School-age child

A 10-year-old child is taking high doses of aspirin. Which finding indicates the child is experiencing early salicylate toxicity?

dizziness

An 8-year-old with diabetes is placed on an intermediate acting insulin and regular insulin before breakfast and before dinner. She will receive a snack of milk and cereal at bedtime. The snack will:

prevent late night hypoglycemia

The nurse is caring for a child in Bryant's traction (see figure). The nurse should:

provide frequent skin care

The nurse is assisting with spirometry testing for a 6-year-old child with asthma. Which of the following instructions is most important for the nurse to give the child to obtain an accurate reading?

"Breathe out as hard as possible, and then breathe in deeply."

38s The nurse is assessing a child with suspected juvenile hypothyroidism. Which signs or symptoms should the nurse expect this child to manifest?

dry skin and constipation

A school-age child has a fever, joint inflammation, and a nonpruritic rash. Knowing that these are signs of rheumatic fever, the nurse should ask the parents:

"Has your child had strep throat recently?"

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.

What should the nurse include as a reason to seek prompt health care in the discharge teaching for the parents of a child following a sickle cell crisis?

sore throat and fever

The parent tells the nurse that an 8 year old is continually telling jokes and riddles to the point of driving other family members crazy. The nurse should explain this behavior is a sign of: 1. inadequate parental attention 2. mastery of language ambiguities 3. inappropriate peer influence 4. excessive television watching

2 (school age children delight in riddles and jokes. Mastery of the ambiguities of language and of sentence structure allow the school age child to manipulate words and telling riddles and jokes is a way to practice this skill. Children who suffer from inadequate parental attention from parents tend to exhibit abnormal behaviors. Peer influence is less important to school age children, and while the child may learn a joke from a friend, he or or she is telling the joke to master language. Watching TV does not influence the extent of joke telling)

The nurse is discontinuing an intravenous catheter on a 10-year-old child with hemophilia. What would be the most important intervention for this client?

Apply firm pressure on the site for 5 minutes after removal

When teaching the child with scoliosis being treated with a Boston brace about exercises, the nurse explains that the exercises are performed primarily for which of the following purposes? A To decrease back muscle spasms. B To improve the brace's traction effect. C To prevent spinal contractures. D To strengthen the back and abdominal muscles.

D. RATIONALE: Exercises are prescribed for the child with scoliosis wearing a Boston brace to help strengthen spinal and abdominal muscles and provide support. Typically, children wearing a Boston brace do not complain of muscle spasms. Performing exercises provides no effect on the brace's traction ability. Spinal contractures do not occur when a Boston brace is worn.

According to Erikson's theory of development, chronic illness can interfere with which stage of development in an 11-year-old? a. Intimacy versus isolation b. Trust versus mistrust c. Industry versus inferiority d. Identity versus role confusion

Industry versus inferiority

Which nursing intervention should be done first when managing a pediatric client admitted to the emergency department with severe diabetic ketoacidosis (DKA)? You Selected:

Secure the client's airway to ensure adequate ventilation.

A school-age child with cystic fibrosis (CF) is suddenly losing weight, despite having a voracious appetite. The child has large, foul-smelling stools, with excessive gas, distention, and bloating. Which of the following is the nurse's best assessment of the etiology of this problem?

The dose of pancreatic enzyme needs to be adjusted.

A school-age boy with a spinal cord injury is moved to the rehabilitation unit. The nurse notes that the child tends to refuse to cooperate in care and to be hostile. The nurse interprets this behavior as indicative of which response?

a stage of grief reaction

A child has chickenpox. The father asks how to care for the lesions. The nurse should advise that the child:

take an antihistamine and use calamine lotion on the closed lesions.

A child, age 9, is admitted to the emergency department with abdominal pain. The child's mother states the pain began about 12 hours ago. The nurse notes the child has a temperature of 100.8° F (38.2° C) and nausea. The child vomited once. Which abdominal area would be most appropriate for the nurse to assess? a) Left upper abdominal quadrant b) Left lower abdominal quadrant c) Right upper abdominal quadrant d) Lower right abdominal quadrant

d rationale: The child's symptoms indicate appendicitis. Therefore, the nurse should assess the lower right abdominal quadrant. The nurse would assess the left lower abdominal quadrant to detect descending and sigmoid colon problems; right upper quadrant to detect gallbladder disease; and the left upper quadrant to detect pancreatitis.

When teaching a group of parents of school-age children about growth and development, which characteristic about children of this age should the nurse include?

desire to carry a task to completion

When taking a diet history from the mother of a 7-year-old child with phenylketonuria, a report of an intake of which food should cause the nurse to gather additional information?

diet cola

The nurse should explain that the most common cause for the unhappiness some children experience when first entering school is due to which factor?

feelings of insecurity

What test should the nurse review to best assess the effectiveness of treatment for a child with type 1 diabetes? postpostprandial blood test hemoglobin electrophoresis glucose tolerance test glycosylated hemoglobin

glycosylated hemoglobin

The nurse is planning interventions for a school-aged child hospitalized with acute poststreptococcal glomerulonephritis in need of diversional activity. Which activity should the nurse expect to include?

playing a card game with someone of the same age

A child is admitted with a tentative diagnosis of clinical depression. Which assessment finding is most significant in confirming this diagnosis?

sadness

Which use of restraints in a school-age child should the nurse question?

to substitute for observation

The nurse is teaching the parents of an 8-year-old child receiving treatment for cancer. What will the nurse include in the teaching? Select all that apply. Provide rest periods between activities Expect periods when the child will refuse to eat Avoid vacations with travel The child should not attend school due to cancer Call the healthcare provider with any concerns

• Provide rest periods between activities • Expect periods when the child will refuse to eat • Call the healthcare provider with any concerns

Which assessment would be most important for the nurse to make initially in a school-age child being seen in the clinic who has a sore throat, muscle tenderness, arms feeling weak, and generally is not feeling well?

difficulty swallowing

When obtaining a nursing history from parents who are suspected of abusing their child, which characteristic about the parents should the nurse particularly assess?

difficulty with controlling aggression Explanation: Parents of an abused child have difficulty controlling their aggressive behaviors. They may blame the child or others for the injury, may not ask questions about treatment, and may not know developmental information

The nurse is caring for a child receiving a blood transfusion. The child becomes flushed and is wheezing. What should the nurse do first? a) Administer oxygen. b) Notify the physician. c) Switch the transfusion to normal saline solution. d) Take the child's vital signs.

C. Switch to NS solution. The child is having a reaction to the blood transfusion. The priority is to stop the blood transfusion but maintain an open venous access for medication or high fluid volume delivery. Thus, switching the transfusion to normal saline solution would be done first. Since the child is having difficulty breathing, applying oxygen would be the next action. Additionally, vital signs are taken to determine the extent of circulatory involvement. Then the physician would be notified and, if necessary, the crash cart would be obtained.

While performing cardiopulmonary resuscitation (CPR) on a 5-year-old child, the nurse palpates for a pulse. Which site is best for checking the pulse during CPR in a 5-year-old child? brachial artery radial artery femoral artery carotid artery

Carotid Checking the carotid artery pulse in a child during CPR provides information about perfusion of the brain. The brachial pulse is checked in an infant because the infant's short and typically fat neck makes it difficult to palpate the carotid pulse. The femoral and radial arteries might indicate perfusion to the peripheral body sites, but the critical need is for adequate circulation to the brain.

When teaching a parent of a school-age child about signs and symptoms of fever that require immediate notification of the physician, which description should the nurse include? Burning or pain with urination History of febrile seizures Fever disappearing for longer than 24 hours, then returning Complaints of a stiff neck

Complaints of a stiff neck RATIONALE: The nurse should discuss complaints of a stiff neck because fever and a stiff neck indicate possible meningitis. Burning or pain with urination, fever that disappears for 24 hours then returns, and a history of febrile seizures should be addressed by the physician but can wait until office hours.

A mother states that a health care provider (HCP) described her daughter as having 20/60 vision, and she asks the nurse what this means. The nurse responds based on the interpretation that the child is experiencing which condition?

ability to see at 20 feet what she should see at 60 feet

Which behavior exhibited by parents of a chronically ill child may indicate feelings of guilt about the child's illness?

overindulgence

A 7-year-old boy is hospitalized with cystic fibrosis. To help him manage secretions and avoid respiratory distress, the nurse should:

perform chest physiotherapy every 4 hours.

The nurse explains to the mother of a child receiving digoxin that the primary reason for giving this drug is:

to improve the strength of the heartbeat

A child with iron deficiency anemia is ordered ferrous sulfate, an oral iron supplement. When teaching the child and parent how to administer this preparation, the mother asks why she needs to mix the supplement with citrus juice. Which response by the nurse is best?

"The vitamin C in the citrus juice helps with iron absorption."

A child has experienced successful resuscitation after a cardiopulmonary arrest. What nursing action has the highest priority?

Administration of an appropriate weight-based dose of dopamine.

A 7-year-old client with type 1 diabetes is sick with the flu. What is the most important information for the nurse to convey regarding diabetes management during illness?

Blood glucose needs to be checked more frequently during illness.

Which intervention should the nurse perform for a child who is receiving chemotherapy and allopurinol?

Encourage a high fluid intake.

A typically developing preschool child is experiencing pain after an appendectomy. Which data collection tool is the most appropriate for the nurse use to assess the pain?

FACES pain rating scale

Which relaxation strategy would be effective for a school-age child to use during a painful procedure?

Having the child take a deep breath and blow it out until told to stop

According to Erikson's psychosocial theory of development, an 8-year-old child would be in which stage?

Industry versus inferiority

A school nurse is examining a student at an elementary school and notes vesicular lesions that ooze, forming crusts on the face and extremities. Which of the following actions by the nurse is most appropriate?

Sending the child home and encourage evaluation by physician

A child is brought to the emergency department experiencing severe right lower quadrant pain. The child's pulse and respirations are elevated, and there are localized tenderness and sluggish bowel sounds. Shortly after the initial assessment, the child states that the pain has suddenly resolved. Which of the following would the nurse suspect?

The child has signs that the appendix has ruptured.

The parents of a child just diagnosed with juvenile idiopathic arthritis (JIA) tell the nurse that the diagnosis frightens them because they know nothing about the prognosis. What information should the nurse include when teaching the parents about the disease?

The more joints affected, the more severe the disease will be.

A 10-year-old child is admitted with a brain tumor. Which assessment made by the nurse is most critical to report to the child's health care provider (HCP)?

difficulty recalling the day of the week

Upon the child's return from the postanesthesia recovery unit (PACU) after a tonsillectomy, the nurse should place the child in which position?

side-lying

An emergency room nurse concerned about the emotional health of a child who has been in a motor vehicle accident should collaborate with which of the following disciplines?

social services

A 7-year-old child has taken a game from the hospital playroom that was suppose to remain in that area. The nurse should discuss the problem with the mother and suggest:

the child needs to apologize and return the game to the playroom.

A 4-year-old boy is scheduled for a nephrectomy to remove a Wilms' tumor. Which intervention listed in the care plan should the nurse question?

Palpate his abdomen to monitor tumor growth.

A nurse is assessing the growth and development of a 10-year-old. What is the expected behavior of this child? has a strong sense of justice and fair play is selfish and insensitive to the welfare of others is uncooperative in play and school enjoys physical demonstrations of affection

has a strong sense of justice and fair play

21. Thirty-two children are brought to the emergency department after a school bus accident. Two children were killed along with the three people in the car that caused the crash. Before the victims arrive, in addition to ensuring that the hospital staff are prepared for the emergency, which step should the nurse anticipate carrying out? 1. Calling the nearest crisis response team. 2. Alerting the news media. 3. Notifying the hospital volunteer office. 4. Calling the school to inform teachers of the accident.

1. Calling the nearest crisis response team. The children and their amilies are at risk or experiencing a crisis. Disaster teams are avail- able or crisis intervention in such emergencies. Usually the news media monitors emergency radio requencies and most likely are aware o the acci- dent already. Although volunteers may help in some ways, they are not responsible or crisis interven- tion. Calling the school might be done, but the emer- gency issues take precedence

A school-age child experiences symptoms of excessive polyphagia, polyuria, and weight loss. The physician diagnoses type 1 diabetes and admits the child to the facility for insulin regulation. The physician orders an insulin regimen of insulin and isophane insulin administered subcutaneously. How soon after administration can the nurse expect the regular insulin to begin to act?

1/2 to 1 hour

A child is admitted to the hospital with a febrile seizure. The nurse should: a) Place a padded tongue blade at the bedside. b) Keep the child supine. c) Place the child in isolation. d) Keep the room temperature low and bedclothes to a minimum.

D. Keep the room temperature low and bedclothes to a minimum. One nursing goal for a child with febrile seizures is to maintain the child's temperature at a level low enough to prevent recurrence of seizures. Decreasing the environmental temperature and removing excess clothing and blankets will help decrease the child's temperature. There is no reason to keep the child supine; a side-lying position would be acceptable and help decrease intracranial pressure. A febrile seizure, though, results from abnormal electrical activity in the brain due to elevated body temperature. Isolation precautions are not necessary unless the child has a condition that warrants such an isolation. Using a tongue blade to separate the teeth in the upper jaw from the lower jaw in an attempt to prevent the child from biting the tongue has proven to be ineffective and may result in broken teeth.

A parent of a 9-year-old-child scheduled to have surgery expresses concern about the potential for postoperative infection. A nurse provides the parent with information about the measures taken to maintain surgical asepsis. Typical surgical asepsis involves: A. applying bandages to cover any wounds surgical team members have. B. preoperative cleansing of jewelry worn by the surgical team. C. using sterile surgical scrubs. D. performing a preoperative surgical scrub for at least 3 to 5 minutes.

D. performing a preoperative surgical scrub for at least 3 to 5 minutes. The surgical team should perform a surgical scrub lasting at least 3 to 5 minutes before any operative procedure. Although surgical gowns may be considered sterile, surgical scrubs are considered clean rather than sterile. Jewelry harbors bacteria; team members should remove it rather than simply clean it. A surgical team member with an open wound shouldn't be involved in a procedure requiring asepsis.

The primary health care provider has ordered intravenous mannitol for a child with a head injury. The best indicator that the drug has been effective is: a) Decreased intracranial pressure. b) Increased urine output. c) Improved level of consciousness. d) Decreased edema

a - decreased ICP Mannitol is an osmotic diuretic used to reduce intracranial pressure. The use of the drug is controversial and should be reserved to cases which do not respond to other treatments or when brain herniation is likely. Children this sick should be on intracranial pressure (ICP) monitoring. The best indicator that the drug has produced the desired results is a reduction in the ICP. Improved levels of consciousness should follow reduced ICP. While the drug will cause increased urine output, that measurement in and of itself does not indicate successful treatment. Because the drug is being used for head injuries, not to improve urine output in acute renal failure, the child may not have visible edema.

A nurse is reviewing a care plan for a 10-year-old child who has recently been diagnosed with type 1 diabetes. Which instruction should the nurse remove from a teaching plan focusing on proper hygiene? teach proper foot care take care of scars and cuts encourage dental hygiene teach blood glucose monitoring

teach blood glucose monitoring

The nurse determines that teaching about the correct use of a Boston brace to treat scoliosis has been effective if the child and family state they will remove the brace at which times?

when bathing, for about 1 hour per day