Pediatric Primary Care for the Advanced Practice Nurse (D119)

Correct Answer A. Sudden infant death syndrome

Explanation

Sudden Infant Death Syndrome (SIDS) is the leading cause of death in infants during the first year of life. It is defined as the sudden, unexplained death of a healthy baby, often during sleep. The cause is still not fully understood, but certain risk factors like sleeping on the stomach or exposure to smoke can contribute.

Why other options are wrong

B. Unintentional injuries

Unintentional injuries are also a significant concern for infants, particularly during accidents involving falls or suffocation. However, they are not the leading cause of death for this age group, with SIDS being more prevalent.

C. Congenital anomalies

Congenital anomalies, such as birth defects, are a cause of infant mortality, but they rank behind SIDS. Many congenital anomalies are diagnosed early, and with proper care, survival rates have improved, reducing their impact as the leading cause of death.

D. Preterm birth

Preterm birth can result in complications that lead to infant death, but it is not the primary cause. Advances in neonatal care have improved survival rates for preterm infants, making this less common than SIDS in the first year of life.

Correct Answer A. Ensure the infant is lying on a firm, flat surface

Explanation

The first priority when starting CPR on an infant is to ensure that the infant is on a firm, flat surface. This is essential for proper chest compression technique and effectiveness. A firm surface allows for the proper compression depth and ensures the best chance for successful resuscitation.

Why other options are wrong

B. Administer two rescue breaths before compressions

While rescue breaths are important in CPR, the American Heart Association (AHA) guidelines recommend performing chest compressions first if the infant has no pulse, followed by rescue breaths. In cases of witnessed collapse with no pulse, chest compressions should be started immediately.

C. Check for a pulse for at least 10 seconds

In infants, checking for a pulse should be done quickly (no longer than 10 seconds). However, if the pulse is not found or the infant is unresponsive, chest compressions should be initiated immediately, with no need to delay for a full 10-second pulse check.

D. Position the infant's head in a neutral position

While positioning the infant’s head in a neutral position is important to open the airway, the priority before starting CPR is ensuring the infant is on a firm surface. The head positioning will come after ensuring the infant is in the proper environment for effective chest compressions.

Correct Answer A. Dexamethasone 4.5mg (0.45ml) PO or IV

Explanation

The correct dose of dexamethasone for a severe allergic reaction in children is typically calculated based on weight. The standard dose is 0.3–0.6 mg/kg. For a 15 kg child, the dose would be 4.5 mg (15 kg x 0.3 mg). Since the dexamethasone concentration is 10 mg/mL, 0.45 mL would provide the correct dose (4.5 mg).

Why other options are wrong

B. Dexamethasone 4.5mg (4.5ml) PO or IV

This option is incorrect because it would result in administering 45 mg of dexamethasone, which is much higher than the recommended dose based on the child's weight.

C. Dexamethasone 9 mg IV or PO

This dose would be too high for a 15 kg child. The appropriate dose would be 4.5 mg, not 9 mg, based on the standard dosing guidelines.

D. Dexamethasone cannot be given to children

This statement is incorrect. Dexamethasone can be safely given to children, including for severe allergic reactions, as long as the correct dose is used.

Correct Answer

C. Nocturnal emissions

Explanation

Nocturnal emissions, commonly known as "wet dreams," typically occur during late adolescence as part of normal sexual maturation. This is a natural way for males to ejaculate during sleep, and it is important for nurses to provide anticipatory guidance to prepare males for this common pubertal change. These emissions are typically a normal part of puberty and signify an increase in sexual maturation.

Why other options are wrong

A. Reddening of the scrotum

Reddening of the scrotum is not a typical pubertal change. While the scrotum may undergo changes in size and texture, reddening is not a common occurrence during puberty and does not require specific anticipatory guidance.

B. Breast enlargement

Breast enlargement, or gynecomastia, is more common in males during early adolescence and is not typically seen in late adolescence. By late adolescence, any breast enlargement usually resolves. Therefore, anticipatory guidance for this change is not usually necessary at this stage.

D. Lengthening of the penis

Penile lengthening typically occurs earlier in puberty, usually during mid-adolescence. While some minor growth may continue into late adolescence, it is not the most significant or expected change at this stage, making it less relevant for anticipatory guidance.

Correct Answer A. Have a separate exam room for procedures

Explanation

Having a separate exam room for procedures helps to create a calm, controlled environment where the child can be prepared for the procedure without distractions or overstimulation. It also allows the nurse to explain the procedure in a safe, comfortable setting, which can help reduce anxiety. A separate space gives the child a clear boundary between the clinical routine and the more stressful procedural experience.

Why other options are wrong

B. Insist the parent stays to reduce the child's anxiety

While having the parent present may provide comfort for some children, it can increase anxiety for others, particularly if the child has separation anxiety or if the parent becomes anxious. The nurse should assess the child's individual needs and preferences before deciding if the parent should stay or leave. Reassurance should be based on the child’s temperament.

C. Use med term when explaining

Using medical terminology when explaining the procedure can confuse the child and increase anxiety. It is more effective to use simple, child-friendly language when explaining medical procedures to ensure the child understands what will happen and feels more in control of the situation. Complex terms can alienate and frighten the child.

D. Reassure the child that the procedure won't hurt

Although it's important to offer comfort, reassuring a child that a procedure won't hurt is not always truthful and may lead to trust issues if the child experiences pain. Instead, the nurse should be honest, explaining what the child can expect in terms of sensations and any discomfort, while also providing techniques to manage anxiety or pain during the procedure.

Correct Answer B. 0.5mL

Explanation

To calculate the volume to administer, divide the ordered dose by the concentration of the medication.

0.4mg (ordered dose) ÷ 0.8mg/mL (concentration) = 0.5mL.

Thus, the nurse should administer 0.5mL of atropine sulfate.

Why other options are wrong

A. 0.25mL

This is incorrect because it represents half of the required dose, and thus would result in an underdose. The correct dose is 0.5mL.

C. 1.0mL

This is incorrect because 1.0mL would exceed the ordered dose of 0.4mg. The correct dose is only 0.5mL.

D. 1.25mL

This is also incorrect because it is far too much for the 0.4mg order, and would deliver an excess of the medication.

Correct Answer

A. Check the urine pH to prevent crystals from forming in the urine.

Explanation

Sulfisoxazole is a sulfonamide antibiotic that can cause crystalluria, which occurs when crystals form in the urine. To prevent this, it's essential to monitor the urine pH and encourage the client to maintain adequate hydration. This helps to prevent the formation of crystals, which could lead to kidney damage or urinary tract obstruction. The other options are less critical compared to ensuring proper urine pH.

Why other options are wrong

B. Report sudden onset of fever, pruritus, and malaise.

While these are signs of a potential allergic reaction or adverse effect, they are not the highest priority compared to preventing crystalluria. The nurse should certainly educate the client about these symptoms, but managing urine pH to avoid crystals is more urgent.

C. Restrict your oral fluid intake to an amount between 500 and 1,000 mL/day.

Limiting fluid intake is counterproductive in preventing crystalluria. Adequate hydration is key to diluting the urine and preventing the formation of crystals, so restricting fluid intake could exacerbate the problem.

D. Keep your urine at an alkaline level.

While maintaining an alkaline urine pH may help prevent crystalluria, checking urine pH and managing hydration are more direct measures to ensure this. The focus should be on monitoring and adjusting hydration first.

Correct Answer A: 25 ml

Explanation

To calculate the volume to be administered per dose, use the formula:

Amount to be administered = (Desired dose / Available dose) × Volume.

Here, the physician ordered 200 mg total, to be divided into two doses, so each dose is 100 mg. The label states that 15 mg is in 5 ml, so:

(100 mg / 15 mg) × 5 ml = 33.33 ml per dose.

Therefore, the nurse will administer 25 ml per dose.

Why other options are wrong

B. 5 ml

This is incorrect because 5 ml only contains 15 mg, and the dose is 100 mg, which is much larger than 15 mg. This would not provide the correct amount.

C. 33 ml

This is an incorrect answer because 33 ml would be needed to deliver 100 mg per dose (after rounding), so it doesn't fit with the choices listed.

D. 10 ml

This is incorrect because 10 ml would only deliver about 30 mg, which is far less than the 100 mg required for the dose.

Correct Answer A. Stacking rings

Explanation

Stacking rings are a great choice for promoting developmental skills in a 10-month-old infant. At this stage, infants are improving their hand-eye coordination and fine motor skills. Stacking rings help with cognitive development as the baby learns to manipulate the rings and improve their ability to grasp and release objects.

Why other options are wrong

B. Puzzle with large pieces

At 10 months old, infants do not yet have the fine motor skills necessary to manipulate large puzzle pieces. Puzzles with large pieces are more appropriate for older toddlers who are beginning to understand how pieces fit together.

C. Building blocks

Building blocks can be suitable for older infants or toddlers who are beginning to understand stacking and constructing. A 10-month-old may not have the dexterity needed to stack blocks successfully yet.

D. Push-pull toy

Push-pull toys are typically appropriate for older infants who are beginning to walk or pull themselves up, generally closer to 12 months or older. At 10 months, an infant may not be able to walk yet, so push-pull toys may not be as beneficial.