PEDS CHAPTER 29 (PREP'U LEVEL 8)
The nurse is providing care to a 5-year-old child brought to the emergency department with a cat bite wound on the arm. While teaching the parents how to care for the wound, the child's mother asks the nurse, "Why isn't the bite being stitched closed?" Which response by the nurse would be appropriate? "Bites from cats are likely to become infected, so it is better to leave the wound open and heal from the inside out." "It is too early to close the wound with stitches now, but it can be done in a week or two." "Your child needs to be seen by a plastic surgeon first before the wound is closed." "Your child needs a tetanus vaccine before a wound of this type can be stitched closed."
"Bites from cats are likely to become infected, so it is better to leave the wound open and heal from the inside out." Explanation: Cat bite wounds are more likely to become infected because of the nature of the puncture wound. Cat bite wounds are left open to heal by secondary intention because of the high rate of infections associated with these types of bites. Saying that it is too early to close the wound or that the child needs to be seen by a plastic surgeon or have a tetanus vaccine is inappropriate.
The parent of a child with deep partial-thickness (second-degree) burns on the legs asks the nurse, "One of the staff told me that the dressings being used have silver in them. Why is that?" Which response by the nurse would be most appropriate? "Silver is used to help prevent any scarring." "Dressings containing silver help prevent infection." "Silver has been shown to speed up the healing process." "Silver helps repair nerve endings that were damaged."
"Dressings containing silver help prevent infection." Explanation: Dressings impregnated with silver have been shown to prevent infection. They are not associated with preventing scarring, speed up healing, or repair injured nerve endings.
The nurse is teaching the parents of an 8-year-old child diagnosed with folliculitis on both arms about caring for their child. The nurse determines that additional teaching is needed based on which statement by the parents? "We can apply a steroid cream to the area to help with the itching." "We need to wash the area with warm soap and water to keep it clean." "We should apply warm compresses to the area several times a day." "We should call our health care provider if the lesions get bigger in size."
"We can apply a steroid cream to the area to help with the itching." Explanation: Folliculitis is self-limiting but is often treated with topical antibiotics. However, the lesions generally do not cause pain or pruritus. Therefore, there is no need to apply steroid creams. The parents should wash the affected area with soap and warm water and apply warm compresses several times a day. The parents should also notify their health care provider if the lesions get bigger rather than smaller, feel warm to the touch, or have drainage.
A child is diagnosed with varicella zoster and has been prescribed acyclovir 15 mg/kg q 8 hours IV. The child weighs 61.7 lb (28 kg). How many milligrams should the nurse administer in each dose? Record your answer using a whole number.
420 Explanation: The nurse will use the client's weight in kilograms, multiplying it by the prescribed dosage. 28 kg x 15 mg/kg = 420 mg in each 8-hour dose
A child weighing 66 lb (30 kg) with deep partial thickness burns is receiving fluid resuscitation. The nurse is monitoring the child's urine output via Foley catheter every hour and documenting the findings on the flowsheet above. The nurse would notify the health care provider about which urine output? 60 ml 56 ml 72 ml 80 ml
56 ml Explanation: It is important to maintain adequate fluid volume in a child with burns. The nurse would monitor urine output via a Foley catheter, and notify the health care provider if output is less than 2 ml/kg/h. The child weighs 66 lb (30 kg). So an adequate hourly urine output for this child would be 60 ml/hr. Therefore, the nurse would notify the health care provider about a urine output of 56 ml.
The nurse is preparing to administer acyclovir intravenously to a child with varicella infection who is immunocompromised. The nurse correctly administers the medication over which time frame? 15 minutes 30 minutes 45 minutes 60 minutes
60 minutes Explanation: When acyclovir is given intravenously to a immunocompromised child with varicella, the nurse would administer the medication over a period of 1 hour.
A nurse is providing care to an infant who is admitted with burns over the face, neck and chest. The nurse identifies which goal as priority for planning the infant's care? Airway remains patent. Pain is at a tolerable level. Wounds remain infection-free. Fluid balance is maintained.
Airway remains patent. Explanation: The priority goal is to maintain a patent airway especially because the burns affect the face and neck. Adequate output, maintaining pain at a tolerable level, and keeping the burns free from infection are all appropriate goals for this infant, but maintaining a patent airway is the priority.
A child is hospitalized with a diagnosis of severe cellulitis. The nurse is preparing the family for discharge. Which instruction is most important for the nurse to convey to the family? Keep follow-up appointments. Perform proper hand hygiene. Complete the prescribed antibiotics. Monitor for signs of worsening condition.
Complete the prescribed antibiotics. Explanation: The instruction that is most important for the nurse to convey is to complete the prescribed course of antibiotics. Many times, once the child feels better, the parent stops the medication; this action, though, can cause a rebound infection. Instructing the family to keep follow-up appointments, perform good hand hygiene, and look out for signs of worsening condition are all appropriate, but the most important instruction is to make sure the child completes the course of antibiotics.
The nurse is preparing to perform a dressing change for a 9-year-old child with a severe burn injury. What nonpharmacologic intervention(s) will the nurse perform to decrease pain and discomfort for the child? Select all that apply. Allow the child to choose means of distraction. Provide positive feedback. Allow the child to choose where on the body to start procedure. Avoid speaking during the dressing change. Encourage the child to ignore the procedure.
Allow the child to choose means of distraction. Provide positive feedback. Allow the child to choose where on the body to start procedure. Explanation: The nurse will allow the child to choose a means of distraction such as listening to music or watching television. Positive feedback during the procedure creates a therapeutic environment. The nurse will also allow the child to choose where on the body to start the procedure, because this encourages the child to be involved in the process. Avoiding speaking and encouraging the child to ignore the procedure do not encourage the child's involvement during the procedure.
The nurse is teaching the parents of a 7-year-old child on preventing integumentary disorders. What will the nurse include in the teaching? Select all that apply. Apply sunscreen to your child. Teach your child to recognize and avoid poison oak. Teach your child to not approach strange pets without permission. Learn to identify infestations such as lice, scabies, and bed bugs. Avoid using insect spray on your child.
Apply sunscreen to your child. Teach your child to recognize and avoid poison oak. Teach your child to not approach strange pets without permission. Learn to identify infestations such as lice, scabies, and bed bugs. Explanation: The nurse should teach the parents to have their child apply sunscreen, recognize and avoid poison oak, and avoid approaching strange pets without permission. The parents should learn to identify infestations such as lice, scabies, and bed bugs. The parents should use insect spray because of its importance for preventing insect stings.
The nurse is caring for an 11-year-old child with a primary open skin lesion. What action(s) will the nurse include in the plan of care to prevent infection in the child? Select all that apply. Assess for increased warmth around the wound. Teach hand hygiene to the child and parents. Advise the child not to scratch the affected area. Teach the child and parents to keep the lesion uncovered. Assess for hypopigmentation.
Assess for increased warmth around the wound. Teach hand hygiene to the child and parents. Advise the child not to scratch the affected area. Explanation: The nurse will assess for increased warmth around the wound, which is a sign of infection. Teaching hand hygiene to the child and parents is a preventative measure against secondary infection. The nurse will advise the child not to scratch the affected area. An open skin lesion should be kept covered, if possible. The nurse should assess for erythema, which is a sign of infection, not hypopigmentation.
A school nurse has discovered that one of the children has acquired a case of head lice. The school principal asks the nurse to write a letter that will be sent to parents explaining about head lice and measures to prevent infestation. What information is important for the nurse to include in the letter? Select all that apply. Head lice infestation is the result of poor personal hygiene. Children should avoid sharing personal items such as combs and hats. Parents should inspect their child's head for nits with a fine tooth comb. Any medicated shampoo may be used to treat head lice. A second treatment one week after the first is recommended.
Children should avoid sharing personal items such as combs and hats. Parents should inspect their child's head for nits with a fine-tooth A second treatment one week after the first is recommended. Explanation: To prevent head lice infestation children should avoid sharing personal items such as barrettes, combs, and hats. Parents should also wash and dry clothes, bedding, and hats using high temperatures. Vacuuming soft surfaces that cannot be laundered (sofas and chairs) is also helpful. Parents should inspect their child's head daily with a fine tooth comb for nits (lice eggs) after treatment. A second treatment is often necessary 1 week to 10 days after the first. A head lice infestation can happen to any child and is not a reflection of poor hygiene or socioeconomic status. Shampoos with specific medications are necessary to treat head lice (permethrin).
A parent is observing a nurse provide care for the parent's 2-year-old toddler who was burned in a house fire. When the nurse is finished, the parent tells the nurse "I cannot believe this has happened. I should have been able to prevent this from happening." What is the best action for the nurse to take? Give the parent a hug. .Tell the parent to be thankful that the child is alive. Encourage the parent to talk more about feelings. Tell the parent he or she could not have prevented the fire
Encourage the parent to talk more about feelings. Explanation: The best action for the nurse to take is to encourage the parent to talk about his or her feelings. This gives the parent the opportunity to share feelings and concerns. Giving the parent a spontaneous hug may not be welcomed. Telling the parent he or she could not have prevented the fire or to be thankful that the child is alive is not therapeutic and negates the parent's feelings.
A 30-month-old child has been discharged from the hospital after receiving treatment for second-degree (partial-thickness) burns over 6% of the body. One week later, the parent calls the nurse to say that the child has been drinking from a cup for one year, but is now constantly pulling at the mother's breast trying to nurse and refuses to drink from a cup. What is the best way for the nurse respond? Make an appointment for the parent to bring the child to the clinic for evaluation. Explain that children who have had a serious injury sometimes exhibit regressive behavior. Tell the parent to allow the child to nurse as much as the child wants. Encourage the parent to explain to the child that he or she must drink from the cup.
Explain that children who have had a serious injury sometimes exhibit regressive behavior. Explanation: The best response is for the nurse to explain that children recovering from serious injuries such as burns will often regress in their behaviors. There is no indication for the parent to bring the child to the clinic for evaluation. It is inappropriate to tell the parent to allow the child to nurse as much as he or she wants. If the child has been weaned for one year, the mother likely has no breast milk. At 30 months, the child may not understand fully that he or she cannot nurse any longer. The parent can be supportive to the child, comforting the child with hugs and cuddling, and reinforcing the desired behavior.
The appearance of which hallmark clinical manifestation occurs in measles? Conjunctivitis Koplik spots Fever Cough
Koplik spots Explanation: The hallmark symptom of measles is the appearance of Koplik spots. These occur a few days before the outbreak of the rash. They are classic in appearance, described as a red ring around white dots. They occur on the buccal mucosa generally around the first and second molars. Measles has fever, conjunctivitis, and a cough as prodromal symptoms, but these are not definitive for measles as they can occur with many other illnesses.
When describing measles to a local parent group, the nurse explains that which of the following is the hallmark clinical manifestation? Koplik spots conjunctivitis fever cough
Koplik spots Explanation: The hallmark of measles is the appearance of Koplik spots. Other typical symptoms include fever, conjunctivitis, and a cough.
A nursing instructor is describing the progression of signs and symptoms associated with varicella from earliest to latest. Place the signs and symptoms below in the sequence that the instructor would describe them.
Low-grade fever Macular rash Papular rash Vesicle formation Crusting Explanation: The disease is marked by a low-grade fever, malaise, and, in 24 hours, the appearance of a rash. The lesion begins as a macula, then progresses rapidly within 6 to 8 hours to a papule, then to a vesicle that first becomes umbilicated and then forms a crust.
A 7-year-old child with an earache comes to the clinic. The child's parent reports that 1 day ago the child had a fever and headache and did not want to play. When the nurse asks where it hurts, the child points to the jawline in front of the earlobe. What does the nurse expect the diagnosis will be for this child? Measles Mumps Mononucleosis Fifth disease
Mumps Explanation: Mumps begins with a fever, headache, anorexia, and malaise. Within 24 hours an earache occurs. When pointing to the site of pain, however, the child points to the jawline just in front of the earlobe. Mumps is contagious 1 to 7 days prior to the onset of symptoms and 4 to 9 days after the parotid swelling begins. Fifth disease is also known as the "slapping disease," as the rash on the cheeks look like someone slapped the child's face. Measles does not involve parotid swelling or earaches. Mononucleosis does involve swollen lymph nodes but they are in the neck and the axillary area.
An adolescent is brought to the urgent care clinic for evaluation of the hands. The adolescent had been out snowboarding for the past several hours in 20°F (-6.7°C) temperatures. The adolescent was wearing gloves but took them off because they were wet and causing problems with holding onto the snowboard. The nurse completes an assessment and documents the findings. Based on the assessment findings above, which action would be appropriate as part of the plan of care? Contact a plastic surgeon to debride the skin. Place the hands in warm water for 30 minutes. Massage both hands vigorously for 5 minutes. Notify the health care provider if the hands become red.
Place the hands in warm water for 30 minutes. Explanation: The key to treating second-degree frostbite is to rewarm the affected area. Rewarming is accomplished by placing the affected areas in warm water at a temperature of 98.6°F (37°C) to 102.2°F (39°C) for at least 30 minutes. Wound care specialists and plastic surgeons would be involved with more severe (third-degree) frostbite. Massaging should be avoided because it can cause tissue damage. As the area is rewarmed, the color of the skin typically appears red to purple.
The nurse is caring for a 6-year-old child with contact dermatitis. What action(s) will the nurse include in the plan of care? Select all that apply. Teach the parents to have the child wear loose clothing. Administer oral antihistamines as prescribed. Provide the child with activities to distract from discomfort. Apply moisturizers when the skin is dry. Cleanse the area with lavender oil-infused soap.
Teach the parents to have the child wear loose clothing. Administer oral antihistamines as prescribed. Provide the child with activities to distract from discomfort. Explanation: The nurse will teach the parents to have the child wear loose clothing to minimize sweating and promote air circulation, administer oral antihistamines as prescribed, and provide the child with activities to distract from the discomfort. Moisturizers should be applied while the skin is still damp. The child should avoid moisturizers and soaps that contain fragrances, dyes, or alcohol.
A young girl arrives at the emergency room after being bitten by a neighbor's dog. The mother is concerned her daughter will get rabies. The nurse carefully examines and treats the bite and questions the mother and daughter about the details surrounding the dog biting her. What information would most strongly indicate a risk for rabies infection in this client? The dog was unprovoked when he bit the girl The dog was properly immunized for rabies There have been no other reported instances in the area The dog belonged to a neighbor
The dog was unprovoked when he bit the girl Explanation: An unprovoked attack is much more suggestive that the animal is rabid, rather than if the bite happens during a provoked attack. The dog being immunized for rabies and there being no other reported instances of rabies in the area would indicate a lower risk that the dog was rabid. The fact that the dog belonged to a neighbor does not necessarily indicate a lower risk for rabies infection.
The nurse is caring for a 2-year-old child with nonbullous impetigo. Which outcome(s) indicates the plan of care has been effective for the child? Select all that apply. The presence of lesions has decreased over about 11 days. No secondary infections of primary lesions have occurred. Infection did not spread to family members. Parotid swelling has resolved. Pain is at an acceptable level for the child.
The presence of lesions has decreased over about 11 days. No secondary infections of primary lesions have occurred. Infection did not spread to family members. Explanation: The presence of lesions decreasing over 10 to 14 days, no secondary infections of primary lesions, and infection not spreading to family members are all outcomes that indicate the plan of care has been successful for the child. Parotid swelling occurs in mumps, not impetigo. The lesions caused by impetigo are typically not painful.
The nurse is administering a chickenpox vaccination to a 12-month-old girl. Which concern is unique to varicella? This disease can reactivate years later and cause shingles. Vitamin A is indicated for children younger than 2 years. Dehydration is caused by mouth lesions. Children with this disease need to avoid pregnant women.
This disease can reactivate years later and cause shingles. Explanation: Varicella zoster results in a lifelong latent infection. It can reactivate later in life resulting in shingles. The American Academy of Pediatrics recommends consideration of vitamin A supplementation in children 6 months to 2 years hospitalized for measles. Dehydration caused by mouth lesions is a concern with foot and mouth disease. Avoiding exposure to pregnant women is a concern with rubella, rubeola, and erythema infectiosum.
An 11-year-old child is brought to the health center for evaluation of a rash. The child's parents report that the rash, located on both arms and trunk, suddenly appeared yesterday. After further assessment, the nurse suspects erythema multiforme based on which finding? bull's-eye appearance of the lesions honey-crusted plaques with small vesicles small pustules at the base of hair follicles reddened, painful swollen subcutaneous tissue
bull's-eye appearance of the lesions Explanation: Erythema multiforme appears as an abrupt onset of lesions symmetrically distributed across the upper extremities, trunk, and, possibly, the oral mucosa. The lesions are characteristically doughnut-shaped. Papules have an erythematous border with a central clearing, giving the appearance of a target or a bull's-eye. Impetigo is characterized by small vesicles that develop into plaques with a honey-crusted appearance. Folliculitis is characterized by small pustules located at the base of hair follicles. Cellulitis is characterized by inflammation and infection of the subcutaneous tissue that is warm to the touch, edematous, and painful.
When providing care for a child with herpes zoster (shingles), the parents ask the nurse how the child contracted this infectious disorder. Which response by the nurse is most appropriate? "Your child must have been exposed to someone with herpes zoster." "Herpes zoster is a reactivation of a previous varicella zoster infection." "Children who are immunocompromised are more likely to contract shingles." "Handwashing is an effective way to prevent the spread of infectious disorders."
"Herpes zoster is a reactivation of a previous varicella zoster infection." Explanation: Herpes zoster (shingles) is reactivation of the latent varicella zoster (chickenpox) infection that occurs during times of immunosuppression and aging. Although it is possible to contract the varicella zoster virus from a person with herpes zoster or varicella zoster, a child diagnosed with herpes zoster has already been exposed to varicella zoster. Handwashing will not directly prevent herpes zoster.
A 4-year-old is brought to the urgent care center for evaluation of a burn on the forearm. On inspection, the burn is minor. After teaching the parents about how to care for this minor burn. the nurse determines that the teaching was successful based on which statement by the parents? "We should apply ice to the burned area every few hours." "If blisters form, we should leave them alone and not break them." "We should wrap the area tightly with a compression bandage." "After bathing, we should dry the skin vigorously with a towel."
"If blisters form, we should leave them alone and not break them." Explanation: When caring for a minor burn, the parents should run cold water over the area but not apply ice. The parents should also leave any blisters that form intact. Tight clothing or wraps over the affected area should be avoided. Parents should pat the area dry, not rub it vigorously after bathing.
The nurse is caring for a 6-year-old boy with mumps. Which of the following statements by the child would cause the nurse to suspect the boy is experiencing a complication of mumps? "Please talk a little louder." "My knees are sore and stiff." "I feel wobbly when I walk." "I keep coughing up mucus."
"Please talk a little louder." Explanation: Complications of mumps include meningoencephalitis with seizures and auditory neuritis, which can result in deafness. Joint complaints, which might suggest arthritis, are a complication of erythema infectiosum. Difficulty walking, which might suggest cerebellar ataxia, is a complication of chickenpox. Coughing, which might suggest bronchopneumonia, is a complication of rubeola.
A new parent brings the 3-month-old infant to the clinic for a well-baby check up. During the visit, the parent asks the nurse, "I know the rays from the sun can be harmful, so what should I do to protect my infant?" Which suggestion by the nurse would be most appropriate? "The best thing to do is keep any infant under the age of 6 months out of the sun." "As long as you use a sunscreen, your infant will be protected from the sun." "Invest in clothing that has sun protective factor (SPF) already in the material." "A wide-brimmed hat and an umbrella for shade should be enough for your infant."
"The best thing to do is keep any infant under the age of 6 months out of the sun." Explanation: For infants under the age of 6 months, it is best to keep them out of the sun to reduce their risk of exposure to the sun's damaging rays. Sunscreen should be applied sparingly in infants younger than 6 months. As the infant gets older, he or she should have sunscreen of at least 15 SPF applied to all exposed areas and have it reapplied every 2 hours or after swimming or sweating. Clothing with SPF built in, a wide-brimmed hat, and umbrellas for shade are appropriate once the infant is over the age of 6 months.
The nurse is teaching the parents of a child diagnosed with erythema multiforme about the condition. The nurse determines that the teaching was successful based on which statement by the parents? "The rash should go away in about 2 weeks." "After this one episode, our child will not have it again." "The sulfa drug our child was taking caused this rash." "We need to have our child avoid exposure to nickel."
"The rash should go away in about 2 weeks." Explanation: Parents need to know that the lesions should resolve within 2 weeks. However, some children do develop recurrent erythema multiforme. The most common cause of this condition is infection with the herpes simplex virus, with fewer than 10% of cases being drug related. Stevens-Johnson syndrome is often related to the use of sulfa drugs. Contact dermatitis, specifically nickel contact dermatitis, is caused by exposure to nickel.
Skin inspection reveals linear lesions on both legs, below the knees, numerous reddened macules, and pustules in a linear fashion on the anterior and lateral aspects of the lower legs. The child reports intenese pruritus. The nurse is inspecting the skin of a child with a rash on the lower legs and documents the above findings. Based on the findings, which question would the nurse most likely ask next? "Was your child outside near some plants that could be poison ivy?" "Did you recently change your detergent for washing your clothes?" "What type of soap does your child use to wash the skin?" "Is there any metal in your child's clothing that is near the lower legs?"
"Was your child outside near some plants that could be poison ivy?" Explanation: The rash described in the documentation (linear patter with pustules and erythema) suggest allergic dermatitis associated with exposure to plants such as poison ivy. Therefore, the next question should focus on possible exposure to the plant oils. The questions about detergent or soaps would be appropriate if the rash suggested irritant dermatitis as demonstrated by a more diffuse pattern. Asking about metal in the child's clothing would be appropriate if the rash suggested nickel dermatitis, which would be typically found at the navel, belt line, or earlobes.
The nurse is teaching the parents of a 5-year-old child diagnosed with head lice about using permethrin. The nurse determines that the teaching was successful based on which statement by the parents? "We need to leave the medication on for about 10 minutes before rinsing it off." "We should apply the medication to our child's hair and scalp when it is dry." "One application of the medication should be enough to get rid of the lice." "If we use the medicine, we will not have to use the special comb for the nits."
"We need to leave the medication on for about 10 minutes before rinsing it off." Explanation: Treatment of head lice begins with pediculicidal agents. Permethrin is the treatment of choice and is an over-the-counter drug. The parents should wash the child's hair before applying the medication, apply the medication to wet hair, leaving it on for 10 minutes before rinsing. One treatment is often not sufficient, and the treatment should be repeated in 7 days. Permethrin kills the live adult head lice but is not ovicidal, meaning that it does not kill the nits. Nits should be removed from wet hair with a specialized nit comb. Malathion is used for head lice infestations that do not respond to permethrin. This medication is applied to dry hair and scalp and left on overnight. Nit removal is still needed when this medication is used.
The nursing is caring for a hospitalized child diagnosed with varicella-zoster virus. The child's parents ask how to prevent the child's siblings from contracting the virus. Which response by the nurse is best? "Vaccinating your other children is the only way to prevent them from contracting the virus." "Since this is a virus, there is nothing you can do to prevent your other children from getting it." "We will place your child on contact and airborne precautions. It is best for the other children not to visit." "As long as your other children wash their hands, they should not contract the virus."
"We will place your child on contact and airborne precautions. It is best for the other children not to visit." Explanation: The causative agent for chickenpox is the varicella-zoster virus, which is spread through contact and airborne methods. The client should be placed on precautions and limit visitors who are at risk. Vaccinating is the best way to prevent the spread of varicella; however, it is not the only way. Preventing exposure will work as well. Stating there is nothing that can be done is incorrect. Handwashing is not effective against varicella.
A parent brings a child to the emergency department and states "Our neighbor's dog just bit my child!" The nurse interviews the parent as the child receives treatment. Which question(s) should the nurse ask to assist with the child's care? Select all that apply. "Were the authorities notified of the incident?" "What kind of dog bit your child?" "Are your child's immunizations up to date? "Did your child provoke the dog?" "Do you know if the dog has had its shots?"
"What kind of dog bit your child?" "Are your child's immunizations up to date? "Did your child provoke the dog?" "Do you know if the dog has had its shots?" Explanation: To provide the child the best care, it is important to know the type of dog and whether the dog is up to date on its immunizations, particularly rabies. It is also important to determine if the dog was provoked or if the attack was unprovoked. If unprovoked, this may indicate the dog was ill. It is also important to know whether the child's immunizations are up to date. This will inform whether the child needs a tetanus shot. Lastly, it is appropriate to determine if the authorities were notified, but this is not the priority as related to the child's care.
Head lice infestations have occurred in several of the elementary schools in the surrounding area. The local school district has asked the nurse to conduct a presentation for parents at the community center about this condition. When preparing this presentation, which information is appropriate for the nurse to include? Select all that apply. Head lice is most often occurs from a lack of hygiene. Head lice is mainly spread through play. Head lice can happen in anyone. It is easier to remove nits from wet hair. The child's bed linens should be washed in cold water.
Head lice is mainly spread through play. Head lice can happen in anyone. It is easier to remove nits from wet hair. Explanation: There is a stigma associated with head lice because many people may associate it with uncleanliness. Parents and children need to know that head lice can happen to anyone and there is nothing wrong with them. Head lice infestation is spread through head-to-head contact, mainly through play. However, sharing hairbrushes, combs, hats, and towels contributes to the spread of lice, particularly in the summer months. Medication can be used to treat head lice, but parents must go through the child's hair nightly with a nit comb to remove the nits. It is easier to see and remove the nits if the child's hair is wet. Parents also need to wash the child's sheets and pillows in hot water.
A nurse is conducting a parenting class on infant skin care. What information should the nurse include when preparing materials on the characteristics of the skin of infants? Select all that apply. It is thinner and more fragile than an adult's Substances are easily absorbed. Skin is less susceptible to the sun. The epidermis is thicker than in adults. Sweat glands are fully functioning at birth.
It is thinner and more fragile than an adult's Substances are easily absorbed. Explanation: An infant's skin is more fragile than that of adult's and is more susceptible to breakdown as well as the effects of the sun. The epidermis of an infant's skin is much thinner than an adult's and does not reach the thickness of adult skin until late adolescence. Sweat glands are immature at birth, contributing to the difficulty infants have in regulating temperature. Sweat glands do mature as the infant grows.
The nurse is performing an assessment on a child with mumps. What action(s) does the nurse include in the assessment? Select all that apply. Obtain a history of the illness and immunizations. Inquire about exposure and close contacts. Ask about pain. Inspect the jaw for parotid swelling. Assess for Koplik spots.
Obtain a history of the illness and immunizations. Inquire about exposure and close contacts. Ask about pain. Inspect the jaw for parotid swelling. Explanation: The nurse will obtain a history of the illness and immunization, inquire about exposure and close contacts, ask about pain, and inspect the jaw for parotid swelling in the assessment of a child with mumps. Koplik spots are a sign of infection with measles, not mumps.
The nurse is providing care to a 6-year-old child who was stung by a honey bee. Inspection reveals that the stinger is still present. Which action by the nurse would be appropriate? Remove the stinger by scraping the skin. Pinch the skin to cause the stinger to fall out. Apply a cold compress over the stinger to loosen it. Use a paste of baking soda to soften the stinger.
Remove the stinger by scraping the skin. Explanation: If the stinger is still present, the nurse should remove it by scraping the skin. Pinching the skin should be avoided because it may release more venom from the stinger. Cold compresses are used for pain relief, not to loosen the stinger. Meat tenderizer or a baking soda paste may also be applied to promote comfort, not to soften the stinger for removal.
What is a true statement regarding varicella zoster virus infection? Secondary bacterial infections of the skin can occur. The incubation period is 7 days. It is transmitted by fecal-oral route. It tends to be more severe in children.
Secondary bacterial infections of the skin can occur. Explanation: Varicella zoster virus infection carries with it the complication of a secondary bacterial infection of the skin. The lesions are intensely pruritic, making the child want to scratch the lesions and opening them to a variety of organisms to invade. The incubation period is 10 to 21 days. It is transmitted by direct contact with the vesicles and by airborne route. It tends to be more severe in adolescents and adults.
The nurse is conducting a presentation for a group of parents at the local pediatric community health center. The nurse is describing the importance of immunizations to prevent common viral infections such as rubeola and rubella. As part of the presentation, the nurse describes the development of rubeola and explains the progression of signs and symptoms. Place the signs and symptoms listed below in the order that the nurse would describe them. Use all options.
fever rash Koplik spots desquamation Explanation: Children initially present in the prodromal, or early symptom, phase. During this phase, children experience mild fever, conjunctivitis, coryza, and cough. Koplik spots, which are clustered white lesions, may or may not be apparent on the oral mucosa at the time of presentation. However, Koplik spots appear within 4 days of the rash onset. Fever is highest 1 to 2 days before the appearance of the rash. The rash is maculopapular, beginning at the head and progressing down the trunk and upper extremities. After 5 days, the rash begins to fade, leading to desquamation.
The nurse is assessing a 10-year-old child with severe burn injuries for signs of sepsis. Which finding(s) will the nurse report to the health care provider immediately? Select all that apply. lethargy capillary refill greater than 3 seconds decreased level of consciousness bounding pulses increased bowel sounds
lethargy capillary refill greater than 3 seconds decreased level of consciousness Explanation: The nurse will report lethargy, capillary refill of greater than 3 seconds, and decreased level of consciousness to the health care provider immediately. Diminished pulses, not bounding pulses, are considered a sign of sepsis. Similarly, decreased bowel sounds, not increased bowel sounds, are a sign of sepsis.
The nurse is caring for a child presenting with plaques around the nose and mouth that have a honey-crusted appearance. What treatment does the nurse anticipate for the child? topical mupirocin for 10 to 14 days acyclovir for 5 to 7 days one application of permethrin, then repeat application in 7 days one application of malathion left on overnight
topical mupirocin for 10 to 14 days Explanation: The nurse will anticipate topical mupirocin therapy for 10 to 14 days in the child presenting with plaques around the nose and mouth that have a honey-crusted appearance. These findings are consistent with nonbullous impetigo. Acyclovir is indicated for children with herpes zoster, and permethrin and malathion are indicated for children with head lice.
5-year-old presents with fever (100.2) and fever. Parents report temperature rose to 101 about 24hrs before the rash was seen. Nasal mucosa inflamed with clear discharge. Cunjuctiva reddened with nonpurulent drainage. Maculopapular rash noted on the head and extending to the trunk and upper extremities. Clusters of white lesions with erythematous base apparent on buccal mucosa. A 5-year-old child is brought to the pediatric health clinic for evaluation. The nurse completes the assessment and documents the findings. Based on the assessment findings above, which condition would the nurse suspect? measles rubella varicella cellulitis
measles Explanation: The assessment findings suggest measles (rubeola). Children initially present in the prodromal, or early symptom, phase. During this phase, children experience mild fever, conjunctivitis, coryza, and cough. Conjunctival drainage is nonpurulent. Koplik spots, which are clustered white lesions, may or may not be apparent on the oral mucosa at the time of presentation. However, Koplik spots appear within 4 days of the rash onset. Fever is highest 1 to 2 days before the appearance of the rash. The rash is maculopapular, beginning at the head and progressing down the trunk and upper extremities. Rubella is characterized by a prodromal period consisting of fever, malaise, headache, sore throat, and red eyes. The rash begins on the face and neck as irregular macules. The rash on the face disappears as it spreads to the trunk and lasts no longer than 3 days. Varicella is characterized by prodromal symptoms including fever, malaise, and headache for 24 to 48 hours before the eruption of lesions. Skin lesions appear in various stages. New lesions appear as old ones scab over. The lesion begins as an erythematous macule and progresses to a pustule and finally a clear fluid-filled vesicle. The rash is severely pruritic. Children with cellulitis often have fever, chills, and lymphadenopathy. Infected areas are erythematous and warm to the touch and may be edematous and painful. There is no rash with cellulitis
A nurse is preparing a presentation for a group of parents of toddlers at the local community center. The topic of the presentation is burn prevention. When describing burns in toddlers, which situation would the nurse likely identify as the most common cause of thermal burns? scalding from pulling a hot pan off the stove touching an open, hot oven door playing unsupervised with matches playing with a household cleaning agent container
scalding from pulling a hot pan off the stove Explanation: The most common type of thermal burns during the toddler years is scalding burns, which typically result from a child pulling a hot pan off of a stove or being immersed in bathwater that is too hot. Although less common, hot objects, such as irons, flat irons, curling irons, stoves, and ovens can also cause burns. During the school-age years, thermal burns are often caused by playing with matches, fireworks, or gasoline. Ingesting a household cleaning agent would lead to a chemical burn.
The most common complication of varicella is: pneumonia. secondary bacterial infections. scarring. encephalitis.
secondary bacterial infections. Explanation: Varicella starts with lesions that appear first on the scalp, face, trunk, and then extremities. The lesions begin as macules then develop into papules and finally clear, fluid-filled vesicles. These lesions are intensely pruritic. The most common complication of varicella is secondary bacterial infection caused by the child scratching the lesions. Other complications include pneumonia, scarring, and encephalitis.
An intensive care nurse has received the above hand-off report from the emergency department nurse. Thirty minutes later, the nurse assesses the child again. Which assessment finding should the nurse investigate further? blood pressure 100/56 mm Hg temperature 100.5°F (38.1°C) O2 saturation 96% (0.96) on 2L Pain level 8 out of 10
temperature 100.5°F (38.1°C) Explanation: The nurse should investigate the increased temperature, because it could be a sign of infection or a response to injury. The child's blood pressure and oxygen saturation has changed minimally. The pain level has decreased slightly and will need to be monitored. However, the temperature is increasing and should be investigated.
The patient came in with partial and full thickness and the following vital signs: Temp (99.8), BP (102/50), HR (108BPM), RR (26BPM), and O2 (07%). An intensive care nurse has received the above hand-off report from the emergency department nurse. Thirty minutes later, the nurse assesses the child again. Which assessment finding should the nurse investigate further? blood pressure 100/56 mm Hg temperature 100.5°F (38.1°C) O2 saturation 96% (0.96) on 2L Pain level 8 out of 10
temperature 100.5°F (38.1°C) Explanation: The nurse should investigate the increased temperature, because it could be a sign of infection or a response to injury. The child's blood pressure and oxygen saturation has changed minimally. The pain level has decreased slightly and will need to be monitored. However, the temperature is increasing and should be investigated.
As part of a spring health fair at a local school, the nurse is presenting information for parents about treating insect stings. The nurse determines that more teaching is needed when the parents state that they would apply which substance to provide comfort? meat tenderizer baking soda paste cold compresses topical antibiotic ointment
topical antibiotic ointment Explanation: The nurse would instruct the parents to use cold compresses for pain relief. According to the Academy of Pediatrics, meat tenderizer or a baking soda paste may also be applied to promote comfort. Antihistamines and topical corticosteroids may be used if pain and itching are not relieved by other methods. Topical antibiotics would not be necessary at this time.
The parents of a child diagnosed with varicella are concerned about their other children getting it. The nurse instructs the parents that their child is contagious for how much longer now that the rash has appeared? until there are no more new lesions and lesions have crusted over for up to 8 days more after the rash initially appears for 4 days more now that the rash is present until the rash disappears, which is about 3 days
until there are no more new lesions and lesions have crusted over Explanation: With varicella, children are contagious 1 to 2 days before the rash appears and continue to be contagious until there are no more new lesions and all lesions are crusted over. Children with mumps are infectious for 7 days before parotid swelling and up to 8 days after the onset of swelling. A child with rubeola is contagious for 4 days before and 4 days after the appearance of the rash. The rash of rubella typically lasts no longer than 3 days.
