An adolescent patient with chronic asthma, who has been hospitalized several times during the winter with severe asthmatic exacerbations, confides, 'I wish I could stay here in the hospital because every time I go home, I get sick again!' What is the pediatric nurse's best response?

Correct Answer: A

Rationale: The best response for the pediatric nurse in this scenario is option A: "Let's talk about preventing and managing your asthma on a daily basis at home." This response is the most appropriate because it addresses the patient's expressed concern about repeatedly getting sick after going home and focuses on empowering the adolescent to take an active role in managing their asthma. Option B is not the best response because it deflects the conversation away from the patient and places the responsibility solely on the parents. While involving parents in asthma management is important, it is crucial to empower the adolescent to understand and take ownership of their condition. Option C, "We can arrange for you to stay in the hospital longer," is not the best response either. Prolonged hospital stays should be reserved for acute exacerbations or severe cases, and encouraging a patient to stay in the hospital longer without addressing the underlying issue may not be in the patient's best interest. In an educational context, it is essential for pediatric nurses to foster open communication with adolescent patients, validate their feelings, and empower them to actively participate in their care. By addressing the patient's concerns and involving them in the management of their asthma, the nurse can help promote self-care skills and better health outcomes for the adolescent.

Correct Answer: D

Rationale: The correct answer is D) gives a heavy meal within an hour of bedtime. This option is not included in healthy sleep hygiene practices for children because consuming a heavy meal close to bedtime can lead to indigestion, discomfort, and disrupted sleep. It is important to avoid heavy meals, especially close to bedtime, to promote better sleep quality. Option A) setting a routine, is a key component of healthy sleep hygiene as it helps regulate the child's internal clock, making it easier for them to fall asleep and wake up at consistent times. Option B) avoiding stimulating activities like playing computer games before bedtime is important as these activities can interfere with the child's ability to wind down and fall asleep. Option C) ensuring the child spends time outside every day is beneficial for overall health and well-being, but it may not directly impact sleep hygiene as the other options do. In an educational context, teaching parents and caregivers about healthy sleep hygiene practices for children is crucial for promoting good sleep habits and overall well-being. Emphasizing the importance of a bedtime routine, avoiding stimulating activities before sleep, and ensuring a light and balanced meal are key components in helping children establish healthy sleep patterns. By understanding and implementing these practices, caregivers can support children in getting the restful sleep they need for optimal growth and development.

Correct Answer: B

Rationale: In pediatric practice, autism screening is a crucial component of developmental surveillance due to the importance of early detection and intervention in improving outcomes for children with autism spectrum disorder (ASD). The correct answer, option B) 18 to 24 months, aligns with the American Academy of Pediatrics (AAP) recommendation to conduct universal autism screening at 18 and 24 months of age. At 18-24 months, children are entering a critical period of development where early signs of ASD may become more noticeable. Screening at this age allows for timely intervention and support services to be initiated, maximizing the child's developmental progress and quality of life. Options A) 12 to 18 months and D) 36 to 48 months are incorrect because screening at 12-18 months may miss subtle early signs of ASD that become more apparent later, while screening at 36-48 months delays potential intervention during a critical developmental period. Option C) 24 to 36 months is also not ideal as it misses the opportunity for earlier intervention that can significantly impact the child's developmental trajectory. Educationally, understanding the timing and rationale behind autism screening recommendations empowers healthcare providers to implement evidence-based practices, promote early detection, and provide appropriate support for children and families. By following guidelines such as screening at 18-24 months, professionals can contribute to improved outcomes and better long-term prognosis for children with ASD.

Correct Answer: C

Rationale: In this scenario, the correct answer is C) administer activated charcoal immediately and measure the plasma level of acetaminophen 4 hours after ingestion. The rationale behind this choice is that activated charcoal can help absorb the remaining acetaminophen in the stomach, reducing its absorption into the bloodstream and potentially mitigating toxicity. Additionally, measuring the plasma level of acetaminophen 4 hours after ingestion allows for a more accurate assessment of the extent of toxicity and guides further treatment decisions. Option A is incorrect because measuring the plasma level without administering activated charcoal may result in continued absorption and worsening toxicity. Option B is incorrect as waiting 4 hours without taking any action can lead to increased absorption of acetaminophen and delayed intervention. Option D is incorrect as the ingestion of this magnitude can indeed be toxic, and sending the patient home without appropriate intervention can be dangerous. In an educational context, this question emphasizes the importance of prompt and appropriate management of acetaminophen overdose in pediatric patients. It highlights the significance of quick decision-making, using interventions like activated charcoal, and monitoring the patient closely to prevent adverse outcomes. Understanding the rationale behind each option helps healthcare providers make informed decisions in real-life scenarios involving acetaminophen toxicity in pediatric patients.

Correct Answer: C

Rationale: In this scenario, the correct answer is C) behavioral insomnia of childhood. Behavioral insomnia of childhood is a common sleep disorder in children characterized by difficulties initiating or maintaining sleep. In this case, the 4-year-old boy's refusal to go to bed and remaining active is consistent with this disorder, as children with behavioral insomnia often resist going to bed and exhibit increased activity levels at bedtime. Option A) thyrotoxicosis is less likely as it is a medical condition involving an overactive thyroid gland, which typically presents with symptoms such as weight loss, increased appetite, and hyperactivity, rather than just bedtime resistance. Option B) ADHD (Attention-Deficit/Hyperactivity Disorder) is also less likely as the primary symptoms of ADHD involve inattention, hyperactivity, and impulsivity throughout the day, rather than being specific to bedtime. Option D) sleep-onset association disorder involves needing specific conditions or associations to fall asleep, such as needing a parent present. While this disorder can lead to bedtime resistance, the scenario described is more indicative of behavioral insomnia of childhood. Educationally, understanding the different sleep disorders in children is crucial for healthcare professionals and caregivers to provide appropriate interventions and support. Recognizing the signs and symptoms of behavioral insomnia of childhood can help in implementing behavioral interventions to improve sleep hygiene and promote healthy sleep habits in children.