Question

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

Answer 1

Correct Answers:

Water-soluble vitamin
Acetaminophen
Dornase alfa

Rationale :

✅ A. Water-soluble vitamin

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

💊 As fat absorption is impaired, providers prescribe water-miscible or water-soluble forms of these vitamins to enhance absorption and avoid deficiencies.

💊 Deficiencies in these vitamins can result in vision problems (A), bone demineralization (D), neurologic symptoms (E), and coagulopathy (K).

💊 The child’s clinical profile (e.g., steatorrhea, failure to thrive, vitamin deficiencies) confirms the need for routine vitamin supplementation in a more absorbable form.

💊 This is a standard long-term management strategy in CF to support nutrition and growth.

✅ B. Acetaminophen

🌡️ The child has a temperature of 38.4°C (101.1°F), indicating fever, likely due to an acute respiratory infection, supported by WBC elevation and positive Pseudomonas culture.

🌡️ Acetaminophen is appropriate for managing fever and mild discomfort in children and is commonly used in CF exacerbations.

🌡️ It is well tolerated and avoids complications related to NSAIDs (e.g., GI upset, renal stress), especially in those with chronic conditions.

🌡️ While not curative, acetaminophen improves comfort and reduces metabolic demand during acute illness.

🌡️ It also supports better rest and pulmonary function by reducing the discomfort associated with fever.

✅ C. Dornase alfa

🫁 Dornase alfa (Pulmozyme) is a recombinant human DNase that breaks down thick, sticky DNA-based secretions in the lungs of children with CF.

🫁 It reduces mucus viscosity, improving airway clearance, oxygenation, and reducing the frequency of infections.

🫁 The child has signs of chronic obstructive pulmonary disease with dyspnea, wheezing, rhonchi, and productive cough, indicating a need for airway clearance support.

🫁 Dornase alfa is administered via nebulization, making it suitable for daily use at home or in acute care.

🫁 It is a standard pulmonary maintenance therapy for CF to minimize airway plugging and prevent exacerbations.

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Answer 2

Correct Answers:

Instruct the parent to ensure the pneumococcal vaccine is current.
Administer folic acid as prescribed.
Monitor oxygen saturation continuously_
Give oral hydroxyurea.

Rationale :

✅ A. Instruct the parent to ensure the pneumococcal vaccine is current

💉 Adolescents with sickle cell disease (SCD) are at higher risk for invasive pneumococcal infections due to functional asplenia.

💉 Ensuring the pneumococcal vaccine (PCV13 and PPSV23) is current is a key preventive strategy to avoid sepsis, meningitis, and pneumonia.

💉 The nurse should confirm immunization history and educate the parent on the importance of timely vaccinations as part of long-term disease management.

💉 This aligns with CDC and WHO guidelines for preventive care in children with SCD.

✅ B. Administer folic acid as prescribed

🩺 Folic acid supports the production of new red blood cells, which is crucial in sickle cell patients who experience chronic hemolysis.

🩺 Supplementation helps prevent megaloblastic anemia and supports marrow function during crises.

🩺 It's often a routine part of outpatient and inpatient therapy for patients with SCD.

🩺 The goal is to sustain hemoglobin levels and avoid complications due to ineffective erythropoiesis.

✅ C. Monitor oxygen saturation continuously

🌬️ During a vaso-occlusive crisis, sickled red blood cells can obstruct capillaries, impairing oxygen delivery to tissues.

🌬️ Continuous pulse oximetry helps detect early signs of hypoxia, even before symptoms worsen.

🌬️ Maintaining oxygenation above 95% is vital to prevent worsening of sickling and organ ischemia.

🌬️ Early detection allows for timely intervention, including oxygen therapy or escalation of care.

✅ H. Give oral hydroxyurea

💊 Hydroxyurea increases the production of fetal hemoglobin (HbF), which reduces the polymerization of sickled hemoglobin (HbS).

💊 It helps prevent vaso-occlusive episodes, acute chest syndrome, and the need for frequent transfusions.

💊 While primarily used as preventive outpatient therapy, if the client takes it at home, it should be continued unless contraindicated.

💊 It has been shown to reduce hospitalization rates and pain crises in SCD patients.

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Answer 3

Correct Answers:

Decreased platelet count

Rationale :

🩸 Disseminated intravascular coagulation (DIC) is a serious condition involving widespread activation of clotting, followed by consumption of clotting factors and platelets, leading to bleeding.

🩸 Lab findings typically include decreased platelets, prolonged PT/PTT, elevated D-dimer, and reduced fibrinogen.

🩸 Because platelets are consumed in excessive microthrombi formation, patients experience thrombocytopenia.

🩸 Hgb and RBC levels are usually low due to blood loss, not elevated.

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Answer 4

Correct Answers:

An 18-month-old toddler who has a heart rate of 68/min

Rationale :

❤️ Normal resting heart rate for an 18-month-old is approximately 80–130 bpm.

❤️ A heart rate of 68 bpm is bradycardic and may indicate hypoxia, increased intracranial pressure, or other serious pathology in toddlers.

❤️ This finding is outside normal limits and should be reported immediately.

❤️ The other values (temperature, BP, RR) are within expected ranges for their respective age groups.

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Answer 5

Correct Answers:

Check clothing for loose buttons.

Rationale :

🧷 Toddlers are at high risk of choking, and small items like loose buttons on clothing can easily become foreign body hazards if swallowed.

🧷 Injury prevention for this age group should focus on choking, poisoning, burns, and falls.

🧷 Water heaters should be set no higher than 49°C (120.2°F) to prevent scald burns.

🧷 Balloons are choking hazards, and window screens are not substitutes for window locks or guards.

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Answer 6

Correct Answers:

"Notify the provider if your child is swallowing frequently."

Rationale :

🩺 Frequent swallowing after a tonsillectomy can indicate active bleeding, even if blood is not visible in the mouth.

🩺 This is a medical emergency, as postoperative hemorrhage is the most serious complication.

🩺 Parents must be instructed to report this immediately.

🩺 Dark blood is common early post-op but frequent swallowing suggests active fresh bleeding.

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Answer 7

Correct Answers:

"Your child can rest on your lap during the procedure."

Rationale :

💗 An electrocardiogram (ECG) is a noninvasive, painless test to assess heart rhythm and electrical activity.

💗 In toddlers or young children, allowing the child to rest on the caregiver’s lap provides comfort and minimizes movement artifacts during lead placement.

💗 The test is quick and requires cooperation, so emotional reassurance is key.

💗 It does not involve alarms, back leads, or extended durations.

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Answer 8

Correct Answers:

Check the pH of the gastric secretions.

Rationale :

🧪 Before administering enteral feedings through a nasogastric tube, it is critical to verify tube placement to prevent aspiration or misplacement into the lungs.

🧪 The first priority is checking the pH of gastric secretions—a pH of <5 indicates correct gastric placement.

🧪 Other steps (flushing, connecting, setting rate) should only follow after verifying safe placement.

🧪 This is an essential nursing safety step to prevent serious complications.

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Answer 9

Correct Answers:

Provide an infant with a one-piece pacifier for non-nutritive sucking-

Rationale :

🍼 A one-piece pacifier minimizes the risk of airway obstruction or choking, compared to multi-piece designs that may come apart.

🍼 Infants benefit from non-nutritive sucking for comfort and self-soothing.

🍼 Placing a 1-month-old on a soft mattress is unsafe—infants should be placed supine on a firm surface for sleep.

🍼 Car seats must never be placed behind airbags—doing so increases the risk of fatal injury in collisions.

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Answer 10

Correct Answers:

Place intubation equipment at the bedside.

Rationale :

🫁 Epiglottitis is a life-threatening respiratory emergency in young children, often caused by Haemophilus influenzae type B (Hib).

🫁 It presents with drooling, muffled voice, fever, and difficulty breathing.

🫁 The first action is to ensure airway preparedness, as swelling can rapidly cause complete obstruction.

🫁 Never force a child with suspected epiglottitis to lie down or have their throat examined—intubation equipment must be ready immediately.

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QLexNursing

1 :
A nurse is caring for a school-age child who has cystic fibrosis.

Answer Options

2 :
A nurse is caring for an adolescent who is admitted with a Vaso-occlusive crisis.

Answer Options

3 :
A nurse is caring for a child who has disseminated intravascular coagulation. Which of the following laboratory findings should the nurse expect?

4 :
A nurse is caring for a group of clients. Which of the following findings should the nurse report to the provider?

5 :
A nurse is providing teaching about injury prevention to the parents of a toddler. Which of the following safety measures should the nurse include in the teaching?

6 :
A nurse is providing discharge teaching to the guardian of a preschooler who had a tonsillectomy. Which of the following statements should the nurse include?

7 :
A nurse is providing teaching to the parent of a toddler who is scheduled for an electrocardiogram. Which of the following statements should the nurse make?

8 :
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?

9 :
A nurse is teaching a newly licensed nurse about infant safety. Which of the following information should the nurse include in the teaching?

10 :
A nurse in an emergency department is caring for a toddler who has manifestations of epiglottitis. Which of the following actions should the nurse take first?

QLexNursing

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

Answer Options

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

Answer Options

3 : A nurse is caring for a child who has disseminated intravascular coagulation. Which of the following laboratory findings should the nurse expect?

4 : A nurse is caring for a group of clients. Which of the following findings should the nurse report to the provider?

5 : A nurse is providing teaching about injury prevention to the parents of a toddler. Which of the following safety measures should the nurse include in the teaching?

6 : A nurse is providing discharge teaching to the guardian of a preschooler who had a tonsillectomy. Which of the following statements should the nurse include?

7 : A nurse is providing teaching to the parent of a toddler who is scheduled for an electrocardiogram. Which of the following statements should the nurse make?

8 : 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?

9 : A nurse is teaching a newly licensed nurse about infant safety. Which of the following information should the nurse include in the teaching?

10 : A nurse in an emergency department is caring for a toddler who has manifestations of epiglottitis. Which of the following actions should the nurse take first?

1 :
A nurse is caring for a school-age child who has cystic fibrosis.

2 :
A nurse is caring for an adolescent who is admitted with a Vaso-occlusive crisis.

3 :
A nurse is caring for a child who has disseminated intravascular coagulation. Which of the following laboratory findings should the nurse expect?

4 :
A nurse is caring for a group of clients. Which of the following findings should the nurse report to the provider?

5 :
A nurse is providing teaching about injury prevention to the parents of a toddler. Which of the following safety measures should the nurse include in the teaching?

6 :
A nurse is providing discharge teaching to the guardian of a preschooler who had a tonsillectomy. Which of the following statements should the nurse include?

7 :
A nurse is providing teaching to the parent of a toddler who is scheduled for an electrocardiogram. Which of the following statements should the nurse make?

8 :
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?

9 :
A nurse is teaching a newly licensed nurse about infant safety. Which of the following information should the nurse include in the teaching?

10 :
A nurse in an emergency department is caring for a toddler who has manifestations of epiglottitis. Which of the following actions should the nurse take first?