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A nurse is preparing to administer eye drops to a school-age child. Identify the actions the nurse should take.
- A. Apply pressure to the lacrimal punctum.
- B. Place the child in a sitting position.
- C. Instill the drops of medication.
- D. Pull the lower eyelid downward.
- E. Ask the child to look upward.
Correct Answer: B,C,D,E
Rationale: The correct order is B, C, D, E. First, placing the child in a sitting position ensures safety and easy access to the eyes. Next, instilling the drops of medication into the conjunctival sac is essential for proper administration. Then, pulling the lower eyelid downward helps to create a pocket for the drops to be placed. Finally, asking the child to look upward aids in the proper distribution of the medication. Choice A is incorrect as applying pressure to the lacrimal punctum is not necessary for administering eye drops. Choices F and G are not applicable in this scenario.
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A nurse is providing teaching to the parent of a 10-month-old infant who is having difficulty eating. The parent is feeding the infant goat milk. Which of the following instructions should the nurse include?
- A. Continue breastfeeding.
- B. Warm the goat milk before feeding.
- C. Switch to soy milk.
- D. Add honey to the milk to improve taste.
Correct Answer: A
Rationale: The correct answer is A: Continue breastfeeding. Breast milk is the ideal source of nutrition for infants under one year old. It provides essential nutrients and antibodies that support the infant's growth and immune system. Goat milk is not recommended as a substitute for breast milk or infant formula due to its different nutrient composition. Continuing breastfeeding will ensure the infant receives the necessary nutrients for proper development. Choice B is incorrect as warming the goat milk does not address the issue of inadequate nutrition. Choice C suggests switching to soy milk, which is also not recommended for infants under one year old due to potential allergenicity. Choice D is incorrect and unsafe as honey should not be given to infants under one year old due to the risk of botulism.
A nurse is preparing to admit a 6-year-old with varicella to the pediatric unit. Which of the following actions should the nurse take?
- A. Assign the child to a negative air pressure room.
- B. Administer aspirin to the child for fever.
- C. Use droplet precautions when caring for the child.
- D. Assess the child for Koplik spots.
Correct Answer: A
Rationale: The correct answer is A: Assign the child to a negative air pressure room. Varicella, commonly known as chickenpox, is highly contagious and spreads through respiratory droplets. Placing the child in a negative air pressure room helps prevent the spread of the virus to others by containing the infectious particles within the room. This isolation measure is crucial in protecting both the child and other patients.
Choice B is incorrect because aspirin should not be administered to children with varicella due to the risk of Reye's syndrome. Choice C is incorrect as droplet precautions are not necessary for varicella, which primarily spreads through airborne respiratory droplets. Choice D is incorrect as Koplik spots are associated with measles, not varicella.
A nurse is assessing a child who has bacterial pneumonia. Which of the following manifestations should the nurse expect?
- A. Fever
- B. Steatorrhea
- C. Tinnitus
- D. Dysphagia
Correct Answer: A
Rationale: The correct answer is A: Fever. Bacterial pneumonia commonly presents with fever due to the body's immune response to the infection. This is a classic sign of inflammation caused by the bacterial infection in the lungs. Steatorrhea (B), tinnitus (C), and dysphagia (D) are not typical manifestations of bacterial pneumonia. Steatorrhea is associated with malabsorption disorders, tinnitus is often related to ear issues, and dysphagia is difficulty swallowing, which is not a common symptom of pneumonia. Therefore, the nurse should expect fever as a key manifestation of bacterial pneumonia in the child.
A nurse is teaching a group of school-age children about healthy snack options. Which of the following snacks should the nurse include?
- A. Cheesecake
- B. Air-popped popcorn
- C. Milkshake made with whole milk
- D. Baked potato chips
Correct Answer: B
Rationale: The correct answer is B: Air-popped popcorn. It is a healthy snack option for school-age children because it is low in calories and high in fiber, making it a satisfying and nutritious choice. Popcorn is a whole grain snack that provides essential nutrients like fiber and antioxidants. It is a good alternative to sugary or high-fat snacks. Cheesecake (A) is high in sugar and saturated fat, not a healthy choice. Milkshake made with whole milk (C) is high in calories, sugar, and saturated fat. Baked potato chips (D) may be lower in fat than regular chips but are still high in calories and lack the fiber content of popcorn.
A nurse is assessing a school-age child who is receiving prednisone. For which of the following adverse effects should the nurse monitor?
- A. Renal failure
- B. Stevens-Johnson syndrome
- C. Prolonged wound healing
- D. Hypotension
Correct Answer: C
Rationale: The correct answer is C: Prolonged wound healing. Prednisone is a corticosteroid that can suppress the immune system and delay wound healing due to its anti-inflammatory effects. The nurse should monitor for this adverse effect by assessing the child's wounds regularly for signs of slow or impaired healing. Renal failure (A) is not a common adverse effect of prednisone. Stevens-Johnson syndrome (B) is a severe skin reaction usually caused by medications but is not typically associated with prednisone. Hypotension (D) is not a common adverse effect of prednisone and is more commonly associated with other medications or conditions.