Review ATI Paediatrics Exam 2

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ATI Paediatrics Exam 2

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Total Questions : 66

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Question 1:

A nurse is caring for an 18-month-old toddler in the emergency department. The nurse reviews the toddler's medical record and assessment findings. Which of the following provider prescriptions should the nurse anticipate?

A. acetaminophen suppository. B. oral rehydration solution. C. nebulized albuterol. D. intravenous antibiotics.

Answer and Explanation

Choice A:

Acetaminophen suppository is not a likely prescription, as it is used to reduce fever and pain, which are not the main problems of the toddler. The toddler has a high axillary temperature of 39.5°C (103.1°F), which is not considered a fever in children under 2 years old. The normal axillary temperature range for children is 36.5°C to 37.5°C (97.7°F to 99.5°F).

Choice B:

Oral rehydration solution is not a probable prescription, as it is used to prevent or treat dehydration caused by diarrhea, vomiting, or excessive sweating, which are not the main problems of the toddler. The toddler has a normal respiratory rate of 22/min and oxygen saturation of 98%, which indicate adequate hydration and oxygenation.

Choice C:

Nebulized albuterol is a possible prescription, as it is used to treat bronchospasm, which is a common complication of respiratory infections in children. The toddler has a high apical heart rate of 142/min, which may indicate respiratory distress or hypoxia. The toddler is also pulling at his ear, which may indicate an ear infection or pain.

Choice D:

Intravenous antibiotics are not a likely prescription, as they are used to treat bacterial infections, which are not the main problems of the toddler. The toddler has no signs or symptoms of a bacterial infection, such as purulent discharge, foul odor, or localized inflammation. The toddler may have a viral infection, which does not respond to antibiotics.

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Question 2:

A. intravenous immunoglobulin. B. oral acyclovir. C. intramuscular penicillin. D. topical hydrocortisone.

Answer and Explanation

Choice A:

Intravenous immunoglobulin is a likely prescription, as it is used to treat Kawasaki disease, which is a rare but serious condition that causes inflammation of the blood vessels in children. The toddler has many signs and symptoms of Kawasaki disease, such as high fever, irritability, red eyes, dry lips, strawberry tongue, swollen hands and feet, rash, and enlarged lymph node. Intravenous immunoglobulin can reduce the risk of complications, such as coronary artery aneurysms, which can be life-threatening.

Choice B:

Oral acyclovir is not a probable prescription, as it is used to treat viral infections, such as herpes simplex or varicella zoster, which are not the main problems of the toddler. The toddler has no evidence of a viral infection, such as blisters, vesicles, or crusts.

Choice C:

Intramuscular penicillin is not a likely prescription, as it is used to treat bacterial infections, such as streptococcal pharyngitis or syphilis, which are not the main problems of the toddler. The toddler has no signs of a bacterial infection, such as purulent discharge, foul odor, or localized inflammation.

Choice D:

Topical hydrocortisone is not a helpful prescription, as it is used to treat skin conditions, such as eczema or dermatitis, which are not the main problems of the toddler. The toddler has a rash that is caused by the inflammation of the blood vessels, not by an allergic or irritant reaction. Topical hydrocortisone may also worsen the rash or cause skin thinning or infection.

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Question 3:

A nurse is caring for a 3-year-old child who has had 160 mL of urine output over the past 8 hr period. The child weighs 33 lb. Which of the following actions should the nurse take?

A. Continue to monitor the client. B. Perform a bladder scan at the bedside. C. Provide oral rehydration fluids. D. Notify the provider.

Answer and Explanation

Choice A:

Continuing to monitor the client is not the best action, as it does not address the low urine output of the child. The child has a urine output of 20 mL/hr, which is below the expected range of 30 to 40 mL/hr for a 3-year-old child. Low urine output can indicate dehydration, kidney injury, or urinary tract obstruction, which require prompt intervention.

Choice B:

Performing a bladder scan at the bedside is not the most appropriate action, as it is not the first-line diagnostic tool for low urine output. A bladder scan is a noninvasive ultrasound device that measures the amount of urine in the bladder. It can help detect urinary retention, which is the inability to empty the bladder completely. However, urinary retention is unlikely in a 3-year-old child, and a bladder scan may not be accurate or reliable in children.

Choice C:

Providing oral rehydration fluids is the best action, as it can help restore the fluid and electrolyte balance of the child. Oral rehydration fluids are solutions that contain water, sugar, and salt in specific proportions that match the body's needs. They can prevent or treat dehydration, which is a common cause of low urine output in children. The nurse should offer the child oral rehydration fluids every 15 to 20 minutes, and monitor the urine output, vital signs, and hydration status.

Choice D:

Notifying the provider is not the first action, as it is not the most urgent or effective intervention for low urine output. The nurse should notify the provider after providing oral rehydration fluids and assessing the child's response. The nurse should also report any signs or symptoms of dehydration, such as dry mucous membranes, sunken eyes, poor skin turgor, or lethargy. The provider may order further tests or treatments, such as blood tests, urine tests, or intravenous fluids.

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Question 4:

A nurse is providing teaching to a parent of a child who has celiac disease. The nurse should include which of the following food choices for this child?

A. Rice. B. Rye. C. Wheat. D. Barley.

Answer and Explanation

Choice A:

Rice is a suitable food choice for a child who has celiac disease, as it is a gluten-free grain that does not cause inflammation or damage to the small intestine. Rice can provide carbohydrates, fiber, and vitamins for the child's nutrition.

Choice B:

Rye is not a good food choice for a child who has celiac disease, as it is a gluten-containing grain that can trigger an immune response and harm the small intestine. Rye can cause symptoms such as diarrhea, abdominal pain, bloating, and weight loss in the child.

Choice C:

Wheat is not a good food choice for a child who has celiac disease, as it is a gluten-containing grain that can trigger an immune response and harm the small intestine. Wheat can cause symptoms such as diarrhea, abdominal pain, bloating, and weight loss in the child.

Choice D:

Barley is not a good food choice for a child who has celiac disease, as it is a gluten-containing grain that can trigger an immune response and harm the small intestine. Barley can cause symptoms such as diarrhea, abdominal pain, bloating, and weight loss in the child.

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Question 5:

A nurse is planning care for an infant who has spina bifida and is to undergo surgical closure of the myelomeningocele sac. Which of the following interventions should the nurse include in the plan of care?

A. Maintain the infant in the supine position. B. Limit visitors to immediate family members. C. Initiate contact precautions. D. Provide a latex-free environment.

Answer and Explanation

Choice A:

Maintaining the infant in the supine position is not an appropriate intervention, as it can increase the pressure on the myelomeningocele sac and cause further damage to the spinal cord. The nurse should position the infant prone or side-lying, with the head turned to one side and the hips flexed.

Choice B:

Limiting visitors to immediate family members is not a necessary intervention, as the infant does not have an infectious condition that requires isolation. The nurse should encourage the parents and other family members to visit and bond with the infant, and provide emotional support and education.

Choice C:

Initiating contact precautions is not a required intervention, as the infant does not have a contagious condition that poses a risk of transmission to others. The nurse should follow standard precautions, such as washing hands, wearing gloves, and disposing of contaminated materials properly.

Choice D:

Providing a latex-free environment is an essential intervention, as the infant has a high risk of developing a latex allergy due to the frequent exposure to latex products during surgery and other procedures. The nurse should avoid using latex gloves, catheters, syringes, bandages, or other items that contain latex, and use alternative materials instead. The nurse should also label the infant's chart, crib, and door with a latex allergy alert.

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Question 6:

The nurse is caring for a 4-month-old infant in the emergency department. The nurse reviews the infant's medical record and assessment findings. Which of the following conditions should the nurse suspect, and what actions should the nurse take to address that condition, and what parameters should the nurse monitor to assess the infant's progress?

The nurse should suspect that the infant has

A. meningitis. B. hydrocephalus. C. intracranial hemorrhage. D. sepsis.

Answer and Explanation

Choice A:

Meningitis is a possible condition, as it is an inflammation of the membranes that cover the brain and spinal cord. It can be caused by various microorganisms, such as bacteria, viruses, or fungi. The infant has many signs and symptoms of meningitis, such as fever, irritability, lethargy, bulging fontanel, and clear cerebrospinal fluid from the lumbar puncture.

Choice B:

Hydrocephalus is not a likely condition, as it is an accumulation of cerebrospinal fluid in the brain, which causes increased intracranial pressure and enlargement of the head. The infant has a bulging fontanel, which can indicate increased intracranial pressure, but not necessarily hydrocephalus. The infant does not have other signs of hydrocephalus, such as a rapidly increasing head circumference, prominent scalp veins, or sunset eyes.

Choice C:

Intracranial hemorrhage is not a probable condition, as it is a bleeding within the skull, which can result from trauma, vascular malformation, or coagulation disorder. The infant has retinal hemorrhages, which can indicate intracranial hemorrhage, but not necessarily. The infant does not have other signs of intracranial hemorrhage, such as seizures, vomiting, or altered mental status.

Choice D:

Sepsis is not a definite condition, as it is a systemic inflammatory response to an infection, which can cause organ dysfunction and shock. The infant has a fever, which can indicate sepsis, but not necessarily. The infant does not have other signs of sepsis, such as tachycardia, tachypnea, hypotension, or poor perfusion.

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Question 7:

A. failure to thrive. B. microcephaly. C. hydrocephalus. D. macrocephaly.

Answer and Explanation

Choice A:

Failure to thrive is not a likely condition, as it is a term used to describe inadequate growth or weight gain in children. The infant has a low weight percentile, but not below the 5th percentile, which is the usual cutoff for failure to thrive. The infant's length and head circumference are within the normal range, which also does not indicate failure to thrive.

Choice B:

Microcephaly is not a probable condition, as it is a condition where the head size is much smaller than normal for the age and sex of the child. The infant has a high head circumference percentile, which is the opposite of microcephaly. Microcephaly can be caused by genetic disorders, infections, or brain damage.

Choice C:

Hydrocephalus is a possible condition, as it is a condition where excess cerebrospinal fluid accumulates in the brain, causing increased pressure and enlargement of the head. The infant has a high head circumference percentile, which can indicate hydrocephalus. The infant also has a low weight percentile, which can be a result of poor feeding or vomiting due to increased intracranial pressure. T

Choice D:

Macrocephaly is not a definite condition, as it is a term used to describe a head size that is much larger than normal for the age and sex of the child. The infant has a high head circumference percentile, but not above the 97th percentile, which is the usual cutoff for macrocephaly. Macrocephaly can be caused by genetic factors, benign familial macrocephaly, or other conditions, such as hydrocephalus.

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Question 8:

A nurse on a pediatric unit is preparing to admit a preschooler after receiving a transfer report from a nurse in the emergency department. Which of the following findings should the nurse report to the provider immediately?

A. The child has not had a bowel movement for 5 days. B. The child is crying and clinging to the guardian. C. The child has a temperature of 38.8°C (101.9°F) tympanic. D. The insertion site of the central line catheter is erythematous with a scant amount of purulent drainage.

Answer and Explanation

Choice A:

The child has acute lymphoblastic leukemia (ALL) and is receiving chemotherapy and steroids, which can cause constipation. The nurse should monitor the child's bowel function and provide interventions such as fluids, fiber, and laxatives as prescribed, but this is not an urgent finding.

Choice B:

The child is in the induction phase of treatment for ALL, which can be stressful and frightening for the child and the family. The child's crying and clinging behavior indicates anxiety and fear, which are normal reactions. The nurse should provide emotional support and education to the child and the guardian, but this is not an urgent finding.

Choice C:

The child has a fever, which is a common side effect of chemotherapy and steroids. The nurse should assess the child for other signs of infection, administer antipyretics as prescribed, and monitor the child's vital signs, but this is not an urgent finding.

Choice D:

The child has a double-lumen central line catheter in the left chest wall, which is a potential source of infection. The erythema and purulent drainage at the insertion site indicate that the child has a local infection, which can spread to the bloodstream and cause sepsis. This is a life-threatening complication that requires immediate attention and treatment. The nurse should report this finding to the provider, obtain blood cultures, and administer antibiotics as prescribed.

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Question 9:

A nurse is caring for a 7-year-old child who has a fever, tachycardia, and low oxygen saturation. The nurse reviews the child's laboratory results and notes the following:

- WBC count 15,000/mm^3^ (normal range: 5,000 to 10,000/mm^3^)
- Hgb 8 g/dL (normal range: 10 to 15.5 g/dL)
- Hct 32% (normal range: 32% to 44%)

The nurse should suspect that the child has which of the following conditions?

A. Leukemia. B. Sickle cell anemia. C. Hemophilia. D. Iron deficiency anemia.

Answer and Explanation

Choice A:

Leukemia is not a probable condition, as it is a cancer of the white blood cells that causes abnormal proliferation and accumulation of immature or dysfunctional white blood cells. The child has a high WBC count, which can indicate leukemia, but not necessarily. The child does not have other signs of leukemia, such as bleeding, bruising, bone pain, or lymphadenopathy.

Choice B:

Sickle cell anemia is a possible condition, as it is an inherited disorder that affects the shape and function of the red blood cells, causing them to become sickle-shaped and rigid. The child has a low Hgb and Hct, which can indicate anemia, and a fever, tachycardia, and low oxygen saturation, which can indicate a sickle cell crisis. A sickle cell crisis is a condition where the sickle-shaped red blood cells block the blood flow and cause tissue ischemia and inflammation.

Choice C:

Hemophilia is not a likely condition, as it is an inherited disorder that affects the clotting factors, causing impaired blood clotting and increased risk of bleeding. The child has a low Hgb and Hct, which can indicate anemia, but not necessarily hemophilia. The child does not have other signs of hemophilia, such as bleeding, bruising, hemarthrosis, or hematuria.

Choice D:

Iron deficiency anemia is not a definite condition, as it is a type of anemia that occurs when the body does not have enough iron to produce hemoglobin, the protein that carries oxygen in the blood. The child has a low Hgb and Hct, which can indicate iron deficiency anemia, but not necessarily. The child does not have other signs of iron deficiency anemia, such as pallor, fatigue, weakness, or pica.

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Question 10:

A nurse is administering vaccines at a county health immunization clinic. Which of the following clients should the nurse plan to administer the meningococcal conjugate (MCV4) vaccine?

A. A 2-year-old toddler. B. A 4-month-old infant. C. An 11-year-old school-age child. D. A 4-year-old child.

Answer and Explanation

Choice A:

A 2-year-old toddler is not a recommended recipient of the MCV4 vaccine, as it is not routinely given to children younger than 11 years old, unless they have certain medical conditions that increase their risk of meningococcal disease, such as asplenia, complement deficiency, or HIV infection. A 2-year-old toddler may receive the meningococcal polysaccharide (MPSV4) vaccine instead, if indicated.

Choice B:

A 4-month-old infant is not a recommended recipient of the MCV4 vaccine, as it is not routinely given to children younger than 11 years old, unless they have certain medical conditions that increase their risk of meningococcal disease, such as asplenia, complement deficiency, or HIV infection. A 4-month-old infant may receive the meningococcal serogroup B (MenB) vaccine instead, if indicated.

Choice C:

An 11-year-old school-age child is a recommended recipient of the MCV4 vaccine, as it is routinely given to children aged 11 to 12 years old, with a booster dose at age 16. The MCV4 vaccine protects against four types of meningococcal bacteria (A, C, W, and Y) that can cause serious infections of the lining of the brain and spinal cord (meningitis) or the bloodstream (septicemia).

Choice D:

A 4-year-old child is not a recommended recipient of the MCV4 vaccine, as it is not routinely given to children younger than 11 years old, unless they have certain medical conditions that increase their risk of meningococcal disease, such as asplenia, complement deficiency, or HIV infection. A 4-year-old child may receive the meningococcal polysaccharide (MPSV4) vaccine instead, if indicated.

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Question 11:

A nurse is caring for an adolescent who was brought to the emergency department (ED) with a high fever, headache, and neck stiffness. The nurse reviews the adolescent's cerebrospinal fluid (CSF) analysis results and notes the following:

- WBC count 300 cells/microliter (normal range: 0 to 10 cells/microliter)
- Protein 45 mg/dL (normal range: 15 to 45 mg/dL)
- Glucose 40 mg/dL (normal range: 50 to 75 mg/dL)
- Color Turbid (normal: clear and colorless)

The nurse should suspect that the adolescent has which of the following conditions?

A. Bacterial meningitis. B. Viral meningitis. C. Encephalitis. D. Brain abscess.

Answer and Explanation

Choice A:

Bacterial meningitis is a probable condition, as it is an infection of the membranes that cover the brain and spinal cord, caused by various bacteria, such as Streptococcus pneumoniae, Neisseria meningitidis, or Haemophilus influenzae. The adolescent has many signs and symptoms of bacterial meningitis, such as fever, headache, and neck stiffness.

Choice B:

Viral meningitis is not a likely condition, as it is an infection of the membranes that cover the brain and spinal cord, caused by various viruses, such as enteroviruses, herpes simplex virus, or mumps virus. The adolescent has some signs and symptoms of viral meningitis, such as fever, headache, and neck stiffness, but they are usually less severe than bacterial meningitis.

Choice C:

Encephalitis is not a probable condition, as it is an inflammation of the brain tissue, usually caused by viral infections, such as herpes simplex virus, West Nile virus, or rabies virus. The adolescent has some signs and symptoms of encephalitis, such as fever, headache, and altered mental status, but they are usually accompanied by focal neurological deficits, such as seizures, paralysis, or cranial nerve palsies.

Choice D:

Brain abscess is not a definite condition, as it is a collection of pus within the brain tissue, usually caused by bacterial infections that spread from other parts of the body, such as the ear, sinus, or lung. The adolescent has some signs and symptoms of brain abscess, such as fever, headache, and altered mental status, but they are usually accompanied by focal neurological deficits, such as seizures, paralysis, or cranial nerve palsies.

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Question 12:

A nurse is caring for an adolescent who was brought to the emergency department (ED) with a fever, headache, and neck stiffness. The nurse should determine the assessment findings are consistent with which of the following disease processes?

A. Bacterial meningitis B. Encephalitis C. Gastroenteritis D. Migraine

Answer and Explanation

Choice A:

Bacterial meningitis is an inflammation of the meninges, the membranes that cover the brain and spinal cord, caused by a bacterial infection. It can cause fever, headache, neck stiffness, photophobia, and altered mental status. The cerebrospinal fluid (CSF) analysis may show increased white blood cells, protein, and glucose. The nurse should assess the neck range of motion and the reaction to pupil assessment, as these may indicate increased intracranial pressure.

Choice B:

Encephalitis is an inflammation of the brain tissue, usually caused by a viral infection. It can cause fever, headache, confusion, seizures, and focal neurological deficits. The CSF analysis may show increased white blood cells and protein, but normal glucose. The nurse should assess the level of consciousness and the neurological status, as these may indicate brain damage.

Choice C:

Gastroenteritis is an inflammation of the stomach and intestines, usually caused by a viral or bacterial infection. It can cause nausea, vomiting, diarrhea, abdominal pain, and dehydration. The nurse should assess the gastrointestinal manifestations and the vital signs, as these may indicate fluid and electrolyte imbalance.

Choice D:

Migraine is a type of headache that involves recurrent episodes of moderate to severe pain, usually on one side of the head, often accompanied by nausea, vomiting, and sensitivity to light and sound. The nurse should assess the location and duration of pain, the triggers and relievers, and the history of migraine. The CSF analysis is usually normal.

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Question 13:

A nurse is providing discharge teaching to the parents of a child who has a new diagnosis of diabetes mellitus. Which of the following statements by the parents indicates an understanding of the teaching?

A. The onset of low blood glucose usually occurs slowly. B. My son might complain of feeling shaky when he has a low blood glucose level. C. Sweating can occur with hyperglycemia. D. My son might have nausea and vomiting with hypoglycemia.

Answer and Explanation

Choice A:

The onset of low blood glucose, or hypoglycemia, usually occurs rapidly and can be triggered by skipping meals, exercising too much, or taking too much insulin. The nurse should teach the parents to recognize the signs and symptoms of hypoglycemia and how to treat it promptly.

Choice B:

Feeling shaky is one of the common signs of low blood glucose, along with hunger, sweating, dizziness, confusion, and irritability. The nurse should teach the parents to check the child's blood glucose level and give him a fast-acting carbohydrate, such as juice, candy, or glucose tablets, if it is below 70 mg/dL.

Choice C:

Sweating can occur with low blood glucose, not high blood glucose, or hyperglycemia. Hyperglycemia can cause symptoms such as thirst, frequent urination, dry mouth, blurred vision, and fatigue. The nurse should teach the parents to monitor the child's blood glucose level regularly and adjust his insulin dose, diet, and exercise accordingly.

Choice D:

Nausea and vomiting can occur with high blood glucose, especially if it leads to diabetic ketoacidosis, a serious complication of diabetes. Diabetic ketoacidosis can also cause abdominal pain, fruity breath, rapid breathing, and coma. The nurse should teach the parents to seek emergency medical attention if the child has these symptoms.

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Question 14:

A nurse is creating a plan of care for a child who has sickle cell anemia. Which of the following interventions should the nurse include in the plan?

A. Discourage a high level of fluid intake. B. Administer meperidine every 4 hr for pain. C. Apply cold compresses to painful, swollen joints. D. Observe for indications of hypokalemia.

Answer and Explanation

Choice A:

Discouraging a high level of fluid intake is incorrect, as hydration is essential for preventing sickle cell crises and reducing blood viscosity. The nurse should encourage the child to drink at least 1.5 times the normal fluid requirement.

Choice B:

Administering meperidine every 4 hr for pain is incorrect, as meperidine is not recommended for sickle cell pain due to the risk of neurotoxicity and seizures. The nurse should use other opioids such as morphine or hydromorphone for pain management.

Choice C:

Applying cold compresses to painful, swollen joints is incorrect, as cold can cause vasoconstriction and worsen the sickling of red blood cells. The nurse should use warm compresses or heating pads to promote vasodilation and blood flow.

Choice D:

Observing for indications of hypokalemia is correct, as sickle cell anemia can cause hemolysis and potassium loss. The nurse should monitor the child's serum potassium level and watch for signs of hypokalemia such as muscle weakness, cramps, arrhythmias, and constipation.

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Question 15:

A nurse is providing teaching to the parents of a newborn. Which of the following information should the nurse include?

A. Your baby will receive a hepatitis B vaccine prior to discharge. B. Your baby will have the first diphtheria, tetanus, pertussis vaccine at the 2 week well-baby visit. C. Your baby should receive the pneumococcal conjugate vaccine on his first birthday. D. Your baby should receive the measles, mumps, rubella vaccine at 6 months.

Answer and Explanation

Choice A:

Your baby will receive a hepatitis B vaccine prior to discharge is correct, as this is the recommended schedule for the first dose of the hepatitis B vaccine for all newborns, regardless of maternal hepatitis B status.

Choice B:

Your baby will have the first diphtheria, tetanus, pertussis vaccine at the 2 week well-baby visit is incorrect, as this is too early for the first dose of the DTaP vaccine. The first dose of the DTaP vaccine should be given at 2 months of age.

Choice C:

Your baby should receive the pneumococcal conjugate vaccine on his first birthday is incorrect, as this is too late for the first dose of the PCV13 vaccine. The first dose of the PCV13 vaccine should be given at 2 months of age, followed by three more doses at 4, 6, and 12-15 months of age.

Choice D:

Your baby should receive the measles, mumps, rubella vaccine at 6 months is incorrect, as this is too early for the first dose of the MMR vaccine. The first dose of the MMR vaccine should be given at 12-15 months of age, followed by a second dose at 4-6 years of age.

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Question 16:

A nurse is developing a health program for the parents of school-age boys. Which of the following information about pubescent changes should the nurse include in the program?

A. Changes in the voice signal the beginning of puberty. B. Growth spurts in height occur toward the end of mid-puberty. C. Puberty might be delayed if scrotal changes have not occurred by the age of 11 years. D. Gynecomastia commonly occurs during late puberty.

Answer and Explanation

Choice A:

Changes in the voice signal the beginning of puberty is incorrect, as voice changes usually occur in the middle or late stages of puberty, not the beginning. The first sign of puberty in boys is usually testicular enlargement, followed by pubic hair growth and penile enlargement.

Choice B:

Growth spurts in height occur toward the end of mid-puberty is correct, as this is the typical pattern of growth for boys during puberty. Boys usually start their growth spurt later than girls, but grow faster and for a longer period of time.

Choice C:

Puberty might be delayed if scrotal changes have not occurred by the age of 11 years is incorrect, as this is not a definitive indicator of delayed puberty. Puberty can vary widely among individuals, and some boys may start later than others without any underlying problem. Delayed puberty is usually diagnosed if there is no sign of puberty by the age of 14 years.

Choice D:

Gynecomastia commonly occurs during late puberty is incorrect, as gynecomastia, or the enlargement of breast tissue in males, usually occurs in the early or middle stages of puberty, not the late stage. It is caused by hormonal changes and usually resolves on its own within a few months or years.

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Question 17:

A school nurse is assessing an adolescent who reports feeling shaky and is having trouble focusing and concentrating on the questions. The nurse checks the adolescent's blood glucose level and finds a value of 55 mg/dL. Which of the following findings should the nurse expect? (Select all that apply.)

A. Polyuria B. Tachycardia C. Dry, flushed skin D. Deep, rapid respirations E. Hunger

Answer and Explanation

Choice A:

Polyuria, or excessive urination, is not a sign of low blood glucose level, but of high blood glucose level. It is caused by osmotic diuresis, which occurs when the kidneys try to flush out the excess glucose from the blood.

Choice B:

Tachycardia, or fast heart rate, is a sign of low blood glucose level. It is caused by the activation of the sympathetic nervous system, which releases adrenaline and other hormones to increase the blood glucose level and stimulate the heart.

Choice C:

Dry, flushed skin is not a sign of low blood glucose level, but of high blood glucose level. It is caused by dehydration, which occurs when the body loses fluid due to polyuria and increased thirst.

Choice D:

Deep, rapid respirations are not a sign of low blood glucose level, but of diabetic ketoacidosis, a complication of high blood glucose level. It is caused by the accumulation of ketones, which are acidic substances produced when the body breaks down fat for energy due to lack of insulin.

Choice E:

Hunger is a sign of low blood glucose level. It is caused by the lack of glucose in the cells, which are the main source of energy for the body. The brain signals the body to eat more to raise the blood glucose level.

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Question 18:

A nurse is caring for a school-age child who has a systemic disorder and is receiving antibiotics, immunosuppressants, and corticosteroids. Both of the child's parents have a smoking history. The child reports soreness in his mouth and refuses to eat. Inspection of his mouth reveals a white, milky plaque that does not come off with rubbing. The nurse should suspect which of the following conditions?

A. Herpes simplex B. Dermatitis C. Squamous cell carcinoma D. Candidiasis

Answer and Explanation

Choice A:

Herpes simplex is a viral infection that causes painful blisters or ulcers in the mouth or on the lips. It does not cause a white, milky plaque that does not come off with rubbing.

Choice B:

Dermatitis is a skin inflammation that causes redness, itching, and scaling. It does not affect the mouth or cause a white, milky plaque that does not come off with rubbing.

Choice C:

Squamous cell carcinoma is a type of skin cancer that develops from the squamous cells that line the mouth and other parts of the body. It causes a hard, irregular, or ulcerated growth that may bleed or become infected. It does not cause a white, milky plaque that does not come off with rubbing.

Choice D:

Candidiasis, also known as oral thrush, is a fungal infection that causes a white, milky plaque that coats the tongue, cheeks, and roof of the mouth. It can be scraped off, but may leave a red, sore, or bleeding surface. It is more common in people who have a weakened immune system, such as those who take antibiotics, immunosuppressants, or corticosteroids. It can also be triggered by smoking, dry mouth, or poor oral hygiene.

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Question 19:

A nurse is preparing to discharge a child who has a new prescription for an oral antibiotic. Which of the following information should the nurse include in the discharge instructions? (Select all that apply.)

A. The reason why the child is taking the medication B. The adverse effects of the medication C. Stopping the medication when the child feels better D. Written information about the medication E. Using a kitchen spoon to administer the medication

Answer and Explanation

Choice A:

The reason why the child is taking the medication is an important information to include in the discharge instructions. It can help the parents and the child understand the purpose and the benefits of the medication. It can also motivate them to adhere to the prescribed regimen and prevent misuse or underuse of the medication.

Choice B:

The adverse effects of the medication are also important information to include in the discharge instructions. They can help the parents and the child recognize and report any unwanted or harmful reactions that may occur while taking the medication. They can also inform them about the appropriate actions to take in case of an adverse effect, such as seeking medical attention, adjusting the dose, or discontinuing the medication.

Choice C:

Stopping the medication when the child feels better is not an appropriate information to include in the discharge instructions. It can lead to incomplete treatment and increase the risk of antibiotic resistance, recurrence, or complications. The nurse should instruct the parents and the child to complete the full course of the medication as prescribed, even if the symptoms improve or resolve.

Choice D:

Written information about the medication is a useful information to include in the discharge instructions. It can provide the parents and the child with a clear and concise summary of the medication, such as the name, the dose, the frequency, the duration, the storage, and the administration instructions. It can also serve as a reference and a reminder for them to follow the medication regimen correctly and safely.

Choice E:

Using a kitchen spoon to administer the medication is not a recommended information to include in the discharge instructions. It can result in inaccurate and inconsistent dosing of the medication, which can affect its efficacy and safety. The nurse should advise the parents and the child to use a calibrated measuring device, such as a syringe, a dropper, or a cup, to administer the medication.

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Question 20:

Which of the following is the correct way to write the date in the American format?

A. 2/20/2024 B. 20/2/2024 C. 2024/2/20 D. 2024/20/2

Answer and Explanation

Choice A:

The American format for writing dates is month/day/year, so 2/20/2024 is the correct way to write the date February 20, 2024.

Choice B:

The European format for writing dates is day/month/year, so 20/2/2024 is not the correct way to write the date in the American format.

Choice C:

The ISO format for writing dates is year/month/day, so 2024/2/20 is not the correct way to write the date in the American format.

Choice D:

This is an invalid format for writing dates, as there is no month with 20 days.

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Question 21:

A nurse is caring for a child who has pertussis. The child's parent asks the nurse what the common name for this disease is. The nurse should
respond with which of the following common names?

A. Fifth disease B. Whooping cough C. Chickenpox D. Mumps

Answer and Explanation

Choice A:

Fifth disease is a viral infection that causes a rash on the face and body. It is also known as erythema infectiosum or slapped cheek syndrome. It is not the same as pertussis.

Choice B:

Whooping cough is a bacterial infection that causes severe coughing spells that end with a whooping sound. It is also known as pertussis or the 100-day cough. It is the correct common name for the disease.

Choice C:

Chickenpox is a viral infection that causes an itchy rash with blisters. It is also known as varicella. It is not the same as pertussis.

Choice D:

Mumps is a viral infection that causes swelling of the salivary glands. It is also known as parotitis. It is not the same as pertussis.

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Question 22:

A nurse is caring for a child who has Addison's disease. Which of the following actions should the nurse take?

A. Place the child on a low-sodium diet B. Discuss the manifestations of hyperglycemia with the parents C. Monitor the child for fluid volume excess D. Teach the parents about cortisol replacement therapy

Answer and Explanation

Choice A:

A low-sodium diet is not recommended for a child who has Addison's disease, as they need more sodium to maintain their blood pressure and fluid balance. A high-sodium diet may be advised instead. ¹

Choice B:

Hyperglycemia, or high blood sugar, is not a common manifestation of Addison's disease, as the condition causes low levels of cortisol, which normally raises blood sugar. Hypoglycemia, or low blood sugar, is more likely to occur and should be monitored and treated. ²

Choice C:

Fluid volume excess, or edema, is not a common complication of Addison's disease, as the condition causes low levels of aldosterone, which normally retains sodium and water in the body. Fluid volume deficit, or dehydration, is more likely to occur and should be prevented and corrected. ³

Choice D:

Cortisol replacement therapy is the main treatment for Addison's disease, as it helps restore the normal function of the adrenal glands and prevent adrenal crisis. The parents should be taught about the dosage, timing, and side effects of the medication, as well as the signs and symptoms of underdose and overdose. They should also be instructed to increase the dose during times of stress, illness, or injury, and to carry an emergency injection kit. ⁴.

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Question 23:

A nurse is providing teaching to an adolescent who has type 1 diabetes mellitus. Which of the following should the nurse include in the teaching?

A. Take glyburide with breakfast B. Obtain an influenza vaccine annually C. Inject insulin in the deltoid muscle D. Administer glucagon for hyperglycemia

Answer and Explanation

Choice A:

Glyburide is an oral medication that lowers blood sugar by stimulating the pancreas to produce more insulin. It is not used for type 1 diabetes mellitus, as the pancreas cannot produce enough insulin in this condition. Glyburide is used for type 2 diabetes mellitus, which is caused by insulin resistance.

Choice B:

Obtaining an influenza vaccine annually is recommended for people who have type 1 diabetes mellitus, as they are more prone to complications from the flu, such as pneumonia, ketoacidosis, and hospitalization. The vaccine can help prevent or reduce the severity of the flu and its complications.

Choice C:

Injecting insulin in the deltoid muscle is not the best practice for administering insulin, as the absorption rate and onset of action may vary depending on the muscle mass and blood flow. The preferred sites for insulin injection are the abdomen, the upper arms, the thighs, and the buttocks, as they have more subcutaneous fat and less muscle tissue. The injection site should also be rotated to prevent lipodystrophy.

Choice D:

Administering glucagon for hyperglycemia is not appropriate, as glucagon is a hormone that raises blood sugar by stimulating the liver to release glucose. It is used for hypoglycemia, or low blood sugar, which is a common and serious complication of type 1 diabetes mellitus. Hyperglycemia, or high blood sugar, is treated with insulin, fluids, and electrolytes.

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Question 24:

A nurse is caring for a child who has been physically abused by a family member. Which of the following statements should the nurse say to the child?

A. Promise I won't tell anyone about this B. Your family is bad for doing this to you C. It's not your fault that this happened D. Let's discuss what happened with your family

Answer and Explanation

Choice A:

Promising not to tell anyone about the abuse is not a helpful statement, as it implies that the abuse is a secret that should be hidden. This may make the child feel ashamed, guilty, or isolated. The nurse has a duty to report the abuse to the proper authorities and to protect the child from further harm.

Choice B:

Blaming the family for the abuse is not a helpful statement, as it may cause the child to feel conflicted, angry, or fearful. The child may still love the family member who abused them, or may depend on them for their basic needs. The nurse should avoid making judgments or accusations, and instead focus on the child's feelings and safety.

Choice C:

Reassuring the child that the abuse is not their fault is a helpful statement, as it may help the child cope with the trauma and reduce the feelings of self-blame, guilt, or shame. The nurse should validate the child's emotions and let them know that they are not responsible for the abuse or for stopping it.

Choice D:

Suggesting to discuss the abuse with the family is not a helpful statement, as it may put the child in danger or cause them more distress. The child may not feel comfortable or safe to talk about the abuse with the family member who abused them, or with other family members who may not believe them or support them. The nurse should respect the child's privacy and boundaries, and only involve the family with the child's consent and under professional guidance.

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Question 25:

A nurse is assisting with the admission of a child who has measles. Which of the following isolation precautions should the nurse initiate?

A. Protective environment B. Airborne C. Contact D. Droplet

Answer and Explanation

Choice A:

A protective environment is a type of isolation precaution that is used for patients who are immunocompromised and at high risk of infection from environmental sources, such as fungi or bacteria. It involves using a private room with positive air pressure, high-efficiency particulate air (HEPA) filtration, and strict hand hygiene. It is not indicated for patients who have measles, as they are the source of infection, not the susceptible host.

Choice B:

Airborne is a type of isolation precaution that is used for patients who have diseases that are transmitted by small droplets that can remain suspended in the air and travel over long distances, such as tuberculosis, chickenpox, or measles. It involves using a private room with negative air pressure, HEPA filtration, and respiratory protection for health care workers and visitors. It is the appropriate isolation precaution for patients who have measles, as it prevents the spread of the virus to others.

Choice C:

Contact is a type of isolation precaution that is used for patients who have diseases that are transmitted by direct or indirect contact with the patient or their environment, such as Clostridioides difficile, scabies, or impetigo. It involves using a private room or cohorting with similar patients, wearing gloves and gowns, and using dedicated equipment. It is not indicated for patients who have measles, as the disease is not spread by contact.

Choice D:

Droplet is a type of isolation precaution that is used for patients who have diseases that are transmitted by large droplets that are generated by coughing, sneezing, or talking, such as influenza, pertussis, or meningitis. It involves using a private room or cohorting with similar patients, wearing a surgical mask, and maintaining a distance of at least 3 feet from the patient. It is not indicated for patients who have measles, as the disease is spread by airborne transmission.

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