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Which of the following would be most appropriate to institute when a school-age child with burns becomes angry and combative when it is time to change the dressings and apply mafenide acetate (Sulfamylon)?
- A. Ensure parental support during the dressing.
- B. Allow the child to assist in removing the dressings and applying the cream.
- C. Give the child permission to cry during the procedure.
- D. Allow the child to schedule the time for dressing changes.
Correct Answer: B
Rationale: Allowing the child to participate fosters a sense of control, reducing fear and combative behavior. Parental support and crying are helpful but less empowering, and scheduling may disrupt care.
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The primary health care provider orders pulse assessments through the night for a 12-year-old child with rheumatic fever who has a daytime heart rate of 120. The nurse explains to the mother that this is to evaluate if the elevated heart rate is caused by:
- A. The morning digitalis.
- B. Normal activity during waking hours.
- C. A warmer daytime environment.
- D. Normal variations in day and evening hours.
Correct Answer: B
Rationale: Elevated heart rate in rheumatic fever may be due to activity, which increases cardiac demand. Nighttime assessments help determine if the rate normalizes at rest, ruling out activity as the cause.
A 15-year-old has been diagnosed with acute glomerulonephritis and has been in the hospital for 1 day. Which of the following findings requires immediate action?
- A. Large amount of generalized edema.
- B. Urine specific gravity of 1.030.
- C. Large amount of albumin in the urine.
- D. 24-hour output of 1,500 mL.
Correct Answer: A
Rationale: Severe edema could indicate worsening condition.
A parent brings a 4-month-old to the clinic for a regular well visit and expresses concern that the infant is not developing appropriately. Which findings in the infant would indicate the need for further developmental screening?
- A. Has no interest in peek-a-boo games.
- B. Does not turn front to back.
- C. Does not babble.
- D. Continues to have head lag.
Correct Answer: D
Rationale: Head lag at 4 months suggests delayed motor development, requiring further evaluation.
At the 2 week well-child visit a parent states, 'My baby seems to keep his head tilted to the right.' The nurse should further assess the:
- A. Fontanel.
- B. Cervical vertebrae.
- C. Trapezius muscle.
- D. Sternocleidomastoid muscle.
Correct Answer: D
Rationale: Torticollis is commonly caused by tightness or shortening of the sternocleidomastoid muscle, which should be assessed for asymmetry or tightness.
A preschooler with pneumococcal meningitis is receiving intravenous antibiotic therapy. When discontinuing the intravenous therapy, the nurse allows the child to apply a dressing to the area where the needle is removed. The nurse's rationale for doing so is based on the interpretation that a child in this age-group has a need to accomplish which of the following?
- A. Trust those caring for her.
- B. Find diversional activities.
- C. Protect the image of an intact body.
- D. Relieve the anxiety of separation from home.
Correct Answer: C
Rationale: Allowing the child to apply a dressing supports their developmental need to maintain body integrity, reducing anxiety about medical procedures.