Pediatric 2.5
A parent of three young children has contracted tuberculosis. Which should the nurse expect the health care provider to prescribe for members of the family who have a positive reaction to the tuberculin skin test and are candidates for treatment? 1 Isoniazid 2 Multiple-puncture test 3 Bacille Calmette-Guérin 4 Purified protein derivative
(1) Isoniazid is used as a prophylactic agent for people who have been exposed to tuberculosis; also, it is one of several drugs used to treat the disease. Isoniazid also is used in drug combinations to treat tuberculosis which have improved compliance with drug therapy: Rifamate (containing rifampin and isoniazid), Rifater (containing rifampin, isoniazid, and pyrazinamide). Multiple-puncture tests, such as the tine test, are used to test for tuberculosis; these are no longer recommended. They are not a treatment for the prevention or cure of tuberculosis. Bacille Calmette-Guérin is a vaccine that provides limited immunity; it is not recommended for use in the United States. Purified protein derivative, the Mantoux test, is a widely used skin test for detecting tuberculosis; it is not a treatment for the prevention or treatment of tuberculosis. Study Tip: The old standbys of enough sleep and adequate nutritional intake also help keep excessive stress at bay. Although nursing students learn about the body's energy needs in anatomy and physiology classes, somehow they tend to forget that glucose is necessary for brain cells to work. Skipping breakfast or lunch or surviving on junk food puts the brain at a disadvantage.
What is the best way for the nurse to greet a 3-year-old child sitting in the waiting room of the pediatric clinic? 1 By walking into the waiting room to greet the child 2 By calling the child by name at the waiting room door 3 By asking the receptionist to bring the child into the office 4By standing at the waiting room door while inviting the child into the office
(1) The child may be fearful of the examining room experience. Greeting the child in the safety of the waiting room may help make the experience less threatening. Calling a child's name from a distance, having a stranger greet the child, and summoning the child to the office are all authoritarian approaches that may make the child more fearful.
A preschooler is admitted with a diagnosis of acute glomerulonephritis. The child's history reveals a 5-lb weight gain in 1 week and periorbital edema. How can the nurse obtain the most accurate information on the status of the child's edema? 1 Weighing daily 2 Observing body changes 3 Measuring intake and output 4 Monitoring electrolyte values
(1) Weight monitoring is the most useful means of assessing fluid balance and changes in the edematous state; 1 L of fluid weighs about 2.2 lb. Visual inspection is subjective and generally inaccurate. Measuring intake and output is not as accurate as daily weights; fluid may be trapped in the third compartment. Monitoring of electrolyte values is unreliable; they may or may not be altered with fluid shifts.
A 2-month-old infant with the diagnosis of heart failure is discharged with a prescription for oral digoxin (Lanoxin) 0.05 mg every 12 hours. The bottle of digoxin is labeled "0.05 mg/mL." Which item should the nurse teach the mother to use when administering the medication? 1 Nipple 2 Calibrated syringe 3 Plastic measuring spoon 4 Bottle containing an ounce of water
(2) A calibrated syringe or dropper provides the most accurate measurement of the medication. Using a nipple or spoon is not an accurate way to measure medication. If the dose of medication is diluted and the infant does not drink the entire ounce, the resulting dose will be insufficient.
A 17-year-old mother is to sign the consent for her son's myringotomy. What should the nurse say to the mother about this procedure? 1 "This procedure may not help." 2 "Tell me what you know about this procedure." 3 "Your son will need to have this done again when he's older." 4 "One of your parents must also sign this because you're too young."
(2) Informed consent requires that the responsible person understand the procedure. Predicting therapeutic outcomes is not within the role of the nurse. A 17-year-old mother is an emancipated minor who has the legal authority to sign her child's consent form. Predicting future surgical interventions is not within the role of the nurse.
Methylphenidate (Ritalin SR) is ordered for a 6-year-old boy with the diagnosis of attention deficit-hyperactivity disorder (ADHD). The nurse teaches the father about the safe administration of the medication and concludes that the instructions have been understood when the father says that he should administer it: 1 At bedtime 2 After breakfast 3 When the child gets hungry 4 When the child's behavior is out of control
(2) Methylphenidate (Ritalin SR) may cause nausea, anorexia, and dry mouth, which interfere with appetite and adequate food intake; therefore it should be administered after the child has eaten breakfast. Methylphenidate is a cerebral stimulant that can interfere with sleep; it should not be administered within 6 hours of bedtime. It should be taken exactly as prescribed, not on an as-needed basis.
A school nurse is planning to teach the importance of hand-washing to the children in first grade. What is the most effective approach for this age group? 1 Showing a video of the correct hand-washing technique 2 Demonstrating hand-washing and asking for return demonstrations 3 Involving them in a discussion about the importance of hand-washing 4 Describing how germs cause illness and how hand-washing prevents disease
(2) Six-year-old children are still in the perceptual phase of cognitive development. They base judgments on what they see rather than on what they reason; reasoning begins around age 7. These children are at the developmental stage when they want to show off their accomplishments; just watching the technique without feedback is not sufficient at this age. These children are too young to understand the abstract concepts involved in a discussion of the cause and effect regarding pathogens or to understand why handwashing is so important in preventing illness.
A 4-year-old child being admitted for surgery arrives on the ambulatory surgical unit crying and pulling at the hospital gown while clutching a teddy bear. What is the best response by the nurse? 1 "Please stop crying. Nobody will hurt you." 2 "Hello, I'm your nurse. Let's go and see your room." 3 "I know you feel scared. This must be your special teddy bear." 4 "We want you to be happy here. Let's go to the playroom and play."
(3) Acknowledging that the child is scared and referring to the teddy bear focuses on the child's feelings and a familiar object of security. The child may experience pain as part of the treatment, so the statement that no one will hurt the child is untruthful. Diverting the child's attention will not alleviate fear and anxiety.
The mother of a preschool-age child tells the nurse that her husband is dying of cancer and that she is worried about how her child will cope. As part of their discussion, the school nurse includes that preschool-age children view death as: 1 Universal 2 Irreversible 3 A form of sleep 4 A frightening ghost
(3) Between the ages of 3 and 5 years death is viewed as a departure or sleep and as reversible. The irreversibility and universality of death are concepts held by children starting at 8 to 9 years of age. The early school-age child of 6 or 7 years personifies death and sees it as horrible and frightening; this is consistent with the concrete thinking present at this age.
A nurse is teaching the parents of an infant with cerebral palsy how to provide optimal care. What should the nurse include in the teaching? 1 Focusing on cognitive rather than motor skills 2 Maintaining immobility of the limbs with splints 3 Preserving muscle tone to prevent joint contractures 4 Continuing to offer a special formula to limit gagging
(3) Children with cerebral palsy are especially prone to muscle tone disorders, including spasticity, which can lead to joint contractures. The therapy program must be balanced to promote progress in all areas of growth and development. Splinting of limbs is contraindicated because immobility promotes the development of joint contractures. Although these infants tend to gag and choke during feedings, a special formula is not necessary unless the child is allergic to dairy products.
A Girl Scout leader arrives at the hospital's emergency department with a 7-year-old child who may have a broken ankle. The history reveals that the child fell about 1 mile from the camp while on a hike with the scout leader and four other 7-year-olds. The nurse asks whether all of the other children are safely back in camp. Assuming that the scout leader acted appropriately, the nurse expects the scout leader to respond: 1 "I left the girls and brought the injured child to the hospital." 2 "I sent two of the girls back to camp and had them ask for help." 3 "I carried the injured girl and led the rest of the girls back to camp." 4 "I stayed with the injured girl and sent the four other girls back to camp for help."
(3) Having the other girls stay with the leader and injured girl provided adult supervision for all the children. Leaving the girls alone is unsafe; 7-year-olds should not be without supervision. Sending girls back to camp for help puts too much responsibility on children who are too young and who may get lost or hurt.
During a clinic visit a 4-year-old girl suddenly yells, "Don't sit on Erin!" The parent whispers that Erin is an imaginary friend. What is the nurse's best action? 1 Referring the parents to classes on parenting 2 Providing special instructions for appropriate discipline 3 Avoiding sitting where the child says her imaginary friend is located 4 Making a referral to a child psychologist regarding the imaginary friend
(3) Imaginary friends are typical of children of this age. Avoiding injury to the child's imaginary friend will result in less stress for the child. There is no evidence that the parents are having difficulty with child-rearing. Disciplining the child is inappropriate. The child was protecting an imaginary friend, and having imaginary friends is typical of a 4-year-old child. Referral to a specialist is unnecessary; this is typical behavior for a 4-year-old child.
A 13-year-old girl tells the nurse at the pediatric clinic that she took a pregnancy test and got a positive result. She confides that her grandfather, with whom she, her younger sisters, and her mother live, has repeatedly molested her for the past 3 years. When the nurse asks the girl whether she has told anyone else, she replies, "Yes, but my mother doesn't believe me." Legally, who should the nurse notify? 1 Police concerning a possible sex crime 2 Health care provider to confirm the pregnancy 3 Child protective services for immediate intervention 4 Girl's mother about the pregnancy test's positive result
(3) It is the nurse's legal responsibility to report child abuse to the appropriate agency. Safety is the priority, and child protective services will provide immediate intervention. Although the police may be notified, this is not the nurse's responsibility at this time. Notifying the health care provider may be done later, but it is not the priority. The girl's pregnancy has not been confirmed; at this time it is most important to protect her and her sisters.
A nurse is caring for an infant with Down syndrome. What does the nurse recall as the most common serious anomaly associated with this disorder? 1 Renal disease 2 Hepatic defects 3 Congenital heart disease 4 Endocrine gland malfunction
(3) Many children with Down syndrome have cardiac anomalies, most often ventricular septal defects, which can be life threatening. Renal disease, hepatic defects, and endocrine gland malfunction are not characteristic findings in children with Down syndrome.
While in the playroom a 7-year-old child exhibits twitching of the right arm and leg that progresses to a generalized tonic-clonic seizure. What is the nurse's initial action? 1 Taking other children to their rooms 2 Inserting an airway into the child's mouth 3 Moving toys and furniture away from the child 4 Positioning the child on the back and place a pillow under the head
(3) Safety is the priority during the seizure. The child should not be touched except to maintain safety; removing objects that may cause harm to the child is the priority. It is unsafe to leave the child having the seizure. Trying to open clenched jaws during a seizure may result in injury to the child's teeth and jaw. The supine position may prevent the drainage of secretions; a pillow may cause airway occlusion by flexing the neck.
A parent receives a note from school reporting that a student in class has head lice. The parent calls the school nurse to ask how to check for head lice. What instruction should the nurse provide? 1 "Ask the child where it itches." 2 "Check to see whether your dog has ear mites." 3 "Look at your child's head, along the scalp line, for white dots." 4 "Inspect your child's hands and look between the fingers for red lines."
(3) The white dots are nits, the eggs of head lice (Pediculosis capitis); they can be seen on the shaft of hair along the scalp line, behind the ears, and at the nape of the neck. Asking the child where it itches is too vague; objective visualization will confirm the presence of nits. Canine ear mites are not transferable to humans. Red lines between the fingers are a sign of scabies, infestation with the Sarcoptes scabiei mite.
An 11-year-old child has gained weight. The mother tells the nurse that she is concerned that her child, who loves sports, may become obese. What is the most appropriate response by the nurse? 1 Suggesting an increase in activity 2 Encouraging a decreased caloric intake 3 Explaining that this is expected during preadolescence 4 Discussing the influence of genetics on the child's weight gain
(3) There may be weight gain caused by the influence of hormones before the growth spurt. Most 10- to 12-year-old children can eat an adult-sized meal without becoming obese, especially if they are active. Before advising increased activity, the nurse should assess the child's current activity level. An adequate caloric intake is needed for the growth spurt that will occur during adolescence. Family eating patterns appear to have more effect on weight than do genetics.
A nurse is caring for a first-grader receiving prednisone (Meticorten). What outcome does the nurse expect with adrenocorticosteroid therapy? 1 Accelerated wound healing 2 Development of hyperkalemia 3 Increased antibody production 4 Suppressed inflammatory process
(4) Because of the suppression of the inflammatory process, the nurse must be alert to the subtle symptoms of infection, such as changes in appetite, sleep patterns, and behavior. Adrenocorticosteroid therapy delays, not accelerates, wound healing. Adrenocorticosteroid therapy may cause hypokalemia, not hyperkalemia, because of the accompanying retention of sodium and fluid. Adrenocorticosteroid therapy decreases, not increases, the production of antibodies.
An infant with a diaphragmatic hernia undergoes corrective surgery. What nursing assessment indicates that the infant's respiratory condition has improved? 1 Cessation of crying 2 Retention of 1 oz of formula 3 Reduction of arterial blood pH to 7.31 4 Auscultation of breath sounds bilaterally
(4) Bilateral breath sounds indicate that the lungs are expanded and functioning. Lack of crying is not a reliable indicator that the respiratory status is improving; it may indicate that the infant is hypoxic and too fatigued to cry. The expected pH is 7.35 to 7.45; a decreasing pH indicates respiratory acidosis, which can be attributed to decreased gas exchange. Retention of formula is unrelated to gas exchange.
The nurse is caring for a 6-year-old child admitted from the emergency department after an acute asthma attack. The child has a new order for fluticasone (Flovent). What instructions must the family be given about this drug before the child's discharge? 1 Flovent needs to be taken with food or milk. 2 Flovent is primarily used to treat acute asthma attacks. 3 The child should suck on hard candy to help relieve dry mouth. 4 Watch for white patches in the mouth and report them to the primary care provider.
(4) Fluticasone (Flovent) is a steroid commonly administered by way of inhalation for long-term control of asthma symptoms. Oral thrush is a side effect that manifests as white patches. Flovent is administered via inhalation so food or milk is not needed prior to administration. Dry mouth is not a side effect of Flovent.
A nurse instructs the parents of an adolescent with asthma how to reduce the allergens in the child's bedroom. The mother tells the nurse what she plans to do to make the room hypoallergenic. Which idea indicates that further teaching is needed? 1 Removing a stuffed animal collection 2 Storing off-season clothing in another room 3 Covering the mattress with a plastic slipcover 4 Using flat outdoor carpeting to cover hardwood floors
(4) Hardwood floors can be cleaned more easily than rugs can and are more hypoallergenic than outdoor carpeting. Stuffed toys are often sources of dust and mold. Out-of-season clothing harbors dust and should not be stored in the allergic child's room. Using a plastic slipcover reduces the child's exposure to dust generated by the mattress.
A 4-year-old child is admitted to the pediatric unit with a diagnosis of Wilms tumor. Considering the unique needs of a child with this diagnosis, the nurse should place a sign on the child's bed that states: 1 Keep NPO. 2 No IV medications. 3 Record intake and output. 4 Do not palpate the abdomen.
(4) Palpation increases the risk of tumor rupture and is contraindicated. There are no data to indicate that surgery is scheduled; therefore there is no reason to maintain nothing-by-mouth (NPO) status. There is no contraindication to intravenous medication. Recording of intake and output may or may not be instituted; it is not specific to children with Wilms tumor.
An adolescent child with sickle cell anemia is admitted to the pediatric unit during a vaso-occlusive crisis. What does the nurse identify as the reason that the crisis occurred? 1 Severe depression of the circulating thrombocytes 2 Diminished red blood cell (RBC) production by the bone marrow 3 Pooling of blood in the spleen with splenomegaly as a consequence 4 Blockage of small blood vessels as a result of clumping of RBCs
(4) The red blood cells in sickle cell anemia are fragile. When hypoxia or dehydration occurs, the cells take on a crescent shape; they then clump together and occlude blood vessels. The platelet count is not severely depressed in vaso-occlusive crisis. Diminished RBC production by the bone marrow is an aplastic crisis resulting in severe anemia. Pooling of blood in the spleen that results in splenomegaly is known as a splenic sequestration crisis.
A 7-year-old child with juvenile idiopathic arthritis has difficulty getting ready for school in the morning because of joint pain and stiffness. Which recommendation should the nurse make to the family? 1 Administer acetaminophen before bedtime. 2 Ice the joints that are painful in the evening. 3 Encourage a program of active exercise after awakening. 4 Provide warm, moist heat to the affected joints before arising.
(4) Warm, moist heat will reduce inflammation and pain and thus promote mobility. Acetaminophen administered at night will not decrease pain the following morning. Ice will not be beneficial, regardless when it is administered. Gentle stretching, not active exercise, should be employed.