Nokea
A 10-year-old with leukemia is taking immunosuppressive drugs. To maintain health the nurse should instruct the child and parents to:
- A. Continue with immunizations.
- B. Not receive any live attenuated vaccines.
- C. Receive vitamin and mineral supplements.
- D. Stay away from peers.
Correct Answer: B
Rationale: Live attenuated vaccines are contraindicated in immunosuppression due to infection risk. Other options are unnecessary or overly restrictive.
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Which of the following 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 (Sulfamylon)?
- A. Ensure parental support during the dressing.
- B. Allow the child to assist in removing the dressings and applying the cream.
- C. Give the child permission to cry during the procedure.
- D. Allow the child to schedule the time for dressing changes.
Correct Answer: B
Rationale: Allowing the child to participate fosters a sense of control, reducing fear and combative behavior. Parental support and crying are helpful but less empowering, and scheduling may disrupt care.
A preschooler with a fractured femur of the left leg in traction tells the nurse that his leg hurts. It is too early for pain medication. The nurse should:
- A. Place a pillow under the child's buttocks to provide support.
- B. Remove the weight from the left leg.
- C. Assess the feet for signs of neurovascular impairment.
- D. Reposition the pulleys so the traction is looser.
Correct Answer: C
Rationale: Assessing for neurovascular impairment is critical, as pain could indicate compromised circulation or nerve function.
A 9-month-old infant with eczema has lesions that are secondarily infected. Which of the following is most appropriate to help the parents best meet the needs of the child?
- A. Preventing siblings from being in close contact.
- B. Sending the child to day care as usual.
- C. Playing video games for several hours each evening.
- D. Playing with the child every day.
Correct Answer: D
Rationale: Playing with the child daily promotes emotional bonding and normal development, which is critical for a 9-month-old. Preventing sibling contact is unnecessary unless siblings are ill, day care may risk further infection, and video games are inappropriate for an infant.
When teaching the parents of an infant how to perform back slaps to dislodge a foreign body, which of the following should the nurse tell the parents to use to deliver the blows?
- A. Palm of the hand.
- B. Heel of the hand.
- C. Fingertips.
- D. Entire hand.
Correct Answer: B
Rationale: The heel of the hand is used to deliver back slaps in infants to effectively dislodge a foreign body without causing injury.
A 2-year-old child returns to the clinic after completing a 10-day course of amoxicillin prescribed to relieve an infection in his right ear. After completing the medication, the child has become fussy and has a low-grade fever. On physical examination, his right tympanic membrane is bulging and he is tugging at his ear. The nurse should:
- A. Suggest to the mother that a decongestant be used.
- B. Tell the mother the health care provider will probably repeat the 10-day course of amoxicillin.
- C. Suggest that the child should see an ear, nose, and throat specialist for myringotomy tubes.
- D. Report the assessment to the health care provider with the probability that another antibiotic will be used for a 10-day course.
Correct Answer: D
Rationale: Persistent symptoms like fussiness, fever, a bulging tympanic membrane, and ear tugging after completing amoxicillin suggest treatment failure, possibly due to resistant bacteria. The nurse should report these findings to the health care provider, who may prescribe a different antibiotic for another 10-day course.