Question 1

The nurse is providing education to the parents of a child diagnosed with chronic allergic rhinitis that is triggered by dust and pollen. Which of the following statements by the parents indicate that the teaching has been effective? Select all that apply.

Accepted Answer

Chronic allergic rhinitis is a hypersensitivity response to specific allergen triggers (eg, dust, mold, pollen, animal dander). Symptoms include sneezing, nasal drainage and congestion, throat soreness, and itching of the eyes and/or nose. Clients and their families can minimize symptoms by identifying the client's individualized allergen triggers and implementing strategies to reduce or avoid exposure to them. Interventions to reduce exposure to household and environmental allergens include: Installing high-efficiency particulate air (HEPA) air-conditioner filters Keeping windows closed and staying indoors, particularly during times of heavy pollen Applying hypoallergenic pillow and mattress covers to prevent exposure to dust mites (Option C) Reducing or removing carpet and area rugs Vacuuming carpet at least once a week with a HEPA filter vacuum (Option A) Mopping hard floors and damp-dusting furniture at least once a week (Option D) (Option B) If the client is not allergic to animal dander, removing household pets is likely unnecessary. However, pets can carry pollen, dust, and other allergens in their fur, and further precautions may be needed to reduce allergen exposure (eg, bathing pets frequently, keeping pets outdoors). (Option E) Opening windows allows environmental allergens, such as pollen, to enter the home. Educational objective: Limiting exposure to allergen triggers is helpful for reducing and preventing symptoms of allergic rhinitis. Interventions include installing high-efficiency particulate air (HEPA) filters, keeping windows closed, applying hypoallergenic pillow and mattress covers, eliminating carpet, mopping and vacuuming regularly with a HEPA filter vacuum, and damp-dusting furniture frequently.

Question 2

A 12-month-old with Kawasaki disease received IV immunoglobulin (IVIG) 2 months ago. The child is in the clinic for follow-up and scheduled immunizations. Which vaccine should be delayed? Select all that apply.

Accepted Answer

Kawasaki disease is treated with aspirin and IVIG to prevent coronary artery aneurysms. Antibodies acquired from the IVIG therapy will remain in the body for up to 11 months and may interfere with the desired immune response to live vaccines. Therefore, live vaccines (eg, varicella, MMR) should be delayed for 11 months after IVIG administration as this therapy may decrease the child's ability to produce the appropriate amount of antibodies to provide lifelong immunity (Options C and E). (Option A) Hib vaccine is not a live vaccine, and final dose (fourth) is recommended between age 12-15 months, according to the Centers for Disease Control and Prevention (CDC). (Option B) Hep B vaccine is not a live vaccine; the CDC recommends that the final dose (third) be administered between age 6-18 months. (Option D) PCV is also not a live vaccine, and the final dose (fourth) is recommended between age 12-15 months, according to the CDC. Educational objective: Live vaccines (eg, varicella, MMR) should be delayed for up to 11 months after IVIG administration as IVIG therapy may decrease the child's ability to produce the appropriate amount of antibodies to provide lifelong immunity.

Question 3

Several 12-month-old infants are brought to the clinic for routine immunizations. Which situation would be most important for the nurse to clarify with the provider before administering the vaccination?

Accepted Answer

Vaccines should be administered at specific ages and intervals as passive placental immunity decreases and the child's immune system develops enough to produce antibodies in response to the vaccine. The nurse should always assess for allergies to vaccine components (eg, neomycin, gelatin, yeast) and screen for an allergy to latex (eg, lips swelling from contact with bananas, kiwis, or latex balloons). Severely immunocompromised children (eg, corticosteroid therapy, chemotherapy, AIDS) generally should not receive live vaccines (eg, varicella-zoster vaccine, measles-mumps-rubella, rotavirus, yellow fever) (Option D). Passive immunization may be the only option for children with severe immunosuppression or those unable to mount an antibody immune response. Common misperceptions of contraindications to immunization: Penicillin allergy (Option A) Mild illness (with or without an elevated temperature) (Option B) Mild site reactions (eg, swelling, erythema, soreness) (Option C) Recent infection exposure Current course of antibiotics Educational objective: Clients should be assessed for allergies to vaccine components. Immunocompromised clients should not receive live vaccines. Local reactions, minor illness, exposure to an infectious source, and allergies to nonvaccine components are not contraindications to immunization.

Question 4

The clinic nurse supervises a student nurse who is preparing to administer routine vaccinations to a child diagnosed with hemophilia. Which instructions should the clinic nurse provide to the student? Select all that apply.

Accepted Answer

Hemophilia is a bleeding disorder caused by a deficiency in coagulation proteins, increasing the risk for bleeding. The nurse should avoid procedures that can cause bleeding (eg, intramuscular injections, rectal temperature measurement). Vaccinations are administered subcutaneously whenever possible to prevent intramuscular hematoma (Option B). The smallest gauge needle is used, and firm, continuous pressure is applied at the site for 5 minutes (Option D). (Option A) Children with hemophilia should avoid aspirin and nonsteroidal anti-inflammatory drugs due to the risk of bleeding. Acetaminophen is recommended for pain relief. (Options C and E) Firm pressure should be held on the site without rubbing or massaging due to the risk of bleeding and hematoma formation. Superficial bleeding can be controlled using ice packs, which promote vasoconstriction. Applying a warm compress would cause vasodilation and prolong bleeding. Educational objective: Procedures that can cause bleeding (eg, intramuscular injections) are avoided in children with hemophilia. Vaccinations are administered subcutaneously when possible, and the smallest gauge needle is used. Firm pressure is applied to the injection site for 5 minutes, often using ice. Nonsteroidal anti-inflammatory agents including aspirin are avoided due to the risk of bleeding.

Question 5

What is the best activity for a school-aged child hospitalized for vaso-occlusive sickle cell crisis?

Accepted Answer

A child in vaso-occlusive sickle cell crisis will be experiencing a high level of pain due to the occlusion of small blood vessels from increased red blood cell sickling. Supportive and symptomatic treatment includes round-the-clock pain management with opioids, intravenous fluids for hydration, and bed rest to decrease energy expenditure and oxygen demand. Age-specific nonpharmacologic strategies should also be implemented to manage pain and help limit the amount of needed narcotic analgesia. For a school-aged child, such activities include distraction (watching TV, listening to music, reading), relaxation, guided imagery, warm soaks, positioning, and gentle massage. (Option A) Finger painting is messy and best done in the activity room; it is not appropriate for a child confined to bed. (Option B) A child must be on bed rest when in vaso-occlusive sickle cell crisis. Playing a game in the activity room does not maintain bed rest and would be too stimulating for the child. (Option C) Playing video games may be too exciting and stimulating for the child; an environment low in stimuli will promote rest. Educational objective: Supportive and symptomatic treatment for vaso-occlusive sickle cell crisis includes pain management and bed rest. Nonpharmacologic measures to alleviate pain include distraction (watching TV, listening to music, reading), relaxation, guided imagery, warm soaks, positioning, and gentle massage.

Question 6

The parent of a 5-year-old child calls the clinic to report the recurrence of a nosebleed for which the child was seen a week ago. Which of the following instructions should the nurse reinforce? Select all that apply.

Accepted Answer

11ecbb05_cacf_0cc4_b433_c35a9c2f6f83_MD0009_00 Epistaxis (nosebleed) is a common and rarely serious nasal condition that can be caused by dry mucous membranes, local injury (eg, nose-picking), insertion of a foreign body, or rhinitis. Epistaxis usually involves the anterior nasal septum and often resolves spontaneously or with simple home management. Home management of epistaxis includes: Prioritizing application of direct, continuous pressure to the soft, compressible area below the nasal bone for 5-15 minutes to promote clot formation (Option B) Prioritizing application of direct, continuous pressure to the soft, compressible area below the nasal bone for 5-15 minutes to promote clot formation (Option B) Holding a cold cloth or ice pack to the bridge of the nose to induce vasoconstriction and slow bleeding (Option A) Holding a cold cloth or ice pack to the bridge of the nose to induce vasoconstriction and slow bleeding (Option A) Attempting to keep the client with epistaxis quiet and calm as emotional outbursts and noncooperation create a challenge to implementing interventions and stopping bleeding (Option C) Attempting to keep the client with epistaxis quiet and calm as emotional outbursts and noncooperation create a challenge to implementing interventions and stopping bleeding (Option C) (Option D) Positioning a child with epistaxis in a horizontal position or with the head tilted backward promotes drainage of blood into the throat, which increases the risk of swallowing or aspirating blood. Clients with epistaxis should sit upright and tilt the head forward. (Option E) Epistaxis is typically managed at home. However, the caregiver should seek emergency care if the client's breathing is impaired, or the bleeding is excessive or uncontrollable with home measures or resulted from a traumatic injury. Educational objective: Epistaxis (nosebleed) is a nasal condition typically occurring from local injury (eg, nose-picking) or irritation. Initial epistaxis management includes calming the client; tilting the head forward; applying direct, continuous nasal pressure for 5-15 minutes; and applying cold packs to the nasal bridge.

Question 7

A nurse on a pediatric unit is admitting a school-aged child with suspected Reye syndrome. Which information obtained during the history taking is most consistent with this condition?

Accepted Answer

11ecbb05_cad5_4e56_b433_559df710cd7a_MD0009_00 Children who develop Reye syndrome often have had a recent viral infection, especially varicella (chicken pox) or influenza. Clinical manifestations include fever, lethargy, acute encephalopathy, and altered hepatic function. Elevated serum ammonia levels are an expected laboratory finding. Acute encephalopathy manifests with vomiting and a severely altered level of consciousness; it can rapidly progress to seizures and/or coma. The risk of developing Reye syndrome increases if aspirin therapy is used to treat the fever associated with varicella or influenza. As a result of this awareness, there has been a significant increase in the use of acetaminophen or ibuprofen for fever management in children. (Option A) Although a child who has not received the varicella vaccine may have an increased risk of developing chicken pox, this evidence alone is not enough to substantiate suspected Reye syndrome. (Option B) Recent exposure to bats would place the child at risk for rabies, a severe infection affecting the nervous system. This finding would not be indicative of Reye syndrome. (Option D) The use of aspirin to treat fever, especially in clients with Kawasaki disease, can be associated with Reye syndrome. Acetaminophen is an appropriate antipyretic choice to reduce the risk of Reye syndrome. Educational objective: Reye syndrome is characterized by fever, acute encephalopathy, and altered hepatic function. It often develops following a viral infection, especially varicella or influenza. The risk of developing Reye syndrome increases if aspirin therapy is used to treat fever.

Question 8

The nurse provides discharge teaching for the parents of a child newly diagnosed with hemophilia A. Which statements by the parents indicate that teaching has been effective? Select all that apply.

Accepted Answer

Hemophilia is a hereditary bleeding disorder caused by a deficiency in coagulation proteins. Treatment consists of replacing the missing clotting factor and teaching the client about injury prevention, including: Avoid medications such as ibuprofen and aspirin that have platelet inhibition properties (Option D). Avoid intramuscular injections; subcutaneous injections are preferred. Avoid contact sports and safety hazards; noncontact activities (eg, swimming, jogging, tennis) and use of protective equipment (eg, helmets, padding) are encouraged (Option E). Dental hygiene is necessary to prevent gum bleeding, and soft toothbrushes should be used. MedicAlert bracelets should be worn at all times (Option C). (Option A) Malnutrition is not commonly associated with hemophilia; a regular diet is indicated. Clients with cystic fibrosis are at risk for malnutrition and need a high-calorie diet. (Option B) Dehydration is not commonly associated with hemophilia. Avoiding dehydration is important for those with sickle cell anemia. Educational objective: Parents of a child with hemophilia should encourage noncontact sports, avoid giving medications that inhibit platelet aggregation, know how to control bleeding when it occurs, and ensure that the child wears a MedicAlert bracelet at all times.

Question 9

The nurse receives 4 prescriptions for a child diagnosed with hemophilia A who was brought to the emergency department following an injury on the school playground. The child has vomited once and has a headache. Which prescription should the nurse carry out first?

Accepted Answer

Hemophilia is a bleeding disorder caused by a deficiency in coagulation proteins. Treatment consists of replacing the missing clotting factor and teaching the client about injury prevention. Clients with hemophilia who are injured should be monitored closely for bleeding (eg, intracranial bleeds, bleeding into joints). Signs of an intracranial bleed include lethargy, headache, irritability, and vomiting. An intracranial bleed is lethal if unchecked, so administration of factor VIII to a client with hemophilia A is the first order of action, followed by a CT scan. (Option B) Ondansetron (Zofran) can be given to treat nausea/vomiting, but administration of factor VIII is the priority. (Option C) Laboratory studies, particularly hemoglobin and hematocrit levels, are necessary, but the priority is to administer factor VIII. (Option D) A CT scan should be performed for diagnostic purposes, but the bleeding must be stopped emergently. Even if bleeding is evident on CT scan and the client is taken to the operating room, surgery cannot be performed without simultaneous factor VIII replacement. Educational objective: A client with hemophilia A and a head injury is at risk for intracranial bleeding (which sometimes occurs spontaneously). When intracranial or another form of bleeding is suspected, administration of factor VIII is a priority as the client's body cannot form a clot without it.

Question 10

A nurse manager on a pediatric oncology unit is leading a discussion about personal coping strategies that nurses can use to remain effective when caring for dying children.  What should be included in the discussion?

Accepted Answer

Nurses who care for dying children experience many of the same feelings that the child's family does, resulting in stress that may lead to compassion fatigue. To remain positive in the caring role, nurses must implement appropriate coping strategies to enhance self-care and grief resolution. Attending a memorial service can demonstrate care for the grieving family while also providing closure for the nurse. Other helpful strategies for coping include: taking time off from work if distancing is needed, utilizing personal and professional support systems (eg, spouse, employee assistance programs, experienced mentors), and maintaining good health through adequate rest, regular exercise, and proper nutrition. (Option B) The nurse should maintain a level of objectivity to make effective care decisions, but it is sometimes appropriate to share personal emotions of loss or sadness with the family of a dying child. Honesty and personal connection support the coping process for the nurse and the family. (Option C) Personal contact with the family of the deceased child for an extended period after their loss is helpful for the nurse and the family during the grieving process, particularly if a close relationship was established during hospitalization. (Option D) Although exercise is an important part of maintaining overall health, there is no evidence that increasing the length of daily exercise routines is an effective coping strategy. Educational objective: Nurses who care for dying children experience many of the same feelings that the family of the dying child does, resulting in stress that may lead to compassion fatigue. To remain effective in the care-giving role, nurses should utilize professional and personal support systems, share in end-of-life celebration rituals, and take time off from work when distancing is needed. The family and the nurse can gain support by remaining in contact during the grieving process.

Question 11

The nurse just administered routine immunizations to a healthy 15-month-old.  What information should the nurse provide the caregivers before they leave the clinic?

Accepted Answer

Common side effects of immunizations include a mild fever and soreness and redness at the injection site. Caregivers should be instructed to apply a warm compress to the injection site and taught how to correctly calculate the dose of acetaminophen or ibuprofen needed for these symptoms. (Option A) The health care provider should be notified if the child's temperature is higher than 100.4 F (38 C). (Option B) Children may have increased fussiness and anorexia following immunizations. These symptoms should not last more than 24 hours. (Option D) A child's activity level should not be restricted following immunizations. Being active may actually help decrease any soreness if the child moves the injected extremity. Educational objective: Common side effects of immunizations include a mild fever and soreness and redness at the injection site. Anorexia and fussiness can be present for the first 24 hours.

Question 12

A school-age child is brought to the emergency department due to nausea, vomiting, and severe right lower quadrant pain. The child's white blood cell count is 17,000/mm³ (17.0 x 10⁹/L). Which statement by the child is of most concern to the nurse?

Accepted Answer

A child with acute-onset right lower quadrant abdominal pain, nausea, and vomiting and a high white blood cell count likely has acute appendicitis. Appendicitis is a serious condition that usually requires emergency surgery due to the risk of appendix rupture. The pain results from swelling and inflammation of the appendix. However, once the appendix ruptures, pain is relieved only temporarily and will return with full-blown peritonitis and sepsis. (Option A) Clients diagnosed with appendicitis often need immediate surgery. The client will be placed NPO until surgery is performed to remove the appendix. (Option B) This is a normal statement that will be made by many children. (Option C) Tiredness is nonspecific and could be due to many reasons (eg, pain medication). Educational objective: Appendicitis is an acute condition that needs immediate surgical intervention to prevent appendix rupture and subsequent peritonitis and sepsis.

Question 13

The nurse is completing chemotherapy education with an adolescent client.  The client states "I would rather continue to have cancer than lose all of my hair."  How should the nurse respond?

Accepted Answer

Adolescent clients who are hospitalized often fear separation from their friends and altered body image related to disease processes or treatment. Interaction with peers who are experiencing similar health issues can help alleviate anxiety. Clients should be offered opportunities to discuss fears and experiences with peers in a supportive environment (eg, "teen rooms") (Option B). (Option A) Automatic or clichéd responses (eg, "It won't be so bad") are nontherapeutic as they limit discussion and expression of the client's experience and emotion. (Option C) Although the adolescent client may choose to wear head scarves, adjustment to alterations in body image is best achieved by connecting with peers in similar circumstances. (Option D) Shifting the client's focus to the future does not address the current crisis. In addition, adolescent clients are still developing abstract thinking and may have difficulty conceptualizing the future in times of distress. Educational objective: Adolescent clients who are hospitalized often fear altered body image and separation from their friends. Interaction with peers who are experiencing similar health issues can help alleviate anxiety.

Question 14

A child received the varicella immunization.  The day after the injection, the parent calls the nurse to say that the child has discomfort, slight redness, and 2 vesicles at the injection site.  What instruction would be appropriate for the nurse to provide to this parent?

Accepted Answer

The varicella immunization is administered to prevent infection of varicella zoster, commonly known as chickenpox. Side effects of the immunization include discomfort, redness, and a few vesicles at the injection site. Covering the vesicles with clothing or a small bandage will reduce the risk of transmission from any exudate. Once the vesicles have dried, or crusted, a dressing is no longer necessary. (Option A) Acetaminophen is the appropriate medication to reduce the discomfort of the injection. Aspirin should be avoided in children due to the risk of Reye syndrome. (Option C) Unless the rash becomes widespread, isolation of the child is unnecessary. It is unlikely that the infection will be transmitted by the 2 vesicles, but covering them with clothing or a small bandage will decrease the risk of transmission. (Option D) Discomfort, redness, and a few vesicles at the injection site are common side effects of the varicella immunization and do not require the attention of an HCP. Educational objective: Discomfort, redness, and vesicles at the injection site are common side effects of the varicella immunization. Covering the vesicles with clothing or a small bandage will reduce the risk of transmission from any exudate.

Question 15

The nurse is caring for a child who has had a tonsillectomy. Which of the following are appropriate nursing interventions? Select all that apply.

Accepted Answer

A tonsillectomy may be indicated in some cases of chronic tonsillitis, peritonsillar abscess, or obstructive sleep apnea. Postoperative bleeding is a primary concern after a tonsillectomy because the surgical site is not easily visualized and is vulnerable to irritation and trauma from swallowing and coughing. The nurse should observe for signs of postoperative bleeding (eg, frequent, increased swallowing or clearing of the throat; vomiting bright red blood) and notify the health care provider (Option D). Expected postoperative findings include ear pain when swallowing (ie, referred pain from the throat) and low-grade fever (<101 F [38.3 C]); analgesics (eg, acetaminophen) may be administered as needed (Option A). Superficial infection at the surgical site is common and causes white, fluid-filled exudate in the throat with halitosis (ie, bad breath); this is not concerning because it usually resolves spontaneously after 5-10 days (Option B). (Option C) Drinking through a straw creates suction that causes localized pressure at the back of the throat and may contribute to bleeding. The client should avoid use of straws or other pointed objects in the mouth. (Option E) Routine suctioning can cause trauma to the surgical site and induce bleeding. Suction equipment should be available but used only for emergency airway obstruction. Educational objective: Postoperative tonsillectomy interventions include close observation for signs of bleeding (eg, frequent swallowing) as well as avoidance of routine oral suctioning and the use of straws. Expected findings include white, fluid-filled exudate in the throat with halitosis, low-grade fever, and referred ear pain.

Question 16

A parent calls the nurse telehealth triage line with concerns about an allergic reaction to something a child ate. Which symptoms should the nurse instruct the parent to assess for to determine if the child is having an anaphylactic reaction? Select all that apply.

Accepted Answer

11ecbb05_cad3_2b75_b433_23769476ca52_MD0009_00 The nurse should instruct the parent to first assess for signs of swelling of the mouth, tongue, lips, and upper airway. The child will have wheezing and difficulty breathing next, followed soon by cardiovascular symptoms. These include lightheadedness due to hypotension, loss of consciousness, and cardiovascular collapse. An anaphylactic reaction is life-threatening and requires rapid assessment and intervention. (Option B) Fever is not a symptom of an anaphylactic reaction that would be included in the rapid assessment. Educational objective: Anaphylaxis is a medical emergency requiring rapid assessment and intervention. Symptoms of an anaphylactic reaction include signs of respiratory compromise (eg, oral and airway swelling, stridor, wheezing, chest tightness) and shock (eg, dizziness, loss of consciousness).

Question 17

The nurse planning teaching for the parents of a child newly diagnosed with hemophilia will include information about which long-term complication?

Accepted Answer

Hemophilia is a bleeding disorder caused by a deficiency in coagulation proteins. Clients with classic hemophilia, or hemophilia A, lack factor VIII. Clients with hemophilia B (Christmas disease) lack factor IX. When injured, clients with hemophilia should be monitored closely for external as well as internal bleeding. The most frequent sites of bleeding are the joints (80%), especially the knee. Hemarthrosis can occur with minimal or no trauma, with episodes beginning during toddlerhood when the child is active and ambulatory. Over time, chronic swelling and deformity can occur. (Option A) Heart valve injury is common with rheumatic heart disease not hemophilia. (Option B) Intellectual disability in children is commonly seen with fetal alcohol syndrome, Down syndrome, hypothyroidism, and lead poisoning. In rare cases, hemophilia can cause life-threatening intracranial bleeding. However, isolated intellectual disability is not seen. (Option D) Recurrent pneumonia is commonly seen with cystic fibrosis not hemophilia. Educational objective: Clients with hemophilia are at risk for permanent joint destruction due to frequent bleeds into the joint spaces. Assisting clients with decreasing the incidence of bleeding episodes and prompt treatment when bleeding occurs can help minimize joint destruction.

Question 18

A nurse is caring for a school-age client with fever, somnolence, and a skin rash from suspected meningococcal meningitis. Which of the following interventions should the nurse plan to implement for this client? Select all that apply.

Accepted Answer

Bacterial meningitis is an infection that causes inflammation of the membranes covering the brain and spinal cord (ie, meninges). Inflammation and bacterial growth within the meninges lead to increased cerebrospinal fluid (CSF) volume and increased intracranial pressure (ICP). Without intervention, increased ICP may lead to nerve ischemia and permanent functional impairment (eg, hearing loss, visual impairment, paralysis), brain herniation, or death. The nurse should perform the following interventions: Maintain the head of the bed elevated at 30 degrees with the head and neck midline to reduce ICP by promoting drainage of cerebral venous blood and CSF (Option A) Implement seizure precautions due to potential neurologic irritability from increased ICP (Option B) Ensure a restful environment (eg, quiet, dimly lit, cool temperature) by reducing potentially irritable stimuli (Option D) (Option C) The nurse should initiate droplet precautions for clients with meningococcal meningitis that require the nurse (not the client) to wear a mask when caring for the client. The client wears a mask only if being transported outside the room. (Option E) A negative-pressure air flow room is appropriate for a client requiring airborne precautions (eg, active tuberculosis). Educational objective: Nursing care for a client with suspected meningococcal meningitis includes elevating the head of the bed at 30 degrees, implementing seizure precautions, and minimizing environmental stimuli. The nurse should implement droplet precautions that require the nurse (not the client) to wear a mask when caring for the client. The client wears the mask only if transported outside the room.

Question 19

The nurse is caring for a pediatric client with end-stage leukemia who is on comfort care and is unresponsive. The child's parent asks, "How can you tell if my child is in pain?" Which of these would the nurse describe as signs of discomfort? Select all that apply.

Accepted Answer

11ecbb05_cace_2263_b433_f92229fcc998_MD0009_00 The FLACC scale(face, legs, activity, cry, and consolability) can be used to assess pain in the child who is nonverbal. This includes assessment for: Facial grimacing Leg movement, tension, or bending up toward the chest Activity, including squirming, arching, jerking Crying or moaning Difficulty consoling or comforting the child The nurse will provide teaching on signs that should prompt the parent to administer as-needed pain medication to the child. (Option A) A child who is comfortable will usually have a neutral facial expression. A child in pain is likely to exhibit grimacing, frowning, or clenching of the jaw, based on the FLACC face assessment. (Option E) A child who is comfortable will be lying quietly. A child who is squirming and moving is more likely to be in pain, based on the FLACC activity assessment. Educational objective: It is difficult to assess for pain in the nonverbal client, particularly if the person is unresponsive at the end of life. The FLACC scale is an accurate method of assessing pain in the nonverbal child. This tool should be used to teach parents how to promote comfort for their nonverbal child.

Question 20

The nurse is triaging a 7-year-old with sickle cell crisis. The client is short of breath and vomiting and has severe generalized body and joint pains. Which assessment finding requires the most immediate intervention?

Accepted Answer

This client is exhibiting signs and symptoms of sickle cell crisis, which occurs when the client's sickle-shaped cells block blood flow through the vessels. These clients tend to have a small spleen due to repeated small splenic infarctions (autosplenectomy). Splenic sequestration crisis occurs when a large number of "sickled" cells get trapped in the spleen, causing splenomegaly. This is a life-threatening emergency as it can lead to severe hypovolemic (hypotensive) shock. The classic assessment finding is a rapidly enlarging spleen. (Option A) Normal red blood cells live about 120 days. Sickle cells break apart and die within less than 20 days; therefore, the client always has a shortage of red blood cells (anemia). Due to anemia, clients often report feeling fatigued. (Option C) Right arm weakness could indicate new-onset stroke, a common complication of sickle cell disease that needs to be assessed. However, splenic sequestration is immediately life-threatening and a priority. (Option D) Swelling of hands and feet (dactylitis) is another symptom of this disease due to the sickled red blood cells blocking blood flow to the hands and feet. This is often detected in babies as the first sign of the disease. Educational objective: Splenic sequestration crisis is a potentially life-threatening emergency of sickle cell disease. A rapidly enlarging spleen and hypotension are the characteristic assessment findings.

Exam 2: Child Health

The nurse is providing education to the parents of a child diagnosed with chronic allergic rhinitis that is triggered by dust and pollen. Which of the following statements by the parents indicate that the teaching has been effective? Select all that apply.

A 12-month-old with Kawasaki disease received IV immunoglobulin (IVIG) 2 months ago. The child is in the clinic for follow-up and scheduled immunizations. Which vaccine should be delayed? Select all that apply.

Several 12-month-old infants are brought to the clinic for routine immunizations. Which situation would be most important for the nurse to clarify with the provider before administering the vaccination?

The clinic nurse supervises a student nurse who is preparing to administer routine vaccinations to a child diagnosed with hemophilia. Which instructions should the clinic nurse provide to the student? Select all that apply.

What is the best activity for a school-aged child hospitalized for vaso-occlusive sickle cell crisis?

The parent of a 5-year-old child calls the clinic to report the recurrence of a nosebleed for which the child was seen a week ago. Which of the following instructions should the nurse reinforce? Select all that apply.

A nurse on a pediatric unit is admitting a school-aged child with suspected Reye syndrome. Which information obtained during the history taking is most consistent with this condition?

The nurse provides discharge teaching for the parents of a child newly diagnosed with hemophilia A. Which statements by the parents indicate that teaching has been effective? Select all that apply.

The nurse receives 4 prescriptions for a child diagnosed with hemophilia A who was brought to the emergency department following an injury on the school playground. The child has vomited once and has a headache. Which prescription should the nurse carry out first?

A nurse manager on a pediatric oncology unit is leading a discussion about personal coping strategies that nurses can use to remain effective when caring for dying children. What should be included in the discussion?

The nurse just administered routine immunizations to a healthy 15-month-old. What information should the nurse provide the caregivers before they leave the clinic?

A school-age child is brought to the emergency department due to nausea, vomiting, and severe right lower quadrant pain. The child's white blood cell count is 17,000/mm³ (17.0 x 10⁹/L) . Which statement by the child is of most concern to the nurse?

The nurse is completing chemotherapy education with an adolescent client. The client states "I would rather continue to have cancer than lose all of my hair." How should the nurse respond?

A child received the varicella immunization. The day after the injection, the parent calls the nurse to say that the child has discomfort, slight redness, and 2 vesicles at the injection site. What instruction would be appropriate for the nurse to provide to this parent?

The nurse is caring for a child who has had a tonsillectomy. Which of the following are appropriate nursing interventions? Select all that apply.

A parent calls the nurse telehealth triage line with concerns about an allergic reaction to something a child ate. Which symptoms should the nurse instruct the parent to assess for to determine if the child is having an anaphylactic reaction? Select all that apply.

The nurse planning teaching for the parents of a child newly diagnosed with hemophilia will include information about which long-term complication?

A nurse is caring for a school-age client with fever, somnolence, and a skin rash from suspected meningococcal meningitis. Which of the following interventions should the nurse plan to implement for this client? Select all that apply.

The nurse is caring for a pediatric client with end-stage leukemia who is on comfort care and is unresponsive. The child's parent asks, "How can you tell if my child is in pain?" Which of these would the nurse describe as signs of discomfort? Select all that apply.

The nurse is triaging a 7-year-old with sickle cell crisis. The client is short of breath and vomiting and has severe generalized body and joint pains. Which assessment finding requires the most immediate intervention?

Exam 2: Child Health

The nurse is providing education to the parents of a child diagnosed with chronic allergic rhinitis that is triggered by dust and pollen. Which of the following statements by the parents indicate that the teaching has been effective? Select all that apply.

A 12-month-old with Kawasaki disease received IV immunoglobulin (IVIG) 2 months ago. The child is in the clinic for follow-up and scheduled immunizations. Which vaccine should be delayed? Select all that apply.

Several 12-month-old infants are brought to the clinic for routine immunizations. Which situation would be most important for the nurse to clarify with the provider before administering the vaccination?

The clinic nurse supervises a student nurse who is preparing to administer routine vaccinations to a child diagnosed with hemophilia. Which instructions should the clinic nurse provide to the student? Select all that apply.

What is the best activity for a school-aged child hospitalized for vaso-occlusive sickle cell crisis?

The parent of a 5-year-old child calls the clinic to report the recurrence of a nosebleed for which the child was seen a week ago. Which of the following instructions should the nurse reinforce? Select all that apply.

A nurse on a pediatric unit is admitting a school-aged child with suspected Reye syndrome. Which information obtained during the history taking is most consistent with this condition?

The nurse provides discharge teaching for the parents of a child newly diagnosed with hemophilia A. Which statements by the parents indicate that teaching has been effective? Select all that apply.

The nurse receives 4 prescriptions for a child diagnosed with hemophilia A who was brought to the emergency department following an injury on the school playground. The child has vomited once and has a headache. Which prescription should the nurse carry out first?

A nurse manager on a pediatric oncology unit is leading a discussion about personal coping strategies that nurses can use to remain effective when caring for dying children. What should be included in the discussion?

The nurse just administered routine immunizations to a healthy 15-month-old. What information should the nurse provide the caregivers before they leave the clinic?

A school-age child is brought to the emergency department due to nausea, vomiting, and severe right lower quadrant pain. The child's white blood cell count is 17,000/mm3 (17.0 x 109/L) . Which statement by the child is of most concern to the nurse?

The nurse is completing chemotherapy education with an adolescent client. The client states "I would rather continue to have cancer than lose all of my hair." How should the nurse respond?

A child received the varicella immunization. The day after the injection, the parent calls the nurse to say that the child has discomfort, slight redness, and 2 vesicles at the injection site. What instruction would be appropriate for the nurse to provide to this parent?

The nurse is caring for a child who has had a tonsillectomy. Which of the following are appropriate nursing interventions? Select all that apply.

A parent calls the nurse telehealth triage line with concerns about an allergic reaction to something a child ate. Which symptoms should the nurse instruct the parent to assess for to determine if the child is having an anaphylactic reaction? Select all that apply.

The nurse planning teaching for the parents of a child newly diagnosed with hemophilia will include information about which long-term complication?

A nurse is caring for a school-age client with fever, somnolence, and a skin rash from suspected meningococcal meningitis. Which of the following interventions should the nurse plan to implement for this client? Select all that apply.

The nurse is caring for a pediatric client with end-stage leukemia who is on comfort care and is unresponsive. The child's parent asks, "How can you tell if my child is in pain?" Which of these would the nurse describe as signs of discomfort? Select all that apply.

The nurse is triaging a 7-year-old with sickle cell crisis. The client is short of breath and vomiting and has severe generalized body and joint pains. Which assessment finding requires the most immediate intervention?

A school-age child is brought to the emergency department due to nausea, vomiting, and severe right lower quadrant pain. The child's white blood cell count is 17,000/mm³ (17.0 x 10⁹/L) . Which statement by the child is of most concern to the nurse?