PrepU Chapters 35 + 36 + 40 + 41 + 51
A 4-week-old infant is diagnosed with acute bronchiolitis. The parent states, "I do not know how the baby got this!" How should the nurse respond?
"Has your infant been around any crowds?"
The parents of a 7-month-old boy with a broken arm agree on how the accident happened. Which account would lead the nurse to suspect child abuse (child maltreatment)?
"He was climbing out of his crib and fell."
A 9-year-old has suffered a severe anaphylactic reaction and dies. The nurse is providing support for the grieving parents. Which comment would best help them cope?
"How can I help you get through this?"
A nurse is caring for a boy preparing to undergo a dressing change. Which statement by the father lets the nurse know that the child's pain experience is at risk of being intensified?
"I hope that you will be a brave boy and not cry."
The nurse has completed teaching a CPR course for a local day care. Which statement by a participant indicates a need for further education?
"I will place the heel of my hand on the sternum of a 9-month-old when performing CPR."
The nurse is teaching parents of a 12-year-old child how to administer otic medication. Which statement by the parent indicates a need for further education?
"I will pull the outer ear down and back before administering the medication."
The nurse is auscultating the lungs of a lethargic, irritable 6-year-old boy and hears wheezing. The nurse will most likely include which teaching point if the child is suspected of having asthma?
"I'm going to have this hospital worker take a picture of your lungs."
The mother of a child with asthma tells the nurse that she occasionally gives her child the steroid medicine she takes for her rheumatoid arthritis when the child has a "flare-up" of asthma. "It's easier than going to the hospital or doctor every time a flare-up happens," the mother says. What is the best response by the nurse?
"I'm sure it must be difficult to cope with the flare-ups, but there are many side effects from steroid use and the physician needs to monitor your child's asthma symptoms."
The nurse is teaching the parents of a child with congenital heart disease about clubbing. Which statement by the parents demonstrates a need for further teaching?
"If clubbing is noted, we should administer oxygen to our child immediately."
The nurse is providing education to a client newly diagnosed with asthma. Which statement by the parents indicates additional teaching is needed?
"It is okay for our child to do chores such as sweeping the floor."
The parents of a 5-year-old child with a cardiovascular disorder tell the nurse they don't understand why their child isn't gaining weight, "We make sure our child has 3 very nutritious meals every day." How should the nurse respond?
"It's great you are providing nutritious meals, but small, frequent meals will tire your child less and promote weight gain."
A school-aged child will have an intravenous line inserted. His mother asks if he could have this placed in his left hand so that he can do homework. What is the nurse's best response?
"Let's take a look at the left hand first."
A child will be undergoing a Holter monitor test. Which statement by the parent indicates the need for further instruction?
"My child cannot have any thing to eat or drink after midnight the day of the test."
The nurse has been caring for a 12-year-old boy during his 5-day hospitalization. The child's IV has infiltrated, and the care provider is getting ready to change the intravenous line site. Which statement made by the nurse would be appropriate in supporting the child?
"The client is left-handed and likes to draw; an IV site in his right arm would be best."
The parents of a 2-year-old toddler newly diagnosed with tricuspid atresia ask the nurse, "I do not understand why our toddler's fingertips are spread out and rounder than normal fingertips?" Which response by the nurse is best?
"The low blood oxygen levels from the heart defect causes the lack of oxygen to the fingers, causing these changes."
A 5-year-old child fell on the playground and briefly lost consciousness. Magnetic resonance imaging (MRI) of the head was normal, and the child is now alert and awake with stable vital signs. The nurse provides discharge teaching for this family. Which statement by the caregiver indicates a need for additional teaching by the nurse?
"We will wake the child up every hour to assess overnight."
A child's parent calls the clinic nurse and states, "My child just drank an unknown amount of a cleaning solution. What should I do?" Which statement by the nurse is best?
"You need to hang up with me and call the poison control center now."
The nurse is assessing the blood pressure of an adolescent. In which range should the nurse expect the blood pressure measurement for a healthy 13-year-old boy?
100 to 120/70 to 80 mm Hg
The nurse is caring for a child who weighs 47 lb (21.3 kg). The medication prescribed for the child has a therapeutic dosage of 3 mg/kg/day. The medication prescribed is to be given every 6 hours. Calculate the total number of milligrams per dose of medication the child will receive? Record your answer using a whole number.
16
The nurse is assessing a child with a suspected head injury. The child opens the eyes only in response to the nurse placing pressure in the child's nail bed. What score on the Glasgow coma scale for eye opening should the nurse assign based on this assessment finding?
2
The child's physician requests that the nurse should notify her if the child's urine output is less than 1 ml/kg of body weight each hour. The child weighs 56 lb (25.46 kg). Calculate the minimum amount of urine output the child should produce each hour. Record your answer using a whole number.
25
The nurse must calculate the adolescent's cardiac output. The child's heart rate is 76 beats per minute and the stroke volume is 75 ml. Calculate the child's cardiac output in ml/min. Record your answer using a whole number.
5700
The child needs a tracheal tube placed. The child is 8 years old. Calculate the size, in millimeters, of the tracheal tube that should be used for this child. Record your answer using a whole number.
6
A nurse is providing supplemental oxygen therapy to a young child. Based on the nurse's understanding of oxygen delivery methods, what would the nurse expect to be used to deliver the highest concentration of oxygen to the child?
A nonrebreather (face) mask provides 95% oxygen concentration.
A 3-year-old child with asthma and a respiratory tract infection is prescribed an antibiotic and a bronchodilator. The nurse notes the following during assessment: oral temperature 100.2°F (37.9°C), respirations 52 breaths/minute, heart rate 90 beats/minute, O2 saturation 95% on room air. Which action will the nurse take first?
Administer the bronchodilator via a nebulizer.
What scenario demonstrates the nurse's knowledge when using guided imagery to relieve pain in pediatric clients?
After achieving a relaxed state, begin by encouraging the 13-year-old client to imagine walking down a sandy beach and collecting seashells, a favorite activity.
The nurse is preparing the room for a client admitted from the emergency department with suspected tuberculosis (TB). Which type of infection control precautions would the nurse anticipate?
Airborne precautions
A child is brought to the emergency department in severe respiratory distress. As the nurse begins an assessment, the child becomes unresponsive and stops breathing. The nurse calls for help and the health care team begins resuscitative measures. The nurse attempts to escort the child's parent from the room but the parent refuses to leave. Which is the best action for the nurse to take?
Allow the parent to stay in the room but remain at the parent's side for support.
The nurse notes a 3-year-old child is restless, has a respiratory rate of 55 breaths/minute, and has an oxygen saturation of 90%. Which action will the nurse take first?
Apply oxygen via a facemask.
The nurse is caring for a 5-year-old client and notes respiratory rate of 45 breaths per minute, blood pressure 100/70 mm Hg, heart rate 115, temperature 101°F (38.3°C), and oxygen saturation 86%. Which diagnostic test is priority for the nurse to complete?
Arterial blood gas (ABG)
The nurse enters the room to give a subcutaneous injection of insulin to a 6-year-old child with diabetes. What is the best method of medication administration?
Ask the child where the child would like to have the injection.
The nurse is mentoring a new graduate who is completing a respiratory assessment on a client with suspected epiglottitis. Which action by the new graduate would require clarification?
Assessment of the nasopharynx
What information would be included in the care plan of an infant in heart failure?
Begin formulas with increased calories.
Which assessment is most important for determining an accurate dose of a pediatric medication?
Body surface area
What will the nurse include in the feeding plan for a breastfed infant with congenital heart disease?
Breastfeed with small, frequent feeds.
The nurse notices that a child is spitting up small amounts of blood in the immediate postoperative period after a tonsillectomy. What would be the best intervention?
Continue to assess for bleeding.
What is the most common debilitating disease of childhood among those of European descent?
Cystic fibrosis
The nurse is administering medications to the child with congestive heart failure (CHF). Large doses of what medication are used initially in the treatment of CHF to attain a therapeutic level?
Digoxin
A child is receiving IV fluids for dehydration. The nurse notes coarse breath sounds and increased pulse and blood pressure. What does the nurse do first?
Discontinue the IV infusion.
The nurse plans to educate the parents of a child experiencing septic shock about the purpose of administering dobutamine intravenously to their child. What would the nurse include in this educational plan?
Dobutamine is used to improve cardiac contractility.
An 8-year-old with cystic fibrosis has had a noted decline on the growth chart. Which nursing intervention is best for maintaining adequate nutrition?
Encourage high-calorie, high-protein snacks.
The caregivers of a child report that their child had a cold and complained of a sore throat. When interviewed further they report that the child has a high fever, is very anxious, and is breathing by sitting up and leaning forward with the mouth open and the tongue out. The nurse recognizes these symptoms as those seen with which disorder?
Epiglottitis
The nurse is caring for a 12-year-old with cerebral palsy who is unable to communicate verbally. Which pain assessment tool is the most appropriate for the nurse to use when assessing pain in this client?
Face, leg, activity, cry, and consolability (FLACC) descriptors
A nurse admits an infant with a possible diagnosis of congestive heart failure. Which signs or symptoms would the infant most likely be exhibiting?
Feeding problems
A school nurse is caring for a child with a severe sore throat and fever. What is the nurse's best recommendation to the parent?
Have the child be seen by the primary care provider.
The nurse wishes to use a distraction technique when administering an injection to an anxious school-aged child. Which technique should the nurse implement?
Have the child blow bubbles.
The off-duty nurse is in the park and is present when a child collapses. Which step should be performed first?
Implement head tilt-chin lift maneuver.
An 8-month-old infant has a ventricular septal defect. Which nursing diagnosis would best apply?
Ineffective tissue perfusion related to inefficiency of the heart as a pump
What statement is the most accurate regarding the structure and function of the newborn's respiratory system?
Most infants are nasal breathers rather than mouth breathers.
A nurse suspects a child is experiencing cardiac tamponade after heart surgery. What would be the priority nursing intervention?
Notify the doctor immediately.
Which tool would be the least appropriate scale for the nurse to use when assessing a 4-year-old child's pain?
Numeric pain intensity scale
Which nursing diagnosis would best apply to a child with allergic rhinitis?
Pain related to sinus edema and headache
The caregivers of a child who was diagnosed with cystic fibrosis 5 months ago report that they have been following all of the suggested guidelines for nutrition, fluid intake, and exercise, but the child has been having bouts of constipation and diarrhea. The nurse tells the caregiver to increase the amount of which substance in the child's diet?
Pancreatic enzymes
A nurse is caring for a child with Kawasaki disease. Which assessment finding would the nurse expect to see?
Peeling hands and feet; fever
The parents of a preschool child are distraught as they carry their limp child into the emergency room. The parents report the child fell approximately 10 feet from a large slide and hit his head "hard enough to knock him out." What is the nurse's next action?
Perform a jaw-thrust technique to assess the patency of the airway.
When the nurse is caring for a child presenting with a traumatic injury, which action is priority?
Perform a primary assessment
An infant with tetralogy of Fallot becomes cyanotic. Which nursing intervention would be the first priority?
Place the infant in the knee-chest position.
When reviewing the record of a child with tetralogy of Fallot, what would the nurse expect to discover?
Polycythemia
The nurse is preparing to give a 4-month-old an oral medication. Which technique demonstrates the nurse's accurate knowledge of the infant's developmental level?
Position the infant upright, offer the infant a bottle of formula, remove the bottle and squirt the medication on the side of the tongue toward the cheek, then offer the infant the bottle again.
When caring for pediatric clients, which distraction technique is age-appropriate for the nurse to use?
Provide action-oriented video games to a 15-year-old client.
A nurse is administering ear drops to a 7-year-old girl. What should the nurse do?
Pull the pinna of the ear up and back to straighten the external ear canal.
During an assessment, a child exhibits an audible high-pitched inspiratory noise, a tripod stance and intercostal retractions. Using SBAR communication, the nurse notifies the health care provider and states which breath sounds that are congruent with the clinical presentation of the child?
Respiratory stridor
A worried mother calls the nurse and tells her that her son has developed a horrible croup cough and is having trouble breathing. What would be the best intervention for the nurse to recommend to the mother?
Run a hot shower to fill the bathroom with steam and have the boy stay there.
The school nurse is caring for a 12-year-old boy with a bloody nose. Which action would be most appropriate for the nurse to do?
Seat the child leaning forward and pinch the anterior portion of the nose closed.
A nurse is caring for a 4-year-old child who is exhibiting extreme anxiety and behavioral upset prior to receiving stitches for a deep chin laceration. Which nursing intervention is a priority?
Serving as an advocate for the family to ensure appropriate pharmacologic agents are chosen.
Which electrolyte does the client with cystic fibrosis need in abundance?
Sodium
The nurse is caring for a child who has been admitted with a possible diagnosis of cystic fibrosis. Which laboratory/diagnostic tools would most likely be used to help determine the diagnosis of this child?
Sweat sodium chloride test
When caring for a child with a congenital heart defect, which assessment finding may be a sign the child is experiencing heart failure?
Tachycardia
At 3 years of age, a child has a cardiac catheterization. After the procedure, which interventions would be most important?
Taking pedal pulses for the first 4 hours
The nurse is taking a health history for a 3-year-old girl suspected of having pneumonia who presents with a fever, chest pain, and cough. Which information places the child at risk for pneumonia?
The child attends day care.
A parent expresses concern to the nurse that her 18-month-old child might have an ear infection. Which symptom would alert the nurse that this is a possibility?
The child is pulling on the ear.
A six-year-old child is observed sucking the thumb and baby talking while hospitalized for cellulitis. How would the nurse explain this to the parents?
The child may be in pain.
The nurse working in the emergency department is caring for an 8-year-old boy who was hit by a car while running across the street and has suffered extensive abrasions, contusions, and broken bones. IV morphine analgesia has been given. The child is unable to follow simple directions to allow for procedures to be completed. What is the best action to take for this child?
The child should be sedated.
The nurse is reviewing the documentation from a previous shift concerning the client's scoring on the FLACC scale. The score concerning the assessment of the child's face reports a score of "2". What can be inferred by this?
The child was fretful and grimacing.
The nurse is caring for a 2-year-old child who has been hospitalized after being injured in an automobile accident. During the assessment the child is quiet and watchful of all the nurse's actions. When considering the level of pain being experienced by the child what inference can be made?
The child's nonverbal behaviors may indicate the presence of discomfort.
A preschool-age child who is receiving gastrostomy feedings occasionally vomits following a feeding. When the parent describes the feeding process, what does the nurse note as the likely cause of the vomiting?
The mother does not check gastric residual prior to feedings.
The health care team is performing cardiopulmonary resuscitation on a child following a suspected poisoning. Which action by the nurse would indicate that CPR is warranted?
The nurse assesses the child's heart rate at 45 and begins chest compressions.
A 2-year-old toddler is seen for acute laryngotracheobronchitis. What observation would lead the nurse to suspect airway occlusion?
The respiratory rate is gradually increasing.
A nurse is caring for an infant who just had open-heart surgery and the parents are asking why there are wires coming out of the infant's chest. What is the best response by the nurse?
These wires are connected to the heart and will detect if your infant's heart gets out of rhythm.
A child with a congenital heart defect is getting an echocardiogram. How would the nurse describe this test to the parent?
This test will check how blood is flowing through the heart.
The nurse is working to gain a preschooler's cooperation to swallow an oral medication. What would be the nurse's best approach?
ask if the child would like to take the medicine in a cup or through an oral syringe
The health care provider has prescribed beclomethasone for long term control of asthma. The nurse is most correct to advise the client that beclomethasone is a:
corticosteroid.
A 6-year-old child was diagnosed as having streptococcal pharyngitis. At the follow-up visit, the nurse will assess the child for which potential complication?
development of rheumatic fever
What is a symptom of bacterial pharyngitis?
fever
A group of nursing students are reviewing information about variations in the anatomy of a child's respiratory tract structures in comparison to adults. The students demonstrate an understanding of the information when they describe the shape of the larynx in infants as:
funnel.
A nurse is assessing the skin of a 12-year-old with suspected right ventricular heart failure. Where should the nurse expect to note edema in this child?
lower extremities
A child is diagnosed with rheumatic fever. For which medication will the nurse educate the caregivers?
nonsterioidal anti-inflammatory drugs (NSAIDs)
The nurse is caring for a child who is critically ill and requires fluid resuscitation. Which intravenous fluid(s) is appropriate for use? Select all that apply.
normal saline lactated Ringer's
What would be the most important measure to implement for an infant who develops heart failure?
placing the infant in a semi-Fowler position
A parent must administer a medication in syrup form to a 2-month-old infant. The nurse suggests:
placing the syrup in an medicine syringe.
What is a complication of cystic fibrosis?
pneumothorax
A 4-year-old child is admitted to the hospital for surgery. Before the nurse administers medicine, the best way to identify the child would be to:
read the child's armband.
The nurse is preparing an in-service program on pediatric cardiopulmonary resuscitation. The nurse would include a discussion that cardiopulmonary arrest in infants and children is most likely the result of:
respiratory failure.
After teaching the parents of an 8-year-old girl with asthma about common allergens their child should avoid, the nurse determines that the parents need additional teaching when they identify what as a common allergen for asthma?
shellfish
The nurse is assessing a 6-week-old infant in the home setting. The nurse notes the infant has a regular breathing pattern with brief periods of apnea followed by a respiratory rate of 40. What would the nurse further assess in the infant?
skin color and heart rate
A 5-year-old girl who was already admitted to the hospital for an unrelated condition suddenly becomes irritable, restless and anxious. These may be early signs of respiratory distress in a child if accompanied by:
tachypnea.
A 9-year-old boy nearly drowned when he fell through the ice while skating on a pond. The child is exhibiting bradycardia. What would the nurse expect to implement to resolve the child's bradycardia?
using a convective air warming blanket
The nurse is preparing to administer a dose of ketorolac to a 15-year-old adolescent. How should the nurse administer the medication to reduce the potential for gastrointestinal upset?
with meals
