RN Nursing Care of Children 2019 With NGN

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When should a child receive the first dose of the hepatitis B virus (HBV) vaccine if the mother is hepatitis B surface antigen (HBsAg) negative?

  • A. 2 months of age, before hospital discharge.
  • B. Birth before discharge from the hospital.
  • C. 6 months of age, at the third well-child visit.
  • D. No time (this vaccine is not currently recommended).
Correct Answer: B

Rationale: If the mother is HBsAg negative, it is recommended that the child receives the first dose of the hepatitis B vaccine at birth before discharge from the hospital. This is to provide early protection against the hepatitis B virus. The second dose of the vaccine is typically given at the first well-child visit, and the third dose is usually administered at a later date. The Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention and the Committee on Infectious Diseases of the American Academy of Pediatrics govern the recommendations for immunization, including the hepatitis B virus vaccine. Choice A is incorrect as the first dose should ideally be given at birth. Choice C is incorrect as waiting until 6 months of age may leave the child vulnerable to infection during the early months of life. Choice D is incorrect as the hepatitis B vaccine is recommended for all newborns, especially if the mother is HBsAg negative, to prevent transmission of the virus.

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What measure of fluid balance status is most useful in a child with acute glomerulonephritis?

  • A. Proteinuria
  • B. Daily weight
  • C. Specific gravity
  • D. Intake and output
Correct Answer: B

Rationale: Daily weight is the most accurate measure of fluid balance in children with acute glomerulonephritis, as it reflects changes in body fluid status more reliably than other measures like proteinuria or specific gravity.

What is an important consideration in understanding the reactions of parents when their infant is born with physical defects?

  • A. Grief lasts until the defects are repaired.
  • B. Denial is a common adaptive reaction.
  • C. The psychologic reaction is similar to that with the death of an infant.
  • D. Reactions of health professionals to the birth of an infant can affect parents' reactions.
Correct Answer: C

Rationale: When a parent's infant is born with physical defects, understanding the psychological reactions is crucial. The reaction is often similar to the grief experienced when facing the death of a child. Parents need to grieve for the loss of the expected child and adapt to the needs of a child with physical defects. The grief process typically involves stages like shock, frustration, and anger, which can last for years. Denial during the shock phase is not maladaptive but can help parents cope initially. Additionally, parents are sensitive to the behavior of health professionals, whose interactions can significantly influence the parents' reactions to the infant. Therefore, recognizing the similarity of the psychological reaction to grief is an important consideration in understanding how parents cope with their infant's physical defects.

A child is admitted in acute renal failure (ARF). Therapeutic management to rapidly provoke a flow of urine includes the administration of what medication?

  • A. Propranolol (Inderal)
  • B. Calcium gluconate
  • C. Mannitol (Osmitrol) or furosemide (Lasix)
  • D. Sodium, chloride, and potassium
Correct Answer: C

Rationale: Mannitol and furosemide are diuretics commonly used to induce diuresis in acute renal failure, helping to provoke urine flow and manage fluid overload. Calcium gluconate and electrolyte supplementation are used for other specific conditions and not primarily for diuresis.

According to Erikson's developmental theory, toddlers need to be encouraged to become independent to successfully complete which developmental challenge?

  • A. Trust vs. mistrust
  • B. Industry vs. inferiority
  • C. Autonomy vs. shame and doubt
  • D. Initiative vs. guilt
Correct Answer: C

Rationale: The correct answer is C: Autonomy vs. shame and doubt. Erikson's developmental stage for toddlers focuses on the conflict between developing a sense of independence (autonomy) and feelings of inadequacy (shame and doubt). Encouraging toddlers to explore their environment and make choices helps them build self-confidence and independence. Choices A, B, and D are incorrect because trust vs. mistrust relates to infancy, industry vs. inferiority is associated with school-age children, and initiative vs. guilt is linked to preschoolers.

The nurse is educating a new nurse on the identification of pain in children. What does the nurse teach about physiologic measurements in children's pain assessment?

  • A. Not useful as the only indicator for pain
  • B. Best indicator of pain in children of all ages
  • C. Most valuable when children also report having pain
  • D. Essential to determine whether a child is telling the truth about pain
Correct Answer: A

Rationale: Physiologic manifestations of pain may vary considerably, so they do not provide a consistent measure of pain. Heart rate may increase or decrease. The same signs that may suggest fear, anxiety, or anger also indicate pain. In chronic pain, the body adapts, and these signs decrease or stabilize. Physiologic measurements are of limited value and must be viewed in the context of a pain rating scale, behavioral assessment, and parental report. When the child reports pain on an appropriate pain scale, the appropriate interventions should be used. Therefore, physiologic measurements are not considered a reliable standalone indicator for pain in children, making choice A the correct answer. Choice B is incorrect because physiologic measurements alone do not serve as the best indicator of pain. Choice C is incorrect as physiologic measurements are still limited even when children report pain. Choice D is incorrect as physiologic measurements are not primarily used to determine the truthfulness of a child's pain report.

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