Question

A nurse is educating the parent of a toddler who has sickle cell anemia. Which of the following statements by the parent indicates that the teaching was effective?

Answer 1

Correct Answers:

"My child should not participate in contact sports."

Rationale :

💠 Children with sickle cell anemia are at risk for vaso-occlusive crises triggered by dehydration, hypoxia, and physical trauma.

💠 Contact sports increase the risk of injury, hypoxia, and splenic rupture, which can precipitate a sickling crisis.

💠 Avoiding high-impact or contact activities helps reduce tissue hypoxia and physical stress, both known triggers of painful episodes.

💠 Children are encouraged to participate in moderate, well-hydrated, low-impact activities instead of strenuous contact sports.

💠 Proper education includes maintaining hydration, preventing infection, and avoiding extreme temperatures to reduce crisis risk.

"My child should not receive immunizations."

💠 Children with sickle cell anemia require up-to-date immunizations, especially pneumococcal and meningococcal vaccines.

💠 They are at increased risk for infection due to functional asplenia.

"Daily medicine to prevent viral infections."

💠 Prophylactic antibiotics (such as penicillin) are used primarily to prevent bacterial infections, not viral infections.

💠 The statement reflects misunderstanding of the purpose of preventive therapy.

"Monthly blood transfusions."

💠 Routine monthly transfusions are not required for all children with sickle cell disease.

💠 Transfusions are reserved for specific complications such as stroke prevention.

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Answer 2

Correct Answers

Blank 1 Correct Option: pyelonephritis
Blank 2 Correct Option: renal scarring

Rationale :

💠 Vesicoureteral reflux (VUR) allows urine to flow backward from the bladder to the kidneys, increasing the risk of upper urinary tract infection.

💠 The child has fever, lethargy, positive nitrites, leukocyte esterase, and elevated WBCs, all of which strongly suggest a bacterial urinary tract infection.

💠 When infection ascends to the kidneys, it can lead to acute pyelonephritis, a serious renal infection.

💠 Infants and toddlers are particularly vulnerable because their immune systems are still developing.

💠 Recurrent UTIs combined with VUR significantly increase the likelihood of kidney involvement.

Renal Scarring

💠 Repeated kidney infections associated with vesicoureteral reflux can cause permanent renal scarring.

💠 Renal scarring may impair kidney function over time and increase the risk for hypertension and chronic kidney disease.

💠 Early identification and treatment of UTIs are essential to prevent long-term structural kidney damage.

💠 The child’s history of three UTIs in one year increases concern for cumulative renal injury.

💠 Preventing recurrent infections is critical to preserving normal renal development in children.

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Answer 3

Correct Answers:

Loosen restrictive clothing during a seizure.

Rationale :

💠 During a generalized seizure, the priority nursing intervention is to maintain airway patency and prevent injury.

💠 Loosening restrictive clothing, especially around the neck, helps promote adequate breathing and reduces the risk of airway obstruction.

💠 This intervention supports oxygenation without interfering with the seizure activity.

💠 The nurse should also protect the child’s head and turn the child to the side if possible to reduce aspiration risk.

💠 Safety measures focus on non-restrictive protection, allowing the seizure to run its course safely.

Administer oral valproic acid during a seizure

💠 Oral medications cannot be safely administered during active seizure activity due to aspiration risk.

💠 Antiepileptic medications are used for maintenance therapy, not during an active seizure episode.

Restrain the child's arms

💠 Restraining can cause musculoskeletal injury.

💠 It does not stop seizure activity and increases harm risk.

Elevate the head of the bed to 30°

💠 Raising the head may increase fall risk during convulsions.

💠 The child should be positioned safely, preferably side-lying, on a flat surface.

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Answer 4

Correct Answers:

Check the pH of the gastric secretions.

Rationale :

💠 The first and most critical step before administering enteral feeding is verifying proper NG tube placement.

💠 Checking the pH of gastric aspirate (expected ≤5.5 in most clients) helps confirm the tube is in the stomach.

💠 Administering feeding without verifying placement can result in aspiration pneumonia or respiratory compromise if the tube is misplaced in the lungs.

💠 Patient safety principles require confirmation of placement before flushing, connecting tubing, or initiating feeding.

💠 Ensuring correct placement prevents serious complications and follows evidence-based enteral feeding guidelines.

Set the administration rate

💠 The feeding rate is adjusted only after placement has been confirmed.

💠 Programming the pump first could delay recognition of incorrect tube placement.

Flush the tube with water

💠 Flushing is appropriate after verifying placement.

💠 Flushing prior to confirmation risks instilling fluid into the lungs.

Attach feeding bag tubing

💠 Connecting feeding tubing before verification could result in accidental aspiration.

💠 Placement confirmation is always the priority.

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Answer 5

Correct Answers:

15

Rationale :

👍Step 1: Calculate total daily dose

50 mg/kg/day × 30 kg = 1,500 mg/day

👍Step 2: Divide into 4 equal doses (every 6 hr)

1,500 mg ÷ 4 = 375 mg per dose

👍Step 3: Use the available concentration

125 mg = 5 mL

👍Step 4: Set up the proportion

125 mg : 5 mL = 375 mg : x mL

125x = 375 × 5

125x = 1,875

x = 1,875 ÷ 125

x = 15 mL

👍Final Answer: 15 mL per dose

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Answer 6

Correct Answers:

Compartment syndrome

Rationale :

🔴 Compartment syndrome is a life-threatening complication that can develop within hours after fractures due to increased pressure inside a closed muscle compartment.

🔴 Multiple closed fractures increase internal bleeding and edema, which raises intra-compartmental pressure and compromises blood flow.

🔴 Early signs include severe pain unrelieved by analgesics, pain with passive movement, paresthesia, pallor, and decreased pulses (the 6 P’s).

🔴 Without rapid intervention (fasciotomy), prolonged ischemia can cause permanent nerve and muscle damage within 4–6 hours.

🔴 The first 24 hours after injury are the highest-risk period because swelling peaks during this time.

Osteomyelitis

🔴 Osteomyelitis is a bone infection that typically develops days to weeks after injury.

🔴 It is not an immediate complication within the first 24 hours of a closed fracture.

Volkmann Ischemic Contracture

🔴 Volkmann contracture is a late complication resulting from untreated compartment syndrome.

🔴 It does not occur immediately but develops after prolonged ischemia.

Renal Calculi

🔴 Renal stones are unrelated to acute fracture trauma.

🔴 They are not expected within 24 hours of musculoskeletal injury.

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Answer 7

Correct Answers:

Place gates at the top and bottom of the stairs.
Ensure the crib mattress is in the lowest position.

Rationale :

🟢 A 10-month-old infant is typically crawling and beginning to pull to stand, increasing fall risk.

🟢 Safety gates help prevent serious injuries from stair falls, which are common in this age group.

🟢 Gates should be securely mounted, especially at the top of stairs, to prevent displacement.

🟢 Infants at this developmental stage have curiosity without awareness of danger.

🟢 Fall prevention is a priority injury-prevention strategy in late infancy.

🟢 Ensure the crib mattress is in the lowest position

🟢 At 10 months, infants often pull to stand and may attempt to climb out of the crib.

🟢 Lowering the mattress reduces the risk of falling over the crib rails.

🟢 This adjustment aligns with developmental milestones of increased mobility.

🟢 Falls from cribs can result in head injury or fractures.

🟢 Safe sleep environments must adapt as the infant becomes more mobile.

Select a toy chest with a heavy hinged lid

🟢 Heavy lids pose a risk for finger injury or suffocation if the lid closes unexpectedly.

🟢 Toy chests should have lightweight or safety-hinged lids.

Keep toilet lids upright

🟢 Toilets should remain closed to prevent drowning risk.

🟢 Even small amounts of water pose a danger to infants.

Remove labels from toxic containers

🟢 Labels should remain on containers to identify substances in case of poisoning.

🟢 Removing labels increases risk during emergencies.

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Answer 8

Correct Answers:

Consult with a nutritionist.

Rationale :

🔵 Medical nutrition therapy is a cornerstone of managing type 1 diabetes mellitus.

🔵 Adolescents require individualized meal planning to balance carbohydrate intake with insulin administration and physical activity.

🔵 A registered nutritionist provides education on carbohydrate counting, portion control, and glycemic management, which are essential for maintaining stable blood glucose levels.

🔵 Proper dietary guidance reduces the risk of hyperglycemia, hypoglycemia, and long-term complications such as nephropathy and retinopathy.

🔵 Early referral promotes self-management skills and empowers the adolescent to take an active role in diabetes care.

Store opened vials of insulin for up to 60 days

🔵 Opened insulin vials are typically stable for about 28 days at room temperature, not 60 days.

🔵 Extended use may reduce insulin potency and compromise glycemic control.

Follow up with physical therapy

🔵 Physical therapy is not routinely required for adolescents with type 1 diabetes unless mobility issues exist.

🔵 Exercise guidance is important, but PT referral is not a primary recommendation.

Monitor capillary blood glucose daily

🔵 Clients with type 1 diabetes must monitor blood glucose multiple times daily, not just once per day.

🔵 Daily monitoring alone is insufficient for safe insulin management.

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Answer 9

Correct Answers:

Increased abdominal girth

Rationale :

💠 Nephrotic syndrome is characterized by massive protein loss in the urine (proteinuria). This excessive loss of albumin is the primary underlying problem in this condition.

💠 Hypoalbuminemia develops as a result of protein loss. Low serum albumin reduces the blood’s ability to maintain normal fluid balance within the vascular space.

💠 Decreased oncotic pressure causes fluid to shift into interstitial and third spaces. This fluid movement leads to widespread edema throughout the body.

💠 Ascites develops due to fluid accumulation in the peritoneal cavity. In toddlers, this presents clinically as increased abdominal girth.

💠 Abdominal distention is a hallmark sign of fluid retention in nephrotic syndrome. Monitoring abdominal circumference helps assess severity and progression of edema.

Constipation

💠 Nephrotic syndrome primarily affects renal filtration and protein balance rather than gastrointestinal function.

💠 Constipation is not a typical clinical manifestation associated with this condition.

Irritability

💠 Irritability is a nonspecific pediatric symptom that can occur in many illnesses.

💠 It does not directly reflect the underlying pathophysiology of protein loss and edema seen in nephrotic syndrome.

Increased urinary output

💠 Nephrotic syndrome leads to fluid retention due to decreased oncotic pressure.

💠 Children are more likely to experience decreased urine output rather than increased urinary output.

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Answer 10

Correct Answers:

Secure the restraints with a quick-release knot.

Rationale :

💠 A quick-release knot ensures the nurse can rapidly remove the restraint if the child develops respiratory distress, vomiting, or circulatory compromise.

💠 Pediatric restraint guidelines require that safety mechanisms allow for instant release to prevent injury or suffocation.

💠 Quick-release ties reduce the risk of impaired circulation by allowing prompt assessment and adjustment of the restraint.

💠 This method promotes compliance with legal and ethical standards for safe restraint application.

💠 Proper restraint technique prioritizes patient safety while maintaining control of aggressive behavior.

Tie the restraints to the side rails of the child's bed

Restraints should never be attached to side rails.

💠 Side rails move when raised or lowered, increasing the risk of strangulation or injury.

💠 Restraints must be secured to the bed frame to ensure stability and safety.

Assess the child every 4 hr while in restraints

Children in restraints require frequent monitoring.

💠 Assessments should occur much more frequently, typically every 15 to 30 minutes depending on policy.

💠 Circulation, skin integrity, and psychological status must be closely evaluated to prevent complications.

Request that the provider renew the prescription for restraints every 48 hr

Restraint prescriptions for children must be renewed more frequently than every 48 hours.

💠 Pediatric restraint orders are generally limited to 24 hours and require ongoing reassessment.

💠 Frequent provider review ensures restraints are used for the shortest duration necessary.

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QLexNursing

1 :
A nurse is educating the parent of a toddler who has sickle cell anemia. Which of the following statements by the parent indicates that the teaching was effective?

2 :
A nurse in a provider's office is caring for a 1-year-old toddler.

Correct Answers

3 :
A nurse is caring for an 8-year-old child who has a new onset of generalized seizures. Which of the following interventions should the nurse include in the plan of care?

4 :
A nurse is preparing to administer an enteral feeding to an adolescent who has an NG tube. Which of the following actions should the nurse take first?

6 :
A nurse is assessing a child who has multiple closed fractures of the lower extremities due to a motor-vehicle crash. The nurse should monitor the child for which of the following complications during the first 24 hr after the injury occurred?

7 :
A nurse is teaching a parent of a 10-month-old infant about home safety. Which of the following instructions should the nurse include in the teaching? (Select all that apply.

8 :
A nurse is caring for an adolescent who has a new diagnosis of type 1 diabetes mellitus. Which of the following recommendations should the nurse make?

9 :
A nurse is assessing a toddler during a well-child visit. Which of the following findings should the nurse identify as an indication of nephrotic syndrome?

10 :
A nurse is applying soft limb restraints to a child who is acting aggressively toward staff. Which of the following actions should the nurse take?

QLexNursing

1 : A nurse is educating the parent of a toddler who has sickle cell anemia. Which of the following statements by the parent indicates that the teaching was effective?

2 : A nurse in a provider's office is caring for a 1-year-old toddler.

Correct Answers

3 : A nurse is caring for an 8-year-old child who has a new onset of generalized seizures. Which of the following interventions should the nurse include in the plan of care?

4 : A nurse is preparing to administer an enteral feeding to an adolescent who has an NG tube. Which of the following actions should the nurse take first?

6 : A nurse is assessing a child who has multiple closed fractures of the lower extremities due to a motor-vehicle crash. The nurse should monitor the child for which of the following complications during the first 24 hr after the injury occurred?

7 : A nurse is teaching a parent of a 10-month-old infant about home safety. Which of the following instructions should the nurse include in the teaching? (Select all that apply.

8 : A nurse is caring for an adolescent who has a new diagnosis of type 1 diabetes mellitus. Which of the following recommendations should the nurse make?

9 : A nurse is assessing a toddler during a well-child visit. Which of the following findings should the nurse identify as an indication of nephrotic syndrome?

10 : A nurse is applying soft limb restraints to a child who is acting aggressively toward staff. Which of the following actions should the nurse take?

1 :
A nurse is educating the parent of a toddler who has sickle cell anemia. Which of the following statements by the parent indicates that the teaching was effective?

2 :
A nurse in a provider's office is caring for a 1-year-old toddler.

3 :
A nurse is caring for an 8-year-old child who has a new onset of generalized seizures. Which of the following interventions should the nurse include in the plan of care?

4 :
A nurse is preparing to administer an enteral feeding to an adolescent who has an NG tube. Which of the following actions should the nurse take first?

6 :
A nurse is assessing a child who has multiple closed fractures of the lower extremities due to a motor-vehicle crash. The nurse should monitor the child for which of the following complications during the first 24 hr after the injury occurred?

7 :
A nurse is teaching a parent of a 10-month-old infant about home safety. Which of the following instructions should the nurse include in the teaching? (Select all that apply.

8 :
A nurse is caring for an adolescent who has a new diagnosis of type 1 diabetes mellitus. Which of the following recommendations should the nurse make?

9 :
A nurse is assessing a toddler during a well-child visit. Which of the following findings should the nurse identify as an indication of nephrotic syndrome?

10 :
A nurse is applying soft limb restraints to a child who is acting aggressively toward staff. Which of the following actions should the nurse take?