NR-328 Pediatric Nursing - Set 5 - Part 3

Correct Answer: The four year old who asks repeated questions

Preschoolers use magical thinking and see death as reversible and deserved, so a sibling this age commonly decides that a thought, a wish or a misbehaviour caused it. The nurse states plainly that nothing they did caused the death. Option a is incorrect because school age children reason concretely and want facts about the body and the funeral. By roughly nine or ten years the adult concept of death is largely in place. Option b is incorrect because adolescents already hold an adult understanding and grieve the future the sibling lost. Withdrawal here reflects peer orientation and privacy needs rather than any belief about blame. Option c is incorrect because infants form no concept of death whatsoever. Crying and clinging register separation, disrupted routine and the distress of the caregivers, and comfort with consistent holding is the whole intervention.

Correct Answer: Immobilize the neck and arrange urgent cervical imaging

Neck pain with a change in gait signals possible cord compression from atlantoaxial instability. The child needs immediate neck immobilization and a lateral neutral cervical radiograph, since symptomatic instability can progress to permanent spinal cord injury. Option a is incorrect because clumsiness that is new, progressive and paired with neck pain is never a normal variant. Reassurance here delays recognition of cord compression and allows a treatable mechanical problem to become permanent weakness. Option c is incorrect because no sport is safe until the cervical spine is evaluated. Clearance decisions belong after imaging, and any neck flexing or high impact activity risks worsening the very injury the symptoms already suggest. Option d is incorrect because a routine referral weeks away treats an emergency as an outpatient question. Progressive myelopathy from atlantoaxial subluxation is managed the day it is recognized, with the neck protected while imaging is obtained.

Correct Answer: Offer confidential time alone with the adolescent

Transition is a planned process starting around twelve to fourteen years. Private time with the adolescent builds self management, lets her name her condition and medications, and shifts responsibility gradually rather than all at once. Option a is incorrect because an abrupt handover at eighteen is linked to lost follow-up, disease deterioration and preventable death. The skills being built take years, so the conversation opens in early adolescence. Option b is incorrect because leaving the regimen with the mother preserves exactly the dependence transition is meant to undo. By mid adolescence the teen should be ordering refills and speaking for herself. Option d is incorrect because moving records is paperwork, not preparation. A transition needs a written policy, a portable medical summary the teen owns, an identified adult provider and confirmation the first appointment happened.

Correct Answer: Apply the rinse to damp, towel-dried hair

Permethrin works on damp towel-dried hair, and conditioner coats the shaft so the drug cannot reach the louse. A second application near day nine kills the lice that hatch afterward. Option a is incorrect because conditioner leaves a film that blocks the medication from binding to hair and scalp. Families who condition first often report treatment failure when the product itself was fine. Option b is incorrect because overnight contact belongs to the scabies cream, not to this rinse, which is washed out after about ten minutes. Longer exposure adds irritation without killing more lice. Option c is incorrect because the rinse is designed for hair that is wet and towel-dried, not bone dry. Dry hair gives uneven coverage and leaves pockets of scalp where lice survive the application.

Correct Answer: Turner syndrome with a forty five X karyotype

Short stature, a webbed neck and widely spaced nipples in a girl with primary amenorrhea point to a missing X. Coarctation or a bicuspid aortic valve explains the murmur, and intelligence is usually normal. Option b is incorrect because that karyotype belongs to males. The picture there is a tall adolescent boy with small firm testes, gynecomastia and infertility, which cannot describe a girl being evaluated for absent periods. Option c is incorrect because a repeat expansion produces a long narrow face, large protruding ears and intellectual disability, most obviously in boys. Nothing about short stature, a webbed neck or amenorrhea belongs to that condition. Option d is incorrect because trisomy twenty one is recognized in infancy through hypotonia and facial features, not discovered in an adolescent with normal school performance. Its cardiac lesion is typically an atrioventricular canal defect rather than coarctation.

Correct Answer: Urinary catecholamine metabolites and an MIBG scan

Neuroblastoma arises from neural crest tissue and secretes catecholamines, so their breakdown products appear in the urine. Crossing the midline with orbital bruising and bone pain fits this tumor rather than a kidney mass. Option a is incorrect because that pairing chases osteosarcoma, a bone tumor of adolescence that shows a sunburst pattern at the metaphysis. A three-year-old with an abdominal mass does not fit that picture. Option c is incorrect because marrow sampling for blasts confirms leukemia, which announces itself through pallor, fever and bleeding rather than a solid mass crossing the midline. Marrow study here would follow the tissue diagnosis. Option d is incorrect because those cells define Hodgkin lymphoma, which presents in adolescents with a painless firm node in the neck. Neither the age nor the abdominal findings point toward nodal disease.

Correct Answer: Cheeks, scalp, and extensor surfaces of the arms

Infantile eczema settles on the cheeks, scalp, trunk, and the outer surfaces of the limbs, while the moist diaper area stays clear. The pattern shifts to the flexures once the child passes toddlerhood. Option b is incorrect because flexural involvement of the elbow and knee creases belongs to the childhood phase after about age two. A young infant has not yet developed that lichenified pattern in the folds. Option c is incorrect because the skin under a diaper stays humid and protected, so eczema characteristically spares it. A beefy red rash in that area points to candidal diaper dermatitis instead. Option d is incorrect because palm and sole involvement with scaling between the toes describes tinea pedis in an older child. Infants rarely show that distribution, and their rash weeps rather than peels.

Correct Answer: Applying a topical antifungal at each change

Rash sitting in the creases with satellite pustules after several days of good barrier care is candidal, so nystatin or clotrimazole goes on at every change. Checking the mouth for thrush follows. Option a is incorrect because more barrier paste treats the irritant rash that sits on convex skin and spares the folds. Yeast is already established here, and paste alone will not clear it. Option b is incorrect because a diaper acts as an occlusive dressing that drives steroid absorption upward, so only brief low-potency hydrocortisone is acceptable there. Stronger preparations risk growth and adrenal effects. Option c is incorrect because cornstarch feeds yeast and loose powders can be inhaled by an infant during a change. Powder of any kind is left out of routine diaper care for those two reasons.

Correct Answer: Covering the strong eye forces the weak one to work

Amblyopia comes from the brain suppressing the blurred image, so blocking the better eye pushes the visual cortex to use the weaker one. The pathway can only be rebuilt while the child is young. Option a is incorrect because resting a healthy eye serves no purpose and reverses the aim of therapy. The weak eye is the one that must be exercised, which happens only while the strong eye is covered. Option b is incorrect because alignment is corrected by glasses, prisms, or muscle surgery rather than by a patch. Patching addresses the vision lost in the deviating eye, which is a separate problem. Option d is incorrect because covering both eyes would blind the child temporarily and stop all visual input to the cortex. Therapy depends on the weaker eye receiving images, not on removing them altogether.

Correct Answer: He has lost words he used to say

Loss of previously acquired language or social skills at any age is the one autism red flag treated as urgent. It calls for immediate referral for diagnostic evaluation and early intervention rather than watchful waiting. Option a is incorrect because lining objects up is a restricted repetitive behavior that does belong in the autism picture, yet it is a routine screening finding. On its own it prompts standardized screening, not emergency referral. Option c is incorrect because covering the ears reflects hypersensitivity to sound, one of the sensory differences seen across the spectrum. Sensory reactivity shapes how the child is cared for but does not by itself outrank skill loss. Option d is incorrect because absent pretend play is a real social communication concern and is screened for at this age. Still, a skill the child never had is less alarming than a skill that has disappeared.