Ch 13 Health Problems of Toddlers & Preschoolers

A toddler has developed lead poisoning. During the assessment the nurse learns that the toddler has a peanut allergy. The nurse is ordered to administer British antilewisite to the patient. What is the appropriate nursing action in this situation? 1 Question the order of British antilewisite. 2 Administer British antilewisite in a high dose. 3 Administer flumazenil to the patient. 4 Avoid administration of British antilewisite with EDTA.

1 British antilewisite should not be administered to a patient who has a peanut allergy, because this may lead to complications. It should not be administered in high doses, because this can prove fatal. Flumazenil is not helpful in this condition. Flumazenil is an antidote for benzodiazepines. British antilewisite administration is contraindicated in this patient. It is always administered in conjunction with EDTA.

What are some warning signs of physical abuse in children? Select all that apply. 1 Multiple fractures 2 Delay in seeking medical care 3 Similar histories given by different caregivers 4 Inappropriate affect in relation to the child's injury 5 History incompatible with the pattern or degree of injury

1, 2, 4, 5 Warning signs of physical abuse in children include multiple fractures, delay in seeking medical care, inappropriate affect in relation to the injury, and incompatible history with the pattern or degree or injury. Histories are similar among caregivers, not inconsistent.

A child who ate chips of old paint at an ancestral house developed acute abdominal pain and seizures. The child is treated with intravenous ethylenediaminetetraacetic acid (EDTA). What should the nurse monitor in this child? 1 Lipid profile 2 Cardiac function 3 Lung function 4 Renal function

4 (I guessed 3) The clinical presentation and history of the child show that the child is suffering from lead poisoning. Lead and EDTA are toxic to the kidneys; therefore, the nurse must keep records of intake and output and send the child's urine for urinalysis. The urinalysis results should be monitored closely to detect any change in renal functioning. Monitoring of lipid profile, cardiac function, and lung function is not required, because lead and EDTA do not cause related toxicities.

The mother of a 4-year-old explains to the nurse that her child frequently shouts while asleep, thrashing in the bed, and is unaware that she has entered the room. The child will return to sleep without incident and is unaware the next day that this has occurred. What does the nurse suspect the toddler is experiencing? 1 Enuresis 2 Nightmares 3 Night terrors 4 Narcolepsy

3 Children who experience night terrors do not recall thrashing or yelling and are usually unaware of the presence of another person. Enuresis is bed-wetting. Nightmares are generally recalled by the child after they are over and represent a real fear. Children who experience nightmares are often aware of and reassured by the presence of another person. Narcolepsy is a sleep disorder characterized by extreme daytime sleepiness.

The nurse received a call from the mother of a 2-year-old who had just been bitten by the neighbor's dog. Which piece of the nurse's advice to the mother is the priority? 1 Seek medical attention immediately. 2 Advise the mother to cover the bite. 3 Advise the mother to administer an antihistamine. 4 Wash the bite with antibacterial soap.

1 Medical evaluation is advised because of the danger of tetanus and rabies, although dogs in most residential areas must be immunized against rabies. A dressing would be applied after wound care has been provided by medical personnel. An antihistamine is not necessary unless the child is having an allergic reaction. The child needs the wound cleansed with normal saline or lactated ringers to irrigate the wound and remove any bacteria.

The nurse is teaching the parents of a child with a first-degree burn. The nurse should include which statement in the teaching? 1 "First-degree burns include the top layer of skin." 2 "First-degree burns do not cause pain sensations." 3 "First-degree burns will include blisters on the skin." 4 "First-degree burns expose muscle and bone."

1 Superficial (first-degree) burns are usually of minor significance, involving the epidermal layer only. Pain is the predominant symptom, but there will be no blisters or exposed muscle and bone.

The nurse is caring for a toddler who has inhaled carbon monoxide. Which intervention is the nurse's priority of care? 1 50% oxygen via nasal cannula 2 Maintaining airway patency 3 Administration of surfactant 4 Administration of morphine sulfate

2 To treat carbon monoxide poisoning, the patient first needs a patent airway. After that, 100% oxygen and surfactant can be administered. Morphine sulfate is used to manage pain.

The nurse is caring for a toddler with a diagnosis of accidental poisoning. What should the nurse prioritize in teaching parents to protect the child from accidental poisoning in the future? 1 Keep all cleaning solutions locked up. 2 Never leave the toddler alone. 3 Label all chemical agents in the home. 4 Place chemical agents in clear bottles.

1 Cleaning solutions can be harmful if ingested and should be locked up. Although it is important to supervise a toddler as much as possible; it is unrealistic to do so at all times. Labeling chemical agents in the home will not help, because the child cannot yet read. Placing chemical agents in clear bottles will not deter a child from exploring them.

Which statement about young children who report sexual abuse by a parent is correct? 1 In most cases, the child has fabricated the story. 2 They may exhibit various behavioral manifestations. 3 Their stories are not believed unless other evidence is apparent. 4 They should be able to retell the story the same way to another person.

2 There is no diagnostic profile of the child who is being sexually abused. Many different behavioral manifestations may be exhibited, from outward sexual behaviors with others to withdrawal and introversion. It is never appropriate to assume that a child has fabricated the story of sexual abuse. Adults are reluctant to believe children, and sexual abuse often goes unreported. Physical examination is normal in approximately 80% of abused children. The child will usually try to protect the parents and may accept responsibility for the act.

The nurse is teaching parents about lead poisoning. The nurse should warn the parents about which sources of lead? Select all that apply. (p. 414) 1 Lead-based paint 2 Vinyl mini-blinds 3 Mercury thermometers 4 Battery casings 5 Sunscreen

1, 2, 4 (I put 1 & 2) Although there are numerous sources of lead, in most instances of acute childhood lead poisoning, the source is nonintact lead-based paint in an older home. Vinyl mini-blinds and battery casings also contain lead. The mercury in glass thermometers is a dangerous substance but does not contain lead. Sunscreen is not a source of lead.

The nurse is providing education to parents of toddlers regarding sleep hygiene. Which should the nurse include in this teaching? Select all that apply. (p. 393) 1 Develop a bedtime ritual. 2 Allow the child to watch television in the bedroom. 3 Leave a cup of soda by the bed at night. 4 Provide a favorite toy with which to sleep. 5 Do not let the child nap during the day.

1, 4 (I put 1, 4, 5) A bedtime ritual and a favorite toy with which to sleep can promote good sleep hygiene for toddlers. TV before bed can disrupt sleep, as can sugar from soda. Toddlers should be allowed to nap during the day.

The emergency room nurse is caring for an unconscious toddler after an accidental poisoning. Which intervention is the nurse's priority? 1 Administer a chelating agent. 2 Establish a patent airway. 3 Initiate intravenous (IV) access. 4 Administer prophylactic antibiotics.

2 The most important intervention at this time is cardiorespiratory function; therefore, the priority is establishing an airway. Depending on the type of poisonous agent, a chelating agent may be required, but there is no documentation yet as to the type of poisoning. IV access will also be required, but respiratory status is the priority. Prophylactic antibiotics are not the standard of care for poisoning.

The nurse is providing education about accidental poisonings to a group of parents. Which intervention should the nurse tell parents is the priority? 1 Induce vomiting. 2 Call the physician's office. 3 Administer an emetic. 4 Call the Poison Control Center.

4 A poisoning may or may not require emergency intervention, but in every instance, medical evaluation is necessary to initiate appropriate action. Parents should call the Poison Control Center before initiating any intervention. Inducing vomiting may not be necessary. The Poison Control Center will be better able to instruct the parents than will the physician's office. Administering an emetic may not be necessary.

The nurse is caring for a 3-year-old patient who is the victim of a house fire. The patient has burns to the face, head, and neck. The nurse should prioritize which assessment for this patient? 1 Nutritional 2 Cardiac 3 Respiratory 4 Neurologic

3 The primary emphasis during the emergent phase is the treatment of burn shock and the management of pulmonary status since respiratory obstruction poses the biggest threat to the patient's life. Monitoring vital signs, output, fluid infusion, and respiratory parameters are ongoing activities in the hours immediately after injury. Following assessment of the patient's airway, the nurse can assess the patient's nutritional, cardiac, and neurologic statuses.

What are some warning signs of child abuse? Select all that apply. 1 A delay in seeking medical care 2 Physical evidence of old injuries 3 A parent who comforts the injured child 4 Significant trauma found in a child with a minor unrelated complaint 5 A reported mechanism of injury that is not possible at the child's stage of development

1, 2, 4, 5 Warning signs of child abuse include a delay in seeking medical care; physical evidence of old injuries; the discovery of significant trauma in a child brought in with a minor, unrelated complaint; and a reported mechanism of injury that is not possible at the child's level of development. Parents who abuse their children tend to be unwilling or uncomfortable comforting their children.

The nurse is teaching the parents of a child with a third-degree burn. Which statement will the nurse include in the teaching? 1 "Third-degree burns include only the epidermal layer." 2 "Third-degree burns do not cause pain sensations." 3 "Third-degree burns will have blisters on the skin." 4 "Third-degree burns expose muscle and bone."

2 Full-thickness (third-degree) burns are serious injuries that involve the entire epidermis and dermis and extend into subcutaneous tissue. Nerve endings, sweat glands, and hair follicles are destroyed, so pain in the wound itself is minimal. First-degree burns include only the epidermis. Second-degree burns include blisters, and fourth-degree burns expose muscle and bone.

The nurse is screening children at a community health care center to detect possible metal poisoning. Part of the screening process includes asking the parents what year the house was built. The parents state that their house was built in 1960. Based on this information, for which metal should the nurse test the child? 1 Fe (iron) 2 Pb (lead) 3 Cu (copper) 4 Hg (mercury)

2 Lead-based paint in an old home is one of the sources of lead poisoning. Children living in old houses have an increased risk of developing lead poisoning. Old houses are generally not considered to be an important source of iron, copper, or mercury toxicity because these substances are not used in building materials.

The nurse is explaining to the parents of a 2-year-old burned in a house fire how the severity of the burn is calculated. How does the medical team determine the severity of a burn? 1 The percentage of body surface area 2 Measurements of each burn 3 The development of sepsis for each burn 4 The locations of each burn

1 The physiological responses, treatment modalities, prognosis, and disposition of the injured child are all directly related to the amount of tissue destroyed. Therefore, the severity of the burn injury is assessed on the basis of the percentage of total body surface area burned and the depth of the burn. Measurements of each burn on their own are not enough to determine severity. Sepsis does not necessarily develop right away. The locations of each burn may determine the treatment plan but not the severity.

A mother calls the emergency room (ER) stating that her 4-year-old child has been bitten by a bat. Which instruction is the priority? 1 Bring the child to the ER. 2 Clean the wound with peroxide and water. 3 Call animal control to come to the home. 4 Apply antibiotic ointment to the affected area.

1 In the case of a bat bite, medical evaluation is advised because of the danger of tetanus and rabies. Once the wound has been assessed, the nurse can clean it with saline or lactated Ringer solution. Calling animal control does not help the child. Once the wound is assessed, the medical team can determine if antibiotic treatment is necessary.

The nurse finds that the parents of an infant are not able to console their baby. The nurse learns that the baby keeps crying for long hours and the parents sometimes shake the baby vigorously in frustration. What should the nurse teach the parents? 1 Shaking the baby may lead to permanent brain injuries in the baby. 2 Shaking is very therapeutic and will help the baby to calm down. 3 Shaking promotes sleep in the baby and should be done more often. 4 Shaking the baby may result in Munchausen syndrome by proxy.

1 It is important for a nurse to stress to the parents that they should never shake their infant vigorously. Babies have more fluid in their brain than an adult because their head-to-body ratio is higher. Therefore, when they are shaken vigorously, their brain may rotate, causing brain injuries. Shaking the baby does not have any therapeutic effect. Shaking does not promote sleep, so it should be avoided. Munchausen syndrome by proxy is a disorder in which parents tend to exaggerate the symptoms and histories of their child.

What is the most frequent source of lead poisoning in children? 1 Lead-based paint 2 Cigarette butts and ashes 3 Folk remedies that contain lead 4 Pottery or dishes that contain lead

1 Lead-based paint in houses built before 1978 is the most common source of lead poisoning in children. Cigarette butts and ashes do not contain lead. Folk remedies that contain lead and pottery and dishes that contain lead are not the most common sources of lead poisoning in children.

What is the priority principle in treating a child who has ingested a poison? (p. 410) 1 Treat the child first, not the poison. 2 Remove the poison, then assess the child. 3 Establish what contributed to the poisoning. 4 Administer syrup of ipecac to treat a poisoning that occurs in the home.

1 The first and most important principle in dealing with a poisoning is to treat the child first, not the poison. Removing the poison first and then assessing the child is not the method of treating a poisoning. Establishing what contributed to the poisoning is not the most important principle in treating a poisoning. Ipecac is not recommended for routine poison treatment in the home.

The triage nurse is advising a parent of a toddler with a suspected chemical burn over the phone. Which should the nurse include when advising the parents what to do? (p. 399) 1 Continuously flush the burn to remove the chemical. 2 Apply a neutralizing agent to the burn. 3 Apply antibiotic ointment to the burn. 4 Cover the burn, and transport the child to the emergency room.

1 (I put 4) Chemical burns require continuous flushing with large amounts of water to remove the chemical. The use of neutralizing agents on the skin is contraindicated, because a chemical reaction is initiated and further injury may result. No attempt should be made to treat the burn. Application of topical ointments, oils, or other home remedies is contraindicated. It is important to flush the burn before transporting the child to a medical facility.

The camp nurse is checking preschool-aged children for ticks. The nurse understands that ticks can cause which disease? 1 Syphilis 2 Meningitis 3 Lyme disease 4 Ménière disease

3 Exposure to deer ticks can cause Lyme disease. Syphilis is a sexually transmitted disease and is not caused by ticks. Meningitis is an inflammation of the neurologic system caused by a number of bacterial and viral pathogens. Ménière disease is a disorder of unknown origin that causes vertigo.

The parents of a 2-year-old have brought the child in after the child crawled into the kitchen cabinet and spilled ammonia. The child has diffuse red areas all over the skin. What does the nurse suspect? 1 Allergic reaction to ammonia 2 Erythema caused by multiple spankings 3 Histamine reaction caused by possible ingestion 4 Chemical burn caused by the alkalinity of the ammonia

4 Chemical burns are seen in the pediatric population and can cause extensive injury because noxious agents exist in many cleaning products commonly found in the home. Because ammonia is toxic to the skin, it is a burn rather than an allergic reaction. There is no information to indicate the child has been spanked. If the child had ingested the ammonia, it is likely there would be gastrointestinal manifestations.

The nurse is teaching the parents of a child with a second-degree burn. The nurse should include which statement in the teaching? 1 "Second-degree burns include only the epidermal layer." 2 "Second-degree burns do not cause pain sensations." 3 "Second-degree burns will have blisters on the skin." 4 "Second-degree burns expose muscle and bone."

3 Partial-thickness (second-degree) burns are painful, moist, red, and blistered. They include both the dermis and epidermis and are painful. Fourth-degree burns expose muscle and bone.

The triage nurse is on the phone advising a parent of a toddler who fell into a fire. Which instructions will the nurse provide? Select all that apply. (p. 399) 1 Remove any burned clothing. 2 Apply a wet, cool dressing to the burn. 3 Apply antibiotic ointment to the burn. 4 Cover the burn, and transport the child to a hospital. 5 Apply aloe vera to the burned areas.

1, 4 The parents should remove any burned clothing to avoid further trauma to the skin. The burn should be covered with a clean, dry cloth to prevent contamination, decrease pain by eliminating air contact, and prevent hypothermia. Major burns with large amounts of denuded skin should not be cooled. Heat is rapidly lost from burned areas, and additional cooling leads to a drop in core body temperature and potential circulatory collapse. Wet dressings also promote vasoconstriction because of cooling, resulting in impaired circulation to the burned area and increased tissue damage. No attempt should be made to treat the burn. Application of antibiotic ointments, aloe vera, oils, or other home remedies is contraindicated.

The nurse is caring for a toddler with a burn. The nurse understands which therapy will be used to remove necrotic skin? 1 Hydrotherapy 2 Debridement 3 Allograft 4 Xenograft

2 Partial-thickness burns require debridement of devitalized tissue to promote healing. Debridement is painful and requires analgesia and a sedative before the procedure. Hydrotherapy is used to cleanse the burn and involves either showering (spraying off the burn) or immersion (soaking in a tub) at least once a day. Allograft (homograft) skin is obtained from human cadavers that are screened for communicable diseases. Allograft is particularly useful as a temporary skin covering of surgically excised deep partial- and full-thickness burns and extensive burns when available donor sites are limited. Xenograft from a variety of species, most notably pigs, is commercially available. In large burns, the porcine xenograft is commonly applied when extensive early debridement is indicated to cover a partial-thickness burn; this provides a temporary covering for the burn until an available autograft can be applied to the full-thickness areas.

The nurse is providing community education regarding childproofing a home. Which should the nurse prioritize in this teaching? 1 Keep all doors exiting the house locked. 2 Do not have family pets until the child is of school age. 3 Ensure all medications are kept inside a locked cabinet. 4 Remove protective coverings over all electrical outlets.

3 Since the 1970 enactment of the Poison Prevention Packaging Act, which requires that certain potentially hazardous drugs and household products be sold in child-resistant containers, the incidence of poisonings in children has decreased dramatically. Despite these advances, poisoning remains a significant health concern, with most cases (49% in 2011) occurring in children younger than 6 years old, so it is important to keep all medications in a locked cabinet. Locking all doors in the home is not necessary when the toddler cannot reach the handles. There is no harm in having family pets, as long as the pet and child are supervised. The parents would not remove protective covering over the outlets but would ensure that the outlets were covered.

The nurse is caring for a 3-year-old child with burns. Which finding would be suggestive of child abuse? 1 Splash patterns 2 Nonuniform patterns 3 Splatter patterns 4 Symmetrical pattern

4 Burns that are symmetrical and uniform, such as from a stocking glove or foot, are suspicious for child abuse. Splash, nonuniform, and splatter patterns are more indicative of an accident than of abuse.

The nurse is teaching the parents of a child with a fourth-degree burn. The nurse should include which statement in the teaching? 1 "Fourth-degree burns include only the epidermal layer." 2 "Fourth-degree burns do not cause pain sensations." 3 "Fourth-degree burns will have blisters on the skin." 4 "Fourth-degree burns may expose muscle and bone."

4 Fourth-degree burns are full-thickness burns that involve underlying structures, such as muscle, fascia, and bone. The wound appears dull and dry, and ligaments, tendons, and bone may be exposed. First-degree burns include only the epidermis. Third-degree burns can be painless. Second-degree burns feature blisters.

What is the best way to prevent poisoning in preschoolers? 1 Consistently using safety caps 2 Keeping ipecac syrup in the home 3 Storing poisonous substances out of reach 4 Storing poisonous substances in a locked cabinet

4 Storing poisonous substances in a locked cabinet is the best way to prevent poisoning in preschoolers. Consistent use of safety caps is helpful but not the best way to prevent poisoning in preschoolers. Keeping ipecac syrup in the home is no longer recommended. Although it is important to store poisonous substances out of reach, the best way to prevent poisoning is to store them in a locked cabinet.

A mother calls the pediatrician's after-hours line and tells the nurse that her 5-year-old child has ingested toilet-cleaning solution. The parent reports that the child is experiencing violent hemoptysis, severe burning in the mouth, drooling, and extreme agitation. What should the nurse recommend to the parent? 1 Administer activated charcoal. 2 Administer ipecac to induce vomiting. 3 Observe the child closely and call back in 1 hour. 4 Take the child to the nearest emergency department.

4 The child needs to be taken to the nearest emergency department for treatment. The parent should not observe the child closely and call back in 1 hour, because emergency treatment is indicated. The parent should not administer activated charcoal or ipecac, because induced vomiting will damage the mucosa.