School - Aged Child

Question 1 See full question 54s A school nurse is examining a student at an elementary school. Which findings would lead the nurse to suspect impetigo? You Selected: Vesicular lesions that ooze, forming crusts on the face and extremities Correct response: Vesicular lesions that ooze, forming crusts on the face and extremities Explanation: Impetigo starts as papulovesicular lesions surrounded by redness. The lesions become purulent and begin to ooze, forming crusts. Impetigo occurs most commonly on the face and extremities. Small red lesions on the trunk and in the skin folds are characteristic of scarlet fever. A discrete pink-red maculopapular rash that starts on the face and progresses down to the trunk and extremities is characteristic of rubella (German measles). Red spots with a blue base found on the buccal membranes, known as Koplik's spots, are characteristic of measles (rubeola). Add a Note Question 2 See full question 1m 25s The parents of a school-age child with a brain tumor have elected to have only comfort measures instituted for their dying child. The child has been experiencing significant discomfort and has been receiving pain medication. A nurse knows that the pain-management principle most effective in controlling the child's pain is: You Selected: striving to prevent pain by routine administration of pain medication. Correct response: striving to prevent pain by routine administration of pain medication. Explanation: When providing comfort measures for a child, the nurse should strive to prevent pain by providing routine pain medication. Although the nurse should administer pain medication promptly, the goal of treatment should be to prevent pain rather than simply respond to it. Assessing pain with an age-appropriate tool is important; however, the effective assessment of pain shouldn't take precedence over the effective treatment of pain. Alternating stronger opioid medications with nonopioid medications may be effective, but the nurse should individualize the treatment to meet the child's needs. Add a Note Question 3 See full question 20s Which meal would be appropriate for the child with osteomyelitis to choose? You Selected: beef and bean burrito with cheese, carrot and celery sticks, and a glass of milk Correct response: beef and bean burrito with cheese, carrot and celery sticks, and a glass of milk Explanation: Children with osteomyelitis need a diet that is high in protein and calories. Milk, eggs, cheese, meat, fish, and beans are the best sources of these nutrients. Add a Note Question 4 See full question 2m 38s A 7-year-old child is admitted to the hospital with acute rheumatic fever with chorea-like movements. Which eating utensil should the nurse remove from the meal tray? You Selected: drinking straw Correct response: fork Explanation: For a child with chorea-like movements, safety is of prime importance. Feeding the child may be difficult. Forks should be avoided because of the danger of injury to the mouth and face with the tines. Add a Note Question 5 See full question 19s A child with partial- and full-thickness burns is admitted to the pediatric unit. What should be the priority at this time? You Selected: maintaining fluid and electrolyte balance Correct response: maintaining fluid and electrolyte balance Explanation: Although monitoring vital signs frequently is important, for the first few days the primary concern in burn care is fluid and electrolyte balance, with the goal being to replace fluid and electrolytes lost. With burns, fluid and electrolytes move from the interstitial spaces to the burn injury and are lost. These must be replaced. Once the child's fluid and electrolyte status has been addressed and fluid resuscitation has begun, preventing wound infection is a priority and efforts to control the child's pain can be initiated. Add a Note Question 6 See full question 1m 20s When teaching the child with scoliosis being treated with a Boston brace about exercises, the nurse explains that the exercises are performed primarily for what reason? You Selected: to strengthen the back and abdominal muscles Correct response: to strengthen the back and abdominal muscles Explanation: Exercises are prescribed for the child with scoliosis wearing a Boston brace to help strengthen spinal and abdominal muscles and provide support. Typically, children wearing a Boston brace do not have muscle spasms. Performing exercises provides no effect on the brace's traction ability. Spinal contractures do not occur when a Boston brace is worn. Add a Note Question 7 See full question 8s The nurse is assessing a child with ketoacidosis. The nurse should particularly observe if the client has: You Selected: deep, rapid respirations. Correct response: deep, rapid respirations. Explanation: The accumulation of ketones, organic acids that readily release free hydrogen ions causing blood pH to fall, leads to ketoacidosis. To compensate, the respiratory buffering system is activated, which results in the child taking deep, rapid breaths to rid the body of excess carbon dioxide. This characteristic breathing pattern is known as Kussmaul's respirations. Typically with ketoacidosis, the pulse rate would be more rapid and weak due to dehydration and loss of electrolytes. Typically with ketoacidosis, the skin would be dry due to dehydration. With ketoacidosis, hypotension results from the contracted blood volume secondary to dehydration. Add a Note Question 8 See full question 10s Upon the child's return from the postanesthesia recovery unit (PACU) after a tonsillectomy, the nurse should place the child in which position? You Selected: side lying Correct response: side lying Explanation: Placing the child in a side-lying position facilitates drainage of secretions and helps prevent aspiration. The Trendelenburg position is contraindicated because it decreases effective lung volumes. The supine position is contraindicated because of the increased risk of aspiration. The lithotomy position is used for a pelvic examination. Add a Note Question 9 See full question 1m 3s The nurse is planning care for a child with acute glomerulonephritis. The nurse should report which finding to the primary care provider? You Selected: blood pressure of 140/92 mm Hg Correct response: blood pressure of 140/92 mm Hg Explanation: The elevated blood pressure may indicate hypertension, which is a serious complication of acute glomerulonephritis. The temperature is only slightly elevated and may be related to the glomerulonephritis infection. The serum sodium level is in the normal range. The weight loss is not as significant as the elevated blood pressure and may be due to a loss of fluid that the child had been retaining. Add a Note Question 10 See full question 44s When talking with 10-year-old children about death, the nurse should incorporate which guidelines? Select all that apply. You Selected: Attitudes of the adults in their lives will influence the children. The children will be curious about the physical aspects of death. The children will know that death is inevitable and irreversible. Correct response: The children will be curious about the physical aspects of death. The children will know that death is inevitable and irreversible. Attitudes of the adults in their lives will influence the children. Explanation: By age 10 years, most children know that death is universal, inevitable, and irreversible. School-age children are curious about the physical aspects of death and may wonder what happens to the body. Their cognitive abilities are advanced and they respond well to logical explanations. They should be encouraged to ask questions. The adults in their environment influence their attitudes toward death. Adults should be encouraged to include children in the family rituals and should be prepared to answer questions that might seem shocking. Teaching about death should begin early in childhood. Comparing death to sleep can be frightening for children and cause them to fear falling asleep.

LvL 4 to 5

Question 1 See full question 1m 13s A school-age child has a fever, joint inflammation, and a nonpruritic rash. Knowing that these are signs of rheumatic fever, the nurse should ask the parents: You Selected: "Has your child had strep throat recently?" Correct response: "Has your child had strep throat recently?" Explanation: Asking if the child had strep throat recently is appropriate because group A streptococcal infection typically precedes rheumatic fever — an inflammatory disease that affects the heart, joints, and central nervous system. Rheumatic fever isn't infectious and can't be transmitted from one person to another. Congenital heart defects don't play a role in the development of rheumatic fever. H. influenzae vaccine doesn't prevent streptococcal infection or rheumatic fever. Add a Note Question 2 See full question 42s According to Erikson's theory of development, chronic illness can interfere with which stage of development in an 11-year-old child? You Selected: Industry versus inferiority Correct response: Industry versus inferiority Explanation: According to Erikson, an 11-year-old child is working through the stage of industry versus inferiority. Chronic illness may interfere with this stage of development in an 11-year-old child because the child may not be able to accomplish tasks, which prevents him from achieving a sense of industry. Intimacy is the developmental task of a young adult. Trust is the developmental task to be achieved during infancy. Identity is the developmental task of adolescence. Add a Note Question 3 See full question 51s A preadolescent child is suspected of being sexually abused because he demonstrates the self-destructive behaviors of self-mutilation and attempted suicide. Which common behavior should the nurse also expect to assess? You Selected: truancy and running away Correct response: truancy and running away Explanation: Truancy and running away are common symptoms for young children and adolescents. The stress of the abuse interferes with school success, leading to the avoidance of school. Running away is an effort to escape the abuse and/or lack of support at home. Rather than an inability to play or a lack of play, play is likely to be aggressive with sexual overtones. Children tend to act out anger rather than control it. Head banging is a behavior typically seen with very young children who are abused. Add a Note Question 4 See full question 36s The parent tells the nurse that an 8-year-old child is continually telling jokes and riddles to the point of driving the other family members crazy. The nurse should explain this behavior is a sign of which factor? You Selected: mastery of language ambiguities Correct response: mastery of language ambiguities Explanation: School-age children delight in riddles and jokes. Mastery of the ambiguities of language and of sentence structure allows the school-age child to manipulate words, and telling riddles and jokes is a way of practicing this skill. Children who suffer from inadequate attention from parents tend to demonstrate abnormal behavior. Peer influence is less important to school-age children, and while the child may learn the joke from a friend, he is telling the joke to master language. Watching television does not influence the extent of joke telling. Add a Note Question 5 See full question 33s A 42-year-old husband and father of a 7-year-old girl and a 10-year-old boy is concerned about what he should tell his children regarding his wife's impending death from aggressive breast cancer. The nurse should first: You Selected: begin education about strategies for communication with his children. Correct response: begin education about strategies for communication with his children. Explanation: Without clear, consistent communication, the parent-child relationship may become strained during the illness and subsequent death of a parent. A great number of parents do not know how to communicate with their children, especially about difficult emotional topics at a time when they are also under great emotional stress. The nurse should begin by providing information and developmentally appropriate books about the grieving process for children. Referral to pastoral care services may be appropriate; however, the nurse's direct intervention of beginning education about strategies for communication will be of immediate and long-term benefit. The grieving process cannot be rushed for the husband, nor should an opportunity for the father and children to communicate and grieve together be delayed. Excluding children from participating in the grieving ritual does not shield them from the sorrow and sadness, and having the HCP tell the children does not promote health communication between the father and the children. Add a Note Question 6 See full question 40s The nurse should explain that the most common cause for the unhappiness some children experience when first entering school is due to which factor? You Selected: feelings of insecurity Correct response: feelings of insecurity Explanation: The child entering school is moving into a new environment after having experienced security at home. Unhappiness with resulting feelings of insecurity is a normal response to the lost sense of security. Social isolation, emotional maladjustment, and poor language development all suggest a psychosocial disturbance and should not play a role in a normal child's unhappiness about entering school. Add a Note Question 7 See full question 40s The nurse is planning interventions for a school-aged child hospitalized with acute poststreptococcal glomerulonephritis in need of diversional activity. Which activity should the nurse expect to include? You Selected: playing a card game with someone the same age Correct response: playing a card game with someone the same age Explanation: Generally, school-age children enjoy activities with their peers first, then family members, and lastly younger children. School-age children like to be busy but also to accomplish something. This helps to meet their task of industry versus inferiority, feeling good about what they are able to accomplish. Add a Note Question 8 See full question 1m 8s A child who was intubated after a craniotomy now shows signs of decreased level of consciousness. The health care provider (HCP) prescribes manual hyperventilation to keep the PaCO2 between 25 and 29 mm Hg and the PaO2 between 80 and 100 mm Hg. The nurse interprets this prescription based on the understanding that this action will accomplish which goal? You Selected: Decrease intracranial pressure. Correct response: Decrease intracranial pressure. Explanation: Hypercapnia, hypoxia, and acidosis are potent cerebral vasodilating mechanisms that can cause increased intracranial pressure. Lowering the carbon dioxide level and increasing the oxygen level through hyperventilation is the most effective short-term method of reducing intracranial pressure. Although ensuring a patent airway is important, this is not accomplished by manual hyperventilation. Manual hyperventilation does not lower the arousal level; in fact, the arousal level may increase. Manual hyperventilation is used to reduce hypoxia, not produce it. Add a Note Question 9 See full question 20s The nurse is caring for a 7-year-old child who has just returned from the postoperative unit after surgery. The child is playing in bed with toys. The child's parents are smiling and state, "Isn't it great that our child does not have any pain?" What is the best response by the nurse? You Selected: "Some children distract themselves with play while in pain." Correct response: "Some children distract themselves with play while in pain." Explanation: Some children distract themselves with play or music while in pain and may sleep as a result of exhaustion. Nurses commonly underestimate children's pain when they do not rely on children's self-reports. Narcotics can be used safely with children. Add a Note Question 10 See full question 1m 15s A school nurse is examining a student at an elementary school and notes vesicular lesions that ooze, forming crusts on the face and extremities. Which of the following actions by the nurse is most appropriate? You Selected: Sending the child home and encourage evaluation by physician Correct response: Sending the child home and encourage evaluation by physician Explanation: The nurse should send the child home due to possible impetigo and encourage the parents to have the child evaluated by the physician. Impetigo is contagious until the child has been on antibiotics for 24-48 hours, which is why the child should be sent home to be seen by the physician. Impetigo starts as papulovesicular lesions surrounded by redness. The lesions become purulent and begin to ooze, forming crusts. Impetigo occurs most commonly on the face and extremities. Small red lesions on the trunk and in the skin folds are characteristic of scarlet fever. A discrete pink-red maculopapular rash that starts on the face and progresses down to the trunk and extremities is characteristic of rubella (German measles). Cleansing the lesions with Dakin's solution is not appropriate.

LvL 5 to 6

Question 1 See full question 45s A school-age child is admitted to the facility with a diagnosis of acute lymphocytic leukemia (ALL). The nurse formulates a nursing diagnosis of Risk for infection. What is the most effective way for the nurse to reduce the child's risk of infection? You Selected: Practicing thorough hand washing Correct response: Practicing thorough hand washing Explanation: Both ALL and its treatment cause immunosuppression. Therefore, thorough hand washing is the single most effective way to prevent infection in an immunosuppressed client. Reverse isolation doesn't significantly reduce the incidence of infection in immunosuppressed clients; furthermore, isolation may cause psychological stress. Standard precautions are intended mainly to protect caregivers from contact with infectious matter, not to reduce the client's risk of infection. Staff and others needn't wear masks when visiting because most infections are transmitted by direct contact. Instead of relying on masks and other barrier methods, the nurse should keep persons with known infections out of the client's room. Add a Note Question 2 See full question 1m 54s Which beverage should the nurse plan to give a child with leukemia to relieve nausea? You Selected: a carbonated beverage Correct response: a carbonated beverage Explanation: Carbonated beverages ordinarily are best tolerated when a child feels nauseated. Many children find cola drinks especially easy to tolerate, but non-cola beverages are also recommended. Orange juice usually is not tolerated well because of its high acid content. Tea may also be too acidic, and many children do not like tea. Water does not relieve nausea. Add a Note Question 3 See full question 1m 28s The nurse and parents plan for the discharge of a child with leukemia who is receiving dactinomycin and vincristine. Which intervention should the nurse include in the teaching plan? You Selected: Keep the child out of the sun. Correct response: Encourage increased fluid intake. Explanation: Dactinomycin and vincristine both cause nausea and vomiting. Oral fluids are encouraged, and antiemetics are given to prevent dehydration. Avoiding sun exposure is not necessary because photosensitivity is not associated with these drugs. Heart rate changes and memory issues also are not associated with either of these two drugs. Add a Note Question 4 See full question 52s A school-age child hospitalized with acute poststreptococcal glomerulonephritis during the acute stage has elevated blood pressure and low urine output for 14 hours. What should the nurse do next? You Selected: Assess the child's neurologic status. Correct response: Assess the child's neurologic status. Explanation: The nurse should assess the child's neurologic status because hypertensive encephalopathy is a major potential complication of the acute phase of glomerulonephritis. Seizure precautions also should be instituted. Hypertensive encephalopathy can result in transient loss of vision, hemiparesis, disorientation, and grand mal seizures. Encouraging the child to drink more water is inappropriate because the child has had a low urine output for 14 hours. Typically, in this situation, fluids would be restricted. Although a low-sodium diet is encouraged, it is not the priority action at this time. Initially, bed rest, not ambulation, is advocated during the acute phase of glomerulonephritis. Add a Note Question 5 See full question 1m 31s A 9-year-old child with Guillain-Barré syndrome requires mechanical ventilation. Which action should the nurse take? You Selected: Turn the child slowly and gently from side to side to prevent respiratory complications. Correct response: Turn the child slowly and gently from side to side to prevent respiratory complications. Explanation: Even in the absence of respiratory problems or distress, the child must be turned frequently to help prevent the cardiopulmonary complications associated with immobility, such as atelectasis and pneumonia. Maintaining the child in a supine position is unnecessary. Doing so does not prevent unnecessary nerve stimulation. In addition, maintaining a supine position may lead to stasis of secretions, placing the child at risk for pneumonia. Transferring the child to a chair will not prevent postural hypotension. However, doing so will increase vascular tone and help prevent respiratory and skin complications. During the acute disease phase, vigorous physiotherapy is contraindicated because the child may experience muscle pain and be hypersensitive to touch. Careful and gentle handling is essential. Add a Note Question 6 See full question 55s A child with newly diagnosed osteomyelitis has nausea and vomiting. The parent wishes to give the child ginger cookies to help control the nausea. What should the nurse tell the parents? You Selected: "You can try them and see how he does." Correct response: "You can try them and see how he does." Explanation: Some clients find ginger cookies or "snaps" help relieve nausea. Ginger, in small doses such as would be found in the cookies, has few side effects. There is no reason that the parent should not try this dietary intervention; however, the nurse must monitor the client's response. If the child has a diet as tolerated prescription, there is no need for an additional prescription. Ultimately, the child may need an antiemetic medication, but dietary strategies are often successful in treating vomiting related to osteomyelitis. Making a universal statement disregarding home remedies is not a client-centered approach. Add a Note Question 7 See full question 41s The mother of an 8-year-old child with a fluid restriction of 1,000 mL/day is staying in the child's room. Which intervention would be most appropriate for the nurse to include in the child's plan of care? You Selected: Discuss the fluid restriction with the mother and child, and allow them to decide how to allocate the fluids over the 24 hours. Correct response: Discuss the fluid restriction with the mother and child, and allow them to decide how to allocate the fluids over the 24 hours. Explanation: Planning the child's fluid restriction with the mother and child is most appropriate because the mother and child would best know the child's usual pattern of fluid intake. Doing so also provides the mother with a feeling of some control over her child's situation and helps to promote compliance. Anyone, not just hospital personnel, can provide the child with fluids. However, a strict record of the child's intake must be kept to ensure adherence to the restriction. Jello counts as a fluid, thus it must also be limited. Telling the mother exactly how much fluid the child can have each hour restricts the extent of the mother's and child's participation in care. Additionally, doing so ignores the child's usual needs, such as the usual pattern of fluid intake, possibly interfering with adherence to the fluid restriction. Add a Note Question 8 See full question 18s The nurse planning care for a child in vasoocclusive crisis because of sickle cell disease should include increasing fluid intake in the list of interventions because: You Selected: decreased blood viscosity prevents the sickling process. Correct response: decreased blood viscosity prevents the sickling process. Explanation: Treatment of a child in vasoocclusive crisis from sickle cell disease includes measures to prevent further sickling. Sickling occurs in the presence of decreased oxygen tension and alterations in pH. The hard sickle-shaped cells catch on each other and can eventually occlude vessels; that decreases oxygenation of the area and increases the sickling process. Increasing fluids will increase hemodilution and prevent the clumps of sickle cells from occluding vessels. Children in sickle cell crisis do not lose more water than normal through diaphoresis. The life span of a normal red blood cell is 120 days; there is no way to increase this life span. Hemolysis refers to the breakdown of red blood cells, something to be avoided in a child with sickle cell disease. Add a Note Question 9 See full question 37s Which goal is most important when developing a long-term care plan for a child with hemophilia? You Selected: Prevent injury during each stage of development. Correct response: Prevent injury during each stage of development. Explanation: The priority for ongoing care for this child is to prevent injury while maintaining normal growth and interests. As with all chronic illnesses, there is a potential for self-esteem problems, but no data are presented to support this as a priority for care planning. The parents should have a good understanding of the disease process and realize the importance of obtaining regular health care for their child. The client may have episodes of acute pain, for the child who has bleeding into a joint, but this is a transient situation. Add a Note Question 10 See full question 43s A 7-year-old client is admitted to the hospital for a tonsillectomy. After the surgery, the physician orders a clear liquid diet. The nurse is correct in giving the child which items? Select all that apply. You Selected: Lime gelatin Chicken broth Apple juice Correct response: Apple juice Lime gelatin Chicken broth Explanation: Clear liquids include clear broth, gelatin, clear juices, water, and ice chips. Cream of chicken soup, orange juice, and ice cream are included in a full liquid diet.

LvL 6 to 7

Question 1 See full question 37s A child is admitted to the pediatric unit with a serum sodium level of 118 mEq/L. Which nursing action takes highest priority at this time? You Selected: Instituting seizure precautions Correct response: Instituting seizure precautions Explanation: A serum sodium level of 118 mEq/L indicates severe hyponatremia, which places the client at risk for seizures. Therefore, instituting seizure precautions takes highest priority. Fluid and sodium replacement should be done rapidly. Diuretic therapy isn't indicated because it may cause additional sodium loss. In a child with hyperkalemia, administering sodium bicarbonate would be appropriate because it promotes movement of potassium into the intracellular spaces. Add a Note Question 2 See full question 27s Which of the following should the nurse include in the teaching plan for the parents of a child who is receiving methylphenidate? You Selected: Give the single-dose form of the medication early in the day. Correct response: Give the single-dose form of the medication early in the day. Explanation: The single-dose form of methylphenidate should be taken 10 to 14 hours before bedtime to prevent problems with insomnia, which can occur when the daily or last dose of the medication is taken within 6 hours (for multiple dosing) or 10 to 14 hours (for single dosing) before bedtime. It is recommended that a missed dose be taken as soon as possible; the dose is skipped if it is not remembered until the next dose is due. Any other medication, including over-the-counter medications, should be discussed with the health care provider (HCP) before use to eliminate the risk of a possible drug interaction. Add a Note Question 3 See full question 31s When caring for a child who has been receiving long-term steroid therapy, the nurse should assess the child for: You Selected: development of truncal obesity. Correct response: development of truncal obesity. Explanation: One of the side effects of steroid therapy is fat deposition on the trunk and face, producing classic Cushingoid signs. Therefore, the nurse should expect to find truncal obesity. Steroids also can cause altered moods or mood swings. Typically, long-term steroid use results in weight gain. Steroids may inhibit the action of growth hormone. Therefore, a growth spurt is not likely. Add a Note Question 4 See full question 25s A 7-year-old child is admitted to the hospital with acute rheumatic fever. When discussing long-term care for the child with the parents, the nurse should teach them that a necessary part of this care is: You Selected: antibiotic therapy. Correct response: antibiotic therapy. Explanation: A child who has had rheumatic fever is likely to develop the illness again after a future streptococcal infection. Therefore, it is advised that the child receive antibiotic prophylaxis for at least 5 years and sometimes even longer after the acute attack to prevent recurrence. Add a Note Question 5 See full question 2m 23s After doing well for a period of time, a child with leukemia develops an overwhelming infection. The child's death is imminent. Which statement offers the nurse the best guide in making plans to assist the parents in dealing with their child's imminent death? You Selected: Parents are especially grieved when a child does well at first but then declines rapidly. Correct response: Parents are especially grieved when a child does well at first but then declines rapidly. Explanation: It has been found that parents are more grieved when optimism is followed by defeat. The nurse should recognize this when planning various ways to help the parents of a dying child. It is not necessarily true that knowing about a poor prognosis for years helps prepare parents for a child's death. Death is still a shock when it occurs. Trust in health care personnel is not necessarily destroyed when a death is untimely if the family views the personnel as having done all that was possible. It is not more difficult for parents to accept the death of an older child than that of a younger child. Add a Note Question 6 See full question 1m 35s A nurse is proving anticipatory guidance to the family of a school-age child with acute lymphocytic leukemia. Which recommendation should the nurse make? You Selected: being treated as "normal" as much as possible Correct response: being treated as "normal" as much as possible Explanation: Any child with a chronic illness should be treated as normally as possible. Unless the child has severe bone marrow depression, he should be allowed to go to school with others and can go to the mall. If the child is in remission, athletic activities are allowed. Add a Note Question 7 See full question 53s Which diet plan would be appropriate for the nurse to discuss with the family of a child with acute renal failure? You Selected: high fat and carbohydrate Correct response: high fat and carbohydrate Explanation: The child with acute renal failure needs extra calories to reduce tissue catabolism, metabolic acidosis, and uremia. Using a high-fat and carbohydrate diet helps to supply the necessary extra calories. If the child is able to tolerate oral foods, concentrated food sources that are high in carbohydrate and fat but low in protein, potassium, and sodium may be provided. Add a Note Question 8 See full question 49s Which intervention would be most appropriate to institute when a school-age child with burns becomes angry and combative when it is time to change the dressings and apply mafenide acetate? You Selected: Allow the child to assist in removing the dressings and applying the cream. Correct response: Allow the child to assist in removing the dressings and applying the cream. Explanation: Expressions of anger and combativeness are often the result of loss of control and a feeling of powerlessness. Some control over the situation is regained by allowing the child to participate in care. Although having parental support during the dressing changes may be helpful, this action does nothing to allow the child control. Giving the child permission to cry may help with verbalizing feelings, but doing so does nothing to provide the child with control over the situation. Although allowing the child to determine the time for dressing changes may provide a sense of control over the situation, doing so is inappropriate because the dressing changes need to be performed as prescribed to ensure effectiveness and healing. Add a Note Question 9 See full question 27s When the nurse is obtaining the initial health history from a 10-year-old child with abdominal pain and suspected appendicitis, which question would be most helpful in eliciting data to help support the diagnosis? You Selected: "Where did the pain start?" Correct response: "Where did the pain start?" Explanation: The most helpful question would be to determine the location of the pain when it started. The pain associated with appendicitis usually begins in the periumbilical area and then progresses to the right lower quadrant. After the nurse has determined the location of the pain, asking about what was done for the pain would be appropriate. Asking about the child's usual bowel movement pattern is a general question unrelated to child's condition. Children with appendicitis may have diarrhea or constipation. Additionally, knowledge about the child's usual pattern would not be a priority because the child with appendicitis typically is not hospitalized long enough to reestablish the normal pattern. Although the characteristics of the pain are important, asking if the pain is continuous or intermittent is vague and general because the pain could be associated with numerous conditions. With appendicitis, the client's pain may begin as intermittent, but it eventually becomes continuous. Add a Note Question 10 See full question 34s A child had a colostomy performed 4 weeks ago. The parents report to the nurse that for the past 3 weeks the child's stoma drained adequate amounts of stool, but several days ago, the stoma ceased to drain stool. Which of the following interventions should the nurse take? You Selected: Report the findings immediately. Correct response: Obtain an order for a stool softener. Explanation: The child is exhibiting symptoms of stomal stenosis, which is defined as impairment of effluent drainage due to narrowing or contraction of the stomal tissue at the level of the skin or fascia. Conservative therapy involves use of stool softeners and a low-residue diet. Stomal belts are often used for stoma retraction. Stoma prolapse requires a larger pouch. Stoma necrosis should be reported immediately to the physician.

LvL 7 to 8

Question 1 See full question 1m 1s A nurse is caring for a school-age child with cerebral palsy. The child has difficulty eating using regular utensils and requires a lot of assistance. Which referral is most appropriate? You Selected: Occupational therapist Correct response: Occupational therapist Explanation: An occupational therapist helps physically disabled clients adapt to physical limitations and is most qualified to help a child with cerebral palsy eat and perform other activities of daily living. A registered dietitian manages and plans for the nutritional needs of children with cerebral palsy but isn't trained in modifying or fitting utensils with assistive devices. A physical therapist is trained to help a child with cerebral palsy gain function and prevent further disability but not to assist the child in performing activities of daily living. A nursing assistant can help a child eat; however, the nursing assistant isn't trained in modifying utensils. Add a Note Question 2 See full question 3m 13s Which relaxation strategy would be effective for a school-age child to use during a painful procedure? You Selected: Having the child take a deep breath and blow it out until told to stop Correct response: Having the child take a deep breath and blow it out until told to stop Explanation: Having the child take a deep breath and blow it out is a form of distraction and will help the child cope better with the procedure. A child may prefer to keep his eyes open, not shut, during a procedure so he can see what is going on and can anticipate what is going to happen. Letting a child yell during a procedure is a form of helpful distraction. In addition, holding the breath isn't beneficial and could have adverse effects (such as feeling dizzy or faint). The nurse should prepare a child for a procedure by using nonpain descriptors and not suggesting pain. For example, the nurse might say, "Sometimes this feels like pushing or sticking, and sometimes it doesn't bother children at all." Add a Note Question 3 See full question 1m 47s A 6-year-old child has had heart surgery to repair tetralogy of Fallot. When developing the discharge plan, the nurse should include information about: You Selected: treating tet spells. Correct response: allowing the child to lead a normal, active life. Explanation: Most parents find it especially difficult to allow a child who was unable to be normally active before corrective heart surgery to lead a normal and active life after surgery. These parents are less likely to be apprehensive about persuading the child of the need for rest, about postoperative complications, or having the child out of school for a month. Tet spells are no longer not expected after the surgical repair. Add a Note Question 4 See full question 2m 13s The parents of a child on sulfamethoxazole and trimethoprim for a urinary tract infection report that the child has a red, blistery rash. The nurse should tell the parents to: You Selected: discontinue the medicine and come for immediate further evaluation. Correct response: discontinue the medicine and come for immediate further evaluation. Explanation: Sulfonamides have been associated with severe adverse reactions. A blistering rash may be a sign of Stevens-Johnson syndrome, a severe allergic reaction that manifests as skin lesions. This reaction is life threatening and requires immediate attention. Lotion should not be applied to skin with blisters. Sulfamethoxazole and trimethoprim may cause photosensitivity, but this usually appears as a mild red rash, not blisters. Increasing the child's fluid intake may help the urinary tract infection, but does not address the rash. Add a Note Question 5 See full question 1m 48s After a plaster cast has been applied to the arm of a child with a fractured right humerus, the nurse completes discharge teaching. The nurse should evaluate the teaching as successful when the mother agrees to seek medical advice if the child experiences which symptom? You Selected: inability to extend the fingers on the right hand Correct response: inability to extend the fingers on the right hand Explanation: Inability to extend the fingers of the involved arm may indicate neurologic impairment caused by pressure on soft tissue. It is not unusual for a child to vomit after experiencing a traumatic injury. It may take up to 72 hours for a plaster cast to dry. Until the cast dries, the dampness causes the sensation of coolness. The cast will seem heavy until the child adjusts to the extra weight. The child may exhibit fussiness (such as whining, crying, or clinging) as a result of numerous causes, such as placement of the cast, the hospital experience, or pain. These reactions are normal and do not warrant medical advice. Add a Note Question 6 See full question 4m 26s For the child experiencing excessive vomiting secondary to pyloric stenosis, the nurse should assess the child for which acid-base imbalance? You Selected: metabolic alkalosis Correct response: metabolic alkalosis Explanation: Metabolic alkalosis occurs because of the excessive loss of potassium, hydrogen, and chloride in the vomitus. Chloride loss leads to a compensatory increase in the number of bicarbonate ions. The bicarbonate side of the carbonic acid-base bicarbonate increases, and the pH becomes more alkaline. Respiratory alkalosis is caused by conditions such as hyperventilation that result in loss of partial pressure of arterial carbon dioxide (PaCO2). Respiratory acidosis is caused by conditions such as inadequate ventilation that result in excessive retention of PaCO2. Metabolic acidosis results from the loss of large amounts of bicarbonate, such as with severe diarrhea. Add a Note Question 7 See full question 1m 37s What finding should the nurse interpret as indicating that a child is receiving too much IV fluid too rapidly? You Selected: moist crackles in the lung fields Correct response: moist crackles in the lung fields Explanation: Moist crackles in the lung fields are an indication that fluid is accumulating in the lungs due to overhydration or too rapid delivery of fluids. Abdominal girth would not provide information about the child's fluid status. Protein in the urine may be due to a disease process not fluid status. Dark amber-colored urine would be an indication of underhydration. Add a Note Question 8 See full question 3m 54s The nurse is assessing a child with ketoacidosis. The nurse should particularly observe if the client has: You Selected: deep, rapid respirations. Correct response: deep, rapid respirations. Explanation: The accumulation of ketones, organic acids that readily release free hydrogen ions causing blood pH to fall, leads to ketoacidosis. To compensate, the respiratory buffering system is activated, which results in the child taking deep, rapid breaths to rid the body of excess carbon dioxide. This characteristic breathing pattern is known as Kussmaul's respirations. Typically with ketoacidosis, the pulse rate would be more rapid and weak due to dehydration and loss of electrolytes. Typically with ketoacidosis, the skin would be dry due to dehydration. With ketoacidosis, hypotension results from the contracted blood volume secondary to dehydration. Add a Note Question 9 See full question 1m 3s A 7-year-old has been diagnosed with bacterial meningitis. Who should receive chemoprophylaxis? You Selected: all household contacts and close contacts Correct response: all household contacts and close contacts Explanation: Chemoprophylaxis should be given to household contacts and close contacts only. To prevent community outbreaks, chemoprophylaxis with rifampin 600 mg twice a day for 2 days or a single dose of ciprofloxacin 500 mg is indicated. Add a Note Question 10 See full question 1m 28s A school nurse is asked to speak with a 10-year-old child who is constantly bullying other children. When talking with the child, what information would be most helpful for the nurse to obtain to help with understanding the child's actions? You Selected: Determine whether the child is also a victim of bullying. Correct response: Determine whether the child is also a victim of bullying. Explanation: Children who are bullies are generally lashing out with violence because they are being bullied themselves.

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Question 1 See full question 1m 2s A child, age 9, is admitted to the emergency department with abdominal pain. The child's mother states the pain began about 12 hours ago. The nurse notes the child has a temperature of 100.8° F (38.2° C) and nausea. The child vomited once. Which abdominal area would be most appropriate for the nurse to assess? You Selected: Lower right abdominal quadrant Correct response: Lower right abdominal quadrant Explanation: The child's symptoms indicate appendicitis. Therefore, the nurse should assess the lower right abdominal quadrant. The nurse would assess the left lower abdominal quadrant to detect descending and sigmoid colon problems; right upper quadrant to detect gallbladder disease; and the left upper quadrant to detect pancreatitis. Add a Note Question 2 See full question 2m 1s A nurse is teaching parents how to reduce the spread of impetigo. The nurse should encourage parents to: You Selected: teach children the importance of proper hand washing. Correct response: teach children the importance of proper hand washing. Explanation: The spread of childhood infections, including impetigo, can be reduced when children are taught proper hand-washing technique. Because impetigo is spread through direct contact, covering the mouth and nose when sneezing won't prevent its spread. Currently, there is no vaccine to prevent a child from contracting impetigo. Isolating the child with impetigo is unnecessary. Add a Note Question 3 See full question 23s Several children in a kindergarten class have been treated for pinworm. To prevent the spread of pinworm, the school nurse meets with the parents and explains that they should: You Selected: tell the children not to bite their fingernails. Correct response: tell the children not to bite their fingernails. Explanation: Pinworms come out of the intestine through the anus at night to lay eggs, causing perianal itching. The child wakes up and may begin scratching. Eggs under the fingernails are carried to the mouth if the child chews on his nails, and the life cycle of the pinworm continues. In addition to teaching children not to bite their fingernails, parents should keep the nails short and encourage hand washing before food preparation and eating. Sharing hairbrushes contributes to the spread of head lice, not pinworms. Although covering the mouth and nose are hygienic practices to reduce the spread of infections from respiratory droplets, doing so doesn't affect the spread of pinworms. There are no immunizations to protect against pinworms. Add a Note Question 4 See full question 1m 19s A 6-year-old child is being discharged from the emergency department after being diagnosed with varicella (chickenpox). The nurse knows the parents need more medication teaching when they state they will give the child which over-the-counter medication? You Selected: Aspirin Correct response: Aspirin Explanation: The parents require additional teaching if they state they will give their child aspirin because using aspirin during a viral infection has been linked to Reye's syndrome, a serious illness that can lead to brain damage and death in children. If the child requires medication for fever or discomfort, the nurse should recommend acetaminophen or ibuprofen. Naproxen isn't indicated for the treatment of fever. Add a Note Question 5 See full question 4m 11s The parents of a child with cystic fibrosis express concern about how the disease was transmitted to their child. The nurse should explain that: You Selected: two parents who are carriers may produce a child who has the disease. Correct response: two parents who are carriers may produce a child who has the disease. Explanation: Cystic fibrosis is the most common inherited disease in children. It is inherited as an autosomal recessive trait, meaning that the child inherits the defective gene from both parents. The chances are one in four for each of this couple's pregnancies. Add a Note Question 6 See full question 41s A 10-year-old child proudly tells the nurse that brushing and flossing her teeth is her responsibility. How does the nurse interpret the statement? You Selected: She is most likely capable of this responsibility. Correct response: She is most likely capable of this responsibility. Explanation: Children are capable of mastering the skills required for flossing when they reach 9 years of age. At this age, many children are able to assume responsibility for personal hygiene. She is not too young to assume this responsibility, and she should not have been expected to assume this responsibility much earlier. It is not likely that she is exaggerating; this is an expected behavior at this age. Add a Note Question 7 See full question 1m 38s Which food would be the best to offer first to a child who has had a tonsillectomy? You Selected: cherry fruit drink Correct response: yellow ice pop Explanation: The nurse must consider both the color and consistency of foods and fluids given initially. Red or brown foods and fluids should be avoided so that if vomiting occurs, fresh or old blood can be distinguished from the ingested liquids. Clear liquids are offered first. Therefore, a yellow ice pop would be best. Cherry fruit drink, because of its red color, would be an inappropriate choice. Vanilla pudding, although an appropriate color, is considered part of a full liquid diet and should not be offered until the child can retain clear liquids. Chocolate milk would be inappropriate because of its color and because it is considered a full liquid. Add a Note Question 8 See full question 56s Which breathing rate should the nurse use when performing rescue breathing during cardiopulmonary resuscitation for a 5-year-old? You Selected: 10 breaths/minute Correct response: 10 breaths/minute Explanation: Rescue breaths should be delivered slowly at a volume that makes the chest rise and fall. For a 5-year-old child, the rate is 10 breaths per minute. If the nurse is also administering chest compressions, the rate is 2 breaths for every 30 compressions. Add a Note Question 9 See full question 24s The nurse is educating parents of a child diagnosed with seasonal allergies. The nurse discusses therapeutic management of the child's allergies and works with the parents to set goals that best support a quality childhood experience. Which of the following goals is most important for the nurse to set with the parents? You Selected: Identifying ways to reduce the child's exposure to the allergens Correct response: Identifying ways to reduce the child's exposure to the allergens Explanation: The primary goal of therapeutic management for the parents of a child diagnosed with allergies includes reducing the child's exposure to the allergen. This intervention will inevitably reduce the presenting clinical manifestations and corresponding discomfort. Add a Note Question 10 See full question 1m 58s A new graduate nurse is assigned to care for several children with advanced cancer, and the nurse finds the assignment extremely challenging and is considering requesting a different assignment. Which of the following is the best course of action by the nurse to resolve the situation? You Selected: Suggest a shared assignment with a senior staff nurse. Correct response: Suggest a shared assignment with a senior staff nurse. Explanation: Suggesting a shared assignment shows collaboration and uses the experience and skills of colleagues. It would never be wise to continue with an assignment that was too difficult for the skill set and experience of the graduate nurse.

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Question 1 See full question 1m 28s When teaching a parent of a school-age child about signs and symptoms of fever that require immediate notification of the physician, which description should the nurse include? You Selected: Complaints of a stiff neck Correct response: Complaints of a stiff neck Explanation: The nurse should discuss complaints of a stiff neck because fever and a stiff neck indicate possible meningitis. Burning or pain with urination, fever that disappears for 24 hours then returns, and a history of febrile seizures should be addressed by the physician but can wait until office hours. Add a Note Question 2 See full question 5m 4s The nurse leading a group session for parents of children diagnosed with oppositional defiant disorder. The nurse should give which recommendation for discipline? You Selected: Be consistent with discipline while assisting with ways for the child to more positively express anger and frustration. Correct response: Be consistent with discipline while assisting with ways for the child to more positively express anger and frustration. Explanation: Consistent discipline and alternative methods of anger management are two important tools for parents who have a child with oppositional defiant disorder. Consistent discipline sets limits for the child. Helping the child learn more appropriate ways to manage anger assists the child in living within societal expectations. Avoiding restriction of television and computer time for punishment or using time-out as the primary means of punishment has not been suggested as an appropriate management method. Typically, using many strategies is more effective. Ignoring bad behavior could be dangerous and does not reinforce to the child that limits on behavior exist in society. Add a Note Question 3 See full question 10s A 10-year-old child has blood glucose readings during a 24-hour period. Which reading requires the most immediate intervention? You Selected: 200 mg/dL (11.2 mmol/L) Correct response: 50 mg/dL (2.8 mmol/L) Explanation: A normal blood is 70 to 110 mg/dL. Hypoglycemia is an immediate concern. When the brain does not have enough glucose, the client will become rapidly unconscious and, if uncorrected, seizures and death can result. A reading of 100 mg/dL is normal, and no intervention is necessary. Readings of 150 and 200 mg/dL are elevated and could cause complications, but complications from the elevation would not occur as rapidly. Add a Note Question 4 See full question 5m 6s Which of the following should the nurse expect to include in the plan of care for a child who is diagnosed with rheumatic fever and carditis and admitted to the hospital? You Selected: Ensuring continuous parental presence at the child's bedside. Correct response: Providing the child with periods of rest. Explanation: The nurse should encourage and plan to provide periods of rest for the child with rheumatic fever and carditis to allow the heart to rest. The parents should be made to feel that they can come and go as they need to. The child is not in critical condition, so the parents do not need to be present at the child's bedside continuously. The child should be allowed to participate in nonstrenuous activities that avoid overtaxing the heart, thus allowing the heart time to rest. There is no reason to encourage the child to eat as much as possible; in fact, overeating should be discouraged because it taxes the heart muscle. Add a Note Question 5 See full question 2m 44s A school-age child has been diagnosed with Graves' disease and is to start drug therapy. Which instruction should the nurse include in the teaching plan for the child's parent and teacher? You Selected: Provide the child with a calm, nonstimulating environment. Correct response: Provide the child with a calm, nonstimulating environment. Explanation: Because it takes approximately 2 weeks before the response to drug treatment occurs, much of the child's care focuses on managing the child's physical symptoms. Signs and symptoms of the disorder include inability to sit still or concentrate, increased appetite with weight loss, emotional lability, and fatigue. Nursing care is directed toward ensuring that the mother and teacher know how to handle the child and suggesting a shortened school day, a nonstimulating environment, and decreased stress and workload. The child should be encouraged to eat a well-balanced diet. Add a Note Question 6 See full question 1m 2s A child with leukemia has petechiae; gums, lips, and nose that bleed easily; and bruising on various parts of her body. Which laboratory test results should the nurse correlate with these findings? You Selected: platelet count of 80 x 103/mm3 (80 X 109/L) Correct response: platelet count of 80 x 103/mm3 (80 X 109/L) Explanation: In leukemia, megakaryocytes, from which platelets are derived, are decreased. Normal platelet counts range from 150 to 300 × 103/mm3 (150 to 300 X 109/L). A platelet count of 80 × 103/mm3 (80 X 109/L) is low, predisposing the child to bruising and bleeding easily. Although the serum calcium level is decreased, low serum calcium levels are not related to bleeding and bruising in a child with leukemia or any aspect of leukemia. Normal fibrinogen levels range from 200 to 400 mg/dL (5.9 to 11.8 µmol/L). However, insufficient fibrinogen concentration is not related to bleeding and bruising in a child with leukemia or any aspect of leukemia. Partial thromboplastin time (PTT), a measurement of clotting factors (except factor XIII), normally ranges from 25 to 40 seconds. The child's PTT is within the normal range. Add a Note Question 7 See full question 47s A child with asthma has a heart rate of 160 bpm and a respiratory rate of 36 breaths/minute. The child appears restless and anxious and is given albuterol via nebulizer. Which finding would indicate that the nebulizer treatment has been effective? You Selected: increase in peak expiratory flow rate Correct response: increase in peak expiratory flow rate Explanation: The best indicator of the effectiveness of the albuterol is an increase in peak expiratory flow rate. Albuterol, a bronchodilator, opens and relaxes the airways, allowing a greater exchange of air, which is reflected as a higher peak expiratory flow rate. Pulse oximetry reflects how well the client is oxygenating: the higher the reading, the better the client's oxygenation. Typically, a pulse oximeter reading of 95% or greater is the goal. Furthermore, a pulse oximeter reading of 91% is meaningless in this scenario unless previous readings are available for comparison. As the airways open, the child should begin to have a productive cough. Wheezing may or may not be a reliable indicator for determining the effectiveness of the albuterol treatment. The nebulizer treatment may increase wheezing by opening the airways enough so that air can travel through the excessively mucus-filled bronchioles. Because this child is still experiencing respiratory distress, some wheezing would be expected. However, wheezing in a child with asthma who is in acute distress may indicate an improvement, demonstrating the movement of air through the airways that were previously blocked. Add a Note Question 8 See full question 2m 4s What response would be most appropriate when responding to a mother who asks how to manage her child's morning hyperglycemia? You Selected: Ask the mother what her child's blood glucose levels have been for the last few days. Correct response: Ask the mother what her child's blood glucose levels have been for the last few days. Explanation: Management of children with early morning hyperglycemia depends on whether the hyperglycemia is due to insulin waning, a progressive rise in blood glucose throughout the day, or rebound hyperglycemia (Somogyi effect: an increase in blood sugar glucose at bedtime, a drop at about 0200, and then a rebound rise early in the morning). Information about the child's blood glucose levels would provide clues to determine which event is occurring. Telling the mother that this is normal is inappropriate. Early morning hyperglycemia is not unusual nor is it an emergency situation. Although questioning the mother to gain more information is appropriate, asking her specifically about avoiding sweets may imply the mother is at fault for not monitoring the child's intake closely. Additionally, carbohydrates, not merely sweets, are implicated in diabetes. Add a Note Question 9 See full question 37s A 5-year-old child is brought to the emergency department after injuries sustained in a motor vehicle accident. The child is diagnosed with a cervical spinal cord injury. Which assessment data would the nurse consider as most significant when assessing for signs of cervical spinal cord swelling? You Selected: Changes in respiration Correct response: Changes in respiration Explanation: Impaired diaphragm function is common with cervical cord injuries in children and is potentially life threatening. It interferes with the ability to breathe, causing changes in respiration. Add a Note Question 10 See full question 51s A home care nurse is visiting a family with a chronically ill 9-year-old child. Which of the following is a priority nursing diagnosis when working with a family caring for their chronically ill child at home? You Selected: Caregiver role strain related to the demands of the child's care Correct response: Caregiver role strain related to the demands of the child's care Explanation: The families of children with chronic illness require considerable support to manage the stress and challenges of caring for the child at home. These families are at high risk for caregiver role strain. Nursing support is needed to help families learn new adaptation skills to manage the child's care.

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Question 1 See full question 1m 43s A third-grade child is referred to the mental health clinic by the school nurse because he is fearful, anxious, and socially isolated. After meeting with the client, the nurse talks with his mother, who says, "It is that school nurse again. She has done nothing but try to make trouble for our family since my son started school. And now you are in on it." The nurse should respond by saying: You Selected: "You sound pretty angry with the school nurse. Tell me what has happened." Correct response: "You sound pretty angry with the school nurse. Tell me what has happened." Explanation: The mother's feelings are the priority here. Addressing the mother's feelings and asking for her view of the situation is most important in building a relationship with the family. Ignoring the mother's feelings will hinder the relationship. Defending the school nurse and the school puts the client's mother on the defensive and stifles communication. Add a Note Question 2 See full question 57s Which measure is contraindicated when the nurse assists a child who has leukemia with oral hygiene? You Selected: cleaning the teeth with a toothbrush Correct response: cleaning the teeth with a toothbrush Explanation: The oral mucous membranes are easily damaged and are commonly ulcerated in the client with leukemia. It is better to provide oral hygiene without using a toothbrush, which can easily damage sensitive oral mucosa. Applying petroleum jelly to the lips, swabbing the mouth with moistened cotton swabs, and rinsing the mouth with a nonirritating mouthwash are appropriate oral care measures for a child with leukemia. Add a Note Question 3 See full question 27s What is the most appropriate method to use when drawing blood from a child with hemophilia? You Selected: Schedule all labs to be drawn at one time. Correct response: Schedule all labs to be drawn at one time. Explanation: Coordinating labs to minimize sticks reduces trauma and the risk of bleeding. Finger sticks in general are more painful and associated with more bleeding than venipunctures. In hemophilia, platelets are typically normal. Heat would increase vasodilatation and increase bleeding. Add a Note Question 4 See full question 1m 35s A school-age boy with a spinal cord injury is moved to the rehabilitation unit. The nurse notes that the child tends to refuse to cooperate in care and to be hostile. The nurse interprets this behavior as indicative of which response? You Selected: a stage of grief reaction Correct response: a stage of grief reaction Explanation: After a catastrophic injury, individuals commonly experience grief. Initially, the person experiences denial, the most common response. With gradual awareness of the situation, anger commonly occurs. The child is demonstrating anger, not rebellion, as he gradually becomes aware of his situation. Rebellion is the child's way to maintain autonomy and individuality. It is a reaction to rigid rules. Examples include refusing to follow a treatment protocol when the child had no input and running away. Sensory overload would cause the child to be irritable and tired and to have difficulty sleeping. Too much attention usually would lead to irritability, difficulty sleeping, and mood swings. Add a Note Question 5 See full question 39s To help promote independence in the area of feeding for a school-aged child in skeletal traction, the nurse should help the child choose which meal? You Selected: chicken nuggets with sauce, carrot sticks, apple slices, ice cream sandwich, and milk in a carton Correct response: chicken nuggets with sauce, carrot sticks, apple slices, ice cream sandwich, and milk in a carton Explanation: To promote self-feeding, the nurse should provide the child with foods that can be eaten with the fingers or that do not spill easily. Fluids should be provided in containers with straws to prevent spills. Gravies, small round vegetables, and soups can easily spill from a spoon or fork when the child is eating in an unfamiliar position. Spaghetti can be very difficult for the child to eat. Add a Note Question 6 See full question 1m 7s A child brought to the hospital with ketoacidosis is to receive regular insulin via an IV infusion. Which IV solution should the nurse expect the primary care provider to prescribe initially? You Selected: 0.9% saline Correct response: 0.9% saline Explanation: A child with ketoacidosis has elevated blood glucose levels. Therefore, the child should initially receive normal saline solution because it is isotonic and does not contain glucose. The child receives this solution until the blood glucose level approaches the normal range. The rate, or units given per hour, is based on the child's weight. Solutions of 0.45% dextrose, 2.5% dextrose, and 5% dextrose are not used because their glucose content would only further elevate the child's glucose levels. Add a Note Question 7 See full question 7m 7s A school nurse assesses that an 8-year-old child is preoccupied with sexual comments and activities. The nurse is concerned that the child may have been sexually abused at home. What is the nurse's best response to this situation? You Selected: Notify the local Child Protective Services. Correct response: Notify the local Child Protective Services. Explanation: If a nurse suspects abuse of any nature, it must be reported to the appropriate authorities, such as Child Protective Services. The other options are incorrect because they do not demonstrate the required action of the nurse in this situation. Add a Note Question 8 See full question 5m 4s A nurse is taking a health history of a 10-year-child and discovers that the child has difficulties in urinary control during the day. The parents are confused about the condition and ask the nurse for help. What is the most appropriate response by the nurse? You Selected: "There may be a significant stressor in your child's life that's causing this." Correct response: "There may be a significant stressor in your child's life that's causing this." Explanation: Diurnal enuresis is urinary incontinence that occurs during the day. It is most often caused by stress, urinary infections, or a defect of the urinary tract. However, a child with a urinary tract infection often exhibits additional signs and symptoms such as cloudy urine, pain with urination, and frequency. Nocturnal enuresis is urinary incontinence that occurs during the night. Children with primary enuresis never have a period of dryness. Children with secondary enuresis have had a 6- to 12-month period of dryness after a period of wetting. Add a Note Question 9 See full question 30s The nurse is caring for a child in Bryant's traction (see figure). What action should the nurse take? You Selected: Provide frequent skin care. Correct response: Provide frequent skin care. Explanation: The traction is positioned correctly; the nurse should provide frequent skin care to the back and shoulder areas. The hips and buttocks should be lifted off the bed to provide counter traction; the nurse should not adjust the weights. The nurse should not place a pillow under the buttocks as this would prevent counter traction. The elastic wraps should remain on the legs unless removal is prescribed by the health care provider (HCP). Add a Note Question 10 See full question 34s A child with iron deficiency anemia was prescribed ferrous sulfate. Which statement by the parent would indicate a need for further instruction on proper administration? You Selected: "I mix the medication in milk to make it taste better." Correct response: "I mix the medication in milk to make it taste better." Explanation: Ferrous sulfate absorbs better with juices containing vitamin C. However, food containing calcium will decrease the medication's absorption. Ferrous sulfate should be given on an empty stomach if tolerated. Many medications alter the absorption of ferrous sulfate and they should be administered at least 1-2 hours apart. Drinking lots of fluid will help with constipation, a common side effect of ferrous sulfate.

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