Week 1 Peds EAQ

On World Hygiene Day, the nurse is conducting a health screening in a school. The nurse finds that a student is untidy and has dirt under the nails. Which instruction does the nurse give to the child? "You should trim your nails or you will be prone to infections." "A person can lead a healthier life by maintaining good hygiene." "Improper hygiene will make you susceptible to infections." "I would like to talk to your mother about your habits."

"A person can lead a healthier life by maintaining good hygiene." The child should be taught using third-person technique. Explaining that a person can lead a healthier life by maintaining hygiene can help the child understand the importance of hygiene in a nonthreatening manner. Statements starting with "you" indicate that the nurse is judging the student and should thus be avoided. The response, "You should trim your nails or you will be prone to infections," is inappropriate. The response, "Improper hygiene will make you susceptible to infections," may make the nurse come across as a schoolteacher. The response, "I would like to talk to your mother about your habits," is inappropriate. It gives the impression of complaining, and the student may feel annoyed.

The nurse is assessing a school-age child who complains of pain in the stomach. Which question helps the nurse identify the severity of the pain? "Can you show me where you have the most pain?" "Does the pain move from one side to the other?" "Does the pain prevent you from sleeping?" "Do you feel like crying when it hurts?"

"Does the pain prevent you from sleeping?" The nurse can determine whether the pain is severe by finding out how the pain affects the usual activity of the child. If the child is unable to sleep, play, eat, or interact with others, it means that the pain is severe. Asking the child to show where it hurts or whether the pain moves from one side to the other helps the nurse determine the location of the pain. The nurse does not ask whether the child feels like crying because negative questions like this may actually make the child cry.

The nurse intern is performing an assessment of a child with attention-deficit/hyperactivity disorder (ADHD). The nurse intern reports to a nurse practitioner that the child is not effectively participating and is moving all around the room during the assessment. Which suggestion does the nurse practitioner give to the nurse intern? Select all that apply. One, some, or all responses may be correct. "Give instructions to the child in a detailed manner." "Interact with the child in an open area." "Gently restrain the child for a few minutes." "Complete the assessment as quickly as possible." "Conduct the assessment in the presence of the child's parents."

"Gently restrain the child for a few minutes." "Complete the assessment as quickly as possible." "Conduct the assessment in the presence of the child's parents." When the child is not effectively participating and is uncooperative, the nurse should have an attendant gently restrain the child for a few minutes. This helps control the child's aggressive and impulsive behavior. The nurse should complete the assessment as quickly as possible. The assessment needs to be short because the child cannot pay attention for a long time. The child is more likely to feel comfortable in the presence of parents, so it is advisable to conduct the assessment in the presence of the child's parents. A child with ADHD lacks patience, so the nurse should avoid giving detailed instructions. The child has a reduced attention and concentration span, so conducting the assessment in an open area may make the child anxious and hamper the interaction.

The nurse is interviewing the mother of a 9-year-old boy. Which question is the most appropriate as the nurse begins to assess the child's school performance? "Did he go to preschool?" "How is he doing in school?" "Does he have problems at school?" "How well does he seem to be doing in school?"

"How is he doing in school?" "How is he doing in school?" is an open-ended question without any descriptive terms that may limit the mother's responses. "Did he go to preschool?" is a closed-ended question that will elicit a yes-or-no answer. "Does he have problems at school?" is a closed-ended question that implies that the child is not doing well. "How well does he seem to be doing in school?" is a closed-ended question that will elicit a short answer and assumes that the child is doing well.

During a class excursion, one of the students with a history of lactose intolerance develops manifestations of an allergic reaction after drinking a milkshake. The teacher calls a nurse on a telephone and explains the student's condition. Which is the nurse's priority instruction for the teacher? "Give Ipecac syrup (Ipecac) to the student to induce vomiting." "Inform the student's parents to come pick up the child." "I will notify the child's primary health care provider." "It is better to avoid giving any cold foods to the students."

"I will notify the child's primary health care provider." In telephonic triage and counseling, the nurse determines the significance of the signs and symptoms of the illness. Following this, the nurse identifies the appropriate interventions to be made, in this case, arranging an appointment for the child to be seen by the primary health care provider right away. It helps the child to get immediate medical help. The nurse does not suggest any medications on the phone without knowing the child's medical history because some medications can cause drug and food interactions. The student needs immediate care and treatment. The student's parents must be informed about the condition, but it will not provide immediate help to the student. The student had an allergic reaction caused by lactose intolerance, not cold foods. An appropriate piece of advice would be to avoid giving milk products to the student.

During the assessment of a 2-year-old child with breathing problems, the nurse asks for the birth history of the child. The parent asks, "How will pregnancy and birth affect the child's present condition?" What is the best response by the nurse? "Prenatal influences have effects on the child's development." "Vaccines taken at birth affect the child's development." "I need to check what medications were administered earlier." "I need to know whether your pregnancy was planned or unexpected."

"Prenatal influences have effects on the child's development." Prenatal influences such as the mother's health during pregnancy, the labor and delivery, and the infant's condition immediately after birth affect the physical and emotional development of the child. Vaccines are given for health promotion, and negative statements about vaccines may make the parent anxious. Medication history can be obtained without asking for the birth history of the child. Asking whether a pregnancy was expected may embarrass the parent. The nurse instead refers to specific facts relating to the pregnancy, such as the spacing between offspring or pregnancy during adolescence.

While assessing a child, the nurse finds that the child has glossy and pink conjunctiva. Which does the nurse report about the patient's condition to the primary health care provider? "The child has vitamin A deficiency." "The child has excessive riboflavin." "The child has adequate nutrition." "The child has riboflavin deficiency."

"The child has adequate nutrition." The presence of clear, bright vision and a pink and glossy conjunctiva indicate adequate nutrition. The manifestations of vitamin A deficiency are scaling of the cornea and conjunctiva. Excessive riboflavin is characterized by paresthesia. The signs of riboflavin deficiency are burning, itching, and photophobia.

Which question would the nurse ask to assess the quality of a child's current dietary intake? Select all that apply. One, some, or all responses may be correct. "Does your child exercise regularly?" "How often does your child brush the teeth?" "What are your child's favorite snacking foods?" "When did you start giving your child solid foods?" "Does your child eat breakfast, lunch, and dinner daily?"

"What are your child's favorite snacking foods?" "Does your child eat breakfast, lunch, and dinner daily?" Questions about the child's favorite snacking foods and whether the child eats breakfast, lunch, and dinner on a daily basis are important ways for the nurse to assess the quality of a child's current dietary intake. Asking whether the child exercises regularly, how often the child brushes the teeth, or when the child started solid foods is not a good way to assess the quality of a child's current dietary intake.

The nurse is interacting with a mother of a neonate while assessing the health of the neonate. The neonate's mother looks tired and does not effectively interact with the nurse. Which response does the nurse make for effective interaction? "Is there any problem? You seem sad." "Your baby looks very cute and pretty." "You look tired because of lack of sleep." "You are handling the baby very well.""You are handling the baby very well."

"You are handling the baby very well." Parents are an important source of information regarding the child's health. Therefore the nurse should be able to effectively interact with the child's parents while performing the assessment of the child. The parents of neonates generally feel tired and do not interact with the nurse, giving monosyllabic answers. The nurse should encourage the mother by saying, "You are handling the baby very well." Appreciating the mother for her caregiving skills would make the mother feel happy and stimulate effective interaction. The nurse should avoid asking, "Is there any problem? You seem to be sad," because it diverts the conversation away from the child's health. Appreciating the baby by saying that the baby looks very cute and pretty may be nice for the patient to hear but does not provide the same level of information for the nurse. The response, "You look tired because of lack of sleep" can be used when the nurse wants to assess the mother's health and condition.

Which statement is true concerning the increased use of telephone triage by nurses? Home care is often recommended when it is not appropriate. Telephone triage has led to an increase in the cost of health care. Access to high-quality health care services has increased with telephone triage. Emergency department visits are not recommended by nurses and therefore are not a component of telephone triage.

Access to high-quality health care services has increased with telephone triage. The judicious use of telephone triage has decreased the number of unnecessary visits, allowing time for improved care. Home care is recommended only when indicated by the answers to the screening questions. Health care costs have decreased because of a decreased number of emergency departments. The triage nurse determines whether the child needs to be referred to emergency medical services on the basis of the child's responses to screening questions. The nurse can then initiate the call if needed.

Which factor has encouraged the increased use of telephone triage by nurses? Select all that apply. One, some, or all responses may be correct. Access to high-quality health care services has increased. Unnecessary emergency department visits have increased. Patient satisfaction with medical care services has decreased. Home nursing care is recommended when it is not appropriate. Empowered parents are participating in their children's medical care.

Access to high-quality health care services has increased. Empowered parents are participating in their children's medical care. Telephone triage by nurses has increased as a result of increased access to high-quality health care services and empowered parents taking a more active role in their children's medical care. The incidence of unnecessary emergency department visits has decreased, not increased, and patient satisfaction with medical care services has increased rather than decreased. Guidelines for home management are given if the triage assessment indicates that this level of care is required. Parents are given instructions about changes in the child's condition to report.

Which intervention can the nurse implement to help involve a younger child in the physical examination process? Examine painful areas last. Limit the number of people in the room. Perform the examination as quickly as possible. Allow the child to handle or hold the equipment.

Allow the child to handle or hold the equipment. By allowing the child to handle or hold the equipment, the nurse involves the child in the physical examination process. Examining painful areas last allays fear but will not involve the child in the physical examination. Limiting the number of people in the room will ensure privacy but will not encourage the child to become involved in the physical examination. Performing the examination as quickly as possible increases the speed of examination but does not necessarily help the child feel more involved in the physical examination.

Which explains the importance of detecting strabismus in young children? Color vision deficit may result. Ptosis may develop secondarily. Amblyopia, a type of blindness, may result. An epicanthal fold may develop in the affected eye.

Amblyopia, a type of blindness, may result. Amblyopia may develop if the eyes do not work together. The brain may ignore the visual cues from one eye, resulting in blindness. Color vision depends on rods and cones in the retina, not muscle coordination. Ptosis, or drooping of the eyelid, is not related to strabismus (crossed eyes). The epicanthal folds are present at birth.

How can the nurse avoid stimulating the cremasteric reflex when palpating a 2-year-old boy for the presence of testes? Asking the boy to sit in the tailor position Instructing the boy to cough during the exam Asking the boy to sit on a cold examination table Having the boy exercise before beginning the assessment

Asking the boy to sit in the tailor position Asking the boy to sit in the tailor or "Indian" position helps stretch the muscle, preventing its contraction. Instructing the boy to cough during the exam will not help avoid stimulating the cremasteric reflex. Exercise, excitement, and cold temperatures can stimulate the cremasteric reflex.

Which is an atraumatic way in which nurses can encourage deep breathing in children? Select all that apply. One, some, or all responses may be correct. Having the child pretend to suck up liquid through a straw Asking the child to "blow out" the light on an otoscope or pocket flashlight Placing a small tissue on the top of a pencil and asking the child to blow off the tissue Applying firm pressure on the stethoscope's chest piece but not enough to prevent vibrations and transmission of sound Placing a cotton ball in the child's palm, asking the child to blow the ball into the air, and having the parent catch it

Asking the child to "blow out" the light on an otoscope or pocket flashlight Placing a small tissue on the top of a pencil and asking the child to blow off the tissue Placing a cotton ball in the child's palm, asking the child to blow the ball into the air, and having the parent catch it Atraumatic ways in which nurses can encourage deep breathing in children include asking the child to "blow out" the light on an otoscope or pocket flashlight, placing a cotton ball in the child's palm and asking the child to blow the ball into the air and having the parent catch it, and placing a small tissue on the top of a pencil and asking the child to blow off the tissue. Having the child pretend to suck up liquids through a straw is not an effective way to encourage deep breaths. Applying firm pressure on the chest piece but not enough to prevent vibrations and transmission of sound is helpful in obtaining effective auscultation but not effective in encouraging deep breaths.

Which is the most appropriate method for a nurse to use to view the tonsils and oropharynx of a 6-year-old child? Asking the child to open the mouth wide and say "Ah" Examining the mouth when the child is crying to avoid use of tongue blade Pinching the nostrils closed until the child opens the mouth, then insert the tongue blade Asking the child to open the mouth wide and then placing the tongue blade in the center back area of the tongue

Asking the child to open the mouth wide and say "Ah" A cooperative child can be asked to open the mouth and move the tongue around for the examiner. When the child cries, there is insufficient opportunity to completely visualize the tonsils and oropharynx. It is traumatic to pinch a child's nostrils closed until the child opens the mouth, and there is no reason to use such measures, especially with cooperative children. No tongue blade is necessary to visualize the tonsils and oropharynx if the child cooperates.

The nurse is ready to begin the physical examination of an 8-month-old infant. The child is sitting contentedly on the mother's lap, chewing on a toy. Which would the nurse do first? Elicit reflexes. Auscultate the heart and lungs. Examine the eyes, ears, and mouth. Examine the head and move systematically toward the feet.

Auscultate the heart and lungs. While the child is quiet, auscultation should be performed. It may disturb or upset the child to elicit reflexes or examine the eyes, ears, and mouth first, making auscultation and the remainder of the physical examination difficult. Although most physical examinations proceed from the head to the feet, the nurse should perform the assessment for a child in an order that moves from least disturbing to most disturbing from the child's perspective.

Which nursing care guideline does the nurse implement when communicating with children? Select all that apply. One, some, or all responses may be correct. Be honest only when it is helpful for the child. Avoid extended eye contact and other threatening gestures. Hurry through the exam to help the child cope with the experience. Communicate through transitional objects such as dolls and puppets. Minimize or ignore fearful reactions by children to enhance coping skills.

Avoid extended eye contact and other threatening gestures. Communicate through transitional objects such as dolls and puppets. Transitional objects such as dolls and puppets should be used to enhance communication with children. Avoid extended eye contact and other threatening gestures when communicating with children. Be honest with children at all times, not just when it is perceived to be helpful for the child. It is not helpful to hurry through the exam, which will stress the child rather than help the child cope with the experience. Never minimize or ignore fearful reactions by children; instead, allow them to express their concerns and fears in a nonthreatening environment.

What is an important part of establishing therapeutic communication with adolescents? Using nonverbal techniques Communicating through transition objects Building a foundation for a trusting relationship Explaining procedures using short sentences and simple words

Building a foundation for a trusting relationship Building a foundation for a trusting relationship is an important part of establishing therapeutic communications with adolescents. Many adolescents have a difficult time understanding nonverbal cues; therefore this is not an important part of therapeutic communication with adolescents. Communicating through transition objects, such as dolls or toys, and using short sentences with simple words are both helpful strategies for use with younger children.

The nurse is providing teaching to the family of a young child. Which is a sign of information overload? Select all that apply. One, some, or all responses may be correct. Eye contact Constant fidgeting Long periods of silence Soft eyes and a relaxed facial expression Attempting to change the topic of discussion

Constant fidgeting Long periods of silence Attempting to change the topic of discussion The nurse should assess the family for the following signs of information overload: long periods of silence, wide eyes and fixed facial expression, constant fidgeting or attempts to move away, nervous habits (e.g., tapping, playing with hair), sudden interruptions (e.g., asking to go to the bathroom), looking around, yawning, drooping eyes, frequently looking at a watch or clock, and attempting to change the topic of discussion. Eye contact and soft eyes and a relaxed facial expression are not signs of information overload.

The nurse is performing a physical assessment of a 1-year-old infant. Which is the recommended method for assessing this infant's heart rate? Counting the radial pulse for a full minute Counting the brachial pulse for a full minute Counting the apical impulse for a full minute Counting the radial pulse for 30 seconds and the femoral pulse for 1 minute and comparing the two

Counting the apical impulse for a full minute The recommended method of assessing a 1-year-old infant's heart rate is to use a stethoscope to count the apical impulse for a full minute. Counting the radial pulse for a full minute is not recommended in a 1-year-old infant, nor is counting the radial pulse for 30 seconds and the femoral pulse for 1 minute and then comparing the two. Counting the brachial pulse for a full minute is not the recommended method for assessing this infant's heart rate.

Which is the appropriate direction in which to pull the pinna of an infant during an otoscopic examination? Up and back Up and forward Down and back Down and forward

Down and back The correct procedure for examining an infant's ear is to pull the pinna down and back. Pulling the pinna up and forward will not permit sufficient visualization of the ear, and neither will pulling the pinna up and back. Pulling the pinna down and forward is the correct position for a child 3 years or older.

Which is included in guidelines for a nurse using an interpreter in developing a care plan for an 8-year-old child admitted to rule out epilepsy? Not giving the interpreter too much information so the interview evolves Encouraging the interpreter to ask several questions at a time to make the best use of time Explaining to the interpreter what information must be obtained from the patient and family Discouraging the interpreter and patient from discussing topics that are irrelevant to the original intent of the interview.

Explaining to the interpreter what information must be obtained from the patient and family The interpreter should be given guidance regarding what information must be elicited during the interview. The interpreter should not have to guess what to ask and what information to obtain during the interview. One question should be asked at a time, with sufficient time left for the family to answer. The interpreter should gain as much information from the family as they are willing to share in response to the questions posed. Limits should not be placed on the interview.

A 5-year-old boy is having a well-child visit before starting kindergarten. Which test does the nurse use to assess cerebellar function? Cover test Finger-to-nose test Eliciting deep tendon reflexes Biting down hard and opening the jaw

Finger-to-nose test The finger-to-nose test is an indication of cerebellar function. The cover test is used to assess eye alignment. Deep tendon reflexes do not indicate cerebellar function. Having the child bite down hard and open the jaw is used to assess the strength and symmetry of the trigeminal nerve.

When a measuring device for assessing a young child's height is not available, how would the nurse accurately measure the length of an 18-month-old child? Have the child stand on the scale to use a wall-mounted unit. Have the child stand next to the wall and mark the child's height. Have someone assist by holding the child's head in midline while the child stands on the wall-mounted unit. Have the child lie on a paper-covered surface, mark the paper at the points for the top of the head and the heels, then measure between these points.

Have the child lie on a paper-covered surface, mark the paper at the points for the top of the head and the heels, then measure between these points. When a measuring device for height is not available, the best approach is to have the child lie on a paper-covered surface while the nurse marks the top of the head and the heels and measures between these points. Having a child of this age stand on the scale to use a wall-mounted unit is not appropriate. Having the child stand next to the wall and marking the height is not appropriate. Having someone assist by holding the child's head in midline while the child stands on the wall-mounted unit is not appropriate at this age.

Superficial palpation of the abdomen is often perceived by the child as tickling. Which measure by the nurse is most likely to minimize this sensation and promote relaxation? Palpating another area simultaneously Asking the child not to laugh or move if it tickles Beginning with deeper palpation and gradually progress to superficial palpation Having the child "help" with palpation by placing a hand over the palpating hand

Having the child "help" with palpation by placing a hand over the palpating hand Having the child "help" allows the nurse to perform the assessment while including the child in the care. Palpating another area simultaneously would not promote relaxation and would make it more difficult to perform the abdominal assessment. Asking a child not to laugh or move if the examination tickles may only contribute to the child's laughter or prove frustrating for both the child and the nurse. Deeper palpation will enhance the tickling sensation, not lessen it.

When taking a child's blood pressure the nurse understands that the most important factor in accurately measuring blood pressure is which? That blood pressure is stable throughout the life span How the Korotkoff sounds can be affected by pressure on the antecubital fossa How choosing the appropriate cuff size most accurately reflects radial arterial pressure That blood pressure measuring devices have no effect on the accuracy of the measurement

How choosing the appropriate cuff size most accurately reflects radial arterial pressure Researchers have found that the selection of a cuff with a bladder with equal to 40% of the upper arm circumference most accurately reflects directly measured radial arterial pressure. Blood pressure is not stable throughout the life span. The Korotkoff sounds can be affected by the pressure on the antecubital fossa, but this is not the most important factor in accurately measuring blood pressure. Blood pressure measuring devices can affect the accuracy of the measurement.

The nurse needs to take the blood pressure of a small child. One of the available cuffs is too large, and the other is too small. Which is the best nursing action? Use the large cuff. Use the small cuff. Use either cuff, employing the palpation method. Locate the proper size of cuff before taking the blood pressure.

Locate the proper size of cuff before taking the blood pressure. To obtain an accurate blood pressure reading, it is preferable to use the proper size of cuff. Therefore locating one before taking the blood pressure is the best nursing action. The larger cuff, which may give a falsely low blood pressure reading, is preferable to the smaller cuff, but neither is the method of choice. The smaller cuff gives a falsely high blood pressure reading and is not the method of choice. Auscultation is preferred to palpation.

Which would the nurse expect when assessing a preschooler's chest? Respiratory movements to be chiefly thoracic Intercostal retractions on respiratory movement Anteroposterior diameter to be equal to the transverse diameter Movement of the chest wall to be symmetric bilaterally and coordinated with breathing

Movement of the chest wall to be symmetric bilaterally and coordinated with breathing The preschool-age child should have bilateral and symmetric chest movement and a coordinated breathing pattern. At this age, breathing is a coordinated function and is primarily abdominal or diaphragmatic. Thoracic breathing occurs in older children, particularly girls. Intercostal retractions are indicative of respiratory distress. The anteroposterior diameter is equal to the transverse diameter in infants. As the child grows, the chest normally increases in the transverse direction; therefore the anteroposterior diameter is less than the lateral diameter.

A nurse notes during physical assessment that the infant's chest anteroposterior (AP) diameter equals the transverse diameter. How would the nurse interpret this finding? Normal Abnormal Normal in a child younger than 18 Reflecting a need for further evaluation

Normal An infant with an AP chest diameter equal to the transverse diameter is normal. Equal AP and transverse chest diameters are abnormal in an older child. There is no need for further evaluation; as the child grows, the chest normally increases in the transverse direction, causing the AP diameter to be less than the lateral diameter.

The nurse is performing a clinical assessment of nutritional status for a group of patients and documents the assessment findings. Which patient's findings indicate excess manganese levels in the blood? Patient 1 = osteoporosis of log bones Patient 2 = hard, tender lumps Patient 3 = unsteady gait; numb feet and hands Patient 4 = masklike facial expression; slurred speech

Patient 4 A masklike facial expression and slurred speech, as found with patient 4, indicate the presence of excess manganese levels in the blood. Patient 1's findings indicate excess vitamin D levels in the blood, which causes osteoporosis of long bones. Patient 2's hard, tender lumps in the extremities indicate excess vitamin A levels in the blood. The findings of Patient 3's unsteady gait, and numb feet and hands indicate excess pyridoxine levels in the blood.

The nurse manager instructs the staff to arrange the assessment room in a new pediatric ward. Which appropriate instruction does the nurse manager give to the staff? Color the room with bright colors. Maintain the room temperature at 59°F. Place toys and dolls in the room. Decorate the room with strange and novel items.

Place toys and dolls in the room. The nurse should create an appropriate ambiance and environment in the pediatric assessment room. This helps children feel comfortable and interact effectively with the nurse. Children enjoy having toys around them and playing with them. Thus the nurse should ask the staff members to keep toys in the pediatric ward. The room should be colored with neutral colors, not bright colors. Bright colors can make children aggressive. A room temperature of 59°F would feel cold to the average person and may make patients feel uncomfortable. The nurse should ensure that the room temperature is increased to a more comfortable level. Strange and novel items such as frightening pictures must not be kept in the room because they may scare children.

After performing a clinical assessment of a patient's nutritional status, the nurse concludes that the patient has adequate nutritional intake. Which finding supports the nurse's conclusion? Select all that apply. One, some, or all responses may be correct. Presence of prominent large potbelly Presence of tongue with rough texture Presence of uniform, smooth, intact teeth Presence of enlarged costochondral junctions Presence of cylindric and prominent abdomen

Presence of tongue with rough texture Presence of uniform, smooth, intact teeth Presence of cylindric and prominent abdomen The presence of a tongue with a rough texture; the presence of uniform, smooth, intact teeth; and the presence of a cylindric and prominent abdomen are normal findings that indicate that the patient has adequate nutritional intake. The presence of a prominent potbelly is evidence of vitamin D deficiency. The presence of enlarged costochondral junctions indicates vitamin C or vitamin D deficiency.

During a physical assessment the nurse notes that the child's height and weight are below the 5th percentile and that the child has pale skin; stringy, dull, dry, thin hair; and a flat abdomen. The child also exhibits generalized muscle wasting. The parent reports not having enough money to buy groceries several times a month. In light of these clinical findings, which deficiency does the nurse suspect the child has? Zinc Protein Sodium Vitamin A

Protein A deficiency in protein is evidenced by low percentiles in height and weight on the growth charts; stringy, friable, dull, dry, thin hair; and muscle wasting. Zinc deficiency manifests as scaly dermatitis, lesions around the nares, and a diminished sense of taste. Sodium deficiency is manifested by weakness, pain, and cramps. Vitamin A deficiency is evidenced by skin that is hardened or scaling and by dental carries.

The nurse is assessing the cornea and the pupils of a child. Which finding indicates that the pupils are normal? Select all that apply. One, some, or all responses may be correct. Pupils constrict when light approaches. Pupils dilate when light is suddenly flashed. Pupils appear to be round, clear, and equal. Pupils constrict if a bright object moves near the face. The cornea appears to be milky and cloudy.

Pupils constrict when light approaches. Pupils appear to be round, clear, and equal. Pupils constrict if a bright object moves near the face. The nurse can check the child's reaction to light by quickly shining a light toward the eye and then removing the light. The pupils should constrict when light approaches and dilate when the light fades. Normal pupils are round, clear, and equal. The nurse can test the pupil for movement by asking the child to look at a shiny object while the nurse moves the object toward the face. Pupils should constrict as the object is brought near the eye. Pupils dilate when the light fades. A milky and cloudy cornea indicates vision problems.

Which statement correctly explains why it can be difficult to assess a child's dietary intake? Families usually do not understand much about nutrition. Biochemical analysis for nutrition assessment is expensive. Recall of children's food consumption is frequently unreliable. No systematic assessment tool has been developed for this purpose.

Recall of children's food consumption is frequently unreliable. It is difficult for parents to recall exactly what their child has eaten. Concurrent food diaries are somewhat more reliable. The family does not need nutritional knowledge to describe what the child has eaten. Nutrients for different foods are known; the quantity and type of food consumed are the facts that are difficult to ascertain. Systematic tools are available.

Which is the most accurate method of determining the length of a child younger than 12 months of age? Standing height Recumbent length measured in the prone position Recumbent length measured in the supine position Estimation of length to the nearest centimeter or ½ inch

Recumbent length measured in the supine position The crown-heel length measurement is the most accurate measurement in infants. The infant should be measured in the supine position, not the prone position. Infants are generally unable to stand for a height measurement. Measurement should not be estimated because an accurate measurement is required to determine growth.

Which do nurses recognize as appropriate actions when they are communicating with families through an interpreter? Select all that apply. One, some, or all responses may be correct. Using closed-ended questions when attempting to elicit the patient's feelings Refraining from interrupting family members and the interpreter while they are conversing Using different interpreters with the same family as a means of validating the accuracy of information Being aware that cultural differences may exist with regard to views on sex, marriage, and pregnancy Explaining to the interpreter the reason for the interview and listing the types of questions that will be asked

Refraining from interrupting family members and the interpreter while they are conversing. Being aware that cultural differences may exist with regard to views on sex, marriage, and pregnancy. Explaining to the interpreter the reason for the interview and listing the types of questions that will be asked. When using an interpreter, it is important for the nurse to refrain from interrupting family members and the interpreter while they are conversing, explaining to the interpreter the reason for the interview and what types of questions will be asked, and being aware that cultural differences may exist regarding views on sex, marriage, and pregnancy. Open-ended questions, not closed-ended ones, should be used to elicit the patient's feelings. It is not appropriate for the nurse to use different interpreters with the same family; rather, the same interpreter should be used on subsequent visits whenever possible.

While performing an assessment of children in an orphanage, the nurse diagnoses that a child has manifestations of excessive niacin. Which finding does the nurse identify in the child? Dry and rough skin Scaly dermatitis Seborrheic dermatitis Depigmentation

Seborrheic dermatitis An excess of niacin causes seborrheic dermatitis. Deficiency of vitamin A causes dry and rough skin. Deficiency of riboflavin causes scaly dermatitis. Depigmentation is a finding of excess vitamin A, protein, and calories.

A nurse is obtaining a health history of an adolescent patient. Which is a component of the health history? Select all that apply. One, some, or all responses may be correct. Sexual history Review of systems Physical assessment Growth measurements Family medical history

Sexual history Review of systems Family medical history Sexual history, review of systems, and review of family medical history are all components of the health history. Physical assessment is a component of the physical examination, as are growth measurements.

Which is one of the best estimates of adequate hydration and nutrition in a child? Skin color Skin turgor Skin texture Skin temperature

Skin turgor Skin turgor or elasticity is one of the best estimates of adequate hydration and nutrition in a child. Skin color is not the most helpful way to determine a child's level of hydration/nutrition. Skin texture will help reveal whether the child has oily or dry skin. Skin temperature is helpful in determining the child's level of comfort rather than hydration or nutrition status.

Which is the most common test of visual acuity in children beyond infancy? HOTV Tumbling E Photoscreening Snellen letter chart

Snellen letter chart The Snellen letter chart is the most common test of visual acuity in children beyond infancy. The HOTV test is a wall chart composed of the letters H, O, T, and V. The child is given a board with a large H, O, T, and V; the examiner points to the letter on the wall chart, and the child matches the correct letter on the board by holding it up with a hand. The tumbling E is used to assess visual acuity in children who cannot read letters or numbers. Photoscreening is a technique used to screen for amblyopia, refractive disorders, and media opacities.

Which creative communication technique involves using the language of children to probe areas of their thinking while bypassing conscious inhibitions or fears? Storytelling Facilitative response Sentence completion Third-person technique

Storytelling Storytelling is a creative communication technique that nurses can use with children. The language of children is used to probe areas of their thinking while bypassing their conscious inhibitions or fears. The simplest technique is asking a child to relate a story about an event, such as "being in the hospital." In facilitative response, the nurse listens carefully and reflects back to the patient the feelings and content of the child's statements. In sentence completion, the nurse presents a partial statement and has the child complete it. In third-person technique, a feeling is expressed in terms of a third person.

The nurse is teaching about techniques for maintaining good oral hygiene to children at a primary health care center. The nurse asks the children to describe a picture in which a child eats lot of chocolates and develops cavities. Which technique does this indicate? Sentence completion Bibliotherapy Storytelling Mutual storytelling

Storytelling The nurse should follow appropriate techniques while teaching children. In the storytelling technique, the nurse asks the child to describe a picture, which helps children learn by analyzing and thinking. In sentence completion, children are given partial sentences such as "The best thing." The children are asked to complete the sentence by filling in the blanks. It helps the nurse understand the children's feelings. In the bibliotherapy method, children are given a storybook to read, which helps the nurse assess the cognitive development in the children. In mutual storytelling, children are encouraged to tell a story, which helps the nurse identify children's perceptions.

A nurse needs to assess a young child's blood pressure. Which is a developmentally appropriate way for the nurse to prepare the child for the procedure? Telling the child, "I'm going to squeeze the bulb really tightly and then release it." Telling the child, "You may feel a little pressure in your arm when the cuff inflates." Telling the child, "It's just a procedure that your doctor ordered. I promise that it won't hurt." Telling the child, "Squeezing the bulb pushes air into the cuff and makes the silver in the tube go up."

Telling the child, "Squeezing the bulb pushes air into the cuff and makes the silver in the tube go up." The most developmentally appropriate way to prepare the young child for blood pressure procedure is to show and tell the child, "Squeezing the bulb pushes air into the cuff and makes the silver in the tube go up." Saying "I'm going to squeeze the bulb really tightly and then release it" may frighten the child. Saying "You may feel a little pressure in your arm when the cuff inflates" is not developmentally appropriate because the child will not understand the word inflates. Saying to the child "It's just a procedure that your doctor ordered. I promise that it won't hurt" is not an appropriate way to prepare the child for the procedure; this response does not explain the procedure.

At which age would the nurse expect the anterior fontanel to fuse?

The anterior fontanel fuses between 12 and 18 months of life. The posterior fontanel closes by the second month of life.

While assessing a child, the nurse finds that the child's hair is stringy, dry, and depigmented. Which does the nurse conclude from this finding? The child is normotensive. The child has poor nutrition. The child has cerebral hypoperfusion. The child has ecchymosis.

The child has poor nutrition. The quality and texture of hair help the nurse to determine the state of nutrition. Hair that is stringy, dry, brittle, and depigmented indicates that the child gets poor nutrition. Normotensiveness is an indication that the child's blood pressure is below the 90th percentile. Cerebral hypoperfusion is decreased blood flow to the brain. Ecchymosis is the presence of large, diffuse areas caused by hemorrhage of blood into skin.

The nurse is assessing skin turgor in a child. The nurse grasps the skin of the abdomen between the thumb and index finger, pulls it taut, and quickly releases it. The tissue remains suspended, or tented, for a few seconds and then slowly falls back on the abdomen. The nurse, drawing on knowledge of the assessment of skin turgor, interprets this finding to indicate what? The child is properly hydrated. The child has poor skin turgor. The tissue shows normal elasticity. The assessment is done incorrectly.

The child has poor skin turgor. Tenting is the term for an indication of poor skin turgor. In normal elasticity, the skin returns immediately to its original position. If the child is properly hydrated, the skin is elastic. The correct way to assess turgor is to grasp the skin of the abdomen between the thumb and index finger, pull it taut, and quickly release it.

While performing a mental health assessment of a child, the nurse asks the child to draw a family picture on a piece of paper. The nurse notices that the child has drawn a small picture of the parents with large limbs at one corner of the page with broken wavering lines. Which does the nurse infer from the child's drawing? Select all that apply. One, some, or all responses may be correct. The child is depressed. The child is aggressive. The child has feelings of guilt. The child has feelings of insecurity. The child is extremely happy.

The child is aggressive. The child has feelings of insecurity. Drawing is an efficient means of nonverbal communication through which the perception and feelings of a child can be assessed. The nurse is able to properly evaluate the drawing to identify the behavior and mental health of the child. A picture drawn with large hands and legs is a sign of aggression. The picture drawn by the child is very small, in one corner of the page. This indicates that the child has feelings of insecurity. Small hands indicate depression. Hidden hands in the picture indicate guilty feelings. A picture with bright flowers and colors indicates that the patient is happy.

The nurse is assessing a 3-year-old African American child who is being seen in the clinic for the first time. The child's height and weight are in the 20th percentile on the commonly used growth chart from the National Center for Health Statistics. When interpreting the data, which does the nurse recognize? The child's growth is within normal limits. The child's growth is not within normal limits. The growth chart is not accurate for African American children. The growth chart is not useful until several measurements have been plotted over time.

The child's growth is within normal limits. The growth charts are population based and include all children without regard to race or ethnicity. A child's growth within the 20th percentile is in the normal range. Children from different ethnic and racial groups are included, making the growth chart representative of all groups. The growth chart is useful both for screening and for assessment over time.

Which is the most appropriate way for the nurse to ensure correct measurement of the brachial artery blood pressure? The stethoscope bell should be placed over the radial artery pulse. The cuff bladder length should cover 50% of the arm circumference. Blood pressure should be measured with the cubital fossa below heart level. The cuff bladder width should be 40% of the circumference of the upper arm.

The cuff bladder width should be 40% of the circumference of the upper arm. A properly sized cuff has a bladder width approximately 40% of the circumference of the arm measured at a point midway between olecranon and acromion. The stethoscope bell should be placed over the brachial artery pulse, rather than the radial artery pulse. The cuff bladder length should cover 80% to 100%, rather than 50%, of arm circumference. Blood pressure should be measured with the cubital fossa at heart level, rather than below heart level.

The primary health care provider instructed the nurse to give anticipatory guidance to an infant's parents. Which anticipatory guidance does the nurse provide to the parents to prevent anxiety while taking care of the infant? Select all that apply. One, some, or all responses may be correct. The nurse advises the infant's parents about the identified needs. The nurse informs the infant's parents about support groups. The nurse advises the parents to reserve adequate financial resources for optimal care. The nurse advises the parents on the needs indicated only by the primary health care provider. The nurse motivates the parents to provide competent and effective care.

The nurse advises the infant's parents about the identified needs. The nurse informs the infant's parents about support groups. The nurse motivates the parents to provide competent and effective care. The nurse provides anticipatory guidance for the infant's parents to avoid anxiety and stress. The nurse considers a few factors when providing anticipatory guidance. The nurse gives advice on the needs indicated by the infant's parents, which helps the infant's parents have complete information and discuss all the questions. The nurse informs the parents about support groups from which they can access financial help. The nurse considers the infant's parents to be competent to provide effective care to the child, which helps enhance the self-esteem of the infant's parents. Taking care of the infant is not too expensive, and thus the nurse does not ask the parents to reserve adequate financial resources. The nurse avoids giving advice based only on the needs indicated by the primary health care provider. Parents may not share some of their questions with the primary health care provider.

While visiting the home of a patient, a nurse interacts with the child's parents to assess the physical and mental health of the child. Which interviewing strategy does the nurse implement during the assessment? The nurse refrains from asking questions of the child during the assessment. The nurse asks the name of each family member and interacts with them. The nurse records the first names of the parents and the child on the medical record. The nurse asks the parents to engage the child by turning on the television.

The nurse asks the name of each family member and interacts with them. While assessing the physical and mental health of the child, the nurse interacts with all the family members present during the assessment. The nurse first gives a self-introduction. Following this, the nurse asks the name of each family member and addresses them with appropriate titles, such as "Mr." and "Mrs." The nurse interacts with the child and asks questions. The nurse records the preferred name of the patient and the child's parents in the medical record instead of the first names, which helps the nurse build a rapport for effective communication. The nurse suggests that the parents switch off the television, radio, and cell phone during assessment. The child must be engaged by having toys to play with instead, which helps the parents concentrate and give complete information during the assessment.

The nurse is performing an assessment of a neonate. Which body site does the nurse choose to safely and accurately obtain a neonate's temperature? The nurse places the tip of the thermometer under the tongue. The nurse places the tip of the thermometer in the axilla. The nurse places the tip of the thermometer on the tongue. The nurse places the tip of the thermometer into the ear.

The nurse places the tip of the thermometer in the axilla. Axillary and rectal routes are usually recommended to assess body temperature in children up to 2 years of age. The nurse places the tip of the thermometer in the axilla. The oral route is not recommended for neonates; it is used for measuring temperature in children more than 2 years of age. To measure body temperature through the oral route, the nurse places the tip of the thermometer under the tongue. The nurse does not place the thermometer on the tongue because it does not help in recording the temperature. Because the ear canal in neonates has a smaller diameter, inserting the thermometer in the ear can be painful to the child. Therefore it is not used for measuring body temperature in neonates.

The nurse is caring for an adolescent patient with measles. Which action does the nurse follow for effective communication while interacting with the patient? The nurse remains silent and just listens to the patient. The nurse restates the statement made by the patient. The nurse advises the patient to take measures to maintain personal hygiene. The nurse maintains extended eye contact with the patient.

The nurse remains silent and just listens to the patient. The nurse should be cautious while interacting with adolescent patients because they fluctuate between the behavioral patterns of adults and children. While interacting with a child with measles, the nurse should remain silent and just listen to the patient for effective communication, which helps the nurse to know the patient's perceptions and feelings. The nurse should not restate the statement made by the patient because the patient may feel criticized and become irritated. The nurse should not advise the patient to maintain good hygiene habits because the patient may feel judged. The nurse should not maintain extended eye contact because it can threaten the patient and give an impression of anger.

The nurse is performing an assessment of the mental and physical health of a child at a community health center. The nurse finds that the child is very shy and avoids interacting with the nurse. Which action does the nurse follow for effective interaction with the child during the assessment? The nurse smiles broadly at the child during the assessment. The nurse asks the parents to wait outside the assessment room. The nurse uses short sentences while interacting with the child. The nurse refrains from giving directions to the child during the assessment.

The nurse uses short sentences while interacting with the child. The nurse follows appropriate techniques for effective communication while interacting with the child, which helps identify the child's condition and needs and facilitates better provision of care. The nurse uses simple language and short sentences while interacting with children, which helps children understand what the nurse is asking or conveying to them. The nurse avoids using a broad smile because it can threaten the child. If the child is shy and is not interacting, the nurse will initially talk to the parent until the child feels comfortable. Asking the parents to wait outside the assessment room is not appropriate. The child may feel threatened by the absence of the parents. The nurse gives directions and positive suggestions to the child while interacting.

The nurse is interviewing the parent of a 6-year-old child who has a behavior problem. The parent says, "Of course there is nothing to worry about. It is just once in a while that I see that the child's bed is wet in the morning. It will wear off with age." What can be concluded from the parent's communication? The parent is not worried about the child. The parent is actually anxious about the child. The parent is lying about the child's condition. The parent wants to hide some other behavior.

The parent is actually anxious about the child. Repetition of certain words or an emphasis on something by the interviewee is an indication that the parent is anxious about the child. Concerns and anxieties are also sometimes expressed in a casual manner, even though the parent is really worried. The nurse should not interpret the parent's remarks as lying or hiding the child's behavior but instead should consider them as evidence of the parent's genuine anxiety about the child.

The nurse is caring for a preschooler, and the mother asks the nurse how many calories the child should consume each day. Which is the best response to this mother's question? The average daily intake by preschoolers should be about 1000 calories. The quality of food consumed by the child is more important than the quantity. Nutritional requirements for preschoolers are very different from those of toddlers. The caloric requirement per unit of body weight increases slightly during the preschool period.

The quality of food consumed by the child is more important than the quantity. Telling the mother that the quality of food consumed is more important than the quantity is the best response that the nurse could offer. Average intake is about 1800 calories each day. Requirements for preschoolers and toddlers are similar. The caloric requirement per unit of body weight slightly decreases, rather than increases, during the preschool period.

The nurse manager observes that a nurse is teaching a child's parents about the dietary requirements for managing protein energy malnutrition (PEM). After the teaching, the nurse manager says to the nurse, "It looked to me like the child's parents were feeling overwhelmed with your teaching." Which sign did the nurse manager observe in the child's parents to support this conclusion? Select all that apply. One, some, or all responses may be correct. They asked the nurse many questions. They were silent for a long period of time. They looked at the clock frequently. They maintained eye contact with the nurse. Their facial expressions were fixed.

They were silent for a long period of time. They looked at the clock frequently. Their facial expressions were fixed. While interacting with patients and their guardians, the nurse continually assesses the situation to determine that appropriate information is being provided. Giving too much information can cause information overload. The nurse keeps the teaching simple and concise. Remaining silent for a long period of time indicates information overload. Frequently looking at the clock and having an expressionless face indicates that listeners are getting impatient or bored, which are signs of information overload. Asking many questions indicates that the parents are concerned and actively participating in the discussion. Listeners who lose interest are unlikely to maintain eye contact.

Which test is used to assess visual acuity in children ages 3 to 5 years? Select all that apply. One, some or all responses may be correct. Tumbling E Bruckner test Snellen letters Snellen numbers Ophthalmoscope

Tumbling E Snellen letters Snellen numbers The "tumbling E" and Snellen letters and numbers are recommended tests for assessing visual acuity in children between 3 and 5 years of age. The Bruckner test is used to test for ocular alignment. The ophthalmoscope is used to inspect the internal structures of the eye and red reflex.

Parents of a school-age child with rheumatoid arthritis inform the nurse, "My child has stopped interacting with others, refrains from eating, and is unable to sleep because of the pain." Which would be the best nursing intervention to determine the severity of the child's pain? Use the FACES pain scale. Ask the child what the pain feels like. Ask the parents where the pain is located. Confer with the health care provider about the pain.

Use the FACES pain scale. Severity is best determined by finding out how it affects a child's usual behavior. Pain may interfere with a child's routines such as interacting with others, eating, and sleeping. To assess pain intensity further, the nurse uses the FACES scale to analyze the severity of pain. It is important to ask the child what the pain feels like, but that only determines the type of pain. Because pain is subjective, it would not be appropriate to ask the parents about the child's level of pain. Conferring with the health care provider is important in determining how to treat the pain, but it will not determine the severity.