Nokea
Before starting kindergarten, the child should receive boosters of which primary immunizations to ensure ongoing protection?
- A. IPV, HepB, Td.
- B. DTaP, HepB, Td.
- C. MMR, DTaP, Hib.
- D. DTaP, IPV, MMR.
Correct Answer: D
Rationale: Before starting kindergarten, the child should receive boosters of DTaP, IPV, and MMR. DTaP provides protection against diphtheria, tetanus, and pertussis, IPV protects against polio, and MMR immunization covers measles, mumps, and rubella. These boosters are essential to maintain immunity and protect the child from these diseases as they enter school. Choices A, B, and C are incorrect because they do not include the recommended boosters for kindergarten entry and may leave the child susceptible to certain infections.
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At 7 AM, a healthcare professional receives the information that an adolescent with diabetes has a 6:30 AM fasting blood glucose level of 180 mg/dL. What is the priority nursing action at this time?
- A. Encourage the adolescent to start exercising.
- B. Ask the adolescent to obtain an immediate glucometer reading.
- C. Inform the adolescent that a complex carbohydrate such as cheese should be eaten.
- D. Tell the adolescent that the prescribed dose of rapid-acting insulin should be administered.
Correct Answer: D
Rationale: The correct priority nursing action in this situation is to administer the prescribed dose of rapid-acting insulin. Rapid-acting insulin is necessary to help lower the elevated blood glucose level quickly, thereby preventing potential complications of hyperglycemia. Encouraging exercise, obtaining a glucometer reading, or suggesting consumption of complex carbohydrates like cheese may not address the immediate need to bring down the high blood glucose level effectively. Exercise could potentially raise blood glucose levels, obtaining a glucometer reading may delay necessary treatment, and consuming complex carbohydrates can further elevate blood glucose levels in this scenario.
While assessing a child admitted for an asthma attack, a nurse in the emergency department observes large welts and scars on the child's back. What additional information must be included in the nurse's assessment?
- A. History of an injury
- B. Signs of child abuse
- C. Presence of food allergies
- D. Recent recovery from chickenpox
Correct Answer: B
Rationale: The correct answer is B: Signs of child abuse. When a nurse observes large welts and scars on a child, it raises concern for possible child abuse. It is crucial for the nurse to assess further for signs of abuse, document findings, and report appropriately to protect the child. Choice A, history of an injury, is not specific to potential abuse and may not provide insight into the current situation. Choice C, presence of food allergies, is not directly related to the observed welts and scars. Choice D, recent recovery from chickenpox, is also unrelated to the signs of abuse and does not impact the immediate assessment of the child's safety.
When picked up by a parent or the nurse, an 8-month-old infant screams and seems to be in pain. After observing this behavior, what should the nurse discuss with the parent?
- A. Accidents and the importance of preventing them
- B. Limiting the infant's playtime with other children in the family
- C. Any other behaviors that the parent may have noticed
- D. Nutrition and specific vitamins recommended for infants
Correct Answer: C
Rationale: Discussing any other observed behaviors with the parent is important to identify patterns or potential issues that could be affecting the infant's well-being. By exploring additional behaviors, the nurse can gather more information to assess the infant comprehensively. This approach allows for a more holistic understanding of the infant's health status, rather than focusing solely on the observed behavior of screaming and apparent pain. Options A, B, and D are incorrect as they do not directly address the need to explore other behaviors that may provide insights into the infant's condition and well-being.
A 5-year-old child is admitted to the hospital with a diagnosis of bacterial meningitis. What is the priority nursing intervention?
- A. Administering antibiotics
- B. Isolating the child
- C. Monitoring vital signs
- D. Administering fluids
Correct Answer: B
Rationale: The priority nursing intervention for a child admitted with bacterial meningitis is isolating the child. Isolation is crucial to prevent the spread of the highly contagious infection to other patients and healthcare workers. Administering antibiotics (Choice A) is important but isolating the child takes precedence to contain the spread of the infection. Monitoring vital signs (Choice C) and administering fluids (Choice D) are essential aspects of care but do not address the immediate need to prevent transmission of the infection.
When evaluating a child with a diagnosis of attention-deficit/hyperactivity disorder (ADHD) for medication management, what is an important assessment for the nurse to perform?
- A. Assess the child's sleep patterns
- B. Assess the child's dietary intake
- C. Assess the child's academic performance
- D. Assess the child's behavior at home
Correct Answer: B
Rationale: Assessing the child's dietary intake is crucial as certain foods and additives can affect ADHD symptoms. Ensuring a balanced diet can help manage symptoms and provide proper nutrition. Assessing sleep patterns (Choice A) is also important, but dietary intake is more directly linked to symptom management in ADHD. Academic performance (Choice C) and behavior at home (Choice D) may be affected by ADHD but are not as directly related to medication management as dietary intake.