UTC PEDS EXAM TWO PRACTICE QUESTIONS

A 4-month-old has had a fever, vomiting, and loose watery stools every few hours for 2 days. The mother calls the physician's office and asks the nurse what she should do. Which response by the nurse is most appropriate? "Give a clear pediatric electrolyte replacement for the next few hours, then call back to report on how your child is doing." "Continue breastfeeding as you have been doing. The fluid from the breast milk is important to maintain fluid balance." "Bring the child to the office today so we can evaluate her fluid balance and determine the best treatment." "Do not give the child anything to drink for 4 hours. If the fever goes down and the loose stools stop, you can resume breastfeeding."

"Bring the child to the office today so we can evaluate her fluid balance and determine the best treatment." Explanation: An infant's body comprises a high percentage of fluid that can be lost very quickly when vomiting, fever, and diarrhea are all present. This infant needs to be seen by the physician based on her age and symptoms; hospitalization may be necessary for intravenous rehydration depending upon her status when assessed.

A 6-year-old has had a viral infection for the past 5 days and is having severe vomiting, confusion, and irritability, although he is now afebrile. During the assessment, the nurse should ask the parent which question?

"Did you use any medications, like aspirin, for the fever?" Severe and continual vomiting, changes in mental status, lethargy, and irritability are some of the signs and symptoms of Reye syndrome, which can occur as a result of ingesting aspirin or aspirin-containing products during a viral infection. Tylenol (acetaminophen) is allowed for viral infections in the school-age child. The type of fluids consumed during the illness has nothing to do with Reye syndrome. The temperature rise would be important for a much younger child because of the chance of febrile seizures, but not in this age child.

The mother of a newborn with a caput succedaneum asks the nurse how this happened to her baby. Which response by the nurse would be most appropriate?

"During delivery, your vaginal wall put pressure on the baby's head." Caput succedaneum results from pressure from the uterus or vaginal wall during a head-first delivery. The use of forceps is associated with a cephalohematoma. Caput succedaneum is not due to the baby's head becoming blocked inside the vagina. The cause of caput succedaneum is known; it is caused by pressure from the uterus or vaginal wall during a head-first delivery.

The nurse is discussing fever with the parents of a child who is in the emergency department with a temperature of 101°F (38.3°C). Which statement by a parent indicates an understanding of fevers and their management in the ill child? We've had to wake him up in the night to give him more medicine to reduce his temperature." "Fevers can be beneficial because they can slow down the growth of the bacteria or virus that may be causing the infection." "We've been giving him a little extra acetaminophen to help bring his fever down." "My wife and I have been using cold water and washcloths on him because of the fever."

"Fevers can be beneficial because they can slow down the growth of the bacteria or virus that may be causing the infection." Explanation: Fevers can be protective and can help the body fight the infection. Fevers slow down bacterial or viral growth. Mismanaging fevers include inappropriate dosing of antipyretics, awakening a child at night to administer antipyretics, and using cold water or sponging the child with alcohol to reduce the temperature.

When providing care for a child with herpes zoster (shingles), the parents ask the nurse how the child contracted this infectious disorder. Which response by the nurse is most appropriate? "Herpes zoster is a reactivation of a previous varicella zoster infection." "Your child must have been exposed to someone with herpes zoster." "Handwashing is an effective way to prevent the spread of infectious disorders." "Children who are immunocompromised are more likely to contract shingles."

"Herpes zoster is a reactivation of a previous varicella zoster infection." Herpes zoster (shingles) is reactivation of the latent varicella zoster (chickenpox) infection that occurs during times of immunosuppression and aging. Although it is possible to contract the varicella zoster virus from a person with herpes zoster or varicella zoster, a child diagnosed with herpes zoster has already been exposed to varicella zoster. Handwashing will not directly prevent herpes zoster.

The nurse is caring for an infant. The infant's mother asks the nurse, "What did the doctor mean when he said she may have regurgitation?" What response by the nurse is appropriate? "Regurgitation is just another term for vomiting. All infants vomit some." "Regurgitation is not normal in infants. She will need more testing to see what is causing this." "Regurgitation is when an infant can't tolerate their formula. You will need to switch." "Regurgitation is the backflow of stomach contents up into the esophagus or mouth."

"Regurgitation is the backflow of stomach contents up into the esophagus or mouth." Explanation: Regurgitation is the backflow of stomach contents up into the esophagus and/or oral cavity. The muscle tone of the lower esophageal sphincter is not fully developed until age 1 month, so infants younger than 1 month of age frequently regurgitate after feedings. Many children younger than 1 year of age continue to regurgitate for several months, but this usually disappears with age.

The parents of a 4-month-old diagnosed with sepsis tell the nurse that the physician explained sepsis to them but they don't really understand it. The parents state, "Could you please explain it to us?" What is the best response by the nurse? Sepsis results in systemic inflammatory response syndrome (SIRS) due to infection." "The infection your child has causes the release of toxins into the system, which can lead to impaired function in the lungs, liver, and kidneys." "The pathophysiology of sepsis is complex." "The pathogens cause an overproduction of proinflammatory cytokines. These cytokines are responsible for the clinically observable effects of the sepsis."

"The infection your child has causes the release of toxins into the system, which can lead to impaired function in the lungs, liver, and kidneys." Keeping the answer to what sepsis is will help the parents understand the pathophysiology. While all answers are correct, the response: "The infection your child has causes the release of toxins into the system, which can lead to impaired function in the lungs, liver, and kidneys" provides the most understandable explanation and addresses the parent's question.

The parents of a 3-year-old child report he was exposed to pertussis 2 days ago. They are concerned and ask the nurse how long it will take until he becomes ill if he indeed contracted the infection. What response by the nurse is indicated? "If your child had contracted the disease symptoms would have be noted by this time." "The signs of disease will be noted in 1 to 3 weeks." "If you child has contracted the illness he will become ill in about 2 weeks." "It normally takes about 3 weeks before symptoms begin."

"The signs of disease will be noted in 1 to 3 weeks." Explanation: Pertussis is an acute respiratory disorder characterized by paroxysmal cough (whooping cough) and copious secretions. The disease is caused by Bordetella pertussis. The incubation period is 6 to 21 days, usually 7 to 10 days.

A child is home with the caregivers following a treatment for a head injury. The caregiver should contact the care provider if the child makes which statement?

"You look funny. Well, both of you do. I see two of you." The caregiver should notify the health care provider immediately if the child vomits more than three times, has pupillary changes, has double or blurred vision, has a change in level of consciousness, acts strange or confused, has trouble walking, or has a headache that becomes more severe or wakes him or her from sleep. These instructions should be provided in written form to the caregiver. Just feeling nauseated is not a reason to notify the provider.

The nurse is caring for a 13-year-old girl with suspected autoimmune hepatitis. The girl inquires about the testing required to evaluate the condition. How should the nurse respond?

"You will most likely have a blood test to check for certain antibodies." Explanation: Anti-nuclear antibodies are one of the diagnostic tests performed to diagnose autoimmune hepatitis. Ultrasound is performed to assess for liver or spleen abnormalities. Viral studies are performed to screen for viral causes of hepatitis. Ammonia levels may be ordered if hepatic encephalopathy is suspected.

The nurse is assessing the neurological functioning of a preschool child. What actions will best review functioning of cranial nerve III?

A bright-colored toy is moved in the child's visual fields. Cranial nerve III, the oculomotor nerve, is assessed by using a brightly colored object to assess the child's ability to watch its movement. Cranial nerve I (olfactory nerve) controls the sense of smell. Asking the child to smell objects would be an assessment of this cranial nerve. Cranial nerve VII (facial nerve) is assessed by monitoring symmetry of facial movements. Cranial nerve VIII (acoustic nerve) is assessed by whispering.

The nurse is caring for a child after surgery. Which interventions will the nurse implement to prevent a hospital-acquired infection? Select all that apply. Remove urinary catheter as soon as possible. Access intravenous line using sterile technique. Administer postoperative antibiotics as prescribed. Clean stethoscope before and after auscultation. Use hand sanitizer prior to entering the child's room.

All of the above

What information is most correct regarding the nervous system of the child?

As the child grows, the gross and fine motor skills increase. As the child grows, the quality of the nerve impulses sent through the nervous system develops and matures. As these nerve impulses become more mature, the child's gross and fine motor skills increase in complexity. The child becomes more coordinated and able to develop motor skills.

A child has been diagnosed with a basilar skull fracture. The nurse identifies ecchymosis behind the child's ear. This would be documented as:

Battle sign Two signs of basilar skull fracture include Battle sign (bruising or ecchymosis behind the ear) and "raccoon eyes" (blood leaking into the frontal sinuses causing an edematous and bruised periorbital area). Rhinorrhea is CSF leakage from the nose. Otorrhea is CSF leaking from the ear.

The nurse is performing a physical examination for a 7-year-old girl who was bitten by a tick. What would alert the nurse to the possibility of early localized Lyme disease? Cranial nerve palsies Multiple erythema migrans on the skin Recurrent arthritis in the large joints Bull's-eye rash around the bite

Bull's-eye rash around the bite Explanation: A bull's-eye rash (ring-like rash) around the bite is typical of early localized Lyme disease. Multiple erythema migrans on the skin occurs during early disseminated disease. Cranial nerve palsies are indicative of early disseminated disease. Recurrent arthritis in the large joints occurs in the late stage of the disease.

During the physical assessment of a 2½-month-old infant, the nurse suspects the child may have hydrocephalus. Which sign or symptom was observed?

Dramatic increase in head circumference A dramatic increase in head circumference is a symptom of hydrocephalus, suggesting that there is a build-up of fluid in the brain. Only one pupil that is dilated and reactive is a sign of an intracranial mass. Vertical nystagmus indicates brain stem dysfunction. A closed posterior fontanel (fontanelle) would be frequently seen by this age.

The nurse is caring for a child admitted with gastroesophageal reflux (GER). Which clinical manifestation would likely be seen in this child?

Effortless vomiting just after the child has eaten Explanation: The child with GER usually gains weight and feeds well. It must be determined if there are underlying symptoms or complications that might suggest GERD. In the child with GERD, almost immediately after feeding, the child vomits the contents of the stomach. The vomiting is effortless, not projectile in nature. The child with GERD is irritable and hungry, but may refuse to eat. Aspiration after vomiting may lead to respiratory concerns, such as apnea, wheezing, cough, and pneumonia. Failure to thrive and lack of normal weight gain occurs. Symptoms seen in the older child may include heartburn, nausea, epigastric pain, and difficulty swallowing. Forceful vomiting with the child wanting to eat shortly after vomiting is associated with pyloric stenosis. Severe constipation with ribbon-like stools would be indicative of Hirschsprung disease. Bouts of diarrhea with failure to gain weight is associated with Crohn disease.

A parent brings a 2-year-old child to the health clinic with reports of diarrhea, vomiting, and abdominal pain. The father tells the nurse that he is a single parent and his child is enrolled in a local day care center. Based on this information, what gastrointestinal condition might the nurse suspect? Hirschsprung disease Pancreatitis Appendicitis Gastroenteritis

Explanation: Outbreaks of gastroenteritis routinely occur in day care centers, schools, institutions for the handicapped, and other places where overcrowding is prevalent and hygiene is inadequate. Typical signs and symptoms include diarrhea, nausea, vomiting, and abdominal pain.

Which statement is most accurate related to the diagnosis of gastroesophageal reflux?

In this disorder the sphincter that leads into the stomach is relaxed. Explanation: Gastroesophageal reflux (GER) occurs when the sphincter in the lower portion of the esophagus, which leads into the stomach, is relaxed and allows gastric contents to be regurgitated back into the esophagus. Congenital aganglionic megacolon is characterized by persistent constipation resulting from partial or complete intestinal obstruction of mechanical origin. Colic consists of recurrent paroxysmal bouts of abdominal pain. Pyloric stenosis is characterized by hypertrophy of the circular muscle fibers of the pylorus, which leads to an obstruction at the distal end of the stomach.

A 6-month-old infant is admitted with suspected bacterial meningitis. She is crying, irritable, and lying in the opisthotonic position. Which intervention should the nurse take initially?

Institute droplet precautions in addition to standard precautions. Bacterial meningitis is a medical emergency. The child must be placed on droplet precautions until 24 hours of antibiotics have been given. Encouraging the mother to hold and comfort the child is an intervention but not the priority one; the focus is to get the infant the appropriate medications to fight the infection and to prevent its spread. Educating the family about preventing bacterial meningitis would be appropriate later once the initial infection has been controlled. Palpating the fontanels (fontanelles) is used to assess for hydrocephalus.

After teaching a class to a group of nursing students about reporting infectious diseases to the Centers for Disease Control and Prevention, the instructor determines a need for additional discussion when the students identify which infection as being reportable: pertussis Lyme disease gonorrhea pinworm

Pinworm infections are not required to be reported. Gonorrhea, Lyme disease, and pertussis are all reportable infectious diseases.

The nurse at an outpatient facility is obtaining a blood specimen from a 9-year-old girl. Which technique would most likely be used? Puncturing a vein on the dorsal side of the hand. Using an automatic lancet device on the heel. Administering sucrose prior to beginning. Accessing an indwelling venous access device.

Puncturing a vein on the dorsal side of the hand. Explanation: The usual sites for obtaining blood specimens are veins on the dorsal side of the hand or the antecubital fossa. Administration of sucrose prior to beginning helps control pain for young infants. Accessing an indwelling venous access device may be appropriate if the child is in an acute care setting. An automatic lancet device is used for capillary puncture of an infant's heel.

The nurse is preparing a care plan for a child who has a seizure disorder. The child experiences tonic-clonic seizures. Which nursing diagnosis will the nurse identify as having the highest priority?

Risk for injury A seizure disorder is caused by a disruption in the electrical impulses in the brain. Tonic-clonic seizures are the most dramatic seizure disorder. It is characterized by a loss of consciousness, along with the entire body experiencing tonic contractions followed by rhythmic clonic contractions alternating with relaxation of all muscle groups. Cyanosis may be noted due to apnea, and saliva may collect in the mouth due to an inability to swallow. All of these symptoms would make Risk for injury the highest priority.

What is a true statement regarding varicella zoster virus infection? It tends to be more severe in children. Secondary bacterial infections of the skin can occur. The incubation period is 7 days. It is transmitted by fecal-oral route.

Secondary bacterial infections of the skin can occur. Explanation: Varicella zoster virus infection carries with it the complication of a secondary bacterial infection of the skin. The lesions are intensely pruritic, making the child want to scratch the lesions and opening them to a variety of organisms to invade. The incubation period is 10 to 21 days. It is transmitted by direct contact with the vesicles and by airborne route. It tends to be more severe in adolescents and adults.

Which nursing assessment data should be given the highest priority for a child with clinical findings related to meningitis?

Signs of increased intracranial pressure (ICP) Assessment of fever and evaluation of nuchal rigidity are important aspects of care, but assessment for signs of increasing ICP should be the highest priority due to the life-threatening implications. Urinary and fecal incontinence can occur in a child who's ill from nearly any cause but doesn't pose a great danger to life.

The nurse is interviewing the caregivers of a child brought to the emergency unit. The caregiver states, "She has a history of seizures but this time it lasted more than 30 minutes and she just keeps having them." The most accurate description of this child's condition would be:

The child is in status epilepticus. Status epilepticus is the term used to describe a seizure that lasts longer than 30 minutes, or a series of seizures in which the child does not return to his or her previous normal level of consciousness. The child likely is having generalized seizures, but the most accurate description of what is happening is status epilepticus. With infantile spasms, muscle contractions are sudden, brief, symmetrical, and accompanied by rolling eyes. With absence seizures the child loses awareness and stares straight ahead but does not fall.

A nurse on the neurology unit is monitoring an 8-year-old child admitted with seizures. The child experiences a prolonged tonic-clonic seizure. The nurse should first _________________ followed by _________________

The nurse first ensures a patent airway and proper oxygenation using a blow-by method.The nurse then administers an antiepileptic medication such as benzodiazepines intravenously or intramuscularly for prolonged seizure activity. Nothing should be inserted into the child's airway when the child is seizing, not even suction. The nurse can place the child in a side-lying position to prevent the tongue from occluding the airway and help with secretions that may pool up in the back of the throat.The child should not receive anything orally when the child is seizing. The nurse should administer medications via intravenous push (IVP) or intramuscular (IM) during prolonged seizure activity.It is appropriate for the nurse to allow the child to sleep once the seizure has ended. The child should be placed in the left lateral recumbent recovery position.

The nurse is caring for a child hospitalized with pertussis. Which nursing intervention would be the highest priority for this child? The nurse will encourage bed rest. The nurse will administer antibiotics. The nurse will administer oxygen. The nurse will monitor caloric intake. SUBMIT ANSWER

The nurse will administer oxygen. Explanation: The major complication of pertussis (whooping cough) is pneumonia and respiratory complications. Oxygen, bed rest, and monitoring for airway obstruction are nursing interventions. The highest priority is administering oxygen to maintain adequate oxygenation of cells.

The nurse is educating the parents of a 7-year-old girl with epilepsy about managing treatment of the disorder at home. Which intervention is most effective for eliminating breakthrough seizures?

Understanding the side effects of medications The most common cause of breakthrough seizures is noncompliance with medication administration, which may occur if the parents do not understand what side effects to expect or how to deal with them. Treating the child as though she did not have epilepsy helps improve her self-image and self-esteem. Placing the child on her side on the floor is an intervention to prevent injury during a seizure. Instructing the teacher on how to respond when a seizure occurs will help relieve anxiety and provide a sense of control.

A 5-year-old girl catches the flu from a friend at day care after the friend sneezed and wiped mucus on a toy that the girl subsequently played with. In this case, what is the portal of exit in the chain of infection? The friend Upper respiratory excretion Toy The 5-year-old girl

Upper respiratory excretion Explanation: The portal of exit is the route by which an organism leaves an infected child's body to be spread to others. An organism can be carried out of the body by upper respiratory excretions, feces, vomitus, saliva, urine, vaginal secretions, blood, or lesion secretions. The friend would be the reservoir, which is the container or place in which an organism grows and reproduces. The toy would be the means of transmission. The 5-year-old girl would be the susceptible host

After teaching nursing students about childhood exanthems, the instructor determines that the teaching was successful when the students identify what as the primary cause? Fungi Bacteria Viruses Parasites

Viruses Explanation: Most childhood exanthems are caused by viruses

The nurse is concerned that the child is developing septic shock. Which finding(s) are consistent with this condition? Select all that apply. White blood cell count is elevated. C-reactive protein is decreased. The child is pale and lethargic. The child's blood pressure is reduced. The child's respiratory rate is elevated.

White blood cell count is elevated. The child is pale and lethargic. The child's respiratory rate is elevated. The child's blood pressure is reduced. Assessment findings consistent with septic shock include elevated white blood cell counts, pallor, lethargy, tachypnea, and hypotension. Often, the C-reactive protein level is elevated, not decreased.

A school-aged child is recovering from varicella. The parent calls the school nurse and states, "my child is feeling much better" and asks when the child can return to school. What information does the nurse provide the parent? "Your child may return to school when a health care provider has given written permission." "Your child may return to school when free of any lesions." "Your child may return to school when there has been no fever for 48 hours." "Your child may return to school when all of the lesions have crusted over."

Your child may return to school when all of the lesions have crusted over." Explanation: Varicella is a highly communicable disease. It is spread via airborne transmission or by direct contact with the nasopharyngeal secretions of an infected person. Varicella is communicable from 1 to 2 days before the rash occurs until all the vesicles have crusted over. The nurse would be correct in telling the parent the child cannot return to school, even though the child is feeling better, until all the vesicles have crusted over. The child does not have to be free of lesions. Being free of fever does not make the child less communicable. The child would not need a permission slip from the health care provider unless this is a specific requirement by the child's school district.

A group of nursing students are reviewing cerebral vascular disorders and risk factors in children. The students demonstrate understanding of the material when they identify which as a risk factor for hemorrhagic stroke?

arteriovenous malformations (AVMs) Vascular malformations such as intracranial AVMs are a risk factor for hemorrhagic stroke. Sickle cell disease is a risk factor for ischemic stroke. Congenital heart defects are risk factors for ischemic stroke. Meningitis or other infection is a risk factor for ischemic stroke.

A 6-year-old boy is suspected of having late-stage Lyme disease. Which assessment should the nurse use to produce findings supporting this concern? observing for facial palsy examining for conjunctivitis asking the child if his knees hurt inspecting for erythema migraines

asking the child if his knees hurt Explanation: Recurrent arthritis in large joints such as the knees is an indication of late-stage Lyme disease. The appearance of erythema migraines would suggest early-localized stage of the disease. Facial palsy or conjunctivitis would suggest the child is in the early disseminated stage of the disease.

A nurse taking a health history of a newborn notes that there is a maternal history of polyhydramnios. What GI condition might this history precipitate?

esophageal atresia (EA) Explanation: A maternal history of polyhydramnios is usually present in one-third of cases of EA and in some cases of tracheoesophageal fistula (TEF).

The nurse knows that the heads of infants and toddlers are large in proportion to their bodies, placing them at risk for what problem?

head trauma A larger head size in relation to the rest of their body size gives young children a higher center of gravity, which causes them to hit their head more readily, thus placing them at risk for head trauma. Fragile capillaries in the periventricular area of the brain put preterm infants at risk for intracranial hemorrhage. Congenital hydrocephalus may be caused by abnormal intrauterine development or infection. Positional plagiocephaly is caused by an infant's head remaining in the same position for too long.

The nurse is caring for a child with suspected increased intracranial pressure (ICP). Which assessment finding would indicate increased ICP?

hypertension Symptoms of increased intracranial pressure include slowing of both pulse and respirations, increasing blood pressure, and the development of hypothermia. All of these symptoms result from the increased ICP putting pressure on the cranial vessels and the hypothalamus. Double vision, or diplopia, also occurs as a result of increasing ICP.

A 6-year-old child is being treated for a parasitic infection. When reviewing results from the child's white blood cell count, which finding would be anticipated? reduced neutrophil levels reduced basophil levels increased eosinophil levels elevated monocytes

increased eosinophil levels Explanation: Eosinophils are the first line of defense against parasitic infections and allergic reactions and will be elevated. Monocytes are a second line of defense and will be elevated in response to leukemias, lymphomas, and chronic inflammation. Basophils respond to allergic disorders and hypersensitivity reactions. Neutrophils are the first line of defense upon invasion of bacteria, fungus, cell debris, and other foreign substances.

The nurse caring for an infant with craniosynostosis, specifically positional plagiocephaly, should prioritize which activity?

moving the infant's head every 2 hours Positional plagiocephaly can occur because the infant's head is allowed to stay in one position for too long. Because the bones of the skull are soft and moldable, they can become flattened if the head is allowed to remain in the same position for a long period of time. Massaging the scalp will not affect the skull. Measuring the intake and output is important but has no effect on the skull bones. Small feedings are indicated whenever an infant has increased intracranial pressure, but feeding an infant each time he fusses is inappropriate care.

The nurse is caring for an adolescent diagnosed with syphilis. The drug of choice for treating syphilis is: acyclovir ceftriaxone penicillin griseofluvin

penicillin Syphilis responds to one intramuscular injection of penicillin G benzathine; if the child is sensitive to penicillin, oral doxycycline, tetracycline, or erythromycin can be administered as alternative treatment.

A child is diagnosed with group A streptococcal pharyngitis. The nurse would teach the parents to be alert for signs and symptoms of: impetigo. scarlet fever. osteomyelitis. pneumonia.

scarlet fever. Explanation: Group A streptococcal pharyngitis can progress to scarlet fever with the rash appearing in about 12 hours after the onset of the disease. Group A streptococcal pharyngitis is not associated with pneumonia. Impetigo is a group A strep infection involving the skin. Osteomyelitis can occur with an infection by group B streptococcus.

Dexamethasone is often prescribed for the child who has sustained a severe head injury. Dexamethasone is a(n):

steroid Increased intracranial pressure (ICP) may be caused by several factors: head trauma, birth trauma, hydrocephalus, infection, and/or tumors. Whatever the reason, the brain swells and becomes inflamed. Dexamethasone is a steroid. A steroid may be prescribed to reduce inflammation and pressure on vital centers of the brain. The diuretic mannitol may be used to decrease edema. An anticonvulsant is used with increased ICP to prevent seizures. An antihistamine would not be warranted for the treatment of a head injury.

The nurse is taking a health history for an 8-year-old boy who is hospitalized. Which is a risk factor for sepsis in a hospitalized child? resuscitation or invasive procedures lack of juvenile immunizations maternal infection or fever use of immunosuppression drugs

use of immunosuppression drugs Explanation: The use of immunosuppression drugs is a risk factor for the hospitalized child. Maternal infection or fever and resuscitation or invasive procedures are sepsis risk factors related to pregnancy and labor. Lack of juvenile immunizations is a risk factor affecting the overall health of the child but does not impact the chance of sepsis.

The nurse is educating parents of a child admitted to the hospital with rubella (German measles). Which statement by the parents indicates the further education is needed? "Our child is contagious for 1 week after the rash appeared." "Family members should wear a mask when coming to visit us." "Antibiotics are needed to help our child recover from rubella." "Acetaminophen or ibuprofen can be given to help with pain." SUBMIT ANSWER

"Antibiotics are needed to help our child recover from rubella." Explanation: Rubella (German measles) is caused by the rubella virus. Children will be contagious for 1 week before to approximately 1 week after the rash appears. Acetaminophen or ibuprofen can be given to help with pain or fever, and the child will be on droplet precautions (mask) while in the hospital.

The nurse is caring for a 2-year-old boy with an umbilical hernia and is teaching the mother about this condition. Which response from the mother indicates a need for further teaching?

"I can tape a quarter over the hernia to reduce it." Explanation: The use of home remedies to reduce an umbilical hernia should be discouraged because of the risk of bowel strangulation. The mother needs to be aware that strangulation can occur, but it is rare with an umbilical hernia. Pain, tenderness, or redness indicates an incarcerated hernia, which although rare with umbilical hernias, can occur.She needs to understand the signs of strangulation and understand that some children have self-esteem issues related to the large protrusion of the unrepaired umbilical hernia. Physical needs of the child have priority over any types of potential psychosocial issues. Self-esteem issues may arise due to a large protrusion of an unrepaired umbilical hernia.

The nurse is caring for a child who has suffered a febrile seizure. While speaking with the child's parents, which statement by a parent indicates a need for further education?

"I hate to think that I will need to be worried about my child having seizures for the rest of his life." Febrile seizures occur most often in preschool children but can occur as late as 7 years of age. They occur when the child has a rapid rise in temperature and are not associated with the development of seizures later in life. Administering correct dosages of acetaminophen and ibuprofen, checking temperatures at night, and anticipating fevers associated with the administration of live vaccines are all ways to prevent the development of febrile seizures.

The parents of a 17-year-old adolescent diagnosed with bacterial meningitis tell the nurse, "We just do not understand how this could have happened. Our adolescent has always been healthy and just received a booster vaccine last year." How should the nurse respond?

"I understand your frustration. Unfortunately, immunizations are not 100% effective in preventing the infection." Showing empathy while letting the parents know that vaccines are not 100% effective is the best response. Meningococcal conjugate vaccine protects against four types of meningitis. There is nothing in the scenario to lead the nurse to believe that a different strain of bacteria caused the infection, or that the adolescent's immune system is compromised.

The nurse is caring for a child diagnosed with hand-foot-mouth disease. When educating the family about this disease, which education by the nurse is most important?

"Make sure your child drinks plenty of nonirritating fluid." Explanation: Children with hand-foot-mouth disease can experience dehydration related to the high fever, anorexia, and painful mouth lesions. The nurse should educate the family to provide nonirritating fluids to encourage the child to drink to avoid dehydration. Hand-foot-mouth disease is associated with a high fever, and parents can provide acetaminophen. The lesions should disappear in a few days; however, the most important education is aimed at prevention of dehydration.

The nurse is providing education to the parents of a 2-year-old boy with hydrocephalus who has just had a ventriculoperitoneal shunt placed. Which information is most important for the parents to be taught?

"Watch for changes in his behavior or eating patterns." Changes in behavior or in eating patterns can suggest a problem with his shunt, such as infection or blockage. Irritability, lack of appetite, increased crying, or inability to settle down may indicate increased intracranial pressure. Any headache needs to be monitored, but if it goes away quickly, such as after eating, it probably isn't a problem. It is not necessary to keep the child's head raised 30 degrees. The child's shunt will not be affected by the amount of television viewed.

A 9-year-old client who suffered a head injury has strabismus. The nurse assesses the client for intracranial pressure (ICP). Which additional intervention is most important for the nurse to perform?

Assess the level of consciousness (LOC). Decreased LOC is frequently the first sign of a major neurologic problem after head trauma. The nurse would assess the client's LOC before notifying the health care provider. The child may need to be placed on fall precaution, depending on the results of the assessment. The child's eyes will correct themselves when the ICP is reduced; therefore, an eye patch is not necessary.

The nurse is caring for a pediatric client with idiopathic celiac disease. Which meal will the nurse select for this client?

Baked salmon, potato slices, vanilla ice cream, and apple juice Explanation: Celiac disease is an autoimmune condition where contact with gluten causes a reaction from the body's immune system. Clients with celiac disease should be educated to eat a gluten-free diet to decrease symptoms and limit small intestine irritation. Gluten is a protein found in wheat, barley, and rye. Most commercially used flour contains wheat and should be avoided. The nurse would select foods such as meats/fish (salmon), fruits, vegetables (potatoes), and rice. Single flavor ice creams, such as chocolate, vanilla, and strawberry are gluten free, while cookies contain flour and should be avoided. Fruit juices, water, and milk are all gluten free. Meatloaf may contain oats; however, studies suggest oats are fine to consume, as long as the oats did not come into contact with wheat during processing. Reading the label would indicate if wheat was contacted. Sandwich bread and pastas contain gluten unless special gluten-free products are purchased or it is homemade. The nurse would not assume those items were gluten-free.

Antibiotic therapy to treat meningitis should be instituted immediately after which event?

Collection of cerebrospinal fluid (CSF) and blood for culture Antibiotic therapy should always begin immediately after the collection of CSF and blood cultures. After the specific organism is identified, bacteria-specific antibiotics can be administered if the initial choice of antibiotic therapy isn't appropriate. Admission and initiation of IV therapy aren't, by themselves, appropriate times to begin antibiotic therapy.

A preschool-age child has just been admitted to the pediatric unit with a diagnosis of bacterial meningitis. The nurse would include which recommendation in the nursing plan?

Decrease environmental stimulation

The nurse is preparing a toddler for a lumbar puncture. For this procedure, the nurse should place the child in which position?

Lying on one side, with the back curved Lumbar puncture involves placing a needle between the lumbar vertebrae into the subarachnoid space. For this procedure, the nurse should position the client on one side with the back curved because curving the back maximizes the space between the lumbar vertebrae, facilitating needle insertion. Prone and seated positions don't achieve maximum separation of the vertebrae.

The nurse is collecting data from a child who may have a seizure disorder. Which nursing observations suggest an absence seizure?

Minimal or no alteration in muscle tone, with a brief loss of responsiveness or attention Absence seizures are characterized by a brief loss of responsiveness with minimal or no alteration in muscle tone. They may go unrecognized because the child's behavior changes very little. A sudden loss of muscle tone describes atonic seizures. A frozen position describes the appearance of someone having akinetic seizures. A brief, sudden contraction of muscles describes a myoclonic seizure.

A child with a seizure disorder is being admitted to the inpatient unit. When preparing the room for the child, what should be included? Select all that apply.

O2 Suction Padding for side rails When planning the client's environment it is imperative that both safety items and those to manage the seizure are present. The side rails should be padded to prevent injury during seizure activity. Oxygen setup should be provided. Suction may be needed. Tongue blades and smelling salts are not employed.

The nurse is caring for a child admitted with congenital aganglionic megacolon. Which clinical manifestation would likely have been noted in the child with this diagnosis? Chronic cough Prolonged bleeding Persistent constipation Irregular breathing SUBMIT ANSWER

Persistent constipation Explanation: Congenital aganglionic megacolon, also called Hirschsprung disease, is characterized by persistent constipation resulting from partial or complete intestinal obstruction of mechanical origin. Prolonged bleeding is a manifestation of hemophilia. A chronic cough is noted in the child with cystic fibrosis. Irregular breathing occurs in children with seizures.

A 9-month-old child has been admitted to rule out sepsis. Which finding offers the most support to the presence of this disorder? The child's birth history indicates he was born at 42 weeks' gestation. The child has had 7 wet diapers in the past 24 hours. The child has had 8 ounces of formula in the past 24 hours. The child cries when his mother is not in sight.

The child has had 8 ounces of formula in the past 24 hours. Explanation: Sepsis is a systemic overresponse to infection resulting from bacteria and viruses, which are the most common fungi, viruses, rickettsia, or parasites. It can lead to septic shock, which results in hypotension, low blood flow, and multisystem organ failure. Signs of sepsis include a lack of appetite, lethargy, hypotonia, and temperature elevations.

The nurse is caring for an adolescent diagnosed with genital herpes. The drug of choice for treating genital herpes is: penicillin ceftriaxone griseofluvin acyclovir

The drug acyclovir is useful in relieving or suppressing the symptoms of genital herpes.

The nurse is using the pediatric Glasgow Coma Scale to assess a child's level of consciousness. What would the nurse assess?

The pediatric Glasgow Coma Scale assesses level of consciousness using three parts: eye opening, verbal response, and motor response.

A group of nursing students are reviewing the functions of white blood cells. The students demonstrate an understanding of the information when they identify which white blood cell as responsible for combating allergic disorders? monocytes eosinophils neutrophils lymphocytes

eosinophils Explanation: Eosinophils function to combat allergic disorders and parasitic infestations. Neutrophils function to combat bacterial infections. Lymphocytes function to combat viral infections. Monocytes function to combat severe infections

The labor and delivery nurse is caring for a mother who has demonstrated polyhydramnios upon delivery. The newborn displays copious, frothy bubbles of mucus in the mouth and nose, as well as drooling. The nurse is concerned that the infant has what disorder?

esophageal atresia Explanation: Esophageal atresia refers to a congenitally interrupted esophagus where the proximal and distal ends do not communicate; the upper esophageal segment ends in a blind pouch and the lower segment ends a variable distance above the diaphragm. Polyhydramnios is often the first sign of esophageal atresia because the fetus cannot swallow and absorb amniotic fluid in utero, leading to accumulation. Omphalocele and gastroschisis are congenital anomalies of the anterior abdominal wall. Hiatal hernia involves a weakened diaphragm.

Preterm infants have more fragile capillaries in the periventricular area than term infants. This put these infants at risk for which problem?

intracranial hemorrhaging Fragile capillaries in the periventricular area of the brain put preterm infants at risk for intracranial hemorrhage. Closure of the fontanels (fontanelles) has nothing to do with fragile capillaries within the brain. Larger head size gives children a higher center of gravity, which causes them to hit their head more readily. Congenital hydrocephalus may be caused by abnormal intrauterine development or infection.

Which of these age groups has the highest actual rate of death from drowning?

toddlers Toddlers and older adolescents have the highest actual rate of death from drowning.

The nurse is caring for a child admitted to the hospital for sepsis. Which assessment finding is the most concerning?

urine output of 10 ml over 3 hours Explanation: Children with sepsis will show alteration in temperature, heart rate, respiratory rate, and white blood cell count. Septic shock with organ dysfunction is more serious and can be manifested by decreased urine output.

The nurse is caring for an infant recently diagnosed with oral candidiasis (thrush) who has been prescribed nystatin. Which statement by the infant's mother would suggest a need for further education?

"I will add the nystatin to her bottle four times per day." Explanation: Administer nystatin suspension four times per day following feeding, not mixed in the bottle, to allow the medication to remain in contact with the lesions. In the younger infant, apply nystatin to the lesions with a cotton-tipped applicator. Infants and young children often mouth their toys, so it is important to clean them appropriately. Explain to parents of infants with oral candidiasis (thrush) the importance of reporting diaper rash because fungal infections in the diaper area often occur concomitantly with thrush and also need to be treated.

A physician recommends a gastrostomy for a 4-year-old client with an obstruction. The parents ask the certified wound, ostomy, and continence nurse (CWOCN) what the surgery entails. What is the nurse's best response?

"The surgery creates an opening between the stomach and abdominal wall." Explanation: Ostomies can be created at various sites in the GI tract, depending on the child's clinical condition. A gastrostomy provides an opening between the stomach and the abdominal wall, and an esophagostomy communicates between the esophagus and an external site on the neck. Ostomies may be created at various sites in the small intestine (e.g., jejunostomy, ileostomy) or in the large intestine (e.g., colostomy).

The nurse is educating the family of a 7-year-old with epilepsy about care and safety for this child. What comment will be most valuable in helping the parent and the child cope?

"Use this information to teach family and friends." Families need and want information they can share with relatives, child care providers, and teachers. Wearing a helmet and having a monitor in the room are precautions that may need to be modified as the child matures. The child may be able to bike ride and swim with proper precautions.

The nurse is providing teaching to the parents of a child with varicella. Which statement by the parents indicates the teaching was successful? "We need to make sure that our child washes their hands frequently." "The lesions should eventually form soft crusts that drain." "We should apply alcohol to the lesions every 4 hours." "If our child has a fever, we can give them some aspirin."

"We need to make sure that our child washes their hands frequently." The child with varicella needs to wash their hands frequently with antibacterial soap to reduce bacterial colonization. A cool bath with soothing colloidal oatmeal may aid the skin discomfort. Alcohol would be too drying to the skin. Acetaminophen, not aspirin, should be used to reduce fever. The lesions should eventually crust over. Soft crusts with drainage may suggest an infection.

A child is experiencing an acute exacerbation of Crohn disease for which she is prescribed prednisone. The nurse teaches the parents and child about this medication. Which statement by the parents indicates that the teaching was successful?

"We should not stop this medication abruptly." Explanation: Prednisone is a corticosteroid. Stopping the medication abruptly could lead to adrenal insufficiency. Weight gain would be associated with corticosteroid use. Weight loss is associated with the disease. Corticosteroids help to reduce inflammation and suppress the normal immune response. Typically, anti-inflammatory agents such as mesalamine may appear in the stool. This indicates poor absorption.

The nurse is providing education to the parents of a 3-year-old girl with hydrocephalus who has just had an external ventricular drainage system placed. Which question is best to begin the teaching session?

"What questions or concerns do you have about this device?" Always start by assessing the family's knowledge. Ask them what they need to know. Knowing when to clamp the drain is important, but they might not be listening if they have another question on their minds. Autoregulation is too technical. Teaching should be based on the parents' level of understanding. Keeping her head elevated is not part of the information which would be taught regarding the drainage system.

The parents of a 10-month-old child bring the infant to the emergency department after finding the infant face down in the bathtub. The parent states, "I just left the bathroom to answer the phone." Which assessments are priority for the nurse to complete? Select all that apply.

Airway Respiratory status Circulation With a submersion injury, hypoxia is the primary problem. Therefore, assessment of the airway, breathing, and circulation (ABCs) are the primary assessments the nurse will complete. These guide implementation of resuscitative measures. Other assessments such as level of consciousness, vital signs, and pupillary response would be done once the child is stable. The nurse would also perform a complete assessment, looking for signs of child abuse (child mistreatment) once the child is stable.

A preschooler has celiac disease. The parent is preparing a gluten-free diet. The nurse knows that the parent understands the diet when the parent prepares which breakfast foods? Cheerios (oat cereal) and skim milk Wheat toast and grape jelly Eggs and orange juice Rye toast and peanut butter

Eggs and orange juice Explanation: Celiac disease is an immunological disorder in which gluten causes damage to the small intestines. Gluten is commonly found in grains. Children with celiac disease cannot digest the protein in common grains, such as wheat, rye, and oats. Providing foods with rye, wheat, and oats would cause the child to develop symptoms and worsen the situation.

The mother of a 10-year-old child diagnosed with rubella asks what can be done to help her child feel better during her illness. What information can be provided? Range of motion to prevent contractures. Encourage rest and relaxation. Antiviral medications can be prescribed. Antibiotic therapy may be initiated.

Encourage rest and relaxation. Rubella infection is usually mild and self-limited. The care given is normally supportive. Rest is encouraged. Medications administered are normally limited to antipyretics and analgesics. Antibiotic and antiviral therapies are not normally included in the plan of treatment. Range of motion is not needed as mobility of the client is not limited.

What is the leading cause of neonatal sepsis and death?

Group B streptococcus Explanation: Sepsis is a systemic overresponse to infection. It is very serious and can produce septic shock and death. In infants under the 3 months of age the most causative agents are group B streptococcus, Escherichia coli, Staphylococcus aureus, enteroviruses, and the herpes simplex virus. Any time a febrile, ill-appearing neonate is seen, a full septic work-up is done. Neonates have the poorest outcomes from sepsis. Neisseria meningitidis is one cause of sepsis in older children. The Epstein-Barr virus is a herpes virus that causes mononucleosis. The cytomegalovirus is a common herpes virus. It is spread through bodily fluids and is not necessarily a concern unless the person is immunocompromised or is pregnant.

The nurse is observing an infant who may have acute bacterial meningitis. Which finding might the nurse look for?

Irritability, fever, and vomiting Findings associated with acute bacterial meningitis may include irritability, fever, and vomiting along with seizure activity. Fontanels (fontanelles) would be bulging as intracranial pressure rises, and Kernig sign would be present due to meningeal irritation. Jaundice, drowsiness, and refusal to eat indicate a GI disturbance rather than meningitis.

The student nurse is discussing the plan of care for a child admitted to the hospital for treatment of an infection. Which action should be taken first? Obtain blood cultures. Obtain urine specimen for analysis. Initiate intravenous therapy. Initiate antibiotic therapy.

Obtain blood cultures. Explanation: When treating a child suspected of having an infection, the blood cultures must be obtained first. The administration of antibiotics may impact the culture's results. A urine specimen may be obtained but is not the priority action. Intravenous fluids will likely be included in the plan of care but are not the priority action.

A 12-year-old boy has just undergone a liver transplantation and is recovering. After performing a fingerstick puncture and assessing the results, the nurse administers a 10% solution of dextrose IV. What is the correct rationale for this intervention? Prevention of hypoglycemia Maintenance of electrolyte balance Prevention of T-cell rejection of the transplanted liver Reduction of hypertension

Prevention of hypoglycemia Explanation: Hypoglycemia is a major danger following liver transplantation because glucose levels are regulated by the liver, and the transplanted organ may not function efficiently at first. Assess serum glucose levels hourly by fingerstick puncture. A 10% solution of dextrose IV may be necessary to prevent hypoglycemia. Careful tissue matching before the transplantation is needed to reduce the possibility of stimulating T-cell rejection. Sodium, potassium, chloride, and calcium levels are evaluated approximately every 6 to 8 hours to be certain electrolyte balance is maintained, but potassium is rarely added to IV solutions because of the risk that renal failure has occurred. IV therapy with hypotensive agents such as hydralazine and nitroprusside may be needed to reduce hypertension.

A nurse practitioner suspects that a child has scarlet fever based on which assessment finding? An enanthematous rash White exudate on the tonsils Severity of the sore throat Red, strawberry tongue

Red, strawberry tongue Explanation: The characteristic assessment finding that distinguishes scarlet fever from other disorders is the appearance of the red, strawberry tongue. Sore throat, an enanthematous and exanthematous rash, and white exudate on the tonsils are also seen with scarlet fever, but it is the strawberry tongue that helps to confirm the diagnosis.

An adolescent comes to the clinic and is diagnosed with syphilis. The nurse discusses the treatment plan with the adolescent. In addition to medication, what instruction will the nurse give the adolescent? The sexual partners need to be tested. How the infection will progress if not treated. Syphilis is a reportable disease. Limit the number of sexual partners.

The sexual partners need to be tested. Syphilis is a sexually transmitted infection. It can be experienced by both men and women. The primary infection is treated with benzathine penicillin G injection. This will cure the infection. If not treated, the infection can develop into secondary, later, or tertiary stages. At the tertiary stage, the disease cannot be treated or reversed. The most important thing for the adolescent to understand besides the treatment is that all sexual partners need to be evaluated and treated. Otherwise, the disease will just continue to spread among all the partners. Additional teaching for this adolescent includes condom use and limiting the number of sexual partners.

The nurse is obtaining the history of an infant with a suspected intestinal obstruction. Which response regarding newborn stool patterns would indicate a need for further evaluation for Hirschsprung disease?

passed a meconium plug Correct response: passed a meconium plug Explanation: If the parent reports that the child passed a meconium plug, the infant should be evaluated for Hirschsprung disease. Constipation, not diarrhea, is associated with this condition; however, constipation alone would not necessarily warrant further evaluation for Hirschsprung disease. Passing a meconium stool in the first 24 to 48 hours of life is normal.

The nurse is caring for an infant who is at risk for increased intracranial pressure. What statement by the parent would alert the nurse to further assess the child's neurological status?

"She has been irritable for the last hour....seems like she is just upset for some reason." Irritability in an infant can be a sign of declining neurological function. Because infants are not able to answer questions pertaining to person, place and time, their neurological assessment must be catered to their level of development. The other responses would be typical and normal for an infant.

The parent of a 12-year-old child with Reye syndrome approaches the nurse wanting to know how this happened to the child, saying, "I never give my children aspirin!" What could the nurse say to begin educating the parent?

"Sometimes it is hard to tell what products may contain aspirin." Salicylates are in a wide variety of products, so consumers must read the small print very carefully or they will miss the warning. Two common medications containing salicylates are bismuth subsalicylate and effervescent heartburn relief antiacid. The parent needs to be receptive to further education, and raising the possibility the child was responsible does not accomplish that goal. The nurse should not state the obvious, but also should not minimize the situation. Encouraging the parent to ask for information and offering explanations in terms the parent will understand are important, but this response does not address the parent's assertion. Telling the parent not to worry is offering platitudes and false reassurance. Giving the description of what complications could happen with the disease would be inappropriate. This would only exacerbate the parent's concern, and it does not address how the child ingested salicylates.

A 7-year-old child with an earache comes to the clinic. The child's parent reports that 1 day ago the child had a fever and headache and did not want to play. When the nurse asks where it hurts, the child points to the jawline in front of the earlobe. What does the nurse expect the diagnosis will be for this child? Fifth disease Mumps Mononucleosis Measles

Mumps Explanation: Mumps begins with a fever, headache, anorexia, and malaise. Within 24 hours an earache occurs. When pointing to the site of pain, however, the child points to the jawline just in front of the earlobe. Mumps is contagious 1 to 7 days prior to the onset of symptoms and 4 to 9 days after the parotid swelling begins. Fifth disease is also known as the "slapping disease," as the rash on the cheeks look like someone slapped the child's face. Measles does not involve parotid swelling or earaches. Mononucleosis does involve swollen lymph nodes but they are in the neck and the axillary area.

Which assessment finding would suggest that a child's postoperative feeding schedule following pyloric stenosis surgery should be slowed?

Vomiting Explanation: Vomiting after a feeding suggests the pyloric valve is not yet able to accommodate feedings well, possibly from edema. Flatulence and semi-formed stools would be positive signs that motility is active and digestion is occurring. Falling asleep is a sign that the child is full and satisfied.

A 6-week-old infant is diagnosed with pyloric stenosis. When taking a health history from the parent, which symptom would the nurse expect to hear described?

Vomiting immediately after feeding Explanation: With pyloric stenosis the circular muscle pylorus is hypertrophied. This thickness causes gastric outlet obstruction. The condition is seen in younger infants starting at 3 to 6 weeks of age. The infant has projectile nonbilious vomiting. It occurs directly after eating and is not related to the feeding position. The infant is hungry shortly after eating. There is weight loss and/or dehydration. The treatment is a pyloromyotomy to reduce the increased size and increase the opening. Diarrhea is not associated with the disorder.

A young client arrives at the clinic with a rash on the trunk and flexor surfaces of the extremities. The parent informs the nurse that the rash started a day before on the exterior surfaces of the extremities; 2 days before, the child had a really bad rash on the face. The health care provider diagnoses the child with erythema infectiosum. The nurse tells the parent that this is also known as: pityriasis rosea. rosacea. fifth disease. enterovirus.

fifth disease. Explanation: Erythema infectiosum is also known as "fifth disease." It starts with a fever, headache, and malaise. One week later, a rash appears on the face. A day later, the rash appears on the extensor surfaces of the extremities. One more day later, the rash appears on the trunk and flexor surfaces of the extremities. Pityriasis rosea is a skin rash that begins with a large spot on the chest, abdomen, or back that is followed by a pattern of small lesions. It is self-limiting and can be treated with steroid creams. Rosacea is a chronic inflammatory skin condition that causes redness to the face. An enterovirus infection can many times cause the same symptoms as the common cold or it can include the respiratory system. It is contagious.

The most common complication of varicella is: pneumonia. scarring. encephalitis. secondary bacterial infections.

secondary bacterial infections. Explanation: Varicella starts with lesions that appear first on the scalp, face, trunk, and then extremities. The lesions begin as macules then develop into papules and finally clear, fluid-filled vesicles. These lesions are intensely pruritic. The most common complication of varicella is secondary bacterial infection caused by the child scratching the lesions. Other complications include pneumonia, scarring, and encephalitis.

The nurse is providing teaching to the parents of a child recently prescribed carbamazepine for a seizure disorder. Which statement by a parent indicates successful teaching?

"I need to watch for any new bruises or bleeding and let my health care provider know about it." Carbamazepine is an antiseizure medication. It can cause bone marrow depression, so parents need to watch for any signs of bruising, bleed, or infection and notify their health care provider if this happens. Administer this medication with food to minimize GI upset. This medication can cause drowsiness, so do not give any sleep-inducing or other sedative type medications. Antiseizure medication does not cure seizures; it only controls the seizures. Lifelong antiseizure medication may be needed.

A 7-year-old client has been complaining of headache, coughing, and an aching chest. The care provider makes a diagnosis of a viral infection. The child's mother tells the nurse that when she first said she had a headache, the child's father gave her half of an adult aspirin. The mother has heard of Reye syndrome and asks the nurse if her child could get this. Which statement would be the best response by the nurse?

"This might or might not be a problem. Watch your daughter for signs of lethargy, unusual irritability, confusion, or vomiting. If you notice any of these, bring her to the emergency room immediately so she can be checked for Reye syndrome." Reye syndrome usually occurs after a viral illness, particularly after an upper respiratory infection or varicella (chickenpox). Administration of aspirin during the viral illness has been implicated as a contributing factor. As a result, the American Academy of Pediatrics recommends that aspirin or aspirin compounds not be given to children with viral infections. The symptoms appear within 3 to 5 days after the initial illness: The child is recuperating unremarkably when symptoms of severe vomiting, irritability, lethargy, and confusion occur. Immediate intervention is needed to prevent serious insult to the brain, including respiratory arrest.

The nurse provides education to the parent of an infant being treated for hydrocephalus with a ventriculoperitoneal (VP) shunt. Which statement by the parent indicates the need for further instruction?

"This shunt is the only surgery my baby will need." Hydrocephalus results from an imbalance in the production and absorption of CSF. In hydrocephalus, CSF accumulates within the ventricular system and causes the ventricles to enlarge, and increases in ICP subsequently occur. A VP shunt can be used to drain excess CSF, but it will need to be replaced as the child grows, requiring shunt revision surgery at various times during the client's life. The parent should be taught to monitor for signs and symptoms of increased ICP, which include irritability and vomiting. Increased ICP indicates the shunt is not functioning properly.

The nurse is providing care to a child who has had an appendectomy for a perforated appendix. The nurse would anticipate intravenous antibiotic therapy for how long? 5 to 7 days 3 to 5 days 7 to 14 days 1 to 3 days

7 to 14 days Explanation: The child with a perforated appendix requires 7 to 14 days of intravenous antibiotic therapy. If the child has a suppurative or gangrenous appendix that was not perforated, 2 to 3 days of antibiotics would be most likely ordered.

A 10-year-old child has an unknown infection and will need to provide a urine specimen for culture and sensitivity. To assure that the sensitivity results are accurate, which step is most important? Collect three specimens on three different days. Use aseptic technique when getting the specimen. Ensure that the specimen is obtained from proper area. Obtain specimen before antibiotics are given.

Obtain specimen before antibiotics are given. Explanation: In order to ensure a successful culture, the nurse must determine if the child is taking antibiotics. Throat cultures require specimens taken from the pharyngeal or tonsillar area. Stool cultures may require three specimens, each on a different day. The nurse would use aseptic technique when getting a blood specimen as well as the urine, but antibiotics cannot be received by the child prior to the test being done.

An 18-month-old infant is brought to the emergency department with flu-like symptoms. The infant is diagnosed with pneumonia secondary to aspiration of stomach contents. The nurse explains to the parents that pneumonia is a condition that often occurs secondary to:

gastroesophageal reflux disease. Gastroesophageal reflux (GER) is the passage of gastric contents into the esophagus. These refluxed contents may be aspirated into the lungs. The child with gastroesophageal reflux disease may present with the physical findings of pneumonia or GER-induced asthma. GER may cause apnea or an apparent life-threatening event in the younger infant. Pneumonia can occur in children with cystic fibrosis, but the child would need to have the cystic fibrosis diagnosis first. Hirschsprung and inflammatory bowel diseases are diseases of the gastrointestinal tract that do not present with respiratory symptoms.

To detect complications as early as possible in a child with meningitis who's receiving IV fluids, monitoring for which condition should be the nurse's priority?

Cerebral edema The child with meningitis is already at increased risk for cerebral edema and increased intracranial pressure due to inflammation of the meningeal membranes; therefore, the nurse should carefully monitor fluid intake and output to avoid fluid volume overload. Renal failure and cardiogenic shock aren't complications of IV therapy. The child with a healthy heart wouldn't be expected to develop left-sided heart failure.

The nurse is administering an enteral feeding to a child with a gastrostomy tube (G-tube). Which action will the nurse take when administering a prescribed feeding through the client's G-tube? Check for gastric residual before starting feeding. Position the client with the head of the bed at a 20° angle. After feeding, flush the tube with a small amount of saline and leave the G-tube open for 2 minutes. Use a syringe plunger to administer the feeding.

Check for gastric residual before starting feeding. Explanation: The nurse should check for gastric residual before starting feeding by gently aspirating from the tube with a syringe or positioning the tube below the level of the stomach with only the barrel of the syringe attached. The client should be positioned with his or her head elevated 30° to 45° and the formula should be allowed to flow with gravity, not plunged unless the tube is clogged. After feeding, the nurse should flush the tube with a small amount of water, unless contraindicated, and leave the G-tube open for 5 to 10 minutes after feeding to allow for escape of air.

A nursing instructor is teaching the students about the standard and transmission-based precautions. What type of precautions require placing a client in an isolated room with limited access, wearing gloves during contact with the client and all body fluids or contaminated items, wearing two layers of protective clothing, and avoiding sharing equipment between clients? Airborne precautions Contact precautions Droplet precautions Standard precautions

Contact precautions Contact precautions means placing the client in an isolation room with limited access, wearing gloves during contact with the client and all body fluids, wearing two layers of protective clothing, limiting movement of the client from the room, and avoiding sharing equipment between clients. Standard precautions are used with every client. They involve good handwashing and the use of gloves for client contact. Airborne precautions are used for diseases where small particles are dispersed in the air. They require that the client be in a negative-pressure room and, in addition to standard personal protective equipment, the mask should be N95 or higher. Varicella would need airborne precautions. Droplet precautions are used for diseases such as pertussis, which produce large droplets. They require standard precautions plus a surgical mask, preferably with a face shield.

When caring for a child diagnosed with West Nile virus, the nurse will question which prescription from the primary health care provider? Monitor the client's cardiac status. acetaminophen every 4 to 6 hours PRN fever Place client on fall precautions. amoxicillin 40 mg/kg/day orally every 8 hours

amoxicillin 40 mg/kg/day orally every 8 hours Explanation: West Nile virus is transmitted to humans primarily through the bite of infected mosquitoes and manifestations include: fever, weakness, fatigue, balance problems, memory impairment, headache, myocarditis, hepatitis, myositis and orchitis, and rhabdomyolysis. Treatment is symptomatic. Since this is a viral illness, antibiotics would not be given and the nurse would question such prescriptions. It is appropriate to give acetaminophen for the fever or pain; place on fall precautions due to fatigue, balance problems, and weakness; and monitor the cardiac status for the development of myocarditis.

A 15-year-old male visits their health care provider's office reporting fever, headache, malaise, and pain with chewing and along the jawline just in front of the ear lobe. After asking his parent to leave the room, the client then tells the nurse that he is also experiencing testicular pain and swelling. Which condition does the nurse suspect this client is most likely experiencing? mumps poliomyelitis herpes zoster infectious mononucleosis

mumps Explanation: Initial symptoms of mumps include fever, headache, anorexia, and malaise. Within 24 hours, pain on chewing and an "earache" occurs. When the child points to the site of the earache, however, the child points to the jawline just in front of the ear lobe, the site of the parotid gland. By the next day, the gland appears swollen and feels tender; the ear becomes displaced upward and backward. Boys may also develop testicular pain and swelling (orchitis). None of the other conditions listed matches the symptoms indicated.

The nurse is attempting to control the infectious process while caring for a client. The nurse changes the client's wound dressing when the dressing becomes soiled. Which link of the chain of infection is the nurse interrupting with this intervention? mode of transmission reservoir portal of exit susceptible host

reservoir Explanation: The reservoir is the place where a microorganism grows and reproduces. Dressings left unchanged leave a dark, warm, moist environment for microorganisms to thrive. Covering the mouth and using personal protective equipment are ways to control portals of exit. Modes of transmission can be controlled with handwashing and personal protective equipment. The susceptible host is the person who is susceptible to developing an infection. Promotion of natural defenses is a good way to prevent infection.

The mother of a toddler tells the nurse during a routine well-child appointment that she is concerned because, "It seems like my son is falling and hitting his head all of the time." What is the best response by the nurse?

"Due to the size of their heads and immature neck muscles falling is common, but I will let the physician know your concerns." The head of the infant and young child is large in proportion to the body, and is the fastest-growing body part during infancy and continues to grow until the child is 5 years old. In addition, the infant's and child's neck muscles are not well developed. Both of these differences lead to an increased incidence of head injury from falls. The nurse should still let the physician know the mother's concerns in case there is another issue causing the falls.

The nurse is providing discharge teaching to the parents of a child recently diagnosed with a seizure disorder. The nurse determines learning has occurred with which statement(s) by the parents? Select all that apply.

"We will be sure to keep the area safe and turn our child on the side during seizure activity." "We should time the seizure and write down what happens during the seizure." The area should be made safe so injury does not occur during the seizure, and turning the child on the side helps maintain an open airway. Documentation of the seizure should be kept so the health care provider can review what occurred during the seizure. The child should not be restrained, because this will more likely lead to injury. Emergency medical services (EMS) only needs to be contacted if the child stops breathing; if any injury has occurred; if the seizure lasts for more than 5 minutes; or if the child is unresponsive to painful stimuli after the seizure. The other time EMS should be activated is if a child has a seizure for the first time, which does not apply to this case. The child's jaws should never be forced open.

A school-aged child is recovering from varicella. The parent calls the school nurse and states, "my child is feeling much better" and asks when the child can return to school. What information does the nurse provide the parent? "Your child may return to school when free of any lesions." "Your child may return to school when all of the lesions have crusted over." "Your child may return to school when there has been no fever for 48 hours." "Your child may return to school when a health care provider has given written permission."

"Your child may return to school when all of the lesions have crusted over." Varicella is a highly communicable disease. It is spread via airborne transmission or by direct contact with the nasopharyngeal secretions of an infected person. Varicella is communicable from 1 to 2 days before the rash occurs until all the vesicles have crusted over. The nurse would be correct in telling the parent the child cannot return to school, even though the child is feeling better, until all the vesicles have crusted over. The child does not have to be free of lesions. Being free of fever does not make the child less communicable. The child would not need a permission slip from the health care provider unless this is a specific requirement by the child's school district.

The parents of a child voice concern to the nurse that they believe their child has Lyme disease but their physician won't do the proper testing. The nurse reviews the chart to determine if specific testing for the disease has been performed. Which tests is the nurse looking for? erythrocyte-sedimentation rate (ESR) C-reactive protein (CRP) enzyme immunoassay (EIA) Western immunoblot immunofluorescent assay (IFA)

-enzyme immunoassay (EIA) -immunofluorescent assay (IFA) -Western immunoblot When testing for Lyme disease, the CDC recommends a two-step test—a sensitive enzyme immunoassay (EIA) or immunofluorescent assay (IFA), if positive, followed by a Western immunoblot test. CRP and ESR may be tested as an indication of inflammation in the body, but they aren't specific to Lyme disease.

A nurse is obtaining a history from the parents of a child diagnosed with an infection. The parents report that the child started running a fever a couple of days ago and that he "just didn't seem like himself." Then this morning, the child started having yellow-green discharge from the nose. The nurse would identify the child has just completed which stage of an infectious disease? incubation prodrome convalescence illness

Prodrome Explanation: The child is in the prodrome stage of the infection. Prodrome refers to the time from the onset of nonspecific symptoms—such as fever, malaise, and fatigue—to more specific symptoms. Incubation refers to the time from the entrance of the pathogen into the body to the appearance of the first symptoms. The illness stage is the time during which the child demonstrates signs and symptoms specific to an infection type. Convalescence refers to the time when the acute symptoms of the illness disappear.

The nurse is caring for a 7-year-old child in droplet precautions due to the diagnosis of pertussis. While visiting the child, which actions by the parents require the nurse to intervene? Select all that apply. The parents state, "We should postpone immunizing our 5-year-old since there has been contact with the infection." The parents remove their personal protective equipment (PPE) at the door before exiting, then wash their hands. The parents wear a respiratory mask when entering their child's room. The parents state, "We have been limiting our child's fluids to help decrease the amount of coughing." The parents state, "We will be sure to finish any antibiotic if our child is sent home with a prescription."

The parents state, "We should postpone immunizing our 5-year-old since there has been contact with the infection." The parents state, "We have been limiting our child's fluids to help decrease the amount of coughing." All close contacts who are younger than 7 years of age and who are unimmunized or underimmunized should have pertussis immunization initiated or the series completed according to the recommended dosing schedule. Fluids should be increased in order to help thin secretions and prevent dehydration during the infection. The parents are correct in removing their PPE at the door and washing their hands when leaving the room, and wearing a mask. All antibiotics should be finished in order to treat the infection adequately and prevent immunity to antibiotics.

Parents bring their 9-year-old child to the clinic for a well-child visit. They are concerned because several children in the neighborhood have developed Lyme disease and ask for suggestions on what to do to reduce their child's risk. What would be appropriate for the nurse to suggest? Select all that apply. -Wearing protective clothing when playing in wooded areas. -Contacting the health care provider if there is any area of inflammation that might be a bite. -Inspecting the skin closely for ticks after the child plays in wooded areas. -Removing ticks by rubbing them away from the skin with a credit card. -Dressing the child in dark clothing when going outdoors.

Wearing protective clothing when playing in wooded areas. Inspecting the skin closely for ticks after the child plays in wooded areas. Contacting the health care provider if there is any area of inflammation that might be a bite.

The nurse is caring for a child with a suspected head injury. The nurse observes for what response to the child's eye reflex examination that would indicate potential increased intracranial pressure (ICP)?

While assessing the child's pupils, there is no change in diameter in response to a light. To perform the child's eye reflex examination, the nurse will shine a penlight into the eyes and observe if the pupils constrict, which is a normal response. Lack of pupillary light reflex can indicate increased intracranial pressure (ICP). To perform the "doll's eye" reflex examination, the nurse will place the child in a supine position and move the head gently but rapidly to one side. During this movement, it is normal for the child's eye to move to the opposite side. If the child has increased ICP, this response will be absent. While the other options are potential signs of increased ICP, they do not demonstrate the child's eye reflex examination.

A mother is alarmed because her 6-week-old boy has begun vomiting almost immediately after every feeding. In the past week, the vomiting has grown more forceful, with the vomit projecting several feet from his mouth. He is always hungry again just after vomiting. At the physician's office, the nurse holds the child and offers him a bottle. While he drinks, the nurse notes an olive-size lump in his right abdomen. Which condition should the nurse suspect in this child?

pyloric stenosis Explanation: With pyloric stenosis, at 4 to 6 weeks of age, infants typically begin to vomit almost immediately after each feeding. The vomiting grows increasingly forceful until it is projectile, possibly projecting as much as 3 to 4 feet. Infants are usually hungry immediately after vomiting because they are not nauseated. A definitive diagnosis can be made by watching the infant drink. If pyloric stenosis is present, the sphincter feels round and firm, approximately the size of an olive in the right abdomen. Peptic ulcer disease in neonates usually presents with hematemesis (blood in vomitus) or melena (blood in the stool). Gastroesophageal reflux involves a small (1-2 tsp) volume and is not forceful. Appendicitis typically begins with anorexia for 12 to 24 hours; children do not eat and do not act like their usual selves. Nausea and vomiting may then occur, followed by diffuse abdominal pain.

The nurse is caring for a child following surgery due to a motor vehicle accident. The child suffered extensive damage to the small intestine resulting in short bowel syndrome. The parents voice concern to the nurse that their child will "never be the same." Which is the best response by the nurse?

"I cannot imagine what you are going through. We are here to support and educate you on your child's condition and treatments."

A nurse is assessing a 3-year-old child for possible bacterial meningitis. Which sign would indicate irritation of the meninges?

Positive Kernig sign A positive Kernig sign can indicate irritation of the meninges. A positive Brudzinski sign also is indicative of the condition. A positive Chadwick sign is a bluish discoloration of the cervix indicating pregnancy.

In caring for an infant diagnosed with pyloric stenosis the nurse would anticipate which intervention?

Prepare the infant for surgery. Explanation: In pyloric stenosis, the thickened muscle of the pylorus causes gastric outlet obstruction. The treatment is a surgical correction called a pyloromyotomy. The condition is not painful, so no analgesics would be needed until after surgical repair. The condition is not related to lactose in the diet, so changing to lactose-free formula would not correct the condition. A barium enema would be used to diagnose intussusception

The nurse has received the morning report on a group of pediatric clients. Which pediatric client will the nurse see first? a child exposed to Zika virus reporting headache, fever, and arthralgia a child reporting dark brown urine and a fine sandpaper rash a child with a positive monospot test reporting pharyngitis a child experiencing a rash with honey-colored crusts on the mouth

a child reporting dark brown urine and a fine sandpaper rash The child with a fine sandpaper rash and dark brown urine may be experiencing renal complications secondary to scarlet fever (group A streptococcus), and will be seen first. Treatment with penicillin or another antibiotic is needed. Pharyngitis is an expected symptom of mononucleosis, and treatment for mononucleosis consists of supportive measures. A child with a rash with honey-colored crusts most likely has impetigo (a skin infection). Headache, fever, and arthralgia are expected symptoms of Zika virus. Treatment for Zika virus consists of supportive measures.

The nurse is caring for multiple clients on the pediatric unit. Which child will the nurse see first? a child diagnosed with measles experiencing photophobia and coryza a child diagnosed with chicken pox reporting nausea and malaise a child with herpes simplex who is reporting mouth pain and pruritis a child with erythema infectiosum experiencing fatigue and confusion

a child with erythema infectiosum experiencing fatigue and confusion A child with erythema infectiosum experiencing fatigue and confusion is showing signs of decreased oxygenation, possibly related to aplasia of erythrocytes caused by the virus. A child with signs and symptoms of decreased oxygenation should be seen first. Nausea and malaise are symptoms of chicken pox. A child with herpes simplex will most likely report pain an pruritis. Signs and symptoms of measles include photophobia and coryza.

The nurse is reinforcing dietary teaching with the caregiver of a child diagnosed with celiac syndrome. Which foods would be permitted in the diet of the child with celiac syndrome? Select all that apply.

applesauce bananas skim milk The child is usually started on a gluten-free, low-fat diet. Skim milk and bananas are usually well tolerated. Lean meats, puréed vegetables, and fruits are gradually added to the diet. Wheat, rye, and oats (unless specifically gluten free) are not included in the diet.

A 3-week-old infant is diagnosed with pertussis. Which antimicrobial agent would the nurse expect the physician to prescribe?

azithromycin

The nurse and an adolescent are reviewing the adolescent's record of her headaches and activities surrounding them. What activity would the nurse identify as a possible trigger?

drinking three cans of diet cola Cola contains caffeine, which is an associated trigger. Intense activity, not regular exercise, may be a trigger. Odors, such as strong perfumes, may be a trigger. Changes in sleeping patterns may be a trigger.

A 4-year-old child is brought to the emergency department after being in a motor vehicle accident. The child experienced head trauma in the accident. When assessing the child, which will be the first change noted in the presence of increasing intercranial pressure?

change in level of consciousness A change in the level of consciousness is the initial finding in the client who is experiencing an increase in intracranial pressure.