Question

A nurse is caring for a pediatric client receiving radiation therapy to the abdominal area. Which of the following statements by the nurse promotes proper skin integrity for the client?

Answer 1

Correct Answers:

"Do not wash the area with strong soaps and do not rub the area dry, just pat it dry."

Rationale :

🔷 Abdominal radiation commonly causes skin erythema, dryness, itching, and fragile skin, so gentle care is essential to prevent breakdown.

🔷 Using mild soap and lukewarm water protects the skin’s barrier and reduces irritation in the radiation field.

🔷 Rubbing can cause friction injury and worsen inflammation, so the area should be patted dry with a soft towel.

🔷 This approach lowers risk for skin tears, infection, and delayed healing in a child whose skin is already sensitive.

🔷 It also supports comfort while maintaining hygiene without disrupting the radiation-treated skin.

“You should get an abdominal binder and try to keep the area covered.”

🔷 Binders increase friction and trap heat/moisture, which can worsen irritation and skin breakdown.

🔷 Tight covering can also cause pressure injury over already fragile radiated skin.

“You need to keep the area exposed to air and direct sunshine.”

🔷 The radiation area should be protected from direct sunlight, which can worsen skin damage and hyperpigmentation.

🔷 Air exposure is fine, but sunshine is not recommended due to increased sensitivity.

“Apply some triple antibiotic ointment to help the dryness and itching.”

🔷 Topical products should not be applied unless specifically ordered because they can irritate skin or interfere with treatment recommendations.

🔷 Dryness/itching is better managed with approved moisturizers and provider-directed products, not routine antibiotic ointment.

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Answer 2

Correct Answers

Blank 1 Correct Option: Pelvic inflammatory disease
Blank 2 Correct Option: Maintain an NPO status and Instruct the adolescent about the use of sitz baths .
Blank 3 Correct Option: Temperature greater than 38.3°C (100.9°F) and Vaginal bleeding.

Rationale :

Pelvic inflammatory disease

🔷 The client has pelvic/abdominal pain, cervical mucopurulent discharge, and a positive cervical culture for chlamydia trachomatis, which strongly supports PID.

🔷 PID is an ascending infection from the cervix to the uterus/fallopian tubes and is strongly linked to STIs (chlamydia/gonorrhea).

🔷 The client also has systemic inflammation with fever, WBC 12,000/mm³, and CRP 2.6 mg/dL, which fits pelvic infection.

🔷 Urinalysis shows no leukocytes and negative nitrites, making a UTI less likely as the primary cause of dysuria.

🔷 Her negative hCG (2 IU/L) helps rule out pregnancy-related causes like ectopic pregnancy.

urinary tract infection

🔷 UA does not show infection markers: leukocyte esterase is negative, nitrites are none, and WBCs are 0.

🔷 Dysuria can occur with PID due to pelvic inflammation, so urinary symptoms alone do not confirm UTI.

Acute appendicitis

🔷 Appendicitis usually presents with RLQ pain and often rebound tenderness, which is not the key pattern emphasized here.

🔷 The stronger evidence is cervical discharge + chlamydia, pointing to genital tract infection.

Ectopic pregnancy

🔷 Ectopic pregnancy typically has positive pregnancy test and often vaginal bleeding with abdominal pain.

🔷 This client’s hCG is negative, making ectopic pregnancy unlikely.

Actions

Administer acetaminophen 650 mg PO every 6hr PRN pain

🔷PID causes significant pelvic inflammation and cramping, so pain and fever control improves comfort and recovery.

🔷Acetaminophen helps reduce pain and lowers fever, supporting physiologic stability.

🔷It is appropriate because the client is vomiting but still can receive PO if tolerated, or it prompts reassessment if unable to keep PO down.

🔷Treating fever and pain also supports better hydration and participation in care.

🔷Symptom control is important while definitive antimicrobial therapy is initiated by the provider.

Place the adolescent on bedrest in semi-Fowler’s position

🔷Semi-Fowler’s positioning can improve comfort by reducing pressure on the inflamed pelvic structures.

🔷Bedrest supports symptom control when the client has severe cramping, fever, nausea/vomiting, and systemic illness signs.

🔷Semi-Fowler’s also supports easier breathing and reduces discomfort during abdominal pain episodes.

🔷This position is often used to promote pelvic drainage and decrease pelvic congestion discomfort.

🔷It is an appropriate supportive nursing intervention while medical treatment is initiated.

Maintain an NPO status

🔷NPO is used when surgery is anticipated (e.g., appendicitis), not routine PID management.

🔷PID treatment focuses on antibiotics, pain control, hydration, not bowel rest.

Instruct the adolescent about the use of sitz baths

🔷Sitz baths are more helpful for perineal irritation (hemorrhoids, episiotomy pain), not for pelvic infection.

🔷They do not address the infection source or systemic inflammatory response in PID.

Administer an enema

🔷An enema is not indicated and may worsen discomfort in pelvic inflammatory conditions.

🔷It does not treat PID and may increase cramping.

Parameters

Temperature greater than 38.3°C (100.9°F)

🔷 PID is an infection, so temperature trends are a key indicator of whether treatment is working.

🔷 Persistent fever above 38.3°C can signal worsening infection, inadequate response to antibiotics, or complications like tubo-ovarian abscess.

🔷 The client already reports fever with chills, making temperature monitoring essential for progress evaluation.

🔷 Fever reduction is a measurable sign of decreasing systemic inflammation.

🔷 Ongoing fever also raises dehydration risk, especially with vomiting.

Vaginal bleeding

🔷PID can cause abnormal uterine bleeding due to cervical and endometrial inflammation.

🔷Monitoring bleeding helps assess progression and complications and supports safety evaluation.

🔷New or worsening bleeding can reflect worsening reproductive tract inflammation or coexisting pathology.

🔷Since the client has mucopurulent cervical discharge, monitoring for additional genital tract symptoms helps track response.

🔷Bleeding status is also essential for ongoing reproductive assessment and clinical improvement.

Rebound tenderness

🔷 Rebound tenderness is more associated with peritoneal irritation such as appendicitis.

🔷 PID can cause tenderness, but rebound is not the most specific progress marker here.

Irritation of the phrenic nerve

🔷 Phrenic nerve irritation is linked to referred shoulder pain from diaphragmatic irritation (e.g., free air, rupture).

🔷 This is not a standard PID progress indicator.

Presence of a Cullen sign

🔷 Cullen sign suggests intra-abdominal bleeding (e.g., pancreatitis/hemorrhage), not PID monitoring.

🔷 It is unrelated to this client’s confirmed STI/pelvic infection picture.

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Answer 3

Correct Highlights :

Capillary refill 4 seconds
Extremities cool
Reports no tears
Lethargic

Rationale :

Capillary refill 4 seconds

🟣A capillary refill of 4 seconds is abnormal and indicates poor peripheral perfusion.

🟣In a toddler with 3 days of diarrhea and now vomiting, this strongly suggests worsening dehydration and possible hypovolemia.

🟣Delayed refill reflects reduced circulating volume and the body’s attempt to preserve blood flow to vital organs.

🟣This is a circulation warning sign that can progress to hypovolemic shock if not corrected quickly.

🟣 Immediate follow-up is needed to reassess hydration status, perfusion, and IV fluid adequacy.

Extremities cool

🟣 Cool extremities indicate peripheral vasoconstriction, a compensatory response to low circulating volume.

🟣 With ongoing fluid losses and no oral intake, the toddler’s body is shunting blood to core organs.

🟣 This finding pairs dangerously with delayed capillary refill, confirming impaired perfusion.

🟣 Cool extremities can be an early sign of circulatory compromise in pediatric dehydration.

🟣 This requires immediate follow-up to prevent progression to shock.

Reports no tears

🟣Absence of tears is a classic pediatric sign of moderate to severe dehydration.

🟣 The toddler has had diarrhea for 3 days, refuses oral intake, and vomited, increasing fluid deficit.

🟣No tears reflect decreased body water and reduced secretions due to volume depletion.

🟣This finding supports escalation of hydration interventions and close monitoring of perfusion and urine output.

🟣Immediate follow-up is needed because dehydration in toddlers can worsen rapidly.

Lethargic

🟣Lethargy in a toddler with GI fluid losses is a red flag for worsening dehydration and decreased cerebral perfusion.

🟣The toddler was alert earlier and is now sleeping, vomiting, and lethargic, showing clinical decline.

🟣Lethargy may also indicate evolving electrolyte imbalance or hypovolemia affecting neurologic status.

🟣This is an urgent change because children can compensate until they suddenly decompensate.

🟣Immediate follow-up is required to reassess vitals, perfusion, glucose/electrolytes, and fluid resuscitation needs.

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Answer 4

Correct Answers:

"I saw on the internet that there's a new treatment option."

Rationale :

🔷 This statement reflects active coping because the guardian is seeking information and exploring options for the child’s care.

🔷 Looking for treatment possibilities shows engagement, hope, and problem-solving, which are common signs of positive adjustment.

🔷 It indicates the guardian is not withdrawing but is trying to understand the situation and participate in decisions.

🔷 The nurse can build on this by guiding the guardian to reliable medical sources and encouraging discussion with the healthcare team.

🔷 This approach supports a sense of control and preparedness during a very stressful diagnosis.

“I don’t want my family to know about my child’s diagnosis.”

🔷 This suggests secrecy and isolation, which can reduce emotional support and increase caregiver burden.

🔷 Avoiding disclosure often reflects maladaptive coping and difficulty processing the situation.

“I wish I knew what I did to cause my child to be sick.”

🔷 This reflects guilt and self-blame, which are common in grief but are not signs of positive adjustment.

🔷 Persistent self-blame can worsen stress and interfere with effective coping and caregiving.

“I am not sure how to care for my dying child.”

🔷 This indicates uncertainty and lack of confidence, suggesting the guardian needs support and education.

🔷 While honest, it reflects unmet coping resources rather than positive adjustment.

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Answer 5

Correct Answers

Blank 1 Correct Option: IV hydromorphone
Blank 2 Correct Option: pain

Rationale :

🔷 The child is in a vaso-occlusive crisis with escalating severe pain from 7/10 to 10/10, which requires rapid, effective analgesia.

🔷 Severe sickle cell pain is caused by microvascular occlusion, leading to tissue ischemia and intense inflammation in areas like the swollen, warm knee.

🔷 IV hydromorphone is appropriate because it provides fast, potent pain relief when oral medications are inadequate for crisis-level pain.

🔷 Prompt pain control helps reduce physiologic stress that can worsen sickling and supports improved oxygen delivery and comfort.

🔷 The lab values show anemia (Hgb 9, Hct 18%), but the immediate priority in this scenario is managing the uncontrolled acute pain.

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Answer 6

Correct Answers:

"Two separate samples will be collected to ensure accuracy of the test results."

Rationale :

🔷 The sweat chloride test confirms cystic fibrosis by measuring chloride concentration in sweat, which is elevated in CF due to abnormal CFTR function.

🔷 Best practice is to collect two sweat specimens to improve accuracy and reliability of the result.

🔷 The test is noninvasive, using mild electrical stimulation (iontophoresis) to produce sweat, then collecting it on gauze or a coil.

🔷 It does not require fasting, and it is not typically painful—children usually feel mild tingling at most.

🔷 Emphasizing two samples helps the guardian understand that the team is ensuring a valid, confirmatory measurement.

“Your child should avoid eating and drinking 6 hours prior to the test.”

🔷 Fasting is not required because the test measures sweat chloride, not blood glucose or gastric contents.

🔷 The child can usually eat and drink normally unless other tests are scheduled.

“It will take approximately 3 hours to complete the test.”

🔷 The sweat test is usually completed in well under 3 hours (collection and processing are typically much shorter).

🔷 Stating 3 hours may increase anxiety and is not an accurate expectation for most settings.

“Your child will need to receive sedation to minimize pain during the test.”

🔷 Sedation is not needed because the sweat test is noninvasive and only causes mild tingling or warmth.

🔷 Sedation would add unnecessary risk and is not standard for this procedure.

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Answer 7

Correct Answers

WBC count [ Indication of potential worsening condition ]
Temperature [ Indication of potential improvement ]
Weight-bearing ability on the affected leg [ Indication of potential improvement ]
Wound assessment [ Indication of potential improvement ]

Rationale :

WBC Count → Indication of potential worsening condition

✨ The WBC count increased from 14,000/mm³ to 15,000/mm³, which indicates a continued or worsening inflammatory response.

✨In cellulitis, an elevated WBC reflects active infection, and an upward trend suggests treatment may not yet be fully effective.

✨Despite clinical improvements in other areas, a rising WBC can signal persistent bacterial activity.

✨This finding warrants close monitoring for systemic spread or need for antibiotic adjustment.

✨Trending laboratory values are critical in evaluating infection response, and an increase is concerning.

Temperature → Indication of potential improvement

✨The temperature decreased from 38.8°C (101.8°F) to 37.6°C (99.7°F), which shows a reduction in systemic inflammatory response.

✨Fever reduction is one of the earliest signs that antibiotic therapy is effective.

✨Lower temperature suggests decreased cytokine-mediated immune activation.

✨The adolescent is moving toward a more stable physiologic state.

✨This downward trend supports partial improvement of infection.

Weight-bearing ability on the affected leg → Indication of potential improvement

✨On Day 1, the adolescent reported pain with walking rated 6/10, but by Day 2 ambulated twice and tolerated it well.

✨Improved ambulation indicates reduced pain and inflammation at the cellulitis site.

✨Increased functional mobility suggests decreasing tissue edema and discomfort.

✨This demonstrates that local infection symptoms are improving with treatment.

✨Functional improvement is an important clinical marker of recovery.

Wound assessment → Indication of potential improvement

✨ The indurated area decreased from 6 × 6 cm to 5 × 5 cm, indicating reduction in localized inflammation.

✨ Decreasing size of erythema and induration suggests the antibiotics are limiting bacterial spread.

✨ Although warmth and tenderness persist, the smaller wound borders reflect positive response.

✨ Marking the wound borders allows accurate tracking of progression, and shrinkage is a favorable sign.

✨ Overall, this supports gradual improvement of the cellulitis.

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Answer 8

Correct Answers:

89

Rationale :

🔷 Convert weight: 13 lb ÷ 2.2 = 5.9 kg.

🔷 Daily dose ordered: 30 mg/kg/day × 5.9 kg = 177 mg/day.

🔷 The order says divided every 12 hr, so that is 2 doses/day.

🔷 Dose per administration: 177 ÷ 2

📌88.5 mg.

📌Round to the nearest whole number: 89 mg per dose.

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Answer 9

Correct Answers:

Indicate on a stuffed animal where the procedure will be performed.

Rationale :

🟣 A 9-year-old benefits from concrete, visual teaching to reduce fear and improve understanding.

🟣 Using a stuffed animal helps the child visualize where the surgery occurs and what to expect.

🟣 This supports coping by making the explanation age-appropriate and less abstract.

🟣 It also encourages questions and participation in learning.

🟣 This method improves cooperation and reduces anxiety before surgery.

Provide teaching immediately before the procedure.

🟣 Teaching right before surgery increases anxiety and limits time to process information.

🟣 School-age children learn better when teaching occurs in advance.

Use simple diagrams to explain the procedure.

🟣 Diagrams can help, but demonstration on a stuffed animal is usually more developmentally concrete.

🟣 The stuffed animal approach is often more effective for anxiety reduction.

Discuss the benefits of the procedure.

🟣 Benefits matter, but children still need concrete understanding of what will happen to their body.

🟣 This alone is not the best teaching action for this age group.

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Answer 10

Correct Answers:

"Share a bedroom with your infant for the first 6 months."

Rationale :

🔴 Room-sharing (same room, separate sleep surface) lowers the risk of sleep-related infant death.

🔴 It allows the caregiver to monitor the infant and respond promptly.

🔴 This supports safer sleep without the risks of bed-sharing.

🔴 Safe sleep teaching also includes firm mattress and avoiding soft bedding.

🔴 This statement aligns with evidence-based SUID prevention.

“Use bumper pads around the interior of your infant’s crib.”

🔴 Bumper pads increase suffocation and entrapment risk.

🔴 The crib should be kept free of soft objects.

“Cover your infant with a nonflammable blanket at bedtime.”

🔴 Loose blankets increase suffocation risk; use a sleep sack instead.

🔴 Safe sleep requires keeping soft bedding out of the sleep area.

“Place your infant on a soft crib mattress after they are 4 months old.”

🔴 Infants should sleep on a firm mattress at all ages.

🔴 Soft surfaces increase risk of airway obstruction and SUID.

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Findings	Indication of potential improvement	Indication of potential worsening condition
WBC count
Temperature
Weight-bearing ability on the affected leg
Wound assessment

QLexNursing

1 :
A nurse is caring for a pediatric client receiving radiation therapy to the abdominal area. Which of the following statements by the nurse promotes proper skin integrity for the client?

2 :
A nurse is caring for an adolescent.

Correct Answers

3 :
A nurse is caring for a toddler admitted to the hospital.

Correct Highlights :

4 :
A nurse is assessing the coping skills of the guardian of a child who has a terminal cancer. Which of the following statements by the guardian demonstrates positive adjustment?

5 :
A nurse is caring for a 12-year-old client who has sickle cell disease.

Correct Answers

6 :
A nurse is teaching the guardian of a child who is suspected of having cystic fibrosis and is scheduled for a sweat chloride test. Which of the following statements should the nurse include?

7 :
A nurse is caring for a 15-year-old adolescent who has cellulitis of the left lower calf.

Correct Answers

9 :
A nurse is providing preoperative teaching for a 9-year-old child who is scheduled for a tonsillectomy. Which of the following actions should the nurse take?

10 :
A nurse is providing teaching to a parent about sudden unexpected infant death (SUID). Which of the following statements should the nurse include?

QLexNursing

1 : A nurse is caring for a pediatric client receiving radiation therapy to the abdominal area. Which of the following statements by the nurse promotes proper skin integrity for the client?

2 : A nurse is caring for an adolescent.

Correct Answers

3 : A nurse is caring for a toddler admitted to the hospital.

Correct Highlights :

4 : A nurse is assessing the coping skills of the guardian of a child who has a terminal cancer. Which of the following statements by the guardian demonstrates positive adjustment?

5 : A nurse is caring for a 12-year-old client who has sickle cell disease.

Correct Answers

6 : A nurse is teaching the guardian of a child who is suspected of having cystic fibrosis and is scheduled for a sweat chloride test. Which of the following statements should the nurse include?

7 : A nurse is caring for a 15-year-old adolescent who has cellulitis of the left lower calf.

Correct Answers

9 : A nurse is providing preoperative teaching for a 9-year-old child who is scheduled for a tonsillectomy. Which of the following actions should the nurse take?

10 : A nurse is providing teaching to a parent about sudden unexpected infant death (SUID). Which of the following statements should the nurse include?

1 :
A nurse is caring for a pediatric client receiving radiation therapy to the abdominal area. Which of the following statements by the nurse promotes proper skin integrity for the client?

2 :
A nurse is caring for an adolescent.

3 :
A nurse is caring for a toddler admitted to the hospital.

4 :
A nurse is assessing the coping skills of the guardian of a child who has a terminal cancer. Which of the following statements by the guardian demonstrates positive adjustment?

5 :
A nurse is caring for a 12-year-old client who has sickle cell disease.

6 :
A nurse is teaching the guardian of a child who is suspected of having cystic fibrosis and is scheduled for a sweat chloride test. Which of the following statements should the nurse include?

7 :
A nurse is caring for a 15-year-old adolescent who has cellulitis of the left lower calf.

9 :
A nurse is providing preoperative teaching for a 9-year-old child who is scheduled for a tonsillectomy. Which of the following actions should the nurse take?

10 :
A nurse is providing teaching to a parent about sudden unexpected infant death (SUID). Which of the following statements should the nurse include?