A 13-year-old is worried because his breasts are growing and are tender. What should the nurse tell him?

Correct Answer: C

Rationale: Gynecomastia and breast tenderness occur in about one-third of boys during mid-puberty and usually resolve within 2 years.

Correct Answer: B

Rationale: When dehiscence, which is the separation of the layers of a surgical incision, occurs in a patient, it is important to have the patient lie down. This position will help decrease intra-abdominal pressure and reduce the risk of further complications. Having the patient sit upright in a chair can increase intra-abdominal pressure, worsening the dehiscence. Slowing IV fluids may be necessary to prevent fluid overload in certain situations, but it is not the immediate action required when dehiscence occurs. Obtain a sterile suture set may eventually be needed, but the priority in this situation is to stabilize the patient by having them lie down.

Correct Answer: C

Rationale: Nephrotic syndrome is characterized by the presence of edema due to loss of protein in the urine. One of the nursing goals in managing a child with minimal change nephrotic syndrome receiving high doses of prednisone is to monitor for the development or worsening of edema. Detecting evidence of edema is important as it can help in assessing the effectiveness of treatment, such as monitoring the response to prednisone therapy and adjusting the treatment plan accordingly. Monitoring for edema can also help in preventing complications associated with fluid overload, such as hypertension and respiratory distress. Therefore, detecting evidence of edema is an appropriate nursing goal in this scenario.

Correct Answer: C

Rationale: When a child is admitted to the hospital with dehydration and a urinary tract infection (UTI), the urinalysis result that the nurse should expect is an increased white blood cell (WBC) count, indicated by WBC >2, along with a slightly elevated specific gravity, typically around 1.016. A specific gravity of 1.016 suggests some concentration of urine due to dehydration, while an increased WBC count indicates the presence of infection in the urinary tract. These findings are consistent with dehydration and UTI in a preschool child. Options A, B, and D do not fully align with the expected urinalysis results in this clinical scenario.

Correct Answer: C

Rationale: Gynecomastia and breast tenderness occur in about one-third of boys during mid-puberty and usually resolve within 2 years.