TEST 9: The Child with Dermatologic and Endocrine Health Problems

Question 1

The Client with Skin Disorders
1. A 17-year-old female with severe nodular acne is considering treatment with isotretinoin
(Accutane). Prior to beginning the medication, the nurse explains that the client will be required to:
1. Enroll in a risk management plan.
2. Have proof of a mental health evaluation.
3. Begin an effective form of birth control.
4. Temporarily give up sports.

Answer 1

The Client with Skin Disorders
1. 1. Because of the risk of birth defects with isotretinoin, risk management plans require all
clients to meet certain requirements to obtain the medication. Providers are advised to closely
monitor clients for signs of depression, but a mental health evaluation is not universally required.
Women of child-bearing age must use two forms of effective birth control for 2 months before, during,
and 1 month after taking the drug. Isotretinoin may cause muscle aches and extreme exercise should be
avoided, but general participation in sports should be considered on an individual basis.
CN: Safety and infection control; CL: Synthesize

Question 2

2. When teaching an adolescent with facial acne about skin care, the nurse should instruct the
   adolescent to:
3. Wash the face twice a day with mild soap and water.
4. Remove whiteheads and comedones after washing his face with antibacterial soap.
5. Apply vitamin E ointment twice daily to the affected skin.
6. Apply tretinoin (Retin-A) daily in the morning and expose the face to the sun.

Answer 2

2. 1. Washing the face once or twice a day with a mild soap removes fatty acids from the skin.
      Acne is an inflammation of the sebaceous glands that produce sebum. Washing the face with mild
      soap and water keeps the sebaceous glands from becoming plugged. Excessive washing or squeezing
      the eruptions can cause rupture of these glands, spreading the sebum and causing further inflammation.
      Applying vitamin E to the lesions does not reduce the inflammation and, due to the greasiness of the
      preparation, may plug the ducts. Retin-A should be applied at night. Exposure to the sun can result in
      sunburn and an increased risk of skin cancer and should be avoided. Sunscreen with a sun protection
      factor of at least 15 must be applied before the client can be exposed to the sun.
      CN: Physiological adaptation; CL: Synthesize

Question 3

3. A 9-month-old infant with eczema has lesions that are secondarily infected. Which of the
   following is most appropriate to help the parents best meet the needs of the child?
4. Preventing siblings from being in close contact.
5. Sending the child to day care as usual.
6. Playing video games for several hours each evening.
7. Playing with the child every day.

Answer 3

3. 4. The parents can best meet the needs of their 9-month-old infant by playing with the child
      every day. All infants need time with their parents to develop trust and thus attain optimal
      development. The parents of a child with a chronic problem may need more guidance to meet the
      child’s needs because of the focus on medical problems. The child’s lesions are secondarily infected
      and therefore should not be contagious. Siblings do not need to stay away. Even with lesions that are
      infected, the child can still attend day care, but the child needs attention from the parents as well.
      Playing video games for several hours is not appropriate for a 9-month-old infant.
      CN: Health promotion and maintenance; CL: Synthesize

Question 4

4. After the nurse teaches the mother of a child with atopic dermatitis how to bathe her child,
   which of the following statements by the mother indicates effective teaching?
5. “I let my child play in the tub for 30 minutes every night.”
6. “My child loves the bubble bath I put in the tub.”
7. “When my child gets out of the tub I just pat the skin dry.”
8. “I make sure my child has a bath every night.”

Answer 4

4. 3. Atopic dermatitis is a chronic pruritic dermatitis that usually begins in infancy. Many of the
      children diagnosed with it have a family history of eczema, allergies, or asthma. Atopic dermatitis is
      best treated with hydrating the skin, controlling the pruritus, and preventing secondary infection.
      Patting the skin dry removes less natural skin moisturizer and thus maintains skin hydration. Water has
      a drying effect on the skin. Playing in the tub for 30 minutes each night would deplete the skin of its
      natural moisturizers, thereby leading to increased pruritus and dry skin. Bubble baths are to be
      avoided in children with atopic dermatitis because they may act as an irritant, possibly exacerbatingthe condition. Also, bubble baths deplete the skin of its natural moisturizers. The issue is not whether
      the child bathes every night. Rather, the goal is to decrease dryness and itching.
      CN: Physiological adaptation; CL: Evaluate

Question 5

5. A 5-year-old child brought to the clinic with several superficial sores on the front of the left
   leg is diagnosed with impetigo. Which of the following instructions should the nurse give the parent?
6. Wash the child’s legs gently three times per day with a mild soap.
7. Cover the sores with loose gauze.
8. Allow the child to go back to school after 24 hours of treatment.
9. Have the child return to the clinic the next week for a follow-up examination

Answer 5

5. 3. Impetigo involving several superficial lesions is usually treated topically, including washing
      the affected areas, removing crusts, and applying antibiotic ointment several times a day. The child
      can return to day care or school after being treated for 24 hours. The lesions do not need to be
      covered, they can remain open to the air. There is no need for follow-up unless the lesions have not
      resolved or have become more severe.
      CN: Physiological adaptation; CL: Create

Question 6

6. When developing the teaching plan for the mother of a 2-year-old child diagnosed with
   scabies, which of the following points should the nurse expect to include?
7. The floors of the house should be cleaned with a damp mop.
8. The child should be held frequently.
9. Itching should cease in a few days.
10. The entire family should be treated.

Answer 6

6. 4. Scabies is caused by the scabies mite, Sarcoptes scabiei. The mite burrows into the stratum
      corneum of the epidermis, where the female deposits eggs and fecal material. These burrows are
      linear. Scabies is highly contagious. The length of time from infestation to physical symptoms is 30 to
      60 days, so everyone in close contact with the child will need to be treated. The bed linens and the
      child’s clothing should be washed in hot water and dried on the hot setting. It is not necessary to damp
      mop the floors to prevent the spread of scabies. The child should be held minimally until treatment is
      completed. Family members should wash their hands after contact with the child. Itching lasts for 2 to
      3 weeks until the stratum corneum is replaced.
      CN: Safety and infection control; CL: Create

Question 7

The Client with Burns
7. A 10-year-old has just spilled hot liquid on his arm, and a 4-inch (10.2-cm) area on his
forearm is severely burned. His mother calls the emergency department. What should the nurse advise
the mother to do?
1. Keep the child warm.
2. Cover the burned area with an antibiotic cream.
3. Apply cool water to the burned area.
4. Call 911 to transport the child to the hospital.

Answer 7

The Client with Burns
7. 3. To prevent further injury to the skin, the mother should apply cool water to the burn site.
Doing so causes vasoconstriction, retards further damage to tissues, and decreases fluid loss.
Keeping the child warm promotes vasodilation, increases fluid loss, and decreases blood pressure
and, thus, circulation to the area. Applying ointment to the burn is contraindicated because it does not
allow healing to occur and may need to be removed in the hospital. Only a clean cloth should be used
to cover the wound to prevent contamination or decrease pain or chilling. If only the arm is burned, a
call to 911 for emergency care is not necessary, but the mother should seek health care services
immediately.
CN: Health promotion and maintenance; CL: Synthesize

Question 8

8. A school-age child who has received burns over 60% of his body is to receive 2,000 mL of IV fluid
   over the next 8 hours. At what rate (in milliliters per hour) should the nurse set the infusion pump?
   _______________ mL/h.

Answer 8

8. 250 mL/h

2000 ml / 8 hr = 250 ml / h

CN: Pharmacological and parenteral therapies; CL: Apply

Question 9

9. Which of the following would be most appropriate to institute when a school-age child with
   burns becomes angry and combative when it is time to change the dressings and apply mafenide
   acetate?
10. Ensure parental support during the dressing changes.
11. Allow the child to assist in removing the dressings and applying the cream.
12. Give the child permission to cry during the procedure.
13. Allow the child to schedule the time for dressing changes.

Answer 9

9. 2. Expressions of anger and combativeness are often the result of loss of control and a feeling
      of powerlessness. Some control over the situation is regained by allowing the child to participate in
      care. Although having parental support during the dressing changes may be helpful, this action does
      nothing to allow the child control. Giving the child permission to cry may help with verbalizing
      feelings, but doing so does nothing to provide the child with control over the situation. Although
      allowing the child to determine the time for dressing changes may provide a sense of control over the
      situation, doing so is inappropriate because the dressing changes need to be performed as prescribed
      to ensure effectiveness and healing.
      CN: Physiological adaptation; CL: Synthesize

Question 10

10. A 5-year-old child with burns on the trunk and arms has no appetite. The nurse and the mother
    develop a plan of care to stimulate the child’s appetite. Which of the following suggestions made by
    the mother would indicate that she needs additional teaching?
11. Deciding that she will feed the child herself.
12. Withholding dessert and treats unless meals are eaten.
13. Offering the child finger foods that the child likes.
14. Serving smaller and more frequent meals.

Answer 10

10. 2. Withholding certain foods until the child complies is punitive and rarely successful.Allowing the mother to feed the child, serving smaller and more frequent meals, and offering finger
       foods are all acceptable interventions for a 5-year-old child. This is true whether the child is well or
       ill.
       CN: Basic care and comfort; CL: Evaluate

Question 11

11. After teaching the mother of a child with severe burns about the importance of specific
    nutritional support in burn management, which of the following, if chosen by the mother from the
    child’s diet menu, indicates the need for further instruction?
12. Bacon, lettuce, and tomato sandwich; milk; and celery and carrot sticks.
13. Cheeseburger, cottage cheese and pineapple salad, chocolate milk, and a brownie.
14. Chicken nuggets, orange and grapefruit sections, and a vanilla milkshake.
15. Beef, bean, and cheese burrito; a banana; fruit-flavored yogurt; and skim milk.

Answer 11

11. 1. Hypoproteinemia is common after severe burns. The child’s diet should be high in protein
       to compensate for protein loss and to promote tissue healing. The child will also require a diet that is
       high in calories and rich in iron. The menu of bacon, lettuce, and tomato sandwich; milk; and celery
       sticks is lacking in sufficient protein and calories.
       CN: Physiological adaptation; CL: Evaluate

Question 12

12. When caring for a child with moderate burns from the waist down, which of the following
    should the nurse do when positioning the child?
13. Place the child in a position of comfort.
14. Allow the child to lie on the abdomen.
15. Ensure the application of leg splints.
16. Have the child flex the hips and knees.

Answer 12

12. 3. A child with moderate burns is at high risk for contractures. A position of comfort would
       encourage contracture formation. Therefore, splints need to be applied to maintain proper positioning
       and joint function, thereby preventing contractures and loss of function. Allowing the child to lie on
       the abdomen or with the hips and knees flexed often encourages contracture formation.
       CN: Reduction of risk potential; CL: Synthesize

Question 13

The Client with Hyperthyroidism
13. An adolescent is to receive radioactive iodine for Graves’ disease. Which statement by the
client reflects the need for more teaching?
1. “I plan to talk on Facebook since I have to keep several feet (kilometers) from my friends for 3
days.”
2. “Taking radioactive iodine will not affect my ability to have children in the future.”
3. “The advantage of radioactive iodine is that I will not need future medication for my disease.”
4. “I should try to use a separate bathroom from the rest of my family for several days.”

Answer 13

The Client with Hyperthyroidism
13. 3. Most clients will need lifelong thyroid replacement after treatments with radioactive
iodine. Most clients are treated as outpatients. To reduce the risk of exposure to radioactivity to
others, clients are advised to avoid public places for at least 1 day and maintain a prudent distance
from others for 2 to 3 days. Additionally, clients are advised to avoid close contact with pregnant
women and children for 5 to 11 days. The use of radioiodine to treat Graves’ disease has not been
found to affect long-term fertility. Clients are taught not to share food, utensils, and towels. Use of a
private bathroom is desirable. Clients are also instructed to flush the toilet more than one time after
each use.
CN: Safety and infection control; CL: Evaluate

Question 14

14. The nurse should instruct the family of a child with newly diagnosed hyperthyroidism to:
15. Keep their home warmer than usual.
16. Encourage plenty of outdoor activities.
17. Promote interactions with one friend instead of groups.
18. Limit bathing to prevent skin irritation.

Answer 14

14. 3. Children with hyperthyroidism experience emotional lability that may strain interpersonal
       relationships. Focusing on one friend is easier than adapting to group dynamics until the child’s
       condition improves. Because of their high metabolic rate, children with hyperthyroidism feel too
       warm. Bright sunshine may be irritating because of disease-related ophthalmopathy. Sweating is
       common and bathing should be encouraged.
       CN: Physiological adaptation; CL: Synthesize

Question 15

15. An 11-year-old child has been diagnosed with Graves’ disease and is to start drug therapy.
    Which of the following instructions should the nurse include in the teaching plan for the child’s mother
    and teacher?
16. Continue with the same amount of schoolwork and homework.
17. Understand that mood swings are rare with this disorder.
18. Limit the amount of food that is offered to the child.
19. Provide the child with a calm, nonstimulating environment.

Answer 15

15. 4. Because it takes approximately 2 weeks before the response to drug treatment occurs, much
       of the child’s care focuses on managing the child’s physical symptoms. Signs and symptoms of the
       disorder include inability to sit still or concentrate, increased appetite with weight loss, emotional
       lability, and fatigue. Nursing care is directed toward ensuring that the mother and teacher know how
       to handle the child, suggesting a shortened school day, a nonstimulating environment, and decreased
       stress and workload. The child should be encouraged to eat a well-balanced diet.
       CN: Physiological adaptation; CL: Create

Question 16

The Client with
Mellitus
Insulin-Dependent Diabetes
16. A student with type 1 diabetes tells the nurse she is feeling light-headed. The student’s blood
sugar is 60 mg/dL (3.3 mmol/L). Using the 15-15 rule, the nurse should give:
1. 15 mL of juice and give another 15 mL in 15 minutes.
2. 15 g of carbohydrate and retest the blood sugar in 15 minutes.
3. 15 g of carbohydrate and 15 g of protein.
4. 15 oz of juice and retest in 15 minutes

Answer 16

The Client with Insulin-Dependent Diabetes Mellitus
16. 2. The 15-15 rule is a general guideline for treating hypoglycemia where the client consumes15 g of carbohydrate and repeats testing the blood sugar in 15 minutes. Fifteen grams of carbohydrate
equals 60 cal and is roughly equal to 1⁄2 cup of juice or soda, six to eight lifesavers, or a tablespoon of
honey or sugar. The general recommendation is if the blood sugar is still low, the client may repeat
the sequence. Fifteen milliliters of juice would only provide 15 cal. This would not be sufficient
carbohydrates to treat the hypoglycemia. Protein does not treat insulin-related hypoglycemia;
however, a protein-starch snack may be offered after the blood glucose improves. Fifteen ounces of
juice would be 450 mL—almost four times the recommended 4 oz (120 mL) of juice.
CN: Physiological adaptation; CL: Synthesize

Question 17

17. An overweight adolescent has been diagnosed with type 2 diabetes. To increase the client’s
    self-efficacy to manage their disease, the nurse should:
18. Provide the client with a written daily food and exercise plan.
19. Discuss eliminating junk food in the home with the parents.
20. Arrange for the school nurse to weigh the child weekly.
21. Utilize a peer with type 2 diabetes to role model lifestyle changes.

Answer 17

17. 4. Self-efficacy, or the belief that one can act in a way to produce a desired outcome, can be
       promoted through the observation of role models. Peers are particularly effective role models
       because clients can more readily identify with them and believe they are capable of similar
       behaviors. Providing a written plan alone does not promote self-efficacy. Having parents eliminate
       junk food and having the school nurse weigh the adolescent can be part of the plan, but these actions
       do not empower the client.
       CN: Management of care; CL: Synthesize

Question 18

18. After 6 months of treatment with diet and exercise, a 12-year-old with type 2 diabetes still
    has a fasting blood glucose level of 140 mg/dL (7.8 mmol/L). The primary care provider has decided
    to begin metformin (Glucophage). The adolescent asks how the medication works. The nurse should
    tell the client that the medicine decreases the glucose production and:
19. Replaces natural insulin.
20. Helps the body make more insulin.
21. Increases insulin sensitivity.
22. Decreases carbohydrate adsorption.

Answer 18

18. 3. Metformin is currently approved by the FDA and Health Canada to treat type 2 diabetes in
       children. The medication decreases glucogenesis in the liver and increases insulin sensitivity in the
       peripheral tissues. Only insulin can actually replace insulin. This treatment is reserved for clients
       with type 1 diabetes or those with type 2 who do not respond to diet, exercise, and an oral diabetic
       agent. Other oral medications used to treat diabetes augments insulin production or decreases
       carbohydrate absorption, but those medications are primarily used in adults.
       CN: Pharmacological and parenteral therapies; CL: Apply

Question 19

19. The nurse is evaluating a child’s skills in self-administering insulin (see figure). The nurse
    should: (with picture - the child is holding the insulin syringe 90-degree with her left hand while administering insulin on her left upper thigh )
20. Have the child use both hands on the syringe.
21. Ask the child to place the needle at a 45-degree angle.
22. Tell the child to use a site lower on her thigh.
23. Remind the child to rotate sites.

Answer 19

19. 4. The child is using correct injection technique, and the nurse can remind the child to rotate
       sites. The nurse should also reinforce that the child has used correct technique and praise the child for
       doing so. If the child can manipulate the plunger of the syringe with one hand, this is appropriate.
       Insulin is administered at a 90-degree angle as shown. The child should identify appropriate sites on
       the thighs as one handbreadth below the hip and above the knee; the child is using appropriate sites.
       CN: Health promotion and maintenance; CL: Apply

Question 20

20.A 14-year-old is using glargine and lispro to manage type I diabetes. The prescription for sliding
scale lispro reads:
Lispro subcutaneous give units according to sliding scale:
Blood glucose: 70–150 mg/dL (3.9–8.3 mmol/L) = 0 units
151–200 mg/dL (8.4–11.1 mmol/L) = 1 unit
201–250 mg/dL (11.2–13.9 mmol/L) = 2 units
251–300 mg/dL (13.93–16.65 mmol/L) = 3 units
301–350 mg/dL (17–19.4 mmol/L) = 4 units
Call for Blood glucose > 350 (19.4 mmol/L)
In addition give 1 unit for every 15 g of carbohydrate.
The morning blood glucose is 202 mg/dL (11.2 mmol/L) and the client is going to eat two
carbohydrate exchanges. The nurse has the client administer how many units of lispro?
____________________ units.

Answer 20

20. 4 Units. Each carbohydrate food exchange has 15 g of carbohydrate. Two units are needed to
    cover the current blood glucose and 2 units are needed to cover the anticipated carbohydrate intake.
    CN: Pharmacological and parenteral therapies; CL: Apply

Question 21

21. An 8-year-old with diabetes is placed on neutral protamine Hagedorn (NPH) and regular
    insulin before breakfast and before dinner. She will receive a snack of milk and cereal at bedtime.
    The snack will:
22. Help her regain lost weight.
23. Provide carbohydrates for immediate use.3. Prevent late night hypoglycemia.
24. Help her stay on her diet.

Answer 21

21. 3. NPH insulin peaks in 6 to 8 hours, which would occur during sleep. A bedtime snack is
       needed to prevent late night hypoglycemia. The snack is not given to help regain weight. Milk
       contains fat and protein, which cause delayed absorption into the blood stream and maintains the
       blood glucose level at night when the NPH insulin will peak. The snack is not used to provide
       carbohydrates for immediate use because NPH insulin, unlike regular insulin, does not peak
       immediately. The snack has nothing to do with a diet.
       CN: Psychosocial integrity; CL: Apply

Question 22

22. A nurse is teaching an 8-year-old with diabetes and her parents about managing diabetes
    during illness. The nurse determines the parents understand the instruction when they indicate that,
    when the child is ill, they will provide:
23. More calories.
24. More insulin.
25. Less insulin.
26. Less protein and fat.

Answer 22

22. 2. The child needs more insulin during an illness, because the cells become more insulin
       resistant during illness and need more insulin to achieve a normal blood glucose level. During an
       acute illness, simple carbohydrates and fluids are usually tolerated best.CN: Physiological adaptation; CL: Evaluate

Question 23

23. A nurse is assessing an 8-year-old with diabetes who is experiencing hyperglycemia. Which
symptom(s) indicate(s) that the hyperglycemia requires immediate intervention? Select all that apply.
1. Weakness.
2. Thirst.
3. Shakiness.
4. Hunger.
5. Headache.
6. Dizziness.

Answer 23

23. 1, 2, 6. Weakness, thirst, and dizziness are symptoms related to dehydration caused by
    excretion of large amounts of glucose and water in the urine. The nurse should notify the primary
    health care provider. Shakiness, hunger, headache, and irritability are related to hypoglycemia and
    result from the brain and other cells being starved for nutrients.
    CN: Physiological adaptation; CL: Analyze

Question 24

24. The nurse talks to an adolescent about how she can tell her friends about her new diagnosis
    of diabetes. Which of the following behaviors by the adolescent indicates that the adolescent has
    responded positively to the discussion?
25. She asks the nurse for material on diabetes for a school paper.
26. She introduces the nurse to her friends as “the one who taught me all about my diabetes.”
27. She says, “I’ll try to tell my friends, but they’ll probably quit hanging out with me.”
28. She asks her friends what they think about someone who has a lifelong illness.

Answer 24

24. 2. The ability to talk about her diabetes indicates that the adolescent feels good enough about
       herself to share her problem with her peers. Asking for reference material does not specifically
       indicate that the client’s self-esteem has improved or that she has accepted her diagnosis. Saying that
       her friends will probably desert her if she tells them about the illness indicates that the adolescent
       still needs to work on her self-esteem and her feelings about the disease. Asking her friends what they
       think of someone with a lifelong illness would not indicate that the nurse’s interventions targeted
       toward improving self-esteem have been successful. Rather, this statement demonstrates the
       adolescent’s uncertainty about herself.
       CN: Psychosocial integrity; CL: Evaluate

Question 25

25. An adolescent with insulin-dependent diabetes is being taught the importance of rotating the
    sites of insulin injections. The nurse should judge that the teaching was successful when the
    adolescent identifies which of the following as a result of using the same site?
26. Destruction of the fat tissue and poor absorption.
27. Destruction of nerves and painful neuritis.
28. Destruction of the tissue and too-rapid insulin uptake.
29. Development of resistance to insulin and need for increased amounts.

Answer 25

25. 1. Repeated use of the same injection site can result in atrophy of the fat in the subcutaneous
       tissue and lead to poor insulin absorption. The neuritis that develops from diabetes is related to
       microvascular changes that occur. Subcutaneous tissue is not destroyed and insulin is not rapidly
       absorbed. Resistance to insulin is caused by an immune response to the insulin protein.
       CN: Pharmacological and parenteral therapies; CL: Evaluate

Question 26

The Client with Polycystic Ovarian Syndrome
26. A 16-year-old has been diagnosed with polycystic ovarian syndrome (PCOS). Which
statement indicates the need for more teaching?
1. “High levels of male hormones contribute to my PCOS.”
2. “I am at risk for type 2 diabetes.”
3. “Maintaining a healthy weight is an important part of my treatment plan.”
4. “Untreated PCOS will make getting pregnant impossible.

Answer 26

The Client with Polycystic Ovarian Syndrome
26. 4. While pregnancy may be difficult for some clients, the nurse must work to prevent the false
conception that a sexually active teen with PCOS does not need to use a reliable form of birth control.
PCOS is associated with high levels of androgens and excessive insulin. It is the excess insulin that is
thought to increase androgen production. Clients with PCOS are at risk for type 2 diabetes. Initial
treatment focuses on weight management and exercise. These measures often reduce insulin
production and restore normal menstrual cycles.
CN: Physiologic adaption CL: Evaluate

Question 27

27. A 15-year-old female client suspects that she might have polycystic ovarian syndrome
(PCOS). Which of the following symptoms would be consistent with PCOS? Select all that apply.
1. Primary amenorrhea.
2. Obesity.
3. Increased body hair.
4. Acne.
5. Darkened skin in body fold.
6. Enlarged breast.

Answer 27

27. 2,3,4,5. PCOS is associated with obesity, increased body or facial hair (hirsutism), acne, and
    darkening of the skin usually in body folds (acanthosis nigricans). When a female has never had a
    menstrual cycle, it is referred to as primary amenorrhea. PCOS is associated with irregular menstrual
    cycles and/ or secondary amenorrhea, not primary amenorrhea. High androgen levels frequently lead
    to decreased versus enlarged breast size.
    CN: Physiologic adaptation CL: Analyze

Question 28

28. A 17-year-old with polycystic ovarian syndrome (PCOS) has been placed on metformin
    (Glucophage). Which would NOT be an expected treatment outcome?
29. Reduced androgen levels.
30. Normalization of the menstrual cycle.
31. Increased insulin levels.
32. Reduced blood glucose levels.

Answer 28

28. 3. Metformin works by decreasing the production of glucose in the liver and improving insulin
       sensitivity. These two mechanisms reduce insulin and blood glucose level. Reducing insulin levels
       reduces androgens and helps to restore menstruation.
       CN: Pharmacology and parental therapies CL: Evaluate

Question 29

29. A 16-year-old female with polycystic ovarian syndrome (PCOS) is extremely upset saying,
    “I’m so embarrassed. I feel like the bearded lady in the circus. I just don’t fit in.” Which intervention
    is most needed?
30. Refer the client to a hair removal specialist.
31. Screen the client for depression.
32. Provide more information on causes and treatment options.
33. Suggest the client join a support group.

Answer 29

29. 2. Many clients with PCOS suffer from depression. As depression is associated with asignificant risk of suicide, the priority would be to determine if the client has symptoms of depression
       requiring further evaluation and treatment. Referrals to a hair removal specialist and possibly a
       support group would be appropriate, but only after determining if the client needs a referral for a
       major mood disorder. Providing more information on causes and treatment options is better saved for
       when the client is less distraught.
       CN: Psychosocial integrity; CL: Analyze

Question 30

Managing Care Quality and Safety
30. The parent of a 17-year-old boy, who is hospitalized for complications related to type I
diabetes, requests to review the adolescent’s medical record. The client reported receiving mental
health counseling during the admission history, but did not want his parent to know. The nurse, who is
uncertain of how to protect the adolescent’s privacy and accommodate the parent’s request, should
consult:
1. The unit nurse manager.
2. The primary care provider.
3. The organization’s privacy officer.
4. The customer service representative.

Answer 30

Managing Care Quality and Safety
30. 3. Confidentiality legislation specifies that institutions designate a “privacy officer” who is
responsible for developing and implementing privacy policies. This would be the very best resource
for the nurse to contact. Depending on the nurse manager’s experience, he or she may or may not know
the answer and may have to consult the privacy officer. While primary care providers would have an
understanding of confidentiality laws, it is unlikely they understand the specifics of nursing policies.
The customer service representatives typically address client concerns or complaints. At this time,
the family has not voiced a complaint.
CN: Management of care; CL: Apply

Question 31

31. The charge nurse on the pediatric floor has assigned a 6-year-old girl of Arab ethnicity with
    newly diagnosed type 1 diabetes and an 8-year-old girl recovering from ketoacidosis to the same
    semiprivate room. The 6-year-old’s mother is upset because the parent staying with the other child is
    the father. The nurse should:
32. Explain to the parents that this room arrangement facilitates teaching.
33. Reassign the children to different rooms.
34. Offer the Arab parent another place to sleep.
35. Refer the parent to the customer service representative

Answer 31

31. 2. People of Arab descent most frequently practice Islam. Sleeping in the same room with a
       person of the opposite sex most likely would be viewed as a violation of their faith. If at all possible,
       the charge nurse should reassign the family to a different room. While it makes sense to have two
       clients with similar educational needs in the same room, it is likely that the arrangement would be
       sufficiently distressing enough to create a learning barrier. Offering the mother another place to sleep
       deprives the child of her parent at night. The customer service representative would only need to be
       involved if it became impossible to accommodate the mother’s needs.
       CN: Management of care; CL: Synthesize

Question 32

32. A 10-year-old child is admitted to the hospital with complications related to chickenpox. The
    nurse should do which of the following to prevent the transmission of the infection to other children
    on the unit? Select all that apply.
33. Place the child on contact isolation.
34. Wear a gown, mask, and gloves before entering the room.
35. Place the child in a room with a 10-year-old who has had chickenpox.
36. Place the child in a negative air-flow room.
37. Maintain isolation until lesions have disappeared.

Answer 32

32. 2, 4. Gowns, mask, and gloves are needed before the nurse or anyone can enter the room of a
    client who has chickenpox because the varicella virus is spread by air, droplets, and contact. It is
    very contagious, so a negative-air flow room is recommended. Contact isolation only includes a
    gown and gloves. Because varicella is spread by air and contact, a private room is needed. The child
    should remain in isolation until all lesions have crusted.
    CN: Physiological adaptation; CL: Synthesize

Question 33

33. The mother of an 8-year-old with diabetes tells the nurse that she does not want the school to
    know about her daughter’s condition. The nurse should reply:
34. “I think that would be a good idea.”
35. “What is it that concerns you about having the school know about your daughter’s condition?”
36. “It would be fine not to tell your daughter’s friends, but the teacher must know.”
37. “In order to keep your daughter safe, it is necessary for all adults in the school to know her
    condition.”

Answer 33

33. 2. The nurse’s first response should be to obtain more information about the mother’s
       concerns. It is true that the child may have a diabetic reaction anywhere at school, and it is advisable
       that her teacher, classmates, and other adults know about her diabetes in order to help her; however, it
       is ultimately the client and her parents who will make the decision about informing the school. The
       nurse can facilitate a dialogue that will help the mother reach this decision. Dictating to the mother
       does not explain any rationale for the necessity of the information.
       CN: Safety and infection control; CL: Synthesize