Which finding would alert a nurse that a hospitalized 6-year-old child is at risk for a severe asthma exacerbation?

Correct Answer: D

Rationale: In this scenario, option D, "History of steroid-dependent asthma," is the correct answer indicating a child is at risk for a severe asthma exacerbation. Children with steroid-dependent asthma have a history of severe and recurrent asthma attacks, requiring long-term steroid therapy. This places them at higher risk for exacerbations due to the chronic nature of their condition and potential for poor asthma control. Option A, "Oxygen saturation of 95%," may seem like a good sign, but in asthma exacerbations, oxygen saturation can initially be maintained before dropping rapidly during a severe attack. Therefore, a child with a history of severe asthma exacerbations may still be at risk despite a seemingly normal oxygen saturation level. Option B, "Mild work of breathing," and option C, "Absence of intercostals or substernal retractions," both suggest a lack of significant respiratory distress. However, in severe asthma exacerbations, children may not exhibit these signs until the condition rapidly deteriorates. This emphasizes the importance of considering the child's medical history and risk factors for predicting severe asthma exacerbations. Educationally, this question highlights the critical role of recognizing risk factors in pediatric asthma management. Understanding a child's medical history, especially in chronic conditions like asthma, can help healthcare providers anticipate and prevent severe exacerbations. It also underscores the need for proactive monitoring and early intervention in children with a history of severe asthma to prevent potentially life-threatening situations.

Correct Answer: B

Rationale: In this scenario, option B, "He tires out during feedings," is the correct choice that would alert the nurse about the presence of a congenital heart defect in a 1-month-old infant. Infants with congenital heart defects may display symptoms such as fatigue during feeding due to the increased effort required by the heart to pump blood effectively. This can lead to poor feeding, inadequate weight gain, and failure to thrive. Option A, "He is always hungry," is incorrect as it is a common behavior in infants and does not specifically indicate a heart defect. Option C, "He is fussy for several hours every day," could be due to various reasons such as colic or general infant fussiness and does not directly point to a heart condition. Option D, "He sleeps all the time," is also non-specific and could be a normal pattern for a newborn. Educationally, understanding the signs and symptoms of congenital heart defects in infants is crucial for nurses and healthcare providers working in pediatric settings. Early recognition and intervention can significantly impact the outcomes for these infants. It is essential to educate parents on what to observe and report to healthcare providers to ensure timely diagnosis and management of congenital heart defects.

Correct Answer: A

Rationale: In caring for a child with acute glomerulonephritis, an increased urine output with normal color and consistency would most likely indicate improvement because it suggests that the kidneys are functioning better and able to filter waste products effectively. This is a positive sign as it indicates improved kidney function and clearance of toxins from the body. Option B, a decrease in blood pressure, is not necessarily an indicator of improvement in acute glomerulonephritis as it could be due to other factors such as fluid restriction or medications. Option C, a reduction in protein levels in the urine, is also not the most reliable indicator of improvement as proteinuria can persist even after the condition starts to improve. Option D, a decrease in hematuria, is a positive sign but not as indicative of improvement as increased urine output. Educationally, it is crucial for nurses to understand the various indicators of improvement in pediatric patients with acute glomerulonephritis to provide effective care and monitor the child's progress accurately. Recognizing the significance of increased urine output in color and consistency can guide nursing interventions and help in assessing the child's response to treatment accurately.

Correct Answer: B

Rationale: In the case of a 2-year-old child being treated for lead poisoning, the correct answer is B) Decreased hemoglobin levels indicating the need for further intervention. Lead poisoning can lead to anemia by inhibiting the body's ability to produce hemoglobin. Monitoring hemoglobin levels is crucial in children with lead poisoning to assess the severity of anemia and the effectiveness of treatment. Option A) Increased urine output is not typically a concerning finding in the context of lead poisoning. It may actually be a positive sign as increased urine output can help in excreting lead from the body. Option C) Weight gain is also not a common indicator of the need for further intervention in lead poisoning. In fact, weight loss or failure to thrive may be more indicative of lead poisoning complications. Option D) Improved developmental milestones would generally be seen as a positive outcome of treatment for lead poisoning rather than a reason for further intervention. Monitoring developmental milestones is important in assessing the overall progress of the child's treatment. Educationally, understanding the potential complications of lead poisoning in pediatric patients is crucial for nurses and healthcare providers. Recognizing the signs and symptoms that require further intervention is vital for providing effective care and ensuring positive outcomes for children affected by lead poisoning. Regular monitoring of hemoglobin levels, along with other relevant parameters, is essential in managing lead poisoning in pediatric patients.

Correct Answer: D

Rationale: In recommending a heart-healthy diet for a child with high cholesterol, the school nurse should advocate for a significant reduction in fat intake. Option D, which suggests reducing fat intake by 25-35% of total calories, is the most appropriate choice. This level of reduction is crucial in managing cholesterol levels and promoting cardiovascular health in children. Option A, with a fat intake reduction of 5-10% of total calories, is too conservative and may not have a significant impact on lowering cholesterol levels. Option B, with a reduction of 10-15%, is also not substantial enough for a child with high cholesterol. Option C, suggesting a reduction of 15-20%, is closer but may still fall short of the necessary dietary changes needed to effectively manage high cholesterol in children. Educationally, it is important to highlight the link between dietary fat intake and cholesterol levels in pediatric patients. Teaching students and parents about the impact of dietary choices on cardiovascular health from a young age can instill lifelong habits that promote heart health. Emphasizing the significance of a well-balanced, low-fat diet in managing high cholesterol is essential in preventing long-term health complications in children.