Question

A nurse in the emergency department is preparing to discharge a 3-year- old child.

Answer 1

Correct Answers:

"You should cut and file your child's fingernails frequently."
"You should use a mild detergent for your child's laundry."
"Your child will experience occasional flare-ups of this condition."
"You can apply gloves to your child's hands."
"You should apply emollients to your child's skin after bathing.

Rationale :

🟢 A. "You should cut and file your child's fingernails frequently."

▪️Short fingernails help prevent skin trauma caused by scratching.

▪️Scratching can lead to secondary bacterial infections, particularly from Staphylococcus aureus, which colonizes broken skin.

▪️Filing smooths sharp nail edges, reducing excoriation risk.

▪️This practice is part of standard eczema management in children, where itch-scratch cycles can significantly worsen lesions.

🟢 B. "You should use a mild detergent for your child's laundry."

▪️Harsh detergents and fragranced laundry products can trigger irritation and eczema flare-ups.

▪️Mild, fragrance-free or hypoallergenic detergents reduce the risk of skin barrier disruption.

▪️The National Eczema Association (NEA) recommends avoiding fabric softeners and bleach, which may also exacerbate symptoms.

🟢 D. "Your child will experience occasional flare-ups of this condition."

▪️Atopic dermatitis is chronic and typically follows a relapsing-remitting course.

▪️Flare-ups can be caused by allergens (dust, food, pet dander), temperature changes, or skin dryness.

▪️Education about flare management, triggers, and long-term maintenance is essential for caregiver readiness and consistent control.

🟢 F. "You can apply gloves to your child's hands."

▪️Soft cotton gloves or mittens may help minimize nighttime scratching, which worsens during sleep.

▪️Gloves act as a physical barrier against skin damage and may improve sleep quality by reducing irritability and frequent waking.

▪️They should be used cautiously, ensuring comfort, breathability, and safety (no choking hazard in young children).

🟢 G. "You should apply emollients to your child's skin after bathing."

▪️Applying emollients (moisturizers) immediately after bathing (within 3 minutes) is part of the "soak and seal" method.

▪️Emollients restore the skin barrier, reduce transepidermal water loss, and prevent flare-ups.

▪️Use of fragrance-free, thick moisturizers (like ointments or creams) is highly recommended for daily maintenance and after bathing.

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Answer 2

Correct Answers

Blank 1 Correct Option: keep the child NPO
Blank 2 Correct Option: prepare the child for flexible endoscopy

Rationale :

📌A. Keep the child NPO (nothing by mouth)

🔹 Why it's FIRST:

🔺The child has excessive drooling, gagging, and confirmed esophageal foreign body—likely a button battery.

🔺NPO status is immediately required to prevent aspiration if sedation is used and to avoid worsening esophageal damage.

🔹 Risks of not doing this:

🔺Giving fluids/food could lead to aspiration pneumonia.

🔺The foreign body may shift and obstruct the airway or cause perforation.

🔹 Nursing role:

🔺Enforce NPO as soon as ingestion is suspected.

🔺Inform the team of last oral intake.

🔺 Educate caregivers not to give anything, including the "sippy cup" requested by the child.

🔹 Clinical reasoning:

🔺Button batteries can cause burns and perforation within 2 hours due to electric current and alkaline leakage.

This is a medical emergency, requiring surgical planning without delay.

📌Prepare the child for flexible endoscopy

🔸 Why it's NEXT:

🔺Once NPO is confirmed, the nurse should immediately prepare the child for an urgent endoscopic removal.

🔺Flexible endoscopy is the safest, most effective method to locate and retrieve the foreign object.

🔸 Preparation steps include:

🔸 IV access, vital signs, and medication readiness (for sedation).

🔸 Support the child and comfort the caregiver.

🔸 Ensure the provider obtains informed consent.

🔸 Complete pre-procedure safety checks.

🔸 Why it matters:

🔺Delay in removal increases risk of esophageal erosion, fistula, or airway compromise.

🔺The nurse facilitates urgent coordination for this lifesaving procedure.

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Answer 3

Correct Answers:

Monitor oxygen saturation continuously.
Give oral hydroxyurea.
Instruct the parent to ensure the pneumococcal vaccine is current.
Place the client on strict bed rest.
Administer folic acid as prescribed

Rationale :

🩸 A. Monitor oxygen saturation continuously

🩸 Hypoxia can worsen sickling of red blood cells, increasing the risk of further vaso-occlusion, organ ischemia, and pain.

🩸 Pulse oximetry ensures that the nurse can detect and respond to oxygen desaturation quickly.

🩸 While the current O₂ sat is 95%, it is critical to monitor continuously during crises, as the client is in pain, febrile, and tachypneic.

🩸 Ensuring adequate oxygen delivery supports tissue perfusion and reduces the risk of complications such as acute chest syndrome.

💊 C. Give oral hydroxyurea

💊 Hydroxyurea is a disease-modifying medication for sickle cell disease that increases fetal hemoglobin (HbF) production, which reduces the occurrence and severity of vaso-occlusive episodes.

💊 It decreases the number of sickled cells, thereby reducing pain crises, hospitalizations, and transfusion needs.

💊 Although it’s not an acute pain reliever, continuing or initiating hydroxyurea as prescribed supports long-term crisis reduction and bone marrow suppression management.

💊 This should be administered unless contraindicated, and dosing is based on weight and blood count monitoring.

💉 E. Instruct the parent to ensure the pneumococcal vaccine is current

💉 Clients with sickle cell disease are functionally asplenic due to repeated splenic infarcts, placing them at high risk for pneumococcal infections.

💉 Vaccination against Streptococcus pneumoniae is essential for infection prevention, which can trigger or worsen crises.

💉 The nurse should reinforce that routine and booster vaccinations (PCV13, PPSV23) must be up to date, especially if the child is febrile or recovering.

💉 Infection prevention is a cornerstone of long-term management in pediatric sickle cell care.

🛏️ F. Place the client on strict bed rest

🛏️ Bed rest reduces oxygen demand, minimizes joint strain, and helps control pain and inflammation during vaso-occlusive crises.

🛏️ This does not mean complete immobility, but during the acute pain phase, rest is essential to reduce metabolic stress and prevent further sickling.

🛏️ Once the crisis subsides, gentle mobilization can be introduced to prevent thromboembolic events and deconditioning. 🍃 G. Administer folic acid as prescribed

🍃 Folic acid supports red blood cell production, which is vital because patients with sickle cell disease are constantly undergoing hemolysis.

🍃 This adolescent has a low hemoglobin of 6 g/dL, which reflects chronic anemia common in sickle cell.

🍃 Supplementation helps the bone marrow produce new RBCs, supporting oxygen transport and recovery.

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Answer 4

Correct Answers:

Dornase alfa
Acetaminophen
Water-soluble vitamins
Pancreatic lipase

Rationale :

💨 B. Dornase alfa

💨 Dornase alfa (Pulmozyme) is a recombinant human deoxyribonuclease (DNase) enzyme. It is used specifically in cystic fibrosis to reduce viscosity of pulmonary secretions.

💨 It works by breaking down DNA in the thick mucus that accumulates in the lungs, making it easier to expectorate.

💨 This improves airway clearance, decreases the frequency of respiratory infections, and slows the progression of lung damage.

💨 This medication is commonly inhaled via nebulizer on a daily basis.

🌡 C. Acetaminophen

🌡 Acetaminophen is a safe, effective antipyretic and analgesic, commonly used for children.

🌡 In this case, the child has a fever of 38.4°C (101.1°F) and dyspnea, which can increase metabolic demands and oxygen consumption.

🌡 Reducing fever and discomfort supports overall respiratory status, preserves energy, and improves comfort.

🌡 It is an appropriate choice for fever management unless contraindicated (e.g., liver dysfunction).

💊 D. Water-soluble vitamins

💊 Children with cystic fibrosis have exocrine pancreatic insufficiency, leading to malabsorption of fat-soluble vitamins (A, D, E, and K).

💊 Therefore, water-miscible (soluble) forms of these vitamins are required to ensure absorption and bioavailability.

💊 These vitamins support:

Vision and immune health (Vitamin A)

Bone health (Vitamin D)

Neurological and muscle function (Vitamin E)

Clotting (Vitamin K)

💊 Deficiency can cause night blindness, osteopenia, bleeding, and poor wound healing.

🧃 E. Pancreatic lipase

🧃 Pancreatic enzyme replacement therapy (PERT) is essential in children with cystic fibrosis due to pancreatic insufficiency.

🧃 Pancrelipase (a combination of lipase, amylase, and protease) aids in digestion and nutrient absorption, especially of fats and fat-soluble vitamins.

🧃 The child has steatorrhea (frothy, foul-smelling stools with fat) — a classic sign of enzyme deficiency.

🧃 Administering enzymes with every meal and snack improves:

Weight gain

Growth

Stool quality

Nutrient absorption

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Answer 5

Correct Answers:

"Provide a doll for your 3-year-old child to imitate parental behaviors."

Rationale :

🧸 At 3 years of age, children are in the preoperational stage of development, marked by symbolic play and imitation.

🧸 Providing a doll allows the child to practice caregiving behaviors they observe in parents, easing the transition into becoming an older sibling.

🧸 This strategy helps address feelings of displacement, promotes emotional bonding, and fosters a sense of inclusion during family changes.

🧸 It's also developmentally appropriate for managing anticipation and anxiety.

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Answer 6

Correct Answers:

Initiate contact isolation precautions.

Rationale :

🧼 Impetigo contagiosa is a highly contagious bacterial skin infection, commonly caused by Staphylococcus aureus or Streptococcus pyogenes.

🧼 It spreads via direct contact with lesions or contaminated items, which necessitates contact precautions in a healthcare setting.

🧼 This includes wearing gloves and gowns, using dedicated equipment, and isolating the child if in a shared room to prevent nosocomial spread.

🧼 Reporting to public health authorities is not required for isolated impetigo, and amphotericin B is an antifungal (not appropriate here).

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Answer 7

Correct Answers:

Clear urine

Rationale :

💧 Poststreptococcal glomerulonephritis (APSGN) is an immune-mediated renal condition following a streptococcal infection.

💧 It typically presents with tea-colored urine, hematuria, proteinuria, and edema.

💧 The return of clear urine signifies reduced hematuria/proteinuria and improvement in glomerular filtration, indicating treatment effectiveness.

💧 Other signs of recovery may include decreased edema, normalized blood pressure, and stable renal function labs.

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Answer 8

Correct Answers:

FLACC

Rationale :

🧍 The FLACC scale (Face, Legs, Activity, Cry, Consolability) is validated for use in infants and toddlers, especially those who are nonverbal or cognitively impaired.

🧍 It assigns scores based on observable behaviors rather than self-reporting.

🧍 This scale is ideal in non-communicative children or after sedation, providing reliable assessment of pain before and after interventions.

🧍 Tools like FACES require more cognitive engagement and are suited for children age 3 years and older who can self-report.

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Answer 9

Correct Answers:

Prolonged wound healing

Rationale :

🩹 Prednisolone is a corticosteroid that suppresses inflammation and immune response.

🩹 One key adverse effect is delayed wound healing due to inhibition of fibroblast function, collagen synthesis, and immune cell activity.

🩹 Other side effects may include hyperglycemia, mood swings, Cushingoid features, and immunosuppression.

🩹 The nurse should monitor for signs of infection, bruising, or poor incision recovery if the child has had any procedure or trauma.

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Answer 10

Correct Answers:

Lateral

Rationale :

🛌 The lateral recumbent position (side-lying with knees pulled up and chin tucked) is the standard for lumbar puncture in children.

🛌 This position opens up the intervertebral spaces, allowing easier access to the subarachnoid space for cerebrospinal fluid (CSF) collection.

🛌 Proper positioning is critical for both procedure success and reducing complications, such as trauma to spinal structures.

🛌 The nurse should provide age-appropriate support, encourage the child to stay still, and use comfort measures (e.g., parent presence, distraction).

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QLexNursing

1 :
A nurse in the emergency department is preparing to discharge a 3-year- old child.

Answer Options

2 :
A nurse in the emergency department is caring for a toddler.

Correct Answers

3 :
A nurse is caring for an adolescent who is admitted with a vaso-occlusive crisis.

Answer Options

4 :
A nurse is caring for a school-age child who has cystic fibrosis.

Answer Options

5 :
A nurse is teaching the guardian of a newborn about how to prepare their 3-year-old child to meet their new sibling. Which of the following statements should the nurse make?

6 :
A nurse is caring for a child who has impetigo contagiosa that developed in the hospital. Which of the following actions should the nurse take?

7 :
A nurse is caring for a 5-year-old child who has acute poststreptococcal glomerulonephritis. Which of the following findings should indicate to the nurse that treatment has been effective?

8 :
A nurse is evaluating the pain level of a toddler who is cognitively impaired to a non-pharmacologic intervention. Which of the following pain scales should the nurse use to evaluate the toddler's pain level?

9 :
A nurse is assessing a school-age child who is receiving prednisolone. For which of the following adverse effects should the nurse monitor?

10 :
A nurse is preparing a child for a lumbar puncture. In which of the following positions should the child be placed for the procedure?

QLexNursing

1 : A nurse in the emergency department is preparing to discharge a 3-year- old child.

Answer Options

2 : A nurse in the emergency department is caring for a toddler.

Correct Answers

3 : A nurse is caring for an adolescent who is admitted with a vaso-occlusive crisis.

Answer Options

4 : A nurse is caring for a school-age child who has cystic fibrosis.

Answer Options

5 : A nurse is teaching the guardian of a newborn about how to prepare their 3-year-old child to meet their new sibling. Which of the following statements should the nurse make?

6 : A nurse is caring for a child who has impetigo contagiosa that developed in the hospital. Which of the following actions should the nurse take?

7 : A nurse is caring for a 5-year-old child who has acute poststreptococcal glomerulonephritis. Which of the following findings should indicate to the nurse that treatment has been effective?

8 : A nurse is evaluating the pain level of a toddler who is cognitively impaired to a non-pharmacologic intervention. Which of the following pain scales should the nurse use to evaluate the toddler's pain level?

9 : A nurse is assessing a school-age child who is receiving prednisolone. For which of the following adverse effects should the nurse monitor?

10 : A nurse is preparing a child for a lumbar puncture. In which of the following positions should the child be placed for the procedure?

1 :
A nurse in the emergency department is preparing to discharge a 3-year- old child.

2 :
A nurse in the emergency department is caring for a toddler.

3 :
A nurse is caring for an adolescent who is admitted with a vaso-occlusive crisis.

4 :
A nurse is caring for a school-age child who has cystic fibrosis.

5 :
A nurse is teaching the guardian of a newborn about how to prepare their 3-year-old child to meet their new sibling. Which of the following statements should the nurse make?

6 :
A nurse is caring for a child who has impetigo contagiosa that developed in the hospital. Which of the following actions should the nurse take?

7 :
A nurse is caring for a 5-year-old child who has acute poststreptococcal glomerulonephritis. Which of the following findings should indicate to the nurse that treatment has been effective?

8 :
A nurse is evaluating the pain level of a toddler who is cognitively impaired to a non-pharmacologic intervention. Which of the following pain scales should the nurse use to evaluate the toddler's pain level?

9 :
A nurse is assessing a school-age child who is receiving prednisolone. For which of the following adverse effects should the nurse monitor?

10 :
A nurse is preparing a child for a lumbar puncture. In which of the following positions should the child be placed for the procedure?