NUR 404 Exam 3 Questions with Correct Answers Graded A+
The nurse sees a school-aged child in an ambulatory setting because of rheumatic fever. Which of the
following would the nurse expect to find revealed by the health history?
A. knee pain, abdominal rash, subcutaneous nodules
B. an elevated temperature, back pain, loss of hair
C. fatigue, slow pulse, frequent urination
D. loss of weight, abdominal pain, chest pain - Answers A
Classic signs of rheumatic fever are joint pain, a rash on the trunk, and subcutaneous nodules near major
joints.
Which nursing diagnosis would best apply to a child with rheumatic fever?
A. Ineffective breathing pattern related to cardiomegaly
B. Activity intolerance related to inability of heart to sustain extraworkload
C. Disturbed sleep pattern related to hyperexcitability
D. Risk for self-directed violence related to development of cerebral anoxia - Answers B
Acute rheumatic fever affects the joints, central nervous system, skin, and soft tissue. It causes chronic,
progressive damage to the heart and valves. Children with rheumatic fever need to reduce activity to
relieve stress on the heart and joints during the course of the illness. Rheumatic fever does not produce
cardiomegaly nor does it interfere with respirations or the ability to oxygenate the body. Children with
rheumatic fever may develop chorea. These movements are involuntary and are not related to
hyperexcitability
Some children with iron-deficiency anemia may be prescribed iron dextran by injection. This should be
injected:
A. intradermally.
B. subcutaneously.
,C. intramuscularly.
D. via Z-track technique - Answers D
Iron dextran stains the skin unless it is given by a technique that does not allow it to flow back into the
superficial skin.
A school-aged child is admitted to the hospital with a vaso-occlusive sickle cell crisis. Which measure in
the child's care plan should be given priority?
A. Beginning active range-of-motion exercises
B. Seeing that the child ingests a protein-rich diet
C. Maintaining fluids through an intravenousline
D. Encouraging the child to take deep breaths hourly - Answers C
Sickle cells clump together and prevent normal blood flow. This leads to tissue hypoxia. With a vaso-
occlusive crisis, the cells are clumped together and prevent blood flow to the joint or organ. The blood
with the clumped sickled cells is very viscous. Adequate hydration is crucial in relieving the problems of a
vaso- occlusive crisis. The hydration dilutes the blood and decreases the viscosity. During a crisis the
recommended fluid intake (IV and PO) is 150 ml/kg/day. During a vaso- occlusive crisis, the child has
severe pain. The goal is to get the pain under control and increase blood flow. Range-of-motion
exercises will add to the increased pain during this period of time, so should not be started until crisis in
under control. The diet and hourly deep breaths are important, but they are not crucial to correcting the
crisis.
To prevent further sickle cell crisis, the nurse would advise the parents of a child with sickle cell anemia
to:
A. notify a health care provider if the child develops an upper respiratory infection.
B. prevent the child from drinking an excess amount of fluids per day.
C. encourage the child to participate in school activities, such as long-distance running.
D. administer an iron supplement daily. - Answers A
,Infections caused by the Streptococcus pneumoniae can be lethal to a child with sickle cell, because they
can cause overwhelming sepsis or meningitis. By 2 months of age the child should be started on
Penicillin V as prophylaxis against pneumococcal infections. The child should receive the 7 valent
pneumococcal series in infancy. After 2 years of age the child should receive the 23 valent
pneumococcal vaccine. He or she should also be immunized against meningitis. Participating in
strenuous activities such as running and limiting the amount of fluids leads to a reduction of oxygen and
dehydration. This can lead to the increased sickling of cells. The anemia of sickle cell disease is not the
result of iron deficiency. It is the result of the abnormal shape of the red blood cell. Administering iron
will not correct the anemia.
It is determined that a preschooler developed anemia after exposure to an insecticide. What should the
nurse teach the parents before the child is discharged from the hospital?
A. Schedule weekly chelating treatments.
B. Provide the child with a high-protein diet.
C. Schedule hospital visits to desensitize the child to the insecticide.
D. Ensure that the child has no further exposure to the insecticide. - Answers D
The first step in therapy is to immediately ensure that the child is never exposed to the substance again.
Chelation therapy is to remove excess iron from the blood and body. A highprotein diet is not indicated
for this health problem. The child does not need weekly hospital visits for desensitization.
The nurse is assessing a school-aged child with sickle-cell anemia. Which assessment finding is consistent
with this child's diagnosis?
A. Slightly yellow sclera
B. Enlarged mandibular growth
C. Increased growth of long bones
D. Depigmented areas on the abdomen - Answers A
In sickle-cell anemia, eye scleras become icteric or yellowed from the release of bilirubin from the
destruction of the sickled cells. Mandibular and long bone growth and depigmentation are not
manifestations of this health problem.
, The nurse is instructing the parents of a child with sickle cell anemia on safety precautions. What should
the nurse emphasize during this teaching?
A. Suggest the child participate in sports activities without restriction.
B. Treat upper respiratory infections with over-the-counter medication.
C. Ensure a consistent and daily intake of adequate fluids to prevent dehydration.
D. Remind parents that the child should avoid immunizations to preventthe introduction of bacteria into
the body - Answers C
Safety interventions for the child with sickle cell anemia include ensuring an adequate daily intake of
fluids to prevent dehydration. Dehydration will precipitate a crisis, which can be avoided. The child
should avoid contact sports and longdistance running. Upper respiratory infections should be reported
to the health care provider so appropriate treatment can be provided. Routine health care such as
immunizations should be provided in order to prevent common childhood illnesses.
The developmental task of the school-aged period, according to Erikson, is gaining a sense of:
A. autonomy versus shame.
B. independence versus dependence.
C. industry versus inferiority.
D. identity versus failure. - Answers C
The school-age years, according to Erickson, are the stage of industry versus inferiority. The
developmental stage helps increase the child's sense of self worth. Industry is associated with the child's
increased interest in knowledge and the development of social skills. Autonomy versus shame is the
developmental tasks of 1 to 3 year old children. Erickson's stages do not include the developmental
tasks of independence versus dependence nor identity versus failure.
A 9-year-old is hospitalized for a long-term illness. The best project to give the to help achieve the child's
developmental task would be:
A. a scrapbook that will take 3 weeks to complete.
The nurse sees a school-aged child in an ambulatory setting because of rheumatic fever. Which of the
following would the nurse expect to find revealed by the health history?
A. knee pain, abdominal rash, subcutaneous nodules
B. an elevated temperature, back pain, loss of hair
C. fatigue, slow pulse, frequent urination
D. loss of weight, abdominal pain, chest pain - Answers A
Classic signs of rheumatic fever are joint pain, a rash on the trunk, and subcutaneous nodules near major
joints.
Which nursing diagnosis would best apply to a child with rheumatic fever?
A. Ineffective breathing pattern related to cardiomegaly
B. Activity intolerance related to inability of heart to sustain extraworkload
C. Disturbed sleep pattern related to hyperexcitability
D. Risk for self-directed violence related to development of cerebral anoxia - Answers B
Acute rheumatic fever affects the joints, central nervous system, skin, and soft tissue. It causes chronic,
progressive damage to the heart and valves. Children with rheumatic fever need to reduce activity to
relieve stress on the heart and joints during the course of the illness. Rheumatic fever does not produce
cardiomegaly nor does it interfere with respirations or the ability to oxygenate the body. Children with
rheumatic fever may develop chorea. These movements are involuntary and are not related to
hyperexcitability
Some children with iron-deficiency anemia may be prescribed iron dextran by injection. This should be
injected:
A. intradermally.
B. subcutaneously.
,C. intramuscularly.
D. via Z-track technique - Answers D
Iron dextran stains the skin unless it is given by a technique that does not allow it to flow back into the
superficial skin.
A school-aged child is admitted to the hospital with a vaso-occlusive sickle cell crisis. Which measure in
the child's care plan should be given priority?
A. Beginning active range-of-motion exercises
B. Seeing that the child ingests a protein-rich diet
C. Maintaining fluids through an intravenousline
D. Encouraging the child to take deep breaths hourly - Answers C
Sickle cells clump together and prevent normal blood flow. This leads to tissue hypoxia. With a vaso-
occlusive crisis, the cells are clumped together and prevent blood flow to the joint or organ. The blood
with the clumped sickled cells is very viscous. Adequate hydration is crucial in relieving the problems of a
vaso- occlusive crisis. The hydration dilutes the blood and decreases the viscosity. During a crisis the
recommended fluid intake (IV and PO) is 150 ml/kg/day. During a vaso- occlusive crisis, the child has
severe pain. The goal is to get the pain under control and increase blood flow. Range-of-motion
exercises will add to the increased pain during this period of time, so should not be started until crisis in
under control. The diet and hourly deep breaths are important, but they are not crucial to correcting the
crisis.
To prevent further sickle cell crisis, the nurse would advise the parents of a child with sickle cell anemia
to:
A. notify a health care provider if the child develops an upper respiratory infection.
B. prevent the child from drinking an excess amount of fluids per day.
C. encourage the child to participate in school activities, such as long-distance running.
D. administer an iron supplement daily. - Answers A
,Infections caused by the Streptococcus pneumoniae can be lethal to a child with sickle cell, because they
can cause overwhelming sepsis or meningitis. By 2 months of age the child should be started on
Penicillin V as prophylaxis against pneumococcal infections. The child should receive the 7 valent
pneumococcal series in infancy. After 2 years of age the child should receive the 23 valent
pneumococcal vaccine. He or she should also be immunized against meningitis. Participating in
strenuous activities such as running and limiting the amount of fluids leads to a reduction of oxygen and
dehydration. This can lead to the increased sickling of cells. The anemia of sickle cell disease is not the
result of iron deficiency. It is the result of the abnormal shape of the red blood cell. Administering iron
will not correct the anemia.
It is determined that a preschooler developed anemia after exposure to an insecticide. What should the
nurse teach the parents before the child is discharged from the hospital?
A. Schedule weekly chelating treatments.
B. Provide the child with a high-protein diet.
C. Schedule hospital visits to desensitize the child to the insecticide.
D. Ensure that the child has no further exposure to the insecticide. - Answers D
The first step in therapy is to immediately ensure that the child is never exposed to the substance again.
Chelation therapy is to remove excess iron from the blood and body. A highprotein diet is not indicated
for this health problem. The child does not need weekly hospital visits for desensitization.
The nurse is assessing a school-aged child with sickle-cell anemia. Which assessment finding is consistent
with this child's diagnosis?
A. Slightly yellow sclera
B. Enlarged mandibular growth
C. Increased growth of long bones
D. Depigmented areas on the abdomen - Answers A
In sickle-cell anemia, eye scleras become icteric or yellowed from the release of bilirubin from the
destruction of the sickled cells. Mandibular and long bone growth and depigmentation are not
manifestations of this health problem.
, The nurse is instructing the parents of a child with sickle cell anemia on safety precautions. What should
the nurse emphasize during this teaching?
A. Suggest the child participate in sports activities without restriction.
B. Treat upper respiratory infections with over-the-counter medication.
C. Ensure a consistent and daily intake of adequate fluids to prevent dehydration.
D. Remind parents that the child should avoid immunizations to preventthe introduction of bacteria into
the body - Answers C
Safety interventions for the child with sickle cell anemia include ensuring an adequate daily intake of
fluids to prevent dehydration. Dehydration will precipitate a crisis, which can be avoided. The child
should avoid contact sports and longdistance running. Upper respiratory infections should be reported
to the health care provider so appropriate treatment can be provided. Routine health care such as
immunizations should be provided in order to prevent common childhood illnesses.
The developmental task of the school-aged period, according to Erikson, is gaining a sense of:
A. autonomy versus shame.
B. independence versus dependence.
C. industry versus inferiority.
D. identity versus failure. - Answers C
The school-age years, according to Erickson, are the stage of industry versus inferiority. The
developmental stage helps increase the child's sense of self worth. Industry is associated with the child's
increased interest in knowledge and the development of social skills. Autonomy versus shame is the
developmental tasks of 1 to 3 year old children. Erickson's stages do not include the developmental
tasks of independence versus dependence nor identity versus failure.
A 9-year-old is hospitalized for a long-term illness. The best project to give the to help achieve the child's
developmental task would be:
A. a scrapbook that will take 3 weeks to complete.
