FINAL 8

What observation in a child should indicate the need for a referral to a specialist regarding a communication impairment?

At 2 years of age, the child fails to respond consistently to sounds.

The nurse needs to assess a 15-month-old child who is sitting quietly on his father's lap. What initial action by the nurse would be most appropriate?

Begin the assessment while the child is in his father's lap.

The parents of a child with cognitive impairment ask the nurse for guidance with discipline. What should the nurse's recommendation be based on?

Behavior modification is an excellent form of discipline.

A parent needs to leave a hospitalized toddler for a short period of time. What action should the nurse suggest to the parent to ease the separation for the toddler?

Leave a favorite article from home with the child.

Because of their striving for independence and productivity, which age group of children is particularly vulnerable to events that may lessen their feeling of control and power

School-age children

A 10-year-old girl needs to have another intravenous (IV) line started. She keeps telling the nurse, "Wait a minute," and, "I'm not ready." How should the nurse interpret this behavior?

This is expected behavior for a school-age child.

The nurse is teaching parents of a child with cataracts about the upcoming treatment. The nurse should give the parents what information about the treatment of cataracts?

"Cataracts require surgery to remove the cloudy lens and replace it."

What choice of words or phrases would be inappropriate to use with a child?

"Catheter" for "intravenous"

The nurse is teaching feeding strategies to a parent of a 12-month-old infant with Down syndrome. What statement made by the parent indicates a need for further teaching?

"I will place the food on the top of the tongue."

The nurse is caring for a 3-year-old child during a long hospitalization. The parent is concerned about how to support the child's siblings during the hospitalization. What statement is appropriate for the nurse to make?

"You could encourage a nightly phone call between the siblings as part of the bedtime routine."

The nurse is talking to the parent of a child with special needs. The parent has expressed worry about how to support the siblings at home. What suggestion is appropriate for the nurse to give to the parent?

"You should help the siblings see the similarities and differences between themselves and your child with special needs."

The camp nurse is choosing a toy for a child with cognitive impairment to play with during swimming time. What toy should the nurse choose to encourage improvement of developmental skills?

A large beach ball

The nurse is notified that a 9-year-old boy with nephrotic syndrome is being admitted. Only semiprivate rooms are available. What roommate should be best to select?

An 8-year-old boy with a fractured femur

A 2-week-old infant with Down syndrome is being seen in the clinic. His mother tells the nurse that he is difficult to hold, that "he's like a rag doll. He doesn't cuddle up to me like my other babies did." What is the nurse's best interpretation of this lack of clinging or molding?

A physical characteristic of Down syndrome

What behavior seen in children should be addressed by the nurse who is providing care to a child with a chronic illness?

A preschooler who refuses to participate in self-care

The nurse is doing a prehospitalization orientation for a girl, age 7 years, who is scheduled for cardiac surgery. As part of the preparation, the nurse explains that after the surgery, the child will be in the intensive care unit. How might the explanation by the nurse be viewed?

An appropriate part of the child's preparation

Autism is a complex developmental disorder. The diagnostic criteria for autism include delayed or abnormal functioning in which area with onset before age 3 years?

Ability to maintain eye contact

The American Association on Intellectual and Developmental Disabilities (AAIDD), formerly the American Association on Cognitive Impairment, classifies cognitive impairment based on what parameter?

Adaptive skill domains

An adolescent with long-term, complex health care needs will soon be discharged from the hospital. The nurse case manager has been assigned to the teen and family. The adolescent's care involves physical therapy, occupational therapy, and speech therapy in addition to medical and nursing care. Who should be the decision maker in the adolescent's care?

Adolescent and family

Cognitive development influences response to pain. What age group is most concerned with the fear of losing control during a painful experience?

Adolescents

A 4-year-old girl is admitted to outpatient surgery for removal of a cyst on her back. Her mother puts the hospital gown on her, but the child is crying because she wants to leave on her underpants. What is the most appropriate nursing action at this time??

Allow her to wear her underpants.

What condition is defined as reduced visual acuity in one eye despite appropriate optical correction?

Amblyopia

The nurse should suspect a hearing impairment in an infant who fails to demonstrate which behavior?

Babbling by age 12 months

A child, age 4 years, tells the nurse that she "needs a Band-Aid" where she had an injection. What nursing action should the nurse implement?

Apply a Band-Aid.

The school nurse is caring for a child with a penetrating eye injury. Emergency treatment includes what intervention?

Apply a Fox shield to the affected eye and any type of patch to the other eye.

What action should the school nurse take for a child who has a hematoma (black eye) with no hemorrhage into the anterior chamber?

Apply ice for the first 24 hours.

One of the supervisors for a home health agency asks the nurse to give a family of a child with a chronic illness a survey evaluating the nurses and other service providers. How should the nurse recognize this request?

Appropriate to improve quality of care

The nurse is admitting a 7-year-old child to the pediatric unit for abdominal pain. To determine what the child understands about the reason for hospitalization, what should the nurse do?

Ask the child why he came to the hospital today.

The parents of a 4-month-old infant cannot visit except on weekends. What action by the nurse indicates an understanding of the emotional needs of a young infant?

Assign her to the same nurse as much as possible.

The psychosexual conflicts of preschool children make them extremely vulnerable to which threat?

Bodily injury and pain

What is the single most prevalent cause of disability in children and responsible for the recent increase in childhood disability?

Cancer

The nurse outlines short- and long-term goals for a 10-year-old child with many complex health problems. Who should agree on these goals?

Child, family, and all professionals involved

A spinal tap must be done on a 9-year-old boy. While he is waiting in the treatment room, the nurse observes that he seems composed. When the nurse asks him if he wants his mother to stay with him, he says, "I am fine." How should the nurse interpret this situation?

Children in this age group often do not request support even though they need and want it.

What intervention should be included in the nursing care of a child with autism spectrum disorder (ASD)?

Communicate with the child at his or her developmental level.

The nurse is caring for a 10-year-old child during a long hospitalization. What intervention should the nurse include in the care plan to minimize loss of control and autonomy during the hospitalization?

Create a calendar with special events such as a visit from a friend to maintain a routine.

The nurse is teaching a preschool child with a cognitive impairment how to throw a ball overhand. What teaching strategy should the nurse use for this child?

Demonstrate how to throw a ball overhand.

Using knowledge of child development, what approach is best when preparing a toddler for a procedure?

Demonstrate on a doll how the procedure will be done.

The parents of a child on a ventilator tell the nurse that their insurance company wants the child to be discharged. They explain that they do not want the child home "under any circumstances." What principle should the nurse consider when working with this family?

Desire to have the child home is essential to effective home care.

The nurse is preparing a 9-year-old boy before obtaining a blood specimen by venipuncture. The child tells the nurse he does not want to lose his blood. What approach is best by the nurse?

Discuss with him how his body is always in the process of making blood.

The mother of a young child with cognitive impairment asks for suggestions about how to teach her child to use a spoon for eating. The nurse should make which recommendation?

Do a task analysis first.

A newborn assessment shows a separated sagittal suture, oblique palpebral fissures, a depressed nasal bridge, a protruding tongue, and transverse palmar creases. These findings are most suggestive of which condition?

Down syndrome

The nurse is planning care for a 3-year-old boy who has Down syndrome and is on continuous oxygen. He recently began walking around furniture. He is spoon fed by his parents and eats some finger foods. What goal is the most appropriate to promote normal development?

Encourage mobility

A 7-year-old is identified as being at risk for skin breakdown. What intervention should the nursing care plan include?

Ensuring that nutritional intake meets requirements

The mother of a 7-month-old infant newly diagnosed with cystic fibrosis is rooming in with her infant. She is breastfeeding and provides all the care except for the medication administration. What should the nurse include in the plan of care?

Ensuring that the mother has time away from the infant

A 10-year-old child requires daily medications for a chronic illness. Her mother tells the nurse that the child continually forgets to take the medicine unless reminded. What nursing action is most appropriate to promote adherence to the medication regimen?

Establish a contract with her, including rewards.

An 8-year-old girl is being admitted to the hospital from the emergency department with an injury from falling off her bicycle. What intervention will help her most in her adjustment to the hospital?

Explain hospital schedules to her, such as mealtimes.

The nurse asks the mother of a child with a chronic illness many questions as part of the assessment. The mother answers several questions, then stops and says, "I don't know why you ask me all this. Who gets to know this information?" The nurse should respond in what manner?

Explain who will have access to the information.

What suggestion by the nurse for parents regarding stuttering in children is most helpful?

Give the child plenty of time and the impression that you are not in a hurry.

One of the techniques that has been especially useful for learners having cognitive impairment is called fading. What description best explains this technique?

Gradually reduces the assistance given to the child so the child becomes more independent

The parents of a 3-year-old admitted for recurrent diarrhea are upset that the practitioner has not told them what is going on with their child. What is the priority intervention for this family?

Help the family develop a written list of specific questions to ask the practitioner.

A 16-year-old girl comes to the pediatric clinic for information on birth control. The nurse knows that before this young woman can be examined, consent must be obtained from which source?

Herself

A bone marrow biopsy will be performed on a 7-year-old girl. She wants her mother to hold her during the procedure. How should the nurse respond?

Holding may help your child relax.

The nurse is assessing a child's functional self-care level for feeding, bathing and hygiene, dressing, and grooming and toileting. The child requires assistance or supervision from another person and equipment or device. What code does the nurse assign for this child?

III

A child with a serious chronic illness will soon go home. The case manager requests that the family provide total care for the child for a couple of days while the child is still hospitalized. How should the request be viewed?

Important because it can be beneficial to the transition from hospital to home

What behavior should most likely be manifested in an infant experiencing the protest phase of separation anxiety?

Inconsolable and crying

The nurse is discussing sexuality with the parents of an adolescent girl who has a moderate cognitive impairment. What factor should the nurse consider when dealing with this issue?

Individuals with cognitive impairment need a well-defined, concrete code of sexual conduct

A 9-year-old boy has an unplanned admission to the intensive care unit (ICU) after abdominal surgery. The nursing staff has completed the admission process, and his condition is beginning to stabilize. When speaking with the parents, the nurse should expect what additional stressor to be evident?

Insufficient remembering of his condition and routine

A father calls the emergency department nurse saying that his daughter's eyes burn after getting some dishwasher detergent in them. The nurse recommends that the child be seen in the emergency department or by an ophthalmologist. The nurse also should recommend which action before the child is transported?

Irrigate the eyes copiously with tap water for 20 minutes.

A 6-year-old child is admitted to the pediatric unit and requires bed rest. Having art supplies available meets which purpose?

Lets the child express thoughts and feelings through pictures rather than words

The nurse has been visiting an adolescent with recently acquired tetraplegia. The teen's mother tells the nurse, "I'm sick of providing all the care while my husband does whatever he wants to, whenever he wants to do it." What reaction should be the nurse's initial response?

Listen and reflect the mother's feelings.

The community nurse is planning prevention measures designed to avoid conditions that can cause cognitive impairment. Taking folic acid supplements during pregnancy to prevent neural tube defects is which type of prevention strategy?

Primary

The nurse is performing a physical assessment on a 3-year-old child. The parents state that the child excessively rubs the eyes and often tilts the head to one side. What visual impairment should the nurse suspect?

Myopia, or nearsightedness

A 13-year-old child with cystic fibrosis (CF) is a frequent patient on the pediatric unit. This admission, she is sleeping during the daytime and unable to sleep at night. What should be a beneficial strategy for this child?

Negotiate a daily schedule that incorporates hospital routine, therapy, and free time.

Secondary prevention for cognitive impairment includes what activity?

Newborn screening for treatable inborn errors of metabolism

Parents of a hospitalized child often question the skill of staff. The nurse interprets this behavior by the parents as what?

Normal

For case management to be most effective, who should be recognized as the most appropriate case manager?

Nurse

What is a primary goal in caring for a child with cognitive impairment?

Promoting optimum development

The nurse is counseling a pregnant 35-year-old woman about estimated risk of Down syndrome. What is the estimated risk for a woman who is 35 years of age?

One in 350

A 14-year-old adolescent is hospitalized with cystic fibrosis. What nursing note entry represents best documentation of his breakfast meal?

One pancake, eggs, and 240 ml OJ

A 5-year-old child has bilateral eye patches in place after surgery yesterday morning. Today he can be out of bed. What nursing intervention is most important at this time?

Orient him to his immediate surroundings.

What parents should have the most difficult time coping with their child's hospitalization?

Parents of a child hospitalized for sepsis resulting from an untreated injury

The nurse is providing support to parents adapting to the hospitalization of their child to the pediatric intensive care unit. The nurse notices that the parents keep asking the same questions. What should the nurse do?

Patiently continue to answer questions, trying different approaches.

The nurse needs to take the blood pressure of a preschool boy for the first time. What action would be best in gaining his cooperation?

Permit him to handle the equipment and see the cuff inflate and deflate before putting the cuff in place.

A 6-year-old is being discharged home, which is 90 miles from the hospital, after an outpatient hernia repair. In addition to explicit discharge instructions, what should the nurse provide?

Prescribed pain medication before discharge

What intervention is most appropriate to facilitate social development of a child with a cognitive impairment?

Provide peer experiences, such as infant stimulation and preschool programs.

When a preschool-age child is hospitalized without adequate preparation, the nurse should recognize that the child may likely see hospitalization as what?

Punishment

A 5-year-old child returns from the pediatric intensive care unit after abdominal surgery. The orders state to monitor vital signs every 2 hours. On assessment, the nurse observes that the child's heart rate is 20 beats/min less than it was preoperatively. What should be the nurse's next action?

Recheck the pulse and blood pressure in 15 minutes.

The nurse should expect a toddler to cope with the stress of a short period of separation from parents by displaying what?

Regression

A 6-year-old boy is hospitalized for intravenous antibiotic therapy. He eats very little on his "regular diet" trays. He tells the nurse that all he wants to eat is pizza, tacos, and ice cream. What nursing action is the most appropriate?

Request these favorite foods for him

The nurse has been assigned as a home health nurse for a child who is technology dependent. The nurse recognizes that the family's background differs widely from the nurse's own. The nurse believes some of their lifestyle choices are less than ideal. What nursing intervention is most appropriate to institute?

Respect the differences.

When communicating with other professionals about a child with a chronic illness, what is important for nurses to do?

Restrict communication to clinically relevant information.

What description applies to fragile X syndrome?

Second most common genetic cause of cognitive impairment

The nurse is instructing student nurses about the stress of hospitalization for children from middle infancy throughout the preschool years. What major stress should the nurse relate to the students?

Separation anxiety

What technique facilitates lip reading by a hearing-impaired child?

Speak at an even rate.

Two hospitalized adolescents are playing pool in the activity room. Neither of them seems enthusiastic about the game. How should the nurse interpret this situation?

The adolescents may be enjoying themselves but have lower energy levels than healthy children.

The nurse is talking with a 10-year-old boy who wears bilateral hearing aids. The left hearing aid is making an annoying whistling sound that the child cannot hear. What intervention is the most appropriate nursing action?

Suggest he reinsert the hearing aid.

A child's parents ask the nurse many questions about their child's illness and its management. The nurse does not know enough to answer all the questions. What nursing action is most appropriate at this time?

Tell them, "I don't know, but I will find out."

Many of the clinical features of Down syndrome present challenges to caregivers. Based on these features, what intervention should be included in the child's care?

Use a cool-mist vaporizer to keep the mucous membranes moist and secretions liquefied.

A 6-year-old child needs to drink 1 L of GoLYTELY in preparation for a computed tomography scan of the abdomen. To encourage the child to drink, what should the nurse do?

Use little cups and make a game to reward him for each cup he drinks.

A toddler is being sent to the operating room for surgery at 9 AM. As the nurse prepares the child, what is the priority intervention?

Verifying that the child and procedure are correct