Nokea
You are evaluating a 6-year-old male child with Langerhans cell histiocytosis (LCH); the parents state that the most common site of bone involvement is
- A. skull
- B. vertebra
- C. mandible
- D. pelvis
Correct Answer: A
Rationale: Skull is the most common site of bone involvement in LCH.
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The Denver II assesses the development of children from birth to 6 years of age, it includes the following domains EXCEPT
- A. language
- B. intelligence
- C. gross motor
- D. personal-social
Correct Answer: B
Rationale: The Denver II does not specifically assess intelligence.
A nurse is assessing a preterm newborn for the possibility of necrotizing enterocolitis (NEC). Which assessment findings should the nurse expect to find if NEC is confirmed? (Select all that apply.)
- A. Minimal gastric residual
- B. Abdominal distention
- C. Apnea
- D. Urinary output at 2 ml/kg/hr
Correct Answer: B
Rationale: Abdominal distention: NEC is characterized by abdominal distention due to gas and fluid accumulation in the intestines, leading to a bloated appearance of the abdomen.
Which finding would you expect in a 4-week-old with biliary atresia?
- A. Abdominal distention, enlarged liver and spleen, clay-colored stools, and tea-colored urine.
- B. Abdominal distention with bruises and hematuria.
- C. Yellow sclera/skin, oily skin, and prolonged bleeding times.
- D. No manifestations until advanced disease.
Correct Answer: A
Rationale: Biliary atresia typically presents with hepatosplenomegaly, pale stools, and dark urine due to impaired bile excretion.
A nurse is assessing a 5 year old with a history of heart failure. Which finding indicates that the child has adequate cardiac output?
- A. Urine output of 30 mL/h
- B. Heart rate of 120 beats/min
- C. Cap refill time of 10 to 15 sec
- D. Bilateral crackles heard on auscultation.
Correct Answer: A
Rationale: Adequate cardiac output is a measure of how well the heart is able to pump blood effectively to meet the body's metabolic demands. An adequate cardiac output ensures sufficient oxygen and nutrients are delivered to the tissues and organs. One of the most reliable indicators of adequate cardiac output is urine output. A urine output of at least 1 mL/kg/hour, which translates to around 30 mL/hour in a 5-year-old child, indicates adequate perfusion and renal function. In heart failure, decreased cardiac output may lead to decreased renal perfusion, resulting in a decreased urine output, so a stable or increased urine output suggests adequate cardiac output.
Which action by the school nurse is important in the prevention of rheumatic fever?
- A. Encourage routine cholesterol screenings.
- B. Conduct routine blood pressure screenings.
- C. Refer children with sore throats for throat cultures.
- D. Recommend salicylates instead of acetaminophen for minor discomforts.
Correct Answer: C
Rationale: Referring children with sore throats for throat cultures is important in the prevention of rheumatic fever. Rheumatic fever is a complication of untreated streptococcal throat infections, specifically caused by group A Streptococcus bacteria. By identifying and treating streptococcal infections promptly with antibiotics, the risk of developing rheumatic fever is significantly reduced. The school nurse plays a crucial role in recognizing the symptoms of strep throat and ensuring that affected children are appropriately referred for testing and treatment. This can help prevent the serious consequences of rheumatic fever, which can affect the heart, joints, skin, and brain if left untreated. Encouraging routine cholesterol screenings (choice A) and blood pressure screenings (choice B) are important for overall health monitoring but are not directly related to the prevention of rheumatic fever. Recommending salicylates over acetaminophen (choice D) is not advisable in children due to the risk of Reye's syndrome