Chapters 50,51,&53
to clean the discharge away from the inner to outer canthus. Preventing the infection from spreading to the other eye is important
A 10-year-old boy develops bacterial conjunctivitis of the right eye. The eye is inflamed and drains a thick, yellow discharge. An important measure you would want to teach him is: to keep his eye covered at all times. not to apply ophthalmic drops for more than 3 days. to clean the discharge away from the inner to outer canthus. not to attend school for 2 weeks.
Conjunctivitis Conjunctivitis is inflammation of the conjunctiva and is demonstrated by watery eyes with reddened conjunctiva and sensitivity to light. Sticking of eyelids with pustular drainage is also a sign. It is very contagious and requires antibiotics for treatment. Blepharitis is a chronic scaling with discharge along the eyelid margin. A stye is a localized infection of the sebaceous gland of the eyelid. A chalazion is a chronic painless infection of the meibomian gland. The stye and blepharitis will require antibiotic treatment. A chalazion will clear on its own. Most cases of pink eye are typically caused by adenovirus but can also be caused by herpes simplex virus, varicella-zoster virus, and various other viruses, including the virus that causes coronavirus disease 2019 (COVID-19).
A young child in the clinic has watery eyes and reddened conjunctiva. The child keeps the eyes closed a lot, because it hurts to have them open. Which problem does the nurse suspect for this client? Chalazion Stye Conjunctivitis Blepharitis marginalis
Apply hot, moist compresses to the affected area. The stye is an infection of a ciliary gland (a modified sweat gland) that enters the hair follicle at the lid margin, most commonly caused by Staphylococcus. Management of the stye includes the use of hot, moist compresses. Manual expression is not indicated. Petroleum jelly will not be appropriate nor will it reduce inflammation. Cool, dry compresses will not be therapeutic. Heat provides for vasodilation, which will be useful in the resolution of the inflammation.
The 12-year-old child has developed a stye. Which may be included in the child's care? Apply hot, moist compresses to the affected area. Manually express the lesion when a head forms. Apply petroleum jelly to reduce irritation. Apply cool, dry compresses to the affected area.
modify her physical exercise program. Children with arthritis should be encouraged to maintain a school program that is as near to normal as possible; this will help maintain self-esteem. Some physical activities may need to be modified because of pain or joint contractures. She needs to participate in activities; an earlier start is not a good change and swimming might be one of the best activities to consider.
The physician of a child with juvenile idiopathic arthritis asks the nurse to telephone the school to arrange a new activity program for her. A change the nurse would anticipate arranging for the child is to: be excused from all extracurricular activities. begin school earlier in the day than other children. be excused from all swimming classes. modify her physical exercise program.
"Keep in mind that the signs of leukemia are often subtle and difficult to recognize." Pointing out that the signs and symptoms of leukemia are often difficult to recognize indicates to the parents that they were not neglectful, while also providing information about the disease. The other responses minimize the parents' feelings or tell them how they should feel and are not therapeutic.
What is the best response by the nurse to the parents of a child with leukemia who express guilt because they did not take immediate action when their child seemed to develop one respiratory infection after another? "Don't feel bad. Children get lots of colds." "Young children develop minor illness easily and often. Stop being hard on yourselves." "Keep in mind that the signs of leukemia are often subtle and difficult to recognize." "You need to focus on the present treatment now and not worry about the past."
Bracing For spinal curvatures of 25 to 40 degrees, the usual treatment is bracing. Curvatures greater than 40 degrees may be treated with traction or spinal instrumentation and fusion. Exercise may be implemented for very mild curvatures to strengthen the back muscles.
A 12-year-old female client has been diagnosed with scoliosis with a curvature of 30 degrees. What type of treatment would the nurse anticipate being started on this client? Traction Exercise Surgery Bracing
Lungs Metastasis occurs early with bone tumors because of the extensive vascular system in bones. Metastasis to the lungs is very common; as many as 25% of adolescents will have lung metastasis already by the time of initial diagnosis. When this is present, the adolescent usually has noticed a chronic cough, dyspnea, and chest pain in addition to chronic leg pain. Other common sites of metastasis are brain and other bone tissue.
A 15-year-old boy has been diagnosed with an osteosarcoma of the distal femur. He also demonstrates a chronic cough, dyspnea, and chest pain, along with chronic leg pain. Based on these findings, the nurse should suspect metastasis to which body area? Lungs Heart Brain Rib cage
swelling and point tenderness Findings associated with osteomyelitis include swelling, point tenderness, warmth over the site, decreased range of motion, and an elevated sedimentation rate.
A nurse is assessing a child with suspected osteomyelitis. Which finding would help support this suspicion? swelling and point tenderness decreased erythrocyte sedimentation rate coolness of the affected site increased range of motion
Administer the antiemetic before starting chemotherapy Antiemetics are most effective when given before chemotherapy begins and then on a regular schedule to prevent nausea and vomiting throughout administration of chemotherapy. Nonpharmacologic measures can be used in conjunction with antiemetics but not in place of them.
Antiemetics are ordered to control nausea and vomiting in the child undergoing chemotherapy. How can the nurse most effectively use these medications? Administer the antiemetic before starting chemotherapy Provide the antiemetic as needed (PRN) when nausea and vomiting are reported Use the antiemetic after it is clear that nonpharmacologic methods are not effective Start the antiemetic on a scheduled basis when the chemotherapy begins to cause nausea
minerals Minerals such as calcium, phosphorus, magnesium, and fluoride are stored in the bones.
In understanding the physiology of the musculoskeletal system, the nurse recognizes that which of the following are stored in the bones? vitamins minerals spinal fluid cartilage
Leukemia Although Wilms tumor, brain stem tumors, and non-Hodgkin lymphoma can occur in children, the most frequent type of cancer in children is leukemia.
Nursing students are reviewing information about childhood cancers. They demonstrate understanding of the information when they identify what as the most frequent type? Wilms tumor Leukemia Brain stem tumor Non-Hodgkin lymphoma
Vaccination for the human papillomavirus Reminding parents that both boys and girls should receive the vaccine against human papillomavirus (HPV) is an important preventive measure to reduce the incidence of cervical cancer. Smoking is associated with lung cancer, and sunburn (from lack of sunscreen or other protection from the sun) is associated with skin cancer. Consumption of animal fats is not associated with cervical cancer.
The mother of a 13-year-old adolescent is concerned about her daughter getting cervical cancer later in life and asks the nurse if there are any ways to reduce the risk. Which would the nurse recommend? Vaccination for the human papillomavirus Urging the daughter to not begin smoking Insist that the daughter wear SPF 30 sunscreen while outside A diet free from animal fats
prevent edema. Edema tends to be dependent. Elevating the arm, therefore, would reduce swelling from the injury. Elevation of the arm would not promote healing or discourage infection. The cast will maintain proper bone alignment.
The nurse is caring for a child with a broken wrist that has just been placed in a cast. The nurse would elevate the arm to: promote healing. prevent edema. discourage infection. ensure proper bone alignment.
"At least when I take a shower I have a few minutes out of this brace." The treatment for scoliosis is aimed at preventing progression of the curve and decreasing the impact on the pulmonary and cardiac function. For curves 25-40 degrees the recommended treatment is bracing. The brace must be worn 23 hours per day. The child needs to be taught that the brace must be worn at all times, during the day as well as the night. Compliance, especially with adolescents, is difficult due to peer pressure. The other issues with compliance include being hot and being uncomfortable.
The nurse is doing client teaching with a child who has been placed in a brace to treat scoliosis. Which statement made by the child indicates an understanding of the treatment? "At least when I take a shower I have a few minutes out of this brace." "I am so glad I can take this brace off for the school dance." Wearing this brace only during the night will not be so embarrassing." "When I start feeling tired, I can just take my brace off for a few minutes."
epiphyseal plate. The growth plate, also known as the epiphyseal plate is a thin layer of cartilage that lies between the epiphyses and metaphyses, and is where the growth of long bones takes place.Fractures in the area of the epiphyseal plate (growth plate) can cause permanent damage and severely impair growth.
The nurse is educating a group of caregivers about fractures seen in children. One of the caregivers states, "I have heard that if a bone breaks it can cause permanent damage and stop the growth of the bone." This statement is accurate if the break occurs in the: humerus. joint. xiphoid process. epiphyseal plate.
Greenstick Greenstick fractures are one kind of incomplete fracture, caused by incomplete ossification, common in children. The bone bends and often just partially breaks. Spiral fractures are seen when the fracture goes around the bone instead of through (i.e., looks like someone twisted the bone, and can occur in skiing injuries, falls, or abuse). A complete fracture is when the bone is actually broken in two pieces. An epiphyseal fracture occurs at the epiphyseal growth plate.
The type of fracture often seen in young children is one in which there is not complete ossification of the bone, and the bone bends and just partially breaks. What type of fracture is this? Greenstick Spiral Complete Epiphyseal
Wearing ear plugs when swimming To prevent external otitis, the nurse would teach parents and children to wear earplugs when swimming and to avoid use of cotton swabs, headphones, and earphones. A hair dryer on a low setting can be used to dry the ear canals. A mixture of half rubbing alcohol and half vinegar can be used to dry the canal and alter the pH to discourage organism growth.
What would the nurse include when teaching parents how to prevent external otitis (acute otitis externa or swimmer's ear)? Daily ear cleaning with cotton swabs Wearing ear plugs when swimming Using a hair dryer on high to dry the ear canals Using hydrogen peroxide to dry the canal skin
Teach the client not to rest with the crutch pad pressing on the axilla. Pressure of a crutch against the axilla could lead to compression and damage of the brachial nerve plexus crossing the axilla, resulting in permanent nerve palsy. Teach children not to rest with the crutch pad pressing on the axilla but always to support their weight at the hand grip. Always assess the tips of crutches to be certain the rubber tip is intact and not worn through as the tip prevents the crutch from slipping. Be certain the child is walking with the crutches placed about 6 inches to the side of the foot. This distance furnishes a wide, balanced base for support. Caution parents to clear articles such as throw rugs, small footstools or toys out of paths at home, to avoid tripping the child.
A 14-year-old girl with a fractured leg is receiving instructions from the nurse on how to use crutches. Which intervention should the nurse implement to help prevent nerve palsy in the client? Teach the client not to rest with the crutch pad pressing on the axilla. Assess the tips of the crutches to be certain the rubber tip is intact. Be certain the child is walking with the crutches about 6 inches to the side of the foot. Caution parents to clear articles such as throw rugs out of paths at home.
maintaining intravenous antibiotic therapy Osteomyelitis is a serious bacterial infection. It is treated vigorously with intravenous antibiotics. It would not require traction. The stem does not indicate the location of the infection, so the child may not need crutches. Fluid restriction does not help red blood cell production.
A 2-year-old is diagnosed with osteomyelitis. Which of the following would you anticipate as a primary nursing intervention to include in the child's plan of care? maintaining intravenous antibiotic therapy keeping the child quiet while in skeletal traction restricting fluid to encourage red cell production assisting the child with crutch walking
Regulate the rate of IV fluid infusions carefully Be certain to regulate the rate of IV fluid infusions carefully because an increase in the infusion rate has the potential to increase intracranial pressure. The other answers refer to other interventions, unrelated to intracranial pressure.
A nurse is caring for a 12-year-old girl who is recovering from surgery for removal of a brain tumor. Which intervention should the nurse implement to avoid increasing intracranial pressure? Regulate the rate of IV fluid infusions carefully Place a sterile towel under wet dressings Sponge the client's face Apply saline eye drops, as prescribed
Relieving the child's pain Acute otitis media is caused by a bacterial or viral infection of fluid in the middle ear. The fluid behind the eardrum has difficulty draining back out because of the horizontal positioning of the eustachian tube. This causes increased pain. Antibiotics are prescribed to cure the infection. Children need pain relief until the antibiotic prescribed reduces the inflammation and pressure. Children pull on the ear as an attempt to reduce the pain and equalize the pressure. Pulling on the ears, especially in an infant, is one of the first signs the parent sees to warn of the ear infection. Blowing the nose is also an attempt by the child to equalize the pressure in the ear and help reduce the pain. A mydriatic is a drug that induces dilation of the pupils.
A 5-year-old child is diagnosed with acute otitis media. Which nursing intervention would be priority? Relieving the child's pain Administering a mydriatic Cautioning the child not to pull on the ear Cautioning the child not to blow the nose
"You have a sandwich on your plate, a glass of milk to your right, and an apple to your left." Helping children who are visually impaired remain as independent as possible increases self-esteem.
A 9-year-old boy who is blind is admitted to the hospital. When serving him a meal in bed, which statement would be most appropriate to increase his self-esteem? "Here is your tray; if you need help just call me." "I have cut your meat for you. Do you need any other help?" "You have a sandwich on your plate, a glass of milk to your right, and an apple to your left." "I'll have to feed you lunch; spaghetti is very messy."
surgery. A cataract is marked opacity of the lens. It can be present at birth. Treatment for childhood cataracts is surgical removal of the cloudy lens, followed by insertion of an internal intraocular lens.
A child has recently been diagnosed with cataracts. The treatment for cataracts is: eye drops to lower the pressure. surgery. wearing a patch until the cloudiness clears. there is no treatment for childhood cataracts.
Keep him away from people with known infections A child receiving chemotherapy is particularly susceptible to contracting an infection so should be kept away from people with known infections. Caution parents not to give aspirin for pain to children receiving chemotherapy; in addition to increasing the child's susceptibility to Reye syndrome, aspirin may interfere with blood coagulation, a problem that may already be present because of lowered thrombocyte levels. A parent who wants to give a child vitamins should check with the primary health care provider to be certain the vitamin preparation will not interfere with a chemotherapeutic agent. Administration of a vitamin that contains folic acid, for example, could interfere with the effectiveness of methotrexate, a folic acid antagonist. Caution parents that live-virus vaccines should not be given during chemotherapy as these vaccines could cause widespread viral disease if the child's immune mechanism is deficient.
A nurse is giving instructions to the father of a boy who is receiving chemotherapy (including methotrexate) regarding how best to care for the boy during this period of treatment. What should the nurse mention to him? Keep him away from people with known infections Give him aspirin to help manage pain Be sure that the boy receives only live-virus vaccines Give the boy folic acid supplements
Fear related to diagnosis of cancer Although these diagnoses may all be relevant at some point in the process of treatment, at this time the parents are dealing with the shock of learning their child has cancer. Fear is the most relevant diagnosis in this situation. Disturbed body image may occur if the child loses his hair. Decisional conflict may occur if they need to make decisions regarding treatment. Ineffective parenting may also happen if the parents are unable to care for their children appropriately.
Parents have just been informed that their child has a malignancy. The mother breaks down in tears, while the father appears to be in shock. What is an appropriate nursing diagnosis for this family? Fear related to diagnosis of cancer Disturbed body image related to hair loss Decisional conflict related to cancer treatment Ineffective parenting related to diagnosis of cancer
"I will report this to the pediatrician." The "white glow" may indicate retinoblastoma; immediate investigation is needed. The red reflex is indicative of eye health. Eye rubbing and a plugged tear duct are unrelated to the symptom described. Retinoblastoma is a disease in which malignant (cancer) cells form in the tissues of the retina. Children with a family history of retinoblastoma should have eye exams to check for retinoblastoma. Retinoblastoma occurs in heritable and nonheritable forms
Parents tell the nurse who is admitting their infant for a well-child exam that they recently saw a "white glow" in their child's left pupil. What is the nurse's best response? "Most parents mention a red color." "I will report this to the pediatrician." "Has your baby been rubbing either eye?" "A plugged tear duct would not be unusual."
skeletal There are three types of traction: manual, skin, and skeletal. Skeletal traction involves adding pull through the use of pins, wires, screws, or tongs. Skin traction involves directly applying pull to the skin, and manual traction involves direct pulling by the physician or nurse. Counter-traction uses weights, sandbags, or body weight to accomplish pulling.
The nurse is caring for a child in the postanesthesia care unit following a surgical procedure to place pins in the child's fractured femur. This pin placement is an example of which type of traction? manual skin skeletal counter
Stop the IV chemotherapy from infusing. The nurse is correct in assessing the IV site hourly for complications of infusing a chemotherapeutic agent. Verbalizations of the site "hurting" and assessment findings of redness and edema confirm a nursing intervention is needed. The initial intervention is stopping the infusion to prevent additional sclerosing of the drug entering the tissue. Warmth increases tissue absorption/damage. Adjusting and retaping does not address the current problem with the vein. Lowering the IV bag will not stop the infusion and may damage the vein.
The nurse is caring for a child who is receiving peripheral intravenous (IV) chemotherapy. The child tells the nurse that the IV "hurts." The nurse finds that the insertion site is reddened and edematous. Which action will the nurse take? Apply a warm pack to the IV site. Stop the IV chemotherapy from infusing. Adjust then retape the infusion site. Place the IV bag lower on the IV pole.
Assess the fingers for warmth, pain, and function Assess fingers or toes carefully for warmth, pain, and function after application of a cast to be certain a compartment syndrome is not developing. Compartment syndrome occurs when pressure rises in and around muscles. The pressure is painful and can be dangerous. Compartment syndrome can limit the flow of blood, oxygen and nutrients to muscles and nerves. It can cause serious damage and possible death. Compartment syndrome occurs most often in the lower leg.
A nurse is applying a cast to a 12-year-old boy with a simple fracture of the radius in the arm. What is most important for the nurse to do when she has finished applying the cast? Assess the fingers for warmth, pain, and function Apply a tube of stockinette over the cast Cut a window in the cast over the wrist X-ray the cast to make sure the bones are aligned properly
Moving a penlight toward the client's nose and observing whethe eyes can follow it To test for accommodation, ask a child (over 6 months of age) to follow a penlight as you move it in toward the nose. Children who cannot accommodate are unable to fuse their vision to follow a penlight toward their nose this way; instead, they demonstrate double vision (diplopia). The Stereo-Fly dot test, a test where the image of a fly is constructed from a series of colored dots, is used to test stereopsis. When asked to touch the fly's wings, a child with good depth perception touches them accurately. A child with poor depth perception touches a spot 2 or 3 inches above the pattern. Hirschberg test is used to detect true strabismus. The Weber test is a test for hearing.
A nurse is assessing a child's vision. Which test should the nurse use to test for accommodation? Moving a penlight toward the client's nose and observing whethe eyes can follow it Having the child touch the fly's wings in an image constructed of colored dots Performing Hirschberg test Performing a Weber test
osteomyelitis Osteomyelitis is an infection of the bone usually caused by Staphylococcus aureus. Acute osteomyelitis is twice as common in boys and results from a primary infection.
A nursing student tells the staff nurse on the pediatric orthopedic unit that she has heard of a musculoskeletal disorder in which there is an infection of the bone. Which disorder does this statement describe? osteomyelitis muscular dystrophy osteosarcoma juvenile idiopathic arthritis
Place the child close to the blackboard. The most common cause of visual difficulties in children is refractive errors. This is where the light entering the lens does not bend appropriately. Myopia (nearsightedness) is caused when the light falls in front of the retina. With this problem, children see well at close range and cannot see well at a distance. This means that when in the classroom, the child would do best seated close to the blackboard or in the front row of desks. A child with hyperopia (farsightedness) sees better further away and has blurriness at close range. Enabling closed-captioning is used for those children who have more severe eye problems. A reader would not be necessary if the reading material is placed at the correct distance for the child's vision.
After performing eye tests, the school nurse notes a child has symptoms of myopia. Which recommendation will the nurse make to the child's teacher? Place the child close to the blackboard. Place the child further back in the room. Request a reader to help the child. Enable the captions with videos.
Myopia Myopia is nearsightedness, which means that the child can see objects clearly at close range but not at a distance. It occurs because the light entering the eye focuses in front of the retina. Hyperopia is farsightedness. Esotropia is better known as "cross-eyed." It is a form of strabismus in which one or both eyes focus inward. Exotropia is a form of strabismus where the eyes are deviated outward.
The vision impairment in which the child can see objects at close range but not at a distance is known as: Myopia Hyperopia Esotropia Exotropia
The posterior spine when bending forward Diagnosis of scoliosis is best made with inspection and observation. When inspecting the back with the child in a standing position, the nurse should note asymmetries such as shoulder elevation, the prominence of one scapula, an uneven curve at the waistline, or a rib hump on one side. A lateral curvature of the spine is best revealed when the child bends forward. The child should bend forward with the arms hanging freely. The curve and asymmetry of the back can be observed. The height of the iliac crest, not the angle, is measured on both sides and the difference is noted. Bending to the side would not provide an accurate assessment of the spine because the curvature cannot be seen from the side. The lower chest angle would not be an accurate assessment as it would be more associated with the ribs as opposed to the spine.
A 14-year-old adolescent is suspected of having scoliosis. When doing scoliosis screening, what observation would be important for the nurse to note? The posterior spine when bending forward The angle of the iliac crest when bending forward The posterior spine when bending sideways The angle of the lower chest when sitting down
infection symptoms The neutrophils are the primary means of fighting bacterial infection. When the neutrophil count is very low, the child has the potential to have an overwhelming bacterial infection. The child is at the greatest risk when the neutrophil count is less than 500/µL (0.50 ×109/L). The nurse's priority would be to assess for signs and symptoms of infection. A bacterial infection can be life-threatening for this child. This child would be placed in neutropenic precautions. This is a form of isolation where the child is protected from health care workers and outside visitors. Among other precautions, no plants or raw fruits or vegetables would be allowed in the room, and the child should have no rectal examinations or medications and not experience a urinary catheterization. To prevent an infection, the nurse would administer broad spectrum antibiotics. The vital signs should be assessed every 4 hours, and alterations could indicate more problems than just infection. Mucositis occurs when there is an ulcerated oral mucosa. It should be assessed but is not the priority. Bleeding would be more related to low platelet count and not neutrophils.
A child with cancer has developed neutropenia and is in isolation with neutropenic precautions. What nursing assessment takes priority for this child? infection symptoms vital signs mucositis bleeding
pouring unused chemotherapy medicine into a sink drain The experienced nurse will need to intervene if the new nurse pours chemotherapy into a sink drain. Chemotherapy drugs should be considered hazardous substances and have special handling procedures (hospital specific protocols should be followed). When administering such agents, nurses should wear gloves and wash the hands well afterward to prevent skin exposure and absorption of the drug. It is appropriate for the nurse to teach the family about possible side effects and how to deal with them.
An experienced nurse is orienting a new nurse to the oncology unit. Which action by the new nurse would require intervention? wearing gloves when administering chemotherapy washing hands well after administering chemotherapy pouring unused chemotherapy medicine into a sink drain providing information about nausea, mucositis, and susceptibility to infection
"Nothing should be put into the cast. You can blow cool air into it with a hair dryer." Children and caregivers should be cautioned not to put anything inside the cast, no matter how much the casted area itches. Small toys and sticks or stick-like objects should be kept out of reach until the cast has been removed. Ice packs applied over the cast may help decrease the itching. Blowing cool air through a cast with a hair dryer set on a cool temperature or using a fan may help to relieve discomfort under a cast. What happens if you stick something down your cast?Do not put anything in the cast. Sticking something (coat hanger, ruler, etc...) in the cast can scratch the skin, which could lead to an infection. Furthermore, anything you stick in the cast could get stuck, which could also cause skin irritation or an infection.
The caregiver of a 2-year-old who has a polyurethane resin cast on her arm calls the clinic to report that her child is crying and says that the cast has sand in it. The caregiver states that she has had casts herself and knows how badly they can itch. She says she always used a hanger to scratch but is worried that it will be too sharp for the child. Which statement would be appropriate for the nurse to make to this caregiver? "Since the child's cast is synthetic, she could soak it with cool water." "A plastic ruler is less likely than a hanger to cut the child's skin." "Nothing should be put into the cast. You can blow cool air into it with a hair dryer." "You could give the child an extra dose of acetaminophen and see if that helps."
"Bring your child to the primary health care provider to be examined." Symptoms could indicate acute lymphoblastic leukemia (ALL). Compared with other children, children with Down syndrome have 15 times the risk of developing ALL. The nurse would recommend the child come in for further assessment to determine what, if any, treatment is needed for this child. Stating the child needs to be seen within the week if symptoms continue is doing nothing for the child at this time. The child's symptoms are not appropriate for acetaminophen; this choice is also a "do nothing" option. It is appropriate to limit the child's play to conserve energy and provide frequent snacks; however, it is most important for the child to be assessed.
The parent of a child with Down syndrome calls the nurse and reports 3 weeks of a lack of energy, limping, and weight loss in the young child. What is the most appropriate response by the nurse? "If symptoms persist, your child needs to be seen within the week." "Bring your child to the primary health care provider to be examined." "Give your child acetaminophen every 4 hours for a day. If no improvement, call back." "Limit active play and offer frequent small snacks and meals."
lymph node biopsy Hodgkin lymphoma is confirmed by biopsy of the lymph nodes. Further studies such as bone marrow analysis, liver function tests, chest and abdominal computed tomography scans, lymphangiography, and abdominal biopsy are done to classify the clinical stage of the disorder.
A 12-year-old child is suspected of having Hodgkin lymphoma. When preparing the child and family for diagnostic testing, which test would the nurse describe as being used to confirm the diagnosis? 24-hour urine test lymph node biopsy chest computed tomography liver function tests
"It is better to avoid large groups right now." A child receiving chemotherapy is particularly susceptible to contracting an infection and thus should be kept away from people with known infections. Therefore, having the child avoid large groups right now is best. Although it would possibly cheer up the client, it is not best for the client's health. Going to a movie would not be a good idea because it could lead to exposure to someone who is ill. A party in the hospital play room is a possibility for the children in the hospital, but it would not be possible to invite the child's entire class.
A child receiving chemotherapy wants to have a large birthday party and invite all the classmates. When the parent asks the nurse about this, what is the nurse's best response? "That will be a good way to cheer your child up!" "It is better to avoid large groups right now." "What about taking your child to a movie instead?" "We can have the party here in the hospital play room."
"Cataracts are only present in adults." A cataract is a marked opacity of the lens and may be present at birth. It can cause blindness if not treated early. The cataract can be removed as early as 2 weeks of age and the best results are achieved if removed by 3 months of age. Glaucoma is increased intraocular pressure causing damage to the optic nerve.
A nursing instructor is teaching about eye disorders in childhood. Which statement made by a student indicates a need for further instruction? "Glaucoma is caused by increased intraocular pressure." "Cataracts are only present in adults." "Cataracts can be present at birth." "A cataract is a marked opacity of the lens."
The frequency of otitis media is reduced in breastfed infants. Breastfeeding is a way to help prevent acute otitis media in infants. Acute otitis media tends to occur less often in breastfed than bottle-fed infants. One reason is the immunologic benefits from the breast milk. An infant should not start immunizations until 2 months of age, because the organs and immune system are not mature enough at birth. Placing medications and tubes are never done prophylactically.
A parent of a newborn asks the nurse if there is any way to prevent acute otitis media. What would the nurse state to the parent? Prophylactic acetic acid instillations may be helpful. The frequency of otitis media is reduced in breastfed infants. Prophylactic myringotomy tubes can be inserted at birth. Starting immunizations at birth rather than age 2 months might help.
"Let's look at some clothing that you can wear with the brace that will look like everyone else's clothes but cover it." A positive self-image is very important for adolescents wearing a brace. They want to look like their peers and wear the same clothing, but often that is not possible when wearing a brace. Assisting the adolescent in selecting clothing that looks stylish but still hides the brace is one of the best ways to help this client. Telling her she looks fine, to be confident, or bringing up the times she has been embarrassed does not help the client.
An adolescent client who has scoliosis and is wearing a Milwaukee brace tells the nurse that she is ugly and cannot wear the same clothing as her friends. Which response by the nurse best addresses this client's altered self-image? "You should not worry about what everyone else is wearing. You look fine." "Kids can be cruel sometimes. Has anyone told you that you look different?" "Let's look at some clothing that you can wear with the brace that will look like everyone else's clothes but cover it." "Just hold your head up and be confident in how you look. Look for some after-school activities you can do wearing your brace."
Wipe the drainage away from the inner to the outer canthus of the eye. Conjunctivitis is inflammation of the conjunctiva that causes pustular drainage. The eye should be cleansed from the inner to the outer canthus to prevent the spread of infection to the other eye. The child does not need to miss school for 2 weeks with this eye infection. Ophthalmic medication should be used as prescribed, which might be longer than 3 days. The eye does not need to be covered.
The nurse is caring for a 10-year-old child with bacterial conjunctivitis of the right eye. The eye is inflamed and drains a thick, yellow discharge. What should the nurse teach the parents about the care of the eye? Keep the child out of school for at least 2 weeks. Use liquid tear ophthalmic drops for 3 days. Ensure that the child keeps the eye patch on to cover the eye all at all times. Wipe the drainage away from the inner to the outer canthus of the eye.
Assess the child's ability to convey information Children who are unable to hear during the first 36 months of life are unable to learn the language necessary for normal verbal communication; therefore, it will be important to assess the child's ability to convey information. Visual assessment is not indicated. Educating parents about botulinum injections is an intervention for strabismus. Vinegar and alcohol eardrops are a treatment for swimmer's ear.
The nurse is preparing a nursing care plan for a 2-year-old child with hearing impairment. Which intervention will be part of the plan? Assess vision to determine functional capability. Explain botulinum injection procedure and risks. Teach parents to make vinegar and alcohol eardrops. Assess the child's ability to convey information.
Avoiding further abdominal palpation After the initial assessment is performed on a child with Wilms tumor, further palpation of the abdomen should be avoided because the tumor is highly vascular and soft. Therefore, excessive handling of the tumor may result in tumor seeding and metastasis. Preoperatively, the child with Wilms tumor does not have a wound; therefore, dressing changes are not necessary. Although the child may experience abdominal pain, avoiding further abdominal palpation would be the priority. Surgical removal of the tumor and affected kidney is the treatment of choice for Wilms tumor. Amputation would be more likely for a child with osteosarcoma. Also known as nephroblastoma, Wilms tumor can affect both kidneys, but usually develops in just one. Wilms tumor is a rare kidney cancer that is highly treatable. Most kids with Wilms tumor survive and go on to live normal, healthy lives.
A 4-year-old child diagnosed with Wilms tumor is admitted for surgery. What information would be most important for the nurse to include in the child's preoperative plan of care? Avoiding further abdominal palpation Performing dressing changes to the affected area Administering analgesics for pain Preparing the child for amputation
Provide various soft and bland foods to minimize further irritation. Have the child rinse the mouth with lukewarm water three times a day. Apply a lip balm or petroleum jelly to prevent cracking. For the child with stomatitis, the nurse should provide soft foods to prevent further abrasions, have the child rinse the mouth three times a day with lukewarm water to promote comfort and healing, avoid giving the child acidic foods that would further irritate the tissue, and apply a lip balm or petroleum jelly to prevent cracking of the lips. The nurse should offer a soft toothbrush to minimize discomfort.
A child is receiving chemotherapy and develops stomatitis. The nurse identifies a nursing diagnosis of Impaired oral mucous membranes related to the effects of chemotherapy. What instructions would the nurse include in the child's plan of care? Select all that apply. Vigorously rub the child's gums with gauze to clean them. Provide various soft and bland foods to minimize further irritation. Have the child rinse the mouth with lukewarm water three times a day. Give the child acidic foods (e.g., orange juice) to cleanse the mouth. Apply a lip balm or petroleum jelly to prevent cracking.
suggesting referral of the child for a speech evaluation. The behaviors the child displays are common in children who have a hearing deficit. Loud talk and play and turning the TV set to a high volume may occur because the child cannot hear lower levels of sound. The child may not understand directions he or she is given because of poor hearing and, therefore, cannot follow them. Articulation of words is likely not clear because the child cannot hear the sounds and then imitate them. Evaluation of this child's hearing is appropriate.
Parents request help from the nurse in managing their young child's "poor behavior." They describe "loud talk and play, not coming when called, seldom following directions, 'blasting' the volume on the TV set, and difficulty understanding spoken words." The appropriate nursing action is: teaching the parents about consistent, age-appropriate discipline. describing how the child's behaviors fit within the range of normal development. suggesting referral of the child for a speech evaluation. arranging for an evaluation of the child's hearing.
Refer the child to a pediatric ophthalmologist The nurse would refer the child experiencing diplopia (double vision) to a pediatric ophthalmologist for further testing; it is imperative to determine the cause to properly treat diplopia. Treatment may be as simple as eye exercises or glasses or could entail surgery. CT or magnetic resonance imaging (MRI) may be prescribed to assist in determining the cause. Knowledge of previous testing would not be a priority at this time. Botulinum toxin injections may be prescribed for treatment. Surgery may be discussed once the underlying cause is identified.
A child with poor eye alignment cannot establish single binocular vision but has double vision. Which nursing action is most appropriate for this client? Ask if the child has had a computed tomography (CT) before Refer the child to a pediatric ophthalmologist Schedule the child for botulinum toxin injections Discuss surgical options for treatment
Children's cancers, unlike those of adults, often are detected accidentally, not through screening. Children's cancers are often found during a routine checkup, following an injury, or when symptoms appear—not through screening procedures or other specific detection practices. A very small percentage of children may be followed closely because they are known to be at high risk genetically. Most children's cancers are highly responsive to therapy. Few prevention strategies are available for children, although many are known to be effective for adults. Several lifestyle and environmental influences regarding children's cancers are suspect, but few have been scientifically documented. The reverse is true in the adult population.
A nursing student compares and contrasts childhood and adult cancers. Which statement does so accurately? Adult cancers are more responsive to treatment than are those in children. Children's cancers, unlike those of adults, often are detected accidentally, not through screening. Environmental and lifestyle influences in children are strong, unlike those in adults. Little is known regarding cancer prevention in adults, although much prevention information is available for children.
Instill a few drops of a topical anesthetic into the affected eye Children who have eye injuries are usually in acute pain immediately after the injury. A few drops of a topical anesthetic instilled into the eye may be necessary to relieve the pain and allow the eye to be opened for examination. To visualize the inner surface of the lower lid and the bottom half of the eye globe, press firmly on the lower lid with your fingertip until it turns out. Grasp the eyelashes and gently stretch the upper eyelid downward. Place the stick of a cotton-tipped applicator horizontally against the center of the upper lid. While still grasping the eyelashes, pull the eyelid upward and over the applicator until it is everted. A foreign body, such as a speck of dirt or a fragment of glass, often clings to the inside of the upper lid and can be readily removed by touching it with a moistened, sterile, cotton-tipped applicator while the lid is everted.
An 8-year-old boy comes to the emergency room with an eye injury after having a glass bottle shatter near his face. Which intervention should the nurse do first while assisting this client? Instill a few drops of a topical anesthetic into the affected eye Press firmly on the lower lid with the fingertip until it turns out Grasp the eyelashes of the upper eyelid and evert it Touch the glass fragment in the eye with a moistened, sterile, cotton-tipped applicator
Ensure traction weights are hanging freely, not touching the bed or floor. Traction is used as a pulling force on an extremity or body part. For it to be effective, the weights need to hang freely at all times and the ropes need to remain in the pulley grooves. The weights are not replaced or removed during traction. The child can move all extremities except the affected one(s). The child remains in traction until healing occurs, a cast is applied, or surgical repair is performed.
The nurse is caring for a child with a fractured femur in traction. Which action will the nurse complete while caring for this client? Ensure traction weights are hanging freely, not touching the bed or floor. Remove traction weights once per shift for 30 minutes and then replace them. Plan to add additional weights as the fracture heals, usually once per day. Have the unlicensed assistive personnel remove the weights daily and encourage the child to move around in bed.
Children's bones heal faster than adults. Fractures in children heal faster, are generally less complicated, and occur for different reasons than fractures in adults. Thus, children rehabilitate faster than most adults. Children feel pain just like adults. Weight does not lessen the time required for crutches. Compliance is not an issue.
The mother of a child who has sustained a fractured leg is worried how long her child will be unable to walk without crutches. The nurse would explain to the mother that the child should be walking independently soon due to what reason? Children do not feel as much pain as adults. Children's bones heal faster than adults. A child weighs less than an adult so the child can walk earlier. Children are less compliant and tend to quit using the crutches.
Child reports facial palsy and vision problems The presence of facial palsy and vision problems indicates that the central nervous system has been infiltrated by leukemia cells. The petechiae, purpura, or unusual bruising result from decreased platelet levels and may be present regardless of metastasis. Adventitious breath sounds may indicate pneumonia and may be present whether the disease has metastasized or not. Hepatomegaly and splenomegaly result from infection, not metastasis. Acute lymphocytic leukemia (ALL), also called acute lymphoblastic leukemia, is a type of cancer in which the bone marrow makes too many lymphocytes (a type of WBC) that are immature. Leukemia may also affect red blood cells, white blood cells, and platelets."Acute" means that the leukemia can progress quickly, and if not treated, would probably be fatal within a few months. "Lymphocytic" means it develops from early (immature) forms of lymphocytes, a type of white blood cell.
The nurse is assessing a 10-year-old girl with acute lymphoblastic leukemia. What information would lead the nurse to suspect that the cancer has infiltrated the central nervous system? Child reports facial palsy and vision problems Observing petechiae, purpura, or unusual bruising Noting adventitious breath sounds during auscultation Palpation of abdomen reveals enlarged liver and spleen
"Let's come up with things for you to do and see if your friends can come visit." After 2 weeks in traction, an adolescent can become easily bored and isolated from usual peer interaction. The most helpful intervention would be to engage the help of the client to develop a list of books, games, movies, and other activities the client would enjoy. The nurse should also encourage visitation and phone calls from friends. Telling the client friends can come spend the night in the hospital is not most appropriate as minors are not typically encouraged to stay overnight. Telling the adolescent the condition will worsen if the client resists treatment is threatening and inappropriate.
The nurse is caring for a 14-year-old client in traction prior to surgery. The client has been in the hospital for 2 weeks and will require an additional 10 days in the hospital following surgery. The client states, "I feel isolated and I am refusing any more treatment." Which response by the nurse is most appropriate? "I know it is boring here, but the best place for you to remain immobile is the hospital." "I will see if you can have friends come spend a few nights with you." "Let's come up with things for you to do and see if your friends can come visit." "If you refuse further treatment, your condition will only get worse."
Shaking the head and pulling the ear With acute otitis media there is fluid and/or infection in the middle ear causing pain. The child may be very fussy, cry inconsolably, bat the head, tug at the ear or roll the head from side to side to help reduce the pain. Severe vomiting and confusion would be more related to gastroenteritis and dehydration. High-pitched cry and nuchal rigidity are associated with meningitis. Body stiffening and loss of consciousness are associated with seizures.
The nurse is caring for a 6-month-old infant diagnosed with otitis media. Which clinical manifestation would likely have been noted in this child? Shaking the head and pulling the ear Severe vomiting and confusion High-pitched cry and nuchal rigidity Body stiffening and loss of consciousness
inflammation of the joints In the child with juvenile idiopathic arthritis, joint inflammation occurs first; if untreated, inflammation leads to irreversible changes in joint cartilage, ligaments, and menisci (the crescent-shaped fibrocartilage in the knee joints), eventually causing complete immobility.JIA types are autoimmune or autoinflammatory diseases. That means the immune system, which is supposed to fight invaders like germs and viruses, gets confused and attacks the body's cells and tissues . It's not known why this happens, but both heredity and environment seem to play a role.
The nurse is caring for a child admitted with juvenile idiopathic arthritis (JIA). Which clinical manifestation would likely have been noted in the child with this diagnosis? difficulty standing and walking inflammation of the joints poor posture and malformed vertebrae pain in the groin and a limp
Document any signs of pain. Check capillary refill time in the both arms. Monitor the color of the nail beds in the right hand The most important function for the nurse in caring for a child in a cast is frequent neurovascular checks. The nurse should monitor for increased pain and edema, a pale or blue color to the extremities, skin coolness, numbness or tingling, poor capillary refill, and decreased pulse strength. Increased pain, especially unrelieved with pain medications, can indicate serious complications such as compartment syndrome. Wearing a gown or sterile gloves is unnecessary as the cast is not sterile.
The nurse is caring for a child who fractured the arm in an accident. A cast has been applied to the child's right arm. Which action(s) should the nurse implement? Select all that apply. Document any signs of pain. Check capillary refill time in the both arms. Monitor the color of the nail beds in the right hand. Wear a protective gown when moving the child's arm. Wear sterile gloves when removing or touching the cast.
Notify the health care provider of the findings immediately. Cool fingers or toes, extreme pain, and impaired movement are symptoms of compartment syndrome. Compartment syndrome can severely decrease blood flow to the area causing damage and necrosis to the surrounding area. If compartment syndrome occurs, the cast needs to be released immediately; therefore, the health care provider must be notified of these assessment findings immediately. Acute compartment syndrome must be treated in hospital using a surgical procedure called an emergency fasciotomy. The doctor or surgeon makes an incision to cut open your skin and fascia surrounding the muscles to immediately relieve the pressure inside the muscle compartment. Administration of pain medication, positioning, and ice are interventions that may be prescribed after a cast is placed, but they are not the first treatment for compartment syndrome.
The nurse is caring for a child who had a cast on his lower leg placed two hours ago. When assessing the child's foot, the nurse notes that the toes are cool and the child reports extreme pain. What is the best action by the nurse? Notify the health care provider of the findings immediately. Administer prescribed pain medication. Reposition the leg on pillows so that it is above the level of the child's heart. Apply ice bags to the child's foot and ankle.
"Keeping the arm raised helps to lessen the swelling." If an extremity has been casted, the client should keep it elevated with a pillow to prevent edema in the fractured area. Elevating a casted extremity does not promote healing or discourage infection. The cast will ensure proper bone alignment.
The nurse is caring for a child who has just received a cast for a broken wrist. The parents ask, "Why do we need to keep the arm up on a pillow?" Which response by the nurse is appropriate? "Keeping the arm raised helps to lessen the swelling." "Using a pillow helps to promote healing." "There is less chance of infection when the arm is kept elevated." "Positioning the arm like upward helps to make sure the bones stay aligned."
"We need to make sure the crutches are not too tall; there should be about an inch of space between the crutch pad and the axilla." Axilla pain is a common report and should not be ignored or just medicated. Proper fitting crutches should have 1 to 1.5 inches (2.5 to 3.8 cm) between the crutch pad and the axilla. This should help to prevent axilla pain. When crutches fit properly, padding should not be needed on the crutch pad.
The nurse is caring for a child who is using crutches due to a leg injury. The child's parents state that the child reports pain in the axilla when using the crutches. What is the best response by the nurse? "Unfortunately, this is a common problem with crutches. Your child may need to use a walker for a while until the painful area heals." "We need to make sure the crutches are not too tall; there should be about an inch of space between the crutch pad and the axilla." "You can add washcloths or other fabric to the arm pad to make it softer on the axilla." "If it hurts bad enough, your child can take some additional pain medication."
"Because our child is being treated by using braces, the braces will have to be worn almost all the time." The Boston or the thoracolumbosacral orthosis (TLSO) brace is made of plastic and is customized to fit the child for treatment of scoliosis. The brace should be worn constantly, except during bathing or swimming, to achieve the greatest benefit. Halo traction may be used to treat clients with severe scoliosis, but not all clients. Children will be reassessed every 4 to 6 months to determine the prognosis for continuing brace therapy and potentially refitting. Bracing may be indicated for months or years. Surgery may be indicated, depending on the severity and complications resulting from the scoliosis; however, surgery is not the best option for all clients.
The nurse is discussing treatment for a child diagnosed with scoliosis. Which statement indicates the parents understand the nurse's education? "Because our child has scoliosis, treatment will include halo traction." "The treatment for our child's scoliosis is anticipated to last between 3 to 4 months." "Because our child is being treated by using braces, the braces will have to be worn almost all the time." "The most successful treatment for scoliosis is surgery before reaching adult age."