Peds-Chapter 20-GI, Peds-Chapter 23-Skin, Peds-Chapter 21-GU, Peds-Chapter 22-Musculoskeletal
While presenting a panel discussion to a group of parents about urinary tract infections (UTIs) in children, one of the parents asks the nurse, "Why would my daughter be more at risk than my son?" Which response by the nurse would be most accurate?
"A girl's urethra is closer to to the rectal opening"
The nurse is taking a health history of a child with suspected acute poststreptococcal glomerulonephritis. Which response would alert the nurse to a confirmed risk factor for this condition?
"He just got over a head cold with laryngitis."
The nurse is caring for a 4-year-old with a suspected urinary tract infection. What would be most appropriate when obtaining a urine specimen from the child?
"Let your mom help you tinkle in this cup"
The nurse is caring for a 12-year-old girl with nephrotic syndrome. The girl confides that she feels like a "freak" compared to her peers because of her weight, edema, and moon face. Which response by the nurse would be most appropriate?
"Let's put you in touch with some other girls who are also having the same body changes."
A nurse is interviewing the parents of a child diagnosed with obstructive uropathy. Which statement by the parents would the nurse identify as significant?
"She had surgery to repair a problem she had with her anus"
The nurse is caring for a 4-year-old girl with vulvovaginitis. After explaining to the girl's mother how to help prevent subsequent episodes, which statement by the mother indicates a need for additional teaching?
"She needs to wipe from front to back"
After teaching the parents of a child with a hydrocele about this condition, which statement indicates that the teaching was successful?
"This condition should gradually go away on its own"
The nurse is preparing an 8-year-old girl for a cystoscopy. Which instruction would be most appropriate to give to the child?
"You might feel some burning when you go to the bathroom afterward"
A child with Duchenne muscular dystrophy is to receive prednisone as part of his treatment plan. After teaching the child's parents about this drug, which statement by the parents indicates the need for additional teaching? A)"We should give this drug before he eats anything." B)"We need to watch carefully for possible infection." C)"The drug should not be stopped suddenly." D)"He might gain some weight with this drug."
A
An 8-year-old girl was diagnosed with a closed fracture of the radius at approximately 2 p.m. The fracture was reduced in the emergency department and her arm placed in a cast. At 11 p.m. her mother brings her back to the emergency department due to unrelenting pain that has not been relieved by the prescribed narcotics. Which action would be the priority? A)Notifying the doctor immediately B)Applying ice C)Elevating the arm D)Giving additional pain medication as ordered
A
The nurse is assessing the neuromusculoskeletal system of a newborn. What is an abnormal assessment finding? A)Sluggish deep tendon reflexes B)Full range of motion in extremities C)Absence of hypotonia D)Lack of purposeful muscular control
A
The nurse is caring for a 10-year-old in traction. While performing a skin assessment, the nurse notices that the skin over the calcaneus appears slightly red and irritated. Which action would the nurse take first? A)Reposition the child's foot on a pressure-reducing device. B)Apply lotion to his foot to maintain skin integrity. C)Make sure the skin is clean and dry. D)Gently massage his foot to promote circulation.
A
The nurse is caring for a 14-month-old boy with rickets who was recently adopted from overseas. His condition was likely a result of a diet very low in milk products. The nurse is providing teaching regarding treatment. Which response by the parents indicates a need for further teaching? A)"We must give him calcium and phosphorus with food every morning." B)"He must take vitamin D as prescribed and spend some time in the sunlight." C)"He must take calcium at breakfast and phosphorus at bedtime." D)"We should encourage him to have fish, dairy, and liver if he will eat it."
A
The nurse is providing care to a child with a long-leg hip spica cast. What is the priority nursing diagnosis? A)Risk for impaired skin integrity due to cast and location B)Deficient knowledge related to cast care C)Risk for delayed development related to immobility D)Self-care deficit related to immobility
A
The nurse is caring for a school-age child with tinea captitis. The child has open lesions from the disease and has lost hair in the areas affected. Which nursing diagnoses would be a part of this patient's care plan? Select all that apply. A)Impaired skin integrity B)Risk for infection C)Disturbed body image D)Bathing, self-care deficit E)Altered nutrition
A, B, C Tinea is a fungal disease of the skin occurring on any part of the body, in this case the head (scalp, eyebrows, or eyelashes). Since this child has open lesions and hair loss from affected areas, there is impairment of skin integrity (which makes the areas at risk for infection. Body image is disturbed since the hair loss is visible. There is no indication of bathing deficit or altered nutrition.
The nurse is taking a health history of an 11-year-old girl with recurrent abdominal pain. Which response would lead the nurse to suspect irritable bowel syndrome? A)"I always feel better after I have a bowel movement." B)"I don't take any medicine right now." C)"The pain comes and goes." D)"The pain doesn't wake me up in the middle of the night."
A. "I always feel better after I have a bowel movement." In cases of irritable bowel syndrome, the pain may be relieved by defecation. Use of medications and pain that comes and goes or wakes the person up in the middle of the night are all relevant findings pertinent to recurrent abdominal pain.
The nurse is teaching the mother of a 5-year-old boy with a history of impaction how to administer enemas at home. Which response from the mother indicates a need for further teaching? A)"I should position him on his abdomen with knees bent." B)"He will require 250 to 500 mL of enema solution." C)"I should wash my hands and then wear gloves." D)"He should retain the solution for 5 to 10 minutes."
A. "I should position him on his abdomen with knees bent." A 5-year-old child should lie on his left side with his right leg flexed toward the chest. An infant or toddler is positioned on his abdomen. Using 250 to 500 mL of solution, washing hands and wearing gloves, and retaining the solution for 5 to 10 minutes are appropriate responses.
The nurse is caring for a 3-year-old girl with short bowel syndrome as a result of trauma to the small intestine. The girl's mother is extremely anxious and tells the nurse she is afraid she will never learn how to care for her daughter at home. How should the nurse respond? A)"I will help you become an expert on your daughter's care." B)"You must learn how to care for your daughter at home." C)"You really need the support of your husband." D)"There is a lot to learn and you need a positive attitude."
A. "I will help you become an expert on your daughter's care." The nurse needs to empower families to become the experts on their children's needs and conditions via education and participation in care. The most positive approach in this case is to let the mother know the nurse will support her and help her become an expert on her daughter's care. Telling the mother that she must learn how to care for her daughter or that she must have a positive attitude is not helpful. Telling her that she needs the support of her husband is irrelevant and unhelpful.
The nurse is providing care to a child with folliculitis. What would the nurse expect to administer? A)Topical mupirocin B)Oral cephalosporin C)Intravenous oxacillin D)Topical Eucerin cream
A. Topical mupirocin For folliculitis, topical mupirocin is indicated in conjunction with aggressive hygiene and warm compresses. Oral cephalosporins are used for nonbullous impetigo if there are numerous lesions. Intravenous oxacillin is used for severe cases of staphylococcal scalded skin syndrome. Topical Eucerin cream is used for atopic dermatitis.
A group of students are reviewing information about gallbladder disease in children. The students demonstrate a need for additional review when they state: A)cholesterol gallstones are more frequently found in males. B)pigment stones are found primarily in the common bile duct. C)pancreatitis is a common complication of cholecystitis in children. D)cholecystitis is due to chemical irritation from obstructed bile flow.
A. cholesterol gallstones are more frequently found in males Cholesterol gallstones are seen more often in females than males and increased risk occurs with age and onset of puberty. Pigment stones are usually found in the common bile duct. Pancreatitis is a common complication in children with gallstone disease. Cholecystitis is an inflammation of the gallbladder that is caused by chemical irritation due to the obstruction of bile flow from the gallbladder into the cystic ducts.
The nurse is assessing a child with acute poststreptococcal glomerulonephritis. What would the nurse expect to assess? Select all that apply.
Abdominal pain Hypertension Crackles
A group of students are reviewing information about renal failure in children. The students demonstrate a need for additional teaching when they identify which agent as a potential contributor to renal failure?
Amoxicillin
The nurse is preparing to administer intravenous fluids to manage a child with dehydration. The medical record indicates the child weighs 60 pounds (27.2 kg). How many milliliters will initially be administered? Record your answer using two decimal places.
Ans: 545.45 Nursing goals for the infant or child with dehydration are aimed at restoring fluid volume and preventing progression to hypovolemia. Provide oral rehydration to children for mild to moderate states of dehydration. Children with severe dehydration should receive intravenous fluids. Initially, administer 20 mL/kg of normal saline or lactated Ringer, and then reassess the hydration status.
The nurse is caring for an infant with bladder exstrophy. As part of the infant's preoperative plan of care, the nurse monitors for abdominal skin excoriation. Which action would be most appropriate for promoting healing and preventing further skin breakdown?
Applying a barrier/healing cream or paste on skin
A 10-year-old girl is brought to the emergency department by her father after tripping over a rock while running in the yard. She tells the nurse, "I think I twisted my ankle." When assessing the child, what would the nurse most likely assess? A)Bruising B)Edema C)Limited range of motion D)Absent pulse
B
A newborn is diagnosed with metatarsus adductus. The parents ask the nurse how this occurred. Which response by the nurse would be most appropriate? A)"This condition is due to a genetic defect in the bones." B)"It's most likely from how the baby was positioned in utero." C)"They really don't know what causes this condition." D)"There is probably an underlying deformity of the baby's hip."
B
A nurse is preparing a presentation for a parent group about musculoskeletal injuries. When describing a child's risk for this type of injury, the nurse integrates knowledge that bone growth occurs primarily in which area? A)Growth plate B)Epiphysis C)Physis D)Metaphysis
B
The nurse is assessing a child with a possible fracture. What would the nurse identify as the most reliable indicator? A)Lack of spontaneous movement B)Point tenderness C)Bruising D)Inability to bear weight
B
The nurse is assessing a newborn who was delivered after a prolonged labor due to an abnormal presentation. The newborn sustained a cranial nerve injury. The nurse would most likely expect to assess deficits related to which cranial nerve? A)Optic B)Facial C)Acoustic D)Trigeminal
B
The nurse is caring for a 10-year-old with Duchenne muscular dystrophy. As part of the plan of care, the nurse focuses on maintaining his cardiopulmonary function. Which intervention would the nurse implement to best promote maximum chest expansion? A)Deep-breathing exercises B)Upright positioning C)Coughing D)Chest percussion
B
The nurse is caring for an infant with osteogenesis imperfecta and is providing instruction on how to reduce the risk of injury. Which response from the mother indicates a need for further teaching? A)"I need to avoid pushing or pulling on an arm or leg." B)"I must carefully lift the baby from under the armpits." C)"I should not bend an arm or leg into an awkward position." D)"We must avoid lifting the legs by the ankles to change diapers."
B
The nurse is conducting a physical examination of a child with suspected developmental dysplasia of the hip. Which finding would help confirm this diagnosis? A)Abduction occurs to 75 degrees and adduction to within 30 degrees (with stable pelvis). B)A distinct "clunk" is heard with Barlow and Ortolani maneuvers. C)A high-pitched "click" is heard with hip flexion or extension. D)The thigh and gluteal folds are symmetric.
B
What information would the nurse include in the preoperative plan of care for an infant with myelomeningocele? A)Positioning supine with a pillow under the buttocks B)Covering the sac with saline-soaked nonadhesive gauze C)Wrapping the infant snugly in a blanket D)Applying a diaper to prevent fecal soiling of the sac
B
When teaching a group of students about the skeletal development in children, what information would the instructor include? A)The growth plate is made up of the epiphysis. B)A young child's bones commonly bend instead of break with an injury. C)The infant's skeleton has undergone complete ossification by birth. D)Children's bones have a thin periosteum and limited blood supply.
B
A nurse is providing instructions to the parents of a 3-month-old with developmental dysplasia of the hip who is being treated with a Pavlik harness. Which statements by the parents demonstrate understanding of the instructions? Select all that apply. A)"We need to adjust the straps so that they are snug but not too tight." B)"We should change her diaper without taking her out of the harness." C)"We need to check the area behind her knees for redness and irritation." D)"We need to send the harness to the dry cleaners to have it cleaned." E)"We need to call the doctor if she is not able to actively kick her legs."
B C E
The nurse is assessing an 11-year-old girl with scoliosis. What would the nurse expect to find? Select all answers that apply. A)Complaints of severe back pain B)Asymmetric shoulder elevation C)Even curve at the waistline D)Pronounced one-sided hump on bending over E)Diminished motor function F)Hyperactive reflexes
B D
A nursing instructor is preparing for a class discussion on spinal muscular atrophy (SMA). When describing type 2 SMA, which information would the instructor include? Select all answers that apply. A)Onset before 6 months of age B)Weakness most severe in shoulders and hips C)Difficulty with swallowing D)Slowly progressing condition E)Genetic disease with autosomal recessive inheritance
B D E
When assessing a child for slipped capital femoral epiphysis, what would the nurse identify as possible risk factors? Select all answers that apply. A)Age younger than 8 years B)African American ethnicity C)History of cystic fibrosis D)Excessive activity E)Obesity
B E
The mother of a 15-year-old girl has contacted the clinic to report that her daughter has burned the back of her hand with a curling iron. The child's mother reports the burn is mild but states her daughter is complaining of pain. After consulting with the physician, what instructions can the nurse anticipate will be recommended? Select all that apply. A)Apply a thin film of protective cocoa butter. B)Run cool water over the injured area. C)Apply ice for 15 to 20 minutes each hour until the pain subsides. D)Take acetaminophen using the manufacturer's guidelines. E)Apply a thin layer of petroleum jelly to the burned area
B, D Mild burns may be cared for at home. Cool water may be run over the injured tissue. Acetaminophen or ibuprofen may be administered for pain. Ointments and creams including butter, margarine, cocoa butter, and petroleum jelly should not be applied.
The school nurse is working with a 10-year-old girl with recurrent abdominal pain. The girl's teacher has been less than understanding about the frequent absences and trips to the nurse's office. How should the nurse respond? A)"Be patient; she is trying some new medication." B)"The pain she is having is real." C)"The family is working toward improvement." D)"Please do not add to this family's stress."
B. "The pain she is having is real." It is important to educate the teacher that this recurrent abdominal pain is a true pain that the child feels and it is not "in her mind." Telling the teacher not to add to the family's stress or that the family is working toward improvement does not teach. The nurse must have the permission of the family to discuss the girl's medication.
The nurse is determining maintenance fluid requirements for a child who weighs 25 kg. How much fluid would the child need per day? A)1,560 mL B)1,600 mL C)1,650 mL D)1,700 mL
B. 1600 mL Using the following formula of: 100 mL/kg for the first 10 kg 50 mL/kg for the next 10 kg 20 mL/kg for the remaining kg The child would require (100 × 10) + (50 × 10) + (20 × 5) = 1,000 + 500 + 100 = 1,600 mL in 24 hours.
A nurse is preparing a presentation for a local parent group about burn prevention and care in children. What would the nurse be least likely to include in the presentation when describing how to care for a superficial burn? A)Using cool water over the burned area until the pain lessens B)Applying ice directly to the burned skin area C)Covering the burn with a clean, nonadhesive bandage D)Giving the child acetaminophen for pain relief
B. Applying ice directly to the burned skin area. With a superficial burn, ice should not be applied to the skin. Using cool water over the burn area; covering with a clean, nonadhesive bandage; and using acetaminophen for pain relief are appropriate to include in the presentation.
A nurse is inspecting the skin of a child with atopic dermatitis. What would the nurse expect to observe? A)Erythematous papulovesicular rash B)Dry, red, scaly rash with lichenification C)Pustular vesicles with honey-colored exudates D)Hypopigmented oval scaly lesions
B. Dry, red, scaly rash with lichenification Atopic dermatitis or eczema is characterized by a dry, red, scaly rash with lichenification and hypertrophy. An erythematous papulovesicular rash is associated with contact dermatitis. Pustules and vesicles with honey-colored exudates suggest nonbullous impetigo. Hypopigmented oval scaly lesions are associated with tinea versicolor.
The parents of a 6-week-old boy come to the clinic for evaluation because the infant has been vomiting. The parents report that the vomiting has been increasing in frequency and forcefulness over the last week. The mother says, "Sometimes, it seems like it just bursts out of his mouth." A diagnosis of hypertrophic pyloric stenosis is suspected. When performing the physical examination, what would the nurse most likely find? A)Sausage-shaped mass in the upper midabdomen B)Hard, moveable, olive-shaped mass in the right upper quadrant C)Tenderness over the McBurney point in the right lower quadrant D)Abdominal pain in the epigastric or umbilical region
B. Hard, moveable, olive-shaped mass in the right upper quadrant With hypertrophic pyloric stenosis, a hard, moveable, olive-shaped mass would be palpated in the right upper quadrant. A sausage-shaped mass in the upper midabdomen would suggest intussusception. Tenderness over the McBurney point would be associated with appendicitis. Epigastric or umbilical pain would be associated with peptic ulcer disease.
The parents of a boy diagnosed with Hirschsprung disease are anxious and fearful of the upcoming surgery. The mother states, "I'm worried about having to care for our son's ostomy." Which intervention would be most helpful for the parents? A)Explaining to them about the diagnosis and surgery B)Having a wound, ostomy, and continence nurse meet with them C)Reinforcing that the ostomy will be temporary D)Teaching them about the medications used to slow stool output
B. Having a wound, ostomy, and continence meet with them Although explaining about the diagnosis and surgery, reinforcing that the ostomy will be temporary, and teaching them about medications would be appropriate, the parents are voicing concerns about caring for the ostomy. Therefore, having a wound, ostomy, and continence nurse meet with them would address these concerns and help them deal with the anxieties and care of a newly placed stoma.
An instructor is developing a plan for a class of nursing students on various skin disorders. When describing urticaria, what would the instructor include? A)It is a type IV hypersensitivity reaction. B)Histamine release leads to vasodilation. C)Wheals appear first followed by erythema. D)The nonpruritic rash blanches with pressure.
B. Histamine release leads to vasodilation Urticaria is a type I hypersensitivity reaction caused by an immunologically mediated antigen-antibody response of histamine release from the mast cells. Vasodilation and increased vascular permeability result, leading to erythema and then wheals. The rash is pruritic and blanches with pressure.
A 6-year-old boy with cerebral palsy has been admitted to the hospital for some tests. His condition is stable. The boy's mother remains with her son, but she is obviously exhausted and stressed. Which response by the nurse would be most appropriate? A)"Would you like me to bring you a blanket and pillow?" B)"You are doing such a wonderful job with your son." C)"He's in good hands; consider going home to get some sleep." D)"Are you planning to spend the night or to go home?"
C
A child with spastic cerebral palsy is to receive botulin toxin. The nurse prepares the child for administration of this drug by which route? A)Oral B)Subcutaneous injection C)Intramuscular injection D)Intravenous infusion
C
A nurse is preparing a program for a group of parents about injury prevention. What would the nurse include as an important contributing factor for cervical spine injury in a child? A) Exposure to teratogens while in utero B) Immaturity of the central nervous system C) Increased mobility of the spine D) Incomplete myelinization
C
An 18-month-old was brought to the emergency department by her mother, who states, "I think she broke her arm." The child is sent for a radiograph to confirm the fracture. Additional assessment of the child leads the nurse to suspect possible child abuse. Which type of fracture would the radiograph most likely reveal? A)Plastic deformity B)Buckle fracture C)Spiral fracture D)Greenstick fracture
C
An 8-year-old boy with a fractured forearm is to have a fiberglass cast applied. What information would the nurse include when teaching the child about the cast? A)The cast will take a day or two to dry completely. B)The edges will be covered with a soft material to prevent irritation. C)The child initially may experience a very warm feeling inside the cast. D)The child will need to keep his arm down at his side for 48 hours.
C
The nurse is caring for a 13-year-old boy in traction prior to surgery for slipped capital femoral epiphysis. He has been in an acute care setting for 2 weeks and will require an additional 10 days in the hospital. He is complaining that he feels isolated and is resisting further treatment. Which response by the nurse would be most appropriate? A)"I know it is boring, but you must remain immobile for 2 more weeks." B)"If there are no complications, you only have 2 more weeks here." C)"Let's come up with things to do like books, movies, games, and friends to visit." D)"If you resist your treatment, your condition will only get worse."
C
The nurse is caring for a 2-year-old girl in a bilateral brace with tibia vara. Her parents are upset by their toddler's limited mobility. Which response by the nurse would be most appropriate? A)"If you don't follow the therapy, your daughter could develop severe bowing of her legs." B)"It's important to use the brace or your daughter may need surgery." C)"You are doing a great job. Let's put our heads together on how to keep her busy." D)"You'll need to accept this since treatment may be required for several years."
C
The nurse is caring for a female infant with torticollis and is providing instructions to the parents about how to help their daughter. Which statement by the parents indicates a need for further teaching? A)"We must encourage our daughter to turn her head both ways." B)"Flatness on one side of the head is a common side effect." C)"We must apply firm pressure and stretching every other day." D)"We will do a daily stretching regimen with multiple sessions."
C
The nurse is caring for an active 14-year-old boy who has recently been diagnosed with scoliosis. He is dismayed that a "jock" like himself could have this condition, and is afraid it will impact his spot on the water polo team. Which response by the nurse would best address the boy's concerns? A)"If you wear your brace properly, you may not need surgery." B)"The good news is that you have very minimal curvature of your spine." C)"Let's talk to another boy with scoliosis, who is winning trophies for his swim team." D)"Let's talk to the doctor about your treatment options."
C
The nurse is developing a teaching plan for a child who is to have his cast removed. What instruction would the nurse most likely include? A)Applying petroleum jelly to the dry skin B)Rubbing the skin vigorously to remove the dead skin C)Soaking the area in warm water every day D)Washing the skin with dilute peroxide and water
C
The school nurse is presenting a class to a group of students about common overuse disorders. Which disorder would the school nurse include? A)Dislocated radial head B)Transient synovitis of the hip C)Osgood-Schlatter disease D)Scoliosis
C
The nurse is providing care to a child with an intussusception. The child has a bowel movement and the nurse inspects the stool. The nurse would most likely document the stool's appearance as having what quality? A)Greasy B)Clay-colored C)Currant jelly-like D)Bloody
C. Currant jelly-like The child with intussusception often exhibits currant jelly-like stools that may or may not be positive for blood. Greasy stools are associated with celiac disease. Clay-colored stools are observed with biliary atresia. Bloody stools can be seen with several gastrointestinal disorders, such as inflammatory bowel disease.
A 3-year-old child has sustained severe burns and is ordered to receive 100% oxygen. What would the nurse use to administer the oxygen? A)Nasal cannula B)Venturi mask C)Nonrebreather mask D)Oxygen hood
C. nonrebreather mask All children with severe burns should receive 100% oxygen via a nonrebreather mask or bag-valve-mask ventilation. A nasal cannula provides only low oxygen concentrations (22% to 44%); a Venturi mask provides only 24% to 50% oxygen concentrations. An oxygen hood is used for infants only.
The nurse is preparing a teaching plan for the parents of a child with a urinary tract infection (UTI). What would the nurse encourage the parents to avoid?
Caffeine
A child has undergone surgery using steel bar placement to correct pectus excavatum. What position would the nurse instruct the parents to avoid? A)Semi-Fowler B)Supine C)High Fowler D)Side-lying
D
A child with cerebral palsy has undergone surgery for placement of a baclofen pump. Which instruction would the nurse include when teaching the parents about caring for their child? A)Waiting 48 hours before allowing the child to take a tub bath B)Not allowing the child to sleep on his side for about 4 weeks C)Calling the physician if the child's temperature is over 100.5°F D)Discouraging the child from stretching or bending forward for 4 weeks
D
A group of nursing students are reviewing information about the type of skin and skeletal traction. The students demonstrate understanding of this information when they identify which of these as a type of skeletal traction? A)Russell traction B)Bryant traction C)Buck traction D)Side arm 90-90 traction
D
After teaching a class of nursing students about muscular dystrophy, the instructor determines that the teaching was successful when the students identify which type of muscular dystrophy as demonstrating an X-linked recessive pattern of inheritance? A)Limb-girdle B)Myotonic C)Distal D)Duchenne
D
The nurse is developing a teaching plan for the parents of a child with a myelomeningocele who will require clean intermittent catheterization. What information would the nurse include? A)Applying petroleum jelly to lubricate the catheter B)Cleaning the reusable catheter with peroxide after each use C)Storing the reusable cleaned catheter in a brown paper bag D)Soaking the catheter in a vinegar and water solution to sterilize
D
The nurse is caring for a 4-year-old boy who has undergone an appendectomy. The child is unwilling to use the incentive spirometer. Which approach would be most appropriate to elicit the child's cooperation? A)"Can you cough for me please?" B)"You must blow in this or you might get pneumonia." C)"If you don't try, I will have to get the doctor." D)"Can you blow this cotton ball across the tray?"
D. "Can you blow this cotton ball across the tray?" Children are more likely to cooperate with interventions if play is involved. Encourage deep breathing by playing games. Asking the boy to cough is less likely to engage him. Telling the child he might get pneumonia is not age appropriate and is unhelpful. Threatening to call the doctor is unhelpful and inappropriate. Remember, however, that the incentive spirometer works on the principle of the amount of air inhaled, not exhaled. Having the child take a deep breath prior to blowing the cotton ball is a beginning step.
After teaching the parents of a 6-year-old how to administer an enema, the nurse determines that the teaching was successful when they state that they will give how much solution to their child? A)100 to 200 mL B)200 to 300 mL C)250 to 500 mL D)500 to 1,000 mL
D. 500-1000 For a school-age child, typically 500 to 1,000 mL of enema solution is given. For an infant, 250 mL or less is used; for a toddler or preschooler, 250 to 500 mL is used.
A nurse is caring for a 14-year-old girl who received an electrical burn. The nurse would anticipate preparing the girl for which diagnostic tests as ordered? A)Pulse oximetry B)Fiberoptic bronchoscopy C)Xenon ventilation-perfusion scanning D)Electrocardiographic monitoring
D. Electrocardiographic monitoring Electrocardiographic monitoring is important for the child who has suffered an electrical burn to identify possible cardiac arrhythmias, which can be noted for up to 72 hours after a burn injury. Fiberoptic bronchoscopy and xenon ventilation-perfusion scanning may be ordered to evaluate an inhalation injury, not an electrical burn. Pulse oximetry is used to evaluate pulmonary function and would not be indicated in the case of an electrical burn.
The parents of a child diagnosed with celiac disease ask the nurse what types of food they can offer their child. What recommendation would the nurse include in the teaching plan? A)Frozen yogurt B)Rye bread C)Creamed spinach D)Fruit juice
D. Fruit juice. For the child with celiac disease, foods containing gluten such as frozen yogurt, rye bread, and creamed vegetables should be avoided. Fruit juice would be an appropriate suggestion in a gluten-free diet.
A nurse is preparing a presentation for a local parent group about urinary tract infections (UTIs) in children. Which organism would the nurse incorporate into the presentation as the most common cause?
E. Coli
The nurse is caring for a client with hemolytic-uremic syndrome (HUS). The client is demonstrating oliguria. What does the nurse expect to find when reviewing the client's records?
Elevated BUN and creatinine levels
A nurse is conducting a physical examination of an infant and observes the urethral opening on the dorsal side of the penis. The nurse documents this finding as:
Epispadias
The nurse is caring for a child who is experiencing an acute renal transplant rejection and is to receive muromonab-CD3. What would the nurse most likely expect to assess after the first dose is administered?
Fever with chills, chest tightness
An 8-year-old girl is scheduled for a renal ultrasound. What would the nurse include in the plan of care when preparing the child for this test?
Informing the child she should feel no discomfort
The nurse is applying a urine bag to a 15-month-old boy to collect a urine specimen. Which action would the nurse take first?
Pat the perineal area dry after cleaning
The nurse is assessing a 5-year-old child's genitourinary system. Which findings would the nurse document as normal? Select all that apply.
Round abdomen Positive bowel sounds Dullness over the spleen
A 6-year-old child has undergone a renal transplant and is receiving cyclosporine. The nurse instructs the parents to be especially alert for which complication?
Signs of infection
A 15-year-old boy comes to the emergency department accompanied by his parents. The boy reports an abrupt onset of sudden pain on the right side of his scrotum. When asked to rate his pain on a scale of 1 to 10, with 10 being the most severe, the boy states, "It's a 12." Further assessment reveals a blue-black swelling on the affected side. The nurse suspects testicular torsion and immediately notifies the physician because:
The condition is a surgical emergency
The mother of a child with end-stage renal disease asks the nurse why her son is getting an injection of erythropoietin. When responding to the mother, the nurse explains this as the rationale.
To stimulate red blood cell growth
A child returns from surgery in which a stoma was created in the abdominal wall to the bladder. The nurse identifies this as a:
Vesicostomy
The nurse is providing postsurgical care for an infant who has undergone a hypospadias repair. Which action by the nurse would be most important to help keep the area clean while maintaining proper position of the drainage tubing?
using a double-diapering technique
The nurse is providing postoperative care for a 14-month-old girl who has undergone a myelomeningocele repair. The girl's mother is extremely anxious and tells the nurse she is afraid she will never learn how to care for her daughter at home. Which response by the nurse would be most appropriate? A)"I will help you become comfortable in caring for your daughter." B)"You must learn how to care for your daughter at home." C)"You will need to learn to collaborate with all the caregivers." D)"There is a lot to learn, and you need a positive attitude."
A
When developing the plan of care for a child with cerebral palsy, which treatment would the nurse expect as least likely? A)Skeletal traction B)Physical therapy C)Orthotics D)Occupational therapy
A
A group of students are preparing for a class exam on skin disorders. As part of their preparation, they are reviewing information about acne vulgaris and its association with increased sebum production. The students demonstrate understanding of the information when they identify which areas as having the highest sebaceous gland activity? Select all that apply. A)Face B)Upper chest C)Neck D)Back E)Shoulders
A, B, D The face, upper chest, and back are the areas of highest sebaceous activity and thus the most common areas for acne lesions to occur. The neck and shoulders are not typical areas involved with acne.
The nurse is providing care to a child with pancreatitis. When reviewing the child's laboratory test results, what would the nurse expect to find? Select all that apply. A)Leukocytosis B)Decreased C-reactive protein C)Elevated serum amylase levels D)Positive stool culture E)Decreased serum lipase levels
A, C With pancreatitis, serum amylase and lipase levels are elevated and levels three times the normal values are extremely indicative of pancreatitis. Leukocytosis is common with acute pancreatitis. C-reactive protein levels may be elevated. Stool cultures are not used to evaluate this disorder. Positive stool cultures would indicate a bacterial cause of diarrhea.
The nurse is caring for a child with widespread itching and has recommended bathing as a relief measure. After teaching the mother about this, which statement from the mother indicates a need for further instruction? A)"After bathing, I need to rub his skin everywhere to make sure he is completely dry." B)"I must make sure I use lukewarm water instead of hot water." C)"Oatmeal baths are helpful; we can add Aveeno skin relief bath treatment." D)"We should leave his skin moist before applying medication or moisturizer."
A. "After bathing, I need to rub his skin everywhere to make sure he is completely dry." The nurse needs to emphasize to the mother that she must only pat the child dry and not rub his skin. Rubbing can cause further itching. Additionally, the skin should be left moist prior to applying medication or moisturizer. Lukewarm water and oatmeal baths are appropriate.
An 8-month-old infant is brought to the clinic for evaluation. The mother tells the nurse that she has noticed some white patches on the infant's tongue that look like curdled milk after breastfeeding. The nurse suspects oral candidiasis (thrush). Which question would the nurse use to help confirm this suspicion? A)"Are you having breast pain when you nurse the baby?" B)"Has he had any dairy problems recently?" C)"Is he experiencing any vomiting lately?" D)"How have his stools been this past week?"
A. "Are you having breast pain when you nurse the baby?" The infant may develop thrush from the mother if the mother has a fungal infection of the breast. Asking the mother about breast pain would be important because this type of infection can cause the mother a great deal of pain with nursing. Dairy products are not associated with oral candidiasis but are associated with the development of infectious diarrhea in infants. Vomiting is unrelated to thrush. The infant also may have candidal diaper rash, but this would be manifested on the skin as a beefy-red rash with satellite lesions, not in his stools.
A nurse is caring for a 14-year-old girl scheduled for a barium swallow/upper gastrointestinal (GI) series. Before providing instructions, what would be the priority? A)Screening the girl for pregnancy B)Reminding her to drink plenty of fluids after the procedure C)Ordering a bowel preparation D)Reminding the girl about potential light-colored stools
A. Screening the girl for pregnancy. Females of reproductive age must be screened for pregnancy prior to the test because radiography is used. A bowel preparation is not necessary for a barium swallow/upper GI series. The reminders about fluids and light-colored stools are appropriate but are not the first priority.
A nurse identifies a nursing diagnosis of impaired urinary elimination related to urinary tract infection. When developing the plan of care, what would be most important for the nurse to do first?
Assess usual voiding patterns
A nurse is caring for a 14-year-old girl following myelography. What is the priority nursing action? A)Monitoring for a decrease in spasticity B)Observing for signs of meningeal irritation C)Assessing motor function D)Observing for mental confusion or hallucinations
B
The nurse is caring for a 2-month-old with cerebral palsy. The infant is limp and flaccid with uncontrolled, slow, worm-like, writhing, and twisting movements. What word would the nurse use when documenting these observations? A)Spastic B)Athetoid C)Ataxic D)Mixed
B
The nurse is conducting a physical examination of a child with a brachial plexus injury. Which finding would lead the nurse to be highly suspicious of Erb palsy? A)The child is unable to close one of his eyes. B)The involved extremity is adducted, prone, and internally rotated. C)Asymmetry of the face occurs when the child is crying. D)The mouth is drawn to the noninvolved side.
B
The nurse is teaching a group of students about myelinization in a child. Which statement by the students indicates that the teaching was successful? A)Myelinization is completed by 4 years of age. B)The process occurs in a head-to-toe fashion. C)The speed of nerve impulses slows as myelinization occurs. D)Nerve impulses become less specific in focus with myelinization.
B
A nurse is preparing a class for parents of infants about managing diaper dermatitis. What advice would the nurse include in the presentation? Select all that apply. A)Applying topical nystatin to the diaper area B)Using a blow dryer on warm to dry the diaper area C)Refraining from using rubber pants over diapers D)Using scented diaper wipes to clean the area E)Washing the diaper area with an antibacterial soap
B, C For diaper dermatitis, topical products such as ointments or creams containing vitamins A, D, and E; zinc oxide; or petrolatum help to provide a barrier. Nystatin is an antifungal agent used for diaper candidiasis. Using a blow dryer on warm to dry the area, avoiding the use of rubber pants, and using unscented diaper wipes or ones free of preservatives are appropriate. The area should be washed with a soft cloth, without harsh soaps.
A group of nursing students are reviewing information about inflammatory bowel disease in preparation for a class discussion on the topic. The students demonstrate understanding of the material when they identify which characteristics of Crohn disease? Select all that apply. A)Distributed in a continuous fashion B)Most common between the ages of 10 to 20 years C)Elevated erythrocyte sedimentation rate D)Low serum iron levels E)Tenesmus F)Loss of haustra within bowel
B, C, D Crohn disease is most common between the ages of 10 and 20 years. Erythrocyte sedimentation rate is elevated and serum iron levels are low. Ulcerative colitis is distributed continuously distal to proximal, with tenesmus and loss of haustra within the bowel. Crohn disease is segmental, with disease-free skip areas common, and the bowel wall has a cobblestone appearance.
The nurse is caring for a 6-month-old with a cleft lip and palate. The mother of the child demonstrates understanding of the disorder with which statements? Select all that apply. A)"My smoking during pregnancy didn't have anything to do with this disorder. Smoking primarily causes low birth weight." B)"I know my baby takes a lot longer to feed than most children this age." C)"It really worries me that my baby may have some other disorders that haven't been detected yet." D)"I wonder if my baby will develop speech problems when language development begins?" E)"Thankfully there are doctors that specialize in correcting this type of disorder."
B, C, D, E Feeding and speech are especially difficult for the child with cleft lip and palate until the defect is repaired. Cleft lip and palate occurs frequently in association with other anomalies and has been identified in more than 350 syndromes. Plastic surgeons or craniofacial specialists, oral surgeons, dentists or orthodontists, and prosthodontists are some of the physicians that specialize in repair of this disorder. The mother is incorrect in stating that smoking is not associated with cleft lip or palate. Maternal smoking during pregnancy is a major risk factor for the disorder.
After teaching the parents of a child diagnosed with celiac disease about nutrition, the nurse determines that the teaching was effective when the parents identify which foods as appropriate for their child? Select all answers that apply. A)Wheat germ B)Peanut butter C)Carbonated drinks D)Shellfish E)Jelly F)Flavored yogurt
B, C, D, E Foods allowed in a gluten-free diet include peanut butter, carbonated drinks, shellfish, and jelly. Wheat germ and flavored yogurt should be avoided.
The nurse is performing a gastrointestinal assessment on a 7-year-old boy. The parents are assisting with the history. Which assessment findings are indicative of constipation? Select all that apply. A)"Our child only has 3 to 4 bowel movements per week." B)"Our child complains of pain because his bowel movements are so hard." C)"Our child tells us that his belly hurts a lot of the time." D)"I can tell he holds his bowel movement much of the time because of the way he stands." E)"I find smears of stool in his underwear almost every day."
B, C, D, E Pain, stool withholding behavior (retentive posturing), and encopresis (soiling of fecal contents into the underwear beyond the age of expected toilet training) are all signs of chronic functional constipation. Less than 3 bowel movements is considered constipation.
The nurse is caring for a 2-month-old with a cleft palate. The child will undergo corrective surgery at age 3 months. The mother would like to continue breastfeeding the baby after surgery and wonders if it is possible. How should the nurse respond? A)"There is a good chance that you will be able to breastfeed almost immediately." B)"Breastfeeding is likely to be possible, but check with the surgeon." C)"After the suture line heals, breastfeeding can resume." D)"We will have to wait and see what happens after the surgery."
B. "Breastfeeding is likely to be possible, but check with the surgeon." Postoperatively, some surgeons allow breastfeeding to be resumed almost immediately. However, the nurse needs to advise the mother to check with the surgeon to determine when breastfeeding can resume. Telling the mother that she has to wait until the suture line heals may be inaccurate. Telling her to wait and see does not answer her question.
What would the nurse include when teaching an adolescent about tinea pedis? A)"Keep your feet moist and open to the air as much as possible." B)"Dry the area between your toes really well." C)"Wear nylon or synthetic socks every day." D)"Go barefoot when you are in the locker room at school."
B. "Dry the area between your toes really well." Keeping the feet clean and dry is key for the child with tinea pedis. This includes rinsing the feet with water or a water/vinegar mixture and drying them well, especially between the toes. The adolescent should wear cotton socks and shoes that allow the feet to breathe. Going barefoot at home is allowed, but the adolescent should wear flip-flops around swimming pools and locker rooms.
The nurse is providing parental teaching about home care for an 8-year-old boy with widespread sunburn on his back and shoulders. Which response indicates a need for further teaching? A)"Cool compresses may help cool the burn." B)"He should manually peel off any flaking skin." C)"Nonsteroidal anti-inflammatory drugs like ibuprofen are helpful." D)"He should avoid hot showers or baths for a couple of days."
B. "He should manually peel off any flaking skin." If skin flaking occurs, the child should be discouraged from manually "peeling" the flaked skin as it can cause further injury. Using cool compresses, taking nonsteroidal anti-inflammatory drugs, and avoiding hot showers or baths are appropriate measures.
The nurse is teaching the mother of a toddler about burn prevention. Which response by the mother indicates a need for further teaching? A)"We will leave fireworks displays to the professionals." B)"I will set our water heater at 130 degrees." C)"All sleepwear should be flame retardant." D)"The handles of pots on the stove should face inward."
B. "I will set our water heater at 130." If the temperature of the water heater is set at 130 degrees, a child can be burned significantly in only 30 seconds. The recommended maximal home hot water heater temperature is 120 degrees. Leaving fireworks to the professionals, using flame-retardant sleepwear, and turning the handles of pots on the stove inward are correct.
A teenage girl with psoriasis tells the nurse that she is so embarrassed by the plaque on her skin that she doesn't want to go to school. What is the best response by the nurse? A)"Have you been applying your medication and emollients to your skin as directed by your physician?" B)"It must be really difficult for you. Tell me how you are taking care of your skin on a daily basis." C)"Sunlight really helps the plaque areas heal. Maybe going to a tanning bed routinely will help." D)"You can't miss school because of your skin. Can you wear clothes that will cover the areas?"
B. "IT must be really difficult for you. Tell me how you are taking care of your skin on a daily basis." "It must be really difficult for you. Tell me how you are taking care of your skin on a daily basis" shows empathy and allows the nurse to determine how the girl is taking care of the psoriasis and if any suggestions to the treatment plan can be helpful. Questioning the client if she is doing what the physician has prescribed may make her defensive and does not show empathy. Suggesting tanning can cause too much exposure to unwanted UV rays. Telling the girl that she can't miss school and to cover the areas does not elicit open discussion and does not promote self-esteem.
The mother of a 3-week-old infant old brings her daughter in for an evaluation. During the visit, the mother tells the nurse that her baby is spitting up after feedings. Which response by the nurse would be most appropriate? A)"We need to tell the doctor about this." B)"Infants this age commonly spit up." C)"Your daughter might have an allergy." D)"Don't worry; you're just feeding her too much."
B. "Infants this age commonly spit up." In infants younger than 1 month of age, the lower esophageal sphincter is not fully developed, so infants younger than 1 month of age frequently regurgitate after feedings. Many children younger than 1 year of age continue to regurgitate for several months, but this usually disappears with age. The mother's report is not a cause for concern so the physician does not need to be notified. Additional information would be needed to determine if the infant had an allergy. Although the infant's stomach capacity is small, telling the mother not to worry does not address the mother's concern, and telling her that she is feeding the daughter too much implies that she is doing something wrong.
The nurse is caring for an infant with candidal diaper rash. Which topical agent would the nurse expect the physician to order? A)Corticosteroids B)Antifungals C)Antibiotics D)Retinoids
B. Antifungals Candidal diaper rash would require a fungicide. The nurse would expect to administer topical antifungals as ordered. Corticosteroids are not typically recommended for young infants and are used for atopic dermatitis and certain types of contact dermatitis. Antibiotics would be ineffective against fungal infections. Retinoids are indicated for moderate to severe acne.
The nurse is caring for an infant with a temporary ileostomy. As part of the plan of care, the nurse monitors for skin breakdown around the stoma. If redness occurs, what would be most appropriate to promote healing and prevent further skin breakdown? A)Clean the area well with a scented diaper wipe. B)Apply a barrier/healing cream or paste on the skin. C)Use a barrier wafer to attach the appliance. D)Sanitize the area with an alcohol wipe after each diaper change.
B. Apply a barrier/healing cream or paste on the skin. The nurse should use a barrier/healing cream or paste on the skin around the stoma to promote healing and prevent further skin breakdown. Diaper wipes that contain fragrance or alcohol can sting if used on nonintact skin and can worsen skin breakdown. The barrier wafer would be helpful, but does not address the skin breakdown.
A nurse is performing a primary survey on a child who has sustained partial thickness burns over his upper body areas. What action should the nurse take first? A)Inspect the child's skin color. B)Assess for a patent airway. C)Observe for symmetric breathing. D)Palpate the child's pulse.
B. Assess for a patent airway When performing a primary survey, the nurse first assesses the child's airway for patency and then intervenes accordingly to ensure that the airway is patent. Next the nurse would evaluate the child's skin color, respiratory effort, and symmetry of breathing and breath sounds. Then the nurse would determine the pulse strength, perfusion status, and heart rate.
The nurse is caring for a 15-year-old boy who has sustained burn injuries. The nurse observes the burn developing a purplish color with discharge and a foul odor. The nurse suspects which infection? A)Burn wound cellulitis B)Invasive burn cellulitis C)Burn impetigo D)Staphylococcal scalded skin syndrome
B. Invasive burn celllulitis Invasive burn cellulitis results in the burn developing a dark brown, black, or purplish color with a discharge and foul odor. In burn wound cellulitis, the area around the burn becomes increasingly red, swollen, and painful early in the course of burn management. Burn impetigo is characterized by multifocal, small, superficial abscesses. Staphylococcal scalded skin syndrome is not a burn infection; however, it is managed similarly to burns.
The nurse is conducting a physical examination of a child with suspected Crohn disease. Which finding would be the most suspicious of Crohn disease? A)Normal growth patterns B)Perianal skin tags or fissures C)Poor growth patterns D)Abdominal tenderness
B. Perianal skin tags or fissures. Perianal skin tags and/or fissures are highly suspicious of Crohn disease. Poor growth patterns and abdominal tenderness are common to Crohn disease but are also seen with many other conditions. Normal growth patterns would not point to Crohn disease because of problems with absorbing nutrients.
A nurse is assessing the skin of a child with cellulitis. What would the nurse expect to find? A)Red, raised hair follicles B)Warmth at skin disruption site C)Papules progressing to vesicles D)Honey-colored exudate
B. Warmth at skin disruption site. Cellulitis is manifested by erythema, pain, edema, and warmth at the site of skin disruption. Red raised hair follicles would indicate folliculitis. Papules progressing to vesicles and a honey-colored exudate would suggest nonbullous impetigo.
The nurse is conducting a physical examination of a 9-month-old baby with a flat, discolored area on the skin. The nurse documents this as a: A)papule. B)macule. C)vesicle. D)scale.
B. macule A macule is a flat, discolored area on the skin. A papule is a small, raised bump on the skin. A vesicle is a fluid-filled bump on the skin. Scaling is flaking of the skin.
The nurse is teaching the mother of a 5-year-old boy with a myelomeningocele who has developed a sensitivity to latex. Which response from his mother indicates a need for further teaching? A)"He needs to get a medical alert identification." B)"I will need to discuss this with his caregivers." C)"A product's label indicates whether it is latex-free." D)"He must avoid all contact with latex."
C.
The nurse is interviewing the mother of a 6-month-old being seen at a well-child visit. The mother reports she has used an over-the-counter topical ointment intended for adults on her child for a skin rash. What is the most appropriate response by the nurse? A)"This is dangerous so please do not do this again." B)"Why did you do that instead of contacting your doctor?" C)"Children have thin skin and can absorb medications differently than adults." D)"How often do you use this medication?"
C. "Children have thin skin and can absorb medications differently than adults." Children have thinner skin than adults. They will absorb topical medications more rapidly than adults. Medications concentrated for adults should not be used on children. It is important to explain this to the parent. It is confrontational to tell her this is dangerous or to tell her to contact the physician. The frequency of use is information that should be obtained but the education is most important in this scenario.
The nurse is providing care for a 14-year-old girl with severe acne. The girl expresses sadness and distress about her appearance. Which response by the nurse would be most appropriate? A)"Are you using your medicine every day?" B)"Your condition will most likely improve in a year or two." C)"Many people feel this way; I know someone who can help." D)"If you have any scarring you can undergo dermabrasion."
C. "Many people feel this way; I know someone who can help." Depression can occur as a result of body image disturbances with severe acne. The nurse should provide emotional support to adolescents undergoing acne therapy and refer teens for counseling if necessary. Telling the girl that her condition is likely to improve in a year or two is not helpful. Asking the girl whether she uses her medicine every day or reminding her that her scars can be addressed with dermabrasion does not address her feelings of sadness and distress.
After teaching a class about the differences in the skin of infants and adults, the nurse determines that additional teaching is necessary when the class states: A)"An infant's skin is thinner than an adult's, so substances placed on the skin are absorbed more readily." B)"The infant's epidermis is loosely connected to the dermis, increasing the risk for breakdown." C)"The infant has a lower risk for damage from ultraviolet radiation because the skin is more pigmented." D)"An infant has less subcutaneous fat, which places the infant at a higher risk for heat loss."
C. "The infant has a lower risk for damage from ultraviolet radiation because the skin is more pigmented." Infants have less pigmentation in their skin, placing them at increased risk for skin damage from ultraviolet radiation. The infant's skin is thinner, the epidermis is loosely connected, and there is less subcutaneous fat.
A child is scheduled for a lower endoscopy. What would the nurse include in the child's plan of care in preparation for this test? A)Explaining about the need to ingest barium B)Establishing an intravenous access for radionuclide administration C)Administering the prescribed bowel cleansing regimen D)Withholding prescribed proton pump inhibitors for 5 days before
C. Administering the prescribed bowel cleansing regimen Prior to a lower endoscopy, the child must undergo bowel cleansing to allow visualization of the lower gastrointestinal tract via a fiberoptic instrument. Barium is ingested for an upper gastrointestinal and/or small bowel series. Radionuclides are used with a hepatobiliary scan. Proton pump inhibitors are withheld for 5 days before a urea breath test.
When developing the plan of care for a child with burns requiring fluid replacement therapy, what information would the nurse expect to include? A)Administration of colloid initially followed by a crystalloid B)Determination of fluid replacement based on the type of burn C)Administration of most of the volume during the first 8 hours D)Monitoring of hourly urine output to achieve less than 1 mL/kg/hour
C. Administration of most of the volume during the first 8 hours. With fluid replacement therapy, most of the volume is administered during the first 8 hours. Crystalloids (such as Ringer lactate) are administered for the first 24 hours, and then colloids are used once capillary permeability is less of a concern. Fluid replacement is determined by the amount of body surface area burned. Hourly urine output is expected to be at least 1 mL/kg/hour.
The nurse is preparing a class for a group of adolescents about reducing the risk of skin cancer. What information would the nurse include? A)Using a sunscreen with para-aminobenzoic acid (PABA) with an SPF of at least 10 B)Applying sunscreen at least 1 hour before going outside in the sun C)Avoiding sun exposure between the hours of 10 a.m. and 2 p.m. D)Using artificial ultraviolet (UV) tanning beds instead of sun exposure
C. Avoiding sun exposure between the hours of 10am and 2 pm Avoiding sun exposure between the hours of 10 a.m. and 2 p.m. is one method of reducing the risk for skin cancer. Sunscreens with an SPF of 15 or greater that are fragrance- and PABA-free should be used. Sunscreen should be applied at least 30 minutes before exposure and then reapplied at least every 2 hours while exposed. Artificial UV light, including tanning beds, should be avoided.
A nurse is caring for a 5-year-old in Buck traction. When conducting a skin examination for signs of pressure ulcers, the nurse pays particular attention to which area? A)Sacral area B)Hip area C)Occiput D)Upper arm
C. Occiput Common sites of pressure ulcers in hospitalized children include the occiput and toes, while children who require wheelchairs for mobility demonstrate pressure ulcers in the sacral or hip areas more frequently. The upper arm is not a common site for pressure ulcers.
When examining the abdomen of a child, which technique would the nurse use last? A)Auscultation B)Percussion C)Palpation D)Inspection
C. Palpation. Palpation should be the last part of the abdominal examination. Inspection, auscultation, and percussion should be done before palpation.
A 4-year-old is brought to the emergency department with a burn. What would alert the nurse to the possibility of child abuse? A)Burn assessment correlates with mother's report of contact with a portable heater. B)Parents state that the injury occurred approximately 15 to 20 minutes ago. C)Clear delineations are noted between burned and nonburned skin areas. D)The burn area appears asymmetric and nonuniform.
C. clear delineations are noted between burned and nonburned skin areas Suggested signs of a burn resulting from possible child abuse include a uniform appearance of the burn with clear delineations of burned and nonburned areas. Abuse would also be suspected if the report of the injury was inconsistent with burn injury or there was a delay in seeking treatment. An asymmetric nonuniform burn often correlates with a splatter-type burn resulting from the child pulling a source of hot fluid onto himself or herself.
Which finding would lead the nurse to suspect that a child is experiencing moderate dehydration? A)Dusky extremities B)Tenting of skin C)Sunken fontanels D)Hypotension
C. sunken fontanels A child with moderate dehydration would exhibit sunken fontanels. Severe dehydration would be characterized by dusky extremities, skin tenting, and hypotension.
A nurse is caring for a 7-year-old girl scheduled for an intravenous pyelogram (IVP). Which action would be the priority before the test?
Checking with the parents for any allergies
The nurse is providing instruction to the parents of a newborn boy. The parents have decided not to circumcise the child. What information should be included in the discussion? Select all answers that apply.
Clean the penis gently with soap and water If the foreskin is not retractable do not force it. When the foreskin is retracted, gently replace it prior to completing diapering.
The nurse is visually inspecting a urine specimen from a 12-year-old boy. The nurse documents gross hematuria with a specimen of which color?
Cola colored
The nurse has developed a plan of care for a 6-year-old with muscular dystrophy. He was recently injured when he fell out of bed at home. Which intervention would the nurse suggest to prevent further injury? A)Recommend the bed's side rails be raised throughout the day and night. B)Suggest a caregiver be present continuously to prevent falls from bed. C)Encourage a loose restraint to be used when he is in bed. D)Recommend raising the bed's side rails when a caregiver is not present.
D
A 6-year-old boy has been admitted to the hospital with burns. The nurse notes carbonaceous sputum. What action would be the priority? A)Determining the burn depth B)Eliciting a description of the burn C)Estimating burn extent D)Ensuring a patent airway
D. Ensuring a patent airway Carbonaceous sputum is a sign of potential airway injury due to smoke inhalation. Therefore, the nurse should ensure a patent airway while obtaining a brief history and simultaneously evaluating the child and providing emergency care. If the burn does not pose an immediate, life-threatening risk, the nurse would obtain an in-depth history and elicit a description of the burn. Determining the burn depth and extent are part of the secondary survey.
The nurse has developed a plan of care for a 12-month-old hospitalized with dehydration as a result of rotavirus. Which intervention would the nurse include in the plan of care? A)Encouraging consumption of fruit juice B)Offering Kool-Aid or popsicles as tolerated C)Encouraging milk products to boost caloric intake D)Maintaining the intravenous (IV) fluid rate as ordered
D. Maintaining the intravenous (IV) fluid rate as ordered. The nurse should maintain an IV line and administer the IV fluid as ordered to maintain fluid volume. High-carbohydrate fluids like fruit juice, Kool-Aid, and popsicles should be avoided as they are low in electrolytes, increase simple carbohydrate consumption, and can decrease stool transit time. Milk products should be avoided during the acute phase of illness as they may worsen diarrhea.
A nursing instructor is developing a class presentation about the medications used to treat peptic ulcer disease. Which drug class would the instructor be least likely to include in the presentation? A)Antibiotics B)Proton pump inhibitors C)Histamine antagonists D)Prokinetics
D. Prokinetics Treatment for peptic ulcer disease includes antibiotics if Helicobacter pylori is verified, histamine antagonists, and/or proton pump inhibitors. Prokinetics are used to stimulate the gastrointestinal tract to help empty the stomach faster and promote intestinal motility. They are not used for peptic ulcer disease.
A child is diagnosed with atopic dermatitis. Which laboratory test would the nurse expect the child to undergo to provide additional evidence for this condition? A)Erythrocyte sedimentation rate B)Potassium hydroxide prep C)Wound culture D)Serum immunoglobulin E (IgE) level
D. Serum immunoglobulin E (IgE) level IgE levels are often used to evaluate for atopic dermatitis. IgE levels are elevated in this condition. Erythrocyte sedimentation rate may be used but this test is nonspecific and only indicates infection or inflammation. Potassium hydroxide prep is used to identify fungal infections. Wound culture would be done to identify a specific organism if an infection occurs with atopic dermatitis.
As part of a clinical conference with a group of nursing students, the instructor is describing the burn classification. The instructor determines that the teaching has been successful when the group identifies what as characteristic of full thickness burns? A)Skin that is reddened, dry, and slightly swollen B)Skin appearing wet with significant pain C)Skin with blistering and swelling D)Skin that is leathery and dry with some numbness
D. Skin that is leathery and dry with some numbness Full thickness burns may be very painful, numb, or pain-free in some areas. They appear red, edematous, leathery, dry, or waxy and may display peeling or charred skin. Superficial burns are painful, red, dry, and possibly edematous. Partial thickness and deep partial thickness burns are very painful and edematous and have a wet appearance or blisters.
A group of students are reviewing information about fluid balance and losses in children in comparison to adults. The students demonstrate a need for additional review when they state that: A)children have a proportionately greater amount of body water than do adults. B)fever plays a greater role in insensible fluid losses in infants and children. C)a higher metabolic rate plays a major role in increased insensible fluid losses. D)the infant's immature kidneys have a tendency to over concentrate urine.
D. the infant's immature kidneys have a tendency to over concentrate urine. The young infant's renal immaturity does not allow the kidneys to concentrate urine as well as in older children and adults, placing them at risk for dehydration or over hydration. Children do have a proportionately greater amount of body water than adults, and fever is important in promoting insensible fluid losses in infants and children because children become febrile more readily and their fevers are higher than those in adults. Children also experience a higher metabolic rate, which accounts for increased insensible fluid losses and increased need for water for excretory function.
The nurse is reviewing the laboratory test results of a child with nephrotic syndrome. What would the nurse least likely expect to find?
Decreased blood urea nitrogen
A child is diagnosed with hemolytic-uremic syndrome (HUS). Review of the child's laboratory test results would reveal which finding?
Decreased platelets and leukocytosis
