satas peds

3. Divorced parents of a preschool child are asking whether their child will display any feelings or behaviors related to the effect of the divorce. The nurse is correct when explaining that the parents should be prepared for which type of behaviors? (Select all that apply.) a. Displaying fears of abandonment b. Verbalizing that he or she "is the reason for the divorce" c. Displaying fear regarding the future d. Ability to disengage from the divorce proceedings e. Engaging in fantasy to understand the divorce

ANS: A, B, E A child 3 to 5 years of age (preschool) may display fears of abandonment, verbalize feelings that he or she is the reason for the divorce, and engage in fantasy to understand the divorce. They would not be displaying fear regarding the future until school age, and the ability to disengage from the divorce proceedings would be characteristic of an adolescent

. What factors indicate parents should seek genetic counseling for their child? (Select all that apply.) a. Abnormal newborn screen b. Family history of a hereditary disease c. History of hypertension in the family d. Severe colic as an infant e. Metabolic disorder

ANS: A, B, E Factors that are indicative parents should seek genetic counseling for their child include an abnormal newborn screen, family history of a hereditary disease, and a metabolic disorder. A history of hypertension or severe colic as an infant is not an indicator of a genetic disease

2. A nurse is caring for a child in droplet precautions. Which instructions should the nurse give to the unlicensed assistive personnel caring for this child? (Select all that apply.) a. Wear gloves when entering the room. b. Wear an isolation gown when entering the room. c. Place the child in a special air handling and ventilation room. d. A mask should be worn only when holding the child. e. Wash your hands upon exiting the room.

ANS: A, B, E Droplet transmission involves contact of the conjunctivae or the mucous membranes of the nose or mouth of a susceptible person with large-particle droplets (>5 mm) containing microorganisms generated from a person who has a clinical disease or who is a carrier of the microorganism. Droplets are generated from the source person primarily during coughing, sneezing, or talking and during procedures such as suctioning and bronchoscopy. Gloves, gowns, and a mask should be worn when entering the room. Handwashing when exiting the room should be done with any patient. Because droplets do not remain suspended in the air, special air handling and ventilation are not required to prevent droplet transmission.

1. The advantages of the ventrogluteal muscle as an injection site in young children include which considerations? (Select all that apply.) a. Less painful than vastus lateralis b. Free of important nerves and vascular structures c. Cannot be used when child reaches a weight of 20 pounds d. Increased subcutaneous fat, which increases drug absorption e. Easily identified by major landmarks

ANS: A, B, E The advantages of the ventrogluteal are being less painful, free of important nerves and vascular lateralis, and is easily identified by major landmarks. The major disadvantage is lack of familiarity by health professionals and controversy over whether the site can be used before weight bearing. The use of the ventrogluteal has not been clarified. It has been used in infants, but clinical guidelines address the need for the child to be walking, thus generally being over 20 pounds. The site has less subcutaneous tissue, which facilitates intramuscular (rather than subcutaneous) deposition of the drug.

Play serves many purposes. In teaching parents about appropriate activities, the nurse should inform them that play serves which of the following function? (Select all that apply.) a. Intellectual development b. Physical development c. Socialization d. Creativity e. Temperament development

ANS: A, C, D A common statement is that play is the work of childhood. Intellectual development is enhanced through the manipulation and exploration of objects. Socialization is encouraged by interpersonal activities and learning of social roles. In addition, creativity is developed through the experimentation characteristic of imaginative play. Physical development depends on many factors; play is not one of them. Temperament refers to behavioral tendencies that are observable from the time of birth. The actual behaviors, but not the child's temperament attributes, may be modified through play

3. A nurse is performing an assessment on a school-age child. Which findings suggest the child is getting an excess of vitamin A? (Select all that apply.) a. Delayed sexual development b. Edema c. Pruritus d. Jaundice e. Paresthesia

ANS: A, C, D Excess vitamin A can cause delayed sexual development, pruritus, and jaundice. Edema is seen with excess sodium. Paresthesia occurs with excess riboflavin

1. A child has just been unexpectedly admitted to the intensive care unit after abdominal surgery. The nursing staff has completed the admission process, and the child's condition is beginning to stabilize. When speaking with the parents, the nurses should expect which stressors to be evident? (Select all that apply.) a. Unfamiliar environment b. Usual day-night routine c. Strange smells d. Provision of privacy e. Inadequate knowledge of condition and routine

ANS: A, C, E Intensive care units, especially when the family is unprepared for the admission, are a strange and unfamiliar place with many pieces of unfamiliar equipment. The sights and sounds are much different from those of a general hospital unit. Also, with the child's condition being more precarious, it may be difficult to keep the parents updated and knowledgeable about what is happening. Lights are usually on around the clock, seriously disrupting the diurnal rhythm. There is usually little privacy available for families in intensive care units.

3. A child is being discharged from an ambulatory care center after an inguinal hernia repair. Which discharge interventions should the nurse implement? (Select all that apply.) a. Discuss dietary restrictions. b. Hold any analgesic medications until the child is home. c. Send a pain scale home with the family. d. Suggest the parents fill the prescriptions on the way home. e. Discuss complications that may occur.

ANS: A, C, E The discharge interventions a nurse should implement when a child is being discharged from an ambulatory care center should include dietary restrictions, being very specific and giving examples of "clear fluids" or what is meant by a "full liquid diet." The nurse should give specific information on pain control and send a pain scale home with the family. All complications that may occur after an inguinal hernia repair should be discussed with the parents. The pain medication, as prescribed, should be given before the child leaves the building and prescriptions should be filled and given to the family before discharge.

2. Which of the following data would be included in a health history? (Select all that apply.) a. Review of systems b. Physical assessment c. Sexual history d. Growth measurements e. Nutritional assessment f. Family medical history

ANS: A, C, E, F The review of systems, sexual history, nutritional assessment, and family medical history are part of the health history. Physical assessment and growth measurements are components of the physical examination.

3. A nurse is preparing to administer a Denver II. Which is a correct statement about the Denver II? (Select all that apply.) a. All items intersected by the age line should be administered. b. There is no correction for a child born prematurely. c. The tool is an intelligence test. d. Toddlers and preschoolers should be prepared by presenting the test as a game. e. Presentation of the toys from the kit should be done one at a time.

ANS: A, D, E To identify "cautions," all items intersected by the age line are administered. Toddlers and preschoolers should be tested by presenting the Denver II as a game. Because children are easily distracted, perform each item quickly and present only one toy from the kit at a time. Before beginning the screening, ask whether the child was born preterm and correctly calculate the adjusted age. Up to 24 months of age, allowances are made for preterm infants by subtracting the number of weeks of missed gestation from their present age and testing them at the adjusted age. Explain to the parents and child, if appropriate, that the screenings are not intelligence tests but rather are a method of showing what the child can do at a particular age

4. A nurse is planning to use an interpreter during a health history interview of a non-English speaking patient and family. Which nursing care guidelines should the nurse include when using an interpreter? (Select all that apply.) a. Elicit one answer at a time. b. Interrupt the interpreter if the response from the family is lengthy. c. Comments to the interpreter about the family should be made in English. d. Arrange for the family to speak with the same interpreter, if possible. e. Introduce the interpreter to the family.

ANS: A, D, E When using an interpreter, the nurse should pose questions to elicit only one answer at a time, such as: "Do you have pain?" rather than "Do you have any pain, tiredness, or loss of appetite?" Refrain from interrupting family members and the interpreter while they are conversing. Introduce the interpreter to family and allow some time before the interview for them to become acquainted. Refrain from interrupting family members and the interpreter while they are conversing. Avoid commenting to the interpreter about family members because they may understand some English.

4. A child is being admitted to the intensive care unit (ICU) and the parents are with the child. Which creates stressors for children and parents in ICUs? (Select all that apply.) a. Equipment noise b. Privacy c. Caring behavior by the nurse d. Unfamiliar smells e. Sleep deprivation

ANS: A, D, E The ICU can create physical and environmental stressors for children and their families. Equipment noise (monitors, suction equipment, telephones, computers), unfamiliar smells (alcohol, adhesive remover, body odors), and sleep deprivation all are stressors found in the ICU. Privacy as opposed to no privacy and a caring nurse as opposed to unkind or thoughtless comments from staff help reduce the stressors of the ICU.

3. Which dietary recommendations should a nurse make to an adolescent patient to manage constipation related to opioid analgesic administration? (Select all that apply.) a. Bran cereal b. Decrease fluid intake c. Prune juice d. Cheese e. Vegetables

ANS: A, D, E To manage the side effect of constipation caused by opioids, fluids should be increased, and bran cereal and vegetables are recommended to increase fiber. Prune juice can act as a nonpharmacologic laxative. Fluids should be increased, not decreased, and cheese can cause constipation so it should not be recommended.

1. The nurse must check vital signs on a 2-year-old boy who is brought to the clinic for his 24-month checkup. What criteria should the nurse use in determining the appropriate-size blood pressure cuff? (Select all that apply.) a. The cuff is labeled "toddler." b. The cuff bladder width is approximately 40% of the circumference of the upper arm. c. The cuff bladder length covers 80% to 100% of the circumference of the upper arm. d. The cuff bladder covers 50% to 66% of the length of the upper arm.

ANS: B, C Research has demonstrated that cuff selection with a bladder width that is 40% of the arm circumference will usually have a bladder length that is 80% to 100% of the upper arm circumference. This size cuff will most accurately reflect measured radial artery pressure. The name of the cuff is a representative size that may not be suitable for any individual child. Choosing a cuff by limb circumference more accurately reflects arterial pressure than choosing a cuff by length.

4. Surgery has informed a nurse that the patient returning to the floor after spinal surgery has an opioid epidural catheter for pain management. The nurse should prepare to monitor the patient for which side effects of an opioid epidural catheter? (Select all that apply.) a. Urinary frequency b. Nausea c. Itching d. Respiratory depression

ANS: B, C, D Respiratory depression, nausea, itching, and urinary retention are dose-related side effects from an epidural opioid. Urinary retention, not urinary frequency, would be seen.

2. A nurse plans therapeutic play time for a hospitalized child. Which are the benefits of therapeutic play? (Select all that apply.) a. Serves as method to assist disturbed children b. Allows the child to express feelings c. The nurse can gain insight into the child's feelings. d. The child can deal with concerns and feelings. e. Gives the child a structured play environment

ANS: B, C, D Therapeutic play is an effective, nondirective modality for helping children deal with their concerns and fears, and at the same time, it often helps the nurse gain insights into children's needs and feelings. Play and other expressive activities provide one of the best opportunities for encouraging emotional expression, including the safe release of anger and hostility. Nondirective play that allows children freedom for expression can be tremendously therapeutic. Play therapy is a structured therapy that helps disturbed children. It should not be confused with therapeutic play.

5. A nurse is interviewing the parents of a toddler about use of complementary or alternative medical practices. The parents share several practices they use in their household. Which should the nurse document as complementary or alternative medical practices? (Select all that apply.) a. Use of acetaminophen (Tylenol) for fever b. Administration of chamomile tea at bedtime c. Hypnotherapy for relief of pain d. Acupressure to relieve headaches e. Cool mist vaporizer at the bedside for "stuffiness"

ANS: B, C, D When conducting an assessment, the nurse should inquire about the use of complementary or alternative medical practices. Administration of chamomile tea at bedtime, hypnotherapy for relief of pain, and acupressure to relieve headaches are complementary or alternative medical practices. Using Tylenol for fever relief and a cool mist vaporizer at the bedside to reduce "stuffiness" are not considered complementary or alternative medical practices.

2. A nurse is conducting a teaching session on the use of time-out as a discipline measure to parents of toddlers. Which are correct strategies the nurse should include in the teaching session? (Select all that apply.) a. Time-out as a discipline measure cannot be used when in a public place. b. A rule for the length of time-out is 1 minute per year. c. When the child misbehaves, one warning should be given. d. The area for time-out can be in the family room where the child can see the television. e. When the child is quiet for the specified time, he or she can leave the room.

ANS: B, C, E A rule for the length of time-out is 1 minute per year of age; use a kitchen timer with an audible bell to record the time rather than a watch. When the child misbehaves, one warning should be given. When the child is quiet for the duration of the time, he or she can then leave the room. Time-out can be used in public places and the parents should be consistent on the use of time-out. Implement time-out in a public place by selecting a suitable area or explain to children that time-out will be spent immediately on returning home. The time-out should not be spent in an area from which the child can view the television. Select an area for time-out that is safe, convenient, and unstimulating but where the child can be monitored, such as the bathroom, hallway, or laundry room

1. A nurse recognizes which physiologic responses as a manifestation of pain in a neonate? (Select all that apply.) a. Decreased respirations b. Diaphoresis c. Decreased SaO2 d. Decreased blood pressure e. Increased heart rate

ANS: B, C, E The physiologic responses that indicate pain in neonates are increased heart rate, increased blood pressure, rapid, shallow respirations, decreased arterial oxygen saturation (SaO2), pallor or flushing, diaphoresis, and palmar sweating.

2. A nurse is monitoring a patient for side effects associated with opioid analgesics. Which side effects should the nurse expect to monitor for? (Select all that apply.) a. Diarrhea b. Respiratory depression c. Hypertension d. Pruritus e. Sweating

ANS: B, D, E Side effects of opioids include respiratory depression, pruritus, and sweating. Constipation may occur, not diarrhea, and orthostatic hypotension may occur but not hypertension

Dunst, Trivette, and Deal identified the qualities of strong families that help them function effectively. Which qualities are included? (Select all that apply.) a. Ability to stay connected without spending time together b. Clear set of family values, rules, and beliefs c. Adoption of one coping strategy that always promotes positive functioning in dealing with life events d. Sense of commitment toward growth of individual family members as opposed to that of the family unit e. Ability to engage in problem-solving activities f. Sense of balance between the use of internal and external family resources

ANS: B, E, F A clear set of family rules, values, and beliefs that establishes expectations about acceptable and desired behavior is one of the qualities of strong families that help them function effectively. Strong families also are able to engage in problem-solving activities and to find a balance between internal and external forces. Strong families have a sense of congruence among family members regarding the value and importance of assigning time and energy to meet needs. Strong families also use varied coping strategies. The sense of commitment is toward the growth and well-being of individual family members, as well as the family unit.