exam 3

The nurse is reviewing the record of a 10-year-old child suspected of having Hodgkin's disease. Which characteristic manifestation should the nurse anticipate to be documented in the assessment notes? 1. Fever 2. Malaise 3. Painful lymph nodes in the supraclavicular area 4. Painless and movable lymph nodes in the cervical area

4. Clinical manifestations specifically associated with Hodgkin's disease include painless, firm, and movable adenopathy in the cervical and supraclavicular areas. Hepatosplenomegaly is also noted. Although anorexia, weight loss, fever, and malaise are associated with Hodgkin's disease, these manifestations are vague and can be seen in many disorders.

The patient in a gynecology clinic asks the nurse, "What are the greatest risk factors for developing cervical cancer?" Which statement would be the nurse's best response? A. "The earlier the age of sexual activity and the more partners, the greater the risk." B. "Having no children and use of condoms puts you at the highest risk for cervical cancer." C. "Having routinely scheduled Pap smears will protect you from developing cervical cancer." D. "Eating fast foods that are high in fat and taking birth control pills are the greatest risk factors."

A. "The earlier the age of sexual activity and the more partners, the greater the risk."

The nurse analyzes the laboratory values of a child with leukemia who is receiving chemotherapy. The nurse notes that the platelet count is 19,500 cells/mm3. On the basis of this laboratory result, which intervention should the nurse include in the plan of care? 1. Initiate bleeding precautions. 2. Monitor closely for signs of infection. 3. Monitor the temperature every 4 hours. 4. Initiate protective isolation precautions.

1. Initiate bleeding precautions.

A newborn nursery nurse notes that a baby's body is jaundiced at 36 hours of life. Which of the following nursing interventions will be most therapeutic? 1. Maintain a warm ambient environment. 2. Have the mother feed the baby frequently. 3. Have the mother hold the baby skin to skin. 4. Place the baby naked by a closed sunlit window.

2. Have the mother feed the baby frequently.

A baby has just been born to a type 1 diabetic mother with retinopathy and nephropathy. Which of the following neonatal findings would the nurse expect to see? 1. Hyperalbuminemia. 2. Polycythemia. 3. Hypercalcemia. 4. Hypoinsulinemia.

2. Polycythemia

"A child is diagnosed with Wilms' tumor. During assessment, the nurse in charge expects to detect: "a. Gross hematuria b. Dysuria c. Nausea and vomiting d. An abdominal mass"

d. An abdominal mass"

The nurse is collecting data on a child brought to the health care clinic by the mother with a 1-week-old cat scratch. While assessing the scratch the nurse notes redness, heat, swelling, and red streaking surrounding the area. The child states that the scratch hurts. Cellulitis is diagnosed. When providing home care instructions, which statement by the mother indicates a need for further teaching? 1. "The child should rest in bed." 2. "I will apply cool moist soaks every 4 hours." 3. "I should take the child's temperature and watch for a fever." 4. "The affected extremity should be elevated and immobilized."

2. "I will apply cool moist soaks every 4 hours."

A child being treated for Acute Lymphocytic Leukemia (ALL) has a white blood cell (WBC) count of 7,000/mm3. the nursing care plan lists risk for infection as a priority nursing diagnosis, and measures are being taken to reduce the child's exposure to infection. the nurse determines that the plan has been successful when which outcome has been met? "1. child's WBC count goes up. 2. child's WBC count goes down. 3. child's temperature remains within normal range. 4. parents demonstrate good hand washing technique."

3. child's temperature remains within normal range.

The nurse is reviewing instructions to a client diagnosed with otitis media who is prescribed amoxicillin 500 mg orally every 8 hours. The nurse should determine that which statement by the client most indicates an understanding of the adverse effects related to the medication? 1."If I get diarrhea, I need to call the doctor." 2."I may become dizzy from the medication." 3."Constipation means that the medication needs to be stopped." 4."A headache may mean that I need to discontinue the medication."

1 Amoxicillin is a penicillin. Adverse reactions include superinfections such as potentially fatal antibiotic-associated colitis, which results from altered bacterial balance. Symptoms include abdominal cramps, severe watery diarrhea, and fever. Options 2, 3, and 4 are incorrect. The medication does not cause dizziness. The client should not independently stop the medication.

The nurse is reinforcing instructions regarding the prevention of Lyme disease to a group of teenagers going on a hike in a wooded area. Which points should the nurse include in the session? Select all that apply. 1.Tuck pant legs into socks. 2.Wear closed shoes when hiking. 3.Apply insect repellent containing DEET. 4.Cover the ground with a blanket when sitting. 5.Remove attached ticks by grasping with thumb and forefinger. 6.Wear long sleeves and long pants in dark colors when in high-risk areas.

1.Tuck pant legs into socks. 2.Wear closed shoes when hiking. 3.Apply insect repellent containing DEET. 4.Cover the ground with a blanket when sitting. Measures to prevent tick bites focus on covering the body as completely as possible and spraying insect repellent containing DEET on the skin and clothing. Long sleeves and pants tucked into the socks along with closed shoes will offer some protection. Light-colored clothing should be worn so that ticks would be easily visible. Hikers should not sit directly on the ground and should cover the ground with an item such as a blanket. Ticks should be removed with tweezers.

The nurse is assisting in providing an educational session to new mothers regarding the methods that will decrease the risk of recurrent otitis media in infants. Which statement by a mother in the group indicates a need for further teaching? 1. "I need to feed my infant in an upright position." 2. "I need to stop breast-feeding as soon as possible." 3. "Bottle-feeding should be discontinued as soon as possible." 4. "I should not provide my infant with a bottle during naptime." 2. "I need to stop breast-feeding as soon as possible."

2. "I need to stop breast-feeding as soon as possible."

The nurse is collecting data on a 9-year-old child suspected of having a brain tumor. Which question should the nurse ask to elicit data related to the classic symptoms of a brain tumor? 1. "Do you have trouble seeing?" 2. "Do you feel tired all the time?" 3. "Do you throw up in the morning?" 4. "Do you have headaches late in the day?"

3. "Do you throw up in the morning?"

A 4-year-old child is admitted to the hospital for abdominal pain. The mother reports that the child has been pale and excessively tired and is bruising easily. On physical examination, lymphadenopathy and hepatosplenomegaly are noted. Diagnostic studies are being performed on the child because acute lymphocytic leukemia is suspected. The nurse understands that which diagnostic study should confirm this diagnosis? 1. Platelet count 2. Lumbar puncture 3. Bone marrow biopsy 4. White blood cell count

3. Bone marrow biopsy

Nursing care of the infant with eczema should focus on which action as a priority nursing intervention? 1. Keeping the infant content 2. Maintaining adequate nutrition 3. Applying antibiotic ointment to lesions 4. Preventing secondary infection of the lesions

4. Preventing secondary infection of the lesions

The school nurse notes that the child has a rash and suspects that it is caused by erythema infectiosum (fifth disease). The nurse bases this determination on the observation that the rash results in which appearance? 1.Rose-pink maculopapules 2.Pruritic macule-to-papules 3.Pinkish red maculopapules 4.A "slapped-face" appearance

4.A "slapped-face" appearance The classic rash of erythema infectiosum, or fifth disease, is the erythema on the face. The discrete rose-pink maculopapular rash is the rash of exanthema subitum (roseola). The highly pruritic profuse macule-to-papule rash is the rash of varicella (chickenpox). The discrete pinkish red maculopapular rash is the rash of rubella (German measles)

A child is diagnosed with infectious mononucleosis. The nurse reinforces homecare instructions to the parents about the care of the child. Which instruction should the nurse provide to the parents? 1.Maintain the child on bed rest for 2 weeks. 2.Maintain respiratory precautions for 1 week. 3.Notify the pediatrician if the child develops a fever. 4.Notify the pediatrician if the child develops abdominal or left shoulder pain.

4.Notify the pediatrician if the child develops abdominal or left shoulder pain. The parents need to be instructed to notify the pediatrician if abdominal pain (especially in the left upper quadrant) or left shoulder pain occurs, because this may indicate splenic rupture. Children with enlarged spleens are also instructed to avoid contact sports until the splenomegaly resolves. Bed rest is not necessary 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

A child with lymphoma is receiving extensive radiotherapy. Which of the following is the most common side effect of this treatment? "A. Malaise B. Seizures C. Neuropathy D. Lymphadenopathy"

A. Malaise Malaise is the most common side effect of radiotherapy. For children, the fatigue may be especially distressing because it means they cannot keep up with their peers."

A 4-year-old girl has been admitted to the emergency department after accidentally ingesting a cleaning product. Which of the following treatments is most likely appropriate in the immediate treatment of the girl's poisoning? a) Intravenous rehydration b) Administration of activated charcoal c) Gastric lavage d) Inducing vomiting

Administration of activated charcoal Explanation: Activated charcoal is the most common treatment for many poisonings and is more effective and safe than induced vomiting or gastric lavage. Rehydration is likely necessary, but this does not actively treat the girl's poisoning.

A child returns to school following a 3- week absence due to mononucleosis. The school nurse knows it will be important for the client: A. To drink additional fluids throughout the day B. To avoid contact sports for 1-2 months C. To have a snack twice a day to prevent hypoglycemia D. To continue antibiotic therapy for 5 months

B. To avoid contact sports for 1-2 months

An important nursing intervention in the care of a child with conjunctivitis is A. administering oral antihistamine to minimize itching B. applying intermittent warm, moist compresses to remove crusts in the eye area C. applying continuous warm compresses to relieve discomfort D. administering optic corticosteroids to reduce inflammation

B. applying intermittent warm, moist compresses to remove crusts in the eye area The eye should be kept clean. Intermittent warm, moist compresses can soften the crusting for easier removal, maintaining the cleanliness of the eye. Antihistamines are not usually necessary for bacterial conjunctivitis. Continuous warm compresses would promote bacterial growth. Antibiotics are the treatment of choice for bacterial infections; optic corticosteroids are not warranted.

The nurse is aware which patient comment best correlates with a diagnosis of endometrial cancer? A. "My periods are scant." B. "My periods are heavy and I have cramps." C. "I started bleeding again after being in menopause for two years." D. "I am going through the change (perimenopause) and my periods are irregular."

C. "I started bleeding again after being in menopause for two years."

Which of the following is the drug of choice for initial treatment of acute otitis media? A. Ciprofloxacin B. Erythromycin C. Amoxicillin D. Azithromycin

C. Amoxicillin Amoxicillin (Amoxil) is recommended for initial empiric therapy because it is inexpensive, effective, and convenient to administer. Higher dosages can provide expanded coverage of resistant Streptococcus pneumoniae. First line drugs are Amoxil and Augmentin. Both drugs are given orally. Erythromycin, azithromycin, and cefaclor can be used alternatively in communities with high bacterial resistance rates. Ciprofloxacin (a quinolone) is not indicated for children younger than age 18 years. Antibiotic therapy is given for 10 to 14 days. Refer to ear, nose, and throat (ENT) physician if 6 ear infections occur in one year.

The nurse performs a breast examination on a 68-year-old female patient. Which clinical manifestation, if assessed by the nurse, indicates that further evaluation for breast cancer is needed? A. Bilateral pendulous breasts B. Right breast is warm, painful to touch C. Irregular, nontender lump with induration D. Palpable lump that is tender and movable

C. Irregular, nontender lump with induration Clinical manifestations of breast cancer may include a palpable lump that is hard, irregular, poorly delineated, nonmobile, and nontender. Nipple retraction, peau d'orange, induration, and dimpling of the overlying skin may also be noted. Mastitis presents with breasts that are warm to touch, indurated, and painful. Atrophy of the mammary glands associated with aging may result in pendulous breasts. Manifestations of fibrocystic breast changes include palpable lumps that are round, well delineated, and freely movable. The lump is usually tender and increases in size and tenderness before menstruation.

The nurse practitioner (NP) is evaluating a patient for ovarian cancer risk even though the pelvic exam does not reveal any abnormalities. The NP determines the patient is at high risk for ovarian cancer. Which tests should the NP order to aid in the diagnosis of this cancer? A. CBC and OVA1. B. BRCA1 and HPV. C. Pap smear and CEA. D. CA-125 and abdominal ultrasound.

D. CA-125 and abdominal ultrasound.

A nurse is reviewing a basal body temperature chart with a couple. Which change would indicate probable ovulation? a. Decrease in temperature followed by an increase for several days. b. Steadily increasing temperature over 7 days. c. Increase in temperature followed by a decrease for several days. d. Decrease in temperature that remains until menses begins.

a. Decrease in temperature followed by an increase for several days.

The nurse is assessing a 37-year-old woman who is complaining of mood swings, breast tenderness, and food cravings. The nurse asks the client for which additional information? a "Do you have edema as well?" b "When and how often do these symptoms appear?" c "Have you been in an accident?" d "Do you have a chronic disease?"

b "When and how often do these symptoms appear?"

Which finding would lead the nurse to suspect that a newborn is experiencing respiratory distress syndrome? a. Abdominal distention b. Acrocyanosis c. Depressed fontanels d. Nasal flaring

d. Nasal flaring

The nurse is talking with a 15-year-old client experiencing dysmenorrhea who asks if there are any remedies for the pain. The nurse responds with which advice? a "Increase the intake of sodium." b "Antibiotics will help the symptoms to subside." c "The recommended medication is an NSAID." d "Pain lasts only a few days and does not need treatment."

c "The recommended medication is an NSAID."

When caring for an 11-month-old infant with dehydration and metabolic acidosis, the nurse expects to see which of the following? "a. A reduced white blood cell count b. A decreased platelet count c. Shallow respirations d. Tachypnea"

d. Tachypnea The body compensates for metabolic acidosis via the respiratory system, which tries to eliminate the buffered acids by increasing alveolar ventilation through deep, rapid respirations, altered white blood cell or platelet counts are not specific signs of metabolic imbalance.

A baby with hemolytic jaundice is being treated with fluorescent phototherapy. To provide safe newborn care, which of the following actions should the nurse perform? 1. Cover the baby's eyes with eye pads. 2. Turn the lights on for ten minutes every hour. 3. Clothe the baby in a shirt and diaper only. 4. Tightly swaddle the baby in a baby blanket.

1. Cover the baby's eyes with eye pads.

The nurse is counseling the young mother of a small child recently diagnosed with impetigo. The nurse should make which statement that provides the best information about impetigo? 1. "The main treatment while your daughter has impetigo will be to force fluids." 2. "Your daughter probably caught the impetigo because you don't wash her hands enough." 3. "There is no risk of passing impetigo to the other children once you begin the prescribed antibiotics." 4. "You will need to prevent any of the fluid from the blisters around your daughter's mouth from coming into contact with your other children, especially if they already have skin injuries." 4. "You will need to prevent any of the fluid from the blisters around your daughter's mouth from coming into contact with your other children, especially if they already have skin injuries."The nurse is counseling the young mother of a small child recently diagnosed with impetigo. The nurse should make which statement that provides the best information about impetigo? 1. "The main treatment while your daughter has impetigo will be to force fluids." 2. "Your daughter probably caught the impetigo because you don't wash her hands enough." 3. "There is no risk of passing impetigo to the other children once you begin the prescribed antibiotics." 4. "You will need to prevent any of the fluid from the blisters around your daughter's mouth from coming into contact with your other children, especially if they already have skin injuries."

4. "You will need to prevent any of the fluid from the blisters around your daughter's mouth from coming into contact with your other children, especially if they already have skin injuries."

A 12 year old boy seen in the clinic, and a diagnosis of Hodgkin's disease is suspected . Which diagnostic test results confirm the diagnosis of Hodgkin's disease? 1 . Elevated vanillylmandelic acid urinary level. 2. The presence of blast cells in the bone marrow 3. The presence of Epsetin-Barr virus in the blood. 4. The presence of Reed-Sternberg cells in the lymph nodes

4. The presence of Reed-Sternberg cells in the lymph nodes Hodgkin's disease is a neoplasm of lymphatic tissue. The presence of gaint multinucleated cells ( Reed- Sternbergs cells) is the hallmark of this disease. The presence of blast cells in the bone marrow indicates leukemia. The Epstein-Barr virus is associated with infectious mononucleosis . Elevated levels of vanillylmandelic acid in the urine may be found in children with neroblastoma.

A nurse is teaching a client with infertility about the medication Clomid (clomiphene citrate). The nurse should instruct the client to report which side effect of Clomid to her health care provider? A. Hot flashes. b. Abdominal distention. c. Visual disturbances. d. Headaches.

c. Visual disturbances. Rationale: The woman should be knowledgeable about side effects, and should call her health care provider if they occur. When visual disturbances (flashes, blurring, or spots) occur, bright lighting should be avoided. This side effect disappears within a few days or weeks after discontinuation of therapy. Hot flashes can be due to the antiestrogenic properties of clomiphene citrate. The woman can obtain some relief by increasing intake of fluids and using fans.

A 4-year-old child is diagnosed with otitis media. The mother asks the nurse about the causes of this illness. The nurse responds, knowing that which conditions are risk factors related to otitis media? Select all that apply. 1. Bottle-feeding 2. Household smoking 3. Exposure to illness in other children 4. A history of urinary tract infections 5. Congenital conditions such as cleft palate

1. Bottle-feeding 2. Household smoking 3. Exposure to illness in other children 5. Congenital conditions such as cleft palate

A diagnostic workup is being performed on a 1-year-old child with suspected neuroblastoma. The nurse reviews the results of the diagnostic tests and understands that which of the following findings is most specifically related to this type of tumor? "1. Elevated vanillylmandelic acid (VMA) urinary levels 2. Presence of blast cells in the bone marrow 3. Projectile vomiting, usually in the morning 4. Postive Babinski's sign"

1. Elevated vanillylmandelic acid (VMA) urinary levels

Permethrin (Elimite) is prescribed for a child with a diagnosis of scabies. The nurse should give which instruction to the parents regarding the use of this treatment? 1.Apply the lotion to areas of the rash only. 2.Apply the lotion and leave it on for 6 hours. 3.Avoid putting clothes on the child over the lotion. 4.Apply the lotion to cool, dry skin at least 30 minutes after bathing.

4. Apply the lotion to cool, dry skin at least 30 minutes after bathing. Permethrin is massaged thoroughly and gently into all skin surfaces (not just the areas that have the rash) from the head to the soles of the feet. Care should be taken to avoid contact with the eyes. The lotion should not be applied until at least 30 minutes after bathing and should be applied only to cool, dry skin. The lotion should be kept on for 8 to 14 hours, and then the child should be given a bath. The child should be clothed during the 8 to 14 hours of treatment contact time.

The mother of a 3-year-old child arrives at a clinic and tells the nurse that the child has been scratching the skin continuously and has developed a rash. The nurse assesses the child and suspects the presence of scabies. The nurse bases this suspicion on which finding noted on assessment of the child's skin? 1.Fine grayish red lines 2.Purple-colored lesions 3.Thick, honey-colored crusts 4.Clusters of fluid-filled vesicles

1. Fine grayish red lines Scabies is a parasitic skin disorder caused by an infestation of Sarcoptes scabiei (itch mite). Scabies appears as burrows or fine, grayish red, threadlike lines. They may be difficult to see if they are obscured by excoriation and inflammation. Purple-colored lesions may indicate various disorders, including systemic conditions. Thick, honey-colored crusts are characteristic of impetigo or secondary infection in eczema. Clusters of fluid-filled vesicles are seen in herpesvirus infection.

The nurse caring for a child who sustained a burn injury plans care based on which pediatric considerations associated with this injury? Select all that apply. 1. Scarring is less severe in a child than in an adult. 2. A delay in growth may occur after a burn injury. 3. An immature immune system presents an increased risk of infection for infants and young children. 4. The lower proportion of body fluid to mass in a child increases the risk of cardiovascular problems. 5. Fluid resuscitation is unnecessary unless the burned area is more than 25% of the total body surface area. 6. Infants and young children are at increased risk for protein and calorie deficiency because they have smaller muscle mass and less body fat than adults.

2. A delay in growth may occur after a burn injury 3. An immature immune system presents an increased risk of infection for infants and young children. 6. Infants and young children are at increased risk for protein and calorie deficiency because they have smaller muscle mass and less body fat than adults. Pediatric considerations in the care of a burn victim include the following: Scarring is more severe in a child than in an adult. A delay in growth may occur after a burn injury. An immature immune system presents an increased risk of infection for infants and young children. The higher proportion of body fluid to mass in a child increases the risk of cardiovascular problems. Burns involving more than 10% of total body surface area require some form of fluid resuscitation. Infants and young children are at increased risk for protein and calorie deficiencies because they have smaller muscle mass and less body fat than adults.

A mother brings her child to the health care clinic because the child has developed lesions located around the mouth and nose, and mild impetigo is diagnosed. The nurse reinforces instructions to the mother regarding care of the child. Which statement by the mother indicates the need for further teaching? 1."The impetigo is extremely contagious." 2."My child will need to be treated with oral antibiotics." 3."The crusts on the lesions need to be soaked and carefully removed." 4."The lesions should be washed gently three times a day with a warm, soapy washcloth."

2."My child will need to be treated with oral antibiotics." Impetigo is extremely contagious and may spread to other parts of the child's skin or to others who touch the child, use the same towel, or drink from the same glass. Lesions should be washed gently three times a day with a warm, soapy face cloth and crusts soaked and carefully removed. Mild cases are treated with topical antibiotic ointment. The topical antibiotic ointment is applied to the lesions after they are washed. Severe cases are treated with oral antibiotics.

The school nurse has provided an instructional session about impetigo to parents of the children attending the school. Which statement, if made by a parent, indicates a need for further instruction? 1."It is extremely contagious." 2."It is most common in humid weather." 3."Lesions most often are located on the arms and chest." 4."It might show up in an area of broken skin, such as an insect bite."

3. Lesions most often are located on the arms and chest." Impetigo is a contagious bacterial infection of the skin caused by b-hemolytic streptococci or staphylococci, or both. Impetigo is most common during hot, humid summer months. Impetigo may begin in an area of broken skin, such as an insect bite or atopic dermatitis. Impetigo is extremely contagious. Lesions usually are located around the mouth and nose, but may be present on the hands and extremities.

A 50-year-old patient is preparing to begin breast cancer treatment with tamoxifen (Nolvadex). What point should the nurse emphasize when teaching the patient about her new drug regimen? A. "You may find that your medication causes some breast sensitivity." B. "It's important that you let your care provider know about any changes in your vision." C. "You'll find that this drug often alleviates some of the symptoms that accompany menopause." D. "It's imperative that you abstain from drinking alcohol after you begin taking tamoxifen."

B. "It's important that you let your care provider know about any changes in your vision." Tamoxifen has the potential to cause cataracts and retinopathy. The drug is likely to exacerbate rather than alleviate perimenopausal symptoms. Breast tenderness is not associated with tamoxifen, and it is not necessary for the patient to abstain from alcohol.

A client is prescribed combined oral contraceptives​ (COCs) for treatment of dysfunctional uterine bleeding. The client asks the nurse why this will be helpful. The nurse bases the response on which​ rationale? a COCs act as selective serotonin reuptake inhibitors​ (SSRIs) and help control mood and chronic pain. b COCs help suppress ovulation. c COCs help reduce bloating. d COCs are​ anti-inflammatory agents and will decrease cramping.

b COCs help suppress ovulation.

Griseofulvin is prescribed for a child with tinea capitis. The nurse reinforces instructions to the family regarding administration of the medication. Which statement by the mother indicates a need for further teaching? 1."I need to keep my child out of the sun." 2."I need to continue the therapy as long as it is prescribed." 3."I need to administer the medication 2 hours before meals." 4."I need to shake the oral suspension before preparing the dose.

3."I need to administer the medication 2 hours before meals." Griseofulvin is given with or after meals to avoid gastrointestinal (GI) irritation and to increase absorption. Oral suspensions should be shaken well. Parents are instructed to continue therapy as prescribed and not to miss a dose. Exposure to the sun is avoided during treatment