Protein energy malnutrition, bites, stings, pica, tics
Time: 15:00
A child presents with generalized edema, a distended abdomen, and "flaky paint" dermatosis, but with preserved subcutaneous fat. The nurse recognizes these as classic signs of which form of protein-energy malnutrition?
[a] Marasmus.
[b] Kwashiorkor.
[c] Nutritional rickets.
[d] Scurvy.
A school nurse is providing first aid to a child stung by a bee on the arm. What is the most appropriate initial action?
[a] Squeeze the stinger out with tweezers.
[b] Apply a tourniquet above the sting site.
[c] Scrape the stinger out horizontally with a flat-edged object like a credit card.
[d] Immediately apply a hot compress to the area.
Pica is best defined as a persistent craving and compulsive eating of:
[a] High-carbohydrate foods.
[b] A single, specific food item.
[c] Non-nutritive, non-food substances.
[d] Unusually large quantities of food.
A child is diagnosed with Tourette's Syndrome. For this diagnosis to be made, the child must exhibit:
[a] Only multiple motor tics that have been present for less than a year.
[b] Only one or more vocal tics.
[c] Tics that are completely voluntary and can be stopped at will.
[d] Both multiple motor tics and at least one vocal tic for more than a year.
A nurse assesses an infant with a "wasted" appearance, severe muscle wasting, and significant loss of subcutaneous fat, giving them an "old man" look. This presentation is characteristic of:
[a] Marasmus.
[b] Kwashiorkor.
[c] Anorexia nervosa.
[d] Iron-deficiency anemia.
A child is brought to the emergency department after being bitten by an unknown snake on the leg. The priority first aid nursing intervention in the field or en route is to:
[a] Apply a tourniquet tightly above the bite.
[b] Cut the wound and attempt to suck out the venom.
[c] Apply ice directly to the bite site.
[d] Keep the child calm and immobilize the affected limb below the level of the heart.
Pica is most commonly associated with which nutritional deficiency?
[a] Vitamin C deficiency.
[b] Iron and/or zinc deficiency.
[c] Calcium deficiency.
[d] Vitamin B12 deficiency.
When caring for a child with tics, the nurse should advise the parents that the most effective management approach often involves:
[a] Reminding the child to stop the tic every time it occurs.
[b] Reducing stress and anxiety, as these can exacerbate tics.
[c] Ignoring the child completely when the tic occurs.
[d] Using punishment to stop the involuntary movements.
What is the priority nursing intervention when beginning nutritional rehabilitation for a child with severe protein-energy malnutrition?
[a] Immediately starting a high-protein, high-calorie diet.
[b] Correcting dehydration and electrolyte imbalances cautiously.
[c] Administering a blood transfusion.
[d] Providing a high-fat diet to restore subcutaneous tissue.
A child is brought to the clinic after a dog bite to the hand. Nursing management should include thorough wound cleaning and verification of the child's immunization status for:
[a] Measles, Mumps, and Rubella (MMR).
[b] Hepatitis B.
[c] Tetanus.
[d] Varicella.
A child with a known history of pica who eats paint chips is at highest risk for what condition?
[a] Intestinal parasites.
[b] Dental caries.
[c] Salmonella infection.
[d] Lead poisoning.
An example of a simple motor tic is:
[a] Eye blinking.
[b] Jumping up and down.
[c] Repeating a specific phrase.
[d] Smelling objects.
When initiating refeeding in a severely malnourished child, the nurse must monitor closely for "refeeding syndrome," which is characterized by a severe drop in:
[a] Sodium.
[b] Calcium.
[c] Phosphate.
[d] Glucose.
A child presents with severe muscle cramping, abdominal rigidity, and nausea after being bitten by a spider while playing in a woodpile. The nurse suspects a bite from which spider?
[a] Brown recluse spider.
[b] Black widow spider.
[c] Wolf spider.
[d] Jumping spider.
Which anthropometric measurement is most useful for rapid screening of malnutrition in children between 6 months and 5 years of age?
[a] Head circumference.
[b] Height-for-age.
[c] Mid-Upper Arm Circumference (MUAC).
[d] Body Mass Index (BMI).
The nurse is educating a child's family about tics. Which statement is most accurate?
[a] "Tics are a sign of serious neurological damage."
[b] "The frequency and intensity of tics can wax and wane, often worsening with stress."
[c] "Tics will always progress and become more severe over time."
[d] "The only effective treatment for tics is surgical intervention."
A child is brought to the emergency department with wheezing, hives, and difficulty breathing after an insect sting. The nurse's immediate priority is:
[a] Applying ice to the sting site.
[b] Obtaining a detailed allergy history.
[c] Administering epinephrine and managing the airway.
[d] Starting an intravenous line for fluids.
The primary difference between Kwashiorkor and Marasmus is that children with Kwashiorkor have:
[a] Severe muscle wasting with no subcutaneous fat.
[b] A voracious appetite.
[c] Significant edema due to hypoalbuminemia.
[d] A diet primarily deficient in calories.
The nurse should teach parents in a tick-infested area that the best way to prevent Lyme disease is to:
[a] Administer prophylactic antibiotics to children all summer.
[b] Perform daily tick checks and properly remove any attached ticks as soon as possible.
[c] Avoid all outdoor activities during the summer months.
[d] Apply petroleum jelly to any attached ticks.
A complex vocal tic is best described as:
[a] A simple throat-clearing sound.
[b] A single grunt or sniff.
[c] Repeating words or phrases (palilalia or echolalia).
[d] A facial grimace.
A long-term consequence of severe protein-energy malnutrition in early childhood is:
[a] Increased adult height.
[b] Impaired cognitive development and learning disabilities.
[c] A stronger immune system in adulthood.
[d] A lower risk of chronic diseases.
The nursing management of a child with pica includes behavioral interventions and:
[a] Punishing the child for eating non-food items.
[b] Restricting the child's diet to liquids only.
[c] Encouraging the behavior in a controlled setting.
[d] Screening for and treating any underlying nutritional deficiencies.
A child with Kwashiorkor is often irritable and apathetic, with a poor appetite. What is the most appropriate nursing approach to feeding?
[a] Force-feed the child to ensure adequate intake.
[b] Offer three large, high-protein meals per day.
[c] Provide small, frequent, appealing meals in a calm, encouraging environment.
[d] Withhold food until the child asks for it to stimulate appetite.
A child has an established tic disorder. The school nurse's role includes educating the teacher to:
[a] Send the child to the principal's office whenever a tic occurs.
[b] Isolate the child from peers to avoid embarrassment.
[c] Allow for short breaks and create a supportive, low-stress classroom environment.
[d] Encourage the child to suppress the tics throughout the entire school day.
A child is admitted for an animal bite. In addition to wound care, the nurse should be prepared for the potential administration of rabies prophylaxis, which consists of the rabies vaccine and:
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