Nokea
A child is brought to the clinic after tripping over a rock. The child states, 'I twisted my ankle,' and is given a diagnosis of a sprain. What intervention is most important for the nurse to include in the discharge instructions for this child?
- A. For the first 24 hours, apply ice for 20 minutes and remove for 60 minutes.
- B. Bed rest with the leg elevated for 36 hours.
- C. May take an NSAID for pain as prescribed.
- D. Use a compression dressing for 72 hours.
Correct Answer: A
Rationale: The correct answer is A. Applying ice in intervals helps to reduce swelling and pain in the first 24 hours after a sprain. This intervention is crucial in the initial management of a sprain to decrease inflammation and provide pain relief. Bed rest with the leg elevated for 36 hours (Choice B) is not recommended as prolonged immobilization can lead to stiffness and decreased range of motion. Allowing the child to take an NSAID for pain as prescribed (Choice C) is a supportive measure but not as essential as ice application in the acute phase. Using a compression dressing for 72 hours (Choice D) may assist in reducing swelling, but it is not as critical as the immediate application of ice to manage pain and inflammation effectively.
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A child with a cardiac malformation associated with left-to-right shunting is being cared for by a nurse. What does the nurse consider to be the major characteristic of this type of congenital disorder?
- A. Elevated hematocrit
- B. Severe growth retardation
- C. Clubbing of the fingers and toes
- D. Increased blood flow to the lungs
Correct Answer: D
Rationale: The major characteristic of a cardiac malformation associated with left-to-right shunting is increased blood flow to the lungs. This increased flow can lead to pulmonary hypertension and heart failure if left untreated. Elevated hematocrit (Choice A) is not a typical characteristic of this condition. Severe growth retardation (Choice B) is not directly associated with left-to-right shunting. Clubbing of the fingers and toes (Choice C) is more commonly seen in conditions involving chronic hypoxia.
A nurse is reviewing the immunization schedule of an 11-month-old infant. What immunizations does the nurse expect the infant to have previously received?
- A. Pertussis, tetanus, polio, and measles
- B. Diphtheria, pertussis, tetanus, and polio
- C. Rubella, polio, tuberculosis, and pertussis
- D. Measles, mumps, rubella, and tuberculosis
Correct Answer: B
Rationale: By 11 months of age, the recommended vaccines for infants include diphtheria, pertussis, tetanus, and polio. These vaccines are part of the routine immunization schedule to protect infants from serious infectious diseases. Choice A is incorrect because measles is not typically administered at this age. Choice C is incorrect because rubella and tuberculosis are not part of routine infant immunizations. Choice D is incorrect because measles, mumps, and rubella are usually given as a combination vaccine later in childhood, not at 11 months of age.
A group of students is reviewing information about the endocrine system in infants and children. The students demonstrate understanding of the information when they state:
- A. Endocrine glands begin developing during gestation.
- B. Endocrine glands are fully functional at birth.
- C. Infants may have difficulty regulating glucose and electrolytes.
- D. A child's endocrine system plays a significant role in growth and development.
Correct Answer: C
Rationale: The correct answer is C. Infants may have difficulty regulating glucose and electrolytes due to their immature endocrine systems. This can lead to issues such as hypoglycemia and electrolyte imbalances. Choice A is incorrect because endocrine glands actually begin developing early in gestation, not just in the third trimester. Choice B is incorrect as endocrine glands are not fully functional at birth; they continue to mature and develop after birth. Choice D is incorrect as a child's endocrine system has a significant impact on growth and development through the secretion of hormones that regulate various processes in the body, but it does not specifically address the difficulty in regulating glucose and electrolytes seen in infants.
How is the diagnosis of Hirschsprung disease confirmed in a 1-month-old infant admitted to the pediatric unit?
- A. Colonoscopy
- B. Rectal biopsy
- C. Multiple saline enemas
- D. Fiberoptic nasoenteric tube
Correct Answer: B
Rationale: Rectal biopsy is the definitive diagnostic procedure for Hirschsprung disease in infants. It confirms the absence of ganglion cells in the affected bowel segment, which is characteristic of Hirschsprung disease. Colonoscopy (Choice A) is not typically used for confirmation as it may not provide a definitive result. Multiple saline enemas (Choice C) are utilized in the treatment of meconium ileus, a complication of cystic fibrosis, and not in the diagnosis of Hirschsprung disease. Fiberoptic nasoenteric tube (Choice D) is not a diagnostic tool for Hirschsprung disease; it is commonly used for gastrointestinal decompression or feeding purposes but does not confirm the diagnosis.
A 13-year-old girl tells the nurse at the pediatric clinic that she took a pregnancy test and it was positive. She adds that her grandfather, with whom she, her younger sisters, and her mother live, has repeatedly molested her for the past 3 years. When the nurse asks the girl if she has told this to anyone, she replies, 'Yes, but my mother doesn't believe me.' Legally, who should the nurse notify?
- A. Police regarding a possible sex crime
- B. Healthcare provider to confirm the pregnancy
- C. Child Protective Services for immediate intervention
- D. Girl's mother about the positive pregnancy test result
Correct Answer: C
Rationale: In this scenario, the nurse should notify Child Protective Services for immediate intervention. The girl disclosed ongoing sexual abuse by her grandfather, which is a serious concern requiring immediate protection and intervention by the appropriate authorities. Child Protective Services are trained to handle cases of child abuse and neglect, ensuring the safety and well-being of the child. While notifying the police about a possible sex crime is crucial, Child Protective Services should be the first point of contact in cases of suspected child abuse due to their specialized role. Confirming the pregnancy through a healthcare provider is not the priority at this moment, as ensuring the safety of the child is paramount. Informing the girl's mother about the positive test result is not appropriate given the lack of belief in the abuse disclosure and the potential risk to the child's safety.