exam 1
lead poisoning
- home built before 1980 - watch for windowsill chipping paint - don't give antique toys - wash hands (in soil around house) - s/s are vague, clumsiness, neuro changes, decreased appetite - can eventually lead to seizures coma and death - blood level < 5 is normal - levels 35-45 medication - Succimer - chelant / chelating agent (administer only after confirming no paint chips left in stomach via KUB/Xray)
when to postpone vaccination
- moderate to severe illness - fever (101F + 38.5c +) - immunocompromised patients do not receive attenuated (live) vaccines ex: varicella, MMR, intranasal flu
Acetaminophen pediatric dose
10-15 mg/kg Q 4-6
Ibuprofen pediatric dose
5-10 mg/kg q6 (6mo +)
How do you communicate w child
Address child before parent, get on eye level, listen to teddy bear before child- use play before doing vitals etc Ask open ended questions, not yes/no Incorporate child w/ care. They might have their own ways to take meds If not English speaking- MUST use Medical Interpreter
What anticipatory guidance should you teach a parent of a child with asthma
Avoid second and third hand smoke, not expired meds, avoid triggers, have inhaler before and after exercise, long-term affects dental health beta two agonist
A school nurse is teaching a group of teacher's aides about the cause of lead poisoning in children. What should be considered in terms of prevention? A. Lead poisoning is known to be caused by the ingestion of foods that are high in fat. B. Lead poisoning is attributed to an indigent and passive parent who fails to supervise the children. C. Environmental factors are involved because lead is available for ingestion and inhalation. D. Increasing milk intake will counteract the adverse effects of lead ingestion.
C. Environmental factors are involved because lead is available for ingestion and inhalation.
RSV requires what kind of precautions
Contact precautions
Atraumatic vaccination
Educate patient on what will happen, and parent. Have parents hug child while vaccinating Wake patient if asleep Lateral thigh and deltoid injection site (deltoid preferred, less S/E) Distract pt during injection, toy, bubbles !!!! do not aspirate with vaccinations
FLACC pain scale
F: Faces. L: Legs. A: Activity. C: Cry C: Consolability
What is the most common form of neglect?
Failure to provide basic nutrition needs and clean and adequate clothing
What would you do if your 3 month old baby has a fever of 100.4+? 38C+
If >38C Bring to hospital- risk of sepsis. Baby should have immune response from mom to protect baby. If older than 3 mo and <39C medicate at home
Boy child is potty trained but peeing his bed
It is just regression. Anticipatory guidance says this is normal and once stress is relieved will go back to normal
How can nurse assist 13 year old dying
Pain management and allowing some decision making
Asthma treatment
Short acting beta 2 adrenergic agonist first=albuterol Corticosteroids second
What is a side effect of albuterol
Tachycardia, high BP high HR low CO
What is the leading cause of death among all age groups?
Unintentional Injury
Wong-Baker FACES scale
a pain assessment tool that asks patients (often children) to select one of several faces indicating expressions that convey a range from no pain through the worst pain
A mother tells the nurse that she puts her 3-year-old son in a time-out chair in a corner for 3minutes when he misbehaves. She asks the nurse if this is correct. The nurse responds: a. "You are correctly using the time-out." b. "You should put the time-out chair in the center of family activity." c. "I would increase the time-out to 5 minutes." d. "Do you talk about the misbehavior while he is in the chair?"
a. "You are correctly using the time-out." ---time out is one minute per year of life
A statement that uses effective reasoning techniques is: a. "You are not being very nice when you throw toys at your friend." b. "I would not throw that toy if I were you." c. "I feel embarrassed when you throw toys at someone." d. "I will not let you play at your friend's house if you throw toys."
a. "You are not being very nice when you throw toys at your friend."
The pediatric maintenance dosage for Dilantin (phenytoin) is 4 to 8 mg/kg/day in three equal doses. A safe morning dose for a child weighing 15 kg is: a. 30 mg. b. 60 mg. c. 90 mg. d. any of these dosages
a. 30 mg.
Which core body temperature should be reported? a. 96.5°F b. 36.5°C c. 37.2°C d. 100°F
a. 96.5°F
Which infant is at risk for developing lead toxicity? a. A 10-month-old whose mother crafts stained glass. b. An 8-month-old living in a recently constructed house. c. A 9-month-old who plays with toys that are made in the United States. d. A 6-month-old whose 9-month-old cousin has lead toxicity.
a. A 10-month-old whose mother crafts stained glass.
. Physiologic differences in the gastrointestinal system between children and adults affect which component of a drug's action? a. Absorption b. Distribution c. Metabolism d. Excretion
a. Absorption
What is the nurse's first consideration when planning care for the child with a chronic illness? a. Child's physiologic condition b. Child's development c. Family's coping mechanisms d. Family's understanding of the prognosis
a. Child's physiologic condition
A child with a hearing impairment needs to have an arm cast. What can the nurse do to facilitatecommunication with the child throughout the cast application process? a. Face the child when speaking. b. Speak at a slower pace than usual. c. Talk clearly and directly into the child's ear. d. Keep gestures to a minimum.
a. Face the child when speaking.
Which nursing intervention might help the hospitalized toddler feel a sense of security and control? a. Follow the child's usual bedtime routine. b. Place the child in a crib with a cover over it. c. Tell the child what needs to be done and do not offer choices. d. Suggest to the parents that they bring new toys to the child.
a. Follow the child's usual bedtime routine.
When preparing a child with asthma for discharge, what instructions must the nurse emphasize to the family? select all that apply a. Limit allergens in the home b. Maintain a dry home environment c. Avoid placing limits on the child's behavior. d. Continue the medications even if the child is asymptomatic. e. Prevent exposure to infection by having the child tutored at home.
a. Limit allergens in the home d. Continue the medications even if the child is asymptomatic.
Which is not a manifestation of anorexia nervosa? a. Recurring episodes of binge eating b. Secondary amenorrhea c. Extreme fear of obesity d. Thin extremities with muscle wasting
a. Recurring episodes of binge eating
Although an individual may move back and forth among the various stages of the grieving process, the first stage is usually: a. denial. b. resentment. c. bargaining. d. depression.
a. denial.
Burn shock results from: a. hypovolemia. b. sepsis. c. toxins. d. metabolic acidosis.
a. hypovolemia.
Chronic illness with frequent hospitalizations can affect the psychosocial development of a school-age child by: a. leading to feelings of inferiority. b. preventing a sense of initiative. c. interfering with parental attachment. d. blocking the development of identity.
a. leading to feelings of inferiority.
.The most significant concern of the parents of a dying child is the child's: a. pain. b. hydration. c. safety. d. privacy.
a. pain.
One of the most significant risk factors for teen suicide is: a. poor self-concept. b. anxiety. c. heterosexual orientation. d. introverted personality.
a. poor self-concept.
The purpose of discipline is to: a. teach a child how to effectively function in a society. b. establish the self-fulfilling prophecy. c. assert parental control over the child. d. transmit the family's culture.
a. teach a child how to effectively function in a society.
What is the best response to an adolescent who asks whether he should talk to his dying brother? a. "You might want to hold his hand instead because he cannot hear you." b. "Although he may not answer you, your brother can still hear what you are saying." c. "He can't hear you, but he can feel your presence nearby." d. "Talk about happy things because you don't want to upset him.
b. "Although he may not answer you, your brother can still hear what you are saying." ----hearing is the last sense to lose when dying
A parent wants to wait outside until a procedure is completed on his child. The nurse's best response is: a. "It would be better for your child if you were by his side." b. "That is fine. I will stay with your child during the procedure. "c. "It is hospital policy for parents to step out of the room during procedures." d. "This test will only take a few minutes. Why don't you stay?"
b. "That is fine. I will stay with your child during the procedure.
Which child is most likely to have difficulty with separation during hospitalization? a. A 3-month-old b. An 18-month-old c. A 4-year-old d. A 7-year-old
b. An 18-month-old
A nursing student is caring for a 3-year-old with asthma who has been placed on acardiorespiratory monitor. Just as the student enters the room, the monitor alarm sounds.According to the monitor, the child's heart rate is 32 beats/min (bpm) and decreasing. Whatshould the nursing student do first? a. Find the nurse who is assigned to the child. b. Assess the child's ABCs. c. Call a rapid response. d. Initiate cardiopulmonary resuscitation (CPR)
b. Assess the child's ABCs.
A Muslim woman is admitted to the postpartum unit after delivering a baby girl. Considering thecultural needs of this patient, what should be included in her plan of care? a. Inclusion of meat with every meal b. Having only female nurses care for the patient c. Not putting ice in the bedside water pitcher d. Assessment for herbal use
b. Having only female nurses care for the patient
The parents of an infant ask a nurse why their baby is not receiving the measles, mumps, and rubella (MMR) vaccine at the same time that other immunizations are being given. What explanation should the nurse give about why the MMR vaccine is administered at 12 to 15 months of age? a. There is an increased risk of side effects in infants. b. Maternal antibodies provide immunity for about 1 year. c. It interferes with the effectiveness of vaccines given during infancy. d. There are rare instances of these infections occurring during the first year of life.
b. Maternal antibodies provide immunity for about 1 year.
What advice should the nurse offer a parent about reducing a child's fever? a. Give the child an alcohol bath. b. Offer the child additional oral fluids. c. Administer baby aspirin. d. Dress the child in heavy-weight clothing
b. Offer the child additional oral fluids.
Which nursing action indicates that the nurse understands the components of effectivecommunication? a. The nurse stands right next to the chair where the child is seated. b. The nurse asks an adolescent whether she can give her a hug. c. The nurse speaks to a child who is aphonic in a loud, clear voice. d. The nurse talks with her arms folded across her chest.
b. The nurse asks an adolescent whether she can give her a hug.
A 5-year-old is scheduled for a computed tomography (CT) scan of her head. What is the besttime for her mother to initiate a discussion about the procedure? a. Immediately before the procedure begins b. Two hours before the procedure c. The day before the procedure d. A few days before the procedure
b. Two hours before the procedure
Which action is appropriate for the prevention of diaper dermatitis? a. Apply medicated powder to the perineum after each diaper change. b. Wash the diaper area with a mild soap and water after each voiding or bowel movement. c. Keep the diaper area open to air during rest periods. d. Change diapers at least every 4 hours.
b. Wash the diaper area with a mild soap and water after each voiding or bowel movement.
A preschooler understands death as: a. the loss of a caretaker. b. a temporary separation. c. sad and permanent. d. something that happens to everyone.
b. a temporary separation.
Parents bring their 8-month-old son to the emergency department because "He's breathing so fast that he can't even eat, and he's so hot." Physical examination reveals nasal flaring, intercostal retracting, and moderate expiratory wheezing. The nurse suspects that the infant has: a. acute spasmodic croup. b. bronchiolitis. c. epiglottitis. d. aspirated a foreign body.
b. bronchiolitis.
A child cut his hand a few days ago. Now the area is swollen and painful, and a red streak extends from it up to the forearm. These are signs of: a. impetigo. b. cellulitis. c. contact dermatitis. d. eczema.
b. cellulitis.
The nurse might expect a child with ADHD to be: a. a gifted student who is bored with school subjects. b. easily distracted by internal and external stimuli. c. able to complete one activity before moving to the next project. d. ritualistic about activities of daily living.
b. easily distracted by internal and external stimuli.
A preschooler arrives in the emergency department. She is very anxious and irritable and refusesto lie down to be examined. She is sitting up, leaning forward on her hands, and drooling saliva.She is warm to the touch and her color is pale. The nurse should: a. take the child's vital signs. b. immediately notify the physician. c. ask the parents to wait outside the examining room. d. start an intravenous line.
b. immediately notify the physician.
A toddler is admitted to the hospital with croup. He is tachypneic with substernal retracting andnasal flaring. He has a harsh, bark-like cough. His pulse oximetry reading on room air is 98%. The most accurate nursing diagnosis for him is: a. ineffective breathing pattern. b. ineffective airway clearance. c. impaired gas exchange. d. all of the above.
b. ineffective airway clearance.
When an extremity is restrained, it is essential for the nurse to assess the affected area for: a. clubbing. b. pallor. c. spasm. d. crepitus
b. pallor.
A child has been coming to school early, staying late, and is seen stealing food from the cafeteria.These behaviors are suggestive of: a. physical abuse. b. physical neglect. c. emotional abuse.
b. physical neglect.
Parents of a preschooler are concerned because she wants "to marry" her father and has told hermother to "go outside and play in the street and get hit by a car." The nurse realizes that the: a. family should seek counseling. b. preschooler's behavior is normal. c. child has probably been abused by her mother. d. parents are not addressing the child's need for initiative.
b. preschooler's behavior is normal.
When administering insulin subcutaneously, the nurse should: a. use a 1- to 1 1⁄2 -inch needle. b. rotate injection sites. c. administer a very small volume such as 0.1 mL. d. inject the needle at a 30-degree angle.
b. rotate injection sites.
The developmentally appropriate strategy for the nurse to use when performing preoperativeteaching with a 10-year-old is to: a. keep explanations under 5 minutes. b. sequentially organize information. c. use puppets to explain the surgery. d. start preoperative teaching 3 hours before the surgery.
b. sequentially organize information.
The depth of a burn that appears red to pale ivory, with a moist surface and fluid-filled blisters, is most likely: a. superficial. b. superficial partial thickness. c. deep partial thickness. d. full thickness.
b. superficial partial thickness.
An adolescent tells the school nurse that he has thought about killing himself. An appropriateresponse to the adolescent is: a. "I am going to call your parents about this ASAP." b. "I have the number of a suicide hotline." c. "How are you feeling right now?" d. "Why would you even think about killing yourself?"
c. "How are you feeling right now?"
A child has just been diagnosed with diabetes. The child's father tells the nurse, "My wife will beback in the morning. Before she left, she told me that she has a lot of questions about what to do."What is the most appropriate response for the nurse to make at this time? a. "You will be meeting with the clinical specialist tomorrow. Ask her tomorrow." b. "Did the clinical specialist give you any papers to read? If not, I'll get a pamphlet for you." c. "Your wife might want to write down her questions so she won't forget anything when she comes back tomorrow." d. "Why don't you tell me what information you received from the clinical specialist today?"
c. "Your wife might want to write down her questions so she won't forget anything when she comes back tomorrow."
What is the first priority when initiating treatment on a child with a major burn injury? a. Fluid resuscitation b. Prevention of sepsis c. Airway assessment d. Correcting metabolic imbalances
c. Airway assessment
Which drug is a respiratory stimulant? a. Isoniazid b. Albuterol c. Caffeine d. Ribavirin
c. Caffeine
A nurse is observing hospitalized toddlers in the playroom. What does the nurse identify as their most important need? a. Stimulating play b. Therapeutic play c. Contact with their parents d. Gentle discipline from the nurse
c. Contact with their parents
A child experiences bronchoconstriction 5 hours after an acute asthma attack. This is an example of which kind of inflammatory response? a. Immediate b. Intermediate c. Delayed
c. Delayed
Which action is appropriate for the administration of a rectal suppository? a. Position the child on his abdomen. b. Insert the suppository 1 to 2 inches. c. Direct the child to take a deep breath. d. Ask the child to get up and walk around after insertion.
c. Direct the child to take a deep breath.
Which action represents the predominant trait of resilient families? a. Disengaging the family from the community b. Maintaining rigid family roles c. Engaging in efforts to keep the family intact d. Focusing on the child's condition-related needs
c. Engaging in efforts to keep the family intact
What is the best nursing response to a father who is concerned because his 4-year-old daughter has been using the bathroom independently for more than a year now but has had a few"accidents" since she has been hospitalized? a. Suggest that he take his daughter to the bathroom more often. b. Assure him that this behavior will disappear immediately after the discharge. c. Explain that children often exhibit regressive behaviors because of the stress of hospitalization. d. Set up a reward system to motivate the child to use the bathroom.
c. Explain that children often exhibit regressive behaviors because of the stress of hospitalization.
Ten-year-old Meg told the school nurse that she is worried about her twin sister, Mary, who is in the hospital. What might increase Meg's stress about this situation? a. Meg's grandparents are helping to care for her at home. b. Meg's parents have explained Mary's illness to her. c. Meg wonders whether she will get sick too. d. Meg plans to call her sister on the phone after school
c. Meg wonders whether she will get sick too.
Drug toxicity may occur more rapidly in the infant for which reason? a. Larger surface area requires a larger dosage. b. Fewer enzymes are available to bind with the drug. c. Renal immaturity may delay drug excretion. d. The blood-brain barrier becomes less selective with maturity.
c. Renal immaturity may delay drug excretion.
Which type of behavior would be expected when a child is in the despair stage of separation? a. Agitated b. Playful c. Withdrawn d. Anxious
c. Withdrawn
Teaching about safety to school-aged children should be geared toward their: a. parents. b. chronologic age. c. cognitive level of development. d. ability to answer questions.
c. cognitive level of development.
A nurse reacts with anger because a woman who did not have prenatal care explains that shedoes not see pregnancy as an illness requiring medical care. The nurse's reaction demonstrates: a. cultural diversity. b. ethnicity. c. ethnocentrism. d. fatalism.
c. ethnocentrism.
An 8-year-old child hit by a car has been in the intensive care unit (ICU) for a week. She has alengthy recovery ahead. Both parents have been at her side since the injury. They have not beenproperly eating and look exhausted. An appropriate nursing diagnosis for this family would be: a. parental role conflict relayed to the change in the environment. b. fear related to the child's critical condition. c. ineffective family health maintenance management related to the situational crisis. d. risk of impaired home maintenance related to a lack of support.
c. ineffective family health maintenance management related to the situational crisis.
The stinger of a honeybee should be removed by: a. squeezing it out of the skin. b. using tweezers to lift it out. c. scraping it out horizontally. d. applying heat to draw out the stinger.
c. scraping it out horizontally.
An adolescent who uses drugs regularly and exhibits a physical dependence on the drug is considered to be in the phase of: a. experimentation. b. early drug use. c. true drug addiction. d. severe drug addiction.
c. true drug addiction.
An adolescent tells the nurse, "I don't like this hospital room." An active listening response to thischild's statement is: a. "Don't you know this is the best room in the house?" b. "Let me see whether there are any other rooms available." c. "What's wrong with this room?" d. "So, would you prefer a different room?"
d. "So, would you prefer a different room?"
A young child cries, kicks, and clings to his mother when she tries to leave. What is the nurse's best comment to the mother about this behavior? a. "This child is experiencing ineffective coping." b. "Parents should not leave their children when they are hospitalized." c. "Wait until the child falls asleep to leave." d. "This behavior actually shows a healthy attachment between you and your child."
d. "This behavior actually shows a healthy attachment between you and your child."
Emotional outlet play would be appropriate for which child? a. A child who does not feel well enough to play b. A child who is having a hip spica cast applied in the morning c. A child who is scheduled for surgery next week d. A child who has been physically abused
d. A child who has been physically abused
Why might a 4-year-old child think that she caused her younger sibling's illness, which necessitated hospitalization? a. Preschool-age children have a beginning understanding of disease transmission. b. The child feels insecure since the birth of the sibling. c. The feeling of closeness to her sibling makes her feel responsible for the illness. d. Children are magical thinkers at this age.
d. Children are magical thinkers at this age.
Which action is not developmentally appropriate for a hospitalized adolescent? a. Allow the adolescent to wear her own clothing. b. Provide privacy when giving treatments. c. Suggest that her parents bring in her favorite foods. d. Discourage visits from school friends.
d. Discourage visits from school friends.
A 7-year-old child, who is going to have a lumbar puncture later today, tells the nurse, "I'm really nervous about this test." What is the best way to minimize the child's anxiety until time for the procedure? a. Review the lumbar puncture procedure with him. b. Give him a relaxation tape to practice. c. Read a book to him about being in the hospital. d. Distract him by playing his favorite board game with him.
d. Distract him by playing his favorite board game with him.
Which intervention is appropriate when caring for a chronically ill toddler? a. Prepare for procedures days in advance. b. Arrange for friends to visit in the hospital. c. Limit parental participation in the child's care. d. Keep security objects nearby.
d. Keep security objects nearby.
The parent of a newborn asks a nurse why, except for hepatitis B vaccine, the immunization schedule does not start until the infant is 2 months old. How should the nurse respond? a. A newborn's spleen can't produce efficient antibodies b. Infants younger than 2 months are rarely exposed to infectious disease c. The immunization will attack the infants immature immune system and cause the disease d. Maternal antibodies interfere with the development of active antibodies by the infant when immunized
d. Maternal antibodies interfere with the development of active antibodies by the infant when immunized
What should the nurse teach parents about skin care for the child with atopic dermatitis? a. After bathing, apply moisturizing cream when the skin has been thoroughly dried. b. Avoid clothing made of cotton and polyester because these materials are irritating. c. Dress the child warmly at bedtime to prevent itching due to coldness. d. Moisturizing creams can be applied whenever the skin looks dry.
d. Moisturizing creams can be applied whenever the skin looks dry.
Which family characteristic puts an adolescent most at risk for substance abuse? a. Family practices an authoritarian parenting style b. Family participates in school and community projects c. Open communication among family members is encouraged. d. One parent has chronic physical and mental health problems.
d. One parent has chronic physical and mental health problems.
A parent asks the nurse what to do when the toddler has temper tantrums. What play materials should the nurse suggest that the child be offered as another means of expressing anger? a. Ball and bat b. Wad of clay c. Punching bag d. Pegs and pounding board
d. Pegs and pounding board
Which theorist described how children learn? a. Erikson b. Freud c. Kohlberg d. Piaget
d. Piaget
Which food is the best choice for mixing with a medication to be administered to an infant? a. Honey b. Rice cereal c. Similac with iron d. Pudding
d. Pudding
What is the most common cause of burn injuries in children younger than 3 years? a. Flame b. Electrical c. Chemical d. Scald
d. Scald
Which example describes how a nurse can display an open body posture? a. Speaking to a child with head bowed b. Frequently shifting weight from one leg to the other while speaking c. Leaning away from the child while talking d. Talking while the hands are freely moving
d. Talking while the hands are freely moving
Which statement about the administration of IVPB medications is correct? a. The undiluted medication is pushed directly into the IV catheter through the port closest to the patient. b. The medication is injected into the port nearest the child and flushed through the tubing slowly. c. The IV catheter is used intermittently when medication is infused over a 1- to 2-hour period. d. The medication is diluted in at least 20 mL of IV fluid and infused over at least 15 minutes.
d. The medication is diluted in at least 20 mL of IV fluid and infused over at least 15 minutes.
Nurses can prevent childhood injuries by: a. modeling safety practices. b. educating parents through anticipatory guidance. c. supporting legislation that advocates safety measures. d. all of the above.
d. all of the above.
An example of a family that is classified as high risk is a (an): a. traditional family. b. single-parent family. c. adoptive family. d. family headed by adolescents.
d. family headed by adolescents.
A parent describes her child as irritable for the past month. The child has much less energy thanusual, and her grades have declined. This child meets the criteria for: a. dysthymic disorder. b. cyclothymic disorder. c. school phobia. d. major depressive disorder.
d. major depressive disorder.
A 12-month-old child's immunization record indicates that only one set of immunizations was administered at 2 months. The nurse knows that: a. the entire series of immunizations must be repeated. b. the HPV vaccine should be administered now. c. it is dangerous to readminister the hepatitis b vaccine. d. the DTaP vaccine, and not the Td vaccine, should be administered
d. the DTaP vaccine, and not the Td vaccine, should be administered
Covert lbs to kg
divide lbs by 2.2 1lb = 454g 1oz = 28g
What is anticipatory guidance?
educating parents and caregivers about what to expect in the next phase of development
Eczema, atopic dermatitis - treatment
inflammatory skin disease - treat with topical corticosteroids, prevent scratches, nails short, cotton clothing, keep moisturized---- can apply lotion whenever skin is dry
What is atraumatic care?
therapeutic care that minimizes or eliminates the psychological and physical distress experienced by children and their families in the health care system
Maintenance fluids
up to 10kg 100ml/kg/day 10-20kg 1,000ml/kg/day + 50 per additional kg 20+kg 1,500ml/kg/day + 20 per additional kg
anticipatory guidance
•Education provided by a health care provider to a child or family member based on the child's level of development and anticipated concerns •Ex: Infants- teething, electrical outlet covers, baby gates •Toddlers- locking up poisons, car/booster seats •Preschoolers- helmets while bike riding, water safety, masturbation •School-aged kids- crossing the street, riding bike with traffic •Teenagers- drugs and alcohol, sex education, vehicle safety
