NCLEX Question of The Daily (Child health) 43th Edition

NCLEX Question of The Daily 43th Edition

1. Laboratory studies are performed on a child suspected of iron deficiency anemia. The nurse reviews the laboratory results knowing that which of the following would indicate this type of anemia?

A. An elevated hemoglobin level with a low hematocrit level
B. A decreased reticulocyte count
C. An elevated red blood cell (RBC) count
D. RBCs that are microcytic and hypochromic

Answer: D. RBCs that are microcytic and hypochromic

Rationale: The results of a complete blood cell count in children with iron deficiency anemia will show low hemoglobin levels and microcytic and hypochromic RBCs. The reticulocyte count is usually normal or slightly elevated.

Test-Taking Strategy: Use the process of elimination. Eliminate options 1 and 3 first knowing that the RBC and hemoglobin counts would be decreased. From the remaining options, select option 4 because of the relationship between anemia and RBCs. Review the characteristics of iron deficiency anemia if you had difficulty with this question.

Level of Cognitive Ability: Analysis
Client Needs: Physiological Integrity
Integrated Process: Nursing Process/Data Collection
Content Area: Child Health
References: McKinney, E., James, S., Murray, S., & Ashwill, J. (2005). Maternal-child nursing (2nd ed.). St. Louis: Elsevier, p. 1304.
Price, D., & Gwin, J. (2005). Thompson’s pediatric nursing (9th ed.). Philadelphia: W.B. Saunders, p. 137.

2. A nurse is providing instructions to the parents of a child with iron deficiency anemia regarding the administration of a liquid oral iron supplement. The nurse tells the mother to:

A. Administer the iron through a straw
B. Administer the iron at meal times
C. Add the iron to food for easy administration
D. Mix the iron with cereal for administration

Answer: A. Administer the iron through a straw

Rationale: Oral iron supplements should be administered through a straw or medicine dropper placed at the back of the mouth because iron will stain the teeth. The parents should be instructed to brush or wipe the teeth after administration. Iron is administered between meals because absorption is decreased if there is food in the stomach. Iron requires an acidic environment to facilitate its absorption in the duodenum.

Test-Taking Strategy: Use the process of elimination. Eliminate options 3 and 4 first because they are similar and because medication should not be added to food. To select from the remaining options, note the key word liquid in the question. This should assist in recalling that liquid iron stains teeth. Review the procedure for administering iron to a child if you had difficulty with this question.

Level of Cognitive Ability: Application
Client Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Content Area: Pharmacology
Reference: Price, D., & Gwin, J. (2005). Thompson’s pediatric nursing (9th ed.). Philadelphia: W.B. Saunders, p. 137.

3. A nursing student is asked to discuss the pathophysiology related to childhood leukemia during a clinical conference and reviews the planned presentation with the nursing instructor. The nursing instructor advises the student to review the disorder before the clinical conference if the student states that which of the following is associated with this type of cancer?

A. Normal bone marrow is replaced by blast cells
B. RBC and platelet production become affected
C. The reticuloendothelial system is affected
D. Reed-Sternberg cells are found on biopsy

Answer: D. Reed-Sternberg cells are found on biopsy

Rationale: In leukemia normal bone marrow is replaced by malignant blast cells. As the blast cells take over the bone marrow, eventually RBC and platelet production are affected and the child becomes anemic and thrombocytopenic. The reticuloendothelial system is affected, thus disturbing the body’s defense system and rendering these children unable to fight infections normally. Reed-Sternberg cells are found in Hodgkin’s disease.

Test-Taking Strategy: Note the key words advises the student to review the disorder. These words indicate a false response question and that you need to select the incorrect student statement. Recalling that the Reed-Sternberg cell is found in Hodgkin’s disease will direct you to option D. Review the characteristics of leukemia if you had difficulty with this question.

Level of Cognitive Ability: Comprehension
Client Needs: Physiological Integrity
Integrated Process: Teaching/Learning
Content Area: Child Health
Reference: Leifer, G. (2003). Introduction to maternity & pediatric nursing (4th ed.). Philadelphia: W.B. Saunders, p. 642.

4. A nurse assists the physician in performing a lumbar puncture on a 3-year-old child with leukemia suspected of central nervous system (CNS) disease. Which position will the nurse place the child during this procedure?

A. Prone with knees flexed to the abdomen and head bent with chin resting on the chest
B. Modified Sims position
C. Lateral recumbent with knees flexed to the abdomen and head bent with chin resting on the chest
D. Lithotomy position

Answer: C. Lateral recumbent with knees flexed to the abdomen and head bent with chin resting on the chest

Rationale: A lateral recumbent position with the knees flexed to the abdomen and the head bent with the chin resting on the chest is assumed for a lumbar puncture. This position separates the spinal processes and facilitates needle insertion into the subarachnoid space. Options 1, 2, and 4 are incorrect positions.

Test-Taking Strategy: Use the process of elimination and note the key word lumbar in the question. Visualize each of the descriptions of the positions described in the options. This will assist in directing you to option C. Review this procedure if you had difficulty with this question.

Level of Cognitive Ability: Application
Client Needs: Physiological Integrity
Integrated Process: Nursing Process/Implementation
Content Area: Child Health
Reference: Leifer, G. (2003). Introduction to maternity & pediatric nursing (4th ed.). Philadelphia: W.B. Saunders, p. 507.

5. A nurse is caring for a 9-year-old child with leukemia that is hospitalized for the administration of chemotherapy. The nurse monitors the child for central nervous system (CNS) involvement by checking which of the following most closely?

A. Color, motion, and sensation of the extremities
B. Pupillary reaction
C. Level of consciousness (LOC)
D. The presence of petechiae in the sclera

Answer: C. Level of consciousness (LOC)

Rationale: The presence of CNS involvement is monitored because of the risk of infiltration of blast cells into the CNS. The child’s level of consciousness is assessed, and the child is monitored for signs of irritability, vomiting, and lethargy. Evaluating color, motion, and sensation of the extremities is part of neurovascular assessment. Changes in pupillary reaction are most often noted in conditions related to increased intracranial pressure and are not as specific as changes in LOC. The presence of petechiae in the sclera is an objective sign of leukemia but does not relate to CNS involvement.

Test-Taking Strategy: Use the process of elimination and note the key words central nervous system in the question. Eliminate options 1 and 4 first because they do not relate to the CNS. From the remaining options, select option 3 because LOC will determine CNS function. Option 3 is also the umbrella (global) option. Review care of the child with leukemia if you had difficulty with this question.

Level of Cognitive Ability: Analysis
Client Needs: Physiological Integrity
Integrated Process: Nursing Process/Data Collection
Content Area: Child Health
References: McKinney, E., James, S., Murray, S., & Ashwill, J. (2005). Maternal-child nursing (2nd ed.). St. Louis: Elsevier, p. 1345.
Wong, D., & Hockenberry, M. (2003). Nursing care of infants and children (7th ed.). St. Louis: Mosby, p. 1601.

Source : NCLEX example quiz and answer

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