Question 1

In an interview with the nurse, a mother states that she is concerned that her 14-year-old teenis critical and finding fault with her. The nurse counsels the mother that:&#10;A) the family needs to change its value system to meet the teenagers changing needs.&#10;B) the parentteen relationship is important for the teenager and conflicts are to be expected.&#10;C) teenagers create psychological distance from the parent to separate from the parent.&#10;D) parents need to relinquish their relationship with their teenager to the teens peers.

Accepted Answer

The teenager uses critical and fault-finding behavior as a mechanism to separate from the parent and become independent. Changing the familys value system to meet the teenagers needs is not realistic and will result only in the teenagers being critical of the new system. The parentteen relationship is not as important to the teenager as it was in earlier years. Friends and peers become more important. Parents should not relinquish their relationship with their teenager to the teens peers. Maintaining a consistent parental relationship with the adolescent is important.

Question 2

Place in order the signs of female sexual maturity beginning with the first sign and ending with the last. Use the following format for your answers: A, B, C, D&#10;A) Growth of pubic hair &#10;B) Menarche&#10;C) Appearance of breast buds &#10;D) Ovulation is established&#10;

Accepted Answer

Sexual maturation in girls begins with the appearance of breast buds (thelarche), which is the first sign of ovarian function. Thelarche occurs at approximately age 8 to 11 years and is followed by the growth of pubic hair. Linear growth slows, and menarche begins approximately 1 year after the peak height velocity (PHV). Ovulation occurs with menarche but may or may not accompany the first 2 years of menarche so it is not established until later

Question 3

The nurse is preparing a staff education program about pediatric asthma. What concepts should the nurse include when discussing the asthma severity classification system? (Select all that apply.)&#10;A) Children with mild persistent asthma have nighttime signs or symptoms less than two times a month.&#10;B) Children with moderate persistent asthma use a short-acting b-agonist more than two times per week.&#10;C) Children with severe persistent asthma have a peak expiratory flow (PEF) of 60% to 80% of predicted value.&#10;D) Children with mild persistent asthma have signs or symptoms more than two times per week.&#10;E) Children with moderate persistent asthma have some limitations with normal activity.&#10;F) Children with severe persistent asthma have frequent nighttime signs or symptoms.&#10;

Accepted Answer

Children with mild persistent asthma have signs or symptoms more than two times per week and nighttime signs or symptoms three or four times per month. Children with moderate persistent asthma have some limitations with normal activity and need to use a short-acting b-agonist for sign or symptom control daily. Children with severe persistent asthma have frequent nighttime signs or symptoms and have a PEF of less than 60%.

Question 4

A child with spina bifida is being admitted to the hospital for a shunt revision? The nurseadmitting the child anticipates which type of precautions to be ordered for the child?&#10;A) Latex&#10;B) Bleeding&#10;C) Seizure&#10;D) Isolation

Accepted Answer

Children with spina bifida are at high risk for developing latex allergies because of frequent exposure to latex during catheterizations, shunt placements, and other operations. The child with spina bifida does not have a risk for bleeding. Not all children with spina bifida are at risk for seizures and isolation would not be indicated in a child being admitted for a shunt revision.

Question 5

A child is admitted to the hospital with spastic cerebral palsy. The nurse will assess for whichmanifestations associated with this disorder?&#10;A) Tremulous movements at rest and with activity&#10;B) Sudden jerking movement caused by stimuli&#10;C) Writhing, uncontrolled, involuntary movements&#10;D) Clumsy, uncoordinated movements

Accepted Answer

Spastic cerebral palsy, the most common type of cerebral palsy, will manifest with hypertonicity and increased deep tendon reflexes. The childs muscles are very tight and any stimuli may cause a sudden jerking movement. Tremulous movements are characteristic of rigid/tremor/atonic cerebral palsy. Slow, writhing, uncontrolled, involuntary movements occur with athetoid or dyskinetic cerebral palsy. Clumsy movements and loss of coordination, equilibrium, and kinesthetic sense occur in ataxic cerebral palsy.

Question 6

Which assessment noted in an infant 1 day after placement of a ventriculoperitoneal shunt isindicative of surgical complications?&#10;A) Hypoactive bowel sounds&#10;B) Congestion in upper airways&#10;C) Increasing lethargy&#10;D) Mild incisional pain

Accepted Answer

A decreasing level of consciousness indicates a problem with shunt function and should be reported immediately to the neurosurgeon. Peristalsis is depressed during surgery. Hypoactive bowel sounds may be evident after surgery as peristalsis returns to its preoperative function. Congestion in the upper airways may be evident after surgery. Mild incisional pain is a normal finding in the postoperative period.

Question 7

What specific gravity of the urine is desired so that hemorrhagic cystitis is prevented?&#10;A)1.035&#10;B) 1.030&#10;C) 1.025&#10;D) 1.005

Accepted Answer

Sterile hemorrhagic cystitis is a side effect of chemical irritation to the bladder from chemotherapy or radiotherapy. It can be prevented by a liberal oral or parenteral fluid intake (at least one and a half times the recommended daily fluid requirement). The urine should be dilute so 1.005 is the expected specific gravity.

Deck 4: Care of the Adolescent, Alterations in Respiratory Function, Alterations in Neurological, Sensory Function and Oncological Disorders