More peds questions
The nurse is speaking with the mother of a child diagnosed with contact dermatitis from poison ivy. Which statement by the mother indicates a need for further education?
"As long as he takes a shower as soon as he gets inside, he shouldn't get this again."
A nurse is assessing a 6-month-old girl with an integumentary disorder. The nurse notes three virtually identically sized, round red circles with scaling that are symmetrically spaced on both of the girl's inner thighs. What should the nurse ask the mother?
"Does she wear sleepers with metal snaps?"
The nurse is assessing a child and notes horizontal nystagmus, Which question would the nurse ask the parent first?
"Does your child take phenytoin?"
The nurse helps position a child for a lumbar puncture. Which statement describes the correct positioning for this procedure?
"For a lumbar puncture, the child will be placed in a side-lying position with knees bent and neck flexed to assist with arching the back."
The parents of an 8-year-old boy diagnosed with frostbite are distraught and state to the nurse, "We can't believe we didn't make our child come inside when he complained about his fingers being numb and hurting." How should the nurse respond?
"I can't imagine how you are feeling right now, but I'm sure you had no idea frostbite could happen. We will take good care of your son." The unintentional injury has already occurred so the nurse must be compassionate and supportive of the parents. The other options are judgmental and do not serve a purpose. Instruction can be given with teaching to prevent future incidents when the parents are ready for teaching.
The nurse is caring for a child who has suffered a febrile seizure. While speaking with the child's parents, which statement by a parent indicates a need for further education?
"I hate to think that I will need to be worried about my child having seizures for the rest of his life."
The nurse is teaching parents about the care of diaper rash. The nurse would be concerned about the parents' level of understanding if they made which statement?
"I should be certain to use fabric softener in the care of the infant's clothes."
A topical corticosteroid is prescribed for a child with contact dermatitis. Which statement by the mother would indicate the teaching was successful?
"I should not cover the area with plastic wrap after applying the cream."
The parents of a 17-year-old adolescent diagnosed with bacterial meningitis tell the nurse, "We just do not understand how this could have happened. Our adolescent has always been healthy and just received a booster vaccine last year." How should the nurse respond?
"I understand your frustration. Unfortunately, immunizations are not 100% effective in preventing the infection."
The nurse is caring for an infant who is at risk for increased intracranial pressure. What statement by the parent would alert the nurse to further assess the child's neurological status?
"She has been irritable for the last hour....seems like she is just upset for some reason."
The parent of a 12-year-old child with Reye syndrome approaches the nurse wanting to know how this happened to the child, saying, "I never give my children aspirin!" What could the nurse say to begin educating the parent?
"Sometimes it is hard to tell what products may contain aspirin."
An 8-month-old has been diagnosed with infantile eczema. At a follow-up appointment, the child's caregiver seems exhausted and angry. He explains that he has done all of the child's care because his wife is repulsed by the child's raw and uncomfortable appearance. What responses would be appropriate for the nurse to say to this caregiver?
"That's not an uncommon reaction, although it's hard on you and on your child." The family caregivers of the child with eczema are often frustrated and exhausted. Family caregivers may feel apprehensive or repulsed by this unsightly child. Support them in expressing their feelings and help them view this as a distressing but temporary skin condition. Although the caregiver can be assured that most cases of eczema clear up by the age of 2, this does little to relieve the present situation
A child who has been having seizures is admitted to the hospital for diagnostic testing. The child has had laboratory testing and an EEG, and is scheduled for a lumbar puncture. The parents voice concern to the nurse stating, "I don't understand why our child had to have a lumbar puncture since the EEG was negative." What is the best response by the nurse?
"The lumbar puncture can help rule out any infection in fluid surrounding the brain and spinal cord as the cause of the seizures." Lumbar punctures are performed to analyze cerebrospinal fluid (CSF) to rule out meningitis or encephalitis as a cause of seizures. A normal EEG does not rule out epilepsy because seizure activity rarely occurs during the actual testing time. A 24-hour or longer EEG can help in diagnosing a seizure disorder. Just telling the parents that it needs to be done, to be patient, or it is a routine does not address the parents' concerns.
A 1-year-old infant has just undergone surgery to correct craniosynostosis. Which comment is the best psychosocial intervention for the parents?
"The surgery was successful. Do you have any questions?"
A 7-year-old client has been complaining of headache, coughing, and an aching chest. The care provider makes a diagnosis of a viral infection. The child's mother tells the nurse that when she first said she had a headache, the child's father gave her half of an adult aspirin. The mother has heard of Reye syndrome and asks the nurse if her child could get this. Which statement would be the best response by the nurse?
"This might or might not be a problem. Watch your daughter for signs of lethargy, unusual irritability, confusion, or vomiting. If you notice any of these, bring her to the emergency room immediately so she can be checked for Reye syndrome."
The nurse provides education to the parent of an infant being treated for hydrocephalus with a ventriculoperitoneal (VP) shunt. Which statement by the parent indicates the need for further instruction?
"This shunt is the only surgery my baby will need."
A pediatric client was brought to the emergency department by the parents after experiencing extensive urticaria following consumption of a seafood dinner. Upon discharge from the facility the nurse provided client teaching. Which statement by the parents indicate learning occurred?
"We need to get our child a medical alert bracelet as soon as possible in case this happens again."
The emergency room nurse is taking a history of a 1-year-old child whose parent said that she had a "fit" at home. Which inquiry would be best to start with?
"What happened just before the seizures?"
An adolescent is diagnosed with psoriasis. After speaking with the nurse about treatment options suggested by the primary health care provider, the adolescent states, "Since ultraviolet rays help, I am going to buy a tanning package so I can tan year round." How will the nurse respond?
"Year round tanning is not what your health care provider intended. Tanning puts you at high risk for skin cancer and other problems."
The parent of a 1-week-old infant is concerned with white scales that have begun to flake off the infant's scalp. The parent asks the nurse what to do to treat this. How should the nurse best respond?
"Your child most likely has cradle cap (seborrhea). You can care for it by cleansing the hair and scalp daily with baby shampoo and applying baby oil."
The nurse is caring for a child with a skin disorder. The child presented with papules that progressed to vesicles with a honey-colored exudate. What treatment would the nurse expect to be ordered to treat this disorder? Select all that apply.
-Topical mupirocin ointment -Cool compresses to assist in removing crusts on vesicles -Regular hygiene measures Nonbullous impetigo symptoms include papules progressing to vesicles with honey-colored exudate when the vesicles rupture. Treatment includes topical mupirocin ointment with cool compresses BID to assist in removing honey-colored crust. Oral cephalexin and good hygiene are used to treat bullous impetigo. Warm compresses after washing with soap is used to treat folliculitis.
The nurse is assessing the neurological functioning of a preschool child. What actions will best review functioning of cranial nerve iii?
A bright-colored toy is moved in the child's visual fields.
A nurse is caring for a child with second- and third-degree (partial- and full-thickness) burns over 15% of the body. The child reports severe itching in and around the burn sites. Which action would be most appropriate for the nurse to perform?
Administer diphenhydramine
A nurse is providing care to an infant who is admitted with burns over the face, neck and chest. The nurse identifies which goal as priority for planning the infant's care?
Airway remains patent
The nurse is educating a parent about the treatment for a child's tinea cruris. What medication class would the nurse include in the teaching plan?
Antifungal
The camp nurse is caring for a child who was bitten on the leg by a dangerous spider. The child is being taken to a health care provider. What is the most appropriate action for the nurse to do with this child?
Apply ice to the affected area
A group of nursing students are reviewing cerebral vascular disorders and risk factors in children. The students demonstrate understanding of the material when they identify which as a risk factor for hemorrhagic stroke?
Arteriovenous malformations (AVMs)
What information is most correct regarding the nervous system of the child?
As the child grows, the gross and fine motor skills increase.
cephalohematoma vs caput succedaneum
Cephalohematoma- does NOT cross suture lines- observe Caput succedaneum- CROSSES suture lines
Cephelohematoma
Does not include discoloration and does not cross midline
A nurse on the neurology unit is monitoring an 8-year-old child admitted with seizures. The child experiences a prolonged tonic-clonic seizure. > Complete the following sentence(s) by choosing from the lists of options. The nurse should first Select... • followed by Select...
Ensure patent airway and proper oxygenation using blow by method and admin iv or im benzo
A parent brings an infant to the clinic for a well child visit. During the assessment, the parent asks the nurse why the infant never seems to sweat. What action should the nurse take?
Explain that this normal mechanism keeps the infant from losing too much water through the skin.
The nurse is assessing a child who pulled a boiling pot of soup off of the stove top, The child reports pain at a 9 on a scale of 0 to 10. The burn is red and edematous, and also shows areas of charred skin. The nurse is aware that these signs and symptoms are indicative of what kind of burn?
Full-thickness Full-thickness burns may be very painful or numb or pain-free in some areas. They appear red, edematous, leathery, dry, or waxy and may display peeling or charred skin.
Treatment of Caput succedaneum & Cephalohematoma
Gradual improvement without treatment over weeks-months
The nurse knows that the heads of infants and toddlers are large in proportion to their bodie: placing them at risk for what problem?
Head trauma?
A 10-year-old has been bitten on the lower posterior arm by a dog, requiring several stitches. The child was just admitted to the hospital for 3 days of antibiotic therapy. When developing the care plan, the nurse identifies which nursing diagnoses as being the top 2 priorities?
Impaired skin integrity Risk for infection
The nurse is presenting an in-service to a group of nurses who will be working in a dermatology clinic. One participant asks the nurse about a bacterial skin infection that she has seen in children that involves honey-colored crusted lesions. The nurse most likely is referring to:
Impetigo
The nurse is assessing a child who was brought into the clinic. The nurse notes honey-colored crusting on the toddler's face, as seen in the figure. The nurse recognizes this to be what type of infection?
Impetigo Impetigo is a readily recognizable skin rash that is characterized with honey-colored crusting. Nonbullous impetigo generally follows some type of skin trauma or may arise as a secondary bacterial infection of another skin disorder, such as atopic dermatitis. Bullous impetigo demonstrates a sporadic occurrence pattern and develops on intact skin, resulting from toxin production by S. aureus.
Absence seizures are marked by what clinical manifestation?
Loss of motor activity accompanied by a blank stare
The nurse is collecting data from a child who may have a seizure disorder. Which nursing observations suggest an absence seizure?
Minimal or no alteration in muscle tone, with a brief loss of responsiveness or attention
An infant is seen in the emergency department with several raised red welts over the abdomen and lower extremities. The parent states that the symptoms developed suddenly over the past few hours. The infant is fussy and has a low grade temperature. What assessment is most important for the nurse to perform?
Observe the infant's respiratory effort.
A child with a seizure disorder is being admitted to the inpatient unit. When preparing the room for the child, what should be included? Select all that apply.
Oxygen gauge and tubing Suction at bedside Padding for side rails
nurse is assessing a 3-year-old child for possible bacterial meningitis. Which sign would dicate irritation of the meninges?
Positive kernig
A child with a burn injury is scheduled for skin grafting. Which intervention would be most appropriate for the nurse to include in the child's plan of care?
Provide around the clock pain medication
A nurse completes an assessment on an 8-month-old infant seen in the pediatrician's office for a well-child visit. The nurse notes that the infant's buttocks, perineum and inner thighs are covered in a thick coating of white ointment. When questioned, the parent says the infant has a diaper rash and the ointment is to protect the infant's skin. What is the best action for the nurse to take?
Provide instruction on how to care for a diaper rash.
During the newborn examination, the nurse notes that an infant who is appropriate for gestational age by birth weight has a head circumference below the 10th percentile and the fontanels (fontanelles) are not palpable. What action would the nurse take?
Report the findings to the pediatric health care provider.
The nurse is preparing a care plan for a child who has a seizure disorder. The child experiences tonic-clonic seizures. Which nursing diagnosis will the nurse identify as having the highest priority?
Risk for injury
The nurse is providing education to the parents of a female toddler with hydrocephalus who has just had a shunt placed. Which statement is the best to make during a teaching session?
Tell me your concerns about your child's shunt.
A mother asks the nurse about bathing her child. Which response by the nurse would be most appropriate?
Use lukewarm water with a mild soap and allow the child to remain in the tub for a short time to avoid supersaturation
The nurse is caring for a child with a suspected head injury. The nurse observes for what response to the child's eye reflex examination that would indicate potential increased intracranial pressure (ICP)?
While assessing the child's pupils, there is no change in diameter in response to a light.
craniostenosis
a malformation of the skull due to the premature closure of the cranial sutures
The nurse is caring for a child with a tinea corporis infection involving several sites. Which information would be the most important for the nurse to include in the teaching plan for the parents?
finishing all prescribed oral medication, even after lesions fade
Dexamethasone is often prescribed for the child who has sustained a severe head injury. Dexamethasone is a(n):
steroid. A steroid may be prescribed to reduce inflammation and pressure on vital centers.
The nurse is educating a child and his family about what to expect during the child's electroencephalogram (EEG) exam. Which statement by a parent suggests a need for further education?
"I will make sure my child goes to bed early every night before the exam" During an EEG, the client needs to be cooperative and quiet. Typically, parents are asked to keep their child up later the night before so that the child will fall asleep during the procedure. The room is also darkened to help them rest. If the child is unable to remain still, sedation may be used. The EEG reflects the electrical patterns of the brain.
The nurse is educating the family of a 7-year-old with epilepsy about care and safety for this child. What comment will be most valuable in helping the parent and the child cope?
"Use this information to teach family and friends." Families need and want information they can share with relatives, childcare providers, and teachers. Wearing a helmet and having a monitor in the room are precautions that may need to be modified as the child matures. The boy may be able to bike ride and swim with proper precautions.
Which assessment finding by the nurse would warrant immediate action?
A child with periorbital cellulitis reports changes in vision and pain with eye movement.
Preterm infants have more fragile capillaries in the periventricular area than term infants. This put these infants at risk for which problem?
Intracranial hemorrhaging
The nurse caring for an infant with craniosynostosis, specifically positional plagiocephaly, should prioritize which activity?
Moving the infant's head every 2 hours
Any individual taking phenobarbital for a seizure disorder should be taught:
Never to discontinue the drug abruptly. Phenobarbital should always be tapered, not stopped abruptly, or seizures from the child's dependency on the drug can result.
The nurse is caring for a child with a prescription for PO prednisone. Which statement by the child's mother would indicate a need for further education?
Not on empty stomach
In caring for the child with meningitis, the nurse recognizes that which nursing diagnosis would be most important to include in this child's plan of care?
Risk for injury related to seizure activity The child's risk for injury would be an appropriate nursing diagnosis. Surgery is not indicated for the child with meningitis, and the history of seizures does not impact the airway clearance. Growth and development issues are a concern but not likely delayed due to this diagnosis.
When caring for a child who has a history of seizures, which nursing interventions would be appropriate? Select all that apply.
The nurse pads the crib or side rails before a seizure. The nurse positions the child on the side during a seizure. The nurse stays with the child and calls for help when a seizure begins. The nurse has oxygen available to use during a seizure. The nurse teaches the caregivers regarding seizure precautions. The nurse should pad the crib sides and keep sharp or hard items out of the crib. The nurse should also position the child to one side to prevent aspiration of saliva or vomitus and have oxygen and suction equipment readily available for emergency use. The nurse should teach family caregivers seizure precautions so they can handle a seizure that occurs at home. The nurse should not put anything in the child's mouth; doing so could cause injury to the child or to the nurse. It is important for the nurse to promptly inform other members of the care team when a child is experiencing seizure activity, but leaving the bedside to do so would be unsafe.
The nurse is caring for a child on the burn unit weighing 100 lb (45.5 kg) who has second-degree (partial-thickness) burns over 30% of the body. During the beginning shift assessment which assessment finding is of most concern to the nurse?
Urine output of 15 mL per hour over the last 4 hours
The nurse is planning an educational program on burn prevention at home. Which information should be included?
• Keep pot handles turned in on a stove. • Test bath water temperature before bathing children. • Teach children to "stop, drop and roll" if their clothes catch on fire. Burn prevention techniques include keeping hot water heater temperature set at 120 degrees F or lower, not 130 degrees or lower. Do not drink hot beverages while holding children. Other techniques include keeping pots on the inside of the stove with the handles turned in, testing bath water before bathing a child and teaching them to 'stop, drop and roll' if their clothes catch on fire.
The mother of a toddler tells the nurse during a routine well child appointment that she is concerned because, "It seems like my son is falling and hitting his head all of the time." What is the best response by the nurse?
"Due to the size of their heads and immature neck muscles falling is common, but I will let the physician know your concerns." The head of the infant and young child is large in proportion to the body, and is the fastest-growing body part during infancy and continues to grow until the child is 5 years old. In addition, the infant's and child's neck muscles are not well developed. Both of these differences lead to an increased incidence of head injury from falls. The nurse should still let the physician know the mother's concerns in case there is another issue causing the falls.
The nurse is caring for a 2-year-old boy with a burn. What finding would warrant referral to a burn unit?
A chemical burn According to the American Burn Association, chemical burns warrant referral to a burn unit. A partial-thickness burn greater than 10% of the body surface area would warrant a referral to a burn unit. A superficial burn on the chest or hands does not warrant a referral to a burn unit. A first-degree burn would most likely be classified as a superficial burn, which would not warrant a referral to a burn unit.
The nurse has completed client teaching with a 16-year-old female who has been prescribed isotretinoin for cystic acne. Which statements indicate learning has occurred? Select all that apply.
"If I am sexually active I need to let my doctor know." "This is not a drug to be used for all forms of acne. My sister has minor acne so I told her this wasn't for her." "It's important I get my CBC blood test when my doctor orders it."
A 6-month-old infant is admitted with suspected bacterial meningitis. She is crying, irritable, and lying in the opisthotonic position. Which intervention should the nurse take initially?
Institute droplet precautions in addition to standard precautions. Bacterial meningitis is a medical emergency. The child must be placed on droplet precautions until 24 hours of antibiotics have been given. Encouraging the mother to hold and comfort the child is an intervention but not the priority one: the focus is to get the infant the appropriate medications to fight the infection and to prevent its spread. Educating the family about preventing bacterial meningitis would be appropriate later once the initial infection has been controlled. Palpating the fontanels is used to assess for hydrocephalus.
