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The nurse is caring for a child with sickle cell disease who is experiencing a sickle cell crisis. Which finding should the nurse report to the healthcare provider immediately?
- A. Swelling in the hands or feet.
- B. Ulcers on the legs.
- C. Chest pain.
- D. Jaundice.
Correct Answer: C
Rationale: Chest pain may indicate acute chest syndrome, a life-threatening complication requiring immediate reporting.
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The parent of an infant asks when the baby's first immunization for measles, mumps, and rubella (MMR) should be given. Which age should the nurse provide the parent?
- A. 6 months.
- B. 12 months.
- C. 24 months.
- D. 2 months.
Correct Answer: B
Rationale: The CDC recommends the first MMR dose at 12-15 months of age.
The nurse is assessing the growth and development of a 3-year-old child. Which speech and language skills should the nurse identify as normal developmental milestones for this child?
- A. Speaks in simple sentences with four or more words.
- B. Recognizes most letters and numbers.
- C. Uses gestures with 1-to-2-word sentences.
- D. Uses 1-word sentences.
Correct Answer: A
Rationale: Speaking in simple sentences with four or more words is a normal milestone for a 3-year-old.
A child receives a prescription for loratadine 5 mg by mouth once day. The bottle is labelled 'Loratadine for Oral Suspension, USP 5 mg per 5 mL.' How many teaspoons should the nurse instruct the parent to administer with each dose?
- A. 1 teaspoon
Correct Answer: A
Rationale: 5 mg of loratadine corresponds to 5 mL (1 teaspoon) of the suspension, as per the concentration provided.
Which snack selected by a school-aged child with gastroesophageal reflux indicates to the nurse that the child understands the dietary restrictions?
- A. Sugar cookies.
- B. Pizza.
- C. Tacos.
- D. Chocolate milkshake.
Correct Answer: A
Rationale: Sugar cookies are low-fat and low-sugar, suitable for gastroesophageal reflux, unlike high-fat or acidic options.
When developing a teaching plan for an adolescent male who was recently diagnosed with Type 1 diabetes mellitus, the nurse should instruct the client to eat a source of sugar if which symptom occurs?
- A. Racing pulse.
- B. Profuse perspiration.
- C. Excessive thirst.
- D. Seeing spots.
Correct Answer: B
Rationale: Profuse perspiration is a symptom of hypoglycemia, requiring immediate sugar intake to raise blood glucose levels.