Exam 2 End of chapter questions
A mother calls the clinic because her 2-year-old daughter has a rectal temperature of 37.8°C (100°F). She wonders how high a fever should be before she should give medications to reduce it. What is the best response by the nurse? "All fevers should be treated to prevent seizures." "Antipyretics should be used with any rise in temperature. They can help change the course of the infection." "Give your child aspirin when her fever is above 38°C (100.4°F)." "In a normal healthy child, if your child is not uncomfortable, fevers less than 39°C (102.2°F) do not require medication."
"In a normal healthy child, if your child is not uncomfortable, fevers less than 39°C (102.2°F) do not require medication." Health care providers need to remember and to educate parents that fever is a protective mechanism the body uses to fight infection. Evidence exists that elevated body temperatures enhance various components of the immune response. Studies have shown that the use of antipyretics may actually prolong illness. Concern also exists that reducing fever may hide signs of serious bacterial illness. Aspirin should never be administered to children to reduce fever due to the risk of Reye syndrome.
The nurse is caring for a child with a developmental disability who is starting kindergarten this year. The mother is tearful and doesn't want the child to go to school. What is the best response by the nurse? "Do you need some time alone to collect yourself?" "You've known for a while this time would come." "Can I call your husband or a friend for you?" "It is normal to feel stressed or sad at this time."
"It is normal to feel stressed or sad at this time." (Increased stress in parenting a child with special needs occurs at transition times, such as school entry. The nurse should plan for this transition with the family, helping them to work through their feelings of stress.)
The nurse is caring for a child with cystic fibrosis who receives pancreatic enzymes. Which statement by the child's mother indicates an understanding of how to administer the supplemental enzymes? "I will stop the enzymes if my child is receiving antibiotics." "I will decrease the dose by half if my child is having frequent, bulky stools." "Between meals is the best time for me to give the enzymes." "The enzymes should be given at the beginning of each meal and snack."
"The enzymes should be given at the beginning of each meal and snack." The enzymes are necessary for appropriate digestion and absorption of food and nutrients. They must be given each time the child eats, usually in smaller doses for snacks than for meals.
After teaching a child's parents about the different methods of distraction that can be used for pain management, which statement by the parents indicates a need for additional teaching? "We'll have her focus on her hand and count each finger slowly." "We'll read some of her favorite stories to her." "We'll have her imagine that she's at the beach this summer." "She likes to play video games, so we'll bring in some from home."
"We'll have her imagine that she's at the beach this summer." Having the child imagine that she is at the beach this summer is an example of imagery, where the child creates a mental image that is positive or pleasurable. This is not an example of distraction; thus, the parents would need more instruction. Counting, reading favorite stories, and playing games, including video games, are forms of distraction. (See Also Page 424)
A 10-year-old child is admitted to the pediatric unit after experiencing a seizure. A complete, accurate, and detailed history from a reliable source is essential. What information would you ask for while obtaining the history?
"When did the event occur—while sleeping, eating, playing, just after waking? Provide a description of the child's behavior during the event—what types of movements; progression and length of seizure; respiratory status; any apnea? How did the child behave after the event? Have the episodes been recurrent, and if so how frequent? Have there been any precipitating factors, such as a fever, fall, activity, anxiety, infection, or exposure to strong stimuli such as flashing lights or loud noises?"
The parents of a child with a developmental disability ask the nurse for advice about disciplining their child. What is the best response by the nurse? "You should choose methods that are most congruent with your values about discipline." "Children like this really can't follow directions, so they may be very hard to discipline." "Punish your child only for socially unacceptable or offending behaviors." "Spanking works well for this type of child, as they really don't like pain."
"You should choose methods that are most congruent with your values about discipline." (Parents must choose the type of discipline that works best for them. The individual family's values related to childrearing should be incorporated into the child's plan of care.)
A 6-year-old child is admitted to the hospital because of a possible seizure. The child's mother calls the nurse to the room because the child is "jerking all over" and won't respond when she calls the child's name. List appropriate nursing interventions for this child. Prioritize the list of interventions.
1. Assess ABC's in the child.2. Prevent injury (loosen or remove tight clothing or necklaces if possible, turn child onto his side and open airway if possible, remove hazards).3. Time the seizure.4. Administer appropriate medication and treatments to stop seizure if ordered5. Remain calm and provide education + support to the child plus family6. Provide appropriate documentation (including a description of behavior seen, length of seizure, & response to interventions)
Sandra and Michael Graham have brought their 6-month-old son, Thomas, to the pediatric unit for observation. Thomas's head circumference has increased from the 25th percentile at the 4-month check-up to the 75th percentile at the 6-month check-up. Upon assessment, the nurse notes a bulging anterior fontanel and persistent primitive reflexes.
1. In the infant, the most obvious indication of hydrocephalus is often a rapid increase in head circumference.2. In the infant early signs of increased intracranial pressure includes:Bulging, tense fontanel, wide sutures, dilated scalp veins, high-pitched cry. Other early signs include: Vomiting, possibly projectile, decreased pulse and respirations, increased blood pressure or pulse pressure, pupil reaction time decreased and unequal, sunset eyes, changes in level of consciousness, irritability, seizure activity.3. Late signs of increased intracranial pressure include lowered level of consciousness, decreased motor and sensory responses, bradycardia, irregular respirations, Cheyne−Stokes respirations, decerebrate or decorticate posturing, fixed and dilated pupils.
A child is scheduled for a bone marrow aspiration at 4 p.m. The nurse would plan to apply EMLA cream to the intended site at which time? 1:30 p.m. 3:00 p.m. 3:30 p.m. 4:00 p.m.
1:30 p.m. To ensure the effectiveness of EMLA cream for a bone marrow aspiration, which is considered a deep procedure, the nurse would apply the cream 2 to 3 hours before the time of the procedure. Since the scheduled time is 4 p.m., applying the cream between 1 and 2 p.m. would be appropriate. If the procedure was a superficial procedure such as venipuncture or heelstick, then the nurse would apply the cream 1 hour before the procedure, at 3 p.m. (See Also Page 431 Box 14-1 Applying EMLA)
The nurse is providing teaching about accidental poisoning to the family of a 3-year-old. The nurse understands that a child of this age is at increased risk of accidental ingestion due to which sensory alteration? A lack of fully developed hearing. A less discriminating sense of touch. Visual acuity that has not fully developed. A less discriminating sense of taste.
A less discriminating sense of taste.
The 4-year-old presented in Question 3 above was diagnosed with varicella zoster virus. Write a nursing care plan for a child with varicella.
A nursing care plan for a child with varicella will be individualize for the child.In addition, teach the family that the child remains contagious until all lesions have crusted over, so the child may not return to preschool or day care until that time.
As the nurse in a pediatric clinic, you see a child who comes in because she is having extreme itching, especially at night. The child is diagnosed with scabies. The mother is upset and says to you, "We are clean people! I don't understand how this could happen!"
A. Explain that scabies can happen to anyone and it is not caused by being dirty. Scabies is contacted through direct close contact.B. Treatment: A scabicide, such as permethrin or lindane, should be applied to the entire body below the head. Treatment of infants and young children should include the head, neck, and body. The cream is left on for a specified time (usually 8 to 14 hours) depending on the type of scabicide. Careful instructions on proper use of any product should be given and strict adherence to application instructions should be urged. Itching may not subside for several weeks, even after successful treatment.C. Prophylactic therapy for household members. Bedding and clothing used by infested person or household or close contacts within 4 days before treatment should be laundered in hot water and dried on the hot cycle (mites do not survive more than 3 to 4 days without skin contact). Avoid direct skin-to-skin contact with person or items used by those infested.Room used by an infected person, especially if he or she had crusted scabies, should be thoroughly cleaned and vacuumed. Encourage adhering to instruction for application of treatment closely.
Bradley is 5-year-old with a history of moderate asthma who was started on oral steroids yesterday after visiting his pediatrician for an asthma exacerbation. In addition, he has been receiving aerosol treatments every 4 hours since yesterday. He received his last levalbuterol nebulizer treatment 3 hours ago. His mother has brought him back to the office because she is concerned that he does not seem to be getting any better.
A. Yes. Bradley should be placed on oxygen via face mask. Increased work of breathing and pallor indicate a need for oxygen supplementation.B. The nurse should note adequacy of breath sounds. Is Bradley aerating well in all lobes? Simple absence of wheezes is not enough information.C. The action of Beta-agonist bronchodilators is to relax smooth muscle. The albuterol treatment has eased bronchoconstriction somewhat, allowing for better air movement. Prolonged expiration occurs when bronchospasm is present. Bradley should continue to be observed very closely, as children may deteriorate quickly when suffering from an alteration in oxygenation or respiratory disorder.
A toddler has moderate respiratory distress, is mildly cyanotic, and has increased work of breathing, with a respiratory rate of 40. What is the priority nursing intervention? Airway maintenance and 100% oxygen by mask. 100% oxygen and pulse oximetry monitoring. Airway maintenance and continued reassessment. 100% oxygen and provision of comfort.
Airway maintenance and 100% oxygen by mask. Priorities of care for the child with respiratory distress are to clear the airway and provide oxygen supplementation.
How would you distinguish allergic conjunctivitis from acute bacterial conjunctivitis?
Allergic Conjunctivitis - may be more prevalent during allergy season, eye discharge is watery, eyes are itchy, the child is afebrile, and it may be accompanied by allergic rhinitisAcute Conjunctivitis - more prevalent when it is "going around" the school or day care setting, eye discharge is usually thick and mats, the eyes may hurt, the child may be febrile if the ears are also infected, and it may occur alone or in conjunction with acute otitis media
Which situation would cause the nurse to become concerned about possible hearing loss? A 12-month-old who babbles incessantly, making no sense An 8-month-old who says only "da" A 3-month-old who startles easily to sound A 3-year-old who drops the letter "s"
An 8-month-old who says only "da" Infants should be babbling at the age of 8 months. Lack of babbling is an indicator of possible hearing loss.
When developing the plan of care for a child in pain, the nurse identifies appropriate strategies aimed at modifying which factors influencing pain? Gender Cognitive level Previous pain experiences Anticipatory anxiety
Anticipatory anxiety
The nurse is caring for a 4-year-old girl who returned from the recovery room after a tonsillectomy 3 hours ago. She has cried off and on over the past 2 hours and is now sleeping. What areas should the nurse assess and focus on for this child?
Assess for frequent swallowing, as this may occur when early bleeding is present.Keep the child in a prone or side-lying position to facilitate drainage of secretions. If suction is required, do so carefully in order to avoid trauma to the surgical site. Adequate pain management is also critical in the postoperative period for tonsillectomy. When the child is awake again, encourage oral fluid consumption, avoiding red or brown fluids (so as not confuse emesis from them with blood) and citrus juices (which may irritate the throat).
A 5-year-old child is not gaining weight appropriately. Organic problems have been ruled out. What is the priority action by the nurse? Allow the child unlimited access to the sippy cup to ensure adequate hydration. Encourage sweets for the extra caloric content. Teach the mother about nutritional needs of the preschooler. Assess the child's usual intake pattern at home.
Assess the child's usual pattern at home The nurse must first assess the child's current intake to determine if there is a deficiency.
A 10-month-old girl is admitted to the pediatric unit with a history of recurrent pneumonia and failure to thrive. Her sweat chloride test confirms the diagnosis of cystic fibrosis. She is a frail-appearing infant with thin extremities and a slightly protuberant abdomen. She is tachypneic, has retractions, and coughs frequently. Based on the limited information given here and your knowledge of cystic fibrosis, choose three of the categories below as priorities to focus on when planning her care: Prevention of bronchospasm Promotion of adequate nutrition Education of the child and family Prevention of pulmonary infection Balancing fluid and electrolytes Management of excess weight gain Prevention of spread of infection Promoting adequate sleep and rest
B. Promotion of adequate nutrition C. Education of the child and family D. Prevention of pulmonary infection Children with cystic fibrosis require pancreatic enzyme supplementation with every meal and snack in order to achieve appropriate nutrient absorption. Additionally, supplemental fat-soluble vitamins are needed as well as a balanced high-calorie, high-protein diet in order for adequate growth to occur. Cystic fibrosis is a serious chronic illness that requires daily intervention throughout the individual's lifespan. The child and family experience continual changes and require intensive ongoing education and support. Vigorous pulmonary hygiene is critical in order to mobilize secretions and prevent pulmonary infection.
Which is the most appropriate treatment for epistaxis? With the child lying down and breathing through the mouth, apply pressure to the bridge of the nose. With the child lying down and breathing through the mouth, pinch the lower third of the nose closed. With the child sitting up and leaning forward, apply pressure to the bridge of the nose. With the child sitting up and leaning forward, pinch the lower third of the nose closed.
D. With the child sitting up and leaning forward, pinch the lower third of the nose closed. The child must not lie down, to prevent risk of aspiration. Nosebleeds most often occur in the lower third of the nose, so pinching should occur there.
An adolescent who is a competitive swimmer comes to the emergency department complaining of localized aching pain in his shoulder. He states, "I've been practicing really hard and long to get myself ready for my meet this weekend." The area is tender to the touch. The nurse determines that the adolescent is most likely experiencing which type of pain? Cutaneous pain Deep somatic pain Visceral pain Neuropathic pain
Deep somatic pain
CRITICAL THINKING EXERCISE: A boy with asthma is admitted to the pediatric unit for the fourth time this year. The mother expresses frustration that he is getting sick so often. Besides information about onset of symptoms and events leading up to this present episode, what other types of information would you ask for while obtaining the history?
Does the child experience episodes in relation to seasonal changes in pollen? Does the child also experience allergic rhinitis or atopic dermatitis? If so, what control measures are being used? Has the child been tested for allergies, and if these are known, what type of allergen control or prevention of exposure is being used? Is it on a consistent basis? Does the parent(s) smoke cigarettes, cigars, or a pipe? (Second-hand tobacco smoke is associated with an increase in asthma symptoms in children.) What is the child's socioeconomic status? (Poverty is a risk factor for increased asthma exacerbations.)
What has the most influence in deterring an adolescent from beginning to drink alcohol? Drinking habits of parents Drinking habits of peers Drinking philosophy of adolescent's culture Drinking philosophy of adolescent's religion
Drinking habits of peers
In developing a weight-loss plan for an adolescent, which would the nurse include? (Select all that apply.) Have parents make all of the meal plans. Eat slowly and place the fork down between each bite. Have the family exercise together. Refer to an adolescent weight-loss program. Keep a food and exercise diary.
Eat slowly and place the fork down between each bite. Have the family exercise together. Refer to an adolescent weight-loss program. Keep a food and exercise diary.
The nurse is preparing to assess the pain of a 3-year-old child who had surgery the day before. Which pain assessment method would be most appropriate for the nurse to use? FACES pain rating scale and poker chip tool FACES pain rating scale, observation of the child, and parent report Asking the parents to rate their child's pain using the word-graphic rating scale Visual analog scale
FACES pain rating scale, observation of the child, and parent report
Bryn Carle, a 6-year-old, is brought to the clinic by her mother. She presents with redness of the left eye, edema, and drainage. What other assessment information would be helpful? Based on the history and clinical presentation, Bryn is diagnosed with conjunctivitis. What education will be necessary for the family to assist in alleviating symptoms and preventing infectious spread?
Health History: does she attend school? Any cold symptoms, ear pain, or sore throat? Has here been any know infectious exposure? Does Bryn have any allergies? Ask Bryn if she has any eye pain, or if the eye itches. Determine the onset of symptoms and their progression as well as response to treatments used at home. Inspect the eye and drainage noting extent of edema and redness of the eyelid, and redness of conjunctivae. Note quantity, color, and consistency of discharge. Observe for signs of allergic or atopic disease, runny nose or cough.Teach parents how to apply eye drops or ointment and to use warm compresses to help loosen any crust that may accumulate on the eyelids overnight. Insure Bryn and her parents understand the importance of diligent handwashing in order to prevent spread. Discourage towel and washcloth spread. Bryn may return to school when mucopurulent drainage is no longer present (usually after 24 to 48 hours of treatment with a topical antibiotic).
The mother of a 3-year-old is concerned about her child's speech. She describes her preschooler as hesitating at the beginning of sentences and repeating consonant sounds. What is the nurse's best response? Hesitancy and dysfluency are normal during this period of development. Reading to the child will help model appropriate speech. Expressive language concerns warrant a developmental evaluation. The mother should ask her child's physician for a speech therapy evaluation.
Hesitancy and dysfluency are normal during this period of development Preschoolers often have a period of dysfluency and hesitancy in their language development, but it usually resolves by about age 4 years.
A 4-year-old child presents with a fever and rash. What three of the following items should the nurse obtain during the health history? Immunization history Any exposure to communicable or infectious diseases Whether the child takes a daily vitamin Thorough description and history of the rash Mother's immunization history
Immunization history Any exposure to communicable or infectious diseases Thorough description and history of the rash Immunization history and any exposure to communicable or infectious diseases can help identify infectious or communicable diseases the child is at risk for. Many childhood infectious and communicable diseases involve a rash. Rashes can be difficult to identify, so obtaining a thorough description and history from the caregiver is important.
A child is seen in the doctor's office after hitting his head while skateboarding. The child suffered no loss of consciousness, and has no external injuries and no significant past medical history. He is acting appropriately at this time. His only complaint is a dull headache. What instructions would you give the parents regarding his care at home? Include when they should seek further medical care.
Instruct parents or caregiver that a responsible adult must stay with the child for the next 24 hours and be ready to take the child to the hospital if necessary. The child may require close observation for a few days. Wake the child every 2 hours to ensure that he moves normally, wakes enough to recognize the caregiver, and responds to the caregiver appropriately. Instruct parents to call their medical provider or bring the child to the emergency room if: the child complains of a constant headache that gets worse; presents with slurred speech, dizziness that does not go away or happens repeatedly, or extreme irritability or other abnormal behavior; vomits more than twice; is clumsy or has difficulty walking; is oozing blood or watery fluid from the ears or nose; has difficulty waking up, unequal-sized pupils, or unusual paleness that lasts longer than 1 hour; or experiences any seizure activity.
The nurse is caring for a child who has received all possible medical care for cancer yet continues to experience relapse and metastasis. It is time to make the transition from curative care attempts to palliative care. What is the most important nursing consideration at this time? The health care professionals should make the decision about the child's care. The family may lose a sense of hope, so cancer treatments should continue. Involve the family in the decision-making process about the shift to palliative care. Palliative care can take place only at home, so the child should be discharged.
Involve the family in the decision-making process about the shift to palliative care. (Family-centered care should occur throughout all phases of care of the child with special needs. The parents should be involved in all decision-making processes related to the child's care.)
The mother of two sons, ages 6 and 9, states they want to play on the same baseball team. As the school nurse, what advice would you give their mother? Having the boys on the same team will make it more convenient for the mother. Levels of coordination and concentration differ, so the boys need to be on different teams. Put the boys on the same team because they are both school-age children. It is best to avoid putting the boys on the same team to prevent sibling rivalry.
Levels of coordination and concentration differ, so the boys need to be on different teams.
The nurse is caring for a hospitalized 4-year-old who insists on having the nurse perform every assessment and intervention on her imaginary friend first. She then agrees to have the assessment or intervention done to herself. The nurse identifies this preschooler's behavior as problematic; the child is old enough to begin to have a basis in reality. normal, because the child is hospitalized and out of her routine. normal for this stage of growth and development. problematic, as it interferes with needed nursing care.
Normal for this stage of growth and development Imaginary friends help the preschooler cope with stress in his or her life.
A 4-year-old complains of extreme pain when the tragus is touched. Though not diagnostic, this sign is most indicative of which disorder? Acute otitis media Acute tympanic effusion Otitis interna Otitis externa
Otitis externa Otitis externa, infection and inflammation of the ear canal, results in significant pain, particularly if the tragus is touched
A 1-month-old infant is admitted to the hospital to rule out sepsis. What would be your priority nursing interventions?
PRIORITY nursing interventions include providing close monitoring (including vital signs) and initiate intravenous antibiotic therapy which will be started immediately after the blood, urine, & cerebrospinal fluid cultures have been obtained manage fever to promote comfort
A 2-year-old has been prescribed eye patching for strabismus 6 hr/day. What teaching does the nurse provide for the mother? Try to patch 6 hr/day, but if you miss some, it is OK. Patching is necessary to strengthen vision in the weaker eye. Patching will keep the eye from turning in. Since the child is so young, patching can be delayed until school age.
Patching is necessary to strengthen vision in the weaker eye. Patching instructions must be complied with. Patching is done as early as possible to strengthen the acuity in the weaker eye while vision is still developing. Delay in strabismus treatment may lead to amblyopia and eventual blindness in one or both eyes.
The nurse is caring for an infant who has undergone surgery for infantile glaucoma. What is the priority nursing intervention? Place the child prone postoperatively for comfort. Teach the family use of the contact lens. Place elbow restraints on the infant. Provide a mobile for optical stimulation.
Place elbow restraints on the infant. It is very important to protect the operative site after any eye surgery. Elbow restraints prevent the infant from rubbing the eyes.
The mother of a 4-year-old asks for advice on using time-out for discipline with her child. What advice should the nurse give the mother? If spanking is not working, then time-out is not likely to be helpful either. Place the child in time-out for 4 minutes. Use time-out only if removing privileges is unsuccessful. The child should stay in time-out until crying ceases.
Place the child in time-out for 4 minutes The generally accepted guidelines recommend keeping the child in time-out for 1 minute per year of age.
A 10-year-old child is admitted to the hospital due to history of seizure activity. As his nurse, you are called into the room by his mother, who states he is having a seizure. What would be the priority nursing intervention? Prevention of injury by removing the child from his bed Prevention of injury by placing a tongue blade in the child's mouth Prevention of injury by restraining the child Prevention of injury by placing the child on his side and opening his airway
Prevention of injury by placing the child on his side and opening his airway Placing the child on his side and opening his airway can help prevent aspiration.
The public health nurse has been asked to provide information to local child care centers on controlling the spread of infectious diseases. What is the best information the nurse can provide? The etiology of common infectious diseases Proper handwashing techniques The physiology of the immune system Why children are at a higher risk of infection than adults
Proper handwashing techniques Frequent handwashing is the single most important way to prevent the spread of infection.
The nurse is caring for a 3-year-old with a gastrostomy tube and tracheostomy who is on supplemental oxygen and multiple medications. The mother is rooming in during this hospitalization. What is the priority nursing action? Incorporate the mother's assistance in care when convenient. Recognize the mother as the expert on her child's needs and care. Recommend that the mother go home to get some rest. Provide family-centered care since the mother is there.
Recognize the mother as the expert on her child's needs and care. (Parents of children with special health care needs are the experts on their child's care and desire to be recognized and respected as such.)
A neonate should be evaluated by a physician if which signs and symptoms are present? Acting fussier than normal Refusing the pacifier Rectal temperature above 38°C Mottling that is present during bathing
Rectal temperature above 38°C Neonates or young infants less than 3 months of age with a rectal temperature greater than 38° C are considered at risk for sepsis until proven otherwise and should be seen by a physician. Their immature immune system and inability to localize or handle infection put them at high risk for severe morbidity or mortality from bacterial infections.
Which activities will promote weight loss in an obese school-age child? (Choose all that apply.) Unlimited computer and TV time Role modeling by family Becoming active in sports Eating unstructured meals Involving child in meal planning and grocery shopping Drinking three glasses of water per day
Role modeling by family Becoming active in sports Involving child in meal planning and grocery shopping
The mother of the boy in the previous question tells you that she smokes (but never around the boy), the family has a cat that comes inside sometimes, and she always gives her son the medication prescribed. She gives salmeterol and budesonide as soon as he starts to cough. When he is not having an episode, she gives him albuterol before his baseball games. Diphenhydramine helps his runny nose in the springtime. Based on this new information, what advice/instructions would you give the mother?
Salmeterol is a long-acting bronchodilator and is used for prevention of symptoms, not treatment when they occur. Budesonide is an inhaled steroid, also used for prevention, not acute treatment of symptoms. Salmeterol and budesonide should be given daily as prescribed (usually twice daily) in order to prevent the child from experiencing wheezing episodes. When wheeze or a cough does begin, then albuterol (short-acting bronchodilator) is the drug of choice. The mother may want to speak with the physician or nurse practitioner about whether a different type of antihistamine other than diphenhydramine might be helpful to prevent allergic response.
Which is associated with early adolescence? (Select all that apply.) Uses scientific reasoning to solve problems Still at times wants to be dependent upon parents Incorporates own set of morals and values Is influenced by peers and values memberships in cliques
Still at times wants to be dependent upon parents-Is influenced by peers and values memberships in cliques
A 5-month-old infant with RSV bronchiolitis is in respiratory distress. The baby has copious secretions, increased work of breathing, cyanosis, and a respiratory rate of 78. What is the most appropriate initial nursing intervention? Attempt to calm the infant by placing him in his mother's lap and offering him a bottle. Alert the physician or nurse practitioner to the situation and ask for an order for a stat chest radiograph. Suction secretions, provide 100% oxygen via mask, and anticipate respiratory failure. Bring the emergency equipment to the room and begin bag-valve-mask ventilation.
Suction secretions, provide 100% oxygen via mask, and anticipate respiratory failure. Priorities of care for the child with respiratory distress are to clear the airway and provide oxygen supplementation. Children who experience respiratory distress often deteriorate very quickly, and the nurse must be prepared in the event of respiratory failure or arrest.
The parents of a 5-year-old with special health care needs talk to the parents of a 10-year-old with a similar condition for quite a while each day. What is the nurse's interpretation of this behavior? The nurse has not provided enough emotional support for the parents. This relationship between the children's parents is potentially unhealthy. Support between parents of special children is extremely valuable. Confidentiality is a pressing issue in this particular situation.
Support between parents of special children is extremely valuable. (Parent-to-parent support is extremely valuable. Only another parent in a similar situation really knows what it is like to have a child with special health care needs.)
A child is brought to the school nurse with intense itching. Upon assessment the nurse finds an erythematous, papular rash with excoriations on the child's hands and feet. As suspected, the diagnosis of scabies is confirmed. What teaching is necessary for the parents, family, and classmates of the child?
Teach the family how to apply the scabicide (entire body below head) and leave on for the prescribed amount of time. The entire family should be treated. Inform the family and child that despite successful treatment, itching may persist for several weeks. Any bedding or clothing worn within the 4 days prior to treatment should be washed in hot water and dried on the hot cycle. Classmates have already been exposed; if they develop a rash or itching, they should visit their pediatrician.
When compared with adults, why are infants and children at an increased risk of head trauma? The head of the infant and young child is large in proportion to the body and the neck muscles are not well developed. The development of the nervous system is complete at birth but remains immature. The spine is very immobile in infants and young children. The skull is more flexible due to the presence of sutures and fontanels.
The head of the infant and young child is large in proportion to the body and the neck muscles are not well developed. Infants and young children have a larger head size in relation to the body and a higher center of gravity. Both cause them to hit their head more readily when involved in motor vehicle accidents, bicycle accidents, and falls.
Compared with adults, why are infants and children at an increased risk for infection and communicable diseases? The infant has had limited exposure to disease and is losing the passive immunity acquired from maternal antibodies. The infant demonstrates an increased inflammatory response. Cellular immunity is not functional at birth. Infants have an increased risk for infection until they receive their first set of immunizations.
The infant has had limited exposure to disease and is losing the passive immunity acquired from maternal antibodies. The newborn displays a decreased inflammatory response to invading organisms, contributing to an increased risk for infection. Cellular immunity is generally functional at birth, and the humoral immunity system matures by encountering and then developing immunity to new diseases. Since the infant has had limited exposure to disease as well as losing the passive immunity acquired from maternal antibodies, the risk of infection is higher.
Describe the impact of a cerebral vascular accident in the child as compared with the adult. How does it affect the child's future? How will the nurse provide care differently for the child stroke victim as compared with the adult?
The outcomes reported for cerebral vascular disorders in children vary, but many children will develop some neurologic or cognitive deficit and this may alter growth and development. When caring for the child stroke victim, parental support and education will be essential in helping them care for a child who has new disabilities.
Samantha, a 10-year-old girl, is brought into your clinic for a well-child examination. Her mother states "Samantha's friend group seems to be so much more important to her these days." As the nurse caring for her, how would you explain the role of peers in the school-age child? This allows her the opportunity to learn conflict management. This helps her to shape her concept of self and provides security as she gains independence from her parents. This will encourage her to remain dependent on her teachers and family. This will help her to work through her fears of body safety.
This helps her to shape her concept of self and provides security as she gains independence from her parents
Which of the following are reasons that stealing occurs in school-age children? (Choose all that apply.) To escape punishment High self-esteem Low expectations of family/peers Lack of sense of property Strong desire to own something
To escape punishment Lack of sense of property Strong desire to own something Stealing in the school-age years occurs for multiple reasons: to escape punishment, because of a lack of sense of propriety or ownership, and because of a strong desire to own something they do not have because of lack of money or refusal by parents. Stealing also occurs when a school-age child has low self-esteem and high expectations from his family or peers that the child cannot meet.
Which of these factors contributes to infants' and children's increased risk for upper airway obstruction as compared with adults? Underdeveloped cricoid cartilage and narrow nasal passages. Small tonsils and narrow nasal passages. Cylinder-shaped larynx and underdeveloped sinuses. Underdeveloped cricoid cartilage and smaller tongue.
Underdeveloped cricoid cartilage and narrow nasal passages. Infants and children have smaller nasal passages than adults, thus making obstruction with mucus more common. The funnel shape of the larynx due to underdevelopment of the cricoid cartilage places children less than 10 years of age at increased risk of airway obstruction in the event of edema or mucus production.
A 13-month-old has been diagnosed with severe visual impairment. Develop a list of sample issues or concerns that might be identified in the nursing analysis.
a list of sampling nursing diagnoses for this patient include risk for injury, sensory/perceptual alteration (visual), altered family processes, fear, risk for altered growth and development, knowledge deficit, and inadequate coping
At a well-child visit, hydrocephalus may be suspected in an infant if upon assessment the nurse finds narrow sutures. sunken fontanels. a rapid increase in head circumference. increase in weight since last visit.
a rapid increase in head circumference. In the infant, the most obvious indication of hydrocephalus is often a rapid increase in head circumference. Assessment may also reveal bulging, tense fontanels with widening sutures.
When giving parents guidance for the adolescent years, the nurse would advise the parents to: (Select all that apply.) accept the adolescent as a unique individual. provide strict, inflexible rules. listen and try to be open to the adolescent's views. screen all of his or her friends. respect the adolescent's privacy. provide unconditional love.
accept the adolescent as a unique individual. listen and try to be open to the adolescent's views. respect the adolescent's privacy. provide unconditional love.
A 12-year-old boy presents with a very sore throat and fever. On assessment you find an erythematous rash on his face that feels like sandpaper. You obtain a throat culture, which is positive for group A streptococcus. What instructions would you give the parents regarding his care at home?
care at home would instruct the parents on the importance of taking the antibiotic as directed and finishing all the medicine, instruct them to encourage fluids to maintain adequate hydration due to fever, teach parents ways to provide comfort for the child, and discuss use of a cool mist humidifier to help soothe the child's sore throat; soft foods, warm liquids such as soup, or cold foods such as popsicles may also be helpful.trim the child's fingernails if the rash itches to help prevent infection due to breaks in the skin
The successful resolution of developmental tasks for the school-age child, according to Erikson, would be identified by learning from repeating tasks. developing a sense of worth and competence. using fantasy and magical thinking to cope with problems. developing a sense of trust.
developing a sense of worth and competence. School-age children develop a sense of worth and competence. Toddlers learn from repeating tasks. Preschoolers use fantasy and magical thinking. It is in infancy that the child develops a sense of trust.
A 4-month-old child with a history of hydrocephalus has undergone surgery for placement of a VP shunt. What information would you include in the teaching plan?
information included within the teaching plan includes signs & symptoms of a shunt infection, signs & symptoms of shunt malfunction, and signs & symptoms of increased ICPalso include ways to promote growth + development, need for future revisions as the child grows, and a referral to support groups
A 6-month-old infant is admitted to the hospital with suspected bacterial meningitis. She is crying, irritable, and lying in the opisthotonic position. The priority nursing intervention would be educate the family on ways to prevent bacterial meningitis. initiate appropriate isolation precautions and begin intravenous antibiotics. assess the infant's fontanels. encourage the mother to hold the infant and feed her.
initiate appropriate isolation precautions and begin intravenous antibiotics. Bacterial meningitis is a medical emergency and requires prompt hospitalization and treatment. Deterioration may be rapid and may occur in less than 24 hours, leading to long-term neurologic damage, and even death. Intravenous antibiotics will be started immediately after the LP and blood cultures have been obtained. Appropriate isolation needs to be initiated in any child with suspected or diagnosed bacterial meningitis.
Develop a sample plan for teaching a low-literacy parent about the etiology, treatment, and complications of recurrent acute otitis media.
the teaching plan should include SIMPLE explanations about etiology, treatment, and complications of recurrent Acute Otitis medical language should be avoided, pictures would be helpful
A 16-month-old toddler is being seen for his sixth ear infection. What particular information about his growth and development must the nurse ask about? Be specific about the questions you would ask.
when obtaining the health history, the nurse should ask the parent questions about onset of cooing, babbling, jabbering, and word formation; recurrent Otitis Media causes intermittent bouts of hearing loss that can significantly hinder speech & language development
