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A child who has suspected cystic fibrosis
A nurse is reinforcing teaching about diagnostic tests with the parents of a child who has suspected cystic fibrosis. Which of the following diagnostic tests should the nurse include as the most definitive when diagnosing cystic fibrosis?
- A. Pulmonary function test
- B. Sweat chloride test
- C. Stool fat content analysis
- D. Sputum culture
Correct Answer: B
Rationale: The correct answer is B: Sweat chloride test. This test is the most definitive diagnostic tool for cystic fibrosis as it measures the concentration of chloride in sweat, which is typically elevated in individuals with the condition. The other choices are not as specific to cystic fibrosis. A pulmonary function test (A) evaluates lung function but does not specifically diagnose cystic fibrosis. Stool fat content analysis (C) is used to assess fat malabsorption but does not confirm cystic fibrosis. Sputum culture (D) is used to identify respiratory infections but is not specific to cystic fibrosis.
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A dehydrated child who weighs 10 kg
A dehydrated child has intravenous aid therapy ordered. The child weighs 10 kg. Physician ordered Lactated Ringer's solution 40 ml/kg over 4 hours How many miles per hour will this child receive?
- A. 300ml/hour
- B. 100 mL/hour
- C. 50mL/hour
- D. 200 ml/hour
Correct Answer: B
Rationale: The correct answer is B: 100 mL/hour. To calculate the IV rate, we first multiply the weight of the child (10 kg) by the ordered rate (40 ml/kg) which gives us 400 ml over 4 hours. To convert this to ml per hour, we divide 400 ml by 4 hours, resulting in 100 ml/hour. This calculation ensures the child receives the correct amount of fluid over the specified time frame. Other choices are incorrect because they do not follow the correct calculation method or do not align with the physician's order.
An 8-month-old child who starts to cry when his parents leave
A nurse is caring for an 8-month-old child who starts to cry when his parents leave. The nurse should make which of the following statements to the parents?
- A. At this age you should expect your child to be upset when you leave.
- B. Your child needs to rest.
- C. will notify the provider of his behavior.
- D. Your child is responding to an overstimulating environment.
Correct Answer: A
Rationale: Correct Answer: A
Rationale: At 8 months old, infants develop separation anxiety, causing distress when parents leave. Acknowledging this is crucial for parents to understand normal child development. Choice B is irrelevant as the child's emotional needs should be addressed, not just physical rest. Choice C is unnecessary unless the behavior persists or causes concern. Choice D is incorrect as the child's crying is likely due to separation anxiety, not overstimulation.
A child who has cystic fibrosis
A nurse is reinforcing discharge instructions with a parent of a child who has cystic fibrosis. Which of the following statements by the parent indicates an understanding of the teaching?
- A. I will restrict the amount of salt in my child's meals.
- B. I will put my child in daycare to ensure that she socializes with other children.
- C. I will make sure my child washes her hands before eating.
- D. I will provide low-fat meals for my child.
Correct Answer: C
Rationale: The correct answer is C: "I will make sure my child washes her hands before eating." This statement indicates an understanding of the teaching because proper handwashing is crucial in preventing infections in individuals with cystic fibrosis who are more susceptible to respiratory infections. By washing hands before eating, the child can reduce the risk of exposure to harmful pathogens.
Choice A is incorrect because restricting salt intake is not a priority in managing cystic fibrosis. Choice B is incorrect as the focus should be on hygiene and health rather than socialization. Choice D is incorrect as children with cystic fibrosis actually require a higher calorie and fat intake.
A child who has iron deficiency anemia
A nurse in a pediatric clinic in caring for a child who has iron deficiency anemia and is to start taking ferrous sulfate syrup. Which of the following Instructions should the nurse give the parent?
- A. Administer the medication at meal time
- B. Administer the medication at bedtime.
- C. Offer the medication through a straw
- D. Dilute the medication with 240 mi. (Bar) of milk
Correct Answer: C
Rationale: The correct answer is C: Offer the medication through a straw. This is because iron supplements can stain teeth, and using a straw can help minimize direct contact with the teeth, reducing the risk of staining. Administering the medication at mealtime (choice A) may cause gastrointestinal upset, and administering it at bedtime (choice B) may increase the risk of staining teeth during sleep. Diluting the medication with milk (choice D) is not recommended as calcium in milk can interfere with iron absorption. Offering the medication through a straw is the best option to ensure effective administration while minimizing side effects.
A preschool age child undergoing endotracheal suctioning
A charge nurse is observing a newly licensed nurse who is performing endotracheal suctioning for a preschool age child. Which of the following actions by the newly licensed nurse requires the charge nurse to intervene?
- A. Applying suction for 20 seconds
- B. Introducing the catheter without suction
- C. Rotating the catheter between the thumb and forefinger while suctioning
- D. Allowing the child to rest for 30 to 60 seconds between suctioning passes
Correct Answer: B
Rationale: The correct answer is B: Introducing the catheter without suction. When performing endotracheal suctioning, it is crucial to apply suction while introducing the catheter to effectively remove secretions. Introducing the catheter without suction can result in ineffective suctioning and potential harm to the child.
A: Applying suction for 20 seconds is within the recommended time frame for suctioning.
C: Rotating the catheter while suctioning helps to ensure thorough removal of secretions.
D: Allowing the child to rest between suctioning passes is important to prevent hypoxia and maintain oxygenation.
In summary, choice B is incorrect because it goes against the fundamental principle of effective suctioning, while choices A, C, and D are all appropriate actions during endotracheal suctioning for a preschool-age child.