Nokea
Which age group should the pediatric nurse recognize as being vulnerable to events that lessen their feeling of control and power?
- A. Infants
- B. Toddlers
- C. Preschoolers
- D. School-age children
Correct Answer: A
Rationale: Infants are the age group that the pediatric nurse should recognize as being vulnerable to events that lessen their feeling of control and power. Infants are entirely dependent on others for their care and are still developing their sense of self and autonomy. They are unable to communicate their needs effectively and rely on caregivers to interpret and respond to their cues. Any disruptions in routine or changes in their environment can make infants feel insecure and powerless. Therefore, the pediatric nurse should be particularly attentive to the emotional needs and sense of control of infants when providing care.
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You are discussing the risk of radiotherapy with the parents of a child with medulloblastoma; the mother has a concern about the late neurological complications post radiotherapy. The statement that should be included in the discussion that late neurological sequelae post radiotherapy is more severe with
- A. focal radiotherapy rather than craniospinal irradiation
- B. children with an age of less than 3 year
- C. concomitant chemo-radiotherapy
- D. low grade tumors rather than high grade tumors
Correct Answer: B
Rationale: Younger children (<3 years) are more susceptible to long-term neurotoxic effects of radiotherapy.
A Jewish client has been diagnosed with ulcerative colitis. A nursing diagnosis appropriate for a client who has ulcerative colitis is:
- A. abdominal pain related to decreased peristalsis
- B. diarrhea related to hyperosmolar intestinal contents
- C. fluid volume excess related to increase water absorption by intestinal mucosa
- D. activity intolerance related to fatigue
Correct Answer: A
Rationale: Among the given choices, the nursing diagnosis appropriate for a client with ulcerative colitis is "abdominal pain related to decreased peristalsis." Ulcerative colitis is a chronic inflammatory bowel disease that directly affects the lining of the colon and rectum, leading to symptoms such as abdominal pain, diarrhea, and bloody stool. Decreased peristalsis occurs in patients with ulcerative colitis, resulting in abdominal pain due to inflammation and irritation of the intestines. This pain is a common symptom experienced by individuals with ulcerative colitis and can significantly impact their quality of life. Therefore, addressing the client's abdominal pain is crucial in providing effective nursing care for someone diagnosed with ulcerative colitis.
The nurse encourages a client with an immunologic disorder to eat a nutritionally balanced diet to promote optimal immunologic function. Autoimmunity has been linked to excessive ingestion of:
- A. Protein
- B. Vitamin A
- C. Fat
- D. Zinc
Correct Answer: C
Rationale: Excessive ingestion of fat has been linked to autoimmunity. A diet high in saturated and trans fats can lead to chronic inflammation and disrupt the balance of immune cells, potentially triggering autoimmune responses in the body. Conversely, a nutritionally balanced diet that includes healthy fats like omega-3 fatty acids from sources such as fish, nuts, and seeds can help support optimal immunologic function and reduce the risk of autoimmune disorders.
A nurse is assessing a preterm newborn. Which assessment findings are consistent with prematurity? (Select all that apply.)
- A. Abundant lanugo over the body
- B. Ear cartilage soft and pliable
- C. Flexed body posture
- D. Deep creases on the sole of the foot
Correct Answer: A
Rationale: Abundant lanugo over the body: Premature newborns often have abundant lanugo, which is fine, soft hair covering their bodies. This is a common characteristic of prematurity as the baby has not had enough time to shed this hair before birth.
For a 14-month-old whose cleft palate was repaired 12 hours ago, which should be included in the plan of care?
- A. Allow familiar comfort items (e.g., favorite stuffed animal) and a 'sippy' cup (avoid suction items).
- B. Once liquids are tolerated, encourage a bland diet (e.g., soup, Jell-O, saltine crackers).
- C. Administer scheduled pain medication rather than PRN only.
- D. Use a Yankauer suction catheter to decrease aspiration risk.
Correct Answer: A
Rationale: Providing comfort items and avoiding suction items helps reduce distress and supports healing.