Nursing Care of Children Final
A nurse is caring for a child who has an exacerbation of cystic fibrosis. Which of the following laboratory findings should the nurse report to the provider immediately?
oxygen saturation 85%
A nurse is collecting data from an adolescent who has sustained a broken tibia. Following the application of a fiberglass cast, the adolescent reports pain and a tingling feeling in the limb. Which of the following actions should the nurse take first?
Assess for manifestations of circulatory impairment
A nurse is caring for a child who adheres to a vegetarian diet and has sustained superficial partial thickness burns. The nurse should recommend which of the following food choices as having the highest protein content?
1/2 cup of peanut butter with apple slices
A nurse is preparing to administer diphenhydramine 5mg/kg/day PO to divide equally every 8 hr to a school-age child who weighs 50lb. Available is diphenhydramine oral solution 12.5 mg/5mL. How many mL should the nurse administer per dose?
15
A nurse at a clinic is preparing to administer highlight immunizations to a 5 year old child. Which of the following immunizations should the nurse plan to give?
Diphtheria, tetanus, and pertussis (DTaP)
A nurse is reinforcing teaching with the parents of a child who has rheumatic fever. Which of the following statements by a parent indicates an understanding of the teaching?
My child may take aspirin for his joint pain
A nurse is preparing a school age child for a tonsillectomy. Which of the following actions should the nurse take?
Schedule the child for a preoperative visit to the facility
A school nurse is collecting data from an adolescent child who returned to school following a case of mononucleosis. The child has a note from his provider excusing him from gym class. Which of the following findings should the nurse identify as the reason for his excusal?
potential for sustaining abdominal trauma
A nurse is caring for a 10 year old child who should reduce his fat intake. Which of the following menu choices should the nurse suggest?
3 oz of baked chicken on a whole wheat roll
A nurse is preparing to administer acetaminophen 240 mg PO to a child who has a temperature of 38.9 C (102F). The amount available is acetaminophen oral solution 160 mg/5mL. How many mL should the nurse administer per dose?
7.5
A nurse is caring for a child who has epistaxis. Which of the following actions should the nurse take?
Apply continuous pressure to the child's nose for at least 10mins.
A nurse is caring for 4 month old child who has acute otitis media and a fever of 38.3C (101F). Which of the following medications should the nurse administer?
Amoxicillin
A nurse is caring for a child who has been in Buck's traction for 2 days. Which of the following actions should the nurse take to prevent complications?
Check for pulses in the affected leg every 4 hr.
A nurse is caring for a child who has acute glomerulonephritis. Which of the following actions should the nurse take?
Check the child's blood pressure every 4hr.
A nurse is caring for a toddler who has asthma. The parents are concerned about the toddler's reaction to the hospitalization. Which of the following actions should the nurse take to decrease the child's anxiety?
Encourage rooming-in (provide emotional support) note:Do not Give the child a thorough explanation before providing care. A nurse should provide a toddler with short, simple explanations. A long explanation might cause heightened anxiety in the child.
A nurse is planning care for a preschool age child who has autism and is being admitted tot he facility. Which of the following actions should the nurse plan to take?
Encourage the parents to bring in the child's stuffed animal
A nurse is assessing the pain level of a 3 year old child who is postoperative following abdominal surgery. Which of the following pain scales should the nurse use?
FACES pain rating scale
A nurse is reinforcing teaching with a parent of an infant who has colostomy. Which of the following statements by the parent indicates an understanding of the teaching?
I need to apply paste to the back of the wafer on my child's appliance
A nurse is reinforcing teaching with the parents of a 4 month old infant who has gastroesophageal reflux. Which of the following statements by the parent indicates an understanding of the teaching?
I will add 1 teaspoon of rice cereal per ounce to my baby's formula.
A nurse is reinforcing teaching with the parents of a 10 year old child who has iron deficiency anemia. Which of the following statements by a parent indicates an understanding of the teaching?
I will administer the iron tablet with orange juice
A nurse is caring for 4 year old child who has pneumonia. The child's mother left 2 hr ago and he is currently experiencing the despair stage of separation anxiety. Which of the following findings should the nurse expect?
Inactive and thumb sucking note: A child who is sucking his thumb and refusing to eat or drink is displaying manifestations of the second stage of separation anxiety, which is despair.
A nurse is reinforcing postoperative teaching with the parent of a 3 month old infant who is recovering from an umbilical hernia repair. Which of the following statements by the parent indicates an understanding of the teaching?
I will fold my baby's diaper away from the incision
A nurse is caring for a child who has cystic fibrosis and a pulmonary infection. Which of the following findings is the nurse's priority?
Inability to clear secretions
A nurse is caring for a 2 day old infant who has a myelomeningocele;split spline (A birth defect in which a developing baby's spinal cord fails to develop properly.). Which of the following actions should the nurse take?
Monitor the infant's head circumference. Note:Infants who have myelomeningocele have an increased risk for hydrocephalus. Measuring the infant's head circumference helps to determine any increase. The nurse should place a child who has myelomeningocele in a prone position to minimize risk of trauma or tension to the sac.
A nurse is reinforcing teaching with a group of parents of adolescents about developmental needs. Which of the following statements by a parent should the nurse investigate further?
My child spends 4 hours per day in internet chat rooms
A school nurse is assisting a child who has been stung by a bee. The child's hand is swelling and the nurse notes that the child has allergies to insect stings. Which of the following findings should the nurse expect if the child develops anaphlyaxis?
Nausea Urticaria Stridor
A nurse is reinforcing teaching about preventing poisoning with a group of parents who have toddlers. Which of the following statements should the nurse make?
Put all cleaning supplies in a locked cabinet
A nurse is caring for a child who has acute lymphocytic leukemia. Which of the following laboratory values should the nurse expect?
RBC 2.5 million/uL
A nurse is caring for a child who has Tetralogy of Fallot. Which of the following laboratory values should the nurse expect?
RBC 6.8 million/uL note: Platelet count of 20,000/mm3 MY ANSWER A platelet count of 20,000/mm3 is below the expected range. A child who has Tetralogy of Fallot will not have a decreased platelet count. WBC 4,000/mm3 A WBC count of 4,000/mm3 is below the expected reference range. A child who has Tetralogy of Fallot will not have neutropenia. Thyroid stimulating hormone (TSH) 7.0 microunits/mL This TSH level is above the expected reference range. A child who has Tetralogy of Fallot will not have changes in the thyroid function levels. RBC 6.8 million/uL Tetralogy of Fallot causes cyanosis; therefore, the body responds by increasing RBC production (polycythemia) in an attempt to supply oxygen to all body parts.
A nurse is reviewing the medical record of a 2 month old infant who has rotavirus. The nurse notes a hemoglobin level of 12 g/dL and a hematocrit of 51%. Which of the following statements by the nurse indicates an understanding of the laboratory values?
The infant might be dehydrated
A nurse is reinforcing teaching with a group of parents of toddlers about growth and development. A parents asks, "why does my child's abdomen stick out?" Which of the following statements should the nurse make?
Toddlers do not have well-developed abdominal muscles
A nurse is caring for a group of infants who have congenital heart defects. For which of the following defects should the nurse expect to observe cyanosis?
Transposition of great arteries NOTE:Transposition of great arteries An infant who has transposition of great arteries will have severe cyanosis because reversal of the anatomic position of the aorta and pulmonary artery allows venous blood to enter the systemic circulation without oxygenation. Ventricular-septal defect An infant who has a ventricular-septal defect, a hole in the septal wall between the ventricles, can have increased pulmonary vascular resistance but is unlikely to have cyanosis, because oxygenation of the blood remains adequate for the systemic circulation. Coarctation of the aorta An infant who has coarctation of the aorta, a constricted segment of the aorta that obstructs blood flow to the body, is unlikely to have cyanosis, because even though the left ventricle must generate higher than normal pressures for adequate stroke volume, oxygenation of the blood remains adequate for the systemic circulation. Patent-ductus arteriosus MY ANSWER An infant who has a patent-ductus arteriosus will have a blood vessel connecting the pulmonary artery to the aorta. The infant can have increased pulmonary vascular resistance, but oxygenation of the blood remains adequate for the systemic circulation.
A nurse is caring for a child who has a vesicular rash. The parents of the child ask the nurse what illness can cause this rash for 6 days. The nurse should expect that the child has which of the following conditions?
Varicella
A nurse is preparing to administer an highlight intramuscular injection to a 2 month old infant. In which of the following sites should the nurse plan to administer the injection?
Vastus lateralis
A nurse is reinforcing teaching with the parents of a 3 year old child who has persistent otitis media about prevention. Which of the following statements by the parents indicates an understanding of the teaching?
We should not smoke around our child
A nurse is reinforcing teaching with a school age child who has a new diagnosis of type 1 diabetes mellitus. Which of the following statements should the nurse make?
You can use a vial of insulin for up to 30 days.
A nurse is reinforcing teaching with the parents of a child who has cerebral palsy. Which of the following statements should the nurse make?
Your child will need a botulinum toxic A injection to help with muscle spasticity. Children who have cerebral palsy have spasticity in their muscles. The child can receive botulinum toxin type A injections into affected muscles, which aid in reducing the spasticity.
A nurse is caring for a 2 year old child who has frequent urinary tract infections. When reinforcing teaching with the parents about the prevention of urinary tract infections, which of the following instructions should the nurse include in the teaching?
Teach the child to wipe from front to back
A nurse on the pediatric unit is caring for a group of clients. Which of the following findings should be the nurse's priority?
A child who has sickle cell anemia and a urine specific gravity of 1.030 note:Image result for urine specific gravity rangewww.labpedia.net Ideally, urine specific gravity results will fall between 1.002 and 1.030 if your kidneys are functioning normally. Specific gravity results above 1.010 can indicate mild dehydration. The higher the number, the more dehydrated you may be.
A nurse is caring for a 4 year old child who has superficial partial thickness burns over 50% of his body. When planning for the nutritional needs of the child, which of the following actions should the nurse plan to take?
Supplement the child's feedings with enteral feedings. Note:A child who has burns in excess of 25% of total body surface area requires enteral supplementation to consume enough calories to heal.
