A nurse is caring for an 8-year-old during a well-child exam. The parent states that the child's cousin has intussusception and asks if their child is at risk. Which of the following responses should the nurse make?

"Since there's a family history, your child is at a higher risk of intussusception."

"Intussusception is more common in infants and toddlers, so your child is at a lower risk."

"The risk of intussusception remains the same across all age groups, so your child has an equal risk."

"Intussusception is a common condition in school-age children, so your child is at a higher risk."

Answer and Explanation

The Correct Answer is B

A. "Since there's a family history, your child is at a higher risk of intussusception." is not entirely accurate. Family history does not significantly increase the risk of intussusception. It is more commonly seen in infants and toddlers, not school-age children.

B. "Intussusception is more common in infants and toddlers, so your child is at a lower risk." is correct. Intussusception typically occurs in infants and toddlers between the ages of 6 months and 3 years, so the risk is lower in school-age children.

C. "The risk of intussusception remains the same across all age groups, so your child has an equal risk." is incorrect. The incidence of intussusception is higher in younger children, particularly those under 2 years old.

D. "Intussusception is a common condition in school-age children, so your child is at a higher risk." is incorrect. Intussusception is less common in school-age children and is more frequently seen in younger children.

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Correct Answer is C

Explanation

A. An elevated red blood cell count is not a typical finding in bacterial meningitis. An increase in red blood cells in cerebrospinal fluid (CSF) is more indicative of a traumatic lumbar puncture or hemorrhage.

B. A decreased white cell count would not be expected in bacterial meningitis. Bacterial infections typically lead to an increase in white blood cell count as part of the immune response to fight the infection.

C. An elevated white blood cell count is a hallmark of bacterial meningitis. This finding indicates an immune response in the CSF to the presence of bacteria. The cells are primarily neutrophils in bacterial infections.

D. A normal glucose level is not expected in bacterial meningitis. Glucose is typically decreased due to the consumption of glucose by bacteria and white blood cells in the CSF.

A. Notify the adolescent's primary care provider. B. Collect a detailed past medical history. C. Perform a thorough assessment noting acute conditions D. Administer pain medication to the adolescent.

Correct Answer is C

Explanation

A. Notify the adolescent's primary care provider is incorrect. While it is important to notify the healthcare provider, the immediate priority is performing a thorough assessment to determine the severity of the head injury and any potential complications, such as changes in consciousness or neurological status.

B. Collect a detailed past medical history is incorrect. Although collecting medical history is important, it is not the priority in the acute phase of a suspected head injury. The priority is to assess the current condition of the adolescent, especially signs of deterioration.

C. Perform a thorough assessment noting acute conditions is correct. The priority in suspected head injuries is to perform a thorough assessment to evaluate the patient's neurological status. This includes checking for signs of a concussion, increased intracranial pressure, or any other acute conditions that may require immediate intervention.

D. Administer pain medication to the adolescent is incorrect. Pain management is important, but it should not be the first action when a head injury is suspected, as it can mask symptoms or affect the ability to assess neurological function properly.

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A nurse is caring for an 8-year-old during a well-child exam. The parent states that the child's cousin has intussusception and asks if their child is at risk. Which of the following responses should the nurse make?

Nursing Test Bank

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