Ch 30: Basic Pediatric Nursing Care

24. The best time to bathe an infant is: a. at bedtime. b. early in the morning. c. after a feeding. d. before a feeding.

ANS: D Bathing is usually done before a feeding to reduce the possibility of vomiting, regurgitation, or aspiration. REF: Page 965 TOP: Feeding Step: Planning

4. The nurse recognizes that children who have congenital abnormalities, malignancies, gastrointestinal (GI) diseases, or central nervous system (CNS) anomalies are grouped into a special category called: a. very dependent children. b. children requiring special education. c. children with special needs. d. children requiring long-term care.

ANS: C The definition of children with special needs includes congenital abnormalities, malignancies, GI diseases, and CNS anomalies. REF: Page 944 TOP: Children

41. The nurse recognizes that % of hospitalized children have special needs.

ANS: 35 thirty-five Children with special needs comprise 35% of the pediatric hospitalization admissions. REF: Page 944 TOP: Special needs children

42. The nurse is aware that visual acuity evaluation in a child is best assessed after the age of years.

ANS: 6 six A child's refraction does not reach 20/20 until about the age of 6. REF: Page 952 TOP: Visual acuity

40. The pediatric nurse, along with the primary caregiver(s), has a special duty to the child and the family.

ANS: teach The pediatric nurse is in a position to assess, instruct, and support children and their families about developmental progress, nutrition, and possible undiagnosed anomalies. REF: Page 943 TOP: Teaching

38. When the nurse is inserting a feeding tube in an 8-month-old, the most efficient safety reminder device (SRD) the nurse would use is a(n): a. mummy. b. clove hitch. c. jacket device. d. elbow device.

ANS: A The mummy restraint controls the arms and the body of the infant. REF: Page 967 TOP: Safety reminder devices (SRDs) Step: Planning

16. When the mother of a 3-year-old expresses concern about her daughter's slowed growth rate, the nurse's most informative response would be: a. "Three-year-olds have finished a growth spurt and now their coordination can catch up." b. "Children's growth is hereditary. She may be of small stature like you." c. "The growth of a 3-year-old is associated with their nutrition. How is she eating?" d. "Your daughter is healthy and happy. Don't worry about her growth right now."

ANS: A Three-year-olds slow down in their growth in a natural cycle. REF: Page 946 TOP: Growth

43. The nurse clarifies that the family-centered care approach terminates which policies? (Select all that apply.) a. Rigid visiting hours b. Age restrictions on visitors c. Exclusion of family during procedures d. Discouraging family to stay overnight e. Restricting parents from reading the chart

ANS: A, B, C, D, E Family-centered care terminates all the restrictive policies of traditional hospitals. REF: Pages 944-945 TOP: Family-centered care

39. The nurse welcomes the presence of the family in a pediatric unit because it reduces the stressors of hospitalization. Which are common stressors for the hospitalized child? (Select all that apply.) a. Separation b. Lack of love c. Fear of pain d. Unfamiliar food e. Loss of control

ANS: A, C, E Parents lend stability and comfort for the child and restore his or her sense of control. REF: Page 944 TOP: Parents on the pediatric unit

34. The nurse explains that for stability of the IV insertion site in an infant younger than 9 months of age, the insertion site is the: a. radial vein. b. scalp vein. c. femoral vein. d. brachial vein.

ANS: B A superficial scalp vein is the injection site for administering IV medication to infants younger than 9 months of age. REF: Page 975 TOP: IV medication

25. After feeding, the nurse should position the infant on the: a. stomach. b. right side. c. left side. d. back.

ANS: B After feeding, the infant is positioned on the right side to direct the food into the stomach. REF: Page 966 TOP: Feeding

26. When a safety reminder device (SRD) is used to protect a child, a responsibility of the nurse is to: a. apply it loosely. b. remove it every 2 hours. c. place it over clothing. d. apply only one type.

ANS: B Any SRD should be removed every 2 hours. REF: Page 967 TOP: Safety

12. An 8-year-old child asks how a blood pressure is taken. The nurse should reply: a. "This small machine will measure your systolic and diastolic pressure." b. "The armband will hug your arm and tell me how well your blood is going through your arm." c. "The armband will cut off your circulation for a while and then we can hear when it comes back." d. "When you are ill we need to know if your blood is still moving in your body."

ANS: B Because children are upset by unfamiliar procedures, it is best to explain each step in simple terms. It is best not to mention anything that may increase anxiety. REF: Pages 957-958 TOP: Vital signs

35. Following a lumbar puncture of a 2-year-old, the nurse: a. keeps the child flat for several hours. b. allows the child to play at will. c. holds the child in a flexed position for 5 minutes. d. stands the child upright immediately.

ANS: B Children younger than 3 years of age are usually not affected by post-lumbar headache. These children are allowed to play at will following a lumbar puncture. REF: Page 970 TOP: Lumbar puncture

9. The nurse delays assessing the temperature in an infant because of the false elevation of temperature caused by the child: a. having a bowel movement. b. crying vigorously. c. having just eaten. d. having been in a cold room.

ANS: B Crying increases the temperature; eating and bowel movements do not. A cold room would lower the temperature. REF: Page 949 TOP: Vital signs

30. The toddler is receiving oxygen in a mist tent. One of the disadvantages of the tent is that it requires the nurse to: a. remove the restless child. b. change wet bedding and clothing as needed. c. open the mist tent at least once an hour. d. keep all objects outside of the tent.

ANS: B Frequent linen and clothing changes may be necessary because of the heavy humidity in the tent. REF: Page 971 TOP: Mist tent

2. Lillian Wald, a social reformer at the turn of the 20th century, founded the: a. National Commission on Children. b. Henry Street Settlement. c. White House Conference. d. U.S. Children's Bureau.

ANS: B Lillian Wald, regarded as the founder of public health, founded Henry Street Settlement, which provided nursing services and social assistance. REF: Page 942 TOP: Lillian Wald

32. The pediatric nurse warns student nurses about medicating newborns and young children because these children are: a. less susceptible to medication effects than adults. b. more susceptible to medication effects than adults. c. equally susceptible to medication effects as adults. d. less susceptible to all medications.

ANS: B Newborns and young children are more susceptible to the toxic effects of some medications than adults. REF: Page 972 TOP: Medication

29. When suctioning to remove secretions from an artificial airway, the nurse should limit the suction time to: a. 1 minute. b. 5 seconds. c. 10 seconds. d. 15 seconds.

ANS: B The nurse should limit suctioning to no more than 5 seconds. REF: Page 972 TOP: Tracheal suction

28. When a child with respiratory difficulties is placed in a mist tent, the nurse explains that the purpose of the tent is to: a. provide a constant oxygen supply. b. liquefy respiratory secretions. c. provide moisture to the mucous membranes. d. improve the infant's hydration.

ANS: B The purpose of the mist tent is to liquefy respiratory secretions. REF: Page 971 TOP: Mist tent

18. When assessing a neonate, the pediatric nurse should alert the head nurse or physician about which assessment finding? a. Crossed eyes b. A tuft of hair on the sacrum c. Purposeless movement of the arms d. Blue tint to the soles of the feet

ANS: B The tuft of hair along the spine is an indicator for spina bifida occulta. All other options are normal in the newborn. REF: Page 951 TOP: Newborn assessment

6. The pediatric nurse who uses the developmental approach in her practice will focus on: a. stimulation of the child to reach expected norms. b. age-centered care plans. c. strengths of the child. d. characteristics for the particular age.

ANS: C A developmental approach emphasizes the child's abilities and considers individuality. REF: Page 946 TOP: Developmental approach

36. The nurse can minimize an unpleasant-tasting drug by: a. pouring the drug over ice. b. squirting the drug in the mouth with a syringe. c. administering the drug through a straw. d. enlisting the parent's assistance.

ANS: C Administering the drug through a straw will diminish an unpleasant taste. Having the child hold the nose is helpful, as bad taste is associated with the smell of the drug. REF: Page 974 TOP: Medication

23. When attempting to provide information to the parents of a child undergoing surgery, the nurse notes that the parents appear confused and do not seem to remember what they are being told. This may be because of the: a. noisy environment. b. serious nature of surgery. c. increased level of parents' anxiety. d. developmental age of the child.

ANS: C Anxiety of the parents may result in confusion and forgetfulness. REF: Page 963 TOP: Hospitalization

27. Before performing a gavage feeding, the nurse should: a. hold the feeding tube under water to check for bubbling. b. check for gastric distention. c. aspirate stomach contents. d. ensure sterility of feeding equipment.

ANS: C Aspirating stomach contents to confirm tube placement is the most effective test. REF: Page 967 TOP: Tube feedings

1. Dr. Abraham Jacobi focused attention on health problems in children and made a major stride toward their welfare by initiating: a. pediatric wards in hospitals. b. free inoculations against smallpox. c. milk stations in the city of New York. d. serving nutritious foods in orphanages.

ANS: C Dr. Abraham Jacobi, referred to as the father of pediatrics, initiated the establishment of milk stations in New York showing how to sanitize milk for children. REF: Page 942 TOP: Abraham Jacobi

21. When the newly admitted 2-year-old who was potty-trained before admission begins to wet the bed, the mother is frightened. The nurse can allay anxiety by saying: a. "Don't be concerned. Accidents happen." b. "Let's put a diaper on your child until this gets better." c. "The stress of hospitalization makes children regress a little." d. "Your child will relearn 'potty-training' if you are patient."

ANS: C It is not unusual for children to regress when hospitalized. REF: Page 960 TOP: Hospitalization regression

14. When assessing jaundice in an African-American child with sickle cell anemia, the nurse should: a. examine the sclera. b. press the edge of the pinna. c. apply pressure to the gum. d. compare the color on the soles of the feet.

ANS: C The gums in individuals with dark complexions can be used to assess jaundice by pressing the gums about the teeth. REF: Page 951 TOP: Jaundice

33. The nurse preparing to administer an IM injection to a 2-year-old recognizes the preferred injection site for a child of this age is the: a. deltoid muscle. b. upper thigh. c. mid-thigh. d. gluteus.

ANS: C The primary site for an IM injection for a 2-year-old is the vastus lateralis. REF: Page 976, Box 30-10 TOP: IM medication

3. When the pediatric nurse is attempting to establish a trusting relationship with a child, the most important and lasting thing to be done is to: a. convey respect. b. talk with the child. c. be honest. d. talk with family.

ANS: C To establish a trusting relationship, the most important thing is to be honest. REF: Page 943 TOP: Pediatric nurse

31. The nurse recognizes that getting the hospitalized child to eat adequate amounts of food can be a challenge. One way to enhance nutrition is to: a. reward with sweets for eating meals. b. discourage participation in noneating activities. c. administer large amounts of nutritious fluids. d. leave nutritious finger foods out for the child to eat.

ANS: C Using nutritious liquids may satisfy the nutritional needs when a toddler is "too busy" to eat. Toddlers should not be left to eat unsupervised because of the danger of aspiration. REF: Page 966 TOP: Nutrition

17. The nurse explains to the anxious parents that the administration of an opioid analgesic to their 3-year-old is: a. likely to cause significant respiratory depression. b. done with the knowledge that addiction may occur. c. effective as a pain control method. d. given only in cases of severe pain.

ANS: C When administered to children, opioid analgesics do not have any greater respiratory depression than when given to an adult, and the risk of addiction is virtually nonexistent in children. It is an effective type of analgesia. REF: Page 962 TOP: Opioid analgesia

5. The mother of a child with diabetes asks the nurse in charge of the family-centered pediatric unit if she might see her child's laboratory reports. The nurse should reply: a. "Although the actual reports are not shared, I can tell you her blood sugar is 200 mg." b. "I'll write them down for you and bring them to your room." c. "Come to the conference room where we can have privacy while you look at them." d. "I'll notify the physician that you wish to see the reports."

ANS: C With a family-centered care approach, hospitals welcome parents, and parents have access to information 24 hours a day. REF: Pages 944-945 TOP: Family-centered care

7. When using anticipatory guidance to prepare a 5-year-old for an IM injection, the nurse should state: a. "Ethan, I'm going to give you a shot." b. "Ethan, the doctor wants you to have some medicine, and it will hurt." c. "Ethan, some medicine can only be given with a needle." d. "Ethan, I am going to give you some medicine that will sting, but only for a little while."

ANS: D Anticipatory guidance is the psychological preparation of a patient for a stressful event by explaining what will happen and the probable outcome. REF: Page 947 TOP: Anticipatory guidance

22. When initiating a care plan for a child with special needs, the nurse recognizes the probability that the child will be: a. accustomed to the hospital milieu. b. unable to adapt to the hospital setting. c. withdrawn and uncooperative. d. hospitalized for a longer period of time.

ANS: D Children with special needs who are hospitalized are more vulnerable to the emotional and developmental consequences of hospitalization and will have longer and more traumatic hospital stays. REF: Page 960 TOP: Hospitalization of child with special needs

8. When measuring the head circumference of an infant, the nurse should place the tape measure: a. across the eyebrows and around the occipital lobe. b. over the zygomatic arches and around the parietal areas. c. around forehead and around the crown of the head. d. above the eyebrows and pinnas and around the occipital lobe.

ANS: D Head circumference is measured in children up to 36 months above the eyebrows and pinnas and around the occipital lobe. REF: Page 948 TOP: Head circumference

11. Obtaining the respirations of an infant requires a modified approach from that of an adult because: a. infants breathe through their noses. b. infants have very rapid respirations. c. infants' respirations are thoracic in nature. d. infants' respiratory movements are abdominal.

ANS: D In children under 6 or 7 years of age, respiratory movements are abdominal. REF: Page 950 TOP: Vital signs

15. When discussing growth and development with the parents of a child, the nurse explains that nutrition is the single most important influence on: a. cognitive development. b. secondary sexual characteristics. c. production of blood cells. d. growth of bones and muscle.

ANS: D Nutrition is probably the single most important influence on growth. REF: Page 954 TOP: Nutrition Step: Planning

37. The pediatric nurse recognizes the significant developmental impact that a disfiguring facial wound could have on a: a. 4-year-old. b. 6-year-old. c. 10-year-old. d. 14-year-old.

ANS: D The adolescent fears a change in body image associated with surgery. REF: Page 963, Table 30-8 TOP: Surgery

13. The nurse compresses the nailbed of a child who has just received an arm cast to assess: a. loss of sensation. b. impending edema. c. perception of pain. d. peripheral circulation.

ANS: D The blanch test is done by pressing down on the free edge of the nail and comparing the return of blood flow to assess for peripheral circulation. REF: Page 951 TOP: Circulation

20. The parents ask about preparation of their toddler for hospital admission. The nurse suggests the child be told: a. a week prior. b. 2 weeks prior. c. the day of admission. d. only two or three days before.

ANS: D The nurse should suggest the toddler be told only days before. REF: Page 959 TOP: Hospitalization

10. To ensure accuracy of measurements, the nurse performs vital signs assessment in which order? a. Respiration, temperature, pulse b. Pulse, respiration, temperature c. Temperature, pulse, respiration d. Respiration, pulse, temperature

ANS: D The respiration is taken first on an infant before the child is disturbed, pulses are assessed next, and last the temperature is obtained. REF: Page 949 TOP: Vital signs

19. When communicating with a 5-year-old child, the nurse should: a. use two-word sentences and colored pictures. b. rely on short three-word sentences. c. use descriptive words with hand gestures. d. speak in no more than six-word sentences.

ANS: D When conversing with children, the nurse should use sentences with the number of words being equal to their age plus 1. A 5-year-old can follow a six-word sentence. REF: Page 957 TOP: Development