Question 1

A child with sickle cell disease is seen in the emergency department with increasing back andleg pain for the past 2 days. What is this child most likely experiencing?&#10;A) A vaso-occlusive crisis&#10;B) Acute splenic sequestration&#10;C) Erythroblastopenia&#10;D) Acute chest syndrome

Accepted Answer

A vaso-occlusive crisis is the most common type of crisis and is characterized by mild to severe pain. Pain can occur anywhere, but is typically manifested as bone or joint pain. Symptoms of acute splenic sequestration are associated with blood volume pooling, causing splenic enlargement and hypovolemic shock. Symptoms of pallor, lethargy, headache, and upper respiratory infection seen in erythroblastopenia result from decreased blood cell production by the bone marrow. Chest pain, fever, and cough are characteristic of acute chest syndrome.

Question 2

At a healthy 2-month-old infants well-child clinic visit, the nurse should give whichimmunizations?&#10;A) DTaP, IPV, HepB, Hib, PCV, rotavirus&#10;B) MMR, DTaP, PVC, and IPV&#10;C) Hib, DTaP, rotavirus, and OPV&#10;D) Hib and MMR, IPV, and rotavirus

Accepted Answer

DTaP, IPV, HepB, Hib, PCV, and rotavirus are the appropriate sequence of immunizations for a healthy 2-month-old infant. MMR is given at or after 12 months of age. Oral polio vaccine (OPV) is no longer administered in the U.S.

Question 3

Which is the most appropriate action for the nurse to take when telling a preschool childabout an upcoming procedure?&#10;A) Explain all the information in detail to the child.&#10;B) Speak loudly and clearly to the child.&#10;C) Inform the parents of the procedure and ask them to tell the child.&#10;D) Use symbolic play to explain the procedure.

Accepted Answer

Symbolic play is important for emotional development because it allows the child to work through distressing feelings and can be therapeutic. It is inappropriate to give a preschooler all the information in detail. The child needs to understand what is going to happen to him without
explicit details of the procedure. Speaking in clear sentences with simple words is important, but the conversation should be conducted at a nonthreatening normal sound level. The nurse has the most knowledge and best ability for explaining the procedure to the child; however, the parents can be an important resource when explaining the procedure.

Question 4

In caring for a 4-year-old child with a diagnosis of suspected child abuse, which is the bestnursing intervention?&#10;A) Avoid touching the child.&#10;B) Provide the child with play situations that allow for disclosure.&#10;C) Discourage the child from remembering the incident.&#10;D) Deny the suspected perpetrator visiting rights to the child.

Accepted Answer

Play allows the child to disclose what happened to him or her without having to talk about the incident. Symbolic play is important for emotional development and it allows the child to work through distressing feelings. All children need to be touched. What is important is to tell the child in simple, clear terms what you are doing and why you are doing it. Nurses have the opportunity to teach children the normal, healthy boundaries of their bodies and what constitutes inappropriate behavior. If the child chooses to remember what happened, it is inappropriate to discourage it. It is important to listen to the child in a nonjudgmental way, allowing the child to discuss what happened, to make statements, or to ask questions. It is not the nurses role or responsibility to restrict visitors unless child safety is an issue. The child may be negatively affected if a caregiver, who may be the abuser, does not visit.

Question 5

Parents of a preschool child ask the nurse, What can we do to prepare our child for kindergarten? In response, the nurse should include which critical factor in preparing a child forkindergarten entry?

A) The childs ability to sit still
B) The childs sense of learned helplessness
C) The parents interactions and responsiveness to the child
D) Attending a preschool program

Accepted Answer

Interactions between the parent and child are an important factor in the development of academic competence. Parent encouragement and support maximize a childs potential. The childs ability to sit still is important to learning; however, parental responsiveness and involvement are more important factors. Learned helplessness is the result of a child feeling that he or she has no effect on the environment and his or her actions do not matter. Parents who are actively involved in a supportive learning environment will demonstrate a more positive approach to learning. Preschool and day care programs can supplement the developmental opportunities provided by parents at home, but they are not critical in preparing a child for entering kindergarten.

Question 6

Place in order the gross motor developmental milestones a nurse expects to assess in a toddler. Begin with the earliest gross motor milestone expected and progress to the last gross motor milestone attained. Use the following format for your answers: A, B, C, D

A) Throws a ball overhand
B) Walks
C) Kicks a ball
D) Runs

Accepted Answer

The toddler walks between 12 months and 15 months of age. The next gross motor milestone seen in the toddler is running. The toddler runs soon after learning how to walk, but may fall down. By the end of 24 months the toddler can throw a ball overhand. The toddler does not kick a ball until after 24 months of age.

Question 7

At a seminar for parents with preschool-age children, the nurse has discussed anticipatory tasks during the preschool years. Which statement by a parent should indicate a correctunderstanding of the teaching?

A) I should be worried if my 4-year-old child has an increase in sexual curiosity because this is a sign of sexual abuse.
B) I should expect my 5-year-old to change from a tranquil child to an aggressive child when school starts.
C) I should be concerned if my 4-year-old child starts telling exaggerated stories and has an imaginary playmate, since these could be signs of stress.
D) I should expect my 3-year-old child to have a more stable appetite and an increase in food selections.

Accepted Answer

A 3-year-old child exhibits a more stable appetite than during the toddler years and is more willing to try different foods. A 4-year-old child is imaginative and indulges in telling tall tales and may have an imaginary playmate; these are normal findings, not signs of stress. Also a 4-year-old child has an increasing curiosity in sexuality, which is not a sign of child abuse. A 5-year-old child is usually tranquil, not aggressive like a 4-year-old child.

Question 8

A nurse has completed a teaching session for parents on school-age childrens expected developmental milestones. The parents need further teaching if they indicate which behavior isexpected in a school-age child?

A) Experiments with profanity and dirty jokes
B) Laughs at silly jokes and enjoys using words
C) Understands the concept of conservation
D) Engages in fantasy and magical thinking

Accepted Answer

The preschool child engages in fantasy and magical thinking. The school-age child moves away from this type of thinking and becomes more skeptical and logical. Belief in Santa Claus or the Easter Bunny ends in this period of development. The school-age child goes through a period in which profanity and dirty jokes are explored. This behavior is not unusual for the school-age child. The school-age child has a sense of humor. His increased language mastery and increased logic allow for appreciation of plays on words, jokes, and incongruities. The school-age child understands conservation or that properties of objects do not change when their order, form, or appearance does.

Question 9

A school nurse is conducting a class on safety for parents of school-age children. Which statement indicates the parents need further teaching?&#10;A) Our child needs to wear sunscreen when playing soccer.&#10;B) Our young school-age child will continue to ride belted in the back seat.&#10;C) We will monitor the volume when our child is listening to music on the i-Pod with ear buds.&#10;D) Were glad our child will be home after school to let repairmen in while we are working.

Accepted Answer

Safety teaching for school-age children includes sun protection and wearing sunscreen when participating in sports, having the child belted in the back seat of the car away from airbags, and avoidance of listening to loud music through earphones. A child home alone should not allow others into the home if the parent is not there.

Deck 3: Sickle Cell Anemia, Care of the Newborn and Infant, Care of the Toddler and Care of the School-Age Child