Nokea
A 10-year-old child who is 5'4' (138 cm) tall with a history of asthma uses an inhaled bronchodilator only when needed. He takes no other medications routinely. His best peak expiratory flow rate is 270 L/minute. The child's current peak flow reading is 180 L/minute. The nurse interprets this reading as indicating which of the following?
- A. The child's asthma is under good control, so the routine treatment plan should continue.
- B. The child needs to start a short-acting inhaled beta-agonist medication.
- C. This is a medical emergency requiring a trip to the emergency department for treatment.
- D. The child needs to begin treatment with inhaled cromolyn sodium (Intal) for asthma control.
Correct Answer: B
Rationale: A peak flow reading of 180 L/minute is 66.7% of the child's best (270 L/minute), placing it in the yellow zone (50-80% of personal best), indicating an asthma exacerbation. A short-acting inhaled beta-agonist is needed to relieve symptoms.
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A 7-year-old has had an appendectomy on November 12. He has had pain for the last 24 hours. There is an order to administer Tylenol with Codeine every 3 to 4 hours as needed. The nurse is beginning the shift and reviews the chart below for pain history. Based on the information in the chart, what should the nurse do next?
- A. Administer the Tylenol with Codeine.
- B. Distract the child by giving him breakfast.
- C. Instruct the child to take deep breaths and blow his pain away.
- D. Assess the child again in 1 hour.
Correct Answer: A
Rationale: The FACES score of 4 at 7:00 am indicates pain, and it's been 6 hours since the last dose, warranting medication.
A mother calls the clinic to talk to the nurse. The mother states that a physician described her daughter as having 20/60 vision and she asks the nurse what this means. The nurse responds based on the interpretation that the child is experiencing which of the following?
- A. A loss of approximately one-third of her vision.
- B. Ability to see at 60 feet what she should see at 20 feet.
- C. Ability to see at 20 feet what she should see at 60 feet.
- D. Visual acuity three times better than average.
Correct Answer: C
Rationale: 20/60 vision means the child sees at 20 feet what a person with normal vision sees at 60 feet.
Which of the following should the nurse include in the plan of care for an infant with severe diarrhea to prevent skin breakdown?
- A. Changing diapers every 4 hours.
- B. Applying a petroleum-based ointment.
- C. Using harsh soaps for cleaning.
- D. Keeping the skin exposed to air.
Correct Answer: B
Rationale: Petroleum-based ointment protects the skin from irritation due to frequent stools.
A charge nurse is making assignments for a group of children on a pediatric unit. The nurse should avoid assigning the same nurse to care for a 2-year-old with respiratory syncytial virus (RSV) and:
- A. An 18-month-old with RSV.
- B. A 9-year-old 8 hours post-appendectomy.
- C. A 1-year-old with a heart defect.
- D. A 6-year-old with sickle cell crisis.
Correct Answer: C
Rationale: Assigning the same nurse to a child with RSV and a 1-year-old with a heart defect should be avoided due to the risk of transmitting RSV, which can be particularly severe in children with cardiac conditions.
A nurse is counseling parents of an obese child. Which lifestyle change should be emphasized?
- A. Eliminate all carbohydrates.
- B. Increase physical activity.
- C. Restrict meals to twice daily.
- D. Use meal replacement shakes.
Correct Answer: B
Rationale: Increased physical activity promotes weight control and health. Eliminating carbohydrates, restricting meals, or using shakes are not sustainable or appropriate for children.