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During a clinic visit, the mother of an infant with hydrocele states that the infant's scrotum is smaller now than when he was born. After teaching the mother about the infant's condition, which of the following statements by the mother indicates that the teaching has been effective?
- A. I guess keeping his bottom up has helped.
- B. Massaging his groin area is working.
- C. It seems like the fluid is being reabsorbed.
- D. Keeping him quiet and in an infant seat has helped.
Correct Answer: C
Rationale: Fluid reabsorption is a natural resolution process.
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The hospital is responding to a mass casualty disaster with adult and pediatric victims. After reallocating staff, the charge nurse on the pediatric floor should:
- A. Ask parents to leave to free up the parent sleep areas for incoming victims.
- B. Review the census for clients that are candidates for early discharge.
- C. Initiate paper charting back-up.
- D. Change taking all vital signs to every 8 hours.
Correct Answer: B
Rationale: Reviewing for early discharges optimizes bed availability for new patients.
The nurse is admitting a child who has been diagnosed with bacterial meningitis to the pediatric unit. The nurse should implement which type of isolation?
- A. Standard precautions.
- B. Contact precautions.
- C. Airborne precautions.
- D. Droplet precautions.
Correct Answer: D
Rationale: Bacterial meningitis, such as meningococcal, requires droplet precautions due to transmission via respiratory secretions.
When developing the teaching plan for the parents of a 12-month-old infant with hypospadias and chordee repair, which of the following should the nurse expect to include as most important?
- A. Assisting the child to become familiar with his dressings so he will leave them alone.
- B. Encouraging the child to ambulate as soon as possible by using a favorite push toy.
- C. Forcing fluids to at least 2,500 mL/day by offering his favorite juices.
- D. Preventing the child from disrupting the catheters by using soft restraints.
Correct Answer: D
Rationale: Restraining prevents dislodgment of catheters.
Which of following should the nurse perform to help alleviate a child's joint pain associated with rheumatic fever?
- A. Maintaining the joints in an extended position.
- B. Applying gentle traction to the child's affected joints.
- C. Supporting proper alignment with rolled pillows.
- D. Using a bed cradle to avoid the weight of bed linens on joints.
Correct Answer: D
Rationale: A bed cradle reduces pressure from bed linens, alleviating joint pain in rheumatic fever. Other options may not effectively reduce pain or could cause discomfort.
A 13-year-old has been admitted with a diagnosis of rheumatic fever and is on bed rest. He complains of a sore throat. His joints are painful and swollen. He has a red rash on his trunk and is experiencing aimless movements of his extremities. Use the chart below to determine what the nurse should do first.
- A. Report the heart rate to the physician.
- B. Apply lotion to the rash.
- C. Splint the joints to relieve the pain.
- D. Request an order for medication to treat the elevated temperature.
Correct Answer: A
Rationale: Rheumatic fever can cause carditis, and an elevated heart rate may indicate cardiac involvement, requiring immediate reporting. Other symptoms are managed after assessing cardiac status.