The nurse receives a report from the admission department that a child with a slipped capital femoral epiphysis is in route to the care area. For which type of child should the nurse begin to plan care?

Obese preadolescent male

Preadolescent female

Tall, thin female

Active school-age male

Answer and Explanation

The Correct Answer is A

A. Slipped capital femoral epiphysis (SCFE) is most commonly seen in obese children, particularly males, during the preadolescent growth spurt (typically ages 10–16). Excess body weight increases stress on the growth plate (epiphysis) of the femoral head, making it more prone to slippage. Recognizing the high-risk population allows the nurse to anticipate complications, provide appropriate monitoring, and prepare for surgical intervention, which is the standard treatment.

B. While SCFE can occur in females, it is less common than in males. Female cases often present slightly later and may be associated with hormonal or endocrine factors, but statistically, preadolescent males are at higher risk.

C. SCFE is not typically associated with a tall, thin body type. This description is more characteristic of other orthopedic conditions, such as Marfan syndrome-related skeletal issues, rather than SCFE.

D. Physical activity alone is not a primary risk factor for SCFE. The condition is largely associated with obesity and rapid growth, not activity level.

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Correct Answer is D

Explanation

A. Shakiness, tremors, anxiety, palpitations, and irritability are early signs of hypoglycemia, which occurs when blood glucose drops below the child’s target range (often <70 mg/dL). Prompt recognition allows immediate intervention, such as administering fast-acting carbohydrates (juice or glucose tablets), preventing progression to seizures or loss of consciousness.

B. Fruity or acetone-smelling breath is a hallmark of hyperglycemia with ketosis, commonly associated with diabetic ketoacidosis (DKA). It occurs because insufficient insulin causes the body to metabolize fat for energy, producing ketones. Other signs include nausea, vomiting, abdominal pain, and rapid breathing. Early recognition is crucial to prevent severe metabolic acidosis.

C. Hyperglycemia can lead to dehydration due to osmotic diuresis. The resulting fluid loss can cause warm, flushed skin, along with increased thirst (polydipsia) and frequent urination (polyuria). These signs often develop gradually, unlike hypoglycemia, which presents more suddenly.

D. Sweating, pallor, tremors, irritability, confusion, slurred speech, and weakness are classic signs of hypoglycemia, not hyperglycemia. Hypoglycemia develops rapidly and can progress to seizures, coma, or death if untreated. Misidentifying these symptoms as hyperglycemia could delay administering glucose and lead to serious complications.

A. Cover the sac with a saline-moistened dressing B. Prevent cold stress using an Isolette and blankets C. Keep the mass uncovered and dry D. Change position from side to side hourly

Correct Answer is A

Explanation

A. Myelomeningocele is a type of spina bifida in which a portion of the spinal cord and meninges protrude through a defect in the vertebral column. The exposed sac is fragile and at high risk for infection and trauma. Covering it with a sterile, saline-moistened dressing maintains moisture, prevents desiccation, and reduces the risk of infection. This is the highest priority nursing intervention prior to surgical repair.

B. While thermoregulation is important in newborns, preventing cold stress is secondary to protecting the integrity of the myelomeningocele sac. The sac’s protection and prevention of infection take priority over temperature control.

C. Leaving the sac exposed and dry increases the risk of rupture and infection, which can lead to severe complications including meningitis or neurological damage. This approach is unsafe and contrary to standard preoperative care guidelines.

D. Positioning an infant with myelomeningocele requires caution to avoid pressure on the sac. Typically, the infant is placed prone or on the side with careful padding to prevent sac trauma. Frequent repositioning without proper support could injure the sac. Therefore, routine side-to-side turning is not recommended until after surgical repair and stabilization.

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The nurse receives a report from the admission department that a child with a slipped capital femoral epiphysis is in route to the care area. For which type of child should the nurse begin to plan care?

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Naxlex Comprehensive Predictor Exams

The nurse is speaking with the parents of a child recently diagnosed with diabetes mellitus regarding the differences between hypoglycemia and hyperglycemia. Which statement by a parent indicates a need for further teaching?

Correct Answer is D

Explanation

The nurse caring for an infant with myelomeningocele before surgical intervention will prioritize care in what way?

Correct Answer is A

Explanation

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