Passpoint: School-Age Child

After a series of tests, a 6-year-old client weighing 50 lb (22.7 kg) is diagnosed with complex partial seizures. The physician prescribes phenytoin, 125 mg by mouth twice per day. After the nurse administers phenytoin, where is the drug metabolized? Pancreas Kidneys Stomach Liver

Liver Phenytoin is metabolized in the liver. The pancreas isn't involved in the pharmacokinetic activity of phenytoin. The stomach absorbs orally administered phenytoin, which is excreted by the kidneys in the urine.

A child is receiving total parenteral nutrition (TPN). During TPN therapy, the most important nursing action is: assessing vital signs every 30 minutes. monitoring the blood glucose level closely. elevating the head of the bed 60 degrees. providing a daily bath.

monitoring the blood glucose level closely. Most TPN solutions contain a high glucose content, placing the client at risk for hyperglycemia. Therefore, the most important nursing action is to monitor the child's blood glucose level closely. A child receiving TPN isn't likely to require vital sign assessment every 30 minutes or elevation of the head of the bed. A daily bath isn't a priority.

During chemotherapy, a boy, age 10, loses his appetite. When teaching the parents about his food intake, the nurse should include which instruction? "Let your child eat any food he wants." "Offer dry toast and crackers." "Ignore your child's lack of food intake." "Withhold all food and fluids."

"Let your child eat any food he wants." The nurse should instruct the parents to let the child eat any food he wants because any form of intake is better than none. Dry crackers would be appropriate for a child experiencing nausea. Withholding all foods and fluids or ignoring lack of food intake would be inappropriate.

A nurse in a well-child clinic is collecting data on children for scoliosis screening. Which child is at greatest risk for scoliosis? 6-year-old girl 10-year-old girl 14-year-old boy 8-year-old boy

10-year-old girl Scoliosis is 5 times more common in girls than boys, and its peak age of incidence is between ages 8 and 15. Therefore, the 10-year-old girl is at greatest risk for scoliosis. The 8-year-old or 14-year-old boy may develop scoliosis, but it is more common in females. A 6-year-old girl is typically too young to be diagnosed with scoliosis.

A 10-year-old client with asthma is prescribed 2 mg of albuterol syrup four times per day. The syrup comes in a dosage strength of 2 mg/5 ml. How many milliliters of syrup should the nurse administer? Record your answer using a whole number. 10 mL 7.5 mL 4 mL 5 mL

5 mL Set up the following proportion to obtain the prescribed dose: D/H × mL ____ mg/____ mg × ____ mL 2 mg/2 mg × 5 mL = 5 mL

A school-age client reports pain. After rating the pain on an age-appropriate pain scale, the nurse determines that the client's pain is minor. Which of the following drugs should the nurse administer? Morphine Fentanyl Ibuprofen Acetaminophen

Acetaminophen Acetaminophen, when used as directed, is safe even for neonates and has the benefit of helping to reduce fever in addition to relieving mild pain. Morphine, fentanyl, and ibuprofen aren't drugs of choice for treating mild pain in children. Morphine and fentanyl are reserved for severe pain.

A child is admitted with a tentative diagnosis of clinical depression. Which data collection finding is most significant in confirming this diagnosis? Irritability Sadness Weight gain Fatigue

Sadness Clinical depression is diagnosed if the child exhibits a depressed mood (sadness) or loss of interest. Irritability isn't diagnostic for depression in children. Although a depressed child may gain weight and report fatigue, these findings aren't essential to the diagnosis.

According to Erikson's psychosocial theory of development, an 8-year-old child would be in which stage of development? Trust versus mistrust Identity versus role confusion Initiative versus guilt Industry versus inferiority

Industry versus inferiority In middle childhood, the 6- to 12-year-old child is mastering the task of industry versus inferiority. The trust versus mistrust task is in infancy (birth to 1 year). In early childhood, the 1- to 3-year-old child is in the stage of initiative versus guilt. Identity versus role confusion occurs during adolescence.

A school-age child's family asks the nurse to describe palliative care. Which statement best describes palliative care? Intervention to hasten the death and dying process A means provided to end life Total care given when disease doesn't respond to curative treatment Action of a person to end a client's life because he's suffering from a terminal illness

Total care given when disease doesn't respond to curative treatment The World Health Organization describes palliative care as the total care given to a client who doesn't respond to curative treatment. Intervening to hasten the death and dying process describes mercy killing. Assisting a client to end his life is assisted suicide. Euthanasia is described as the action of a person to end a client's life because he has a terminal illness.

An 11-year old girl with reports of dysuria is suspected of having a urinary tract infection. Which findings on the laboratory report are consistent with a urinary tract infection? WBCs: 20 per high-power field ketones: positive pH 7.8 glucose: positive

WBCs: 20 per high-power field Urinary tract infections are more common in school-aged girls than in school-aged boys. A normal urinalysis would show less than 5 WBCs per high-power field. An elevated WBC count of 20 is an indication of bacteria and urinary tract infection. The normal range of urinary pH is 4.6 to 8.0. The presence of glucose or ketones in the urine does not indicate a urinary tract infection, but may indicate diabetes mellitus.

A nurse is participating in a health class for preteen girls about puberty. The nurse recognizes the teaching has been successful when the students are able to correctly identify which sign as the first sign of sexual maturation in females? breast bud development appearance of axillary hair onset of menstruation appearance of pubic hair

breast bud development The first sign of sexual maturation in females is the development of breast buds (elevation of the nipples and areolae). As sexual development progresses, pubic and axillary hair appear and menstruation begins (menarche).

The parents of a school-age child ask the nurse what to expect from their child during this stage of development. When developing a plan of care to address this matter, the nurse should keep in mind that this child's cognitive development is characterized by: magical thinking. transductive reasoning. abstract thought. conservation skills.

conservation skills. According to Piaget, a school-age child acquires cognitive operations to understand concepts related to objects, including conservation skills, classification skills, and combinational skills. Magical thinking and transductive reasoning are characteristic of the preschooler's preoperational thought. Abstract thought is characteristic of the adolescent's period of formal operations.

A 10-year-old child has been experiencing insatiable thirst and urinating excessively and the serum glucose is normal. Which condition is the child most likely experiencing? type 2 diabetes type 1 diabetes hyperthyroidism diabetes insipidus

diabetes insipidus Polydipsia and polyuria with normal serum glucose are indicative of diabetes insipidus. Interview and laboratory results can determine whether the origin is neurogenic or nephrogenic. Type 1 or 2 diabetes mellitus present with an elevated serum glucose. A child with hyperthyroidism may present as dehydrated from the excessive sweating and rapid respirations that accompany this hypermetabolic state.

An 8-year-old child arrives at the emergency department with chemical burns to both legs. Which nursing action should the nurse perform first? apply topical antibiotics apply sterile dressings debride and graft the burns dilute the burns

dilute the burns Diluting the chemical is the first treatment. It will help remove the chemical and stop the burning process. The remaining treatments are initiated after dilution.

A nurse working as part of a multidisciplinary team is caring for a school-age child who has cerebral palsy. The child has difficulty eating using regular utensils and requires extensive assistance. The nurse advocating for the child would seek out which team member to assist in promoting the child's independence? registered dietitian nursing assistant occupational therapist physical therapist

occupational therapist An occupational therapist helps clients with physical impairments adapt to physical limitations and is most qualified to help a child with cerebral palsy eat and perform other activities of daily living, thereby promoting the child's optimal level of independence. A registered dietitian would be helpful in managing and planning for the nutritional needs of children with cerebral palsy but is not trained in modifying or fitting utensils with assistive devices. A physical therapist is trained to help a child with cerebral palsy gain function and prevent further disability but is not trained to assist the child in performing activities of daily living. A nurse's aide can help a child eat but is not trained in modifying utensils.

A nurse is caring for 10-year-old child with sickle cell anemia admitted for vaso-occlusive crisis. Which would be the most appropriate activity for the nurse to provide for the child? reading walking in the hallways exercising in the physical therapy department finger painting

reading During a vaso-occlusive crisis, the child needs to minimize oxygen consumption by resting. Reading is a quiet, age-appropriate activity. Walking in the hallway and exercising in the physical therapy department are too strenuous for a child in vaso-occlusive crisis. Finger painting is not an appropriate activity for a 10-year-old.

Which use of restraints in a school-age child should the nurse question? to substitute for observation to ensure the child's comfort or safety to facilitate examination to aid in carrying out procedures

to substitute for observation Restraints should never be used as a punishment or as a substitute for observation because if a child is at risk for self-harm when left alone, the child requires one-on-one observation. Ensuring the child's comfort or safety (restraining to keep an I.V., drainage tube, or orthopedic device in place), facilitating examination, and carrying out procedures are all valid reasons for restraint. Restraining devices aren't without risk and must be checked and documented every 1 to 2 hours.

A school-age child has a fever, joint inflammation, and a nonpruritic rash. Knowing that these are signs of rheumatic fever, the nurse should ask the parents: "Has your child recently been exposed to other children with rheumatic fever?" "Is your child's Haemophilus influenzae vaccine up to date?" "Does your child have a congenital heart defect?" "Has your child had strep throat recently?"

"Has your child had strep throat recently?" Group A beta-hemolytic streptococcal infection typically precedes rheumatic fever. An inflammatory disease, rheumatic fever affects the heart, joints, and central nervous system. It isn't infectious and can't be transmitted from one person to another. Congenital heart defects don't play a role in the development of rheumatic fever. H. influenzae vaccine doesn't prevent streptococcal infection or rheumatic fever.

The nurse is planning care for a school-age client. Which action is most appropriate for the nurse to include? restricting the client to quiet activities such as reading instead of playing video games asking caregivers to leave during procedures to allow privacy teaching the client about procedures and conditions using basic medical language assigning multiple nurses to the client to help reduce boredom

teaching the client about procedures and conditions using basic medical language School-age clients can be taught about procedures and conditions using correct, basic medical language and should be encouraged to ask questions. Assigning multiple nurses will impede the continuity of care and should be avoided. Caregivers should be permitted to remain with their child during procedures to comfort the child if they so desire. The child should be permitted to engage in distracting activities such as age-appropriate video games and not be restricted to only quiet activities. Suggested diversions should be based on an individual assessment as well as client and caregiver preferences.

Several children in a kindergarten class have been treated for pinworm. To prevent the spread of pinworm, the school nurse meets with the parents and explains that they should: tell the children not to bite their fingernails. not let children share hairbrushes. tell the children to cover their mouths and noses when they cough or sneeze. have their children immunized.

tell the children not to bite their fingernails. Pinworms come out of the intestine through the anus at night to lay eggs, causing perianal itching. The child wakes up and may begin scratching. Eggs under the fingernails are carried to the mouth if the child chews on his nails, and the life-cycle of the pinworm continues. In addition to teaching children not to bite their fingernails, parents should keep the nails short and encourage hand washing before food preparation and eating. Sharing hairbrushes contributes to the spread of head lice, not pinworms. Although covering the mouth and nose are hygienic practices to reduce the spread of infections from respiratory droplets, doing so doesn't affect the spread of pinworms. There are no immunizations to protect against pinworms.

A pediatric client with iron deficiency anemia is prescribed ferrous sulfate, an oral iron supplement. When teaching the child and parent how to administer this preparation, the nurse should provide which instruction? "Administer ferrous sulfate with milk to promote absorption." "Administer ferrous sulfate with antacids to prevent stomach upset." "Administer ferrous sulfate with fruit juice to promote absorption." "Administer ferrous sulfate with meals to prevent stomach upset."

"Administer ferrous sulfate with fruit juice to promote absorption." Administering an oral iron supplement such as ferrous sulfate with fruit juice or another vitamin C source enhances its absorption. Preferably, doses should be administered between meals because gastric acidity and absence of food promote iron absorption. In contrast, food, milk, and antacids impair iron absorption.

A 10-year-old child monitors and adjusts insulin dosage independently. Which response reflects an understanding of appropriate adjustment of insulin dosage when the child has the flu? "I won't take my insulin because I'm too sick to eat right now." "I'll take my usual dose of regular and NPH insulin." "I'll do a fingerstick test first, then figure out how much insulin to take." "I'll do a fingerstick test and record the results."

"I'll do a fingerstick test first, then figure out how much insulin to take." Because of the stress of illness, serum glucose will likely be elevated during an episode of the flu. Appropriate adjustment of insulin dosage based on a fingerstick reading will help prevent the child from becoming hypoglycemic or ketoacidotic.

The physician prescribes meperidine, 30 mg I.M., as preoperative medication for a school-age child who weighs 66 lb (30 kg). The meperidine is supplied as 50 mg/ml. How much meperidine should the nurse administer? 0.3 ml 0.5 ml 0.6 ml 0.8 ml

0.6 ml By using the fraction method and cross-multiplying to solve for X, the nurse can determine that 0.6 ml should be administered: X ml/30 mg = 1 ml/50 mg X ml × 50 mg = 30 mg × 1 ml X = 0.6 ml.

A child, age 8, reports leg pain shortly after being admitted with a fractured tibia sustained in a fall. The nurse uses which approach to best assess the severity of the pain? Ask the child what makes the leg feel better. Ask the child what the pain feels like. Ask the child what makes the leg hurt more. Ask the child to rate the pain using a pain scale.

Ask the child to rate the pain using a pain scale. Asking what the pain feels like and what makes the pain better or worse assesses the quality of the child's pain, but these questions do not address severity. Having the child rate the pain on an age-appropriate scale is the most effective way to assess pain severity because it quantifies the pain objectively.

The nurse is caring for an 8-year-old child admitted with pneumonia. Based on the child's age, which type of pneumonia does the nurse suspect? streptococcal pneumonia enteric bacilli mycoplasma pneumonia staphylococcal pneumonia

mycoplasma pneumonia Mycoplasma pneumonia is a primary atypical pneumonia seen in children between ages 5 and 12. Streptococcal pneumonia, enteric bacilli, and staphylococcal pneumonia are mostly seen in children in the 3-month to 5-year age group.

A child with diabetes insipidus receives desmopressin acetate (DDAVP). When evaluating for therapeutic effectiveness, the nurse would interpret which finding as a positive response to this drug? Increased urine glucose level Relief of nausea Decreased urine output Decreased blood pressure

Decreased urine output The primary action of DDAVP is to stimulate water reabsorption by the kidneys, thereby decreasing the urine output. DDAVP has no effect on glucose levels, blood pressure, or nausea.

A nurse is teaching newborn care to expectant parents. Which information about sleep should the nurse include in the teaching plan? Infants should not sleep in a bed with another person. Infants should be put to sleep in their own room. Only use soft bedding in the crib. Infants should be placed in the prone position for sleep.

Infants should not sleep in a bed with another person. Parents should be taught to use a firm sleep surface and to avoid loose or soft bedding that might interfere with breathing. Infants should not sleep in a bed or couch with another person. Placing the infant's bed in the parents' room is recommended. Placing infants in the prone position for sleep is associated with an increased risk of sudden infant death syndrome.

When collecting data from a 6-year-old child who has a 20% deep partial-thickness (second-degree) burn of the arms and trunk, the nurse determines that the child has damage to what layer(s) of skin? epidermis and all of the dermis dermis and subcutaneous tissue epidermis and part of the dermis epidermis

epidermis and part of the dermis A deep partial-thickness burn affects the epidermis and part of the dermis. A superficial partial-thickness (first-degree) burn affects the epidermis only. A full-thickness (third-degree) burn involves epidermis and all of the dermis, as well as nerves and blood vessels in the skin.

A 10-year-old child being treated for common warts asks about the cause. The nurse would reveal which virus as the cause? human papillomavirus (HPV) coxsackievirus human immunodeficiency virus (HIV) human herpesvirus (HHV)

human papillomavirus (HPV) HPV is responsible for various forms of warts. Coxsackievirus is associated with hand-foot-and-mouth disease. HHV is associated with varicella and herpes zoster. HIV infections aren't associated with epithelial tumors known as warts.

Which finding would the nurse associate with a partial-thickness burn in a 9-year-old child? erythema and pain minimal damage to the epidermis necrosis through all layers of skin tissue necrosis through most of the dermis

tissue necrosis through most of the dermis A client with a deep partial-thickness burn will have tissue necrosis to the epidermis and dermis layers. Necrosis through all skin layers is seen with full-thickness injuries. Erythema and pain are characteristic of superficial injury. With deep burns, the nerve fibers are destroyed and the client will not feel pain in the affected area. Superficial burns present with slight epidermal damage.

The nurse is reinforcing the correct use of crutches to a client in the emergency. Which should the nurse include? The crutches should fit snugly under the axilla. The crutches should end 2 in (5 cm) below the axilla. The elbow should be flexed to 60 degrees. The elbow should be flexed to 90 degrees.

The crutches should end 2 in (5 cm) below the axilla. The crutches should end 2 in (5 cm) below the axilla, and the elbow should be flexed 20 to 30 degrees.

A nurse is examining the progress record of a client with femur fractures who has had bilateral leg skeletal traction applied. The nurse reinforces education of the child on performing Kegel exercises. What is the most important purpose of these exercises? to strengthen the child's arms so that she can better use the trapeze to lift up for bedpan placement and removal to strengthen the child's calf muscles so that the child is less likely to get leg cramps to distract the child to maintain good perineal muscle tone by tightening the pubococcygeus muscle

to maintain good perineal muscle tone by tightening the pubococcygeus muscle Because there's no evidence of a urinary tract infection, Kegel exercises are the appropriate intervention. Kegel exercises involve tightening the perineal muscles to help strengthen the pubococcygeus muscle and increase its elasticity. This helps to keep the child from becoming incontinent. None of the other interventions are related to Kegel exercises.

A 10-year-old child falls, injures the left shoulder, and is taken to the emergency department. While the child waits to be seen by the primary health care provider, what is the priority nursing action? Apply ice to the injured shoulder. Give the child a nonopioid analgesic for pain. Ask the child to demonstrate full range of motion of the left arm. Apply a warm compress to the injured shoulder.

Apply ice to the injured shoulder. The nurse should help the child into a comfortable position and apply ice to the injured shoulder to reduce swelling and pain. Warm compresses can increase swelling and cause bleeding into the injured tissue. Demonstrating full range of motion of the left arm can cause further damage to the injured area. In the emergency department, the nurse must have a primary care provider's prescription to administer an analgesic.

The nurse is caring for an 11-year-old child with cerebral palsy who has a pressure ulcer on the sacrum. When reinforcing education for the parent about dietary intake, which foods should the nurse plan to emphasize? legumes and cheese whole grain products fruits and vegetables lean meats and low-fat milk

lean meats and low-fat milk Although the child should eat a balanced diet with foods from all food groups, the diet should emphasize foods that supply complete protein, such as lean meats and low-fat milk. Protein helps build and repair body tissue, which promotes healing. Legumes provide incomplete protein. Cheese contains complete protein but also fat, which should be limited to 30% or less of caloric intake. Whole grain products supply incomplete proteins and carbohydrates. Fruits and vegetables provide mainly carbohydrates.

A parent brings a child to the health care provider's office for evaluation of chronic stomach pain stating, "The pain seems to go away when I keep the child home from school." The health care provider diagnoses school phobia. Which other behaviors or symptoms may the child exhibit? Select all that apply. nausea headaches weight loss dizziness fever

nausea headaches dizziness

A school-age child experiences symptoms of excessive polyphagia, polyuria, and weight loss. The physician diagnoses type I diabetes mellitus and admits the child to the facility for insulin regulation. The physician prescribes an insulin regimen of insulin (Humulin R) and isophane insulin (Humulin N) administered subcutaneously. How soon after administration can the nurse expect the regular insulin to begin to act? ½ to 1 hour 1 to 2 hours 8 to 10 hours 4 to 8 hours

½ to 1 hour Regular insulin, a rapid-acting insulin, begins to act in ½ to 1 hour, reaches peak concentration levels in 2 to 3 hours, and has a duration of action of 3 to 6 hours.

The parents of a 9-year-old child in the terminal phase of a fatal illness ask the nurse for guidance in discussing death with their child. Which response is appropriate? "Children of that age view death as temporary and reversible, which makes it hard to explain." "At this developmental stage, most children have an adult concept of death and should be encouraged to discuss it." "Children of that age typically fantasize about what dying will be like, which is much better than knowing the truth." "At this developmental stage, children are afraid of death, so it's best not to discuss it with them."

"At this developmental stage, most children have an adult concept of death and should be encouraged to discuss it." By age 9 or 10, most children have an adult concept of death. Caregivers should discuss death with them in terms consistent with their developmental stage. School-age children respond well to concrete explanations about death and dying. Preschoolers, not school-age children, typically view death as temporary and reversible. School-age children may fantasize about the unknown aspects of death; these fantasies may increase their anxiety. Although a child may fear death, accurate information about death can ease anxiety.

A 10-year-old girl visits a clinic for a checkup before entering school. The child's parent questions the nurse about what to expect at this stage of the daughter's growth and development. Which responses from the nurse would be most appropriate? Select all that apply. "Her physical development will be rapid at this stage, and rapid development will continue from now on." "She'll become more independent and won't require parental supervision." "She may begin to develop secondary sex characteristics, such as breast buds." "Don't anticipate changes at this stage in her growth and development." "Friends will be very important to her, and she'll develop an interest in the opposite sex."

"She may begin to develop secondary sex characteristics, such as breast buds." "Friends will be very important to her, and she'll develop an interest in the opposite sex."

The nurse views the laboratory results for a 9-year-old child hospitalized with severe vomiting and diarrhea. Which serum potassium level would the nurse expect to observe in this child? 4.5 to 7.2 mmol/L 4.7 to 6.0 mmol/L 2.5 to 3.4 mmol/L 3.5 to 5.8 mmol/L

2.5 to 3.4 mmol/L Potassium is lost through diarrhea and is expected to be low normal or low. A level below 3.5 mmol/L should be expected with severe diarrhea. The normal potassium level in children ranges from 3.5 to 4.8 mmol/L. Levels of 4.5 to 7.2 mmol/L are observed in premature infants. Potassium levels of 3.7 to 5.2 mmol/L are observed in full-term infants. Potassium levels of 3.5 to 5.5 mmol/L are usually seen in adults.

The nurse is planning care for a 10-year-old child in the acute phase of rheumatic fever. Which activity would be most appropriate for the nurse to schedule in the care plan? Playing cards in the playroom Reading books Climbing on play equipment in the playroom Unrestricted ambulation

Reading books During the acute phase of rheumatic fever, the child should be placed on bed rest to reduce the workload of the heart and prevent heart failure. An appropriate activity for this child would be reading books. The other activities are too strenuous during the acute phase.

The parents of a school-age child with asthma express concern about letting the child participate in sports. What should the nurse tell the parents about the relationship between exercise and asthma? Asthma attacks are triggered by allergens, not exercise. The child should avoid exercise because it may trigger asthma attacks. Continuous activities such as jogging are less likely to trigger asthma than intermittent activities such as baseball. Taking prophylactic drugs before the activity can prevent asthma attacks and enable the child to engage in most sports.

Taking prophylactic drugs before the activity can prevent asthma attacks and enable the child to engage in most sports. Although exercise may trigger asthma attacks, taking prophylactic asthma drugs before beginning the activity can prevent attacks, enabling the child to engage in most sports. Asthma attacks may be triggered by various factors, including allergens, exercise, medications, upper respiratory infections, and psychological stress. Provided the asthma is under control, most children can participate in sports and other physical activities; in fact, they benefit from exercise. Activity restrictions hamper peer interaction, which is essential to the development of the school-age child. A child with asthma may tolerate intermittent activities better than continuous ones.

The nurse is caring for a child with history of strep throat reporting abdominal pain and joint achiness. Which laboratory data does the nurse communicate with the health care provider immediately? low hemoglobin level anemia normal erythrocyte sedimentation rate leukocytosis

leukocytosis Leukocytosis can be seen as an immune response triggered by colonization of the pharynx with group A streptococci. This finding is expected in a client with rheumatic fever. Laboratory data indicating anemia or a low hemoglobin level will need to be addressed, but are not critical and associated with the current disease process. A normal erythrocyte sedimentation rate would be communicated on the laboratory report.

A parent of a 9-year-old-child scheduled to have surgery expresses concern about the potential for postoperative infection. A nurse provides the parent with information about the measures taken to maintain surgical asepsis. Typical surgical asepsis involves: preoperative cleansing of jewelry worn by the surgical team. applying bandages to cover any wounds surgical team members have. using sterile surgical scrubs. performing a preoperative surgical scrub for at least 3 to 5 minutes.

performing a preoperative surgical scrub for at least 3 to 5 minutes. The surgical team should perform a surgical scrub lasting at least 3 to 5 minutes before any operative procedure. Although surgical gowns may be considered sterile, surgical scrubs are considered clean rather than sterile. Jewelry harbors bacteria; team members should remove it rather than simply clean it. A surgical team member with an open wound shouldn't be involved in a procedure requiring asepsis.

The nurse is developing the plan of care for a 9-year-old client with Down syndrome. How can the nurse best apply age-appropriate interventions? Plan interventions at a 9-year-old level. Plan interventions at a 7-year-old level. Assess the client's current developmental level. Assess the client's neurological functioning level.

Assess the client's current developmental level. Before developing a care plan, the nurse should assess the child's developmental level and plan care at that level. The nurse should not plan care based on the child's chronological age without first assessing the child. The nurse should not assume that the child is at a lower developmental level without assessment. A developmental assessment is more relevant than neurological functioning when determining age-appropriate interventions.

The nurse is reinforcing education regarding insulin injections with an 11-year old child with diabetes Type I. Which guideline is appropriate to follow? Self-injection techniques should be taught only when the child can reach all injection sites. The parents do not need to be involved in learning this procedure. Self-injection techniques are not usually taught until the child reaches 16 years of age. At age 11, the child should be old enough to give injections independently.

At age 11, the child should be old enough to give injections independently. The parents must supervise and manage the child's therapeutic program, but the child should assume responsibility for self-management as soon as he can. Children can learn to collect their own blood for glucose testing at a relatively young age (4 to 5 years), and most can check their blood glucose level and administer insulin at all injection sites by about age 9. Some children can do it earlier.

Parents of a 6-year-old child tell a physician that the child has been having periods of unawareness with short periods of staring. Based on his history, the child is probably having which type of seizure? Complex partial Myoclonic Typical absence Tonic

Typical absence A typical absence seizure has an onset between ages 4 and 8. It's exhibited by an abrupt loss of consciousness, amnesia, or unawareness characterized by staring and a 3-cycle/second spike and waveform on an EEG. The attack lasts from 10 to 30 seconds and may occur as frequently as 50 to 100 times a day. No postictal or confused state follows the attack. A complex partial seizure most commonly occurs in older children and adults, causing a brief impairment of consciousness. A myoclonic seizure occurs in older children and is exhibited by lightning jerks without loss of consciousness. An abrupt increase in muscle tone, loss of consciousness, and marked autonomic signs and symptoms characterize the tonic seizure.

The charge nurse for the pediatric unit is making client care assignments for the staff, which includes licensed practical nurses/licensed vocational nurses (LPNs/LVNs) and unlicensed assistive personnel. Which client would be most appropriate to assign to an LPN/LVN? an 8-year-old child with a concussion whose hourly vital signs are stable a 9-year-old child with a week-old femur fracture who is in traction a 13-year-old adolescent who has just returned from surgery for repair of internal injuries a 15-year-old adolescent who is just beginning to awaken from a drug overdose

a 9-year-old child with a week-old femur fracture who is in traction The most appropriate client to assign to the LPN/LVN is the child who is stable and has a predictable outcome. The 9-year-old child with a week-old fracture would be assigned to LPN/LVN because this client is stable. A child with a concussion requiring vital signs to be taken hourly does not yet have a predictable outcome. The adolescent just returning from surgery requires frequent, close assessment and monitoring for possible complications, which is inappropriate for the LPN/LVN level. The adolescent just beginning to awaken from a drug overdose is not stable and requires close, frequent assessment for changes.

An 8-year-old client has tested positive for West Nile virus infection. The nurse suspects the client has the severe form of the disease when she recognizes which signs and symptoms? Fever, rash, and malaise Anorexia, nausea, and vomiting Fever, muscle weakness, and change in mental status Fever, lymphadenopathy, and rash

Fever, muscle weakness, and change in mental status Severe West Nile virus infection (also called West Nile encephalitis or West Nile meningitis) affects the central nervous system and may cause headache, neck stiffness, fever, muscle weakness or paralysis, changes in mental status, and seizures. Such signs and symptoms as fever, rash, malaise, anorexia, nausea and vomiting, and lymphadenopathy suggest the mild form of West Nile virus infection.

A school-age child reveals to the nurse that a parent has been abusive. What constitutes a breach of the child's right to confidentiality? telling the child you're required by law to report the abuse informing the child's attending physician about the conversation telling the child in the next room, who also suffered abuse, so the two children can talk to each other informing local authorities and reporting the case

telling the child in the next room, who also suffered abuse, so the two children can talk to each other Children have a right to privacy and confidentiality when it comes to their medical condition, treatment plans, and even the fact that they are hospitalized. Therefore, telling another child about the abuse (even if they have that in common) is a breach of confidentiality. A nurse is required by law to report suspected child abuse to the proper local authorities. The attending physician is part of the healthcare team and needs to be informed about the suspected abuse. These actions don't breach the child's right to confidentiality.

The school nurse is creating a quality improvement initiative to reduce the incidence of bullying among school-age children. Which intervention(s) should the nurse include? Select all that apply. Coach children on how to respond to and report bullying incidents. Encourage children to deal with bullying incidents independently. Develop a list of common vocabulary related to bullying to be used. Reduce the reliance on detention and suspension as forms of discipline. Ensure there is adult supervision during the lunch hour and recess time.

Coach children on how to respond to and report bullying incidents. Develop a list of common vocabulary related to bullying to be used. Reduce the reliance on detention and suspension as forms of discipline. Ensure there is adult supervision during the lunch hour and recess time.

An 8-year-old child is brought to the clinic with watery eyes and clear nasal drainage that has lasted more than 10 days, without fever. The nurse observes that the child has dark circles under the eyes and a crease above the tip of the nose. Which intervention should be the nurse's priority? Collect data about potential environmental allergy triggers. Prepare to administer amoxicillin 25 mg/kg. P.O. every 12 hours. Prepare to administer trivalent inactivated influenza vaccine 0.5 mL P.O. Prepare the child for sinus x-rays.

Collect data about potential environmental allergy triggers. Cold symptoms that last longer than 10 days without fever, dark circles under the eyes (from increased blood flow near the sinuses), and a crease near the tip of the nose (from upward nose wiping) are all signs and symptoms of perennial allergic rhinitis. The nurse's priority is to collect data about potential indoor and outdoor environmental allergen triggers. Amoxicillin is used to treat bacterial infections, not allergies. Additionally the nurse will not prepare medication for administration without the appropriate orders from the health care provider. Influenza vaccination is indicated annually. Sinus x-rays may be necessary to check for structural abnormalities, but they are not the priority at this time.

A 9-year-old child is being discharged from the hospital after severe urticaria caused by an allergy to nuts. Which instructions would be included in discharge education for the child's parents? Use emollient lotions and baths. Apply topical steroids to the lesions as needed. Apply over-the-counter products such as diphenhydramine. Instruct parents and child on how to use an epinephrine administration kit.

Instruct parents and child on how to use an epinephrine administration kit. Children who have urticaria in response to nuts, seafood, or bee stings should be warned about the possibility of anaphylactic reactions to future exposure. The use of epinephrine pens should be taught to the parents and to older children. Other treatment choices, such as emollients, topical steroids, and diphenhydramine, are for the treatment of mild urticaria.

A 10-year-old boy falls, injures his left shoulder, and is taken to the emergency department. While the client waits to be seen by the physician, what intervention should the nurse perform first? Apply warm compresses to the injured shoulder. Ask him to demonstrate full range of motion of his left arm. Keep him in a comfortable position and apply ice to the injured shoulder. Give him a nonopioid analgesic for pain.

Keep him in a comfortable position and apply ice to the injured shoulder. Ice would be applied first to reduce swelling and pain. The client should also be helped into a comfortable position. Warm compresses may increase swelling and cause bleeding into the injured tissue. Demonstrating full range of motion of the left arm may further damage the injured area. In the emergency department, the nurse must have a physician's order to administer an analgesic.

An 8-year-old child is suspected of having meningitis. Signs of meningitis include: Cullen's sign. Koplik spots. Chvostek's sign. Kernig's sign.

Kernig's sign. In Kernig's sign, the client is in the supine position with knees flexed; a leg is flexed then at the hip so that the thigh is brought to a position perpendicular to the trunk. An attempt is then made to extend the knee. If meningeal irritation is present, the knee can't be extended and attempts to extend the knee result in pain. Other common signs and symptoms include stiff neck, headache, and fever. Cullen's sign is the bluish discoloration of the periumbilical skin due to intraperitoneal hemorrhage. Koplik spots are reddened areas with grayish blue centers that are found on the buccal mucosa of a client with measles. Chvostek's sign is elicited by tapping the client's face lightly over the facial nerve, just below the temple. A calcium deficit is suggested if the facial muscles twitch.

In providing psychosocial care to a 6-year-old child who has had abdominal surgery for Wilms tumor, which activity initiated by the nurse would be most appropriate? Provide the child with supplies and ask the child to draw how he or she feels. Allow the child to watch a 2-hour movie without interruptions. Give the child a puzzle with five pieces to encourage the child to move while in bed. Tell the child that medication can be given so that there is no pain.

Provide the child with supplies and ask the child to draw how he or she feels. A movie is a good diversion, but giving supplies and encouraging the child to draw feelings is a better outlet. Many procedures have been performed on this child since the child was admitted. The nurse probably can't give enough pain medication so that a child who has had surgery will feel no pain. A puzzle with only five pieces is too basic for a 6-year-old and wouldn't hold his interest.

A nurse manager plans care for an 8-year-old child who requires around-the-clock care by unlicensed assistive personnel. How does the nurse best ensure safe care for the client? Ensure that the work is divided equitably to prevent staff burnout and rapid turnover. Provide written instructions, education, and ongoing supervision. Ensure that the unlicensed assistive personnel are executing the plan of care. Ask the client and family for feedback about the rendered care every week.

Provide written instructions, education, and ongoing supervision. When working with unlicensed assistive personnel, the nurse manager's priority for safe care is to provide written instructions, education, and ongoing supervision. Although the nurse manager should be concerned with the equitable division of work and proper payment for hours worked, these concerns are not the highest priorities. Following up on execution of the plan is part of ongoing supervision, but it is not as complete a response as the correct choice. Asking the client and family for feedback weekly is important but does not ensure safe care.

Which health care team members are necessary to ensure a pediatric approach that combines physical, emotional, social, and spiritual issues? Social worker, chaplain, nurses, nursing assistants, child life specialist, and physicians Physicians, nurses, and child protective services Nurses, physicians, and child life specialists Hospital nurses, community nurses, and social workers

Social worker, chaplain, nurses, nursing assistants, child life specialist, and physicians A social worker, chaplain, nurses, nursing assistants, child life specialist, and physicians should be involved in pediatric client care to ensure that physical, emotional, social, and spiritual issues are addressed. Other health care team members should be added to the client care team according to the client's needs. Child protective services should be involved only in cases of abuse. Options 3 and 4 don't fulfill all of the client's needs.

When attempting to facilitate spiritual support for a school-age child with a life-threatening disease and the child's family, which action would hinder the nurse-client relationship? becoming familiar with the family's spiritual beliefs and practices seeking assistance or referrals to the facility chaplain or other resources promoting the nurse's personal values and beliefs if the nurse considers the family's to be inappropriate being open to the family's and the child's expressions of spiritual concerns

promoting the nurse's personal values and beliefs if the nurse considers the family's to be inappropriate If the nurse attempts to force beliefs on the family, the family may interpret this as a lack of understanding, which could lead to distrust of the nurse. Becoming familiar with the family's spiritual beliefs and practices, seeking assistance or referrals to the facility chaplain or other resources, and being open to the family's and the child's expressions of spiritual concerns are all ways to help children and their families cope with a life-threatening illness.

The nurse is discussing sleep hygiene with the parents of a 9-year-old child who plays video games regularly. Which teaching(s) will the nurse provide? Select all that apply. "Create a ritualistic approach to bed time." "Keep the room at 67°F (19.4°C) or cooler." "Have your child turn the video game off right before going to bed." c "Allow the child to keep a smart phone at the bedside in case of emergencies."

"Create a ritualistic approach to bed time." "Keep the room at 67°F (19.4°C) or cooler." "Have your child turn the video game off right before going to bed." "Encourage reading before bed as a healthy way to rest the mind." Sleep hygiene refers to the behaviors and environmental factors that precede the time set aside for sleep. Poor sleep hygiene may interfere with sleep. Specific symptoms of poor sleep hygiene include daytime sleepiness, trouble getting to sleep, and difficulty staying asleep. Physical and emotional problems are often accompanied by poor sleep hygiene. Caregivers need to plan behaviors and habits around bedtime that establish good sleep hygiene. Habitual, or ritualistic, routines around bedtime are essential for the child, and their importance continues into adolescence. Rituals that immediately precede sleep are important routines, such as washing and brushing teeth. The temperature of the sleeping room should 60°F to 67°F (15.5°C to 19.4°C), or slightly cooler than during waking hours. Reading a book is a healthy way to establish a low-key, sleep-ready atmosphere. The nurse will teach the parents to have the video games turned off 1 to 2 hours before bedtime and to eliminate distracting lights and noises, such as any type of media monitor or smart phone.

A staffing agency is assigning a licensed practical/vocational nurse (LPN/VN) to cover a shift on a pediatric unit. Because the unit manager is unfamiliar with the nurse's skill level, what assignment is best for the LPN/VN? 8-year-old child admitted that morning with suspected meningitis 9-year-old child receiving subcutaneous insulin for diabetes mellitus 10-year-old child who had a tonsillectomy that morning 9-year-old child with Legg-Calve'-Perthes disease

9-year-old child receiving subcutaneous insulin for diabetes mellitus The unit manager should assign the LPN/VN to the child with diabetes mellitus. Because the client is receiving subcutaneous insulin rather than IV insulin, the diabetes is likely stable. Meningitis is an acute condition with the potential to progress into respiratory depression and seizures; this child will require frequent nursing assessments. The child who had a tonsillectomy remains at risk for hemorrhage during the first 24 hours following surgery. Legg-Calve'-Perthes disease is associated with impaired circulation to the femoral capital epiphysis; the child with this condition requires aggressive monitoring.

The nurse is caring for a 10-year-old child with cystic fibrosis. The child's parents tell the nurse that they're having difficulty coping with their child's disease. Which action would be most appropriate for the nurse to take? Encouraging the parents not to visit while the child is hospitalized Consulting with the social worker to help the family find appropriate resources Telling the parents to encourage their child to make friends with other chronically ill children Encouraging the parents to limit their child's activities

Consulting with the social worker to help the family find appropriate resources The nurse can help this family by assisting them with finding appropriate financial, psychological, and social support and by providing referrals to the local community agencies and the Cystic Fibrosis Foundation. The child should be treated as much like a normal child as possible, and he should be encouraged to make friends with other children regardless of their physical condition. The nurse shouldn't encourage the parents not to visit because the child might feel abandoned.

At the beginning of the school day, a student has come to see the school nurse. Upon observing tearing, redness of the eye, and a light crust at the canthus, which action will the nurse take? Apply ice to the canthus. Administer acetaminophen. Contact the parent to retrieve the student. Reassure the student that this is an allergic issue that will resolve without intervention.

Contact the parent to retrieve the student. The student is exhibiting signs suggestive of conjunctivitis. The nurse needs to contact the parent to retrieve the student, and then have the child seen by a health care provider. With conjunctivitis, the eye becomes inflamed and swollen, making the white part of the eye appear pink or red, thus earning the nickname "pink eye." Conjunctivitis symptoms also include tearing, itching, and, sometimes, photophobia, or sensitivity to light. As the client sleeps, a crust forms around the eyelids, and, upon waking, the client complains of difficulty opening the eyes. Conjunctivitis can be bacterial, viral, or allergic in nature. Bacterial conjunctivitis is a serious condition that can lead to permanent eye damage if left untreated. Acetaminophen will not address the symptoms that the student is experiencing. Ice applied to the canthus can compromise tissue integrity of the eye. The nurse will not attempt to discern if the infection is bacterial, viral, or allergic in nature; the health care provider will perform that assessment.

The school nurse learns a school-age student's teacher has used "the strap" on the child in response to misbehavior. Which action(s) should the nurse take in response to learning this information? Select all that apply. Determine the jurisdictional legislation related to corporal punishment in schools; Determine if the misbehavior was serious enough for physical punishment; Determine the jurisdictional legislation related to corporal punishment in schools; Arrange to meet with the child to assess for any physical/emotional effects; Speak to the teacher to discuss alternative approaches to discipline; Report the incident to the school's administration. Determine if the misbehavior was serious enough for physical punishment; Speak to the teacher to discuss alternative approaches to discipline Determine if the misbehavior was serious enough for physical punishment; Report the incident to the school's administration.

Determine the jurisdictional legislation related to corporal punishment in schools; Arrange to meet with the child to assess for any physical/emotional effects; Speak to the teacher to discuss alternative approaches to discipline; Report the incident to the school's administration. The nurse should first determine what jurisdictional laws may apply in this situation. In the United States, the laws related to corporal punishment vary between states while the Supreme Court of Canada ruled in 2004 that corporal punishment cannot be use in any schools in Canada. Evidence-based knowledge should be applied regardless of local legislation related to corporal punishment. The nurse should be aware that research demonstrates corporal punishment leads to negative child outcomes and therefore should help educate the teacher about alternate forms of discipline. However, the nurse should not focus on the child's misbehavior as this sends the message that physical punishment may be appropriate in some cases. The nurse should assess the child for evidence that excessive force was used leading to physical injury and the child's emotional and psychological well-being. The nurse should report the incident because the frequency and pattern of corporal punishment in the school should be monitored.

The nurse is caring for an 8-year old child with acute asthma. Which data collection finding should the nurse immediately report to the charge nurse? The child's mother reports that the child sometimes forgets to take his inhaler. The pulse oximeter reading is 95%. During auscultation, breath sounds are diminished bilaterally and no wheezing is audible. The child's respiratory rate is 24 breaths/minute.

During auscultation, breath sounds are diminished bilaterally and no wheezing is audible. Typically during an acute asthma attack, wheezing is increased and the client has increased respiratory distress. Diminished breath sounds and no wheezing on auscultation indicate that the child isn't moving air in and out and is in respiratory distress. A respiratory rate of 24 breaths/minute in an 8-year-old child is normal. An oxygen saturation of 95% is slightly low, possibly indicating the need for oxygen or the need to clear the airway, but this finding isn't as important at this time as the diminished breath sounds and lack of wheezing. The fact that the mother makes the 8-year-old responsible for taking his medication is of concern and needs to be investigated but this issue isn't the priority at this time.

A school-age child with fever and joint pain has just received a diagnosis of rheumatic fever. The child's parents ask the nurse whether anything could have prevented this disorder. Which intervention is most effective in preventing rheumatic fever? Immunization with the hepatitis B vaccine Isolation of individuals with rheumatic fever Use of prophylactic antibiotics for invasive procedures Early detection and treatment of streptococcal infections

Early detection and treatment of streptococcal infections Rheumatic fever is a systemic inflammatory disease that follows a Group A streptococcal infection. Therefore, early detection and treatment of streptococcal infections helps prevent the development of rheumatic fever. Hepatitis B vaccine provides immunity against the hepatitis B virus — not streptococci. Because rheumatic fever isn't contagious, isolation measures aren't necessary. Prophylactic antibiotics are used for invasive procedures only in clients with a history of carditis to prevent bacterial endocarditis.

A nurse is caring for a disabled school-age child whose parents are overprotective. What is the most appropriate action of the nurse? Encourage the parents to arrange a play date for their child with other children. Advise the parents to limit exposure to children who are not impaired. Focus exclusively on the child's disability. Teach parents to avoid social expectations and demands.

Encourage the parents to arrange a play date for their child with other children. Disabled children whose parents are overprotective tend to have marked dependency, fearfulness, inactivity, and lack of outside interests. The nurse caring for this family should encourage the parents to support the child in participating in group activities that promote peer interactions and accommodate social expectations and demands. Children who are intellectually impaired or developmentally disabled need to be exposed to children who are not impaired and to children with similar challenges. Encourage the parents to also participate in interactive activities, such as reading books and playing, on a regular basis.

A 6-year-old child with a history of varicella and aspirin intake is brought to the emergency department. The nurse suspects Reye's syndrome. Which data collection findings are consistent with this syndrome? Fever, decreased level of consciousness (LOC), and impaired liver function Joint inflammation, red macular rash with a clear center, and low-grade fever Peripheral edema, fever for 5 or more days, and "strawberry tongue" Red, raised "bull's eye" rash, malaise, and joint pain

Fever, decreased level of consciousness (LOC), and impaired liver function Reye's syndrome occurs in children with a history of a viral infection, varicella, or influenza. It's often associated with the administration of aspirin. The child presents with fever and decreased LOC, which can lead to coma and death. As the disease progresses, the child also develops impaired liver function. A child with joint pain, a red macular rash with a clear center, and a low-grade fever probably has rheumatic fever. A child presenting with peripheral edema, fever for more than 5 days, and a "strawberry tongue" probably has Kawasaki disease. A child with a red, raised "bull's eye" rash, malaise, and joint pain should be tested for Lyme disease.

caring for a 10-year-old client diagnosed with acute glomerulonephritis. What is the nurse's priority action? Monitoring vital signs every 4 hours, intake and output, and obtaining daily weight. Obtaining a blood sample for electrolyte analysis. Checking every urine specimen for protein and specific gravity. Maintaining sodium and water restrictions.

Monitoring vital signs every 4 hours, intake and output, and obtaining daily weight. Because major complications such as hypertensive encephalopathy, acute renal failure, and cardiac decompensation can occur, monitoring vital signs is an important measure for a child with acute glomerulonephritis. Frequent, accurate assessment of intake and output is essential for evaluating fluid volume status. Children with severe renal impairment might require measurement of intake and output every 1 to 2 hours. Fluid intake includes oral intake and IV fluids. If urine output is less than 1 mL/kg/hr, this must be reported to the physician, because oliguria suggests impending renal failure or inadequate fluid intake. Obtaining daily weight provides evidence of the child's fluid balance status. Sodium and water restrictions may be ordered depending on the severity of the edema and the extent of impaired renal function. Daily monitoring of serum electrolyte levels and checking urine specimens for protein and specific gravity may be done, but their frequency is determined by the child's status. These are less important nursing measures in this situation.

An 8-year-old client with Down syndrome is admitted to the hospital with pneumonia. Which nursing intervention is most appropriate for this child? Instructing the child to increase his fluid intake Providing a low-calorie diet Encouraging the child to ambulate in the hallway frequently Performing ongoing respiratory assessments to monitor for signs of distress

Performing ongoing respiratory assessments to monitor for signs of distress The nurse should perform ongoing respiratory assessments to watch for signs of distress because the child with Down syndrome may be unable to communicate changes in his respiratory status. The nurse should instruct the client's mother, not the client, to encourage fluid intake by offering fluids frequently. A diet of high-calorie foods in small amounts is required to promote recovery. The nurse should maintain bed rest as needed to conserve the client's energy.

A child is brought to the clinic by a grandparent who states that someone may have sexually abused the child. The grandparent noticed blood and a discharge on the child's underpants. After the child is assessed and treated for injuries, what is the priority intervention by the nurse? Ask the grandparent who else was caring the child during the past 24 hours, Report the suspicion to the appropriate authorities. Notify the child's health care provider so the authorities can be contacted. Ask the child if anyone touched the private area.

Report the suspicion to the appropriate authorities. The nurse's responsibility is to report the incident to the appropriate authorities so that the situation can be investigated. The nurse needs to report the suspicion of abuse to the authorities, not to the health care provider. The safety of the child is of the utmost importance, and asking people who cared for the child will be done with the authorities. The nurse should not question the child about inappropriate touching without the authorities present.

A newer nurse is assigned to care for several children with advanced cancer. The nurse finds the assignment extremely challenging due to a lack of experience and is considering requesting a different assignment. What is the best course of action by the nurse to resolve the situation? Notify the nurse manager that the assignment will be refused. Bring reference materials to the room when providing care. Pretend to be ill and leave the unit as soon as possible. Suggest a shared assignment with a senior staff nurse.

Suggest a shared assignment with a senior staff nurse. Suggesting a shared assignment shows collaboration and uses the experience and knowledge of colleagues. It would never be wise to continue with an assignment that was too difficult for the skill set and experience of the nurse. The notification to the nurse manager will not solve the issue but can bring about a dialogue. The nurse bringing reference materials may cause the clients to suspect problems, which can increase anxiety. Leaving the assignment by pretending to be ill does not allow for learning and client care.

A nurse is caring for a 10-year-old child hospitalized for treatment of acute osteomyelitis. The child's left leg is immobilized in a splint. What is the nurse's most appropriate action? Assist the client to ambulate with crutches. Support and handle the leg gently during turning and repositioning. Encourage the client to participate in age-appropriate activities. Assist the client to bear weight on the affected limb.

Support and handle the leg gently during turning and repositioning. To prevent pressure sores, the child must turn and change positions periodically. During the acute phase of osteomyelitis, moving the affected leg may cause extreme pain and discomfort. The nurse must support and handle the leg gently during turning and repositioning. Weight bearing is contraindicated because it may cause pathologic fractures. Ambulating with crutches is an inappropriate outcome because the child is restricted to bed rest and the affected leg is immobilized to limit the spread of infection. Participation in age-appropriate activities isn't a realistic outcome because an acutely ill child isn't likely to be interested in activities; this outcome would be suitable after the acute disease phase ends.

Which behavior demonstrated by a 6-year-old would help the nurse recognize a learning disability as opposed to attention deficit hyperactivity disorder (ADHD)? The child is always getting into fights during recess. The child is easily distracted and reacts impulsively. The child reverses letters and words while reading. The child has a difficult time reading a chapter book.

The child reverses letters and words while reading. Children who reverse letters and words while reading have dyslexia. Two of the most common characteristics of children with ADHD include inattention and impulsiveness. Although aggressiveness may be common in children with ADHD, it isn't a characteristic that will aid in the diagnosis of this disorder. Six-year-old children aren't usually cognitively ready to read a chapter book.

A child who was hospitalized for sickle cell crisis is being discharged. Which client outcome demonstrates effective teaching regarding prevention of future crises? The client verbalizes the need to restrict fluid intake. The client verbalizes the need to stay away from anyone with a known or suspected infection. The client participates in an aerobic exercise program. The client verbalizes appropriate dietary restrictions.

The client verbalizes the need to stay away from anyone with a known or suspected infection. Preventing infections through proper hand washing and staying away from anyone with a known or suspected infection is an important measure in preventing sickle cell crises. Dietary restrictions aren't significant in preventing these crises. The client should maintain adequate hydration, not restrict fluid intake, and should avoid strenuous activity such as aerobics.

A pediatric nurse is providing discharge instructions for the family of a school-age child with idiopathic thrombocytopenia. Which activity should be restricted until further notice? computer games exposure to large crowds bicycle riding swimming

bicycle riding When routine blood counts reveal the platelet level is 100,000/mm3 or less, the child should not engage in contact sports, bicycle or scooter riding, climbing, or other activities that could lead to injury (especially to the head). Swimming releases energy, builds muscle, and allows the child to compete without risking injury, as long as the child follows normal safety precautions. Computer games do not cause physical injury. It is not necessary for this child to avoid large crowds because idiopathic thrombocytopenia does not suppress the immune system.

A school-age client is admitted to the facility with a diagnosis of acute lymphocytic leukemia (ALL). The nurse formulates a nursing diagnosis of Risk for infection. What is the most effective way for the nurse to reduce the client's risk of infection? maintaining standard precautions requiring staff and visitors to wear masks practicing thorough hand washing implementing reverse isolation

practicing thorough hand washing Both ALL and its treatment cause immunosuppression. Therefore, thorough hand washing is the single most effective way to prevent infection in an immunosuppressed client. Reverse isolation doesn't significantly reduce the incidence of infection in immunosuppressed clients; furthermore, isolation may cause psychological stress. Standard precautions are intended mainly to protect caregivers from contact with infectious matter, not to reduce the client's risk of infection. Staff and others needn't wear masks when visiting because most infections are transmitted by direct contact. Instead of relying on masks and other barrier methods, the nurse should keep persons with known infections out of the client's room.