A. Surgery should be done by one month to prevent bladder infections. This statement is not accurate. While early surgery is generally recommended, the one-month timeframe is not a strict rule. The primary reason for early correction is to improve the cosmetic appearance of the penis, but it is not primarily aimed at preventing bladder infections.

B. Repair should be done before the child is potty-trained.

Hypospadias is a congenital condition where the opening of the urethra is on the underside of the penis rather than at the tip. Surgical correction is typically recommended, and the timing of the surgery is an important consideration.

C. The urethral repair should be done after sexual maturity. This statement is incorrect. Delaying the repair until sexual maturity is not the standard approach. In fact, earlier surgical correction is often recommended to ensure proper urinary function and to avoid potential psychological and social issues in the child.

D. Delaying the repair until school age reduces castration fears. This statement is not supported by current medical practice. Delaying the repair until school age can lead to psychosocial issues, as children may become more self-aware of their condition and experience teasing or psychological distress.

A. Chickenpox is caused by the varicella-zoster virus and is not directly related to the development of acute rheumatic fever.

B. Mumps is caused by the mumps virus and is not directly related to the development of acute rheumatic fever.

C. Sore throat.

Acute rheumatic fever (ARF) is an inflammatory condition that can occur after an untreated or inadequately treated streptococcal throat infection, such as streptococcal pharyngitis (strep throat). It is caused by group A Streptococcus bacteria.

In ARF, the body's immune response to the streptococcal infection can lead to inflammation and damage to various parts of the body, including the heart, joints, skin, and central nervous system. One of the major criteria for diagnosing ARF is a history of a sore throat. Therefore, the most significant recent occurrence for the health history in this case would be a sore throat (option C).

D. Influenza is caused by the influenza virus and is not directly related to the development of acute rheumatic fever.

A. "We should be sure to start our daughter on birth control pills." This statement is not directly related to LHRH treatment for precocious sexual development. The primary goal of LHRH treatment is to delay sexual development, and birth control pills are typically not necessary for this purpose.

B. "Sexual maturity differences between my daughter and her peers will disappear within a few years."
In a case of precocious sexual development, treatment with luteinizing hormone-releasing hormone (LHRH) is often used to delay sexual development and slow down the maturation process. It is not typically a lifelong treatment. The primary goal is to allow the child to develop at a more typical pace, so they can catch up with their peers and avoid the psychosocial challenges associated with early sexual maturity. Therefore, the statement in option B indicates a correct understanding of the treatment, as it recognizes that the differences in sexual maturity between the child and her peers should diminish over time.

C. "Our daughter will be on this hormone treatment the rest of her life." This statement is not accurate. LHRH treatment is usually a temporary measure to delay sexual development. It is not a lifelong treatment.

D. "We should encourage her to dress in clothing that suits her sexual maturity level." While this is a consideration for supporting a child with precocious sexual development, the primary treatment aspect is the LHRH therapy itself, which is aimed at delaying sexual development. This statement does not directly address the treatment process.

A - Maintaining a consistent home schedule is an essential strategy for managing ADHD, as routines and structure can help the child stay organized and focused.

B - Understanding that nonstimulant medications can also be beneficial in the treatment of ADHD is correct, as nonstimulant medications are an alternative or additional treatment option for some individuals with ADHD. It's important to have a comprehensive understanding of available treatment options.

C - The statement "Know that medication is the best approach to treatment" is not accurate. Medication can be an effective component of ADHD treatment, but it is not necessarily the best approach for every child. Treatment plans should be individualized and may include a combination of strategies, such as behavioral interventions, psychoeducation, and medication.

D - Creating an organization chart for tasks is a helpful approach for children with ADHD to manage their responsibilities and activities effectively.

E - Anticipating being automatically entered into a specialized education plan is not necessarily accurate. While some children with ADHD may benefit from an Individualized Education Plan (IEP) or a 504 Plan in the educational setting, these plans are typically established based on specific assessments and the child's needs.

F - Designating an established area for study is important for creating a distraction-free environment, which can support the child's ability to focus on their schoolwork.

A. Comparing the child's vital signs over the past three weeks (option A) may not provide significant information about the underlying cause of his symptoms, as vital signs are unlikely to directly indicate stress or emotional distress.

B. Counseling the parents to pay more attention to the child (option B) is a general suggestion and may not be the most effective way to address the specific issues he is facing. It's important to identify the underlying causes and stressors first.

C. Conducting a complete neurological assessment (option C) is not warranted at this stage, as the child's symptoms are more likely related to emotional or psychological factors rather than a neurological problem. Gathering information about his school experiences would be a more appropriate initial step.

D. Ask the boy to describe a typical day at school.

The child's reported symptoms, including headaches, stomach aches, and difficulty sleeping, may be indicative of stress or emotional issues. To better understand and address the underlying cause of these symptoms, it's important to gather more information about the child's daily experiences. By asking the boy to describe a typical day at school (option D), the nurse can uncover potential stressors or challenges he may be facing, such as academic difficulties, bullying, social issues, or other stressors that might be contributing to his symptoms.

A. Plays "peek-a-boo."

This is a social and cognitive milestone. Infants typically develop social interactions like peek-a-boo around 6-9 months of age. This behavior is normal for a 6-month-old and demonstrates social engagement.

B. Has doubled birth weight.

Infants generally double their birth weight by around 6 months of age. This is a typical growth and developmental milestone, indicating adequate nutrition and growth.

C. Turns head to locate sound.

This is a normal developmental milestone for an infant. By 6 months of age, infants should demonstrate localization of sounds, indicating appropriate auditory and neurological development.

D. Demonstrates startle reflex.

The startle reflex, also known as the Moro reflex, is normal in newborns but typically disappears by 3-6 months of age. If a 6-month-old still exhibits this reflex, it could be a sign of delayed neurological development and might require further evaluation.

A. Giving the injection in the arm, one to 2 inches below the acromion process, is a technique typically used for adults or older children. It may not be suitable for a toddler of this age.

B. Using a needle length of 1/2 inch is not appropriate for intramuscular injections in a toddler. It may not reach the muscle tissue, leading to ineffective administration.

C. Dividing the gluteal area into quarters and giving the injection into the upper outer quadrant is a technique typically used for older children and adults, not for toddlers. It's also important to avoid intramuscular injections in the gluteal area for young children due to the risk of injury to the sciatic nerve.

D. Administering the injection into the middle of the lateral aspect of the thigh is the preferred technique for intramuscular injections in toddlers. The thigh muscles are a safe and effective site for IM injections in this age group. The middle of the lateral aspect of the thigh is commonly chosen because it provides a sufficient muscle mass for proper absorption of the medication and minimizes the risk of injury to nerves or vessels. This technique is recommended for toddlers who are walking and have developed sufficient muscle mass in the thigh area.

A. Documenting the client's relief of pain is important for the medical record but is not the first priority in this situation. The immediate concern is to determine the cause of the sudden pain relief and ensure the child's well-being.

B. Inquiring about the client's last meal is important for pre-operative considerations, but it is not the first action to take when sudden relief of abdominal pain is reported.

C. Giving prescribed intravenous antibiotics may be part of the treatment plan, but it should not be the first action when the child experiences sudden relief of abdominal pain. Contacting the healthcare provider to assess the situation is more urgent.

D Contact the healthcare provider.

In the case of a child diagnosed with appendicitis, sudden relief in abdominal pain can be concerning. This might indicate that the appendix has ruptured, leading to the spread of infection into the abdominal cavity, which can be a critical situation. It's essential for the healthcare provider to be informed immediately so they can assess the child's condition, order any necessary interventions, and potentially expedite the surgical procedure if required.

A. Discontinue the ointment once drainage resolves.The ophthalmic antiinfective ointment should be used for the full prescribed duration, even if symptoms improve, to ensure the infection is completely treated and to prevent recurrence or resistance.

B. Remove secretions by wiping toward the opposite eye.Secretions should be removed by wiping away from the eye, from the inner canthus (near the nose) outward, to prevent spreading infection to the unaffected eye.

C. Use a disposable moist wipe to remove eye crusts.While it is important to keep the eye clean, the primary discharge instruction in this context should focus on the expected side effect of blurry vision.

D. Prepare child for blurry vision after ointment application:Ophthalmic antiinfective ointments can cause temporary blurry vision due to their consistency. Caregivers should be informed about this expected effect and reassured that it is temporary. This helps manage expectations and ensures adherence to the treatment plan.

Correct answer: D

A.This can be a good distraction technique, but it might not directly facilitate the lung sound assessment.

B.This activity might help engage the child but could make it difficult for the nurse to listen to breath sounds accurately.

C.Holding a toy might keep the child occupied but does not directly relate to the assessment process and might not ensure cooperation as effectively as using a stethoscope on a stuffed animal.

D.Allowing the child to use the stethoscope on a stuffed animal can help reduce fear and anxiety by making the procedure more familiar and less intimidating. It engages the child in a playful and interactive manner, helping to build trust and cooperation.