- Phenylketonuria is characterized by blood phenylalanine levels higher than 8 mg/dL. A normal level is lower than 2 mg/dL. A result of 1 mg/dL is a negative test result.
2) D
- Indicators that fluid volume deficit is resolving would be capillary refill less than 3 seconds, specific gravity of 1.002 to 1.025, urine output of at least 1 mL/kg/hour, and adequate tear production. Therefore, a capillary refill time shorter than 3 seconds is the only indicator that the child is improving. Urine output of less than 1 mL/kg/hr, a specific gravity of 1.030 and no tears would indicate that the deficit is not resolving.3) B
- Nephrotic syndrome is defined as massive proteinuria, hypoalbuminemia, hyperlipemia, and edema. Other manifestations include weight gain, periorbital and facial edema that is most prominent in the morning, leg, ankle, labial or scrotal edema, decreased urine output and urine that is dark and frothy, abdominal swelling, and blood pressure that is normal or slightly decreased.4) A
- Hemolytic-uremic syndrome (HUS) is thought to be associated with bacterial toxins, chemicals, and viruses that cause acute renal failure in children. Clinical features of the disease include acquired hemolytic anemia, thrombocytopenia, renal injury, and central nervous system symptoms. A child with hemolytic-uremic syndrome undergoing peritoneal dialysis because of anuria will be on fluid restriction. Pain is not associated with hemolytic-uremic syndrome and potassium would be restricted, not encouraged, if the child was anuric. Peritoneal dialysis does not require an AV shunt (only hemodialysis).5) D
- All vigorous activities should be restricted for 2 weeks following surgery to promote healing and prevent injury. This will prevent dislodging of the suture, which is internal. Normally, 2-year-old want to be active; therefore, allowing the child to decide when to return to his play activities may prevent healing and cause injury. The parent should be taught to monitor the temperature, provide analgesics as needed, and monitor the urine output.6) C
- Epispadias is a congenital defect involving abnormal placement of the urethral orifice of the penis. The urethral opening is located anywhere on the dorsum of the penis. This anatomical characteristic facilitates entry of bacteria into the urine. Options A, B, and D are not characteristically noted in this condition.7) B
- Nephrotic syndrome is a kidney disorder characterized by massive proteinuria, hypoalbuminemia (hypoproteinemia), and edema. A child with edema from nephrotic syndrome will be at high risk for skin breakdown. Skin surfaces should be cleaned and separated with clothing to prevent irritation and resultant skin breakdown. The child will be anorexic so a risk for imbalanced nutrition, more than body requirements is not a concern. A risk for constipation or ineffective thermoregulation is not a concern with nephrotic syndrome.8) A
At the age of 1 year, a child’s fears of separation are great because the child is facing the developmental task of trusting others. Options C and D may be issues if the child was older. No data in the question allow one to determine that siblings exist.9) B
- In bladder exstrophy, the bladder is exposed and external to the body. In this disorder, one must take care to protect the exposed bladder tissue from drying while allowing the drainage of urine. This is accomplished best by covering the bladder with a nonadhering plastic wrap. The use of petroleum jelly gauze should be avoided because this type of dressing can dry out, adhere to the mucosa, and damage the delicate tissue when removed. Dry sterile dressings and dressings soaked in solutions (that can dry out) also damage the mucosa when removed.10) D
- Glomerulonephritis is a term that refers to a group of kidney disorders characterized by inflammatory injury in the glomerulus. Group A beta-hemolytic streptococcal infection is a cause of glomerulonephritis. Often, the child becomes ill with streptococcal infection of the upper respiratory tract and then develops symptoms of acute poststreptococcal glomerulonephritis after an interval of 1 to 2 weeks. The assessment data in options A, B, and C are unrelated to a diagnosis of glomerulonephritis.11) B
- Glomerulonephritis is a term that refers to a group of kidney disorders characterized by inflammatory injury in the glomerulus. Gross hematuria, resulting in dark, smoky, cola-colored or red-brown urine, is a classic symptom of glomerulonephritis. Hypertension is also common. Blood urea nitrogen levels may be elevated. A moderately elevated to high urinary specific gravity is associated with glomerulonephritis.12) A, B, C, D
- Nephrotic syndrome is a kidney disorder characterized by massive proteinuria, hypoalbuminemia, edema, elevated serum lipids, anorexia, and pallor. The child gains weight.13) B
- Sensorium is an accurate guide to determine the adequacy of fluid resuscitation. The burn injury itself does not affect the sensorium, so the child should be alert and oriented. Any alteration in sensorium should be evaluated further. A neurological assessment would determine the level of sensorium in the child. Options A, C, and D would not provide an accurate assessment of the adequacy of fluid resuscitation.14) D
- Pediculosis capitis is an infestation of the hair and scalp with lice. The nits are visible and firmly attach to the hair shaft near the scalp. The occiput is an area in which nits can be seen. White flaky particles are indicative of dandruff. Maculopapular lesions behind the ears or lesions that extend to the hairline or neck are indicative of an infectious process, not pediculosis.15) B
- Eczema is a superficial inflammatory process involving primarily the epidermis. The major goals of management are to relieve pruritus, lubricate the skin, reduce inflammation, and prevent and control secondary infection. Secondary infection can occur when areas affected by eczema are scratched as a result of the itching because open skin is a portal of entry for pathogens. The lesions are not viral and they do not present as thick white crusty plaques. They appear as red and scaly lesions that can weep, ooze, and crust. They commonly occur in the antecubital and popliteal areas. Throat edema and mouth ulcers are not characteristics of this disorder.16) A
- Scabies appears as burrows or fine, grayish-red, thread-like lines. They may be difficult to see if they are obscured by excoriation and inflammation. Purple-colored lesions may indicate various disorders, including systemic conditions. Thick, honey-colored crusts are characteristic of impetigo or secondary infection in eczema. Clusters of fluid-filled vesicles are seen in herpesvirus infection.17) A
- Lindane is contraindicated for children younger than 2 years. These children have more permeable skin and high systemic absorption may occur, placing the child at risk for central nervous system toxicity and seizures. Lindane also is used with caution in children between the ages of 2 and 10 years. Siblings and other household members also should be treated at the same time. Options 2 and 4 are unrelated to the use of lindane. Lindane is not recommended for use by a breast-feeding woman because the medication is secreted into breast milk.18) D
- Pain crisis may be precipitated by infection, dehydration, hypoxia, trauma, or physical or emotional stress. The mother of a child with sickle cell disease should encourage fluid intake of 1½ to 2 times the daily requirement to prevent dehydration.19) B
- Hemophilia refers to a group of bleeding disorders resulting from a deficiency of specific coagulation proteins. The primary treatment is replacement of the missing clotting factor; additional medications, such as those to relieve pain, may be prescribed depending on the source of bleeding from the disorder. A child with hemophilia A will be at risk for joint bleeding after a fall. Factor VIII will be prescribed intravenously to replace the missing clotting factor and minimize the bleeding. Desmopressin (DDAVP) is used to stimulate production of factor VIII, but it is not given intravenously. Factor X and cryoprecipitate are not used for clients with hemophilia A.20) D
- The results of a complete blood cell count in children with iron deficiency anemia will show decreased hemoglobin levels and microcytic and hypochromic red blood cells. The red blood cell count is decreased. The reticulocyte count is usually normal or slightly elevated.21) D
- Hemophilia refers to a group of bleeding disorders resulting from a deficiency of specific coagulation proteins. Results of tests that measure platelet function are normal; results of tests that measure clotting factor function may be abnormal. Therefore, abnormal laboratory results in hemophilia indicate a prolonged partial thromboplastin time. The platelet count, hemoglobin level, and hematocrit level are normal in hemophilia.22) C
- β-Thalassemia is an autosomal recessive disorder characterized by the reduced production of one of the globin chains in the synthesis of hemoglobin (both parents must be carriers to produce a child with β-thalassemia major). The major complication of chronic transfusion therapy is hemosiderosis. To prevent organ damage from too much iron in the blood, chelation drug therapy with deferoxamine (Desferal) is used. Deferoxamine is classified as an antidote for acute iron toxicity. Dalteparin is an anticoagulant used as prophylaxis for postoperative deep vein thrombosis. Meropenem is an antibiotic. Metoprolol is a β blocker used to treat hypertension.23) A, C
- Sickle cell anemia is a group of diseases termed hemoglobinopathies, in which hemoglobin A is partly or completely replaced by abnormal sickle hemoglobin S. It is caused by the inheritance of a gene for a structurally abnormal portion of the hemoglobin chain. Hemoglobin S is sensitive to changes in the oxygen content of the red blood cell; insufficient oxygen causes the cells to assume a sickle shape and the cells become rigid and clumped together, obstructing capillary blood flow. Therefore, oral and intravenous fluids are an important part of treatment. Meperidine (Demerol) is not recommended for the child with sickle cell disease because of the risk for normeperidine-induced seizures. Normeperidine, a metabolite of meperidine, is a central nervous system stimulant that produces anxiety, tremors, myoclonus, and generalized seizures when it accumulates with repetitive dosing. The nurse would thus question the order for restricted fluids and meperidine for pain control. Positioning for comfort, avoiding strain in painful joints, oxygen, and a high-calorie, high-protein diet are also important parts of the treatment plan.24) A, B, C, E, F
- von Willebrand disease is a hereditary bleeding disorder characterized by a deficiency of or a defect in a protein termed von Willebrand factor (vWF). The disorder causes platelets to adhere to damaged endothelium. It is characterized by an increased tendency to bleed from mucous membranes. Assessment findings include epistaxis, gum bleeding, easy bruising, and excessive menstrual bleeding. An elevated creatinine level is not associated with this disorder.25) D
- If a child is severely thrombocytopenic and has a platelet count less than 20,000/μL, bleeding precautions need to be initiated because of the increased risk of bleeding or hemorrhage. The precautions include limiting activity that could result in head injury, using soft toothbrushes or Toothettes, checking urine and stools for blood, and administering stool softeners to prevent straining with constipation. In addition, suppositories and rectal temperatures are avoided. Options A, B, and C are related to the prevention of infection rather than bleeding.Topics Related to NCLEX Preparation Course:
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Lindane should not be used with caution on anyone under 110 lbs. The FDA blackboxed lindane in 2003 and stated that it has caused seizures etc even when used as directed. The EPA banned lindane for use in agriculture due to toxicity to humans and the environment.
California banned lindane for use on headlice and scabies years ago.
Lindane has also been one of several toxic chemicals/pesticides banned by the Stockholm convention.
Safer alternatives are available, such as using a good metal fine tooth comb.
thanks for additional info :)
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