the parents of a child with sickle cell anemia ask why their child did not have a sickle cell crisis until he was approximately 6 months old how shoul
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1. The parents of a child with sickle cell anemia ask why their child did not have a sickle cell crisis until he was approximately 6 months old. How should the nurse respond?

Correct answer: C

Rationale: The correct answer is C. Fetal hemoglobin (HbF) is present in high levels during early infancy, inhibiting sickling unlike adult hemoglobin (HbS). As the levels of HbF decrease and HbS increases, the risk of sickling and crises becomes more pronounced, typically after 6 months of age. Choice A is incorrect because it assumes the crisis went unnoticed, which is not supported by medical knowledge. Choice B is incorrect as it questions the child's diagnosis rather than explaining the phenomenon of delayed crises. Choice D is incorrect as it does not provide the parents with the necessary information regarding their query.

2. You are developing a plan of care for a hospitalized child. Which age group is most likely to view illness as a punishment for misdeeds?

Correct answer: B

Rationale: Preschool-aged children often engage in magical thinking, where they may believe that illness is a punishment for misdeeds. This belief is related to their cognitive development stage, where they may attribute cause and effect in a magical or unrealistic way. Adolescents are more likely to view illness as a disruption to their sense of independence or control. Infants lack the cognitive development to associate illness with punishment for misdeeds. School-aged children typically have a more concrete understanding of illness and its causes, moving away from magical thinking.

3. The mother of a 6-year-old boy who has recently had surgery for the removal of his tonsils and adenoids complains that he has begun sucking his thumb again. Which defense mechanism should the nurse include when responding to the mother?

Correct answer: B

Rationale: The correct answer is B: Regression. Regression is a common defense mechanism where a child reverts to an earlier stage of development, such as thumb-sucking, to cope with stress. In this scenario, the 6-year-old boy is using thumb-sucking (a behavior typical of earlier developmental stages) as a way to deal with the stress of surgery. Repression (choice A) involves unconsciously blocking out thoughts or feelings, which is not applicable in this case. Rationalization (choice C) is a defense mechanism where illogical or unreasonable explanations are provided to justify behavior, which is not relevant here. Fantasy (choice D) refers to the use of imagination to escape from reality, which is also not the appropriate defense mechanism for the situation described.

4. A four-year-old child has a history of repeated otitis media despite antibiotic treatment. Which treatment measure should the nurse discuss with the parents?

Correct answer: C

Rationale: The correct answer is C: The insertion of tympanostomy (pressure equalizing) tubes. This treatment measure is appropriate for a child with recurrent otitis media as it helps drain fluid from the middle ear and prevent further infections. Adenoidectomy (choice B) involves the removal of the adenoids, which may not directly address the ear infections. Antibiotic treatment (choice A) has already been ineffective in this case, so alternative measures are necessary. Tonsillectomy (choice D) is not typically indicated for otitis media unless there are specific reasons such as enlarged tonsils contributing to the condition.

5. What is the typical presentation of pyloric stenosis in infants?

Correct answer: B

Rationale: The correct answer is B: Projectile vomiting. Pyloric stenosis in infants typically presents with projectile vomiting, which is forceful and projective in nature. This occurs due to the obstruction at the pylorus, leading to the stomach being unable to empty properly. Choices A, C, and D are incorrect. Bilious vomiting is more commonly associated with intestinal obstruction, blood in stools can occur in conditions such as necrotizing enterocolitis or allergic colitis, and failure to thrive is a nonspecific finding that can be seen in various pediatric conditions.

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