Nokea
The charge nurse finds the mother of a child with a chronic bladder condition requiring clean intermittent catheterization (CIC) visibly upset. The mother states, "That other nurse said parents are not allowed to perform CIC in the hospital because of increased infection risk." The charge nurse should tell the parent:
- A. Your child is exposed to additional bacterial in the hospital that makes CIC unsafe.
- B. You can catheterize your child as long as you use sterile technique.
- C. You can use CIC on your child. I will talk with your nurse to clarify the policy.
- D. I can tell you are having a conflict with this nurse. I will switch assignments.
Correct Answer: C
Rationale: Clarifying policies supports parental involvement.
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When planning home care for the child with Legg-Calvé-Perthes disease, what should be the primary focus for family teaching?
- A. Need for intake of protein-rich foods.
- B. Little stretching exercises for both legs.
- C. Management of the corrective appliance.
- D. Relaxation techniques for pain control.
Correct Answer: C
Rationale: Management of the corrective appliance, such as a brace or traction, is the primary focus to ensure proper use and compliance, which is critical for treatment success.
A parent of a child with a moderate head injury asks the nurse, 'How will you know if my child is getting worse?' The nurse should tell the parents that the best indicator of the child's brain function is:
- A. The vital signs.
- B. Level of consciousness.
- C. Reactions of the pupils.
- D. Motor strength.
Correct Answer: B
Rationale: Level of consciousness is the most sensitive indicator of brain function, reflecting changes in neurological status.
Which of the following would be most appropriate for the nurse to teach the mother of a 6-month-old infant hospitalized with severe diarrhea to help her comfort her infant who is fussy?
- A. Offering a pacifier.
- B. Placing a mobile above the crib.
- C. Sitting at crib side talking to the infant.
- D. Turning the television on to cartoons.
Correct Answer: A
Rationale: A pacifier provides non-nutritive sucking, soothing a fussy infant.
Which of the following initial physical findings indicate the development of carditis in a child with rheumatic fever?
- A. Heart murmur.
- B. Low blood pressure.
- C. Irregular pulse.
- D. Anterior chest wall pain.
Correct Answer: A
Rationale: A heart murmur is a hallmark of carditis in rheumatic fever, indicating valvular involvement. Other findings may occur but are less specific.
A nurse is teaching parents of a child with PKU about dietary management. Which instruction is most important?
- A. Avoid all fruits and vegetables.
- B. Monitor phenylalanine levels regularly.
- C. Use high-protein supplements.
- D. Limit water intake.
Correct Answer: B
Rationale: Regular monitoring of phenylalanine levels ensures dietary compliance and prevents toxicity. Fruits and vegetables are allowed, high-protein foods are avoided, and water restriction is unnecessary.