Chapter 30: Basic Pediatric Nursing Care

What was founded by Lillian Wald?

Henry Street Settlement -Lillian Wald, regarded as the founder of public health, founded Henry Street Settlement, which provided nursing services and social assistance.

What observation in an emergency department should lead a nurse to suspect child abuse in a child with a fractured arm?

Inconsistency between the injury and the parents' explanation of it -Special attention must be paid to injuries that are inconsistent with the parents' explanation.

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. What response by the nurse is the most appropriate?

"Come to the conference room where we can have privacy while you look at them." -With a family-centered care approach, hospitals welcome parents, and parents have access to information 24 hours a day.

When using anticipatory guidance to prepare a 5-year-old for an IM injection, what statement by the nurse would be most appropriate?

"Ethan, I am going to give you some medicine that will sting, but only for a little while." -Anticipatory guidance is the psychological preparation of a patient for a stressful event by explaining what will happen and the probable outcome.

An 8-year-old child asks how a blood pressure is taken. What would be the most appropriate response?

"The armband will hug your arm and tell me how well your blood is going through your arm." -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.

When the newly admitted 2-year-old who was potty-trained before admission begins to wet the bed, the mother is frightened. What statement by the nurse will be most helpful to the mother?

"The stress of hospitalization makes children regress a little." -It is not unusual for children to regress when hospitalized. Explaining that regression is normal during hospitalization will help allay the mother's anxiety.

The mother of a 3-year-old expresses concern about her daughter's slowed growth rate. What would be the most informative response by the nurse?

"Three-year-olds have typically finished a growth spurt, and you may notice a decreased rate in your daughter's growth." -Three-year-olds slow down in their growth in a natural cycle.

A disfiguring facial wound would have the most significant developmental impact on which child?

14-year-old -The adolescent fears a change in body image associated with surgery.

What is the maximum amount of time that a nurse should suction an artificial airway?

5 seconds -The nurse should limit suctioning to no more than 5 seconds.

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

6 -A child's refraction does not reach 20/20 until about the age of 6.

When measuring the head circumference of an infant, where should the nurse place the tape measure?

Above the eyebrows and pinnas, and around the occipital lobe -Head circumference is measured in children up to 36 months above the eyebrows and pinnas, and around the occipital lobe.

What should the nurse do to minimize an unpleasant-tasting drug?

Administer the drug through a straw -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. Pouring the drug over ice may result in the child not getting the entire amount of the drug. Squirting the drug into the mouth with a syringe will still allow the child to taste the medication. The parent's assistance should be enlisted, but will not minimize the taste of the drug.

Following a lumbar puncture of a 2-year-old, what should the nurse do?

Allow the child to play quietly at will -Children younger than 3 years of age are usually not affected by postlumbar headache. These children are allowed to play at will following a lumbar puncture.

What is the correct way to assess for the presence of jaundice in an African American child?

Apply pressure to the gum -The gums in individuals with dark complexions can be used to assess jaundice by pressing the gums about the teeth.

What should be done before initiating a gavage feeding?

Aspirate stomach contents -Aspirating stomach contents and aspirating a small amount of air while listening for stomach gurgling are the best ways to ensure correct tube placement. Holding the feeding tube under water to check for bubbling is not an effective method to check tube placement. Gastric distention would be important following the feeding. A gavage feeding is not a sterile procedure.

When the pediatric nurse is attempting to establish a trusting relationship with a child, what is the most important and lasting thing to do?

Be honest -To establish a trusting relationship, the most important thing is to be honest.

What is the best time to bathe an infant?

Before a feeding -Bathing is usually done before a feeding to reduce the possibility of vomiting, regurgitation, or stimulation.

The nurse clarifies that child abuse and neglect are complicated and preventable problems falling under which broader term?

Child maltreatment -Child maltreatment is a broad term used to describe neglect and abuse of children.

What is the special category that encompasses children who have congenital abnormalities, malignancies, gastrointestinal (GI) diseases, or central nervous system (CNS) anomalies?

Children with special needs -The definition of children with special needs includes congenital abnormalities, malignancies, GI diseases, and CNS anomalies.

What activity by an infant would cause a false elevation of the tympanic temperature?

Crying vigorously -Crying increases the temperature; eating and bowel movements do not. A cold room would lower the temperature.

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. What is the most probable cause of the parents' forgetfulness?

Increased level of parents' anxiety -Anxiety of the parents may result in confusion and forgetfulness. It is not known if the environment is noisy, if the surgery is serious in nature, or what is the developmental age of the child.

Why does obtaining the respirations of an infant require a modified approach from that of an adult?

Infants' respiratory movements are abdominal -In children under 6 or 7 years of age, respiratory movements are abdominal or diaphragmatic. Abdominal movements must be observed when counting respirations.

When communicating with parents suspected of child abuse, what should the nurse be sure to do?

Interact with them in a nonjudgmental manner -The nurse should maintain a nonjudgmental attitude toward the parents. The nurse does not have to tell the parents that she is reporting them. The nurse does not have to be sympathetic, she only has to be professional at all times. It is not the place of the nurse to suggest counseling.

What was one of the major strides in pediatric care made by Dr. Abraham Jacobi?

Milk stations in the city of New York -Dr. Abraham Jacobi, referred to as the father of pediatrics, initiated the establishment of milk stations in New York demonstrating how to sanitize milk for children.

When the nurse is inserting a feeding tube in an 8-month-old, what safety reminder device (SRD) should the nurse most likely use?

Mummy -The mummy restraint controls the arms and the body of the infant.

What is one way to enhance the nutrition of the hospitalized toddler?

Offer nutritious fluids frequently -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. Junk food should not be used as rewards. Activities are important and should not be discouraged.

How should an infant be positioned after a feeding?

On the right side -After feeding, the infant is positioned on the right side to direct the food into the stomach.

The parents ask about preparation of their toddler for hospital admission. When does the nurse suggest that the parents tell their toddler of the admission?

Only two or three days before -The nurse should suggest the toddler be told only days before. School-age children can be given more time to prepare. Adolescents should be told as far in advance as possible.

When a safety reminder device (SRD) is used to protect a child, what is a responsibility of the nurse?

Remove it every 2 hours -Any SRD should be removed every 2 hours.

What is the correct order for assessing vital signs in an infant to ensure the accuracy of measurements?

Respiration, pulse, temperature -The respiration is taken first on an infant before the child is disturbed, pulses are assessed next, and last the temperature is obtained.

The nurse clarifies that the family-centered care approach terminates which policies? (Select all that apply.)

Ridge listing hours, exclusion fo family during procedures, discouraging family to stay overnight, restricting parents from reading the chart. -Family-centered care terminates all the restrictive policies of traditional hospitals. Medication orders should still be followed.

Where is the typical IV insertion site in an infant younger than 9 months of age?

Scalp vein -A superficial scalp vein is the injection site for administering IV medication to infants younger than 9 months of age.

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.)

Separation, Fear of pain, Loss of control -Parents lend stability and comfort for the child and restore his or her sense of control.

What should be the focus of a practice where the pediatric nurse uses a developmental approach?

Strengths and abilities of the child -A developmental approach emphasizes the child's strengths and abilities and considers individuality. It builds on what the child can do instead of focusing on what the child cannot do.

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

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.

What should be included in the teaching plan for the parents of a 3-year-old child who has been prescribed an opioid analgesic?

The opioid is very effective as a pain control method. -It is an effective type of analgesia. 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.

What is a disadvantage of using a mist tent with a toddler?

The wet bedding and clothing must be changed frequently. -Frequent linen and clothing changes will be necessary because of the heavy humidity in the tent. The nurse can open the tent to soothe the restless child instead of removing the child. The tent does not have to be opened every hour. Toys can be placed inside the tent.

Why must the pediatric nurse be cautious about medicating infants and young children?

They are more susceptible to medication effects than adults. -Newborns and young children are more susceptible to the toxic effects of certain medications than adults.

What is the purpose of a mist tent?

To liquefy respiratory secretions -The purpose of the mist tent is to liquefy respiratory secretions. A constant oxygen supply can be given by methods other than a mist tent. A mist tent does not lower temperature or improve hydration.

What is the preferred IM injection site for a 2-year-old?

Vastus lateralis -The preferred site for an IM injection for a 2-year-old is the vastus lateralis.

After observing parental behavior that leads the nurse to suspect child abuse, when should the nurse report the abuse?

Whenever maltreatment of a child is suspected -Mandatory reporting of child abuse is required when the health care provider has reason to suspect the child has been abused.

When discussing growth and development with the parents of a child, the nurse explains that nutrition is the single most important influence on:

the growth of bones and muscle. -Nutrition is probably the single most important influence on growth.