Nokea
The mother tells the nurse that her 8-year-old child is continually telling jokes and riddles to the point of driving the other family members crazy. The nurse should explain this behavior is a sign of?
- A. Inadequate parental attention.
- B. Mastery of language ambiguities.
- C. Inappropriate peer influence.
- D. Excessive television watching.
Correct Answer: B
Rationale: Telling jokes and riddles reflects cognitive development and understanding of language nuances.
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The parents of a child tell the nurse that they feel guilty because their child almost drowned. Which of the following remarks by the nurse would be most appropriate?
- A. I can understand why you feel guilty, but these things happen.'
- B. Tell me a little bit more about your feelings of guilt.'
- C. You should not have taken your eyes off of your child.'
- D. You really shouldn't feel guilty; you're lucky because your child will be all right.'
Correct Answer: B
Rationale: Encouraging parents to express their feelings facilitates therapeutic communication and supports emotional processing.
The nurse teaches the parents of an infant with developmental dysplasia of the hip how to handle their child in a Pavlik harness. Which of the following is most appropriate?
- A. Fitting the diaper under the straps.
- B. Leaving the harness off while the infant sleeps.
- C. Checking for skin redness under straps every other day.
- D. Putting powder on the skin under the straps every day.
Correct Answer: A
Rationale: Fitting the diaper under the straps ensures hygiene without disrupting the harness's corrective positioning.
The nurse is assessing a 9-year-old child who has third-degree burns as shown below. Using the 'Rule of Nines' adapted for children, the nurse estimates that the extent of burns for this child is:
- A. 9%.
- B. 14%.
- C. 18%.
- D. 24%.
Correct Answer: C
Rationale: In children, the Rule of Nines assigns 18% to each arm (including forearm and hand). A third-degree burn on one forearm approximates 18%, assuming the burn covers the entire forearm as implied.
A nurse is planning a diet for a client with cystic fibrosis. Which of the following foods should not be included in the meal plan?
- A. Roasted chicken.
- B. Fried scallops.
- C. Milk shake.
- D. Egg omelet.
Correct Answer: B
Rationale: Fried scallops are high in fat and difficult to digest for a client with cystic fibrosis due to pancreatic insufficiency. A high-calorie, high-protein diet with moderate fat and pancreatic enzyme supplements is more appropriate.
Which sign should lead the nurse to suspect that a child with meningitis has developed disseminated intravascular coagulation?
- A. Hemorrhagic skin rash.
- B. Edema.
- C. Cyanosis.
- D. Dyspnea on exertion.
Correct Answer: A
Rationale: A hemorrhagic rash, such as petechiae or purpura, is a hallmark of disseminated intravascular coagulation in meningitis, indicating clotting abnormalities.