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The nurse is caring for a preschool age child who just received chemotherapy. The child's mother asks the nurse when it is safe for the child to attend his cousin's birthday party. Which is the correct response:
- A. The best time to attend the party is 7 to 10 days from now.
- B. Any time is a good time, especially if it makes him happy.
- C. About three weeks from today would be the safest time for him to attend a party.
- D. He may need to wait until he's completely finished with chemotherapy.
Correct Answer: C
Rationale: The correct response is C: About three weeks from today would be the safest time for him to attend a party. This answer is correct because chemotherapy can weaken the child's immune system, making him more susceptible to infections. Attending a party with a large number of people increases the risk of exposure to germs. Waiting for about three weeks allows the child's immune system to recover to a safer level before being exposed to a potentially infectious environment.
Choice A is incorrect because 7 to 10 days may not provide enough time for the child's immune system to recover adequately. Choice B is incorrect as it disregards the child's health and safety by prioritizing immediate happiness over well-being. Choice D is incorrect as it may be too restrictive; attending a party may be possible before completing chemotherapy if the child's immune system has recovered sufficiently.
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Your patient has just returned from the OR following an arterial septal defect repair. You are reviewing your orders and question the fluid rate ordered. Your patient is 6 years old and weighs 50 pounds. Select the appropriate hourly maintenance fluid rate for your patient.
- A. 63 ml/hr
- B. 64 ml/hr
- C. 65 ml/hr
- D. 107 ml/hr
Correct Answer: A
Rationale: The appropriate hourly maintenance fluid rate for a 6-year-old patient weighing 50 pounds can be calculated using the Holliday-Segar method, which recommends 100 ml/kg/day for the first 10 kg of body weight, 50 ml/kg/day for the next 10 kg, and 20 ml/kg/day for each additional kg. Converting the patient's weight from pounds to kg (50 lbs / 2.2 = 22.73 kg), the calculation would be:
100 ml x 10 kg + 50 ml x 10 kg + 20 ml x 2.73 kg = 1000 ml + 500 ml + 54.6 ml = 1554.6 ml/day
To convert this to an hourly rate, divide by 24 hours: 1554.6 ml/day / 24 hours = 64.775 ml/hr, which rounds down to 63 ml/hr (Option A).
The other choices are incorrect because
While caring for a hospitalized child, which of the following signs would lead the nurse to suspect the child has diabetes insipidus?
- A. Increased urination
- B. Fruity breath
- C. Weight gain
- D. Slurred speech
Correct Answer: A
Rationale: The correct answer is A: Increased urination. Diabetes insipidus is characterized by excessive urination (polyuria) due to the inability of the kidneys to concentrate urine. This leads to a large volume of dilute urine being produced. The other options are not indicative of diabetes insipidus. Fruity breath (B) is a sign of diabetic ketoacidosis, not diabetes insipidus. Weight gain (C) is not a typical symptom of diabetes insipidus, as patients may even experience weight loss due to dehydration. Slurred speech (D) is not directly related to diabetes insipidus.
A 15-year-old with type 1 diabetes mellitus presents with a fever and 48-hour history of vomiting. As the nurse, you note the child's breath has a fruity odour, his breathing is deep and rapid, and mom states he has become less arousable. You recognize these are the signs of:
- A. Acute Hypoglycemia
- B. Diabetic Ketoacidosis
- C. Hyperglycemia
- D. Polydipsia
Correct Answer: B
Rationale: The correct answer is B: Diabetic Ketoacidosis (DKA). The fruity odor of breath, deep and rapid breathing (Kussmaul breathing), and altered mental status are classic signs of DKA. In DKA, the body produces excess ketones due to lack of insulin, leading to metabolic acidosis. Acute Hypoglycemia (A) presents with low blood sugar levels, not high as in DKA. Hyperglycemia (C) is a general term for high blood sugar without the specific ketone production seen in DKA. Polydipsia (D) refers to excessive thirst, not the symptoms described in the scenario.
A nurse is instructing a school-age child who has asthma about the use of a peak expiratory flow meter. Which of the following instructions should the nurse include?
- A. Place tongue on the mouthpiece of the meter.
- B. Maintain a semi-Fowler's position during testing.
- C. Record the average of the readings.
- D. Blow into the meter as hard and quickly as possible.
Correct Answer: D
Rationale: The correct answer is D: Blow into the meter as hard and quickly as possible. This instruction is correct because when using a peak expiratory flow meter, the individual needs to blow out as forcefully as possible to get an accurate reading of their peak expiratory flow rate. This helps in assessing the severity of asthma symptoms and monitoring the effectiveness of treatment.
A: Placing the tongue on the mouthpiece is incorrect as it may interfere with the airflow and affect the accuracy of the reading.
B: Maintaining a semi-Fowler's position is not necessary for using a peak flow meter.
C: Recording the average of the readings is not typically done with peak flow meters as the focus is on the individual's peak expiratory flow rate.
E, F, G: No other choices were provided.
In summary, blowing into the meter as hard and quickly as possible is the correct instruction for using a peak expiratory flow meter, as it ensures an accurate measurement of peak expir
A nurse is caring for a school-age child who is 2 hr postoperative following a cardiac catheterization. The nurse observes blood on the child's dressing. Which of the following actions should the nurse take?
- A. Apply intermittent pressure 2.5 cm (1 in) below the percutaneous skin site.
- B. Apply continuous pressure 2.5 cm (1 in) above the percutaneous skin site.
- C. Apply continuous pressure 2.5 cm (1 in) below the percutaneous skin site.
- D. Apply intermittent pressure 2.5 cm (1 in) above the percutaneous skin site.
Correct Answer: C
Rationale: Correct Answer: C
Rationale: Applying continuous pressure 2.5 cm below the percutaneous skin site will help control bleeding by promoting clot formation at the catheter insertion site. This pressure point is closer to the source of bleeding, ensuring better hemostasis and preventing further complications.
Summary:
A: Applying intermittent pressure below the site is incorrect as continuous pressure is more effective in achieving hemostasis.
B: Applying continuous pressure above the site is incorrect as it does not target the bleeding source directly.
D: Applying intermittent pressure above the site is incorrect as continuous pressure is preferred for controlling bleeding.
E, F, G: No information provided.