OB/PEDS (Pre-Quiz) 30-32

The parents of an 8-year-old state, "I am happy that our child is healthy," when the nurse says that the child falls into the 95th percentile for BMI. How should the nurse respond?

"For a child BMI between the 85th and 95th percentile alerts us to the risk for being overweight. Let's talk about your child's diet and activity level."

The nurse suspects poor literacy skills in a child's family member when which statement is made?

"I forgot my glasses, so I'll read this when I get home and let you know if I have questions."

The nurse has just finished administering the DTaP vaccine to a 2-month-old infant and is educating the parent about the immunization. Which statement is accurate?

"Bring your infant back for the second dose when the infant is 4 months old."

A parent wants to wait outside the room while a procedure is completed on the young child, saying, "I don't think I can stand to see you do this!" The nurse's best response is:

"Certainly. I will stay with your child during the procedure."

The nurse is obtaining a functional history during an admission assessment of a 12-year-old client. Which questions would be appropriate for the nurse to ask during this part of the assessment? (Select all that apply.)

"Do you use a computer or a smart phone?" "Can you tell me if you play any sports or participate in any physical activities?" "Do you wear a seat belt any time you are a passenger in a car?"

The nurse is preparing to assess the internal ear structures of a 3-year-old toddler. The toddler is resistant to the otoscope. How should the nurse respond?

"Let's see if I can find some puppies or kittens."

The parent of a toddler tells the nurse that the child had a fever the previous night. During the assessment, which statement by the parent indicates further discussion is necessary regarding temperature measurement?

"My mother said she always used a glass thermometer when I was a kid and it was very accurate. Maybe that would be better."

The nurse is discussing measles, mumps, and rubella vaccination with a parent who is concerned about using the combined vaccine for her 12-month-old. Which statements by the nurse will be most helpful to the parent in accepting the vaccine?

"The vaccine is shown to be effective and safe and will reduce the number of injections your child will need."

The parents of a 3-week-old child question the presence of light pink "spots" on the back of their baby's neck. The nurse checks the areas and recognizes they are salmon nevi. What response by the nurse is most appropriate?

"These are harmless and will gradually fade but may not go away."

Which statement is most appropriate when initiating a nursing action with a preschooler?

"These sticky snaps are for your chest."

The parent of a 4-day-old infant brings the child to the clinic concerned about the infant's hands and feet appearing blue. What is the nurse's best response during the admission process?

"This is often a normal occurrence in infants of this age but we will have the healthcare provider assess your baby."

Which question by the nurse is the best one to elicit complete information about a young client's immunization status?

"When and where did your child receive his last immunization?"

The nurse is explaining a diagnostic procedure to a 7-year-old child before the procedure begins. Which statement by the nurse best utilizes the principles of atraumatic care?

"You will lie on a special bed that moves in the machine but you can still see out."

How much ahead of time should nurses recommend that a school-ager be prepared for elective surgery?

A few days

The nurse is teaching home care to the parents of a 4-year-old child with asthma. Which information would be least important to the family's immediate needs?

Determining if the child should enroll in a preschool

A dental home establishes a continuing comprehensive relationship of care with the child and family. The American Academy of Pediatric Dentistry (AAPD) recommends this dental home be established by the time the child is age:

1 year

The nurse is assessing deep tendon reflexes on a child admitted for severe dehydration. The assessment reveals hyperactive reflexes. How should the nurse document this finding?

4+

When administering an injection in a child who is 18 months of age the nurse may utilize both intramuscular (IM) or subcutaneous sites. Intramuscular sites include the deltoid muscle and anterior thigh. The triceps is used for subcutaneous injections. The appropriate needle length for an IM injection into the deltoid muscle is

5/8 in

The nurse is visualizing the ear canal and tympanic membrane of a 14-month-old client. Which finding would warrant further investigation?

A bubble behind the tympanic membrane

The nurse is obtaining the health history for a 9-year-old child who has been brought to the ambulatory care clinic with complaints of a backache. Which initial action by the nurse is most appropriate?

Ask the child when the pain started.

The nurse is examining the testicles of a 6-year-old client. How can the nurse prevent a retractile testis from slipping back up the inguinal canal?

Ask the client to sit cross-legged.

A 14-year-old client has been brought to the pediatric ambulatory care clinic for a "sports physical" by her parent. The adolescent tells the nurse about not wanting to have the parent present during the examination. What action by the nurse is most appropriate?

Ask the parent to wait in a separate area nearby until the physical examination has been completed.

The parent of a 5 month-old tells the nurse that the child may have difficulty hearing. The nurse anticipates assisting with which hearing tests to assess this 5 month-old child's hearing? (Select all that apply.)

Auditory brain stem response Otoacoustic emissions (EOAE)

The nurse working with children and families knows there are certain universal screening tests all children should receive. Which tests are included in this group? (Select all that apply.)

Auditory brain stem response Phenylketonuria

During the health history of a 2-week-old neonate, the nurse discovers the child has not yet had a hearing screening. What test should the nurse schedule?

Auditory brain stem response test

A nursing student is asked to provide reasons it is important for the healthcare provider or nurse practitioner to have knowledge of the community in which the families and children seen in the practice live. Which reason(s) should the student provide? (Select all that apply.)

Awareness of agencies serving children results from knowing the community. Understanding the community promotes improved working relationships between families and healthcare providers. Knowing the community is necessary in developing appropriate health surveillance programs. The community can be a contributor to child-family health or a cause of illness.

When preparing to examine a 2-year-old child, which action by the nurse will best establish rapport?

Bend down to the child's eye level to establish contact.

The nurse practitioner inspects a toddler's teeth. The nurse practitioner encourages the family to establish a dental home in order to achieve optimal dental health for the various family members. Which does the nurse recognize as the rationale(s) for the establishment of a dental home? (Select all that apply.)

Certain dental interventions including fluoride treatments could significantly reduce the cost of oral care for children. Comprehensive health care is possible only if oral health is part of the equation. Dental care is the most unmet health need of children in the United States. A dental home with secure comprehensive care from infancy to adolescence Poor oral health care for children can result in systemic health problems.

The 4-year-old child due for a DTaP, IVP, MMR, and varicella vaccines has a runny nose, slight cough, and temperature of 99° F (37.2° C). What should be the response of the nurse?

Do the well-child examination and give the immunizations due.

The nurse is examining the back and spinal area of a 14-year-old client. A small dimple is noted. What action is most appropriate?

Document the finding as normal.

Choose the options that will assist nurses in overcoming some of the barriers to having children fully immunized. (Select all that apply.)

Checking the immunization status of siblings who accompany the child who has the healthcare appointment Using combination vaccines to reduce the number of injections children receive Using every health contact with the child (hospital, urgent care, emergency, and well-child visits) to check status/administer vaccines

A family is anxious for information about the status of their ill infant. The parents do not understand English, but the 14-year-old child is competent in spoken and written English. The healthcare provider is present, but an interpreter is unavailable. The nurse should:

Coordinate the healthcare provider and interpreter schedules and arrange an information-sharing session for later in the day.

The nurse is preparing to assess the respiratory rate of a crying 15-month-old child. To get the most accurate assessment, what approach should the nurse take?

Count after the child stops crying and is comfortable.

During a health maintenance visit, the nurse determines that a 12-year-old client is overweight for his age and height. Which approach for promoting healthy weight will help the client maintain self-esteem?

Emphasizing how activity and a nutritious diet promote health

An adolescent remarks rather sarcastically about feeling like a "lab rat." What is the priority nursing action?

Ensure information is shared with and decisions about care are made with and not for the adolescent.

The nurse is providing care for a 2-year-old child with a chronic respiratory disease present since birth. Which would be of least help in working effectively with the parents?

Expect parents to perform procedures precisely as taught.

A nurse asking questions during an infant's health surveillance visit has the parent tell her: "My baby was premature and weighed 3 lb at birth." The medical record provides an Apgar score of 5 at 5 minutes and indicates the child received gentamicin in the neonatal intensive care unit (NICU). What should the nurse consider as the greatest risk for this child?

Hearing deficit

The nurse is teaching a 15-year-old child with diabetes mellitus and the parents how to monitor glucose levels. Which communication technique is least effective?

Ignoring the adolescent's tirade about the therapy

During the health surveillance of a 13-year-old client, the nurse recorded the following information: blood pressure 108/48, pulse 70, respirations 18; dieting, dislikes meat; eats yogurt, drinks two glasses low-fat milk daily; gymnastics team member; fairly regular, normal menstrual periods. What risk would the nurse identify?

Iron-deficiency anemia

The nurse is doing a health history for a 14-year-old pregnant client during a health supervision visit. For which condition should the client be screened?

Iron-deficiency anemia

What action might the nurse take to stimulate trust and open communication with an adolescent?

Listen actively while maintaining a relaxed, open body posture

The nurse is performing a vision screening for a 2-month-old. Which technique should the nurse use?

Move a card with a black-and-white checkerboard pattern in a 180-degree arc past the infant.

A 5-year-old child is being seen at the ambulatory care clinic for a well-child visit. The child is hiding behind the parent. What initial action by the nurse is indicated?

Promise to give the child a small toy or sticker if the child will stop hiding.

A 5-year-old child is obviously relieved yet angry following a procedure he resisted and needed to be restrained to complete. Which nursing action may be most helpful to this kindergartener?

Providing Play-Doh for him to manipulate

The nurse is teaching the parents of a newborn with a metabolic problem about the disorder and its treatment. What is the least effective teaching technique?

Providing a print handout for the parent to read and asking for questions

The nurse is meeting an 8-year-old child with cancer and the family for the first time. What will best help to establish a relationship with the child and family? (Select all that apply.)

Redirecting the conversation to maintain focus Keeping both a relaxed posture and word flow Sitting at eye level with the child and parents

While examining a child, the nurse notes quiet, soft sounds each time the stethoscope is moved over the child's chest. The nurse knows that these are not breath sounds. What actions should the nurse take? (Select all that apply.)

Refer the child for further evaluation. Auscultate with the child lying down. Record the location and timing of the sounds. Auscultate with the child sitting up.

The parent of a 9-month-old child reports the child's eyes are often crossed. The nurse confirms this during the examination. What action is indicated?

Report the findings to the healthcare provider.

The nurse suggests to the parent of a preschooler who had unexpected surgery that the child be given a healthcare provider/nurse kit to play with at home. The nurse bases this advice on which reasons that this would be an effective strategy? (Select all that apply.)

Role-play is an age-appropriate, common form of play for preschoolers through which experimentation and learning occur. The preschooler can pretend to be a health care provider or nurse practitioner who has the power to control events that the child lacked as a recipient of care. The parent can observe the child's play to identify any misperceptions about the unprepared-for experience and correct them. The child can use the kit with dolls or stuffed animals to work through feelings about the health care experience.

The nurse is auscultating the heart of a 6-month-old child. Which finding would warrant further investigation?

S1 varies in intensity.

A nurse is working to provide health promotion services throughout the community. What institutions or organizations best serve as important avenues for disseminating health promotion information? (Select all that apply.)

Schools (public and private) Churches synagogues, and mosques Day-care centers

The nurse has worked diligently with an adolescent to meet teaching-learning needs and make adaptations for managing the adolescent's illness to suit the adolescent's preferences and lifestyle. Even so, there is evidence of noncompliance. The nurse's interpretation is:

Some noncompliance should be expected due to the adolescent's desire for independence, expression of personal values, and peer acceptance.

The nurse is teaching a 6-year-old child and the parent about home care for an eye infection. Which communication techniques would be least effective with this child?

Standing beside the child when doing the teaching

The nurse is working with an interpreter to meet the health needs of a family with limited skills in the English language. Which action is not recommended?

Talking one-on-one with the interpreter at numerous points throughout the session with the family

A single parent has brought her 9-month-old, recently adopted Chinese child for a health supervision visit. Although there are screening documents from China and the child seems healthy, the nurse plans to screen for infectious diseases. What explains the nurse's caution?

Testing by the child's home country is unreliable.

The nurse is assessing the learning needs for a 12-year-old child with a chronic health condition and the parents. Which aspect would be least pertinent to a learning needs assessment?

The family belongs to a mainline traditional faith community

The nurse is examining the heart and peripheral perfusion of an 8-year-old. The nurse will assess the apical impulse at which location?

The fifth intercostal space lateral to the left midclavicular line

The nurse is performing an abdominal assessment on a child. Which assessment techniques demonstrated by the nurse are appropriate when performing an abdominal assessment? (Select all that apply.)

The nurse uses percussion and notes dullness along the costal margins and tympany over the remainder of the abdomen. The nurse auscultates for bowel sounds in all four quadrants of the abdomen. The nurse uses the technique of inspection to assess for the presence of an umbilical hernia.

During the health history of a 3-month-old, the nurse identified risk factors for developmental delay and is preparing to assess the child's development. Which risk factors did the nurse find? (Select all that apply.)

The parent did not complete high school. The infant suffered a perinatal or congenital infection The infant's parent is a single parent.

Due to a certain warning sign, the nurse is anticipating that health supervision for a 7-year-old child will be challenging. Which indicator supports this concern?

The parents made several negative remarks about the child.

The student nurse is assessing a 9-year-old's cardiovascular system. Which assessment technique should the nurse further discuss with the student?

The student auscultates the heart at the third to fourth intercostal space just medial of the child's left midclavicular line.

The student nurse is performing an assessment of an infant. Which action by the student nurse requires further instruction by the instructor?

The student nurse asks the parents to step out of the room while performing the assessment.

The student nurse is preparing to administer an immunization to an 18-month-old child under the direction of a registered nurse. Which actions by the student nurse indicate the need for the registered nurse to intervene? (Select all that apply.)

The student nurse reports that IM injections are to be avoided for children under the age of 2 years. The student nurse reports plans to use a 20G needle for an IM deltoid injection The student nurse prepares the triceps muscle for the IM injection.

The nurse has just taken the blood pressure of a 13-year-old, and the percentile rank is 88%. Why would the nurse categorize the child as having an elevated blood pressure?

The teenager's blood pressure was 122/83.

A 14-year-old male client is brought to the clinic by his parent with concerns that he is developing an excessive amount of breast tissue. The examination confirms that he has slight enlargement of the breast tissue. What information should be relayed to the adolescent and the parent?

This is a normal and transient condition of adolescent males

A family of five seeks care for their preschooler with an upper respiratory infection. The facility has no medical record for the family. Why does the nurse encourage this family to establish a medical home?

To establish a continuing relationship with a healthcare provider or nurse practitioner

The nurse is caring for a 6-year-old child who will be undergoing a surgical procedure that will result in a temporary ileostomy. Which approach would be most effective in helping prepare the child for surgery?

Use a doll to role-play the events surrounding the surgical experience and the procedure.

The nurse is assessing the abdomen of a 3-year-old. Which finding should be reported immediately?

Visible peristaltic waves

A 5-month-old infant has had a head-to-toe assessment by the nurse, been examined by a teaching team of healthcare providers, and now experienced a blood draw. What behaviors might this infant manifest?

Yawning, turning away, and making little eye contact

When caring for hospitalized teens, nurses should choose their words and actions carefully since adolescents typically are concerned about:

appearing out of control of the situation and/or themselves.

A parent rooming-in with the 10-month-old infant appears upset following the visit of a consulting healthcare provider. The parent has questions but states, "The healthcare provider is always so busy." The nurse will:

assist the parent in preparing a list of questions for the healthcare provider's next visit.

A pediatric nurse will state that the priority reason to have a thorough grasp of the growth and development of children is to:

identify developmental risks or delays promptly

A ______ is dark purple-red. It is a flat patch that grows with the child

nevus flammeus (port wine stain)

_____ are pinpoint reddish macules that do not blanch when pressed

petechiae

The nurse is planning to teach children about healthy food choices. At what age can the nurse begin to teach the child or children directly?

preschool

______ are large purple macules created by bleeding under the skin.

purpura

The nurse is conducting a skin assessment of a newborn. The examination reveals a light pink macule on the back of the neck. The nurse understands that this is a normal variation and is most likely which type of birthmark?

salmon nevus

An urgent care nurse is cleaning a forehead laceration on a 7-year-old. The parent is present. The child is crying and screaming. The nurse should:

tell the child, "It's OK to cry, but I need you to hold still."

A new staff member asks veteran nurses about the meaning of atraumatic care for children. These nurses explain that the concept is based on:

the underlying premise of "do no harm."