Question

A nurse is caring for a 6-month-old infant who has a subdural hematoma. Which of the following findings should the nurse expect?

Answer 1

Correct Answers:

Vomiting

Rationale :

🧠A subdural hematoma causes blood to accumulate beneath the dura mater.

📈The accumulating blood can produce increased intracranial pressure.

🤮Vomiting is a common manifestation of increased intracranial pressure in infants.

👶Other possible findings include a bulging fontanel, irritability, seizures, and altered consciousness.

📌Core Message

A subdural hematoma can cause increased intracranial pressure, commonly producing vomiting in an infant.

Answer 2

Correct Answers:

Isolate the child until the fifth day of the rash.

Rationale :

🦠Rubeola, or measles, is a highly contagious viral infection spread through the airborne route.

😷The child requires airborne precautions during the contagious period.

📅Infectivity generally continues through the fourth day after the rash appears.

🚪Isolation until the fifth day of the rash prevents transmission to susceptible individuals.

📌Core Message

Children with rubeola require airborne isolation through four days after rash onset.

Answer 3

Correct Answers:

"My child exercises by playing on the trampoline."

Rationale :

🤸Trampoline use places children at risk for fractures, head injuries, and spinal injuries.

🦴Injuries may occur from falls, collisions, or landing incorrectly.

👧School-age children may attempt dangerous movements without sufficient coordination or supervision.

⚠️The guardian’s statement identifies a significant preventable safety risk.

📌Core Message

Trampoline use is a major childhood safety risk because it can cause severe traumatic injuries.

Answer 4

Correct Answers:

Ask the parent what time of the day they were giving the medication.

Rationale :

🕐The nurse should assess first before recommending a treatment change.

💡ADHD stimulants administered too late in the day can cause insomnia.

🌅Giving the medication earlier may improve sleep without changing the prescribed dose.

🗣️Determining the administration schedule provides the information needed for safe teaching.

📌Core Message

When stimulant-related insomnia occurs, first assess the time of medication administration.

Answer 5

Correct Answers:

875

Rationale :

⚖️Convert the child’s weight: 77 lb ÷ 2.2 = 35 kg.

🧮Calculate the dose: 25 mg × 35 kg = 875 mg.

💉The nurse should administer 875 mg IV.

✅The result is already expressed as the nearest whole number.

📌Core Message

Use lb ÷ 2.2, then multiply the kilograms by the prescribed mg/kg dose.

Answer 6

Correct Answers:

Tachypnea

Rationale :

❤️Heart failure decreases effective cardiac output and promotes pulmonary congestion.

💨Pulmonary congestion makes breathing more difficult and increases the respiratory rate.

🫧Children commonly develop tachypnea, feeding difficulty, diaphoresis, and poor weight gain.

📈An increased respiratory rate can indicate worsening fluid accumulation in the lungs.

📌Core Message

Tachypnea is a common pediatric heart-failure manifestation caused by pulmonary congestion.

Answer 7

Correct Answers

WBC count [ Potential worsening ]
Weight-bearing ability on the affected leg [ Potential improvement ]
Temperature [ Potential improvement ]
Wound assessment [ Potential improvement ]

Rationale :

🧫The WBC count increased from 14,000/mm³ to 15,000/mm³, suggesting persistent or worsening infection.

🚶The adolescent’s ability to ambulate twice and tolerate activity indicates improved weight-bearing ability.

🌡️The temperature decreased from 38.8°C to 37.6°C, showing that the fever is resolving.

📏The indurated area decreased from 6 × 6 cm to 5 × 5 cm, indicating reduced local inflammation.

📌Core Message

A rising WBC count suggests worsening, while improved ambulation, reduced fever, and a smaller wound indicate clinical improvement.

Answer 8

Correct Answers

Blank 1 Correct Option: stroke
Blank 2 Correct Option: musculoskeletal findings

Rationale :

🧠Sudden unilateral weakness following cardiac catheterization suggests an acute stroke.

🖐️Right-sided upper- and lower-extremity weakness represents a focal neurologic deficit.

🚶‍♂️An uncoordinated gait further supports impaired motor function.

🗨️Slurred speech, confusion, and blurred vision provide additional evidence of cerebral injury.

📌Core Message

Sudden unilateral weakness and impaired coordination after catheterization indicate a stroke.

Answer 9

Correct Answers

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

Rationale :

💥A vaso-occlusive crisis causes severe pain from microvascular obstruction and tissue ischemia.

💧The child’s pain increased from 7 to 10 out of 10, requiring rapid analgesia.

💉IV hydromorphone is appropriate for severe acute sickle cell pain.

⏱️Intravenous administration provides a rapid and reliable therapeutic effect.

📌Core Message

A severe vaso-occlusive pain crisis requires prompt administration of a potent IV opioid.

Answer 10

Correct Answers:

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

Rationale :

🧂The sweat chloride test measures the amount of chloride in sweat.

🧴Pilocarpine stimulates sweat production so samples can be collected for analysis.

🔁Separate adequate samples help confirm consistently elevated chloride results.

🧬Elevated sweat chloride levels support a diagnosis of cystic fibrosis.

📌Core Message

The sweat chloride test is a painless procedure that uses separate samples to confirm elevated chloride levels.

Findings	Potential improvement	Potential worsening
WBC count
Weight-bearing ability on the affected leg
Temperature
Wound assessment

1 :
A nurse is caring for a 6-month-old infant who has a subdural hematoma. Which of the following findings should the nurse expect?

2 :
A nurse is planning care for a 10-year-old child who has rubeola. Which of the following interventions should the nurse plan to include?

3 :
A nurse is assessing the lifestyle risks of a school-age child. Which of the following statements made by the guardian should the nurse identify as a risk?

4 :
A nurse is caring for a school-aged child who has ADHD. The parent reports they stopped giving the prescribed medications because the child wasn't sleeping. Which of the following actions should the nurse take first?

5 :
A nurse is preparing to administer imipenem/cilastatin 25 mg/kg IV to a school-age child who weighs 77 lb. How many mg should the nurse plan to administer? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

6 :
A nurse is assessing a child who has heart failure. Which of the following findings is a clinical manifestation associated with this diagnosis?

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

Correct Answers

8 :
A nurse on the pediatric unit is caring for a child.

Correct Answers

9 :
A nurse is caring for a 12-year-old client who has sickle cell disease.

Correct Answers

10 :
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?

1 : A nurse is caring for a 6-month-old infant who has a subdural hematoma. Which of the following findings should the nurse expect?

2 : A nurse is planning care for a 10-year-old child who has rubeola. Which of the following interventions should the nurse plan to include?

3 : A nurse is assessing the lifestyle risks of a school-age child. Which of the following statements made by the guardian should the nurse identify as a risk?

4 : A nurse is caring for a school-aged child who has ADHD. The parent reports they stopped giving the prescribed medications because the child wasn't sleeping. Which of the following actions should the nurse take first?

5 : A nurse is preparing to administer imipenem/cilastatin 25 mg/kg IV to a school-age child who weighs 77 lb. How many mg should the nurse plan to administer? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

6 : A nurse is assessing a child who has heart failure. Which of the following findings is a clinical manifestation associated with this diagnosis?

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

Correct Answers

8 : A nurse on the pediatric unit is caring for a child.

Correct Answers

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

Correct Answers

10 : 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?

1 :
A nurse is caring for a 6-month-old infant who has a subdural hematoma. Which of the following findings should the nurse expect?

2 :
A nurse is planning care for a 10-year-old child who has rubeola. Which of the following interventions should the nurse plan to include?

3 :
A nurse is assessing the lifestyle risks of a school-age child. Which of the following statements made by the guardian should the nurse identify as a risk?

4 :
A nurse is caring for a school-aged child who has ADHD. The parent reports they stopped giving the prescribed medications because the child wasn't sleeping. Which of the following actions should the nurse take first?

5 :
A nurse is preparing to administer imipenem/cilastatin 25 mg/kg IV to a school-age child who weighs 77 lb. How many mg should the nurse plan to administer? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

6 :
A nurse is assessing a child who has heart failure. Which of the following findings is a clinical manifestation associated with this diagnosis?

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

8 :
A nurse on the pediatric unit is caring for a child.

9 :
A nurse is caring for a 12-year-old client who has sickle cell disease.

10 :
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?