Preschooler

A child with suspected rheumatic fever is admitted to the pediatric unit. When obtaining the child's history, the nurse considers which information to be most important? Lack of interest in food ; Vomiting for 2 days; A recent episode of pharyngitis; A fever that started 3 days ago

A recent episode of pharyngitis A recent episode of pharyngitis is the most important factor in establishing the diagnosis of rheumatic fever. Although the child may have a history of fever or vomiting or lack interest in food, these findings are not specific to rheumatic fever.

When teaching a preschool-age child how to perform coughing and deep-breathing exercises before corrective surgery for TOF, which of the following teaching and learning principles should the nurse address first? A. Organizing information to be taught in a logical sequence B. Arranging to use actual equipment for demonstrations C. Building the teaching on the child's current level of knowledge D. Presenting the information in order from simplest to most complex

C. Building the teaching on the child's current level of knowledge

A nurse is working on the pediatric unit. Which assignment best demonstrates primary care nursing?

Caring for the same child from admission to discharge

The parent of a preschool-age child tells the nurse that the child is hyperactive and something needs to be done. Which response by the nurse would be most appropriate initially?

D. "What makes you think your child is hyperactive?" The best approach by the nurse is to determine why the parent thinks the child is hyperactive. Some children are very active but do not have the necessary defining characteristics of hyperactivity. Asking what the parent thinks needs to be done or how the child behaves normally would be an appropriate follow-up question once more information is gathered from the parent to determine whether the child indeed is hyperactive. Telling the parent to wait for the physician ignores the parent's concern and does not deal with the parent's issue.

A nurse is performing a respiratory assessment on a 5-year-old child diagnosed with pneumonia. Which assessment finding should be reported to the physician immediately?

D. Moderate intercostal retractions Normally, children and men use the abdominal muscles to breathe, whereas women use the thoracic muscles. Use of the accessory or intercostal muscles would indicate a respiratory problem and should be immediately reported to the physician. Mouth breathing and a foul odor from the mouth aren't cause for concern. Irregular respirations while awake aren't an unusual finding in a young child.

A 4-year-old with a history of urinary reflux returned from surgery for bilateral ureteral re-implants 2 days ago. Which assessment finding is most concerning?

Decreased oral intake. Children with bilateral ureteral implants often have pain with urination because of bladder spasms. Some children will stop drinking to avoid the pain associated with urination, thus putting them at risk for dehydration. Intermittent bladder spasms are common after ureteral re-implant surgery and can be treated with Ditropan (oxybutynin). Small amounts of blood-tinged urine, bladder spasms, urinary frequency, and urinary incontinence are common following ureteral re-implant surgery.

A nurse is performing a Denver Developmental Screening Test (Denver II) on a 4-year-old. How does the nurse interpret the results?

Delays are failed items that 75% of children that age can perform.

A 5-year-old preschooler suspected of having leukemia is admitted to the hospital for diagnosis and treatment. The physician orders a bone marrow aspiration. Place the interventions below in ascending chronological order according to their importance. Use all options.

Discuss the procedure with his parents. Act out the procedure using a doll and biopsy kit. Explain the discomforts he'll feel. Assure the child that the pain will go away. Check the biopsy site for hemorrhage and infection.

A child with hemophilia is hospitalized after falling. Now the child complains of severe pain in the left wrist. What should the nurse do first?

Elevate the affected arm and apply ice to the injury site.

A mother tells the nurse that she wants her 4-year-old to stop sucking her thumb. When developing the teaching plan, which intervention should the nurse suggest?

Get the child to agree to stop the thumb sucking.

A 4-year-old who weighs 40 lbs (18 kg) is brought to the emergency department with sudden onset of a temperature of 103° F (39.4° C), sore throat, and refusal to drink. The child will not lie down and prefers to lean forward while sitting up. What should the nurse do next?

Have an appropriate-sized tracheostomy tube readily available.

A 5-year-old child is brought to the emergency department after being stung multiple times on the face by yellow jackets. Which symptom of anaphylaxis requires priority medical intervention

Heart rate less than 60 beats/minute

A 36-month-old child weighing 20 kg (44 lb) is to receive ceftriaxone 2 g IV every 12 hours. The recommended dose of ceftriaxone is 50 to 75 mg/kg/day in divided doses. The nurse should:

Withhold administering ceftriaxone and notify the child's physician.

The parents of a preschool child diagnosed with autism must take their child on a plane flight and are concerned about how they can make the experience less stressful for her and their fellow travelers. The nurse suggests a dry run to the airport in which they simulate going through security and boarding a plane. In addition, the nurse suggests taking items to help the child be calm during the flight. In what order of priority from first to last should the parents employ the items listed below? All options must be used.

a DVD player with headphones and favorite games, cartoons, and child films a favorite non-electronic game a favorite stuffed animal or other soft toy medication that can be given as needed to calm the child

The nurse is caring for a lethargic 4-year-old who is a victim of a near-drowning accident. The nurse should first:

a) Administer oxygen. Near-drowning victims typically suffer hypoxia and mixed acidosis. The priority is to restore oxygenation and prevent further hypoxia. Here, the client has blunted sensorium, but is not unconscious; therefore, delivery of supplemental oxygen with a mask is appropriate. Warming protocols and fluid resuscitation will most likely be needed to help correct acidosis, but these interventions are secondary to oxygen administration. Intubation is required if the child is comatose, shows signs of airway compromise, or does not respond adequately to more conservative therapies.

The nurse is discussing post operative care with the parents and their 5-year-old child who is going to have a tonsillectomy and adenoidectomy. The nurse should emphasize which of the following? a) Need for frequent coughing. b) Use of acetylsalicylic acid for pain, as needed. c) Ability to have ice cream right after surgery d) Use of sips of clear liquids when awake and alert.

d) Once the child is alert, he may have sips of clear liquids. Eating enhances the blood supply to the throat, which promotes rapid healing. However, the child should start with clear fluids. Coughing is discouraged because it disrupts the suture line and may cause bleeding. Acetylsalicylic acid is contraindicated because it interferes with platelet aggregation and promotes bleeding. Once the child is able to tolerate clear liquids, he can progress to a full liquid diet that would include ice cream.

The mother of a 4-year-old child is concerned about her child's masturbating. The nurse should tell the mother:

masturbation is normal in children of this age.

The mother asks the nurse why peanuts are one of the worst things a child can aspirate. What should the nurse include in the explanation as the main reason for the problem associated with aspirating peanuts?

they swell when wet

"A child is diagnosed with Wilms' tumor. During assessment, the nurse in charge expects to detect: "a. Gross hematuria b. Dysuria c. Nausea and vomiting d. An abdominal mass"

"CORRECT: D The most common sign of Wilms' tumor is a painless, palpable abdominal mass, sometimes accompanied by an increase in abdominal girth. Gross hematuria is uncommon, although microscopic hematuria may be present. Dysuria is not associated with Wilms' tumor. Nausea and vomiting are rare in children with Wilms' tumor."

A nurse is caring for a child who is 1 day post-op after having a colostomy. The parents are concerned that the stoma has not drained any stool. What is the most appropriate response by the nurse?

"It may take several days for the stoma to function."

A nurse is preparing a child, age 4, for cardiac catheterization. Which explanation of the procedure is appropriate?

"The special medicine will feel warm when it's put in the tubing."

The mother of a 4-year-old child with juvenile idiopathic arthritis (JIA) is worried that her child will have to stop attending preschool because of the illness. Which response by the nurse would be most appropriate?

"Your child should be encouraged to attend school, but he will need extra time to work out early morning stiffness."

Before performing an otoscopic examination on a child, where should the nurse palpate for tenderness? 1. Tragus, mastoid process, and helix 2. Helix, umbo, and tragus 3. Tragus, cochlea, and lobule 4. Mastoid process, incus, and malleus

1. Tragus, mastoid process, and helix RATIONALE: Before inserting the otoscope, the nurse should palpate the child's external ear, especially the tragus and mastoid process, and should pull the helix backward to determine the presence of pain or tenderness. The umbo, incus, and malleus (parts of the middle ear) and the cochlea (part of the inner ear) aren't palpable.

A 3-year-old client is admitted to the pediatric unit with pneumonia. The child has a productive cough and appears to have difficulty breathing. The parents tell the nurse that the child hasn't been eating or drinking much and has been very inactive. Which interventions to improve airway clearance should the nurse include in the care plan? Select all that apply. Encourage coughing and deep breathing. Perform chest physiotherapy as ordered. Perform postural drainage. Maintain humidification with a cool mist humidifier. Keep the head of the bed flat. Restrict fluid intake.

2. Perform chest physiotherapy as ordered., 3. Encourage coughing and deep breathing., 5. Perform postural drainage., 6. Maintain humidification with a cool mist humidifier.

The nurse meets with the family of a 3-year-old child who is seriously ill. In the role as collaborator, the nurse:

3. Coordinate the multidisciplinary services and providing information about them. RATIONALE: Coordinating the multidisciplinary services and providing information about them demonstrate collaboration because the nurse will be explaining the functions of social service, case management, and so forth. Providing parents with information about financial assistance programs is the responsibility of social services, not a nursing role. Informing the family of the diagnosis and recently discovered findings is a physician's responsibility as is referring and consulting with other specialties.

After teaching the parents of a preschooler who has undergone a tonsillectomy and adenoidectomy about appropriate foods to give the child after discharge, which of the following, if stated by the parents as appropriate foods, indicates successful teaching? 1. Meat loaf and uncooked carrots. 2. Pork and noodle casserole. 3. Cream of chicken soup and orange sherbet. 4. Hot dog and potato chips.

3. For the first few days after a tonsillectomy and adenoidectomy, liquids and soft foods are best tolerated by the child while the throat is sore. Children typically do not chew their food thoroughly , and solid foods are to be avoided because they are difficult to swallow. Although meat loaf would be considered a soft food, uncooked carrots would not be. Pork is frequently difficult to chew. Foods that have sharp edges, such as potato chips, are contraindicated because they are hard to chew and may cause more throat discomfort.

A mother tells the nurse that her 4-year-old boy has developed some strange eating habits, including not finishing meals and eating the same food for several days in a row. She would like to develop a plan to correct this situation. When developing such a plan, what should the nurse and mother do?

Allow him to make some decisions about the foods he eats.

A nurse is obtaining the history of a child, age 4. Which question best evaluates the child's developmental status? "Do you like your brother?" "Can you ride a tricycle?" "Can you draw your school?" "What's your mommy's first name?"

Can you ride a tricycle?" Explanation: Asking the child if he can ride a tricycle best helps evaluate the child's developmental status because a 4-year-old child should be able to perform such an action

Which method is most reliable for confirming a preschooler's identity before administering a medication?

Check the hospital identification bracelet. Explanation: The only safe method for identifying the child is to check the identification band for the client's name and medical record number and then compare that information with the medication record. Children sometimes exchange beds during play, so checking the name on the bed isn't reliable. Infants are unable to give their names, toddlers or preschoolers may admit to any name, and school-age children may deny their identities in an attempt to avoid the medication. Parents aren't always at the bedside, so they shouldn't be relied on for identification

A 4-year-old child is brought to the clinic for a checkup. It is determined that the family does not have fluoridated water. The nurse should give which instruction about using fluoride supplements?

Do not eat or drink for 30 minutes after the supplement.

A nurse-manager in a pediatric intensive care unit notices an increase in nosocomial infections. What should the nurse do next?

Gather data on possible reasons for this increase.

Which technique is most effective in preventing nosocomial infection transmission when caring for a preschooler?

Hand washing

When assessing a child for impetigo, the nurse expects which assessment findings?

Honey-colored, crusted lesions

A child is in the emergency department with suspected epiglottitis and has been ordered an X-ray to confirm the diagnosis. The nurse would prepare the child for X-ray by which of the following methods?

In the emergency department, by portable X-ray

A mother of a 5-year-old child who was admitted to the hospital has a Protection from Abuse order for the child against his father. A copy of the order is kept on the pediatric medical surgical unit where the child is being treated. The order prohibits the father from having any contact with the child. One night, the father approaches the nurse at the nurses' station, politely but insistently demanding to see his child, and refusing to leave until he does so. What should the nurse do first?

Notify hospital security or the local authorities. Explanation: The Protection from Abuse order legally prohibits the father from seeing the child. In this situation, the nurse should notify hospital security or the local authorities of this attempt to breach the order, and allow them to escort the father out of the building. The father could be jailed or fined if he violates the order. The nurse shouldn't argue or continue explaining to the father that he must leave because it could place her and the child at risk if the father becomes angry or agitated. The nursing coordinator and nurse-manager should be notified of the incident; the nurse's first priority, however, should be contacting security or the authorities.

When developing a care plan for a hospitalized child, the nurse knows that children in which age-group are most likely to view illness as a punishment for misdeeds?

Pre school

A preschool-age child with sickle cell anemia is admitted to the health care facility in vaso-occlusive crisis after developing a fever and joint pain. What is the nurse's highest priority when caring for this child?

Providing fluids Rationale: During a vaso-occlusive crisis, sickle-shaped red blood cells (RBCs) clump together and obstruct blood vessels, causing ischemia and tissue damage. Therefore, the highest priority is providing I.V. and oral fluids, which promotes hemodilution and aids the free flow of RBCs through blood vessels

10. A 5 -year-old child with burns on the trunk and arms has no appetite. The nurse and the mother develop a plan of care to stimulate the child's appetite. Which of the following suggestions made by the mother would indicate that she needs additional teaching? 1. Deciding that she will feed the child herself. 2. Withholding dessert and treats unless meals are eaten.3. Offering the child finger foods that the child likes. 4. Serving smaller and more frequent meals.

Withholding certain foods until the child complies is punitive and rarely successful. Allowing the mother to feed the child, serving smaller and more frequent meals, and offering finger foods are all acceptable interventions for a 5-year-old child. This is true whether the child is well or ill.

which toy is most appropriate for a 3 year old child?

a puzzle with large pieces Rationale: Toys for the toddler must be strong, safe, and too large to swallow or place in the ear or nose. Toddlers need supervision at all times. Push-pull toys, large balls, large crayons, large trucks, and dolls are some of the appropriate toys. A farm set, a golf set, and jacks with marbles may contain items that the child could swallow.

A 4-year-old child who has been ill for 4 hours is admitted to the hospital with difficulty swallowing, a sore throat, and severe substernal retractions. The child's temperature is 104° F (40° C), and the apical pulse is 140 bpm. The white blood cell count is 16,000/mm3 (16,000 X 109/L). What is priority for nursing intervention?

airway obstruction The child's signs and symptoms in conjunction with the acute onset suggest possible croup or epiglottitis. The priority diagnosis at this time is airway obstruction. The airway may become completely occluded by the epiglottis at any time. Although the child has an infection, and the client has respiratory distress, the immediate priority is to establish and maintain a patent airway. No evidence is provided to support the potential for aspiration.

A nurse discovers a 5-year-old child who's unresponsive, apneic, and pulseless. The correct sequence of events that should follow is:

call for help, open the airway, provide two rescue breaths, and begin compressions at a rate of 100 per minute.

Parents of a 4-year-old child with acute leukemia ask a nurse to explain the concept of complementary therapy. The nurse should tell the parents that:

complementary therapy is an alternative to conventional medical therapies.

hypospadias

congenital abnormality in which the male urethral opening is on the undersurface of the penis, instead of at its tip

The nurse is admitting a 4-year old with a possible meningococcal infection. Which type of isolation is indicated?

droplet precautions Explanation: Meningococcal infections are spread through close mucous membrane or respiratory contact with large respiratory droplets. Meningococcal infections are not spread by small airborne organisms or contact with a person's skin or contaminated items. Standard precautions, used when touching body fluids, are not sufficient to prevent the spread of meningitis.

1m 9s While assessing the penis of a child who has had surgery for repair of a hypospadias, the nurse observes the appearance of the penis. The nurse should report which aspect to the surgeon?

dusky blue at the tip

When interacting with the mother of a child who has Duchenne muscular dystrophy, the nurse observes behavior indicating that the mother may feel guilty about her child's condition. The nurse interprets this behavior as guilt stemming from which factor?

genetic mode of transmission

A nurse has just administered a drug to a child. Which organ is most responsible for drug excretion in children?

kidneys

Which finding is expected when the nurse is assessing a child who has sustained full-thickness burns?

minimal pain

A child with tetralogy of Fallot and a history of severe hypoxic episodes is to be admitted to the pediatric unit. What would be most important for the nurse to have at the bedside?

oxygen tubing and flow meter plugged in Explanation: Because the child has a history of severe hypoxic episodes, having oxygen readily available at the bedside is most important. Should the child experience another hypoxic episode, oxygen could be administered easily and quickly. Although morphine causes peripheral dilation, which causes the blood to remain in the periphery, decreasing system volume and oxygen administration is the priority. Typically a child with tetralogy of Fallot with episodes of hypoxia does not require suctioning.

A child, age 5, is brought to the pediatrician's office for a routine visit. When inspecting the child's mouth, the nurse expects to find how many teeth?

up to 20

A child with leukemia has just completed a course of methotrexate therapy. How soon should the nurse expect to see signs of bone marrow depression in this client?

within 2 weeks

A 4-year-old child is receiving dextrose 5% in water and half-normal saline solution at 100 ml/hour. The nurse should suspect that the child's I.V. fluid intake is excessive if assessment reveals:

worsening dyspnea