EAQs 6-10- School Age
A 7-year-old child survives a near-drowning episode in a cold pond. What factor does the nurse identify that will have the greatest effect on the child's prognosis?
hypoxia
A nurse in the pediatric clinic plans to administer a booster immunization for polio to a child. Which vaccine should the nurse administer?
ipv
The parents of a school-aged child with fever, headache, and a stiff neck ask that the child be tested for meningitis. Which test should the nurse tell the parents is used to confirm the diagnosis of meningitis?
lumbar puncture
A nurse in the pediatric clinic is counseling the parents of a school-aged child with celiac disease. The child has extensive mucosal damage and as a result the digestion of disaccharides is impaired. What substance should the nurse teach the parents to temporarily eliminate from their child's diet?
milk
A woman and her children, who have not received immunizations for childhood diseases, immigrate to the United States. Before being immunized, one of the school-aged children contracts varicella (chickenpox). The nurse teaches the mother that varicella is:
orrect1 Communicable until all vesicles are dry
Allopurinol (Zyloprim) is prescribed for a 6-year-old child undergoing chemotherapy regimen for cancer of the bone. When given the medication, the child asks, "Why do I have to take this pill?" What is the best response by the nurse?
"Because with the other medicines it helps you get rid of the things that are making you sick."
The parents of a school-aged child with cystic fibrosis tell the nurse that they have changed to generic pancreatic enzymes because of money issues. An appropriate response by the nurse is:
"Generic enzymes are not as effective as the brand-name one. This is something you need to discuss with your healthcare provider."
A nurse is teaching a 12-year-old child about a bone marrow aspiration. What statement indicates that the preadolescent needs further explanation of the procedure?
"I'll have to rest after the procedure."
A parent who has been physically abusing a 7-year-old son is undergoing treatment for anger management. What statement by the client indicates the development of some insight into the abusive behavior?
"If I feel upset at my son, I'm going to go into the bedroom and punch a pillow."
A 7-year-old child who is taking medication to prevent seizures has been seizure free for 2 years. The child's parents ask a nurse, "How much longer will my child need to take the medication?" What is the best response by the nurse?
"It is important that the medications be gradually decreased."
The parents of a school-aged child with leukemia ask the nurse why irradiation of the spine and skull is necessary. What is the most accurate response by the nurse?
"Leukemic cells may invade the nervous system, but the usual drugs are ineffective in the brain."
A mother tells the clinic nurse that her 6-year-old child has been wetting the bed for the past 3 weeks. Previously there had been no problems. How should the nurse respond?
"You did the right thing to bring your child in to be examined."
A 9-year-old child with a tentative diagnosis of leukemia is to undergo bone marrow aspiration. What information should the nurse give the child before the procedure?
"You'll be given medication to relax you before the test, and you'll remember nothing afterward."
Parents are considering a bone marrow transplant for their child who has recurrent leukemia. The parents ask the nurse for clarification about the procedure. What is the best response by the nurse?
"Your child's immune system must be destroyed before the transplantation can take place."
The nurse is reviewing discharge instructions for a mother whose school-aged child was recently found to have celiac disease. Which statements by the mother demonstrate understanding of the child's nutritional needs? (Select all that apply.)
-"I'll try to provide meals that are lower in fats and higher in carbohydrates." -"She loves raw carrots for snacking, so I'll have to avoid those when the disease is worse." -"I'll be sure to look at the labels more closely from now on—we need to avoid hydrolyzed vegetable protein."
An 8-year-old boy is found to have a mild concussion and is to be discharged home. The mother was instructed to check her child for responsiveness every 2 hours and to wake him up for this assessment after he goes to sleep. She telephones the nurse and says that she is afraid to allow him to go to sleep. How should the nurse respond? (Select all that apply.)
-"If your son becomes difficult to awaken, bring him to the hospital." -"Awakening your son throughout the night should alert you to any change."
A nurse is changing the dressing of a sixth-grader with severe burns. What basic principles of surgical asepsis must the nurse consider? (Select all that apply.)
-A paper field must remain dry to be considered sterile. - A 1-inch border around a sterile field is considered contaminated. -Sterile objects in contact with clean objects are considered contaminated.
A 9-year-old child who has successfully completed the emergency (resuscitative) phase of treatment for a severe burn injury is started on a high protein, high calorie diet. Which snacks should the nurse encourage between meals? (Select all that apply.)
-Crackers and cheese -Banana pudding and whipped cream -Frozen yogurt and chocolate sprinkles
The regulation of type 1 diabetes in an 8-year-old child is best attained with a combination of therapeutic modalities in addition to the administration of insulin. Which modalities should be included in the teaching plan? (Select all that apply.)
-Dietary control -Regular exercise -Blood glucose monitoring
A nurse is caring for a school-aged child with type 1 diabetes and determines that the child is experiencing an episode of hyperglycemia. What symptoms led the nurse to this conclusion? (Select all that apply.)
-Dry skin -Increased thirst -Deep, rapid breathing
A 12-year-old child with type 2 diabetes is scheduled for abdominal surgery. Which factors are most important for the nurse to consider during the postoperative period? (Select all that apply.)
-The blood glucose level will increase because of the stress of surgery. -Diabetic control is usually maintained with insulin after surgery.
A 6-year-old child is in the acute phase of nephrotic syndrome. The mother asks the nurse about play activities for her child. What should the nurse suggest? (Select all that apply.)
-video games -childern's book
The gross motor skills of a 5-year-old child are being evaluated. According to the principles of developmental direction, in which order do these skills develop? Begin with the skill that is accomplished first.
1.Climbing up and down stairs 2.Riding a tricycle 3.Skipping and hopping on one foot 4.Walking backward
A nurse is planning care for a school-aged child experiencing respiratory acidosis. What is the sequence of events that occurs in the child's respiratory response to acidosis? Place the physiological responses in the order in which they occur.
1.Hyperventilation 2.Increased CO2 elimination 3.Decreased blood H+ ions 4.Increased pH
A 6-year-old child is admitted with an acute infection and dehydration. There is a prescription for an IV antibiotic to be piggybacked to a continuous hydration solution. During the administration of the antibiotic the child becomes restless, flushes, and begins to wheeze. Place the nursing actions in order of their priority.
1.Stopping the antibiotic infusion 2.Assessing the respiratory status 3.Maintaining the hydration infusion 4.Notifying the practitioner
A nurse in the pediatric clinic is evaluating the fine motor skills of a 5-year-old child. According to the principles of developmental direction, in which order does a child develop these skills? Begin with the skill that is accomplished first.
1.Turns a doorknob 2.Places objects into a narrow-necked bottle 3.Uses scissors 4.Copies a square on a piece of paper
Which intelligence quotient (IQ) in a school-age child indicates special learning needs?
60
A nurse is caring for an 8-year-old child who has been admitted to the pediatric unit with a tentative diagnosis of acute poststreptococcal glomerulonephritis (APSGN). Diagnostic tests are ordered. Which tests will help confirm the diagnosis? (Select all that apply.)
ASO titer Urinalysis Blood chemistry
nurse in the pediatric clinic determines that the pancreatic enzyme replacement being taken by a child with cystic fibrosis is inadequate. What clinical finding supports this conclusion?
Abdominal cramping
The day after undergoing an abdominal appendectomy, a school-aged child is prepared for ambulation. Which nursing action would be most effective before the start of ambulation?
Administering the prescribed pain medication
What does the nurse identify as an early sign of chronic lead poisoning (plumbism) in school-aged children
Anemia
A nurse is teaching a group of parents about age-related issues in 5-year-old children. What should the nurse include as a major concern of children of this age?
Anxiety about body integrity
A nurse is teaching parents about growth and development in preadolescent girls, and a mother asks at what age her daughter will have her first period. What is the most accurate response by the nurse?
At the end of the growth spurt
A 10-year-old child who was rescued from a house fire is brought to the emergency department with burns of the extremities. What finding is of most concern to the nurse?
Burns around the mouth
The day after brain surgery a 9-year-old child with type 1 diabetes has a temperature of 103.0° F (39.4° C). What does the nurse suspect as the probable cause of the fever?
Cerebral edema after brain surgery exerts pressure on the hypothalamus.
A 6-year-old child is hospitalized with nephrotic syndrome. The mother asks the nurse what she may bring for her child to play with during the hospitalization. In light of the child's age, what should the nurse suggest? (Select all that apply.)
Checkers Paper and crayons Simple card games
A nurse is obtaining the health history from the mother of a preschooler with Reye syndrome. The nurse should ask the mother if the child has recently had:
Chickenpox
After a preschooler undergoes craniotomy for the removal of a brain tumor, the nurse identifies an area of serosanguineous drainage about the size of a quarter on the child's dressing. What is the immediate response by the nurse?
Circling the area with nonabsorbable ink
A 10-year-old child is undergoing radiation therapy for a brain tumor. What should the nurse include in the skin care for this child?
Cleansing the head with water
What is the cognitive developmental stage of school-age children?
Concrete operations
A nurse is caring for a 9-year-old child with juvenile idiopathic arthritis (JIA). What is most important for the nurse to attempt to prevent?
Contracture deformities
How should a nurse turn a 10-year-old child in a spica cast?
Correct1 By log-rolling the body as one unit
A 10-year-old child is admitted to the pediatric unit in vaso-occlusive sickle cell crisis. The nurse is planning to assign a room. Which child is the best roommate option for this client?
Correct1 Child with thalassemia
A 7-year-old child with cerebral palsy who wears leg braces has a slight sensory loss in the lower extremities. What is the most essential information for the nurse to teach the child and parents?
Correct1 Examine the skin for evidence of pressure points.
The nurse is caring for a school-aged child with cystic fibrosis. Which pathophysiological factor has the greatest impact on the child's health status and is of priority in the care plan?
Correct1 Extremely thick mucus causes obstructed airways.
A school-age child with a fracture of the femur near the epiphyseal plate is admitted to the hospital. The parents ask if there will be any aftereffects when the bone heals. Before responding, what should the nurse consider?
Correct1 Growth of that leg may be affected.
An 8-year-old child is found to have Legg-Calvé-Perthe disease. The health care provider orders an abduction brace 23 hours a day and non-weight-bearing activity. What should the nurse teach the parents to do?
Correct1 Have the child transfer to a wheelchair, using the unaffected leg
A parent of a 7-year-old child asks a nurse how to tell the difference between measles (rubeola) and German measles (rubella). What should the nurse tell the parent differentiates rubeola from rubella?
Correct1 High fever and Koplik spots
The parents of a 12-year-old boy with cystic fibrosis (CF) ask the nurse why he needs a glucose tolerance test. What information should the nurse consider before replying?
Correct1 Pancreatic scarring predisposes the child to diabetes.
During chemotherapy, altered nutrition is a common side effect. Knowing that compromised nutrition can contribute to an increased risk of infection and other problems, the nurse:
Correct1 Provides oral supplements
What nursing intervention is most effective in alleviating the fretfulness of a hospitalized 5-year-old child?
Correct1 Reading a story to the child
The parents of a gifted 4-year-old notice that their child has been showing signs of rebellion and acting out. One important thing to teach the parents about gifted children is: The parents of a gifted 4-year-old notice that their child has been showing signs of rebellion and acting out. One important thing to teach the parents about gifted children is:
Correct1 They need boundaries like any other child
A nurse is caring for several school-aged children with cystic fibrosis. Why does the nurse anticipate that these children will probably be small and underdeveloped for their age?
Correct3 These children digest little food because pancreatic enzymes are blocked.
A 7-year-old child must remain quietly in bed while undergoing peritoneal dialysis. What activity is most appropriate for the nurse to plan for this child?
Correct3 Working multiple-piece puzzles with another child
The parent of a child who has received all of the primary immunizations asks the nurse which ones the child should receive before starting kindergarten. The nurse tells the parent that her child should receive:
DTaP, IPV, MMR
A nurse is planning play activities for a 6-year-old child whose energy level has improved after an acute episode of gastroenteritis. What activity should the nurse encourage?
Drawing and writing with a pencil or marker
What intervention should be included in the nursing plan of care to help a 10-year-old girl live with Crohn disease?
Encouraging her to express feelings while focusing on the ways she is like her friends
A 10-year-old child undergoes open heart surgery to repair a cardiac defect. The health care provider informs the parents that antibiotics are required before any dental work is performed. Later the parents ask the nurse why this is necessary. When responding, the nurse explains that this is done to prevent:
Endocarditis
A nurse is determining whether a 5-year-old child is displaying appropriate behaviors for this age. What developmental findings does the nurse expect? (Select all that apply.)
Enjoys imitative play Makes up rules for a new game
After abdominal surgery, a 5-year-old child is experiencing pain, and an opioid analgesic is prescribed. What should the nurse consider about children in pain and their response to opioid analgesics when an opioid analgesic is prescribed?
Even though children do not like taking medicines, analgesics will make them more comfortable.
A child with recently diagnosed idiopathic scoliosis has a mild structural curve. The child's mother asks whether the problem can be corrected with exercise. What should the nurse tell the mother concerning an exercise program?
Exercise is used in conjunction with a brace.
An 11-year-old child has gained weight. The mother tells the nurse that she is concerned that her child, who loves sports, may become obese. What is the most appropriate response by the nurse?
Explaining that this is expected during preadolescence
An 11-year-old child is found to have acute lymphocytic leukemia (ALL), and the health care provider discusses the diagnosis and treatment with the child and family. What age-appropriate behavior does the nurse expect from the child regarding the life-threatening diagnosis?
Expressing anger by being insolent
The nurse in the pediatric clinic is reviewing the health history of a 10-year-old girl with a diagnosis of juvenile idiopathic arthritis (JIA). Currently the child is experiencing recurrent pain and swelling of the joints, particularly her knees and ankles. What organ is commonly affected in children with this disorder?
Eyes
Which of the following clinical findings should the nurse expect to find during the care of a child with acute glomerulonephritis (AGN)? (Select all that apply.)
Flank pain Periorbital edema
A 4-year-old child is brought to the pediatric clinic for a well-child visit. While entering the examination room the child bumps into the door jamb and then tilts his head to one side. The nurse suspects that the child has strabismus. What additional clinical finding supports this conclusion?
Frequent squinting
Children with special needs have the same needs as other children, although their means of satisfying these needs may be limited. What effect should the nurse expect that these limitations will frequently cause?
Frustration
A nurse is caring for a school-age child with type 1 diabetes. There have been problems maintaining euglycemia. What laboratory test does the nurse expect to be prescribed that will reveal the effectiveness of the diabetic regimen over time?
Glycosylated hemoglobin
What activity beyond the capabilities of a toddler does the nurse conducting an evaluation expect of a 4-year-old child?
Having a vocabulary of about 1500 words
A nurse initiates preparations for an infratentorial craniotomy in a 9-year-old child. What should the nurse include in the plan?
Having the child draw a picture of a brain and briefly clarifying misconceptions
nurse anticipates that dialysis will be necessary for a 12-year-old child with chronic kidney disease when the child begins to exhibit:
Hypervolemia
A nurse is screening children in an elementary school for head lice (pediculosis capitis). What common secondary infection from head lice is of most concern to the nurse?
Impetigo
An adolescent with a history of type 1 diabetes is admitted in ketoacidosis. What does the nurse suspect as a precipitating cause of this episode of ketoacidosis
Infection
Before discharging a 9-year-old child who is being treated for acute poststreptococcal glomerulonephritis (APSGN), what information should the nurse plan to give the parents?
Instructions about which high-sodium foods to avoid
When planning nursing care for a 5-year-old child with acute poststreptococcal glomerulonephritis, what should the nurse emphasize that the child and family must maintain?
Isolation from children with infections
A nurse is planning to teach the four-point alternate crutch gait to a 9-year-old child with cerebral palsy. The nurse teaches the parents that this gait was chosen because:
It provides for equal but partial weight bearing on each limb
The nurse is teaching crutch-walking to a 12-year-old child. What does the child do that indicates the need for more teaching?
Looks down when placing the crutches
A 9-year-old child has been found to have Legg-Calvé-Perthes disease and is on bedrest. The nurse encourages the parents to look for something creative for the child to do or a hobby for the child to begin with the purpose of:
Meeting the developmental task of initiative
A critically ill 5-year-old child exhibits Kussmaul respirations. The nurse suspects an increasing acid-base imbalance related to:
Metabolic acidosis cause by a concentration of cations in body fluids
The mother of a preschooler with acute glomerulonephritis (AGN) asks the nurse whether her child will have to stay in bed. The nurse responds that bedrest is:
No longer a necessary part of the treatment plan
A 5-year-old child is receiving dactinomycin (Cosmegen) and doxorubicin therapy after nephrectomy for Wilms tumor. What intervention should the nurse include when planning care?
Offering warm saline mouthwash
The alkylating agent cyclophosphamide (Cytoxan) is prescribed for a school-aged child with cancer. What is the most important sign or symptom for the nurse to be alert for while the child is receiving this medication?
Pain with urination
The mother of a 5-year-old child recovering from varicella (chickenpox) calls the nurse in the pediatric clinic, asking how the child's itching can be relieved. What is the best response by the nurse?
Pat the lesions while applying the prescribed calamine lotion.
What findings should a nurse expect when examining the laboratory report of a preschooler with rheumatic fever?
Positive antistreptolysin titer
What is the nurse's priority responsibility when abuse of an 8-year-old child is suspected?
Protecting the child from future abuse
What nursing care to prevent a crisis is the same for school-aged children with sickle cell anemia and celiac disease?
Protecting the child from infection
A nurse is caring for an anemic, malnourished 11-year-old child who has celiac disease. The health team develops a plan to help the parents correct their child's nutritional problems. What should the parents be encouraged to do?
Provide foods high in folic acid, iron, and vitamin B12 to correct the anemia
What nursing intervention will be most effective in helping relieve the anxiety of a young school-age child during the postoperative period?
Providing the child with sterile dressing equipment and a doll
A 7-year-old child who has sustained frostbite of the toes after skiing in below-freezing weather is brought to the emergency department. What is the nurse's initial intervention?
Rapidly rewarming the toes by placing the feet in warm water
A nurse is teaching the parents of a child with juvenile idiopathic arthritis how to prevent loss of joint function. Which activities should be encouraged? (Select all that apply.)
Riding a bicycle Walking to school Swimming in the community pool
Methylphenidate (Ritalin) has been prescribed for a 7-year-old child with attention deficit-hyperactivity disorder (ADHD) and is to be taken with meals. What rationale should the nurse provide for the parents about the timing of medication administration?
Ritalin depresses the appetite.
A 10-year-old child who is developmentally delayed and blind must be fed all meals. The child has problems swallowing and frequently chokes and coughs during the feeding. What technique should the nurse use when feeding this child?
Seating the child in a wheelchair, giving small bites of food with metal tableware, and encouraging participation
What is the first activity of daily living (ADL) that the nurse should help teach a developmentally disabled 8-year-old child?
Self-feeding
A nurse is caring for a school-aged child who has had a tonic-clonic seizure. How should the nurse describe the clonic phase?
Spasmodic body jerking
A school-aged child is brought to the emergency department with partial- and full-thickness burns of the lower extremities. The practitioner writes multiple prescriptions. What is the nurse's priority intervention?
Starting an intravenous line with a large-bore catheter
A school-aged child with a seizure disorder is to start taking divalproex (Depakote). What should the nurse teach the parents about caring for their child in regard to this medication?
Take the child for regularly scheduled blood tests
A 4-year-old girl decided to surprise her mother by making hot chocolate and spills hot water on her legs, resulting in partial-thickness burns. Because of the child's age, the nurse's discharge instructions to the parents should emphasize the importance of:
Teaching their child basic safety rules
A school-aged child with cystic fibrosis has recurrent episodes of bronchitis, and the parents ask the nurse why this happens. What reason should the nurse include in the reply?
Tenacious secretions that obstruct the respiratory tract provide a favorable medium for growth of bacteria.
The practitioner prescribes no weight bearing on a leg that has been casted because of a fracture of the femur. How should the nurse determine the appropriate length of the crutches for this child? (Select all that apply.)
The crutches should reach 2 inches below the axillae. The crutches' tips should rest 6 inches outside the feet.
A 10-year-old child is found to have hemophilia. The nurse is explaining how hemophilia is inherited. What is the best explanation of the genetic factor that is involved?
The mother is a carrier of the disorder but is not affected by it.
A preadolescent brings home a note from the school nurse informing the parents that the child should be evaluated for scoliosis. The mother calls the clinic nurse to ask for a description of scoliosis. Before responding, the nurse recalls that in scoliosis:
There is a rotary deformity of the lateral curvature of the spine
What strategy should the nurse employ to be effective when using play therapy with a 6-year-old child with autism?
Use mechanical and inanimate objects for play
A new nurse has been assigned to a school-aged child who is in contact isolation for methicillin-resistant Staphylococcus aureus (MRSA). The primary nurse observes the new nurse during morning care. Which behavior should the primary nurse address to improve isolation technique?
While changing the bed the nurse wears gloves but no gown.
A nurse is reinforcing previous learning about cystic fibrosis and its treatment with a 9-year-old child. What is the most suitable information for a child of this age?
Your mucus is thick because of the way your mucous glands work."
A school-aged child who has just arrived from Africa has been exposed to diphtheria, and a nurse in the pediatric clinic is to administer the antitoxin. Which type of immunity does the antitoxin confer?
passive artificial
When providing care to a 6-year-old child with leukemia, a nurse notes blood on the pillowcase and several bloody tissues. What blood component value on the child's laboratory results should the nurse verify?
platelets
In addition to standard precautions, what protective equipment or precautions should the nurse use when caring for a 4-year-old child admitted with pertussis?
private room
