RN nursing care of children online practice 2019 B w/NGN

a nurse is planning an educational program to teach parents about protecting their children from sunburns. which of the following instructions should the nurse plan to include?

answer: "choose a waterproof sunscreen with a minimum SPF of 15." rational: the nurse should instruct parents to apply a waterproof sunscreen with a minimum SPF of 15 for children. the parents should apply the sunscreen prior to sun exposure to reduce the risk of sunburn.

a nurse is teaching a group of parents about infectious mononucleosis. which of the following statements by a parent indicates an understanding the teacher?

answer: "mononucleosis is caused by an infection with the Epstein Barr virus." rational: the nurse should identify that mononucleosis is a mildly contagious illness that occurs sporadically or in groups, and primary caused by the Epstein Barr virus.

a nurse is providing discharge teaching to the parents of a 6-month-old infant who is postoperative following hypospadias repair with a stent placement. which of the following instructions should the nurse include in the teaching?

answer: "allow the stent to drain directly into your infant's diaper." rational: the nurse should instruct the parents to ensure that the stent drains directly into the infant's diaper to prevent kinking or twist that can interfere with urine flow.

a community health nurse is assessing an 18-month-old toddler in a community day care. which of the following findings should the nurse identify as a potential indication of physical neglect?

answer: poor personal hygiene. rational: a toddler who has poor personal hygiene can be a potential indication of physical neglect. because toddlers are still dependent on their parents or guardians for help with hygiene needs, poor personal hygiene can indicate a lack of supervision.

a nurse is assessing a 6-month old infant during a well-child visit. which of the following findings should the nurse report to the provider?

answer: presence of strabismus. rational: strabismus, or crossing of the eyes, typically disappears at 3 to 4 months of age. if not corrected early, this can lead to blindness.

exhibit 1 (vital signs): temperature: 37.5 C (99.5 F). heart rate: 70/min. respiratory rate: 30/min. birth weight: 3.2 kg (7 lb). current weight: 5.9 kg (13 lb). exhibit 2 (nursing notes): 3 episodes of vomiting. 6 wet diapers in 24 hours. consumed 3 oz concentrated formula every 3 hours. exhibit 3 (MAR): digoxin 0.5 mcg PO Q12 H. furosemide 20 mg PO Q12 H. a nurse is admitting a 4-month-old infant who has heart failure. which of the following findings is the nurse's priority?

answer: episodes of vomiting. rational: when using the urgent vs. nonurgent approach to client care, the nurse should determine that the priority finding is three episodes of vomiting. this can indicate digoxin toxicity, which requires immediate intervention. therefore, this is the nurse's priority finding.

a nurse is creating a plan of care for a child who has varicella. which of the following interventions should the nurse include?

answer: initiate airborne precautions for the child. rational: the nurse should initiate airborne precautions for a child who has varicella because it is spread through droplets in the air. the incubation period for varicella is 2 to 3 weeks, and the child is contagious even before lesions appear.

a nurse is planning care for a school-age child who has a tunneled central venous access device. which of the following interventions should the nurse include in the plan?

answer: use a semipermeable transparent dressing to cover the site. rational: the nurse should cover the site with a semipermeable transparent dressing to reduce the risk of infection.

a nurse is admitting an infant who has intussusception. which of the following findings should the nurse expect? select all that apply.

answer: vomiting and lethargy. rational: - the nurse should expect an infant who has intussusception to exhibit vomiting due to the obstruction that occurs when a segment of the bowel telescopes within another segment of the bowel. - the nurse should expect an infant who has intussusception to exhibit lethargy due to episodes of severe pain during which the infant cries inconsolably, leading to exhaustion and decreased nutritional intake.

a nurse in an emergency department is auscultating the lungs of an adolescent who is experiencing dyspnea. the nurse should identify the sound as which of the following? listen to the audio clip.

answer: wheezes. rational: the nurse should identify the sound during auscultation as wheezes, which are high-pitched, musical, or whistling-like sounds heard primarily on expiration as air passes through and vibrates narrowed airways.

a nurse is caring for a preschooler who was recently admitted to a pediatric unit. the nurse is reviewing the information in the child's EMR. for each EMR finding, state if the finding is consistent with nephrotic syndrome, acute poststreptococcal glomerulonephritis, or hemolytic uremic syndrome. each finding may support more than one disease process. 1. temperature: @0900 -> 37.2 C (99.0 F), @1000 -> 38.2 C (100.8 F). 2. BUN level: 20 mg/dL (ref range 5 to 18 mg/dL). 3. platelet count: 100, 000/mm3 (ref range 150,000 to 400,000/mm3). 4. blood pressure: @0900 -> 108/70, @1000 -> 114/74. 5. cholesterol level: 202 mg/dL (ref range 120 to 200 mg/dL).

temperature - consistent with acute poststreptococcal glomerulonephritis and hemolytic uremic syndrome. - according the the EMR, the child's temperature is outside the expected reference range and is increasing. the child who has acute poststreptococcal glomerulonephritis may present with a low-grade fever. the child who has hemolytic uremic syndrome may experience a fever that is high enough to cause hallucinations and lethargy. BUN level - consistent with acute poststreptococcal glomerulonephritis and hemolytic uremic syndrome. - according to the EMR, the child's BUN level is elevated, which indicates an impairment of kidney function. with acute poststreptococcal glomerulonephritis, a streptococcal infection invades the inner membranes of the kidney, which affects filtration and blood flow. with hemolytic uremic syndrome, intravascular coagulation occurs in the endothelium of the glomeruli of the kidneys, which impairs filtration and blood flow. platelet count - consistent with hemolytic uremic syndrome. - according to the EMR, the child's platelet count is low, which indicated thrombocytopenia. with hemolytic uremic syndrome, intravascular coagulation occurs in the endothelium of the glomeruli of the kidneys, which impairs filtration and blood flow due to the aggregation of platelets. blood pressure - is consistent with nephrotic syndrome, acute poststreptococcal glomerulonephritis, and hemolytic uremic syndrome. - according to the EMR, the child's blood pressure is elevated, which indicates narrowing of the blood vessels, possibly due to kidney impairment from these conditions. cholesterol level - consistent with nephrotic syndrome. - according to the EMR, the child's cholesterol level is slightly elevated. this could be related to diet or increased liver production of lipoproteins to compensate for proteins lost in the urine.

a nurse in an emergency department is assessing a toddler who has kawasaki disease. which of the following findings should the nurse expect? select all that apply.

answer: increased temperature, xerophthalmia, and cervical lymphadenopathy. rational: - kawasaki disease is an acute illness associated with a fever that is unresponsive to antipyretics or antibiotics. - ophthalmic manifestations of kawasaki disease include reddening of the conjunctiva and dryness of the eyes, or xerophthalmia. - a child who has kawasaki disease can develop enlarged cervical nodes on one side of the neck that are nontender and greater than 1.5 cm in size.

a nurse is teaching the parents of a toddler who has a cognitive impairment about toilet training. which of the following instructions should the nurse include in the teaching?

answer: "award your child with a sticker when they sit on the potty chair." rational: a child who has cognitive impairment learns through shaping behaviors. the parents should reward the child for sitting on the potty chair as a reinforcement of the desired behavior of continence. as the child repeats this action, the parents can gradually decrease this reward and then give rewards for the next step in the task, such as voiding while sitting on the chair.

a nurse is teaching a school-age child and their parent about postoperative care following cardiac catheterization. which of the following instructions should the nurse include?

answer: "wait 3 days before taking a tub bath." rational: the child should keep the site clean and dry for at least 3 days to reduce the risk of infection. tub baths should be avoided for 3 days to avoid immersion of the incision in water.

a nurse is teaching the guardian of a 6-month-old infant about teething. which of the following statements should the nurse make?

answer: "your baby might pull at their ears when they are teething." rational: the nurse should inform the guardian that teething can result in discomfort for the infant. therefore, the guardian should look for indications such as pulling on the ears, difficulty sleeping, increased drooling, or increased fussiness.

a nurse is caring for a school-age child who has diabetes mellitus and was admitted with a diagnosis of diabetic ketoacidosis. when performing the respiratory assessment, which of the following findings should the nurse expect?

answer: deep respirations of 32/min. rational: the nurse should expect kussmaul respirations in a child who has diabetic ketoacidosis. these deep and rapid respirations are the body's attempt to eliminate excess carbon dioxide and achieve a state of homeostasis.

a charge nurse is preparing to make a room assignment for a newly admitted school-age child. which of the following considerations is the nurse's priority?

answer: disease process. rational: the transmission of infectious diseases is the greatest risk to this child and other children on the unit. therefore, the child's disease process is the nurse's priority consideration.

a nurse is planning care for a newly admitted school-age child who has generalized seizure disorder. which of the following interventions should the nurse plan to include?

answer: ensure the oxygen source is functioning in the child's room. rational: the nurse should recognize that maintaining the child's airway is important during a seizure. the nurse should ensure that the oxygen source is functioning because the child

a nurse is discussing organ donation with the parents of a school-age child who has sustained brain death due to a bicycle crash. which of the following actions should the nurse take?

answer: explore the parent's feelings and wishes regarding organ donation. rational: the first action the nurse should take when using the nursing process is assessment. the nurse should first explore the parents' feelings and wishes regarding organ donation to assist in determining if organ donation is the right choice for the family.

a nurse is reviewing the dietary choices of an adolescent who has iron deficiency anemia. the nurse should identify that which of the following menu items has the highest amount of nonheme iron?

answer: 1/2 cup of raisins. rational: the nurse should encourage the adolescent to eat raisins because they contain the highest amount of nonheme iron.

a nurse is assessing the pain level of a 3-year-old toddler. which of the following pain assessment scales should the nurse use?

answer: FACES. rational: the nurse should use the FACES pain rating scale for pediatric clients who are 3 years old and older. this scale allows the toddler to point to the face that depicts their current level of pain. the nurse can then determine the need for pain management.

a nurse is caring for a school-age child who has primary nephrotic syndrome and is taking prednisone. following 1 week of treatment, which of the following manifestations indicates to the nurse that the mediation is effective?

answer: decreased edema. rational: a child who has nephrotic syndrome can experience edema due to the increased glomerular permeability, which increases protein loss. prednisone decreased glomerular permeability, which causes fluid to shift from the extracellular spaces, resulting in decreased edema.

a nurse is providing anticipatory guidance to the parent of a toddler. which of the following expected behavior characteristics of toddlers should the nurse include?

answer: expresses likes and dislikes. rational: the nurse should include that expressing likes and dislikes is an expected behavior of toddlers. this is the time in life when a toddler is developing autonomy and self-concept. they will try to assert themselves and frequently refuse to comply. the parent should allow the child to have some control, but also set limits for them so they learn from their behavior and learn to control their actions.

a nurse is assessing an 8-year-old child who has early indications of shock. after establishing an airway and stabilizing the child's respirations, which of the following actions should the nurse take next?

answer: initiate IV access. rational: the next action the nurse should take when using the airway, breathing, and circulation approach to client care is to establish IV access to maintain the child's circulatory volume.

a nurse is caring for an infant who is receiving IV fluids for the treatment of tetralogy of fallot and begins to have a hypercyanotic spell. which of the following actions should the nurse take?

answer: place the infant in a knee-chest position. rational: the nurse should place the infant in a knee-chest position during a hypercyanotic spell to decrease the return of desaturated venous blood from the legs and to direct more blood into the pulmonary artery by increasing systemic vascular resistance.

a nurse is planning developmental activities for a newly admitted 10-year-old child who has neutropenia. which of the following actions should the nurse plan to take?

answer: provide the child with a book about adventure. rational: the nurse should provide a school-age child with a book about adventure as a developmental activity because children are expanding their knowledge and imagination during this age. through reading, school-age children can feel powerful and skillful as they image themselves in the stories they read.

a nurse is caring for a newly admitted school-age child who has hypopituitarism. which of the following medications should the nurse expect the provider to prescribe?

answer: recombinant growth hormone. rational: recombinant growth hormone injections are used to treat hypopituitarism, which inhibits cell growth and results in growth failure. the nurse should expect the provider to prescribe this treatment.

a nurse is providing discharge teaching to the guardians of a toddler who had a lower leg cast applied 24 hours ago. the nurse should instruct the guardians to report which of the following findings to the provider?

answer: restricted ability to move the toes. rational: the nurse should inform the guardians that a restricted ability of the toddler to move their toes is an indication of neurovascular compromise and requires immediate notification of the provider. permanent muscle and tissue damage can occur in just a few hours.

a nurse is assessing an adolescent who received a sodium polystyrene sulfonate enema. which of the following findings indicates effectiveness of the medication?

answer: serum potassium level 4.1 mEq/L. rational: the nurse should monitor the adolescent's serum potassium level following the administration of sodium polystyrene sulfonate. this medication is used to treat hyperkalemia by exchanging sodium ions for potassium ions in the intestine. therefore, a potassium level within the expected reference range of 3.4 to 4.7 mEq/L indicates the effectiveness of the medication.

a nurse in an emergency department is assessing a 3-month-old infant who has rotavirus and is experiencing acute vomiting and diarrhea. which of the following manifestations should the nurse identify as an indication that the infant has moderate to severe dehydration?

answer: sunken anterior fontanel. rational: the nurse should recognize that a sunken anterior fontanel is an indication of moderate to severe dehydration due to the acute loss of fluid.

a nurse is caring for a school-age child following an appendectomy. after reviewing the information in the child's medical record, which of the following findings should the nurse identify as a potential complication? select 3 findings. vital signs (day of admission): - temperature: 37.1 C (98.9 F). - heart rate: 100/min. - respiratory rate: 20/min. - blood pressure: 94/60 mmHg. - pulse ox: 97%. vital signs (following the procedure): - temperature: 38.6 C (101.5 F). - heart rate: 110/min. - respiratory rate: 24/min. - blood pressure: 100/60 mmHg. - pulse ox: 95%. nursing notes (day of admission): child is drowsy but easily aroused and responsive to verbal stimuli. child rates pain as a 4 on a scale of 0 to 10. lungs clear to auscultation. abdomen is soft, flat, and non-distended. bowel sounds hypoactive in all four quadrants. extremities are warm and dry to touch. gauze pads with clear transparent dressings noted to the umbilicus, left lower quadrants, and suprapubic area. nursing notes (24 hours following procedure): child is alert and responsive to verbal stimuli. appears irritable and restless. child rates pain as an 8 on a scale of 0 to 10. respirations are shallow. no accessory muscle use noted. lungs clear to auscultation. abdomen is rigid and distended. bowel sounds hypoactive in all four quadrants. gauze pads with clear transparent dressings noted to the umbilicus, left lower quadrants, and suprapubic area. dressings with scant amount of serous drainage presents. extremities are cool and dry to touch. diagnostic results (day of admission): - hemoglobin 12 g/dL (ref range: 10 to 15.5 g/dL). - hematocrit 38% (ref range: 32% to 44%). - WBC count 16,000/mm3 (ref range: 5,000 to 10,000/mm3). - platelets 350,000/mm3 (ref range: 150,000 to 400,000/mm3). diagnostic results (24 hours following procedure): - hemoglobin 10.5 g/dL (ref range: 10 to 15.5 g/dL). - hematocrit 34% (ref range: 32% to 44%). - WBC count 24,000/mm3 (ref range: 5,000 to 10,000/mm3). - platelets 280,000/mm3 (ref range: 150,000 to 400,000/mm3).

answer: temperature, abdomen assessment, and WBC count. rational: - one day following surgery, the child's temperature has increased and is above the expected reference range. the nurse should identify that this is a potential indication of postoperative infection. - the child's abdomen is rigid and distended and they are reporting increased pain. the nurse should identify that this is a potential indication of a postoperative infection. - the child's WBC count has increased significantly following the procedure. the nurse should identify that this is a potential indication of a postoperative infection.

a nurse on a pediatric unit is admitting a preschooler. after reviewing the information in the medical record, the nurse should identify that the child is at risk or developing which of the following conditions? vital signs @ 0715: - temperature: 38.3 C. - heart rate: 126/min. - respiratory rate: 26/min. - pulse oximeter: 97%. physical examination @ 0715: - guardians report that the child has been tired lately and has been experiencing a sore throat and fever. child is tolerating sips of liquid, but is refusing solid foods. guardians report that the child is voiding dark yellow urine. physical examination @ 0730: - child is alert and responsive to verbal stimuli. mucous membranes are dry and sticky. skin turgor without tenting. tonsils enlarged and erythematous. respirations are regular and non-labored. no accessory muscle use noted. lungs clear anterior and posterior bilaterally. point of maximum intensity is left mid-clavicular line 4th intercostal space. heart rate is regular without murmurs, gallops, or rubs. radial and pedal pulses 2+ bilaterally. capillary refill greater than 2 seconds. abdomen flat and non-distended. bowel sounds active in all four quadrants. extremities warm and dry to touch. diagnostic results @ 0900: - mononucleosis rapid test: positive.

answer: the nurse should identify that the child is at risk for developing splenomegaly as evidenced by positive mononucleosis rapid test. rational: - the child's positive mononucleosis rapid test result indicates the presence of infectious mononucleosis, a condition caused by the epstein-barr virus. therefore, the nurse should identify that the child is at risk for developing splenomegaly, a common complication of infectious mononucleosis. -

a nurse in a pediatric emergency department is planning care for an adolescent. based on the information in the adolescent's medical record, which of the following actions should the nurse plan to take? nurse's notes: 2245: - adolescent arrived via stretcher by EMT following a motor-vehicle crash. EMT personnel report: - client was found conscious at the scene inside of the vehicle with airbag deployed, wearing a seat belt. - vital signs: heart rate 94/min, respiratory rate 20/min, blood pressure 100/60 mmHg. - 18-gauge peripheral IV inserted in left antecubital. - guardians contacted and report the child has no medical conditions. 2300: - adolescent reports sharp pain in chest. - rates pain as a 6 on a scale of 0 to 10. - respirations fast and shallow. - diminished breath sounds in left lung. - S1 and S2 regular and rapid. 2300 vital signs: - temperature: 38.0 C (100.4 F). - heart rate: 110/min. - respiratory rate: 30/min. - blood pressure: 90/60 mmHg. - oxygen saturation: 94% on room air. diagnostic results: - chest x-ray: air present in left pleural space; suggestive of pneumothorax. CT scan recommended for definitive diagnosis.

answers: apply supplemental oxygen: according to the medical record and chest x-ray report, the adolescent could potentially have a pneumothorax. also the adolescent's oxygen saturation level is decreasing, which indicates hypoxia. therefore, the nurse should plan to administer supplemental oxygen. prepare for chest tube intubation: according to the medical record and chest x-ray report, the adolescent could potentially have a pneumothorax. the adolescent could experience dyspnea, tachypnea, tachycardia, hypoxia, and pain. this requires prompt intervention by the provider, such as the placement of a chest tube into the thoracic cavity to remove air and fluid from the plural space, if present, allowing the lung to re-expand.