3
Measurement and interpretation of blood pressure in children requires careful attention and correct procedures. If the child's BP is over 99th percentile, plus 5 mm of Hg, prompt referral is needed. Even if the child is symptomatic, immediate referral and treatment are indicated. If the BP is over 90th percentile, the BP measurement should be repeated twice at the same office visit and an average of systolic blood pressure (SBP) and diastolic blood pressure (DBP) are to be used to confirm the reading. If the BP is over 95th percentile, the BP should be further assessed based on two more measurements. When all the recordings confirm elevated BP, treatment is indicated. If the BP is between 95th to 99th percentile, plus 5 mm Hg, the BP measurement should be repeated twice. If it is confirmed, then referral and treatment is started.
Test-Taking Tip: Do not fret over any one question for too long. If you are having trouble, skip the question and go back to it when you have finished answering the other questions.
3
Deficiency of vitamins B6 and B12 causes symptoms such as tiredness and fatigue, pale skin, sore tongue, bleeding gums, stomach upset, rapid heartbeat, and mood swings. Muscle weakness, anemia, neurological damage, and alopecia are the primary symptoms due to the deficiency of vitamin E. Excess of vitamin A may cause hardening and scaling of skin, pruritis, jaundice, hair loss, and hard tender lumps in occiput. Defective enamel on teeth, bleeding gums, and softened bones are generalized symptoms of both vitamin C and D deficiency.
The nurse is assessing the nutritional status of a child and notices that the child is deficient in vitamins B6 and B12. What clinical signs does the nurse identify in the child?
1
Muscle weakness, anemia, neurological damage, and alopecia
2
Hardening and
scaling skin, pruritis, jaundice, and crackled lips
3
Fatigue, pale skin, sore tongue, bleeding gums, and mood swings
4
Weakened tooth enamel, soft bones, anxiety, and mood swings
2, 6, 1, 5, 3, 4
Foreign bodies in the ear are common, and removal of these foreign bodies prevents infection and ear damage. Six steps are involved in the removal of a foreign body. At first, the nurse determines what type of foreign object there is in the ear canal, using a flashlight or sometimes using an otoscope. After identifying the object as soft or hard, vegetative or an insect, the next step is to keep the equipment tray ready for the removal of the foreign body. The nurse should reassure the child that it will not be painful. This will help reduce stress and increase cooperation. Proper positioning of the child is an important step in the removal because movement of the child may push the foreign body further into the ear canal and hurt the child. The nurse then removes the foreign body completely without leaving any parts or breaking the foreign object. In the last step, the nurse shows the foreign body to the child and parents, and reassures them that there is no damage. The nurse will also teach the parents to administer any medications prescribed by the health care provider.