Usual indications for an exchange transfusion in a child with sickle cell disease include:
- A. Painful vaso-occlusive crisis
- B. Splenic sequestration crisis
- C. Acute chest syndrome
- D. Dactylitis
Correct Answer: C
Rationale: Acute chest syndrome, a severe complication of sickle cell disease, often requires exchange transfusion to reduce the proportion of sickle hemoglobin and improve oxygenation.
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Which is the most appropriate nursing action related to the administration of digoxin (Lanoxin) to an infant?
- A. Counting the apical rate for 30 seconds before administering the medication
- B. Withholding a dose if the apical heart rate is less than 100 beats/min
- C. Repeating a dose if the child vomits within 30 minutes of the previous dose
- D. Checking respiratory rate and blood pressure before each dose
Correct Answer: B
Rationale: As a rule, if the pulse rate of an infant is below 100 beats/min, the medication is withheld and the physician is notified.
The nurse is teaching a client with glomerulonephritis about self-care. Which dietary recommendations should the nurse encourage the client to follow?
- A. Increase intake of high-fiber foods, such as bran cereal
- B. Restrict protein intake by limiting meats and other high-protein foods
- C. Limit oral fluid intake to 500 ml per day
- D. Increase intake of potassium-rich foods such as bananas or cantaloupe
Correct Answer: B
Rationale: Reducing protein intake helps decrease the workload on the kidneys, which is beneficial in glomerulonephritis.
The most common cause of bacterial meningitis in children under 5 years is:
- A. Neisseria meningitidis
- B. Haemophilus influenzae
- C. Streptococcus pneumoniae
- D. Listeria monocytogenes
Correct Answer: C
Rationale: Streptococcus pneumoniae is the leading cause of bacterial meningitis in children under 5 years, especially in those who are not immunized.
During a routine well child exam on a 5-year-old child, a grade II/VI, harsh, late systolic ejection murmur at the upper left sternal border that transmits to both lung fields is auscultated. The child has normal growth and development. What will the nurse practitioner suspect?
- A. Aortic stenosis (AS)
- B. Patent ductus arteriosus (PDA)
- C. Pulmonic stenosis
- D. Tricuspid atresia
Correct Answer: C
Rationale: Pulmonic stenosis may be asymptomatic with a murmur as described above.
HLA B27 positivity is least common in
- A. Ankylosing spondylosis
- B. Juvenile psoriatic arthritis
- C. Inflammatory bowel disease
- D. Reactive arthritis
Correct Answer: C
Rationale: HLA B27 positivity is least common in inflammatory bowel disease compared to the other conditions listed.
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