2920. Exam 4
A school-age child has been diagnosed with strep throat. The parent asks the nurse when the child can return to school. Which is the nurse's best response?
"Twenty-four hours after the first dose of antibiotics."
What is the most important piece of information that the nurse must ask the parent of a child in status asthmaticus?
"When was your child's last dose of medication?" * The nurse needs to know what medication the child had last and when the child took it in order to know how to begin treatment for the current asthmatic condition.
Which should the nurse include when teaching sexuality education to an adolescent with a spinal cord injury?
"You can enjoy a healthy sex life and most likely conceive children." * The reproductive system continues to function properly after a spinal cord injury. Much sexual activity and response occurs in the brain as well.
A 2-year-old has just been diagnosed with cystic fibrosis (CF). The parents ask the nurse what early respiratory symptoms they should expect to see in their child. Which is the nurse's best response?
"You can expect your child to develop wheezing respirations." * Wheezing respirations and a dry, nonproductive cough are common early symptoms in CF.
The nurse is performing an admission assessment on a 9-year-old who has just been diagnosed with systemic lupus erythematosus. Which assessment findings should the nurse expect?
Fever, malaise, and weight loss.
The mother of a newborn relates that this is her first child, the baby seems to sleep a lot, and does not cry much. Which question would the nurse ask the mother?
"How many ounces of formula does your baby take at each feeding?" * Babies can lose up to 10% of birth weight but should regain it by 2 weeks of age.
Which statement by the parent of a child using an albuterol inhaler leads the nurse to believe that further education is needed on how to administer the medication?
"I should administer two quick puffs of the albuterol inhaler using a spacer." * The parent should always give one puff at a time and wait 1 minute before administering the second puff.
A child is complaining of throat pain. Which statement by the mother indicates that she needs more education regarding the care and treatment of her daughter's pharyngitis?
"I will ask the nurse practitioner for some amoxicillin." * Pharyngitis is a self-limiting viral illness that does not require antibiotic therapy. Pharyngitis should be treated with rest and comfort measures, including Tylenol, throat sprays, cold liquids, and Popsicles.
The parent of an infant with CP asks the nurse if the infant will be mentally retarded. Which is the nurse's best response?
"Many children with CP have normal intelligence." * Children with CP have a range of intellectual abilities. Many have normal intelligence. If a child has severe speech problems, some may assume that the child's intelligence is severely affected when that may not be true.
The parents of a preschooler diagnosed with muscular dystrophy are asking questions about the course of their child's disease. Which should the nurse tell them?
"Muscular dystrophies usually result in progressive weakness." * Muscular dystrophies are progressive degenerative disorders. The most common is Duchenne muscular dystrophy.
The nurse judges teaching as successful when the parent of a child with myasthenia gravis states which of the following?
"My child should meditate every day." * Meditation may decrease stress.
The parent of a young child with CP brings the child to the clinic for a checkup. Which parent's statement indicates an understanding of the child's long-term needs?
"My child will grow up and need to learn to do things independently."
The parent of a 4-month-old with cystic fibrosis (CF) asks the nurse what time to begin the child's first chest physiotherapy (CPT) each day. Which is the nurse's best response?
"Thirty minutes before feeding the child breakfast. * CPT should be done in the morning prior to feeding to avoid the risk of the child vomiting.
A parent asks how to care for a child at home who has the diagnosis of viral tonsillitis. Which is the nurse's best response?
"You can give your child Tylenol every 4 to 6 hours as needed for pain." * Tylenol is recommended PRN for pain relief.
The nurse is doing a follow-up assessment of a 9-month-old. The infant rolls both ways, sits with some support, pushes food out of the mouth, and pushes away when held. The parent asks about the infant's development. The nurse responds by saying which of the following?
"Your child needs to see the primary care provider." * A 9-month-old should be able to sit alone, crawl, pull up, not push food out of the mouth (tongue thrust), and push away when held when wanting to get down. This child is not developing normally and must see the primary care provider.
A parent asks the nurse what will need to be done to relieve the constipation of her child who also has cystic fibrosis (CF). Which is the nurse's best response?
"Your child will likely be given MiraLAX."
A child's parent asks the nurse what treatment the child will need for the diagnosis of strep throat. Which is the nurse's best response?
"Your child will need oral penicillin for 10 days and should feel better in a few days."
After surviving a motor vehicle accident but enduring a spinal cord injury, an adolescent is unable to walk but can use his arms, has no bowel or bladder control, and has no sensation below the nipple line. Referring to the following figure, identify the vertebral/spinal cord area most likely injured.
Thoracic, T1-T4.
Which can elicit the Gower sign? Have the patient:
Walk like a duck and rise from a squatting position. * Children with muscular dystrophy display the Gower sign, which is great difficulty rising and standing from a squatting position due to the lack of muscle strength.
The parent of an infant with cystic fibrosis (CF) asks the nurse how to meet the child's increased nutritional needs. Which is the nurse's best suggestion?
"You may need to change your child to a higher-calorie formula." * Infants may also be placed on hydrolysate formulas that contain medium-chain triglycerides.
List the 5 P's of ischemia from a fracture of vascular injury:
1. Pain. 2. Pallor. 3. Pulselessness distal to injury. 4. Paresthesia distal to injury. 5. Paralysis distal to the injury.
A child has a provisional diagnosis of myasthenia gravis. Which should the nurse expect in this child? SATA.
1. Double vision. 2. Ptosis. 3. Fatigue. * This is an autoimmune disease triggered by a viral or bacterial infection. Another symptom is difficulty swallowing and chewing.
What is the most common type of scoliosis?
idiopathic
The callus that develops at a fracture site is important because it provides
means for holding bone fragments together.
What condition is the leading cause of chronic illness in children?
Asthma
Why does spinal cord injury without radiographic abnormality sometimes occur in children?
Children can suffer momentary severe subluxation and trauma to the spinal cord. * Spinal cord injury without radiographic abnormality results from the spinal cord sliding between the vertebrae and then sliding back into place without injury to the bony spine. It is thought to be the result of an immature spinal column that allows for reduction after momentary subluxation.
Which statement about pneumonia is accurate?
Children with bacterial pneumonia are usually sicker than children with viral pneumonia. * Children with bacterial pneumonia can be treated effectively, but they require a course of antibiotics.
An infant with bronchiolitis is hospitalized. The causative organism is respiratory syncytial virus (RSV). The nurse knows that a child infected with this virus requires what type of isolation?
Contact Precautions. ** RSV is caused by bronchiolitis.
The nurse should tell the parents of a child with Duchenne (pseudohypertrophic) muscular dystrophy that some of the progressive complications include:
Contractures, obesity, and pulmonary infections. * The major complications of muscular dystrophy include contractures, disuse atrophy, infections, obesity, respiratory complications, and cardiopulmonary problems.
The parent of a child diagnosed with Werdnig-Hoffmann disease notes times of not being able to hear the child breathing. Which should the nurse do first?
Count the child's respirations. * The first intervention is to check the respiratory rate of the child to see if it is abnormal, then listen to the lung sounds, and then check pulse oximetry.
In what respiratory condition is strider most often heard?
Croup.
The nurse knows that teaching was successful when a parent states which of the following are early signs of muscular dystrophy?
Difficulty climbing stairs. * Difficulty climbing stairs, running, and riding a bicycle are frequently the first symptoms of Duchenne muscular dystrophy.
Which measure is important in managing hypercalcemia in a child who is immobilized?
Promote adequate hydration
The mother of a 20-month-old tells the nurse that the child has a barking cough at night. The child's temperature is 37º C (98.6º F). The mother states the child is not having difficulty breathing. The nurse suspects croup and should recommend
trying a cool-mist vaporizer at night and watching for signs of difficulty breathing.
The most appropriate nursing intervention for a child following a tonsillectomy is to
watch for continuous swallowing.
Which developmental milestone should the nurse be concerned about if a 10-month-old could not do it?
Crawl. * Most infants are able to crawl unassisted by 8 months. Infants learn to cruise (walk around holding onto furniture) at about 9 to 10 months. Walking occurs on average at about 12 months.
A 5-year-old has been diagnosed with pseudohypertrophic muscular dystrophy. Which nursing intervention would be appropriate?
Discuss with the parents the potential need for respiratory support. * Muscles become weaker, including those needed for respiration, and a decision will need to be made about whether respiratory support will be provided.
What are the 3 zones used to interpret PEFR/Peak Expiratory Flow Rate?
Green=all clear at 80 to 100% of personal best. Yellow=signals caution at 50 to 79% of best. Red=signals medical alert at below 50% of best.
Which physical findings would be of most concern in an infant with respiratory distress?
Grunting. * Grunting is a sign of impending respiratory failure and is a very concerning physical finding.
A 3-month-old with spina bifida is admitted to the nurse's unit. Which gross motor skills should the nurse assess at this age?
Head control. * A 3-month-old has good head control.
Ch. 35. Wong Book. The most common complication that should be anticipated and observed for in an infant with myelomeningocele after surgical repair of the defect is:
Hydrocephalus.
A 7-month-old has a low-grade fever, nasal congestion, and a mild cough. What should the nursing care management of this child include?
Instilling saline nose drops and bulb suctioning.
When assessing the neurological status of an 8-month-old, the nurse should check for which of the following?
Interaction with staff.
What should be the nurse's first action with a child who has a high fever, dysphagia, drooling, tachycardia, and tachypnea?
Lateral neck radiographs. * This child is exhibiting signs and symptoms of epiglottitis and should be kept as comfortable as possible. The child should be allowed to remain in the parent's lap until a lateral neck film is obtained for a definitive diagnosis.
Which should the nurse do first when caring for an infant who just had a repair of a myelomeningocele?
Measure head circumference. * Hydrocephalus occurs in about 90% of infants with myelomeningocele, so measuring the head circumference daily and watching for an increase are important. Accumulation of cerebrospinal fluid can occur after closure of the sac.
Cystic fibrosis may affect one system or multiple systems of the body. What is the primary factor responsible for possible multiple clinical manifestations?
Mechanical obstruction caused by increased viscosity of exocrine gland secretions. * Children with CF have thick exocrine gland secretions. The viscous secretions obstruct small passages in organs such as the lungs and pancreas.
The parent of a toddler newly diagnosed with cerebral palsy (CP) asks the nurse what caused it. The nurse should answer with which of the following?
Most cases are caused by unknown prenatal factors. * At least 80% of cases of CP result from unknown prenatal factors.
What is an appropriate nursing intervention when caring for the child with chronic osteomyelitis?
Move and turn the child carefully and gently to minimize pain. (bone infection)
The nurse knows that teaching has been successful when the parent of a child with muscle weakness states that the diagnostic test for muscular dystrophy is which of the following?
Muscle biopsy.
A 5-year-old is brought to the ER with a temperature of 99.5°F (37.5°C), a barky cough, stridor, and hoarseness. Which nursing intervention should the nurse prepare for?
Respiratory treatment of racemic epinephrine. * The child has stridor, indicating airway edema, which can be relieved by aerosolized racemic epinephrine.
A school-age child has undergone a tonsillectomy and is being cared for postoperatively. The nurse assigned to the patient is developing a plan of care with regard to nutrition and hydration. What factors should be included in the postop plan? SATA.
Restrict food and oral fluids initially making sure that the patient is fully alert and there is no evidence of bleeding. Avoid giving fluids that are color tinged red or brown.
The nurse is planning care for a child with a T12 spinal cord injury. Which lifelong complications should the child and family know about? Select all that apply.
Skin integrity. Incontinence.
What are the clinical manifestations (s/s) of idiopathic scoliosis?
occurs with puberty, girls > boys, family tendency. : Uneven shoulders. One shoulder blade that appears more prominent than the other. Uneven waist. One hip higher than the other.
The parent of a child with cystic fibrosis calls the clinic nurse to report that the child has developed tachypnea, tachycardia, dyspnea, pallor (pale), and cyanosis. The nurse should tell the parent to bring the child to the clinic because these symptoms are suggestive of
pneumothorax.
The parents of a 6-year-old who has a new diagnosis of asthma ask the nurse what to do to make their home a more allergy-free environment. Which is the nurse's best response?
"Avoid purchasing upholstered furniture." * Leather furniture is recommended rather than upholstered furniture.
The parent of an infant asks the nurse what to watch for to determine if the infant has CP/Cerebral Palsy. Which is the nurse's best response?
"If the infant has clenched fists after 3 months."
The parent of a child with croup tells the nurse that her other child just had croup and it cleared up in a couple of days without intervention. She asks the nurse why this child is exhibiting worse symptoms and needs to be hospitalized. Which is the nurse's best response?
"Children younger than 3 years usually exhibit worse symptoms because their immune systems are not as developed.".
A mother is crying and tells the nurse that she should have brought her son in yesterday when he said his throat was sore. Which is the nurse's best response to this parent whose child is diagnosed with epiglottitis and is in severe distress and in need of intubation?
"Epiglottitis is rapidly progressive; you could not have predicted his symptoms would worsen so quickly."
Which is the nurse's best response to a parent who asks what can be done at home to help a child with upper respiratory infection (URI) symptoms and a fever get better?
"Give your child small amounts of fluid every hour to prevent dehydration."
Which statement indicates the parent needs further teaching on how to prevent his other children from contracting respiratory syncytial virus (RSV)?
"I should make sure that both my children receive Synagis (palivizumab) injections for the remainder of this year." * Synagis will not help the child who has already contracted the illness. Synagis is an immunization and a method of primary prevention.
Which statement by the parents of a toddler with repeated otitis media indicates they need additional teaching?
"My child will have fewer ear infections if he has his tonsils removed." * Removing children's tonsils may not have any effect on their ear infection. Children who have repeated bouts of tonsillitis can have ear infections secondary to the tonsillitis, but there is no indication in this question that the child has a problem with tonsillitis.
Which should the nurse tell the parent of an infant with spina bifida?
"Physical and occupational therapy will be helpful to stimulate the senses and improve cognitive skills."
The nurse is reviewing discharge instructions with the parents of a child who had a tonsillectomy 24 hours ago. The parents tell the nurse that the child is a big eater, and they want to know what foods to give the child for the next 24 hours. What is the nurse's best response?
"The child's diet should be restricted to soft foods." * Soft foods limit the child's pain and decrease the risk for bleeding.
Which is the nurse's best response to parents who ask what impact asthma will have on the child's future in sports?
"The earlier a child is diagnosed with asthma, the more significant the symptoms."
The mother of a child with Duchenne muscular dystrophy asks the nurse who in the family should have genetic screening. Who should the nurse say must be tested? Select all that apply.
1. Mother. 2. Sister. 4. Aunts and all female cousins. * All female relatives should be tested.
One of the goals for children with asthma is to prevent respiratory tract infection because infections:
can trigger an episode or aggravate asthmatic state. * An annual influenza vaccine is recommended.
A 3-year-old-has just returned from surgery in a hip spica cast. The priority nursing intervention is to
check circulation, sensation, and motion of toes.
The school nurse is called to the cafeteria because a child "has eaten something he is allergic to." The child is in severe respiratory distress. The first action by the nurse is to
have someone call for an ambulance and paramedic rescue squad or 9-1-1.
A pediatric patient has been diagnosed with Type I Osteogenesis Imperfecta (OI). The nurse understands that this specific type of OI?
is the most common form of the disease. OI is brittle-bone disease.
Asthma is classified into four categories: mild intermittent, mild persistent, moderate persistent, and severe persistent. Clinical features used to determine these categories include: SATA
lung function. frequency of symptoms. frequency and severity of exacerbations.
An adolescent has had a lower leg amputation secondary to a motorcycle accident and is complaining of pain in the missing extremity. The nurse should recognize that this is?
normal and called phantom limb sensation.
A 4-year-old is brought to the ED. The child has a "froglike" croaking sound on inspiration, is agitated, and is drooling. The child insists on sitting upright. The priority action by the nurse is to:
notify the health care provider immediately and be prepared to assist with a tracheostomy or intubation.
A parent with a toddler who has a respiratory infection wants to use the traditional method of topical vapor rub. Which statement by the parent indicates that additional teaching is needed with regard to administration of this treatment?
Application of the medication will be given orally to avoid potential sneezing.
Which critical element should be included in a plan of care for a pediatric patient who has to be immobilized as part of the course of therapeutic intervention?
Asking the patient to help organize individual care into a schedule.
A child with asthma is having pulmonary function tests. What explains the purpose of the peak expiratory flow rate (PEFR)?
Assesses the severity of asthma
A child has a chronic cough and diffuse wheezing during the expiratory phase of respiration. This suggests what condition?
Asthma * Bronchiolitis is an acute condition caused by RSV. Foreign body in the trachea occurs with acute respiratory distress or failure and maybe stridor.
Wongs Test Banks. What is a physiologic effect of immobilization on children?
Circulatory stasis can lead to thrombus and embolus formation. * A thrombus is a blood clot that forms in a vein. An embolus is anything that moves through the blood vessels until it reaches a vessel that is too small to let it pass.
Which is the nurse's best response to the parent of a child diagnosed with epiglottitis who asks what the treatment will be?
Complete a course of intravenous antibiotics. * Epiglottitis is bacterial in nature and requires I.V. antibiotics. A 7- to 10-day course of oral antibiotics is usually ordered following the I.V. course of antibiotics.
The nurse is assessing a child with croup in the ED. The child has a sore throat and is drooling. Examining the childs throat using a tongue depressor might precipitate what condition?
Complete obstruction
The nurse is teaching parents the proper use of a hipkneeanklefoot orthosis (HKAFO) for their 4-year-old child. The parents demonstrate basic essential knowledge by making what statement?
Condition of the skin in contact with the brace should be checked every 4 hours.
Which intervention is most appropriate to teach the mother of a child diagnosed with a URI and a dry hacking cough that prevents him from sleeping?
Give 1/2 teaspoon of honey four to five times per day. * Warm fluids, humidification, and honey are best treatments for a URI.
The nurse is teaching the parents of a 1-month-old infant with developmental dysplasia of the hip about preventing skin breakdown under the Pavlik harness. What statement by the parent would indicate a correct understanding of the teaching?
I should gently massage the skin under the straps to stimulate circulation.
Which is diagnostic for epiglottitis?
Lateral neck x-ray of the soft tissue. * A lateral neck x-ray is a definitive test to diagnose epiglottitis. The child is at risk for complete airway obstruction and should always be accompanied by a nurse to the x-ray department.
Which position would be most comfortable for a child with left-sided pneumonia?
Left side. * Lying on the left side may provide the patient with the most comfort. Lying on the left splints the chest and reduces the pleural rubbing.
A child is in the hospital for cystic fibrosis. What health care providers prescription should the nurse clarify before implementing?
Pancreatic enzymes every 6 hours. * Pancreatic enzymes should be administered with meals and snacks to ensure that digestive enzymes are mixed with food in the duodenum.
A child is standing playing with toys and suddenly collapses. Attempts to engage the child in conversation are met with no response. Skin color indicates cyanosis. A preliminary assessment of the environment presents no specific issues. Based on this information, you would suspect that the child is?
Potential aspiration of foreign body
What are considered major goals of the therapeutic management of juvenile rheumatoid arthritis (JRA)?
Prevent physical deformity; preserve joint function.
If an infant is having respiratory issues, is showing signs of needing to rest, but does not want to be put down in a crib, the best choice is to:
Prop up the child in an up-right position.
What measure is important in managing hypercalcemia in a child who is immobilized?
Provide adequate hydration.
An infant is not sleeping well, crying frequently, has yellow drainage from the ear, and is diagnosed with an ear infection. Which nursing objective is the priority for the family?
Providing pain relief for the child. * With pain relief, the child will likely stop crying and rest better.
What is a hallmark sign of Intussusception?
Red, jelly-like stools. * Results from blood & mucous to leaking into the intestinal lumen. Part of the intestine telescopes into itself.
Which should be included in instructions to the parent of a child prescribed amoxicillin to treat an ear infection?
"Administer the amoxicillin until all the medication is gone.
Which is the nurse's best response to the parent of an infant diagnosed with the first otitis media who wonders about long-term effects?
"The child could suffer recurrent ear infections." * When children acquire an ear infection at such a young age, there is an increased risk of recurrent infections.
Which child diagnosed with pneumonia would benefit most from hospitalization?
15-year-old who has been vomiting for 3 days and has a fever of 38.5°C (101.3°F). * The teen should be admitted for I.V. hydration.
A chloride level greater than _____________________ is a positive diagnostic indicator of cystic fibrosis (CF).
60 mEq/L. * The definitive diagnosis of CF is made when a child has a sweat chloride level >60 mEq/L. A normal chloride level is <40 mEq/L.
Which child with asthma should the nurse see first?
A 12-month-old who has a mild cry, is pale in color, has diminished breath sounds, and has an oxygen saturation of 93%. * This child is exhibiting signs of severe asthma.
Which child is at highest risk for requiring hospitalization to treat respiratory syncytial virus (RSV)?
A 2-month-old who was born at 32 weeks. * The younger the child, the greater the risk for developing complications related to RSV.
Which child would benefit most from having ear tubes placed?
A 2-year-old who has had five previous ear infections. * A 2-year-old is at the height of language development, which can be adversely affected by recurrent ear infections.
Which priority item should be placed at the bedside of a newborn with myelomeningocele?
A bottle of normal saline. * Before the surgical closure of the sac, the infant is at risk for infection. A sterile dressing is placed over the sac to keep it moist and help prevent it from tearing.
Who is at the highest priority to receive the flu vaccine?
A healthy 8-month-old who attends day care. * Children between the ages of 6 and 23 months are at the highest risk for having complications as a result of the flu due to immune systems that are not as developed.
A 2-month-old formerly healthy infant born at term is seen in the urgent care clinic with intercostal retractions, respiratory rate of 62, heart rate of 128, refusal to breastfeed, abundant nasal secretions, and a pulse oximeter reading of 88% in room air. The diagnosis of respiratory syncytial virus is made. The infant's oxygen saturation remains 95% in room air, and the respiratory rate is 54, with intercostal retractions; heart rate is 120 beats per minute. After 2 hours of observation and an intravenous bolus of fluids, the infant is being discharged home. The nurse provides which of the following home care instructions for this infant? Select all that apply.
A. Continue breastfeeding infant. C. Observe infant for labored breathing or apnea (cessation of breathing). D. Instill normal saline drops in both nares and suction thoroughly before feeding and before placing to sleep. F. Keep the infant out of day care or nursery.
A 5-year-old is recovering from a tonsillectomy and adenoidectomy and is being discharged home with his mother. Home care instructions should include which of the following? Select all that apply.
A. Observe the child for continuous swallowing. B. Encourage the child to take sips of cool, clear liquids. D. Observe the child for restlessness or difficulty breathing. F. Administer an analgesic such as acetaminophen for pain.
What is the most serious obstructive inflammatory process in a child?
Acute epiglottitis.
Following the sudden death of a 14-year-old seemingly healthy basketball player, his parents ask the school administration to install an automatic external defibrillator (AED) in a central area of the athletic center. The school nurse is asked to participate in a meeting with the parents in which the administrators insist such a device is not necessary. The school nurse advocates by providing which information about AEDs and children?
An AED can be effective in the resuscitation of a child or adolescent with a shockable rhythm.
The nurse evaluates teaching of parents of a child newly diagnosed with cerebral palsy (CP) as successful when the parents state that CP is which of the following?
An increase in muscle tone and deep tendon reflexes.
A nurse is caring for an infant with developmental dysplasia of the hip (DDH). Based on the nurse's knowledge of DDH, which clinical manifestation should the nurse expect to observe? SATA
Asymmetric thigh and gluteal folds. Positive Ortolani and Barlow tests. Shortening of limb on affected side.
A child with cystic fibrosis (CF) receives aerosolized bronchodilator medication. When should this medication be administered?
Before chest physiotherapy (CPT)
Which should the nurse expect as an intervention in a child in the recovery phase of GBS?
Begin an active physical therapy program. * PT helps muscle recovery and prevents contractures.
A 3-year-old is brought to the ER with coughing and gagging. The parent reports that the child was eating carrots when she began to gag. Which diagnostic evaluation will be used to determine if the child has aspirated carrots?
Bronchoscopy. * A bronchoscopy will allow the physician to visualize the airway.
Apnea of infancy has been diagnosed in an infant scheduled for discharge with home monitoring. Part of the infant's discharge teaching plan should include?
Cardiopulmonary resuscitation (CPR)
A child with GBS has had lots of oral fluids but has not urinated for 8 hours. Which is the nurse's first action?
Catheterize the child in and out. * The child must be in-and-out catheterized to avoid the possibility of developing a urinary tract infection from urine left in the bladder for too long.
An adolescent with a T4 spinal cord injury suddenly becomes dangerously hypertensive and bradycardic. Which intervention is appropriate?
Check to be certain that the patient's bladder is not distended.
Ch. 28. Wongs Book. A 12-year-old child is in the urgent care clinic with a complaint of fever, headache, and sore throat. A diagnosis of group A β-hemolytic streptococcus (GABHS) pharyngitis is established with a rapid-strep test, and oral penicillin is prescribed. The nurse knows that which of the following statements about GABHS is correct?
Children with a GABHS infection are at increased risk for the development of rheumatic fever and glomerulonephritis. * Rheumatic fever onset is 18 days after the pharyngitis infection. Acute glomerulonephritis onset is 10 days post infection. Scarlett fever is another complication that would present with a sand-paper-like rash.
Urinary system distress (neurogenic bladder) in children with spina bifida is managed by:
Clean intermittent catheterization
What is a secondary effect when a child experiences decreased muscle strength, tone, and endurance from immobilization?
Decreased exercise tolerance.
Immobilization causes what effect on metabolism?
Decreased metabolic rate
A child with spastic CP had an intrathecal dose of baclofen in the early afternoon. What is the expected result 3 1 /2 hours post dose that suggests the child would benefit from a baclofen pump?
Decreased spasticity. * If baclofen were going to work for this child, one could tell because spasticity would be decreased.
Ch. 29. Evolve. M/S. What is the rationale for elevating an extremity after a soft tissue injury such as a sprained ankle?
Elevation reduces edema formation.
A 3-year-old is brought to the ED with symptoms of stridor, fever, restlessness, and drooling. No coughing is observed. Based on these findings, the nurse should be prepared to assist with what action?
Emergency intubation
The nurse is developing a plan of care for a child recently diagnosed with cerebral palsy (CP). Which should be the nurse's priority goal?
Ensure that the child reaches full potential.
The nurse is planning care for a child who was recently admitted with GBS. Which is a priority nursing diagnosis?
Impaired skin integrity related to infectious disease process. * The goal is to prevent complications related to immobility. Efforts include maintaining skin integrity, maintaining respiratory function, and preventing contractures.
A child is admitted to the pediatric unit with spastic CP. Which would the nurse expect a child with spastic CP to demonstrate? Select all that apply.
Increased deep tendon reflexes. Scoliosis. Contractures. Scissoring when walking.
What clinical manifestation would the nurse expect when a pneumothorax (collapsed lung) occurs in a neonate who is undergoing mechanical ventilation?
Nasal flaring and retractions
How will a child with respiratory distress and stridor and who is diagnosed with RSV be treated?
Nebulized racemic epinephrine. * Racemic epinephrine promotes mucosal vasoconstriction.
Which should the nurse prepare the parents of an infant for following surgical repair and closure of a myelomeningocele shortly after birth? The infant will:
Need lifelong management of urinary, orthopedic, and neurological problems.
Which will help a school-aged child with muscular dystrophy stay active longer?
Normal activities, such as swimming.
Which statement is true concerning osteogenesis imperfecta (OI)?
OI is an inherited disorder.
Which would be appropriate nursing care management of a child with the diagnosis of mononucleosis?
Only family visitors. * Children with mononucleosis are more susceptible to secondary infections. Therefore, they should be limited to visitors within the family, especially during the acute phase of illness.
What condition can result from the bone demineralization associated with immobility?
Osteoporosis
A 14-year-old male with a spinal cord injury is placed on a standing table and suddenly begins to sweat profusely and complain of a headache. The nurse takes a set of vital signs and notes a significant increase in systolic blood pressure and a heart rate of 50 beats per minute. The most helpful intervention in this situation would be for the nurse to:
Palpate the bladder for distention
Which should be included in the plan of care for a newborn with a myelomeningocele who will have a surgical repair tomorrow?
Place a wet dressing on the sac. * Priority care for an infant with a myelomeningocele is to protect the sac. A wet dressing keeps it moist with less chance of tearing.
A pediatric patient at risk for developing complications of immobility during the postoperative period should have which measures incorporated into the plan of care?
Plan for play activities as tolerated.
How can otitis media be prevented?
Pneumococcal conjugate vaccine. Do not prop the bottle. Breastfeeding for up to 6 months. Encourage a "smoking" jacket.
A 17-year-old patient is returning to the surgical unit after Luque instrumentation for scoliosis repair. In addition to the usual postoperative care, what additional intervention will be needed?
Position changes are made by log rolling.
A school-aged child is admitted to the unit pre-operatively for bladder reconstruction. The child is latex-sensitive. Which intervention should the nurse implement?
Post a sign on the door and chart that the child is latex-allergic.
A 15-year-old with spina bifida is seen in the clinic for a well-child checkup. The teen uses leg braces and crutches to ambulate. Which nursing diagnosis takes priority?
Potential body image disturbance.
Which should be the priority nursing diagnosis for a 12-hour-old newborn with a myelomeningocele at L2?
Potential for infection related to the physical defect. * Because this infant has not had a repair, the sac is exposed. It could rupture, allowing organisms to enter the cerebrospinal fluid, so this is the priority.
The primary risk factor for the development of cerebral palsy is:
Premature birth
What is characteristic of fractures in children?
Rapidity of healing is inversely related to the child's age.
What would the nurse advise the parent of a child with a barky cough that gets worse at night?
Take the child outside into the more humid night air for 15 minutes. * The night air will help decrease subglottic edema, easing the child's respiratory effort. The coughing should diminish significantly, and the child should be able to rest comfortably. If the symptoms do not improve after taking the child outside, the parent should have the child seen by a health-care provider.
Over the last week, an infant with a repaired myelomeningocele has had a high pitched cry and been irritable. Length, weight, and head circumference have been at the 50th percentile. Today length is at the 50th percentile, weight is at the 70th percentile, and head circumference is at the 90th percentile. The nurse should do which of the following?
Tell the parent this might mean the baby has increased intracranial pressure.
Which of these statements accurately describes Duchenne muscular dystrophy (DMD)? Select all that apply.
The absence of dystrophin leads to muscle fiber degeneration. DMD is inherited as an X-linked recessive trait. Affected children have a waddling gait and lordosis and fall frequently. Ambulation usually becomes impossible by 12 years of age, and affected children are confined to a wheelchair.
The parent of a child with cystic fibrosis (CF) is excited about the possibility of the child receiving a double lung transplant. What should the parent understand?
The transplant will not cure the child of CF but will allow the child to have a longer life. * A lung transplant does not cure CF, but it does offer the patient an opportunity to live a longer life. The concerns are that, after the lung transplant, the child is at risk for rejection of the new organ and for development of secondary infections because of the immunosuppressive therapy.
In reviewing potential susceptibility to respiratory infections for children, which statement is based on supportive physiological evidence?
There is an increase in infection rate between 3 to 6 months due to loss of protective effects of maternal antibodies.
Which should the nurse instruct children to do to stop the spread of influenza in the classroom?
Wash their hands after sneezing.
It is important that a child with acute streptococcal pharyngitis be treated with antibiotics to prevent:
acute rheumatic fever.
Therapeutic management of the patient with systemic lupus erythematosus (SLE) includes
administration of corticosteroids to control inflammation.
The most appropriate time to perform bronchial postural drainage is
before meals and at bedtime.
A nurse working in triage in the ER is assessing a pediatric patient, age 4, who presents with pain in the wrist. The patient refuses to move the involved extremity. Questioning of the patient and parent reveal no trauma event. Based on this observation the nurse suspects that the patient may have
partial dislocation or subluxation.
An immediate intervention to teach parents for when an infant chokes on a piece of food would be to:
position infant in a head-down, face-down position and administer five quick back slaps.
An infant with a congenital heart defect is receiving palivizumab (Synagis). Based on the nurse's knowledge of medication, the purpose of this medication is to
prevent respiratory syncytial virus (RSV) infection.
If a 14-year-old girl is confined to a wheelchair, one possible therapeutic suggestion would be to:
put stickers on the wheelchair.
Treatment methods used for status asthmaticus focus on
restoring hydration.
A humidified atmosphere is recommended for a young child with an upper respiratory tract infection because it:
soothes inflamed mucous membrane.
A 4-year-old boy needs to use a metered-dose inhaler to treat asthma. He cannot coordinate the breathing to use it effectively. The nurse should suggest that he use a:
spacer.
A 6-week-old is admitted to the hospital with influenza. The child is crying, and the father tells the nurse that his son is hungry. The nurse explains that the baby is not to have anything by mouth. The parent does not understand why the child cannot eat. Which is the nurse's best response to the parent?
"The shorter and narrower airway of infants increases their chances of aspiration so your child should not have anything to eat now." * An infant with influenza has lots of nasal secretions and coughs up mucus. With all the secretions, the infant is at an even higher risk of aspiration.
The parent of a child with influenza asks the nurse when the child is most infectious. Which is the nurse's best response?
"Twenty-four hours before and after the onset of symptoms."
A parent asks the nurse how it will be determined if their child has respiratory syncytial virus (RSV). Which is the nurse's best response?
"We will swab your child's nose and send that specimen for testing."
The parent of a 9-month-old calls the ER because his child is choking on a marble. The parent asks how to help his child while awaiting Emergency Medical Services. Which is the nurse's best response?
"You should administer five back blows followed by five chest thrusts." * This is the recommendation for infants younger than 1 year.
The parent of a child with frequent ear infections asks the nurse if there is anything that can be done to help avoid future ear infections. Which is the nurse's best response?
"Your child should be kept away from tobacco smoke." * The tobacco smoke damages mucociliary function, prolonging the inflammatory process and impeding drainage through the eustachian tube.
What are the clinical manifestations of idiopathic scoliosis?
- children may not experience any pain & parents may see cosmetic changes. - Shoulders and shoulder blades at uneven heights. - Protruding ribs on 1 side due to twisting aspect of the spine.
What are the risk factors with hip dysplasia?
1. Female gender. 2. Breech position. 3. High birth weight (LGA).
What does the therapeutic management of cystic fibrosis (CF) patients include? Select all that apply.
1. Providing a high-protein, high-calorie diet. 3. Encouraging exercise. 4. Minimizing pulmonary complication. 5. Encouraging medication compliance. * Children with CF have difficulty absorbing nutrients because of the blockage of the pancreatic duct. Pancreatic enzymes cannot reach the duodenum to aid in digestion of food. These children often require up to 150% of the caloric intake of their peers.
Which should the nurse expect in a 2-week-old with a brachial plexus injury? Select all that apply.
3. Absent Moro reflex on one side. 4. No sensory loss. 5. Associated clavicle fracture.
A 3-year-old child has a femoral shaft fracture. The nurse recognizes that the approximate healing time for this child is how long?
4 weeks
The nurse is caring for a school-aged child with Duchenne muscular dystrophy in the elementary school. Which would be an appropriate nursing diagnosis?
Activity intolerance. * The child would not be able to keep up with peers because of weakness, progressive loss of muscle fibers, and loss of muscle strength.
Which child is in the greatest need of emergency medical treatment?
6-year-old who has high fever, no spontaneous cough, and frog-like croaking. * This child has s/sof epiglottitis and should receive immediate emergency medical treatment. There is a significant airway obstruction.
Because the absorption of fat-soluble vitamins is decreased in cystic fibrosis, which vitamin supplementation is necessary?
A, D, E, K
The nurse is interviewing the parents of a 4-month-old infant brought to the ED. The infant is dead on arrival, and no attempt at resuscitation is made. The parents state that the baby was found in the crib with a blanket over the head, lying face down in bloody fluid from the nose and mouth. The parents indicate no problems when the infant was placed in the crib asleep. Which of the following causes of death does the nurse suspect?
Sudden infant death syndrome (SIDS)
The nurse is caring for an immobilized preschool child. What is helpful during this period of immobilization?
Take the child for a "walk" by wagon outside the room.
Which assessment is of greatest concern in a 15-month-old?
The child is in the tripod position, has diminished breath sounds, and a muffled cough. * The child is sitting and leaning forward in order to breathe more easily. Diminished breath sounds are indicative of a worsening condition. A muffled cough indicates subglottic edema.
Basic treatment of musculoskeletal soft tissue injuries involves the use of RICE modalities during the first 12 to 24 hours. Which option would be included in RICE?
The extremity should be maintained in proper alignment and activity should be limited.
Which information will be most helpful in teaching parents about the primary prevention of foreign body aspiration?
The most common objects that toddlers aspirate.
Which statement is the most descriptive of rhabdomyosarcoma?
The most common sites are the head and neck.
A child with severe cerebral palsy is admitted to the hospital with aspiration pneumonia. What is the most beneficial educational information that the nurse can provide to the parents?
The most valuable information the nurse can give the parents is how to prevent aspiration pneumonia from occurring in the future.
A child with asthma is having pulmonary function tests. What rationale explains the purpose of the peak expiratory flow rate?
To assess severity of asthma
A preadolescent has been diagnosed with scoliosis. The planned therapy is the use of a thoracolumbosacral orthotic. The preadolescent asks how long she will have to wear the brace. What is the appropriate response by the nurse?
Until your vertebral column has reached skeletal maturity.
What information should the nurse provide the parent of a child diagnosed with nasopharyngitis?
Use comfort measures for the child. * Nasal congestion can be relieved using normal saline drops and bulb suction. Tylenol can also be given for discomfort or a mild fever.
Ch. 21. Evolve. Resp. A 5-year-old child is brought the ED with abrupt onset of sore throat, pain with swallowing, fever, and sitting upright and forward. Acute epiglottitis is suspected. What are the most appropriate nursing interventions? SATA.
Vital signs. Medical history. Assessment of breath sounds. Emergency airway equipment readily available.
An infant is born with one lower limb deficiency. When is the optimum time for the child to be fitted with a prosthetic device?
When the infant is developmentally ready to stand up.
If a patient is in traction, should someone assist in holding the weights while a patient is being slid up in bed.
Yes. Otherwise it will cause the patient pain. The weights should never be on the floor.
A school-age child has been diagnosed with nasopharyngitis. The parent is concerned because the child has had little or no appetite for the last 24 hours. Which is the nurse's best response?
"Be sure your child is taking an adequate amount of fluids. The appetite should return soon."
Which would be an early sign of respiratory distress in a 2-month-old?
Tachypnea. * Tachypnea is an early sign of distress and is often the first sign of respiratory illness in infants.
Ch. 4. Success Book. Resp. The nurse caring for a female pediatric client with CF/cystic fibrosis sends a stool for analysis. The results show an excessive amount of azotorrhea and steatorrhea. What does the nurse realize about the laboratory values?
They reflect that the patient is not compliant with taking her enzymes. * If the patient were not taking her enzymes, the result would be a large amount of undigested food, azotorrhea,and steatorrhea in the stool. CF patients must take digestive enzymes with all meals and snacks. Pancreatic ducts become clogged with thick mucus that blocks the flow of digestive enzymes from the pancreas to the duodenum.Therefore, patients must take digestive enzymes to aid in absorption of nutrients. Often, teens are noncompliant with their medication regimen because they want to be like their peers.
Causes of autonomic dysreflexia include which of the following? Select all that apply.
2. Abdominal distention. 3. Bladder distention. 5. Tight clothing. * Autonomic dysreflexia may be caused by abdominal pressure from a fecal impaction. An overdistended bladder is usually the precipitating factor causing an increase in abdominal pressure. Tight clothing can increase pressure to the central core of the body.
A newborn with a repaired myelomeningocele is assessed for hydrocephalus. Which would the nurse expect in an infant with hydrocephalus?
Bulging fontanel and downwardly rotated eyes.
Ch. 34. Wong book. The potential physiologic and psychologic effects of prolonged immobilization on a 9-year-old child who has experienced significant trauma in a motor vehicle crash include which of the following? Select all that apply.
A. Orthostatic intolerance. B. Deep vein thrombosis. C. Pressure ulcer formation. D. Pneumonia. F. Kidney stones. H. Constipation. (C, D, O, K, P, P).
Disordered eating patterns, which may be observed in the female athlete triad, may include which of the following? Select all that apply.
A. Use of diet pills and laxatives. B. Fasting. D. Restriction of certain foods. E. Inadequate caloric intake.
A 5-year-old is seen in the urgent care clinic with the following history and symptoms: sudden onset of severe sore throat after going to bed, drooling and difficulty swallowing, axillary temperature of 102.2°F (39.0°C), clear breath sounds, and absence of cough. The child appears anxious and is flushed. Based on these symptoms and history, the nurse anticipates a diagnosis of:
Acute epiglottitis
A 3-month-old infant is seen in the clinic with the following symptoms: irritability, crying, refusal to nurse for more than 2 to 3 minutes, rhinitis, and a rectal temperature of 101.8°F (38.8°C). The labor, delivery, and postpartum history for this term infant is unremarkable. The nurse anticipates a diagnosis of:
Acute otitis media (AOM)
Which should the nurse do for a 6-year-old living in a rural area who is missing school shots and who has sustained a puncture wound?
Administer DTaP vaccine. * A child less than 7 years of age and not fully immunized should receive DTaP vaccine to prevent tetanus. Tetanusprone wounds include puncture wounds and those contaminated with dirt, feces, or soil.
Which should the nurse administer to provide quick relief to a child with asthma who is coughing, wheezing, and having difficulty catching her breath?
Albuterol. * Albuterol is the quick-relief bronchodilator of choice for treating an asthma attack.
A 3-year-old child with CP is admitted for dehydration following an episode of diarrhea. The nurse's assessment follows: awake, pale, thin child lying in bed, multiple contractures, drooling, coughing spells noted when parent feeds. T 97.8°F (36.5°C), P 75, R 25, weight 7.2 kg, no diarrheal stool for 48 hours. Which nursing diagnosis is most important?
Alteration in nutrition: less than body requirements. * This weight is average for a 4-month-old.
Which breathing exercises should the nurse have an asthmatic 3-year-old child do to increase her expiratory phase?
Blow a pinwheel. * Blowing bubbles is another method to increase the child's expiratory phase.
After spinal cord surgery, an adolescent suddenly complains of a severe headache. Which should be the nurse's first action?
Check for a full bladder. * The sympathetic nervous system responds to a full bladder or bowel resulting from an uncontrolled, paroxysmal, continuous lower motor neuron reflex arc. This response is usually from stimulation of sensory receptors (e.g., distended bladder or bowel). Because the efferent pulse cannot pass through the spinal cord, the vagus nerve is not "turned off," and profound symptomatic bradycardia may occur.
The parents of a toddler diagnosed with Werdnig-Hoffmann disease ask the nurse what they can feed their child that would be quality food. Which would be good choices for the nurse to recommend?
Chicken and broccoli. * Chicken is a good source of protein, and broccoli is a good choice for naturally occurring vitamins.
The nurse evaluates the teaching as successful when a parent states that which of the following can cause autonomic dysreflexia?
Distended bowel or bladder. * Autonomic dysreflexia results from an uncontrolled, paroxysmal, continuous lower motor neuron reflex arc due to stimulation of the sympathetic nervous system. It is a response that typically results from stimulation of sensory receptors such as a full bladder or bowel.
The mother of an infant diagnosed with Werdnig-Hoffmann disease asks the nurse what she could have done during her pregnancy to prevent this. The nurse explains that the cause of Werdnig-Hoffmann is which of the following?
Inherited as an autosomal-recessive trait. * Werdnig-Hoffmann disease is inherited as an autosomal-recessive trait.
Which symptoms will a child suffering from complete spinal cord injury experience?
Loss of motor and sensory function below the level of the injury.
Which foods would be best for a child with Duchenne muscular dystrophy?
Low-calorie foods to prevent weight gain.
A 12-year-old who was in an ATV accident has a long-leg fiberglass cast on his left leg for a tibia-fibula fracture. He requests pain medication at 2 :00 am for pain he rates at a 10/10 on the Numeric Scale. The nurse brings the pain medication and notes that he has removed the pillows that kept his leg elevated. He complains of pain in the left foot, and she notes that there is 3+ edema in the exposed leg and foot and she is unable to slip a finger under the cast. The nurse's priority interventions in this situation should include:
Notify the surgeon of the findings immediately
Which is the best advice to offer the parent of a 6-month-old with Werdnig-Hoffman disease on how to treat the infant's constipation?
Offer extra water every day.
A 2-day-old infant in the newborn nursery is diagnosed with developmental dysplasia of the hip, and treatment is started by the orthopedist. The nurse assists the parents by providing home care instructions that include:
Remove the Pavlik harness once a day for no more than 2 hours and inspect skin.
Parents bring their 2-month-old into the clinic with concerns that the baby seems "floppy." The parents say the baby seems to be working hard to breathe, eats very slowly, and seems to fatigue quickly. The nurse assesses intercostal retractions, although the baby is otherwise in no distress. They add there was a cousin whose baby had similar symptoms. The nurse would be most concerned with what possible complications?
Respiratory compromise. * This baby may have Werdnig-Hoffman disease, which is characterized by progressive generalized muscle weakness that eventually leads to respiratory failure. Respiratory compromise is the most important complication.
Which should a nurse in the ED be prepared for in a child with a possible spinal cord injury?
Respiratory depression. * A spinal cord injury can occur at any level. The higher the level of the injury, the more likely the child is to have respiratory insufficiency or failure. The nurse should be prepared to support the child's respiratory system.
A child with a repaired myelomeningocele is in the clinic for a regular examination. The child has frequent constipation and has been crying at night because of pain in the legs. After an MRI, the diagnosis of a tethered cord is made. Which should the nurse tell the parent?
Tethered cord is a post-surgical complication. * Tethered cord is caused by scar tissue formation from the surgical repair of the myelomeningocele and may affect bowel, bladder, or lower extremity functioning.
A school-age child is admitted to the hospital for a tonsillectomy. During the nurse's post-operative assessment, the child's parent tells the nurse that the child is in pain. Which of the following observations would be of most concern to the nurse?
The child is swallowing excessively. * Excessive swallowing is a sign that the child is swallowing blood. This should be considered a medical emergency, and the physician should be contacted immediately. The child is likely bleeding and will need to return to surgery.
Which would the nurse explain to parents about the inheritance of cystic fibrosis?
The child of a mother who has CF and a father who is a carrier of the gene for CF has a 50% chance of acquiring CF.
The parents of a 5-week-old have just been told that their child has cystic fibrosis (CF). The mother had a sister who died of CF when she was 19 years of age. The parents are sad and ask the nurse about the current projected life expectancy. What is the nurse's best response?
The nurse answers their questions briefly, listens to their concerns, and is available later after they've processed the information.
Ch 11. Success book. M/S An adolescent presents with sudden-onset unilateral facial weakness. The teen has drooping of one side of the mouth, is unable to close the eye on the affected side, has no other symptoms, and otherwise feels well. The nurse could summarize the condition by which of the following?
This is paralysis of the facial nerve.
A child presents with a history of having had an upper respiratory tract infection 2 weeks ago; complains of symmetrical lower extremity weakness, back pain, muscle tenderness; and has absent deep tendon reflexes in the lower extremities. Which is important regarding this condition?
This may be an acute inflammatory demyelinating neuropathy. * This child probably has GBS / Guillain-Barre Syndrome, which is an acute inflammatory demyelinating neuropathy.
