Ch 52: Nursing Care of a Family when a Child has an Unintentional Injury

d) Providing honest answers in a reassuring manner Pg. 1467 Providing honest answers to the parents' questions and concerns in a reassuring manner will provide the most support. Procedures and treatment plans should be explained in terms they can understand and repeated patiently, if need be. Encouraging the parents to read to their daughter will involve them in their child's care and help normalize the situation for the child.

1. A 7-year-old girl is in the intensive care unit following a bicycle accident. Which would be most helpful in providing support to the girl's parents? a) Encouraging them to read to their daughter b) Giving them brief explanations of procedures c) Describing the treatment plan for their daughter d) Providing honest answers in a reassuring manner

b) Forceps d) Irrigation Pg. 1483 The nurse should anticipate the use of either forceps or irrigation. If the tympanic membrane is not intact, irrigation would not be used as this would increase the risk of infection. Excision, otoscopy, and cotton-tipped applicators are not used for foreign body removal from the outer ear canal.

10. The nurse is caring for a 2-year-old client with a small plastic toy lodged in the outer ear canal. The tympanic membrane is intact. Which interventions should the nurse anticipate as options for removal of the object? Select all that apply. a) Otoscopy b) Forceps c) Cotton-tipped applicator d) Irrigation e) Excision

b) Begin an intravenous line Pg. 1476 When communicating with the health care provider in an emergency situation, the nurse uses clinical judgment to prioritize treatment options. In this case, it is an initial priority to begin an intravenous (IV) line so that fluids for hypotension or blood products can be instilled. The health care provider performing the procedure will obtain the consent from the parent. Medicating for pain and placing a Foley catheter may be completed following IV placement.

11. A child who suffered a blow to the abdomen while snowboarding comes to the emergency department with severe abdominal pain, especially on inspiration. The child is tachycardic, hypotensive, anxious, and very pale. The hematocrit is falling quickly. The health care provider indicates a liver rupture. What is the initial nursing action? a) Obtain surgical consent b) Begin an intravenous line c) Place a Foley catheter d) Medicate for pain

a) Neck stabilization with brace Pg. 1468 All children with head trauma need to have their neck stabilized with a brace until cervical trauma has been ruled out. Intracranial pressure monitoring, mannitol administration, and dexamethasone therapy may also be required, but these should not be anticipated first.

19. The nurse is caring for a 4-year-old client with head trauma. Which intervention should the nurse anticipate first? a) Neck stabilization with brace b) Intracranial pressure monitoring c) Dexamethasone therapy d) Mannitol administration

b) Injuries resulting in ongoing blood loss Pg. 1467-1468 The child has a lower than normal blood pressure and is in hypovolemic shock, secondary to blood loss from a major injury. The nurse would further assess the child for sources of blood loss, including obvious external injuries that are bleeding and those that may not be visible, causing internal blood loss. The child's body should be assessed for malformation (ex: fractured femur), swelling, redness, and pain of the extremities. The child's abdomen should be assessed for signs of internal injury/blood loss in the abdominal cavity (distention, skin discoloration, redness, bowel sounds). The child was injured a few hours prior, so it is unlikely the source of the low blood pressure would be a septic shock, as the injuries are too recent for infection to be present yet. The child's history indicates obvious injuries sustained from a baseball bat, so the nurse would not immediately assess for cardiogenic shock (usually caused by structural heart disease) or anaphylaxis (caused by allergies).

12. A 10-year-old child comes to the emergency department as a victim of abuse. The child's parent reports that the child was hit repeatedly with a baseball bat a few hours prior. The initial assessment indicates the child's blood pressure is 84/40 mm Hg. The nurse would further assess the child for what finding? a) Signs of septic shock resulting from infection b) Injuries resulting in ongoing blood loss c) Allergies, specifically any history of anaphylactic reactions d) History of cardiac structural heart disease or arrhythmias

d) Test the secretions with a glucose reagent strip Pg. 1469 Rhinorrhea or otorrhea (clear fluid draining from the nose or ear, respectively) may be noticeable following a head injury. If the fluid is cerebrospinal fluid (CSF), this is a serious finding because it means that the client's central nervous system is open to infection. To determine if the fluid is CSF or mucus from allergic rhinitis (hay fever), the nurse will test the fluid with a glucose reagent strip. CSF will test positive for glucose, whereas the clear, watery drainage from an upper respiratory tract infection or allergy will not. Waiting for further symptoms of rhinitis may delay needed care. Assessing for inflammation is not definitive and could be present due to the recent allergy. Level of consciousness may be impaired with or without cerebrospinal drainage.

13. A 13-year-old client suffered a serious fall while hiking with friends and suffered a head injury. Upon arrival to the emergency department, the nurse notices clear fluid from the nose. A friend said that the client had been sneezing a lot from a pollen allergy. Which intervention will the nurse implement to determine whether the fluid is cerebrospinal fluid (CSF) or mucus from allergic rhinitis (hay fever)? a) Assess the nasal mucosa for inflammation b) Assess for further rhinitis symptoms such as sneezing c) Evaluate the client's level of consciousness d) Test the secretions with a glucose reagent strip

a) Assess the level of consciousness Pg. 1467 Once the ABCs are completed, the nurse's next step is to assess the child's level of consciousness or disability. This would be followed by removing the child's clothing (exposure) to assess for underlying signs of illness or injury. Next, full vital signs are taken while facilitating the family's presence, followed by giving comfort by managing pain and providing emotional support. The acronym ABCDEFG is a useful reminder of the order of assessment: airway, breathing, circulation, disability, exposure, full vital signs, and facilitating family, and giving comfort. Capillary blood glucose should be obtained to rule out hypoglycemia as the cause of mental status change.

14. A child has fallen from a swing at the playground and the parent states that the child became groggy. After assessing a child's airway, breathing, and circulation (ABCs), what would the nurse do next? a) Assess the level of consciousness b) Obtain blood glucose c) Provide pain management d) Obtain a full set of vital signs

b) The child and parent have conflicting stories on what caused the injury Pg. 1468 Conflicting descriptions of the event or how the injuries occurred is a hallmark sign of maltreatment. Nurses are mandated to report child maltreatment. Bruising to multiple parts of the body may occur with accidents. Greenstick fractures are fractures in which the bone is not completely broken; these fractures are not always associated with maltreatment.

15. The nurse is assessing a child who has been injured. What assessment finding would support the need to initiate a notification to the abuse registry so that child protection specialists can investigate? a) The child has a greenstick fracture b) The child and parent have conflicting stories on what caused the injury c) The child and both parents' descriptions of the accident are the same d) There is bruising to various parts of the body after reported fall from a swing

a) "If feeling better, going to a friend's house and swimming will be a good distraction" Pg. 1487 When a minor burn occurs, apply cool water, not ice, to the burn to cool the skin. Infection is a concern so the application of an antibiotic ointment and a gauze dressing is indicated. A follow-up appointment in about 2 days is indicated to change the dressing and assess for any infection. The dressing should be kept dry and no swimming or getting wet while bathing until the burn is healed.

16. The nurse is caring for an adolescent who has suffered a first-degree partial thickness burn to their forearm. Which statement by the parent indicates a need for further education? a) "If feeling better, going to a friend's house and swimming will be a good distraction" b) "When it first happened I got ice but then I remembered, cool water is better than using ice" c) "We will keep the burn covered with a dressing and apply antibiotic ointment to prevent infection" d) "We will make sure to come back to see the primary health care provider in two to three days"

d) Glasgow scale Pg. 1473 The Glasgow Coma Scale is used to grade comas according to level of consciousness. The Apgar score is assigned immediately after birth to determine how the infant tolerated the birth. Wong-Baker FACES and the visual analogue scales are used to rate pain.

17. A young client in the intensive care unit is in a coma after a severe head injury. The primary nurse is teaching a nursing student how to assess the client's level of consciousness using a coma scale. What type of scale could be used for this purpose? a) Wong-Baker FACES scale b) Apgar scale c) Visual analogue scale d) Glasgow scale

c) Acetylcysteine Pg. 1480 Acetylcysteine is utilized for acetaminophen toxicity. Sodium bicarbonate is used for metabolic toxicity. Naloxone is used for opioid overdose. Activated charcoal is used for salicylate toxicity such as aspirin.

18. Which treatment is the antidote for acetaminophen toxicity? a) Activated charcoal b) Naloxone c) Acetylcysteine d) Sodium bicarbonate

a) Volume replacement Pg. 1491 Volume replacement is the first-line treatment for poor perfusion and hypotension. Atropine is used for symptomatic bradycardia that is unresponsive to ventilation and oxygenation. Sodium bicarbonate is used for metabolic acidosis. Epinephrine is the drug of choice for children during and immediately after resuscitation.

23. A 5-year-old child is exhibiting manifestations of hypotension. What is the first-line treatment for poor perfusion and hypotension? a) Volume replacement b) Atropine c) Sodium bicarbonate d) Epinephrine

d) The child and parent have conflicting stories on what caused the injury Pg. 1468 Conflicting descriptions of the event or how the injuries occurred is a hallmark sign of maltreatment. Nurses are mandated to report child maltreatment. Bruising to multiple parts of the body may occur with accidents. Greenstick fractures are fractures in which the bone is not completely broken; these fractures are not always associated with maltreatment.

2. The nurse is assessing a child who has been injured. What assessment finding would support the need to initiate a notification to the abuse registry so that child protection specialists can investigate? a) The child has a greenstick fracture b) The child and both parents' descriptions of the accident are the same c) There is bruising to various parts of the body after reported fall from a swing d) The child and parent have conflicting stories on what caused the injury

a) Spleen Pg. 1476 In children, the spleen is the most frequently injured organ when there is abdominal trauma because it is usually palpable under the lower left rib. Frequent causes of injury are inappropriately applied seat belts in automobiles, handlebar injuries in bicycle accidents, or skateboard or snowboard accidents. The child will have tenderness in the left upper quadrant of the abdomen, especially on deep inspiration, when the diaphragm moves down and touches the spleen.

20. A 10-year-old boy who was in a car wreck has been brought to the emergency room for evaluation. He appears to have suffered abdominal trauma due to his seat belt. He has tenderness in the left upper quadrant of the abdomen, especially on deep inspiration. Given these circumstances, the nurse should suspect injury to which of the following organs? a) Spleen b) Pancreas c) Stomach d) Liver

d) Risk for suffocation Pg. 1477 Death from drowning occurs from suffocation. Nearly half of all drowning victims are children under the age of 5. Most drowning deaths in young children occur because of inadequate supervision of a bathtub or pool.

21. Which nursing diagnosis would be appropriate for teaching interventions for a single mother who leaves her toddler unattended in the bathtub? a) Risk for imbalanced body temperature b) Risk for falls c) Noncompliance d) Risk for suffocation

d) Lack of interest in surroundings Pg. 1467 An infant who is not interested in the environment is a cause for concern. Vigorous crying is a reassuring sign. Making eye contact with the nurse is a reassuring finding. A normal anterior fontanel (fontanelle) is soft and flat and would be considered a reassuring finding.

22. The nurse is assessing the neurologic status of an infant. What would the nurse identify as an abnormal finding? a) Making eye contact with the nurse b) Vigorous crying c) Soft, flat anterior fontanel (fontanelle) d) Lack of interest in surroundings

b) Keep coffee cups on the counter above the toddler's reach Pg. 1487 Burns are caused by excessive heat, and they are the second most common cause of unintentional injuries. When instructing parents, the nurse considers the developmental age of the child when determining priority instruction. The parent should be instructed to always keep the coffee cup on the counter, so that it is out of reach of the toddler. Toddlers are naturally inquisitive and more mobile than infants, and they fail to understand the dangers of looking into a cup, which can have hot contents. Maintaining the water heater at the appropriate temperature is important; however, the chances of the child having the dexterity needed to turn on the water is not as high as tipping a coffee cup. A parent feeding the child is not a usual cause of accidental thermal injury. Cleaning a deep fryer occurs when the oil is no longer hot.

24. A nurse is providing instructions to the parent of a toddler regarding the prevention of burn injuries. Which instruction is the priority? a) Keep the toddler away when cleaning a deep fryer b) Keep coffee cups on the counter above the toddler's reach c) Keep the water heater set to 120°F (49°C) or lower d) Cool down hot liquids before giving them to the toddler

b) Encourage the parent to discuss specific concerns about the child d) Review signs and symptoms of respiratory distress with the parent e) Reinforce when the health care provider should be called Pg. 1466 The most appropriate actions would be for the nurse to reinforce signs and symptoms of respiratory distress, and when the health care provider or 911 should be called. The nurse should also encourage the parent to share specific concerns about the child and address them at that moment instead of delaying until the follow-up visit. Providing reassurance that the respiratory infection has been cured does not address the parent's expressed concerns.

25. A nurse is providing discharge teaching to the parent of a child hospitalized after experiencing respiratory arrest. The parent expresses concerns about the child's well-being. Which action(s) is appropriate for the nurse take? Select all that apply. a) Reassure the parent that the child's infection has been cured b) Encourage the parent to discuss specific concerns about the child c) Tell the parent that the child's provider will address any concerns during the follow-up visit d) Review signs and symptoms of respiratory distress with the parent e) Reinforce when the health care provider should be called

a) "We will vacuum the surfaces in our child's room and play areas frequently" b) "We will administer the oral chelating medication daily to our child" Pg. Lead paint in older homes (built before 1978) is a common source of lead exposure in children. Any blood lead level above 5 µg/dl (0.24 µmol/l) will require repeat testing to ensure that lead levels are decreasing. Washing the child's hands and toys is recommended to remove lead residue. Oral chelating medication is usually prescribed at levels of above 10 µg/dl (0.48 µmol/l), so is not required for this child until levels are known and should be followed up with further teaching by the nurse. Vacuuming can disperse lead dust in the air and the caregivers should be taught to damp-mop and dust hard surfaces.

26. A 2-year-old client has routine blood testing to assess for potential lead ingestion due to living in an older home with possible exposure to lead paint (above). Which statement(s) by the caregiver indicates a need for additional teaching by the nurse? Select all that apply. a) "We will vacuum the surfaces in our child's room and play areas frequently" b) "We will administer the oral chelating medication daily to our child" c) "We will return to the clinic for follow-up lead blood testing" d) "We will wash our child's toys daily before allowing playtime" e) "We will wash our child's hands before eating"

c) Syrup of ipecac Pg. 1479-1481 Ipecac is rarely used in the health care setting to induce vomiting and is no longer recommended for use in the home setting. Gastric lavage, administration of activated charcoal (binds with the chemical substance in the bowel), or whole bowel irrigation with polyethylene glycol electrolyte solutions may be used.

27. A child is brought to the emergency department with suspected poisoning. What treatment would the nurse least likely expect to be used? a) Whole bowel irrigation b) Activated charcoal c) Syrup of ipecac d) Gastric lavage

a) Establish a patent airway Pg. 1480 Initial treatment for a victim of suspected poisoning involves maintaining breathing and cardiac function. This is a priority over communication with the family, establishing IV access, or administering other medications.

28. An unconscious client is brought to the emergency department after ingesting too much prescribed medication. What is the highest priority nursing intervention? a) Establish a patent airway b) Establish IV access c) Call family members d) Administer antacids

a) Both pupils are pinpoints Pg. 1471 Observe the child's eyes for signs of dilated pupils from increased intracranial pressure (ICP). If both pupils are dilated, irreversible brainstem damage is suggested, although such a finding may also be present with poisoning with an atropine-like drug. Pinpoint pupils suggest barbiturate or opiate intoxication. One pupil dilated or the eye deviated downward or laterally more than the other suggests third cranial nerve compression or a tentorial tear (laceration of the membrane between the cerebellum and cerebrum) with herniation of the temporal lobe into the torn membrane.

29. A 14-year-old girl arrives at the hospital in a comatose state. Her father, who found her comatose in her room, tells the nurse that she has an opiate addiction. Which of the following would confirm that the coma was caused by opiate intoxication? a) Both pupils are pinpoints b) One pupil is dilated and the other is normal c) Both pupils are dilated d) One pupil is dilated and the other deviates downward

a) Administer 100% oxygen by mask Pg. 1478 Management of the near-drowning victim focuses on assessing the client's airway, breathing, and circulation (ABCs) and correcting hypoxemia. Administering oxygen is the primary intervention to assist breathing. It is best to let the adolescent assume the most comfortable position for him or her. Checking capillary refill time helps determine ineffective tissue perfusion, but it does not provide an intervention for the labored breathing. Postural drainage techniques to remove water from the lungs are of no proven value in a near-drowning experience.

3. A 13-year-old adolescent has had a near-drowning experience. The nurse notices the client has labored breathing and a cough. What is the priority intervention? a) Administer 100% oxygen by mask b) Perform postural drainage every hour c) Check the client's capillary refill time d) Have the client sit up straight in a chair

d) Minimal air movement through the lungs Pg. 1467 Minimal or no air movement requires immediate intervention because this child's status is severely compromised. Breath sounds over the trachea typically are high pitched. Breath sounds over the peripheral lung fields are lower pitched. Normally percussion over air-filled lungs reveals resonant sounds.

30. The nurse is assessing the respiratory status and lungs of a 6-year-old child. What finding would the nurse report immediately? a) Low-pitched bronchial sounds over the periphery b) High-pitched breath sounds over the trachea c) Resonance over the lungs on percussion d) Minimal air movement through the lungs

b) Stabilize the cervical spine Pg. 1468 If head or spine injuries are suspected, then after the airway is opened, the cervical spine must be stabilized to prevent damage. Checking the mouth for debris is part of securing an airway. Administering oxygen and IV access occur after the C-spine is stabilized.

31. A 3-year-old child has sustained injuries from a fall. Once the airway is secured, what interventions would be next? a) Administer 100% oxygen b) Stabilize the cervical spine c) Set up antecubital IV access d) Check mouth for debris

b) "Tonight I will start the elbow exercises the physical therapist showed me" Pg. 1485 Initial treatment for client's elbow is rest until the pain, tenderness, and swelling has resolved. Elbow exercises may then be started to prevent further injury. Other treatment can include application of ice, anti-inflammatory medications such as ibuprofen, and cortisone injections.

32. The nurse is assessing a 12-year-old child who has presented with elbow pain, tenderness to touch, and swelling following pitching in a baseball game. What statement by the child indicates a need for further education regarding the treatment plan? a) "I will make sure I eat something when I take the ibuprofen that the health care provider prescribed" b) "Tonight I will start the elbow exercises the physical therapist showed me" c) "I will keep my elbow elevated and apply ice packs for 15 minutes 3 times per day" d) "If it continues to hurt, the health care provider may be able to do a cortisone injection in my elbow"

c) Administration of acetylcysteine Pg. 1480 In the emergency department, activated charcoal or acetylcysteine, a mucolytic agent and also the specific antidote for acetaminophen poisoning, will be administered. Acetylcysteine prevents hepatotoxicity by binding with the breakdown product of acetaminophen so that it will not bind to liver cells. Unfortunately, acetylcysteine has an offensive odor and taste. Administering it in a small amount of a carbonated beverage can help the child to swallow it.

33. A 4-year-old girl is brought to the emergency room following ingestion of large amounts of acetaminophen (Tylenol). Which of the following interventions does the nurse expect? a) Performing hands-only CPR b) Stimulation of vomiting c) Administration of acetylcysteine d) Assessing for consciousness

b) 2 Pg. 1475 In the eye opening section of the Glasgow coma scale, eye opening only in response to painful stimuli would be a score of 2. Spontaneous eye opening is a 4, opening in response to speech is a 3, and no eye opening in response to painful stimuli is a 1.

34. The nurse is assessing a child with a suspected head injury. The child opens the eyes only in response to the nurse placing pressure in the child's nail bed. What score on the Glasgow coma scale for eye opening should the nurse assign based on this assessment finding? a) 3 b) 2 c) 4 d) 1

b) "I just can't believe my baby is going to have brain surgery. It's so scary" Pg. 1470 Treatment of a subdural hematoma in an infant is to drain the blood by a subdural puncture, not surgery. A needle is inserted through the anterior fontanel (fontanelle) to drain the blood. The infant receives conscious sedation and must be held very still during the procedure. This may need to be repeated daily to empty the subdural space.

35. The nurse is caring for an infant who was injured and developed a subdural hematoma that is to be drained. Which statement by the infant's parent indicates a need for further education about the procedure? a) "The medication will help my child sleep during the procedure so my child won't feel anything" b) "I just can't believe my baby is going to have brain surgery. It's so scary" c) "So they will just stick a needle in the soft spot on my child's head and drain the blood" d) "I hope that they won't need to do this more than a couple of times to get all of the blood out"

b) Liver Pg. 1475 The most frequently injured solid organ in a penetrating trauma is the liver.

36. What is the most frequently injured solid organ in a penetrating trauma? a) Lungs b) Liver c) Brain d) Pancreas

b) Water immersions c) Falls d) Burns e) Motor vehicles Pg. 1477-1487 Accidents such as those involving motor vehicles, falls, burns, and water immersions cause more deaths in the 1- to 4-year-old age group than many other types of injuries. Hyperthermia in children is not common.

37. The nurse is providing community education regarding accidents in the infant, toddler, and preschool population. When designing educational materials, which types of accidents would be included? Select all that apply. a) Hyperthermia b) Water immersions c) Falls d) Burns e) Motor vehicles

a) The fluid is clear and watery Pg. To confirm if the fluid is CSF or rhinitis from nasal secretions, the nurse would test the fluid with a glucose reagent strip. CSF will test positive for glucose, whereas the clear, watery drainage from an upper respiratory tract infection or allergy will not. The color of the fluid does not confirm if it is CSF. Cerebrospinal fluid is thin and watery, not thick.

38. A nurse is providing care to a child with a depressed skull fracture. The child has fluid draining from the nose. The nurse confirms the fluid is cerebrospinal fluid based on which finding? a) The fluid is clear and watery b) The fluid is thick with red specks c) The fluid tests positive for glucose d) The fluid is light yellow in color

d) Replace the stomach contents and continue with the feedings as prescribed Pg. 1475 The nurse should always aspirate nasogastric or gastrostomy tubes for stomach contents to check for tube placement and assess gastric residual amounts prior to administering feedings. The nurse will return any amount of stomach residue aspirated so the child does not lose large amounts of stomach acid. 15 ml is a very small amount of gastric contents and should not interfere with feedings.

4. The nurse is caring for a comatose school-age child receiving gastrostomy tube feedings. The nurse aspirates 15 ml of stomach contents prior to administering a feeding. What is the appropriate action by the nurse? a) Replace the stomach contents and hold the feeding b) Discard the stomach contents and notify the health care provider of the aspiration amount c) Discard the stomach contents and continue with the feedings as prescribed d) Replace the stomach contents and continue with the feedings as prescribed

b) Perform a primary assessment Pg. 1467 The nurse would perform a primary assessment. When assessing a child with a traumatic injury, airway (A), breathing (B), and circulation (C) are assessed first: assess the patency of the airway and establish the effectiveness of breathing, examining the child's respiratory effort, breath sounds, and color; evaluate the circulation, noting pulse rate and quality and observing the color, skin temperature, and perfusion. Once this is accomplished, the nurse would notify the health care provider and apply monitors as needed. The nurse should ensure a code cart is available before the start of the shift.

5. When the nurse is caring for a child presenting with a traumatic injury, which action is priority? a) Ensure the code cart is available b) Perform a primary assessment c) Apply an oxygen saturation monitor d) Notify the primary health care provider

a) 30 ml Pg. 1492 Improved urinary output of 1 to 2 ml/kg/hour is the goal. The child weighs 53 pounds, which is equivalent to 24 kg. Thus, improvement in this child would be noted by an hourly urinary output between 24 and 48 ml/hour.

6. A child who weighs 53 lbs (24 kg) is receiving fluid volume replacement as part of the treatment for shock. The nurse is evaluating the child's hourly urinary output to determine if the child's condition is improving. Which output would the nurse interpret as most indicative of improvement? a) 30 ml b) 12 ml c) 15 ml d) 22 ml

a) When a permanent tooth is knocked out, it should be rinsed in water and then placed in milk and brought to the emergency department Pg. 1477 If a permanent tooth is knocked out, it should be rinsed with water, placed in a salt solution or milk, and brought to the emergency department. Permanent teeth may be reimplanted successfully. Deciduous teeth may not be replaced.

7. The student nurse is preparing a presentation on dental trauma care in children. What information should the student include? a) When a permanent tooth is knocked out, it should be rinsed in water and then placed in milk and brought to the emergency department b) If a child has a deciduous tooth knocked out, it should be cleaned with an antiseptic and brought to the emergency department to be replaced c) If a permanent tooth is knocked out, it should be rinsed with water, put on ice, and brought to the emergency department d) Permanent teeth are typically not able to be reimplanted successfully

b) Inspection shows a sluggish pupillary reaction Pg. 1468 A sluggish pupillary reaction may occur with increased intracranial pressure, which would be cause for concern. A closed posterior fontanel (fontanelle) in an 11-month-old would be a normal finding. Crying and looking around are encouraging signs indicating improved neurologic status. Opening the eyes when being spoken to is an encouraging sign.

8. The nurse is assessing the neurologic status of an 11-month-old girl. Which finding would be cause for concern? a) Palpation of the head reveals a closed posterior fontanel (fontanelle) b) Inspection shows a sluggish pupillary reaction c) The child is crying and looking around fearfully d) The child's eyes remain closed unless she is spoken to

c) Keep cleaning solutions in a locked area Pg. 1478-1779 The most essential instruction at discharge is to keep cleaning solutions locked up to protect the toddler from accidental poisoning. Above all, this protects from a reoccurrence. Accidental poisonings usually occur among toddlers and commonly involve substances located in bathrooms or kitchens. Labeling poisonous substances may not help, because most toddlers are unable to read. Not leaving the child alone and closely monitoring the child are important, but not feasible all the time. Posting the number for the Poison Control Center (or saving it in a cellphone) is important but will not prevent the poisoning.

9. A nurse is caring for a toddler in stable condition after being diagnosed with accidental poisoning due to the ingestion of cleaning solution. What teaching point is essential prior to discharge? a) Label poisonous solutions with a red X b) Post the number for the Poison Control Center in your home and store the number in your cellphone c) Keep cleaning solutions in a locked area d) Closely monitor the toddler's activity