Hurst 10
The nurse is performing a home assessment of a two year old. Which behavior by the toddler does the nurse identify as normal development? 1. Drinks from a cup. 2. Cuts food with a knife. 3. Pours juice into a cup. 4. Eats with a fork.
1. Correct: By the time toddlers are 2-years old, they should be able to use cup. 2. Incorrect: By age 5, normal development includes using a knife. 3. Incorrect: By age 5, normal development includes pouring. 4. Incorrect: Forks are used by 3-4 years old.
The parents of a 4 year old child have recently had a new baby and the parents report that the 4 year old had been dry all night for 8 months and is now wetting the bed again. What should the nurse assess first? 1. Urinalysis 2. Normal urination habits. 3. Adjustment to the new baby. 4. Fluid intake after 6 pm.
1. Correct: Always assess the physiologic problem first to rule out a urinary tract infection (UTI). Once a physiologic cause is removed as the cause other assessment should be performed. If a UTI is present, treatment should start immediately. 2. Incorrect: Assessing the normal urination habits is not first. Assessing the urinalysis is priority. 3. Incorrect: Regression is the likely cause but the physiologic problems should be assessed first. 4. Incorrect: The child's fluid intake may be too high after 6 pm, but ruling out a urinary tract infection is the first assessment and requires immediate treatment if there is an infection.
The nurse assessing clients in a pediatric clinic would refer which child for further assessment? 1. A 20 month old who only says "no." 2. A 1 year old who says three words 3. A 9 month old who says "dada" and "mama" 4. A 4 month old who laughs out loud
1. Correct: By 18 months of age, a child should be able to speak 10 or more words. 2. Incorrect: By 1 year of age, a child should be able to say "mama," "dada," and an additional 3 to 5 words. 3. Incorrect: By 9 months of age, a child should be able to say "mama" and "dada." 4. Incorrect: By 4 months of age, a child should be able to laugh out loud.
The nurse is teaching a group of parents how to promote healthy teeth in their newborn. What should the nurse include? 1. Clean gums with a damp washcloth after feedings. 2. Use a firm-bristled toothbrush once teeth have erupted. 3. Beginning at birth use toothpaste the size of a pea. 4. Allow only milk bottles in bed. 5. Wean from bottle by 15 months.
1., & 5. Correct: Wiping milk or juice from the gums, decreases the amount of time that the gums are exposed to the high sugar content of these meals. Weaning from the bottle at age 12-15 months may help prevent dental caries. 2. Incorrect: Use a soft-bristled toothbrush once teeth have erupted. 3. Incorrect: Toothpaste is unnecessary in infancy. At age 2, begin brushing with a pea-sized amount (small smear) of fluoridated toothpaste. 4. Incorrect: Infants should not be allowed to take milk or juice bottles to bed, as the high sugar content of the fluid in contact with the teeth all night leads to dental caries.
A 3-year-old child refuses to take a prescribed medication. Which statements by the mother, regarding the child's refusal, indicate to the nurse that parental education is needed? 1. "My child is trying to make me angry". 2. "I feel like such a bad mother when my child acts this way". 3. "I promise my child a reward for taking medicine". 4. "I am unfazed by my child's actions". 5. "My child doesn't have to take medicine if he doesn't want to".
1., 2. & 5. Correct: If the mother feels the child is trying to "make her angry" she may respond with inappropriate discipline. The nurse can help the mother understand that developing independence is one of the developmental tasks of a child this age, and that the movement toward independence reflects good, not bad, parenting. The child must take the prescribed medicine in order to get well. 3. Incorrect: Rewarding the client for taking medication is not contraindicated.4. Incorrect: Being "unfazed" by the child's actions does not reflect bad parenting.
A child has been diagnosed with varicella in the clinic. What should the nurse tell the parents about home treatment of the child? 1. Apply calamine lotion to affected areas several times a day. 2. Provide cool baths with baking soda. 3. Administer aspirin for fever. 4. Do not allow visitors who have never had varicella. 5. Keep fingernails trimmed short.
1., 2., 4., & 5. Correct: Calamine lotion and cool baths with baking soda will relieve itching. Anyone not vaccinated for chickenpox or who has never had chickenpox should not be exposed. Pregnant women and anyone with a weakened immune system (persons with HIV/AIDS, cancer, had a transplant, receiving chemotherapy, immunosuppressive medications, or long-term use of steroids) should avoid exposure. Keeping fingernails trimmed short may help prevent skin infections caused by scratching blisters. 3. Incorrect: Do not use aspirin or aspirin-containing products to relieve fever from chickenpox. The use of aspirin in children with chickenpox has been associated with Reye's syndrome, a severe disease that affects the liver and brain and can cause death. Instead, use non-aspirin medications, such as acetaminophen, to relieve fever from chickenpox. The American Academy of Pediatrics recommends avoiding treatment with ibuprofen if possible because it has been associated with life-threatening bacterial skin infections.
Which clients should the nurse recommend receive the human papillomavirus (HPV) vaccine? 1. Twelve year old male. 2. Nine year old female. 3. Twenty-five year old bisexual male. 4. Twenty-two year old female with compromised immune system. 5. Twenty-six year old male who has not received the HPV vaccine.
1., 3, & 4. Correct: The HPV vaccine is recommended for preteen boys and girls at age 11 or 12 so they are protected before ever being exposed to the virus. Young women can get HPV vaccine through age 26, and young men can get vaccinated through age 21. The HPV vaccine is recommended for any man who has sex with men through age 26 and for men with compromised immune systems through age 26 if they did not get HPV vaccine when they were younger. The HPV vaccine is recommended for men and women with compromised immune systems through age 26. 2. Incorrect: The HPV vaccine is recommended for preteen boys and girls at age 11 or 12 so they are protected before ever being exposed to the virus. Young women can get HPV vaccine through age 26, and young men can get vaccinated through age 21. 5. Incorrect: Catch up vaccines are recommended for males through age 21 and for females through age 26 if they did not get vaccinated when they were younger.
The parents of a child admitted with rheumatic fever (RF) ask why the child has been placed on bedrest. The nurse explains that bedrest serves what primary purpose for the client? 1. Prevents permanent joint damage. 2. Decreases workload on the heart. 3. Helps regulate body temperature. 4. Reduces joint pain and body aches.
2. Correct: Rheumatic fever is a secondary, infectious process that occurs several weeks after an unresolved streptococcal infection, such as strep throat. The Group A beta-hemolytic strep can cause inflammation in the myocardium or epicardium, ultimately affecting the valves of the heart, particularly the mitral valve. The resulting thickening and fibrosis leads to cardiac stenosis which could lead to heart failure. During this illness, decreasing the workload on the heart is vital to help prevent cardiac complications. 1. Incorrect: Rheumatic fever causes increased body temperature, muscle aches and swollen painful joints, particularly knees, ankles and wrists. Although clients may need ibuprophen for pain and swelling, there is no permanent damage to the joints. Bedrest serves another purpose for this client. 3. Incorrect: It is true that these clients can run a high fever at times and even develop a red rash over the torso. However, the purpose of bedrest is not related to controlling body temperature. 4. Incorrect: It may seem logical that bedrest would decrease joint pain and body aches, but this is not the primary purpose for bedrest.
A community health nurse is presenting a seminar to teen parents on the topic of infant safety. What priority topic presented by the nurse represents the leading cause of injury or death among infants? 1. Monitoring the infant for food allergies. 2. Placing the infant in rear-facing, approved car seat. 3. Never propping bottle to feed when infant is alone. 4. Positioning infant prone when sleeping or napping.
2. Correct: The leading cause of death among infants under the age of one year is motor vehicle accidents. When instructing first time or young parents, it is vital to teach the need to have the infant snuggly restrained in an appropriately sized, approved infant car seat in the back seat and rear-facing. 1. Incorrect: While discussing the signs or symptoms of food allergies is an important topic for new parents, this is not the most vital information the nurse could present to the teen parents. 3. Incorrect: An infant should never be left unattended while feeding, and propping a bottle could lead to aspiration or respiratory distress. This is a dangerous practice that needs to be discussed by the nurse; however, there is another topic that is more urgent. 4. Incorrect: The research studies to date indicate the safest sleeping position for newborns and infants is supine, not prone. Positioning is always a nursing concern, and teaching new parents about the potential for sudden infant death syndrome (SIDS) would be crucial. However, another topic presents more important information.
Which assignment by the charge nurse would be most appropriate for a general pediatric nurse being reassigned to the hematology/oncology pediatric unit? 1. Child dying with leukemia who has been on the hematology/oncology unit for two weeks. 2. Teenager with sickle cell disease in for pain management. 3. Child admitted following a bicycle accident that has idiopathic thrombocytopenic purpura (ITP). 4. New admit scheduled for bone marrow transplant. 5. Child diagnosed with leukemia admitted for stomatitis.
2., 3., & 5. Correct: The nurse should be given an assignment similar to the type of clients and skill level the nurse is accustomed to on the general pediatric unit. Therefore, the choices should be these three clients. Even though one of the clients has leukemia, the child is being treated for stomatitis, not the leukemia. Sickle cell clients are frequently cared for on general pediatric units. The reassigned nurse has the knowledge and skills needed to meet the clients needs for pain management and treatment for the sickle cell disease. The general pediatric nurse should be competent in caring for children with low platelet counts, so the child with ITP could be assigned to this nurse. The nurse would be familiar with bleeding precautions, monitoring for bleeding, and associated care. 1. Incorrect: This client is dying with leukemia and needs consistency in the staff assigned to care for them. Although the general pediatric nurse could competently care for a dying child, the focus should be on the client. This child needs and deserves consistent care and care by those that are familiar to this child. 4. Incorrect: A child who is to receive a bone marrow transplant would not be the best assignment, since the nurse must have special preparation and an understanding of the protocol with a bone marrow transplant client. This is not something that a general pediatric nurse would typically do. Therefore, this client would need to be cared for by the nurses on the hematology/oncology unit who has this special training and/or knowledge.
A toddler with a malfunctioning ventriculoperitoneal (VP) shunt has returned from surgery following new shunt placement. Which post-op assessment finding should the nurse report to the primary healthcare provider immediately? 1. Blood pressure of 90/45 with pulse of 100 2. Urinary output of 30 mL over two hours 3. Sleeping soundly and difficult to arouse 4. Respirations deep and shallow at 20/min
3. CORRECT: Though the toddler is recovering from anesthesia, the nurse should be able to arouse and awaken the client, even expecting some crying. Difficulty arousing this client is one sign of increased intracranial pressure and should be reported immediately. 1. INCORRECT: These vital signs are well within normal limits for the toddler age-group, even post-op. No concerns for the nurse here. 2. INCORRECT: An output of 30 milliliters may seem a bit low, but the toddler is still recovering from surgery and anesthesia, with IV fluids still infusing to rehydrate. Additionally, two hours is not long enough to establish a consistent pattern. 4. INCORRECT: The respiratory rate is within normal limits for this client now. However, with potential changes in the neurological status of this client, the nurse would monitor for any decrease in respirations.
The nurse working in a pediatrician's office is teaching a couple with small children about proper medication administration for children. What statement by the couple would indicate that further teaching is needed? 1. We should carefully measure elixir medication with the provided dropper. 2. Our children should not watch us take medicine. 3. We tell our children the medicine is candy so they will take it without a fuss. 4. Even though medicine comes in a childproof container, we will put medication out of reach.
3. Correct: Calling medication "candy" is inappropriate and misleading to the child. Children may take medication to eat as candy if they have access to it.. 1. Incorrect: This is a correct statement by the parents. Medication should be measured closely because too much or too little might cause harm to the child. 2. Incorrect: Taking medicine in front of children is not recommended, as children often try to imitate adult behavior. 4. Incorrect: All medication should be placed out of the reach of children.
Which action should the nurse recommend to parents so that their home will be safer for a toddler? 1. Place the child in the center of an adult-sized bed when napping. 2. Buckle the child into the high chair if parents leave the room during a meal. 3. Anchor top-heavy furniture or fish tanks so that they cannot be pulled over. 4. Allow the toddler to explore stairs in the home if supervised.
3. Correct: Top-heavy furniture, TVs, and fish tanks can be pulled over by the toddler, especially if the child is trying to reach something on top of them. 1. Incorrect: The safest place for the toddler to nap or sleep is in a crib. The toddler may easily fall from an adult-sized bed.2. Incorrect: The toddler should never be left unsupervised in a highchair. It can tip if the child tries to climb out, or the child may push against something and fall.4. Incorrect: Stairs in the home present a risk for falls and accidents for the toddler. Safety gates should be in place, and the adults should hold the toddler's hand when navigating the stairs.
The nurse working on a pediatric unit is reviewing morning laboratory results. Which client's lab result should be immediately reported to the primary healthcare provider? 1. Client one - newly diagnosed with type I diabetes. 2. Client two - admitted with acute glomerulonephritis. 3. Client three- treated with IV fluids for sickle cell crisis. 4. Client four - transferred in with pneumococcal pneumonia.
The nurse working on a pediatric unit is reviewing morning laboratory results. Which client's lab result should be immediately reported to the primary healthcare provider? Exhibit You answered this question Correctly 1. Client one - newly diagnosed with type I diabetes. 2. Client two - admitted with acute glomerulonephritis. 3. Client three- treated with IV fluids for sickle cell crisis. 4. Client four - transferred in with pneumococcal pneumonia.
The charge nurse in the pediatric unit is making assignments for the day shift. What clients would be most appropriate for an LPN reassigned from the medical surgical unit? 1. A 12 year old with diabetes mellitus. 2. A 6 year old one day post tonsillectomy. 3. A 3 year old admitted in sickle cell crisis. 4. A 9 year old with Hirschsprung's disease. 5. A 2 year old in a mist tent with epiglottitis.
1. &4. Correct: The LPN scope of practice is task oriented. An LPN reassigned to a specialty floor, such as pediatrics, should be assigned the most stable, uncomplicated clients, and ideally those that may have a disease process which also occurs on a medical surgical unit. The 12 year old with diabetes mellitus is a good choice. This client will require accu checks and subcutaneous insulin, both of which are within the scope of practice for the LPN. A client with Hirschsprung's disease experiences bowel dysfunction, usually with constipation, pain or anorexia. This client could also be assigned to an LPN who has experience with bowel issues. 2. Incorrect: Even though this child is one day post-op, throat surgery would require frequent assessments of the airway and the client's ability to swallow. Additionally, pain medication is usually given IV since the child still has difficulty swallowing. The LPN may not give IV meds. 3. Incorrect: Children in sickle cell crisis require on-going assessments of the vascular system as well as the need for supplemental oxygen and pain medication. In addition to the young age of the client, the disease process requires advanced assessments. This client is not appropriate for the LPN. 5. Incorrect: A two year old with epiglottitis in a mist tent will need airway and respiratory assessments frequently, along with teaching the parents about this illness. This client is not appropriate for the LPN.
The home health nurse is assessing the home environment for threats to the safety of the toddler who lives in the home. Which observations should be included in this assessment? 1. Do stairs have guard gates? 2. Are safety covers on electrical outlet plugs? 3. Is the swimming pool inaccessible to the toddler? 4. Are cleaning supplies located out of the toddler's reach? 5. Are stairs brightly lit?
1., 2., 3. & 4. Correct: Toddlers may fall if left unsupervised around stairs. Make sure that gates are in place and that they are used. Toddlers are at risk for exploring the outlets by putting metal objects into the outlets or putting their fingers in them. They should be covered unless in use. Toddlers can drown in small amounts of water and they may try to explore swimming pools if they are accessible. Pools should have fences or locking stairs and the child should never be left unsupervised around the pool. Toddlers are curious and may get into cabinets containing harmful substances.5. Incorrect: This assessment would be important for the visually impaired or elderly, but not specifically for toddlers. The guard gates should be in place so that the toddler does not have access to the stairs.
What discharge teaching should the nurse include to the parent of an adolescent who has a mild concussion? 1. Concussion symptoms may last anywhere from hours and days to weeks and months. 2. Return to the emergency department for worsening headache. 3. Monitor for increased intracranial pressure. 4. Avoid physical activities until released from care. 5. Awaken the client every two hours.
1., 2., 4., & 5. Correct. This injury will result in symptoms that may last anywhere from hours and days to potentially weeks and months. Contact the primary healthcare provider or the Emergency Department if the client has repeated vomiting, severe or worsening headache, severe or worsening dizziness, or any worsening symptom that alarms client or family. Avoid physical activities (sports, gym, and exercise) and reduce cognitive demands (reading, texting, computer use, video games, etc). The brain is responsible for managing physical and cognitive functions of the body; therefore, it is important to decrease any activity that increases symptoms. Awaken every two hours to check level of consciousness. 3. Incorrect. A lay person would not know the signs/symptoms of increased ICP.
A child diagnosed with AIDS is scheduled for grade school immunizations. Which immunizations are safe for the nurse to administer to the child? 1. MMR (measles, mumps, rubella) 2. DTaP (diphtheria, tetanus, pertussis) 3. VAR (varicella) 4. HiB (haemophilus influenza) 5. OPV (oral polio virus)
2 & 4. Correct: Children with AIDS are immunocompromised because of the HIV virus. Vaccines are crucial to provide protection against common childhood diseases. However, only vaccines which contain synthetic or inactivated viral components are acceptable for children with active AIDS. Diphtheria, tetanus, pertussis is inactive and is provided in multiple doses, starting at 2 months of age, with a booster at age 6. Haemophilus influenza is critically important since this flu virus can lead to meningitis, pneumonia or epiglottitis. This vaccine is also administered in multiple injections over a period of months, starting at 2 months, and then yearly throughout life. 1. Incorrect: The combination vaccine of measles, mumps, and rubella contains a live virus. Although research is ongoing, the Center for Disease Control (CDC) suggests while children diagnosed HIV+ may receive the vaccine, those with active AIDS should not be administered this vaccine. 3. Incorrect: Varicella is a live vaccine administered to protect children from chickenpox and the potential for shingles later in life. Though the disease and its dormancy in the body can have serious long-term effects, the vaccine is considered inappropriate for children with AIDS. 5. Incorrect: Oral polio vaccine contains the live polio virus and could be deadly to those with an immunocompromised system. The correct form of polio vaccine for AIDS clients is called IPV, or inactivated polio vaccine, and is given by injection.
A new mother asks the clinic nurse why her baby should receive recommended vaccinations. What is the best response by the nurse concerning vaccinations? 1. "Vaccinations give antibodies to your baby to protect them from disease." 2. "Vaccinations will help your baby produce antibodies against disease causing organisms." 3. "Federal law requires that your baby receive recommended vaccinations." 4. "There is no reason not to vaccinate your baby since only mild, uncomfortable reactions can occur."
2. Correct: Vaccines are suspensions of antigen preparations intended to produce a human immune response to protect the person from future encounters with the organism. 1. Incorrect: Vaccines will cause the body to produce antibodies. Vaccines give possible immunity to the baby. 3. Incorrect: Vaccines are required for admittance into public school. If a child is homeschooled, the parent may not have the child vaccinated. 4. Incorrect: It is true that the vaccination may cause a mild reaction, but this is not the best response. This answer does not address the mother's question.
The nurse is educating a group of teenagers who have expressed an interest in using electronic cigarettes (e-cigarettes). What information about electronic cigarettes should the nurse include? 1. Electronic cigarettes are a safe alternative to smoking. 2. It is difficult for consumers to know what electronic cigarette products contain. 3. Nicotine can harm adolescent brain development. 4. Electronic cigarette aerosol generally contains fewer toxic chemicals than the smoke from regular cigarettes. 5. Defective electronic cigarette batteries can cause fires and explosions.
2., 3., 4., & 5. Correct: It is difficult for consumers to know what e-cigarette products contain. For example, some e-cigarettes marketed as containing zero percent nicotine have been found to contain nicotine. Nicotine can harm adolescent brain development, which continues into the early to mid-20s. E-cigarette aerosol generally contains fewer toxic chemicals than the deadly mix of 7,000 chemicals in smoke from regular cigarettes. However, e-cigarette aerosol is not harmless. It can contain harmful and potentially harmful substances, including nicotine, heavy metals like lead, volatile organic compounds, and cancer-causing agents. E-cigarettes can cause unintended injuries. Defective e-cigarette batteries have caused fires and explosions, some of which have resulted in serious injuries. In addition, acute nicotine exposure can be toxic. Children and adults have been poisoned by swallowing, breathing, or absorbing e-cigarette liquid. 1. Incorrect: Teens need to be aware that electronic cigarettes are not a safe alternative to smoking. Nicotine, which is highly addictive, and other harmful chemicals are still absorbed through the lungs and into the body with the use of electronic cigarettes.
