A mother tells the nurse that one of her children has chickenpox and asks what she should do to care for that child. When teaching the mother, the nurse should instruct the mother to help her child prevent:
- A. Acid-base imbalance.
- B. Malnutrition.
- C. Skin infection.
- D. Respiratory infection.
Correct Answer: C
Rationale: Scratching chickenpox lesions can lead to bacterial skin infections, which should be prevented.
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A parent asks why it is recommended that the second dose of the measles, mumps, and rubella (MMR) vaccine be given at 4 to 6 years of age? The nurse should explain to the parent that the second dose is given at this age for what reason?
- A. If the child has not developed immunity and becomes pregnant when receiving the vaccine, the risks to the fetus are high.
- B. The chance of contracting the disease is much lower at this age.
- C. The dangers associated with a strong reaction to the vaccine are increased at this age.
- D. A serious complication from the vaccine is swelling of the joints.
Correct Answer:
Rationale: The second MMR dose ensures long-term immunity, as some children may not respond fully to the first dose.
A 16-month-old child is seen in the clinic for a checkup for the first time. The nurse notices that the toddler limps when walking. Which of the following would be appropriate to use when assessing this toddler for developmental dysplasia of the hip?
- A. I couldn'ts maneuver.
- B. Barlow's maneuver.
- C. Adam's position.
- D. Trendelenburg's sign.
Correct Answer: B
Rationale: Barlow's maneuver is used to assess for hip instability in infants and toddlers, appropriate for detecting developmental dysplasia of the hip.
The nurse should teach the mother of a child who has a new cast for a fractured radius to do which of the following for the first few days at home?
- A. Use a hair dryer to dry the cast more quickly.
- B. Have the child refrain from strenuous activities.
- C. Check movement and sensation of the child's fingers once a day.
- D. Administer acetaminophen every 8 to 12 hours for discomfort.
Correct Answer: B
Rationale: Refraining from strenuous activities prevents damage to the cast and supports healing during the initial recovery period.
Which of the following client actions should the nurse judge to be a healthy coping behavior for a male adolescent after an appendectomy?
- A. Insisting on wearing a T-shirt and gym shorts rather than pajamas.
- B. Avoiding interactions with other adolescents on the nursing unit.
- C. Refusing to fill out the menu, and allowing the nurse to do so.
- D. Not taking telephone calls from friends so he can rest.
Correct Answer: A
Rationale: Choosing preferred clothing reflects autonomy and positive coping.
The parents of an 18-year-old preparing to enter college ask if their daughter should have the meningococcal (MCV4) vaccine. The nurse should tell the parents:
- A. It is only necessary to have the vaccine if your daughter will be living in a dormitory.'
- B. We recommend the vaccine, but it needs to be given as a series of three injections.'
- C. Let's review your records. The vaccine may have already been given a few years ago.'
- D. We highly recommend this vaccine, but we will need to do a pregnancy screening first.'
Correct Answer: C
Rationale: Checking vaccination records confirms whether the MCV4 vaccine, recommended for adolescents, was previously administered.
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