Which snack choice by a school-aged child with gastroesophageal reflux indicates to the nurse that the child understands the dietary restrictions?
- A. Chocolate milkshake
- B. Sugar cookies
- C. Tacos
- D. Pizza
Correct Answer: B
Rationale: Sugar cookies are less likely to trigger GERD symptoms compared to high-fat or acidic foods.
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An adolescent client reports to the nurse of walking with a limp due to pain localized in the right knee which worsens at night but denies any recent injury or trauma. The nurse observes swelling and tenderness in the right lower thigh and imaging results reveal radial ossification in the soft tissues. What condition should the nurse consider as the probable cause of the findings?
- A. Osteosarcoma
- B. Hemosiderosis
- C. Growing pains
- D. Rhabdomyolysis
Correct Answer: A
Rationale: Symptoms and radial ossification suggest osteosarcoma, a common bone tumor in adolescents.
A 10-year-old boy has been seen frequently by the school nurse over the past three weeks after school begins in the fall. He reports headaches, stomach aches, and difficulty sleeping. Which intervention should the nurse implement?
- A. Compare the child's vital signs over the past three weeks.
- B. Counsel the parents to pay more attention to the child.
- C. Ask the boy to describe a typical day at school.
- D. Conduct a complete neurological assessment.
Correct Answer: C
Rationale: Asking the boy to describe a typical day at school helps identify potential stressors or psychosocial factors contributing to his non-specific symptoms.
The nurse is assessing an infant with aortic stenosis and identifies bilateral fine crackles in both lung fields. What additional finding should the nurse expect to observe?
- A. Hypotension and tachycardia
- B. Vigorous feeding and satiation
- C. Fever
- D. Hemiplegia
Correct Answer: A
Rationale: Aortic stenosis can reduce cardiac output, leading to hypotension, with tachycardia as a compensatory response.
The nurse observes a mother administering ferrous sulfate (iron drops) to her 11-month-old child, followed by 2 ounces (60 mL) of orange juice. What should be the nurse's subsequent action?
- A. Advise the mother to follow the iron drops with infant formula instead of orange juice.
- B. Commend the mother on her method of administering the medication.
- C. Propose mixing the iron drops in the orange juice before feeding the infant.
- D. Direct the mother to refrain from feeding the infant for 30 minutes after giving the iron drops.
Correct Answer: B
Rationale: Orange juice's vitamin C enhances iron absorption, making the method appropriate.
The nurse is assessing the growth and development of a 3-year-old child. Which speech and language skills should the nurse identify as normal developmental milestones for this child?
- A. Recognizes most letters and numbers.
- B. Uses 1-word sentences.
- C. Speaks in simple sentences with four or more words.
- D. Uses gestures with 1 to 2-word sentences.
Correct Answer: C
Rationale: Speaking in simple sentences with four or more words is a normal milestone for a 3-year-old.
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