School-Age Child

A nurse assessing the heart rate and rhythm of an 8-year-old child hears a murmur that's barely audible even in a quiet room. The child's heart rate is 80 beats/minute. The nurse should document her assessment findings as: 1. "Heart rate regular, grade I murmur auscultated." 2. "Heart rate bradycardic, grade I murmur auscultated." 3. "Heart rate regular, grade II murmur auscultated." 4. "Heart rate bradycardic, grade II murmur auscultated."

1. "Heart rate regular, grade I murmur auscultated." RATIONALE: A heart rate of 80 beats/minute is considered normal for an 8-year-old child. In this age-group, bradycardia is typically associated with a heart rate of less than 70 beats/minute. A grade I murmur is barely audible in a quiet room; a grade II murmur is faint but clearly audible.

The parents of a child with cystic fibrosis ask the nurse why their child must receive supplemental pancreatic enzymes. Which response by the nurse would be most appropriate? 1. "Pancreatic enzymes promote absorption of nutrients and fat." 2. "Pancreatic enzymes promote adequate rest." 3. "Pancreatic enzymes prevent intestinal mucus accumulation." 4. "Pancreatic enzymes help prevent meconium ileum."

1. "Pancreatic enzymes promote absorption of nutrients and fat." RATIONALES: Pancreatic enzymes are given to a child with cystic fibrosis to aid fat and protein digestion. They don't promote rest or prevent mucus accumulation or meconium ileus.

A nurse is instructing a school-age child with a fracture on proper use of crutches. Which statement made by the nurse is most accurate? 1. "After advancing both crutches the length of one step, move your 'good' leg forward." 2. "After advancing both crutches the length of one step, move your 'bad' leg forward." 3. "Move one crutch forward, then advance your 'good' leg." 4. "Move one crutch forward, then advance your 'bad' leg."

2. "After advancing both crutches the length of one step, move your 'bad' leg forward." RATIONALE: When walking with crutches, a child should be instructed to advance both crutches, then advance the affected leg. The unaffected leg then supports much of the weight associated with ambulation. It wouldn't be effective to move the unaffected leg forward first. It wouldn't be safe for the child to advance only one crutch.

What should the nurse do first when admitting an 11-year-old client in sickle cell crisis? 1. Administer oral pain medication while obtaining the child's history. 2. Begin I.V. fluids after obtaining the child's history. 3. Instruct the parents about what to expect during this hospitalization. 4. Start oxygen therapy as soon as the child's vital signs are taken.

2. Begin I.V. fluids after obtaining the child's history. RATIONALES: Fluids are one of the most important components of therapy for sickle cell crisis. Fluids help increase blood volume and prevent sickling and thrombosis. A child experiencing a sickle cell crisis often has severe pain requiring the use of I.V. analgesics such as morphine, which would be administered after fluid therapy has been started. Instructing the parents about what to expect during hospitalization is important but it isn't the first action the nurse should take. Oxygen therapy is used only if the child is hypoxic.

When talking with 10-year-old children about death, the nurse should incorporate which guidelines? Select all that apply: 1. Logical explanations aren't appropriate. 2. The children will be curious about the physical aspects of death. 3. The children will know that death is inevitable and irreversible. 4. The children will be influenced by the attitudes of the adults in their lives. 5. Teaching about death and dying shouldn't start before age 11. 6. Telling children that death is the same as going to sleep as a way of relieving fear is appropriate.

2. The children will be curious about the physical aspects of death. 3. The children will know that death is inevitable and irreversible. 4. The children will be influenced by the attitudes of the adults in their lives. RATIONALES: By age 10, most children know that death is universal, inevitable, and irreversible. School-age children are curious about the physical aspects of death and may wonder what happens to the body. Their cognitive abilities are advanced and they respond well to logical explanations. They should be encouraged to ask questions. The adults in their environment influence their attitudes towards death. Adults should be encouraged to include children in the family rituals and should be prepared to answer questions that might seem shocking. Teaching about death should begin early in childhood. Comparing death to sleep can be frightening for children and cause them to fear falling asleep.

A school-age client is complaining of pain. After asking the client to rate his pain using an age-appropriate pain scale, the nurse determines that the client's pain is minor. What is the drug of choice for treating mild pain in children? 1. Morphine 2. Fentanyl 3. Ibuprofen 4. Acetaminophen

4. Acetaminophen RATIONALES: Acetaminophen, when used as directed, is safe even for neonates and has the benefit of helping to reduce fever in addition to relieving mild pain. Morphine, fentanyl, and ibuprofen aren't drugs of choice for treating mild pain in children. Morphine and fentanyl are reserved for severe pain.

A school nurse is evaluating a 7-year-old child who is having an asthma attack. The child is cyanotic and unable to speak, with decreased breath sounds and shallow respirations. Based on these physical findings, the nurse should first: 1. monitor the child with a pulse oximeter in her office. 2. prepare to ventilate the child. 3. return the child to class. 4. contact the child's parent or guardian.

2. prepare to ventilate the child. RATIONALE: The nurse should recognize these physical findings as signs and symptoms of impending respiratory collapse. Therefore, the nurse's top priority is to assess airway, breathing, and circulation, and prepare to ventilate the child if necessary. The nurse should then notify the emergency medical systems to transport the child to a local hospital. Because the child's condition requires immediate intervention, simply monitoring pulse oximetry would delay treatment. The chid shouldn't be returned to class. When the child's condition allows, the nurse can notify the parents or guardian.

An 8-year-old child enters a health care facility. During data collection, the nurse discovers that the child is experiencing separation anxiety from his parents. The nurse assists in making a nursing diagnosis of Fear related to separation from familiar environment and family. Which nursing intervention is most likely to help the child cope with fear and separation? 1. Ask the parents not to visit the child until he is adjusted to the new environment. 2. Ask the physician to explain to the child why he needs to stay in the health care facility. 3. Explain to the child that he must act like an "adult" while he's in the facility. 4. Have the parents stay with the child and participate in his care.

4. Have the parents stay with the child and participate in his care. RATIONALES: Allowing the parents to stay and participate in the child's care can provide support to both the parents and the child. The other interventions won't address the client's diagnosis and may exacerbate the problem.