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The mother of a 5-year-old boy with a myelomeningocele who has developed a sensitivity to latex is being taught by the nurse. Which response from his mother indicates a need for further teaching?
- A. He needs to wear a medical alert identification.
- B. I will need to inform his caregivers about this.
- C. A product's label always indicates if it is latex-free.
- D. He should avoid all contact with latex.
Correct Answer: C
Rationale: Choice C indicates a need for further teaching because not all products are clearly labeled as latex-free. It is essential for the mother to understand that she should not solely rely on product labels to determine latex content. She should be encouraged to verify with manufacturers and consult healthcare providers for accurate information. Choices A, B, and D are correct responses. Wearing a medical alert identification, informing caregivers, and ensuring the boy avoids all contact with latex are crucial steps in managing his sensitivity to latex and preventing potential allergic reactions.
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A parent asks the nurse what they can do to help their child who is experiencing night terrors. What should the nurse suggest?
- A. Encourage the child to talk about the dream
- B. Establish a bedtime routine
- C. Allow the child to sleep with the parents
- D. Wake the child during the night
Correct Answer: B
Rationale: Establishing a bedtime routine is the most appropriate suggestion for a child experiencing night terrors. Consistent bedtime routines help create a sense of security and predictability, reducing the likelihood of night terrors. Encouraging the child to talk about the dream (Choice A) may not be effective as night terrors occur during non-REM sleep, and the child may not remember the dreams. Allowing the child to sleep with the parents (Choice C) can reinforce dependency and may not address the underlying causes of night terrors. Waking the child during the night (Choice D) can disrupt their sleep cycle and worsen the occurrence of night terrors.
The nurse is caring for a 15-year-old boy who has sustained burn injuries. The nurse observes the burn developing a purplish color with discharge and a foul odor. The nurse suspects which infection?
- A. Burn wound cellulitis.
- B. Invasive burn cellulitis.
- C. Burn impetigo.
- D. Staphylococcal scalded skin syndrome.
Correct Answer: B
Rationale: The correct answer is B: Invasive burn cellulitis. Invasive burn cellulitis presents with the burn developing a dark brown, black, or purplish color with discharge and a foul odor. Burn wound cellulitis (choice A) typically involves redness, warmth, and swelling around the burn site. Burn impetigo (choice C) is a superficial infection characterized by honey-colored crusting. Staphylococcal scalded skin syndrome (choice D) is a condition caused by exotoxins from Staphylococcus aureus, leading to widespread skin peeling.
A group of nursing students is reviewing the components of the endocrine system. The students demonstrate understanding of the review when they identify what as the primary function of this system?
- A. Regulation of water balance
- B. Hormonal secretion
- C. Cellular metabolism
- D. Growth stimulation
Correct Answer: B
Rationale: The correct answer is 'Hormonal secretion' (Choice B). The primary function of the endocrine system is to secrete hormones that regulate various bodily functions such as metabolism, growth, and reproduction. Choice A, 'Regulation of water balance,' is primarily controlled by the kidneys and the urinary system, not the endocrine system. Choice C, 'Cellular metabolism,' is more directly related to the functions of individual cells rather than the overall function of the endocrine system. Choice D, 'Growth stimulation,' is a function that can be influenced by hormones secreted by the endocrine system, but it is not the primary function of the system.
A nurse is teaching a class about immunizations to members of a grammar school's Parent-Teachers Association. Which childhood disease is the nurse discussing when explaining that it is a viral disease that starts with malaise and a highly pruritic rash that begins on the abdomen, spreads to the face and proximal extremities, and can result in grave complications?
- A. Rubella
- B. Rubeola
- C. Chickenpox
- D. Scarlet fever
Correct Answer: C
Rationale: The correct answer is C, Chickenpox (varicella). Chickenpox is a viral disease characterized by a highly pruritic rash that typically starts on the abdomen and then spreads to other parts of the body, including the face and proximal extremities. It can lead to complications such as pneumonia and encephalitis. Rubella (German measles) presents with a mild rash and swollen lymph nodes; Rubeola (measles) also presents with a rash but starts on the face before spreading downwards; Scarlet fever is caused by Group A Streptococcus bacteria and is characterized by a rash, fever, and sore throat.
When the working mother of a toddler is preparing to take her child home after a prolonged hospitalization, she asks the nurse what type of behavior she should expect to be displayed. What is the nurse's most appropriate description of her child's probable behavior?
- A. Excessively demanding behavior
- B. Hostile attitude toward the mother
- C. Cheerful, with shallow attachment behaviors
- D. Withdrawn, without emotional ties to the mother
Correct Answer: A
Rationale: After a prolonged hospitalization, a toddler may exhibit excessively demanding behavior as they readjust to being home. This behavior can be a result of the child seeking extra attention and reassurance after a stressful experience. Choices B, C, and D are incorrect because hostility, cheerfulness with shallow attachment, and withdrawal without emotional ties are less likely outcomes in this situation and do not align with common reactions of toddlers after hospitalization.