Unit 7
Permethrin (Elimite) is prescribed for a 4-year-old child with a diagnosis of scabies. The nurse reinforces instructions to the mother regarding the use of this treatment. Which instruction is appropriate?
1. Apply the lotion and leave it on for 4 hours. 2. Apply the lotion to the hair, the face, and the entire body. 3. The child should wear no clothing while the lotion is in place. 4. Apply the lotion to cool, dry skin at least half an hour after bathing. 4. Rationale: Permethrin is applied from the neck downward, with care taken to ensure that the soles of the feet, the areas behind the ears, and the areas under the toenails and fingernails are covered. The lotion should be kept on for 8 to 14 hours, and then the child should be given a bath. The lotion should be applied at least 30 minutes after bathing, and it should be applied only to cool, dry skin. The child should be clothed during treatment.
The nurse is reviewing the health record of a 14-year-old child who is suspected of having Hodgkin's disease. Which is the primary characteristic of this disease?
1. Fever and malaise 2. Anorexia and weight loss 3. Painful, enlarged inguinal lymph nodes 4. Painless, firm, and movable lymph nodes in the cervical area 4. Rationale: Signs and symptoms 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 not the primary characteristics and are seen with many disorders.
A mother of a 3-year-old child tells the nurse that the child has been continuously scratching the skin and has developed a rash. On data collection, which finding indicates that the child may have scabies?
1. Fine, grayish-red lines 2. Purple-colored lesions 3. Thick, honey-colored crusts 4. Clusters of fluid-filled vesicles 1. Rationale: Scabies appears as burrows or fine, grayish-red lines. They may be difficult to see if they are obscured by excoriation and inflammation. Purple-colored lesions may be indicative of various disorders, including systemic conditions. Thick, honey-colored crusts are characteristic of impetigo. Clusters of fluid-filled vesicles are seen in clients with herpes virus.
The nurse reviews the record of an infant who is seen in the clinic. The nurse notes that a diagnosis of esophageal atresia with tracheoesophageal fistula (TEF) is suspected. The nurse expects to note which most likely manifestation of this condition in the medical record?
1. Incessant crying 2. Coughing at nighttime 3. Choking with feedings 4. Severe projectile vomiting 3. Rationale: Any child who exhibits the "3 C's"—coughing and choking during feedings and unexplained cyanosis—should be suspected of having TEF. Options 1, 2, and 4 are not specifically associated with TEF.
The nurse is preparing for the admission of an infant with a diagnosis of bronchiolitis caused by the respiratory syncytial virus (RSV). Which interventions should be included in the plan of care? Select all that apply.
1. Place the infant in a private room. 2. Place the infant in a room near the nurses' station. 3. Ensure that the infant's head is in a flexed position. 4. Wear a mask at all times when in contact with the infant. 5. Place the child in a tent that delivers warm, humidified air. 6. Position the infant side-lying, with the head lower than the chest. 1,2 Rationale: The infant with RSV should be isolated in a private room or in a room with another child with RSV. The infant should be placed in a room near the nurses' station for close observation. The infant should be positioned with the head and chest at a 30- to 40-degree angle and the neck slightly extended to maintain an open airway and to decrease pressure on the diaphragm. Cool, humidified oxygen is delivered to relieve dyspnea, hypoxemia, and insensible water loss from tachypnea. Contact precautions (wearing gloves and a gown) reduce the nosocomial transmission of RSV.
The nurse is reviewing a health care provider's prescription for a child with sickle cell anemia who was admitted to the hospital for the treatment of vaso-occlusive crisis. Which prescriptions documented in the child's record should the nurse question? Select all that apply.
1. Restrict fluid intake. 2. Position for comfort. 3. Avoid strain on painful joints. 4. Apply nasal oxygen at 2 L per minute. 5. Provide a high-calorie, high-protein diet. 6. Administer meperidine (Demerol) 25 mg for pain. 1,6 Rationale: Sickle cell anemia is one of a group of diseases called hemoglobinopathies in which hemoglobin A is partly or completely replaced by abnormal sickle hemoglobin S. It is caused by the inheritance of a gene for a structurally abnormal portion of the hemoglobin chain. Hemoglobin S is sensitive to changes in the oxygen content of the red blood cell, and insufficient oxygen causes the cells to assume a sickle shape; the cells become rigid and clumped together, thus obstructing capillary blood flow. Oral and intravenous fluids are important parts of treatment. Meperidine (Demerol) is not recommended for the child with sickle cell disease because of the risk for normeperidine-induced seizures. Normeperidine, which is a metabolite of meperidine, is a central nervous system stimulant that produces anxiety, tremors, myoclonus, and generalized seizures when it accumulates with repetitive dosing. Therefore, the nurse would question the prescriptions for restricted fluids and meperidine for pain control. Positioning for comfort, avoiding strain in painful joints, oxygen, and a high-calorie, high-protein diet are important parts of the treatment plan.
