Nokea
When reinforcing teaching with the parents of a 7-year-old child with attention-deficit/hyperactivity disorder (ADHD) about the child's medication, which statement by the parents indicates an understanding of the medication's side effects?
- A. We should monitor our child's growth and appetite regularly.
- B. The medication may cause drowsiness, so we will give it at bedtime.
- C. We need to give the medication with food to avoid stomach upset.
- D. The medication can cause increased urination, so fluid intake should be limited.
Correct Answer: A
Rationale: The correct answer is A: 'We should monitor our child's growth and appetite regularly.' Correct monitoring of the child's growth and appetite is crucial when a child is on ADHD medications, especially stimulants, as these medications can have side effects related to growth and appetite. Monitoring these parameters regularly helps in assessing the medication's impact and making any necessary adjustments. Choices B, C, and D are incorrect: B talks about drowsiness, C mentions avoiding stomach upset, and D refers to increased urination and limiting fluid intake. While these are potential side effects of medications, they do not directly address the importance of monitoring growth and appetite, which is crucial in children on ADHD medications.
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The nurse is planning for a 5-month-old with gastroesophageal reflux disease whose weight has decreased by 3 ounces since the last clinic visit one month ago. To increase caloric intake and decrease vomiting, what instructions should the nurse provide this mother?
- A. Give small amounts of baby food with each feeding.
- B. Thicken formula with cereal for each feeding.
- C. Dilute the child's formula with equal parts of water.
- D. Offer 10% dextrose in water between most feedings.
Correct Answer: B
Rationale: Thickening formula with cereal is a recommended intervention for infants with gastroesophageal reflux disease (GERD) to help reduce vomiting and increase caloric intake. This modification can help the infant keep the food down better, reducing reflux symptoms while providing adequate nutrition. Giving small amounts of baby food with each feeding (Choice A) is not recommended for a 5-month-old with GERD as it may exacerbate symptoms. Diluting the child's formula with equal parts of water (Choice C) can lead to inadequate nutrition and is not advisable. Offering 10% dextrose in water between most feedings (Choice D) is not appropriate for managing GERD in infants and does not address the underlying issue of reflux.
The nurse is conducting an admission assessment of an 11-month-old infant with CHF who is scheduled for repair of restenosis of coarctation of the aorta that was repaired 4 days after birth. Findings include blood pressure higher in the arms than the lower extremities, pounding brachial pulses, and slightly palpable femoral pulses. What pathophysiologic mechanisms support these findings?
- A. The aortic semilunar valve obstructs blood flow into the systemic circulation
- B. The lumen of the aorta reduces the volume of the blood flow to the lower extremities
- C. The pulmonic valve prevents adequate blood volume into the pulmonary circulation
- D. An opening in the atrial septum causes a murmur due to a turbulent left to right shunt
Correct Answer: B
Rationale: The findings are consistent with coarctation of the aorta, where narrowing of the aorta leads to decreased blood flow to the lower extremities. This results in higher blood pressure in the arms compared to the lower extremities, pounding brachial pulses, and slightly palpable femoral pulses. Choices A, C, and D are incorrect because they do not align with the pathophysiological mechanisms of coarctation of the aorta, which specifically involves narrowing of the aortic lumen reducing blood flow to the lower extremities.
A 9-year-old child with a history of type 1 diabetes is brought to the clinic for a check-up. The nurse notes that the child's hemoglobin A1c is 8.5%. What is the most appropriate action for the nurse to take?
- A. Increase the child's insulin dose
- B. Review the child's dietary habits and insulin administration technique
- C. Discuss the possibility of switching to oral hypoglycemics
- D. Schedule a follow-up appointment in three months
Correct Answer: B
Rationale: A hemoglobin A1c of 8.5% indicates suboptimal diabetes control. The most appropriate action for the nurse in this scenario is to review the child's dietary habits and insulin administration technique. This approach can help identify potential areas for improvement and optimize diabetes management, aiming to lower the hemoglobin A1c levels towards the target range. Increasing the child's insulin dose (Choice A) without addressing dietary habits and administration technique may not lead to better control and can increase the risk of hypoglycemia. Switching to oral hypoglycemics (Choice C) is not appropriate for type 1 diabetes management. Scheduling a follow-up appointment in three months (Choice D) without intervening to improve diabetes control is not the best immediate action.
A 13-year-old client with type 1 diabetes is admitted to the hospital with a blood glucose level of 450 mg/dL. The client is lethargic and has fruity-smelling breath. What is the nurse's priority action?
- A. Administer insulin as prescribed
- B. Start an IV infusion of normal saline
- C. Check the client's urine for ketones
- D. Monitor the client's vital signs
Correct Answer: B
Rationale: The correct priority action for the nurse is to start an IV infusion of normal saline. The client's presentation with lethargy, fruity-smelling breath, and high blood glucose level indicates diabetic ketoacidosis (DKA). IV fluids are essential to correct dehydration and help stabilize the client's condition. Checking for ketones in the urine is important, but fluid replacement takes precedence to address the immediate risk of dehydration and electrolyte imbalances. Administering insulin is also a crucial intervention for DKA, but fluid resuscitation should first be initiated.
The healthcare provider finds a 6-month-old infant unresponsive and calls for help. After opening the airway and finding the infant is still not breathing, which action should the provider take?
- A. Palpate femoral pulse and check for regularity.
- B. Deliver cycles of 30 chest compressions and 2 breaths.
- C. Give two breaths that make the chest rise.
- D. Feel the carotid pulse and check for adequate breathing.
Correct Answer: C
Rationale: In pediatric basic life support, for an unresponsive infant who is not breathing normally, the correct action is to give two breaths that make the chest rise. This helps provide oxygen to the infant's body and is a crucial step in resuscitation efforts for infants in distress. Choices A, B, and D are incorrect. Palpating the femoral pulse or feeling the carotid pulse is not indicated in this scenario where the infant is unresponsive and not breathing. Delivering cycles of chest compressions and breaths is not the immediate action to take; the priority is to provide two breaths to help with oxygenation.