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Correct Answer: B. Observing the child for 10 minutes to note for signs of anaphylaxis.
When administering chemotherapy, the nurse should observe for an anaphylactic reaction for 20 minutes and stop the medication if one is suspected. Anaphylaxis is a severe allergic reaction, which can cause shock, low blood pressure, and occasionally death. Food allergies, including allergy to peanuts and tree nuts, are said to account for the majority of fatal or near-fatal anaphylactic reactions in the U.S.A. Care is taken especially when chemotherapy medications are known to be common allergic reaction producers, to premedicate to prevent or lessen the reaction.
Option A: Chemotherapy is associated with both general and specific adverse effects, therefore close monitoring for them is important. A major challenge for the nurse caring for a child with fever and neutropenia is monitoring for signs of sepsis (e.g., peripheral perfusion, temperature of extremities, level of consciousness, vital signs, and pulse oximetry).
Option C: Education of the family and child regarding the treatment plan or protocol (e.g., chemotherapy, radiotherapy, and/or surgery) is crucial to relieving parents' fears and anxieties. Even though the explanation of the diagnosis and treatment plan supports the hope that their child may survive cancer, the word cancer still conveys a life-threatening illness.
Option D: Because most infectious origins develop from the child's own endogenous flora, the nurse should encourage the parents/child to adhere to strict handwashing practices, perform frequent mouth care, perineal hygiene, and avoid the use of rectal thermometers owing to the chance of introducing pathogens through the rectal mucosa. Protective isolation and food sterilization have little impact on decreasing infectious rates in neutropenic children.
Correct Answer: C. Sucking ability
Because of the defect, the child will be unable to form a mouth adequately around the nipple, thereby requiring special devices to allow for feeding and sucking gratification. Patients with cleft lips inherently will have some degree of alveolar cleft with potential for collapse of the maxillary arch and class III malocclusion (the maxillary teeth sit posterior to the mandibular teeth). These hard and soft tissue anatomic changes translate to the various changes in appearance, speech, and swallowing/feeding seen in cleft lip patients.
Option A: GI functioning is not compromised in the child with a CL. Speech-language therapists and nutrition consults are usually required to teach parents techniques to meet the special feeding needs of these children. When patients do not meet feeding requirements for adequate nutrition, which is most common when there is a concomitant cleft palate, feeding access is sometimes required with the assistance of the pediatric surgery team.
Option B: Locomotion would be a problem for older infants because of the use of restraints. Nurses who look after these infants should be fully aware of the risk of aspiration, airway obstruction, and difficulties with feeding. There is no single method of feeding that works in all children and the mother should be educated on the different techniques to help the infant latch on the nipple. In general, the recommendation is a soft nipple that may need to be angled.
Option D: Respiratory status may be compromised if the child is fed improperly during the postoperative period. The mother should be taught about the potential for aspiration and choking. If the infant fails to gain weight, a visit to the pediatrician is highly recommended.
Correct Answer: Answer C. Do not give snacks to the child before meals.
If the child is hungry he/she is more likely to finish his meals. Therefore, the mother should be advised not to give snacks to the child. Set times for meals and snacks and try to stick to them. A child who skips a meal finds it reassuring to know when to expect the next one. Avoid offering snacks or pacifying hungry kids with cups of milk or juice right before a meal — this can diminish their appetite and decrease their willingness to try a new food being offered.
Option A: The child is a "busy toddler." He/she will not be able to keep still for a long time. For some kids, dinner becomes a negotiation session from the very start, and parents have been using dessert as an incentive for decades. But this doesn't encourage healthy eating. Instead, it creates the impression that "treats" are more valuable than mealtime food.
Option B: Be alert to what toddlers say through their actions. A child who is building a tower of crackers or dropping carrots on the floor may be telling you he or she is full. Pushing food on a child who's not hungry may dull the internal cues that help kids know when they've eaten enough. Kids can manage their hunger when they come to expect that food will be available during certain times of the day. If a child chooses not to eat anything at all, simply offer food again at the next meal or snack time.
Option D: Kids should start finger feeding around 9 months of age and try using utensils by 15-18 months. Some parents think that not letting kids feed themselves is for the best, but it takes away control that rightfully belongs to kids at this age. They need to decide whether to eat, what they will eat, and how much to eat — this is how they learn to recognize the internal cues that tell them when they're hungry and when they're full. Just as important, toddlers need to learn and practice the mechanics of feeding themselves.
Correct Answer: D. Absorption of digested molecules
This is a function of the digestive system. The small molecules that result from digestion are absorbed through the walls of the intestine for use in the body. Digestion is the process of mechanically and enzymatically breaking down food into substances for absorption into the bloodstream.
Option A: This is a function of the urinary system. The kidneys play an important role in controlling blood levels of Ca2+ by regulating the synthesis of vitamin D. The kidneys have an important role in making vitamin D useful to the body. The kidneys convert vitamin D from supplements or the sun to the active form of vitamin D that is needed by the body. With chronic kidney disease, low vitamin D levels can be found, sometimes even severely low levels.
Option B: This is a function of the urinary system. The kidneys secrete a hormone, erythropoietin, which regulates the synthesis of red blood cells in the bone marrow. The kidney produces 85 percent of circulating erythropoietin; the liver, the remainder. If you move to a higher altitude, the partial pressure of oxygen is lower, meaning there is less pressure to push oxygen across the alveolar membrane and into the red blood cell.
Option C: This is a function of the urinary system. The kidneys are the major excretory organs of the body. They remove waste products, many of which are toxic, from the blood. The urinary system includes the kidneys, ureters, bladder and urethra. This system filters the blood, removing waste and excess water. This waste becomes urine.
Option E: This is a function of the urinary system. The kidneys play a major role in controlling the extracellular fluid volume in the body by producing either a large volume of dilute urine or a small volume of concentrated urine. Due to osmosis, water follows where Na+ leads. Much of the water the kidneys recover from the forming urine follows the reabsorption of Na+. Antidiuretic hormone stimulation of aquaporin channels allows for regulation of water recovery in the collecting ducts. It is through these means that blood volume and osmolarity are regulated by the kidneys.
Correct Answer: A, C, & F
Even with proper antibiotic treatment, most UTI symptoms can last several days. In women with recurrent UTIs, the quality of life is poor. About 25% of women experience such recurrences. Many cases of uncomplicated UTIs will resolve spontaneously, without treatment, but many patients seek therapy for symptom relief.
Option A: Fluid intake helps dilute urine and minimize infection potential. Even without treatment, most UTIs will spontaneously resolve in about 20% of women; especially if increased hydration is used. The likelihood that a healthy female will develop acute pyelonephritis is very small.
Option B: Void before and after intercourse (if sexually active). Sexual intercourse is a common cause of a UTI as it promotes the migration of bacteria into the bladder. Although there is no proof of prevention, women should urinate after sexual intercourse because bacteria in the bladder can increase by ten-fold after intercourse.
Option C: Emptying the bladder fully with each urination prevents stasis. People who frequently void and empty the bladder tend to have a lower risk of a UTI. Frequent urination and high urinary volumes are also known to decrease the risk of UTI.
Option D: Children and teens should wear cotton underwear. The majority of organisms causing a UTI are enteric coliforms that typically inhabit the periurethral vaginal introitus. These organisms ascend the urethra into the bladder and cause UTI.
Option E: Keep the urine acidic. Urine is an ideal medium for bacterial growth. Factors that make it less favorable for bacterial growth include a pH less than 5, the presence of organic acids, and high levels of urea. Normal urine pH is slightly acidic, with usual values of 6.0 to 7.5, but the normal range is 4.5 to 8.0. A urine pH of 8.5 or 9.0 is often indicative of a urea-splitting organism, such as Proteus, Klebsiella, or Ureaplasma urealyticum.
Option F: Bubble baths and tight clothing may act as irritants. Vigorous urine flow is helpful to prevention. Baths should be avoided in favor of showers. A gentle, liquid soap should be used in bathing (such as Ivory or Dial) or a liquid baby soap such as Johnson's baby shampoo which is very acceptable for the vagina.
Correct Answer: B. Fluid intake should be approximately equal to the urine output.
Normally, fluid intake is approximately equal to the urine output. Any other relationship signals an abnormality. One general principle for all patient scenarios is to replace whatever fluid is being lost as accurately as possible. The strategy of managing a patient's fluid differs depending on each patient's clinical condition. If they can drink adequate fluid volumes by mouth, this should be the first choice. Some patients can tolerate other enteral options, such as feeding tubes. IV plus oral orders are effective for those unable to meet their total daily fluid requirements enterally.
Option A: Fluid intake that is double the urine output indicates fluid retention. Monitor for peripheral edema, pulmonary edema, or hepatomegaly. It is important to consider underlying cardiac dysfunction or renal failure and adjust volumes of administration accordingly. These patients might require a lower maintenance fluid rate than expected for their body weight.
Option C: Fluid intake that is half the urine output indicates dehydration. A drop of at least 20 mm Hg systolic blood pressure or 10 mm Hg diastolic blood pressure within 2 to 5 minutes of quiet standing after 5 minutes of supine rest indicates orthostatic hypotension. Dehydrated or elderly patients who have lost sensitivity in their baroreceptors in their blood vessels might display these findings.
Option D: Normally, fluid intake isn't inversely proportional to the urine output. One can see weight gain in states of fluid excess and weight loss in states of fluid deficit. It is also helpful to look at patient records to see any recent outpatient visits before hospitalization, which might indicate a patient's normal baseline weight.
Correct Answer: A. Playing in the park with heavy traffic and with many vehicles passing by.
Lead poisoning may be caused by inhalation of dust and smoke from leaded gas. It may also be caused by lead-based paint, soil, water (especially from plumbings of old houses). Approximately 535000 children between 1 and 5 years of age have an elevated blood lead concentration, defined by the Advisory Committee on Childhood Lead Poisoning Prevention of the Centers for Disease Control and Prevention (CDC) as greater than or equal to 5mcg/dL based on the 97.5 percentile of blood lead concentrations in the most recent National Health and Nutrition Examination Survey (NHANES) dataset.
Option B: Several million young children in the United States live in older homes in which lead-based paint was previously used, and as this old paint ages, it peels, flakes, and crumbles into dust that settles on the interior surfaces of homes and in the soil surrounding the exterior of the home.
Option C: Despite the fact that the amount of lead in paint intended for use in or on residential buildings, furniture, or children's toys in the United States has been restricted to 0.06% since 1978 and was further reduced to 0.009% in 2008, lead-based paint continues to be a major source of lead exposure in young children.
Option D: Prevalence rates of children under 1 year of age with elevated blood lead concentrations are consistently lower than those in the 1 to 4 year age group, likely because lead is a cumulative toxin and because young children are more mobile and overall have more hand-to-mouth behavior compared to infants.
Correct Answer: A, B, C, D, and E
Sickle cell disease (SCD) refers to a group of hemoglobinopathies that include mutations in the gene encoding the beta subunit of hemoglobin. The Cooperative Study of Sickle Cell Disease (CSSCD) (between 1978-88) reported the median age of death for women and men as 42 and 48 years, respectively.
Option A: Sickle cell anemia (SCD) is an inherited disorder of the hemoglobin in blood. SCA is the most common form of SCD with a lifelong affliction for hemolytic anemia requiring blood transfusions, pain crises, and organ damage.
Option B: It requires the inheritance of two sickle cell genes. The sickle cell mutation occurs when negatively charged glutamine is replaced by a neutral valine at the sixth position of the beta-globin chain. The mutation is transmitted via Mendelian genetics and is inherited in an autosomal codominant fashion.
Option C: Sickle cell trait, which is the inheritance of one sickle gene, almost never causes problems. A heterozygous inheritance leads to HbAS. Patients with HbAS are not considered within the spectrum of SCD as most of them never present with typical symptoms of SCA.
Option D: Virtually all of the major symptoms of sickle cell anemia are the direct result of the abnormally-shaped sickled red blood cells blocking the flow of blood. SCA is characterized by two major components: Hemolysis and vaso-occlusive crises (VOC).
Option E: The contemporary treatment of sickle cell anemia is focused primarily toward managing the individual features of the illness as they occur. Pain management is a critical part of SCA. It is challenging for clinicians to accurately assess a patient's needs, especially if they meet them for the first time. Patients with SCA often suffer from the stigma of requiring high doses of opioids for pain control, which leads to them being labeled as 'opioid abusers,' 'manipulators,' or even 'drug seekers.'