Nokea
A 7-year-old obese child was diagnosed at his 6-year primary care visit with idiopathic hypertension. The family was instructed to modify his diet and begin an exercise program to control the hypertension. At this visit, it was decided the child should begin a low dose of Lisinopril (Zestril) at 0.07 mg/kg/day. The child weighs 99 pounds. What is the correct dose for this child?
- A. 70 mg/day
- B. 30 mg/day
- C. 6 mg/day
- D. 3 mg/day
Correct Answer: D
Rationale: The correct dose for this child is 3 mg/day. To calculate the dose, we first need to convert the child's weight from pounds to kilograms by dividing by 2.2 (99 lbs / 2.2 = 45 kg). Next, we multiply the weight in kg by the prescribed dosage of 0.07 mg/kg/day (45 kg x 0.07 mg/kg/day = 3.15 mg/day). Since the dosing is typically rounded down for safety reasons, the correct dose is 3 mg/day.
Choice A (70 mg/day) is incorrect because it is too high for a child of this weight and could lead to adverse effects. Choice B (30 mg/day) is also too high. Choice C (6 mg/day) is incorrect as it does not reflect the calculated dosage based on the weight of the child. Therefore, the correct answer is D (3 mg/day) based on the calculated dosage per kg for this specific child.
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The nurse is caring for a school aged child in sickle cell crisis. Which interventions are appropriate for this patient? (Select all that apply)
- A. Application of a heating pad to the painful areas
- B. Start a Morphine PCA to provide pain relief for this patient
- C. Encourage patient to ambulate often to prevent pneumonia
- D. Hydrate patient with one-and-a-half-time maintenance fluid
Correct Answer: A,B,D
Rationale: Correct Answer: A, B, D
Rationale:
A: Application of a heating pad to the painful areas helps to relieve vaso-occlusive pain in sickle cell crisis by promoting vasodilation and increasing blood flow.
B: Starting a Morphine PCA is appropriate for pain management in sickle cell crisis as it provides controlled analgesia for the patient.
D: Hydrating the patient with one-and-a-half-time maintenance fluid helps prevent dehydration and maintain adequate blood flow, reducing the risk of vaso-occlusive episodes.
Incorrect Choices:
C: Encouraging the patient to ambulate often may not be suitable during a sickle cell crisis as it can increase the risk of pain and further complications.
E, F, G: No additional choices given, but typically options not directly related to pain management, hydration, or symptom relief would be incorrect in this scenario.
The nurse is providing education to parents of a toddler that will receive an iron supplement to treat iron deficiency anaemia. Which statement indicates the parents need further teaching?
- A. It's important to rinse my baby's mouth out with water immediately after giving her the iron
- B. We need to store the iron in a safe place because an accidental overdose can be toxic to the baby
- C. If we notice dark green stools, we should immediately notify the doctor.
- D. A good way to prevent iron deficiency anaemia is to limit the baby's milk consumption to 32 ounces per day.
Correct Answer: C
Rationale: The correct answer is C. If parents notice dark green stools after giving iron supplements, it is actually a common and harmless side effect due to the iron's color. They do not need to immediately notify the doctor unless there are other concerning symptoms. Rinsing the baby's mouth after giving iron (A) is important to prevent staining. Storing iron safely (B) is crucial to prevent accidental ingestion. Limiting milk consumption (D) is recommended as excessive milk can hinder iron absorption.
A 36 pound almost 3-year-old arrives to the ED with dehydration. The provider orders an IV fluid bolus, 15 ml/kg over 30 minutes. How many ml will the nurse administer?
- A. 164 ml
- B. 246 ml
- C. 460 ml
- D. 640 ml
Correct Answer: B
Rationale: The correct answer is B: 246 ml. To calculate the IV fluid bolus amount, first, we need to determine the child's weight in kilograms: 36 lbs ÷ 2.2 = 16.36 kg. Next, multiply the weight in kg by the ordered dose of 15 ml/kg: 16.36 kg x 15 ml/kg = 245.4 ml. Since it is recommended to round up in pediatric dosing, the nurse will administer 246 ml. Choice A is incorrect as it underestimates the dose. Choices C and D are incorrect as they overestimate the dose.
What is the purpose of pediatric hospice?
- A. Provide pain relief so the child doesn't know they are dying
- B. Extend the dying process so the child and family can say goodbye
- C. Hasten the dying process to stop the suffering
- D. Support the highest quality of life possible for whatever time remains
Correct Answer: D
Rationale: The correct answer is D: Support the highest quality of life possible for whatever time remains. Pediatric hospice aims to provide comprehensive care to children with life-limiting illnesses, focusing on enhancing their quality of life through physical, emotional, and spiritual support. This approach prioritizes symptom management, comfort, and dignity for the child, ensuring they live as fully as possible until the end. Other choices are incorrect because A does not acknowledge the child's awareness, B may not align with the child's wishes, and C goes against the ethical principles of hospice care.
When caring for a newborn with Down syndrome, what should the nurse be aware is the most common congenital anomaly associated with Down syndrome?
- A. Diabetes insipidus
- B. Pyloric stenosis
- C. Congenital heart disease
- D. Congenital hip dysplasia
Correct Answer: C
Rationale: The correct answer is C: Congenital heart disease. Down syndrome is commonly associated with congenital heart defects, such as atrioventricular septal defects or ventricular septal defects. This is important for the nurse to be aware of because these heart anomalies can impact the newborn's health and require monitoring or intervention.
Choice A: Diabetes insipidus is not a common congenital anomaly associated with Down syndrome.
Choice B: Pyloric stenosis is not typically associated with Down syndrome.
Choice D: Congenital hip dysplasia is not a common anomaly seen with Down syndrome.
In summary, the nurse should prioritize monitoring for congenital heart disease in a newborn with Down syndrome due to its high prevalence and potential impact on the baby's health.