Exam 3 Questions

A school-age child is admitted to the hospital in vasoocclusive sickle cell crisis. Place the prescriptions in the order of priority (first to last) that the nurse should implement them. All options must be used. 1 Start an intravenous infusion. 2 Administer morphine for the pain. 3 Draw blood for electrolyte levels and pH balance. 4 Start oxygen via nasal cannula.

1 Start an intravenous infusion. 2 Start oxygen via nasal cannula. 3 Administer morphine for the pain. 4 Draw blood for electrolyte levels and pH balance.

A 5-year-old child with burns on the trunk and arms has no appetite. The nurse and parent develop a plan of care to stimulate the child's appetite. Which suggestion made by the parent would indicate the need for additional teaching? offering the child finger foods that the child likes serving smaller and more frequent meals withholding dessert and treats unless meals are eaten deciding that the parent will feed the child

withholding dessert and treats unless meals are eaten Withholding certain foods until the child complies is punitive and rarely successful. Allowing the parent to feed the child, serving smaller and more frequent meals, and offering finger foods are all acceptable interventions for a 5-year-old child. This is true whether the child is well or ill.

The nurse in an outpatient clinic is conducting a follow-up assessment on a child who had a severe streptococcal infection 1 week ago. The client is doing better, and the nurse is providing teaching to the parents about continuing to monitor the client for possible complications of the infection. Which information is most important for the nurse to discuss with the parents?

"Return immediately if acute flank or mid-abdominal pain occurs." Explanation: Acute glomerulonephritis is a major complication of streptococcal infections in children. The onset is often marked by a sudden occurrence of acute flank or mid-abdominal pain. The child may show signs of fluid retention, such as weight gain and edema. Hypertension also commonly occurs.

The nurse is teaching the mother of a newly diagnosed diabetic child about the principles of the diabetic diet. Which statement by the mother indicates effective teaching? "Snacks are used to keep blood glucose at acceptable levels during times when the insulin level peaks." "By spreading the calories throughout the day in small, frequent meals, the risk of hyperglycemia is eliminated." "Most children find it difficult to eat all the calories required by their diets in three main meals." "Snacks are used to offset the desire for sweets and to keep the meals smaller so my child can eat better."

"Snacks are used to keep blood glucose at acceptable levels during times when the insulin level peaks."

A mother tells a nurse that her child has been exposed to roseola. After teaching the mother about the illness, which finding, if stated by the mother as the most characteristic sign of roseola, indicates successful teaching? high fever followed by a drop and then a rash normal temperature followed by a low-grade fever fever and sore throat cold-like signs and symptoms and a rash

high fever followed by a drop and then a rash

A preschool-age child with sickle cell anemia is admitted to the health care facility in vaso-occlusive crisis after developing a fever and joint pain. What is the nurse's highest priority when caring for this child? Maintaining protective isolation Administering antipyretics as ordered Applying cool compresses to affected joints Providing fluids

Providing fluids Explanation: During a vaso-occlusive crisis, sickle-shaped red blood cells (RBCs) clump together and obstruct blood vessels, causing ischemia and tissue damage. Therefore, the highest priority is providing I.V. and oral fluids, which promotes hemodilution and aids the free flow of RBCs through blood vessels. The client must be kept away from known infection sources but doesn't require protective isolation. Warm compresses may be applied to painful joints to promote comfort; cool compresses would cause vasoconstriction, which exacerbates sickling. Antipyretics may be administered to reduce fever but don't play a crucial role in resolving the crisis.

What is the most appropriate method to use when drawing blood from a child with hemophilia? Apply heat to the extremity before venipunctures. Use finger punctures for lab draws. Schedule all labs to be drawn at one time. Prepare to administer platelets.

Schedule all labs to be drawn at one time. Explanation: Coordinating labs to minimize sticks reduces trauma and the risk of bleeding.

A nurse is caring for a child with intussusception. What is an expected outcome for a goal to relieve acute pain from abdominal cramping? The child exhibits no manifestations of discomfort. The child has a normal bowel movement. The child has not vomited in 3 hours. The child is very still.

The child exhibits no manifestations of discomfort. Explanation: An expected client outcome for a goal to reduce acute pain related to cramping is that the client exhibits no manifestations of discomfort, such as crying or drawing the legs to the abdomen. Being very still may indicate either a pain state or a state of relaxation, and the nurse would need to assess the client further. Having normal bowel movements and not vomiting are desired outcomes, but the goal here is to relieve the pain.

A school-age child is being discharged with a diagnosis of rheumatic fever. Which instructions should be included in the teaching plan for the family?

The child should stay on penicillin and return for a follow-up appointment.

A school nurse is examining a student at an elementary school. Which findings would lead the nurse to suspect impetigo? Vesicular lesions that ooze, forming crusts on the face and extremities Small, red lesions on the trunk and in the skin folds Red spots with a blue base found on the buccal membranes A discrete pink-red maculopapular rash that starts on the head and progresses down the body

Vesicular lesions that ooze, forming crusts on the face and extremities

A school-aged child is admitted to the hospital with newly diagnosed insulin-dependent diabetes mellitus. On admission at 1000, his blood glucose is 180 mg/dL (10 mmol/L). He receives 10 units of regular insulin subcutaneously at 1030. The nurse should plan to: carefully regulate an IV solution of normal saline and NPH insulin at 1230. begin IV administration of 5% dextrose in water at 1100. encourage the child to drink at least 500 mL of a sugar-free clear liquid by 1130. assess the child beginning at 1230 for shakiness, feelings of anxiety, or decreased level of consciousness.

assess the child beginning at 1230 for shakiness, feelings of anxiety, or decreased level of consciousness.

The nurse is assessing a child with suspected juvenile hypothyroidism. Which signs or symptoms should the nurse expect this child to manifest? dry skin and constipation rapid pulse and heat intolerance short attention span and weight loss weight loss and flushed skin

dry skin and constipation Clinical manifestations of juvenile hypothyroidism include dry skin, constipation, sparse hair, and sleepiness. Short attention span, weight loss, moist flushed skin, rapid pulse, and heat intolerance suggest hyperthyroidism.

The nurse is planning interventions for a school-aged child hospitalized with acute poststreptococcal glomerulonephritis in need of diversional activity. Which activity should the nurse expect to include? watching a movie with a younger brother playing video games with a 4-year-old playing a card game with someone the same age putting together a puzzle with mother

playing a card game with someone the same age Explanation: Generally, school-age children enjoy activities with their peers first, then family members, and lastly younger children. School-age children like to be busy but also to accomplish something. This helps to meet their task of industry versus inferiority, feeling good about what they are able to accomplish. School-age children typically desire to carry a task to completion to achieve a sense of personal accomplishment.

A nurse is planning care for a 12-year-old with rheumatic fever. The nurse should teach the parents to: allow the child to participate in activities that will not tire him. provide for adequate periods of rest between activities. observe the child closely. encourage someone in the family to be with the child 24 hours a day.

provide for adequate periods of rest between activities. The nurse should teach the parents to provide for sufficient periods of rest to decrease the client's cardiac workload.

A nurse is taking a health history of a 10-year-child and discovers that the child has difficulties in urinary control during the day. The parents are confused about the condition and ask the nurse for help. What is the most appropriate response by the nurse? "Lack of urinary control during the day is indicative of a urinary tract infection." "You need to provide suitable undergarments to prevent embarrassment." "Your child must be forgetting to go to the bathroom during the day." "There may be a significant stressor in your child's life that's causing this."

"There may be a significant stressor in your child's life that's causing this." Diurnal enuresis is urinary incontinence that occurs during the day. It is most often caused by stress, urinary infections, or a defect of the urinary tract.

A nurse is assessing the growth and development of a 10-year-old. What is the expected behavior of this child? has a strong sense of justice and fair play is selfish and insensitive to the welfare of others enjoys physical demonstrations of affection is uncooperative in play and school

has a strong sense of justice and fair play School-age children are concerned about justice and fair play. They become upset when they think someone is not playing fair. Physical affection makes them embarrassed and uncomfortable. They are concerned about others and are cooperative in play and school.

What should the nurse include as a reason to seek prompt health care in the discharge teaching for the parents of a child following a sickle cell crisis? headaches and nausea skin rash and itching fatigue and lassitude sore throat and fever

sore throat and fever Children with sickle cell disease are prone to develop infections as a result of necrosis of areas within the body and a generalized less-than-optimal health status. If the child with sickle cell anemia develops signs of infection, such as sore throat and fever, prompt evaluation is necessary because an infection can precipitate a crisis.

What is the primary reason that the nurse inserts an indwelling urinary (Foley) catheter in a child with severe burns? to monitor for a urinary tract infection to measure urine output accurately to assess urine specific gravity to prevent urinary retention

to measure urine output accurately

According to Erikson's psychosocial theory of development, an 8-year-old child would be in which stage? Industry versus inferiority Initiative versus guilt Identity versus role confusion Trust versus mistrust

Industry versus inferiority

A child who was hospitalized for sickle cell crisis is being discharged. Which parent outcome demonstrates effective teaching regarding prevention of future crises? The parent verbalizes appropriate dietary restrictions. The parent participates in an aerobic exercise program. The parent verbalizes the need to stay away from persons with known infections. The parent verbalizes the need to restrict fluid intake.

The parent verbalizes the need to stay away from persons with known infections. Explanation: Preventing infections through proper hand washing and staying away from persons with known infections is an important measure in preventing sickle cell crises. Dietary restrictions aren't significant in preventing these crises. The client should maintain adequate hydration, not restrict fluid intake, and should avoid strenuous activity such as aerobics.