacteria live in every human." B) "Young children are especially susceptible to these bacteria." C) "You have a choice of two excellent vaccines." D) "Your child needs this final dose for protection."

B) "Young children are especially susceptible to these bacteria."

When teaching a group of new parents about newborn care and development, which immunoglobulin would the nurse explain as being primarily responsible for the passive immunity exhibited by newborns? A) IgA B) IgG C) IgM D) IgE

B) IgG IgG is acquired transplacentally, providing the newborn with passive immunity to antigens to which the mother had developed antibodies. IgA, IgD, IgE, and IgM do not cross the placenta and require an antigenic challenge for production.

Tara is an 11-year-old girl diagnosed with type 1 diabetes mellitus (DM). She asks her attending nurse why she can't take a pill rather than shots like her grandmother does. Which of the following would be the nurse's best reply? A "If your blood glucose levels are controlled, you can switch to using pills." B "The pills correct fat and protein metabolism, not carbohydrate metabolism." C "Your body does not make insulin, so the insulin injections help to replace it." D "The pills work on the adult pancreas, you can switch when you are 18."

C "Your body does not make insulin, so the insulin injections help to replace it.

The nurse is caring for a child who is having an anaphylactic reaction with bronchospasm. The nurse would expect to administer what medication for bronchospasm as ordered? A) Epinephrine B) Corticosteroid C) Albuterol D) Diphenhydramine

C) Albuterol Bronchodilation inhalation treatment (albuterol) if bronchospasm is present. Epinephrine, diphenhydramine, and/or corticosteroids are administered to reverse the allergic process.

The nurse suspects that a 4-year-old with type 1 diabetes is experiencing hypoglycemia based on what findings? Select all that apply. A) Blurred vision B) Dry, flushed skin C) Diaphoresis D) Slurred speech E) Fruity breath odor F) Tachycardia

C) Diaphoresis D) Slurred speech F) Tachycardia

While providing care to a 5-month-old girl whose family has a history of food allergies, the nurse instructs the parents about foods to be avoided in the first year of life. Which response by the parents indicates a need for further teaching? A) "She cannot have any cow's milk." B) "I should continue breastfeeding until at least 6 months." C) "Peanuts in any form should be avoided." D) "Any kind of fruit is acceptable."

D) "Any kind of fruit is acceptable." The nurse should caution the parents that kiwifruit should be avoided. Other foods to avoid include cow's milk, eggs, peanuts, tree nuts, sesame seeds, fish, and shellfish. Breastfeeding also is recommended for at least the first 6 months.

The nurse is obtaining a health history from parents whose 4-month-old boy has congenital hypothyroidism. What would the nurse most likely assess? A) The child has above-normal growth for his age. B) The child is active and playful. C) The skin is pink and healthy looking. D) It is difficult to keep the child awake.

D) It is difficult to keep the child awake. The parents may state, during the health history, that it is difficult to keep the child awake. Physical examination would reveal that the child is below weight and height, that his skin is pale and mottled, and that he is lethargic and irritable.

A group of nursing students are reviewing information about humoral and cellular immunity. The students demonstrate understanding of this material when they identify what as being involved in cellular immunity? A) B cells B) Antibodies C) Antigens D) T cells

D) T cells Cellular immunity involves T cells, which do not recognize antigens. B cells, antibodies, and antigens are involved in humoral immunity.

The mother of a 6-year-old child who has type 1 diabetes mellitus calls a clinic nurse and tells the nurse that the child has been sick. The mother reports that she checked the child's urine and it was positive for ketones. The nurse should instruct the mother to take which action? 1.Hold the next dose of insulin. 2.Come to the clinic immediately. 3.Encourage the child to drink liquids. 4.Administer an additional dose of regular insulin.

3.Encourage the child to drink liquids. When the child is sick, the mother should test for urinary ketones with each voiding. If ketones are present, liquids are essential to aid in clearing the ketones. The child should be encouraged to drink liquids. Bringing the child to the clinic immediately is unnecessary. Insulin doses should not be adjusted or changed.

The nursing student is assigned to administer immunizations to children in a clinic. The student should question whether to administer immunizations to a child with which condition? 1.A cold 2.Otitis media 3.Mild diarrhea 4.A severe febrile illness

4.A severe febrile illness A severe febrile illness is a reason to delay immunization but only until the child has recovered from the acute stage of the illness. Minor illness, such as a cold, otitis media, or mild diarrhea, is not a contraindication to immunization.

An infant receives a diphtheria, tetanus, and acellular pertussis (DTaP) immunization at a well-baby clinic. The parent returns home and calls the clinic to report that the infant has developed swelling and redness at the site of injection. Which intervention should the nurse suggest to the parent? 1.Monitor the infant for a fever. 2.Bring the infant back to the clinic. 3.Apply a hot pack to the injection site. 4.Apply a cold pack to the injection site.

4.Apply a cold pack to the injection site. On occasion, tenderness, redness, or swelling may occur at the site of the DTaP injection. This can be relieved with cold packs for the first 24 hours, followed by warm or cold compresses if the inflammation persists. Bringing the infant back to the clinic is unnecessary. Option 1 may be an appropriate intervention, but is not specific to the subject of the question, a localized reaction at the injection site. Hot packs are not applied and can be harmful by causing burning of the skin.

A parent brings her 4-month-old infant to a well-baby clinic for immunizations. The child is up to date with the immunization schedule. The nurse should prepare to administer which immunizations to this infant? 1.Varicella, hepatitis B vaccine (HepB) 2.Diphtheria, tetanus, acellular pertussis (DTaP); measles, mumps, rubella (MMR); inactivated poliovirus vaccine (IPV) 3.MMR, Haemophilus influenzae type b (Hib), DTaP 4.DTaP, Hib, IPV, pneumococcal vaccine (PCV), rotavirus vaccine (RV)

4.DTaP, Hib, IPV, pneumococcal vaccine (PCV), rotavirus vaccine (RV) DTaP, Hib, IPV, PCV, and RV are administered at 4 months of age. DTaP is administered at 2, 4, and 6 months of age; at 15 to 18 months of age; and at 4 to 6 years of age. Hib is administered at 2, 4, and 6 months of age and at 12 to 15 months of age. IPV is administered at 2, 4, and 6 months of age and at 4 to 6 years of age. PCV is administered at 2, 4, and 6 months of age and at 12 to 15 months of age. The first dose of MMR vaccine is administered at 12 to 15 months of age; the second dose is administered at 4 to 6 years of age (if the second dose was not given by 4 to 6 years of age, it should be given at the next visit). The first dose of HepB is administered at birth, the second dose is administered at 1 month of age, and the third dose is administered at 6 months of age. Varicella-zoster vaccine is administered at 12 to 15 months of age and again at 4 to 6 years of age.

A school-age child with type 1 diabetes mellitus has soccer practice and the school nurse provides instructions regarding how to prevent hypoglycemia during practice. Which should the school nurse tell the child to do? 1.Eat twice the amount normally eaten at lunchtime. 2.Take half the amount of prescribed insulin on practice days. 3.Take the prescribed insulin at noontime rather than in the morning. 4.Eat a small box of raisins or drink a cup of orange juice before soccer practice.

4.Eat a small box of raisins or drink a cup of orange juice before soccer practice. Hypoglycemia is a blood glucose level less than 70 mg/dL (4 mmol/L) and results from too much insulin, not enough food, or excessive activity. An extra snack of 15 to 30 g of carbohydrates eaten before activities such as soccer practice would prevent hypoglycemia. A small box of raisins or a cup of orange juice provides 15 to 30 g of carbohydrates. The child or parents should not be instructed to adjust the amount or time of insulin administration. Meal amounts should not be doubled.

A mother brings her 6-year-old child to the clinic because the child has developed a rash on the trunk and scalp. The mother reports that the child has had a low-grade fever, has not felt like eating, and has been tired. The child is diagnosed with chickenpox. The mother inquires about the communicable period associated with chickenpox, and the nurse bases the response on which statement? 1.The communicable period is unknown. 2.The communicable period ranges from 2 weeks or less to 4 weeks. 3.The communicable period is 10 days before the onset of symptoms to 15 days after the rash appears. 4.The communicable period is 1 to 2 days before the onset of the rash to 6 days, when crusts have formed.

4.The communicable period is 1 to 2 days before the onset of the rash to 6 days, when crusts have formed.

A nurse is assessing a child who may have a latex allergy. The nurse asks the child about allergic reactions to certain foods. Which foods if identified by the child as experiencing an allergic reaction would help support the suspected latex allergy? Select all answers that apply. A) Peaches B) Plums C) Carrots D) Tomatoes E) Apples F) Lettuce

A) Peaches B) Plums C) Carrots D) Tomatoes Foods with a known cross-sensitivity to latex include pear, peach, passion fruit, plum, pineapple, kiwi, fig, grape, cherry, melon, nectarine, papaya, apple, apricot, banana, chestnut, carrot, celery, avocado, tomato, or potato. Apples and lettuce are not associated with a cross-sensitivity.