School-Aged EAQ
An 11-year-old child is found to have acute lymphocytic leukemia (ALL), and the health care provider discusses the diagnosis and treatment with the child and family. What age-appropriate behavior does the nurse expect from the child regarding the life-threatening diagnosis? 1 Expressing anger by being insolent 2 Saying that when people die they go to heaven 3 Being afraid to go to sleep for fear of not awakening 4 Telling the nurse that death is punishment for not being good
1 Expressing anger by being insolent Anger is an appropriate response for an 11-year-old, who sees dying as loss of control over every aspect of living. The child may convey this emotion by physically attempting to run away or by pushing others away through rude behavior; it is a plea for some self-control and power. Saying that when people die they go to heaven is characteristic of the toddler, who is egocentric and has a vague separation of fact and fantasy, which makes it impossible to understand the absence of life. Being afraid of sleep is characteristic of the preschooler, who does not have logical thinking. Telling the nurse that death is a punishment is more typical of the preschool-age child, who sees deviation from accepted behavior as the reason for becoming ill.
7-year-old child who has sustained frostbite of the toes after skiing in below-freezing weather is brought to the emergency department. What is the nurse's initial intervention? 1 Rapidly rewarming the toes by placing the feet in warm water 2 Slowly rewarming the toes by wrapping the feet in a warm cloth 3 Placing the feet in cool water to minimize the temperature difference 4 Wrapping the feet in an ice pack until definitive medical help is available
1 Rapidly rewarming the toes by placing the feet in warm water Rapid rewarming is accomplished by immersing the body part in well-agitated water at 100° F to 108° F (37.8° C to 42.2° C). Rapid rewarming minimizes tissue damage. The body part should be rewarmed as quickly as possible to minimize tissue damage. Prolonged exposure to the cold will worsen tissue damage.
A nurse is determining whether a 5-year-old child is displaying appropriate behaviors for this age. What developmental findings does the nurse expect? (Select all that apply.) 1 Enjoys imitative play 2 Engages in ritualistic games 3 Makes up rules for a new game 4 Asks for a pacifier when uncomfortable 5 Plays near others quietly but not with them
1 Enjoys imitative play 3 Makes up rules for a new game Imitating adults by playing adult roles in society is at its peak in children 5 years of age; activities are strongly identified with same-sex parent. A 5-year-old is able to negotiate and use make-believe to play. These children are able to follow some rules but may cheat to win. Older children in the middle childhood years need conformity and rituals, whether they play games or amass collections. Rules to games are fixed, unvarying, and rigid. Knowing the rules means belonging. The use of a pacifier for oral satisfaction is typical of infants. Parallel play occurs in children ages 2 to 3 years.
After multiple upper respiratory infections, a school-aged child undergoes a tonsillectomy and adenoidectomy. Two weeks after surgery the nurse evaluates the child's condition. On what should the nurse focus? (Select all that apply.) 1 Taste 2 Smell 3 Hearing 4 Breathing 5 Facial symmetry
1 Taste 2 Smell 3 Hearing 4 Breathing Edematous adenoids interfere with nasal breathing, which affects the sense of taste. Enlarged adenoids usually cause mouth breathing, which affects the sense of smell. Because hearing usually is affected by repeated oropharyngeal infections, this is an important postoperative assessment. Breathing is an important postoperative assessment because one goal of a tonsillectomy and adenoidectomy is to convert mouth breathing to nasal breathing. Facial symmetry is not affected by these procedures.
A 6-year-old child is admitted with an acute infection and dehydration. There is a prescription for an IV antibiotic to be piggybacked to a continuous hydration solution. During the administration of the antibiotic the child becomes restless, flushes, and begins to wheeze. Place the nursing actions in order of their priority. 1. Stopping the antibiotic infusion 2. Assessing the respiratory status 3. Maintaining the hydration infusion 4. Notifying the practitioner
1. Stopping the antibiotic infusion 2. Assessing the respiratory status 3. Maintaining the hydration infusion 4. Notifying the practitioner The child is experiencing an allergic reaction. First the antibiotic should be stopped to prevent anaphylactic shock. Maintaining respiratory function is a priority; therefore it should be checked immediately and assessed routinely. The continuation of hydration is important to dilute the effect of the allergen and to keep the vein open if emergency medication is required. After the immediate needs of the child have been met, the practitioner should be notified.
A nurse initiates preparations for an infratentorial craniotomy in a 9-year-old child. What should the nurse include in the plan? 1 Encouraging doll play with simulated surgical equipment 2 Having the child draw a picture of a brain and briefly clarifying misconceptions 3 Scheduling role-playing with other children who have also undergone brain surgery 4 Offering an explanation of the brain's anatomy and howing the surgery is performed
2 Having the child draw a picture of a brain and briefly clarifying misconceptions Having the child draw a picture will elicit the child's level of understanding; an explanation can then proceed. Therapeutic play is more appropriate for younger children; it is inappropriate for a 9-year-old child. Role-play is inappropriate and nontherapeutic at this time. Although the school-age child appreciates some detail, extensive detail is inappropriate.
A school-aged child with a seizure disorder is to start taking divalproex (Depakote). What should the nurse teach the parents about caring for their child in regard to this medication? 1 Crush the tablets and mix them with applesauce 2 Take the child for regularly scheduled blood tests 3 Stop the medication immediately if a rash develops 4 Provide oral hygiene, especially gum massage and flossing
2 Take the child for regularly scheduled blood tests Adverse reactions to divalproex include thrombocytopenia, leukopenia, and lymphocytosis; blood studies must be performed on a regular basis. Tablets must be swallowed whole; they should not be broken, crushed, or chewed. If the medication is stopped suddenly a seizure may result; a rash should be reported to the practitioner. Meticulous oral hygiene is more important for a child who is taking phenytoin (Dilantin).
A child becomes cyanotic during a generalized tonic-clonic seizure. What is the most appropriate action by the nurse? 1 Inserting an oral airway 2 Administering oxygen by mask 3 Continuing to observe the seizure 4 Notifying the practitioner immediately
3 Continuing to observe the seizure The child's status and the progression of the seizure should be monitored; the child will not breathe until the seizure is over, and cyanosis should subside at that time. Attempting to open a clenched jaw may result in injury to the child. Oxygen is useless until the child breathes when the seizure is over. The practitioner may be notified later; provisions for the child's safety and observation are the priorities.
A preadolescent brings home a note from the school nurse informing the parents that the child should be evaluated for scoliosis. The mother calls the clinic nurse to ask for a description of scoliosis. Before responding, the nurse recalls that in scoliosis: 1 The concave lumbar curvature is exaggerated 2 There are pathological changes in the vertebrae 3 There is a rotary deformity of the lateral curvature of the spine 4 The curvature of the thoracic spine has an increased convex angulation
3 There is a rotary deformity of the lateral curvature of the spine A rotary deformity of the lateral curvature of the spine is the correct definition of scoliosis. An exaggerated concave lumbar curvature is a description of lordosis. There are no pathological changes in the vertebrae with scoliosis. A curvature of the thoracic spine with an increased convex angulation is a description of kyphosis.
Allopurinol (Zyloprim) is prescribed for a 6-year-old child undergoing chemotherapy regimen for cancer of the bone. When given the medication, the child asks, "Why do I have to take this pill?" What is the best response by the nurse? 1 "It protects your body from getting new problems after your treatment is over." 2 "Because it stops your sick white cells from going to other parts of your body." 3 "You know the doctor wouldn't order anything for you unless it was very important." 4 "Because with the other medicines it helps you get rid of the things that are making you sick."
4 "Because with the other medicines it helps you get rid of the things that are making you sick." Telling the child it helps get rid of the things making the child sick is the most accurate and age-appropriate response to the child's question. Telling the child that the medicine protects the body from new problems is inaccurate, and not being truthful will interfere with the development of the child's trust in the nurse. Telling the child that it stops sick white cells from spreading is inaccurate and may instill more fear. Telling the child that it is needed because the health care provider says so is insensitive to the question and does not provide an explanation.
A preschool-aged child admitted with Reye syndrome will most likely be placed: 1 In an isolation room 2 On a presurgical unit 3 On the pediatric floor 4 In the intensive care unit
4 In the intensive care unit A child with Reye syndrome is critically ill and needs the constant supervision that is available in an intensive care unit. Reye syndrome is not contagious. Surgery is not required for children with Reye syndrome. A general pediatric unit does not offer the continued assessment and intensive interventions that are necessary for a child with Reye syndrome.
A nurse notes the weights attached to a 7-year-old child in traction are touching the floor. What action should the nurse take? 1 Raising the foot of the bed 2 Lengthening the traction rope 3 Notifying the health care provider 4 Moving the child toward the head of the bed
4 Moving the child toward the head of the bed Moving the child toward the head of the bed will produce sufficient countertraction to raise the weights off the floor. Raising the foot of the bed may provide excessive countertraction. Lengthening the traction rope is contraindicated because it will not raise the weights off the floor. Readjusting the traction is the nurse's responsibility; there is no need to notify the health care provider.
