Parent Child FINAL (Chapters 47, 48, 49, 50, 51, 52, & 53)

In the salt-losing form of congenital adrenal hyperplasia, the most important observation you would make in a newborn would be for:

Dehydration Rationale: With this form of the disorder, children are unable to produce aldosterone. This leads to the inability to retain sodium and fluid.

When a poison has been ingested by a child, what should the parents do first?

Call the local poison control center Rationale: Not all poisons should be vomited. Strong acids, for example, could cause as much destruction of tissue being vomited as being swallowed. The poison control center will provide the most accurate information on the next steps for the client.

An 8-year-old boy develops balanoposthitis. A finding of this is

Denuded, reddened surface of the glans of the penis Rationale: Balanoposthitis is inflammation of the glans and prepuce of the penis. These appear reddened and are painful.

A parent of a child diagnosed with seizures states, "I've heard about a special diet that may control seizures, I think it's called ketogenic. What can you tell me about it?" Which are appropriate responses by the nurse? (Select all that apply).

"About 40% to 50% of children who follow the diet have really good results" "The diet consists of high fat foods" "Protein is limited in this diet" Rationale: A ketogenic diet has been proven highly effective in 40% to 50% of the children who are started on it. The diet is high fat and low carbohydrate and protein. Bread and pasta are typically high in carbohydrates which is limited in this diet. This diet can be difficult for families to adhere to and incorporate into their lifestyle.

A postpartum patient is upset that the baby was born with a congenital port-wine birthmark on the skin of the upper part of the right side of the face. What should the nurse explain to the mother about this birthmark?

"The baby may have some numbness on the left side of the body because of the birthmark" Rationale: Sturge-Weber syndrome is characterized by a congenital port-wine birthmark on the skin of the upper part of the face that follows the distribution of the first division of the fifth cranial nerve. Because of involvement of the meningeal blood vessels, blood flow can be sluggish, and anoxia may develop in some portions of the cerebral cortex. The child will develop symptoms of numbness on the side opposite the lesion from destruction of motor neurons. This syndrome cannot be cured with medication. Removing the birthmark with surgery will not correct the long-term effects of the problem. The birthmark is not caused by a concentration of melanin in the skin. This problem has the potential to cause more than cosmetic health

When assessing school-age children for vision problem, which child would be most important for the nurse to assess for a deficiency in color perception?

A boy who does not participate well in art class Rationale: Color deficit is the inability to perceive color correctly. It occurs in 4% to 8% of boys because one of the sets of cones of the retina that perceive red, green, or blue is absent. It is important for the loss of color perception to be detected early so the child can learn changes in traffic signals or other color-dependent signs necessary for safety. The child who does not participate well in art class could be color blind. Since this is a condition that occurs in boys, the girls do not need to be assessed for color deficit. Color deficit is not associated with ear infections.

A school nurse is screening children for vision problems. Which child would the nurse identify as most important to screen for a deficiency in color perception?

A boy who says he does not like television Rationale: Color deficiency is a sex-linked trait, so it only occurs in males; middle ear infections are not associated with color deficiency.

You are counseling a couple about sexually transmitted diseases. The male partner has genital herpes. To prevent spread of the infection to the female partner, you advise the couple that

A condom should be used during intercourse Rationale: Condoms provide protection against the spread of sexually transmitted diseases as well as conception.

A nurse should recognize that which laboratory result would be most consistent with a diagnosis of diabetes mellitus?

A fasting glucose greater than 126 mg/dL Rationale: A fasting blood glucose greater than 126 mg/dL is diagnostic for diabetes mellitus.

When assisting parents plan home care for a child with Legg-Calve-Perthes disease, the nurse would teach the parents that which is anticipate?

A nonweight-bearing period initially occurs Rationale: Resting the affected femoral epiphysis aids healing.

An infant is born with congenital glaucoma. She is scheduled for surgery to relieve this condition at age 2 days. Which preoperative order would you question for her?

A preoperative injection of atropine Rationale: Glaucoma means the exit for intraocular fluid is blocked. A drug that causes pupil dilation narrows the exit of fluid further and, thus, is contraindicated.

A newborn was diagnosed as having hypothyroidism at birth. Her mother asks the nurse how the disease could be discovered this early. The nurse's best answer would be:

A simple blood test to diagnose hypothyroidism is required in most states Rationale: Hypothyroidism is diagnosed by a screening procedure a few days after birth.

The school nurse is observing a child in the classroom. The child is speaking and then suddenly stops and stares for about 5 seconds and then continues speaking. The nurse charts this as what type of seizure?

Absence Rationale: In absence seizures, a child will have a staring spell that lasts for a few seconds. Tonic-clonic seizures consist of all body muscles rapidly contract and relax. Febrile seizures are associated with a rapid rise in body temperature and follows the tonic-clonic pattern. Partial (focal) seizures originate from a specific brain area. The seizure movement will be localized to a certain part of the body.

An infant has been admitted to the emergency department with acetaminophen poisoning. Which of the following would you expect to administer?

Acetylcysteine Rationale: With acetaminophen poisoning, activated charcoal or acetylcysteine prevents hepatotoxicity by binding with the breakdown products of acetaminophen so it will not bind to liver cells.

A pediatric client has just been diagnosed with diabetes mellitus. What should the nurse do first?

Administer insulin Rationale: Insulin administration is the priority intervention when treating a newly diagnosed pediatric client with diabetes mellitus. Stress management, glucose checks, and nutritional consultation can all be implemented once therapy with insulin begins.

A child is to receive radiation therapy this morning. The nurse would expect to see which type of drug prescribed to this child?

Antiemetic Rationale: Radiation therapy causes nausea because it destroys rapid-growing cells. Among these are the cells of the stomach lining, the reason that nausea occurs.

The nurse is preparing a program for the parents of school-age children on ways to prevent hearing loss. What information should the nurse include in this program? (Select all that apply).

Avoid placing any objects into the ears Ensure that all immunizations are current The impact of chronic exposure to loud music when using earphones Protect the ears with earplugs or earmuffs when in loud environments Rationale: Strategies to protect hearing include not placing any objects into the ears, ensuring that all immunizations are current, understanding the impact of chronic exposure to loud music when using earphones, and protecting the ears when in loud environments. The nurse should teach that prompt treatment should be obtained for sore throats because these can lead to middle ear infections.

An infant is placed in Bryant traction. For Bryant traction to be effective, the infant must be positioned on the:

Back with hips off the bed Rationale: For there to be traction, the infant's hips must be off the bed. On the stomach or hips on the bed are not the correct positions for this child.

A new mother is concerned about the need to provide medication to a newborn every day for an indefinite period of time. What should the nurse encourage the mother to do to help ensure medication compliance? (Select all that apply).

Check the expiration dates on all medications Plan times for medications that fit in with the daily routine Build medication administration into the general home routine Rationale: To be successful in giving a medicine over a long time period, the mother should be urged to build administration into the family's general routine. Expiration dates for the medication should be checked. Plan the times for medication administration so that it allows for a normal lifestyle. Having to take medication during mealtimes is not pleasant and does not support a normal lifestyle. Be certain to anticipate the need to obtain prescriptions so medicine is always available.

A 3-year-old you meet has phenylketonuria. Which of the following foods would you question if you saw it on his lunch tray?

Chocolate pudding Rationale: Milk is high in phenylalanine. Therefore, milk and milk products are contraindicated.

A newborn is born with hypothyroidism. A complication of this disorder if it is not recognized and treated is:

Cognitive impairment Rationale: Congenital hypothyroidism can lead to extreme cognitive challenge impairment if not treated.

A child with cancer is receiving vincristine. It is most important to observe this child for which of the following side effects?

Constipation Rationale: A common side effect of vincristine therapy is constipation.

The nurse is caring for a child with a head injury and suspected intracranial pressure. What order would the nurse question?

Head of bed flat at all times Rationale: Immediate management of a head injury include keeping the child's head elevated, not flat to help decrease inflammation and edema. Administration of a steroid such as dexamethasone, administration of an osmotic diuretic such as mannitol and insertion of a center venous IV line are also included in the immediate management of a head injury.

A school-aged child with cancer is receiving chemotherapy. Which nursing action would best promote the oral comfort of a child receiving chemotherapy?

Keeping the child's lips moist with Vaseline to prohibit cracking Rationale: If a child has oral lesions from chemotherapy, acidic fruit juice or salt water would sting; vigorous tooth brushing would injure tissue further.

The nurse is caring for a school-age child newly diagnosed with juvenile arthritis. Which diagnosis would be a priority for this patient?

Knowledge deficit related to care needs Rationale: With newly diagnosed juvenile arthritis, the child and family will need to learn how to manage the symptoms by planning exercise and medication programs around school or other activities. Juvenile arthritis does not affect peripheral tissue perfusion. Because the child is newly diagnosed, it is premature to use the diagnosis of ineffective coping. There is no evidence that the child has imbalanced nutrition.

A sexually active adolescent female is concerned that she has contracted gonorrhea. Which finding should the nurse expect to assess if gonorrhea is present in this patient?

Slight yellow vaginal discharge Rationale: Although symptoms of gonorrhea in females are not as visible, there may be a slight yellowish vaginal discharge. The manifestations of a low-grade fever, ulcers on the perineum, and a frothy white vaginal discharge are not associated with gonorrhea.

A 3-year-old is scheduled for a surgery to correct undescended testes. An important postoperative consideration the nurse would want to prepare the parents for is

Some discomfort at the surgery site Rationale: After they are returned to the scrotum, testes may be sutured there to prevent them from returning to the abdominal cavity. This produces "tugging" or painful sensation.

An adolescent asks you how to best prevent vulvovaginitis. Your best answer would be to

Wipe from front to back after urinating or defecating Rationale: Vulvovaginitis may be caused by spread of E. coli from the rectum to the vagina.

Which diagnosis would be most appropriate for an infant with a large retinoblastoma after surgery?

Disturbed sensory perception related to enucleation Rationale: he primary therapy for a large retinoblastoma is removal (enucleation) of the affected eye.

At which age, is a child most likely to ingest a poison?

1 to 4 years old Rationale: Preschool children are most apt to swallow a poison. They have great mobility but lack judgment. The younger toddler is less likely to get into the poison and the older children are more aware to avoid.

What is the most important safety rule at hospital discharge you would want to teach the parents of a child who swallowed an overdose of acetaminophen?

Do not make taking medicine seem like fun Rationale: When children think that medicine is fun, they take it after an adult leaves to continue the "fun."

A 5-year-old develops an otitis media with effusion. Myringotomy tube insertion is scheduled. The mother asks, "Why does this have to be done at the hospital?" What would be your best response?

"He will need to lie still afterward, so he will need to remain at the hospital for a short time" Rationale: It is important that children lie still while the tubes are inserted so a portion of the tympanic membrane, important for hearing, is not punctured.

An important intervention to institute with an infant prior to surgery for a Wilms' tumor is to place a sign over his crib that reads:

"Do not palpate abdomen" Rationale: Because the kidney has such a rich blood supply, a Wilms' tumor metastasizes rapidly. It is suspected that excess handling causes even more rapid metastasis.

Before discharging a school-age child being treated for a snake bite, the nurse instructs ways to prevent additional bites in the future. Which statement indicated that the teaching provided to this child has been effective?

"I should look at rocks before touching them" Rationale: Common safety rules to avoid snake bites include being aware that snakes like to sit in the sun on warm rocks. The child should look at a rock before touching it to prevent a snake bite. Wearing long pants will not necessarily prevent snake bits. Snakes should not be poked or sprayed with water. Snakes should be identified in underbrush and under rocks. Snakes should also be identified by sound and markings.

An adolescent has fibrocystic breast disease. What is the best advice you can give her regarding this?

Caffeine may increase the size of lesions Rationale: Cystic breast lesions often swell and cause discomfort under the influence of caffeine.

A preschool-age child is recovering from a surgery to correct undescended testes expresses fear about having a "body part cut off." Which nursing diagnosis should the nurse use to guide care while addressing the child's concern?

Disturbed body image related to change in physical appearance Rationale: The postoperative evaluation after surgery to correct undescended testes should address the boy's feelings about the surgery and the changes in his body. He may need an opportunity to express his fears about mutilation or castration by playing with puppets or dolls after surgery. This surgery is not associated with fluid balance. The child will not have an altered physical appearance after the surgery. The child's fear is more than a knowledge deficit about the surgical procedure.

A school-aged girl is diagnosed as having Cushing syndrome from long-term therapy with oral prednisone. This means that the child:

Has purple striae on her abdomen Rationale: An effect of a corticosteroid is to produce striae on the abdomen. Elevated levels of corticosteroids also cause these during pregnancy.

You care for a 10-year-old boy with growth hormone deficiency. Which therapy would you anticipate will be prescribed for him?

Injections of growth hormone Rationale: Growth hormone deficiency occurs when the pituitary is unable to produce enough hormone for usual growth. Administering subcutaneous growth hormone supplements this.

The nurse is preparing to administer activated charcoal to a 4-year-old who accidentally ingested a family member's heart medication. What should the nurse do to reduce the discomfort from this treatment?

Insert a nasogastric tube Rationale: Activated charcoal absorbs toxic substances that have been swallowed to prevent them from being absorbed by the stomach. The drug is provided as a powder that must be mixed with water, and not milk, and administered orally or through a nasogastric tube. The solution feels gritty and tastes disagreeable, so it may be difficult to swallow. A nasogastric tube will help decrease the child's discomfort when taking the medication. This medication does not require an indwelling urinary catheter or intravenous infusion for fluid replacement.

A child with pauciarticular juvenile arthritis is scheduled for an eye examination every 3 months. When stressing the importance of the visit, which instruction is most accurate?

Iridocyclitis may occur as a basic symptom of the disease Rationale: Inflammation or iridocyclitis can occur as part of the basic involvement of juvenile rheumatoid arthritis. The other choices are not impacted by the JRA diagnosis.

A newborn is diagnosed as having hypocalcemia. A symptom of this is

Jitteriness Rationale: Hypocalcemia interferes with muscle contractility, producing jitteriness.

Children with ALL may need periodic lumbar punctures. You would teach the mother this is done to assess for:

Leukemic cells Rationale: Leukemic cells in cerebrospinal fluid must be identified because, if present, they require additional therapy.

A 15-year-old girl who is sexually active comes to a health care facility because she is concerned that she has contracted gonorrhea from a partner who has the disease. Upon history of present illness, which symptom is anticipated?

No noticeable symptoms. Rationale: Gonorrhea often produces no acute symptoms in females, which is why it is spread so easily among sexual partners.

The nurse screens a school-aged boy for hearing and discovers he has a hearing loss of 60 dB. This means he would have difficulty hearing:

Normal conversations and above Rationale: Normal conversation is conducted at about 50 dB.

The nurse is planning care for a child recovering from neck surgery for rhabdomyosarcoma. Which outcome suggests the best long-term prognosis for this patient?

The child tolerates chemotherapy provided after complete removal of the neck tumor Rationale: An outcome that would support feelings of powerlessness would be the patient attends recommended appointments. Reducing extracurricular activities, reducing the number of work hours, and spending time with elderly grandparents and other family members do not support feelings of powerlessness.

It is determined that 30% of a child's body is burned. Burned areas are assessed as second-degree when they involve

The epithelium and part of the dermis Rationale: A second-degree burn is an intermediate-degree burn, involving part of the dermal layer of skin. Epithelium is a first-degree burn; subcutaneous tissues and muscle are deeper burns.

The nurse is caring for a preschool-age child show survived near drowning. Which interventions should the nurse plan to promote optimum respiratory functioning for this patient? (Select all that apply).

Turn and reposition every 2 hours Administer antibiotics as prescribed Auscultate lung sounds every 2 to 4 hours Encourage deep breathing and incentive spirometry every hour Rationale: After a near drowning, the child should be turned every 2 hours. The child is usually prescribed prophylactic antibiotic therapy to prevent pneumonia. Lung sounds should be auscultated frequently for adventitious sounds. Deep breathing and incentive spirometry should be encouraged every hour help to aerate the lungs fully and prevent the accumulation of fluid, which promotes infection. Monitoring cardiac rhythm and blood pressure are not interventions specifically for respiratory functioning.

A 6-year-old girl suffers head trauma following a motor-vehicle accident. An intravenous infusion of 10% dextrose/water is begun. For which of the following findings would it be most important to monitor during this time?

Urinary output and specific gravity of urine Rationale: A 10% solution is hypertonic, so it moves fluid from extravascular spaces into the bloodstream. If urinary output is not adequate, heart failure from fluid overload can result.

The nurse is assessing pupil size and reaction to light in a child with a cervical neck injury. Which cranial nerve is the nurse assessing in this patient?

III (oculomotor) Rationale: Cranial nerve III (oculomotor) provides motor control and sensation for eye muscles and the upper eyelid. To determine the functioning of this nerve, the nurse would assess pupillary size and reaction to light. Cranial nerve II controls vision. Cranial nerve IV controls the movement of major eye muscles. Cranial nerve VI controls the movement and muscle sense of the eye.

An adolescent is diagnosed as having gonorrhea. You can anticipate that her management will include

Identification of sexual contacts Rationale: Gonorrhea is a reportable contagious disease. Individuals diagnosed with the disease will be asked to identify their sexual contacts so they can receive therapy also.

A child with leukemia is receiving methotrexate for therapy. Which nursing diagnosis should the nurse use to best guide this child's care at this time?

Impaired oral mucous membrane related to effects of chemotherapy Rationale: Mucositis or ulcers of the gum line and mucous membranes of the mouth is a frequent effect of antimetabolic drugs. This is the diagnosis that would have the highest priority for the client's care at this time. Methotrexate does not impair mobility, impact aldosterone secretion, or cause adverse effects to the central nervous system.

The nurse is preparing an educational session for community members that focuses on the 2020 National Health Goals. Which information should the nurse include to ensure a healthy muscoskeletal system?

Importance of daily exercise Rationale: The 2020 National Health Goals focus on proper exercise to maintain a healthy musculoskeletal system. The nurse can help the nation achieve these goals by educating community members on the importance of physical activity. Diagnosis of painful joints, hours of sleep, and dietary intake are not identified as actions to ensure a healthy musculoskeletal system.

A preadolescent girl with scoliosis is prescribed a body brace. What should the nurse teach the child about the purpose of the brace?

Improves spinal stability Rationale: The goal of mechanical bracing is to maintain spinal stability and prevent further progression of the deformity until bone growth is complete. Bracing will not prevent torticollis, correct the curvature, or prevent herniation of a spinal disk.

A 12-year-old girl is diagnosed with hyperthyroidism. What problem would the nurse anticipate she may have in school?

Inability to submit neat handwritten assignments Rationale: Children with hyperthyroidism may develop hand tremors, which leads to poor handwritting.

An 18-month-old child is admitted with signs of increased intracranial pressure. What should the nurse observe when assessing this patient?

Increased temperature and decreased respiratory rate Rationale: Manifestations of increased intracranial pressure include increased body temperature and decreased respiratory rate. Pulse rate slows, and the blood pressure increases.

A child with ALL is beginning treatment with methotrexate in an attempt to eradicate the leukemic cells. The stage of therapy represents the:

Induction stage Rationale: An induction stage is the first attempt at eradicating the leukemic cells to induce or achieve a complete remission.

A mother telephones you because her physician told her that her son has wax in one ear canal. What advice would you give the mother?

Inform her that ear wax is helpful in removing dirt from the ear canal Rationale: Earwax rarely leads to hearing impairment. Excess removal can interfere with its function of removing dirt from the ear canal.

A nurse in an emergent setting is caring for a child with burns. Which of the following is the immediate priority?

Relieving pain and discomfort Rationale: Second-degree burns are extremely painful, so pain relief would be paramount. Once paint control is achieved, the active management of the burn can begin. This is the highest priority at this point.

A nurse is caring for a child who had a complete spinal cord injury at lumbar 2 (L-2). His mother reports that she saw her son move his left leg twice. What response is best?

"That's most likely only a reflex. I'm sorry." Rationale: Although functional ability to lower extremities may be lost with spinal cord injury, reflex responses may remain.

The parents of a child with a thoracic-level spinal injury are anxious to know what the long-term prognosis is for their son. They ask, "Will our son walk again?" What is your response?

"It will be several weeks before an answer to your question is possible." Rationale: Before a long-term prognosis is possible, inflammation and edema must decrease.

Which comment suggests that an adolescent has grasped the concept of how syphilis is spread?

"Next time I'll be smart enough to look at my partner to see if he has any sores" Rationale: Sexually transmitted disease do not leave lasting immunity, so they can be contracted again. Practicing safe sex is a good safeguard.

The nurse instructs the parents of a child with Guillain-Barre syndrome on care that will be needed once the child is discharged home. Which statement made by the parents indicates that teaching has been effective?

"Our child might experience weakness even after recovering from the illness" Rationale: Most children recover completely, without any residual effects of the syndrome; although, some may continue to have minor problems such as residual weakness. To prevent muscle contractures and effects of immobility, turning and repositioning every 2 hours is important in addition to passive range-of-motion exercises about every 4 hours. It will take longer than 10 days for the child to recover and return to school. This disease does not directly affect the heart and lungs. There should be minimal residual disability going forward.

A female patient asks the nurse why she is always asked if she is pregnant before having an x-ray. What should the nurse explain to the patient?

"Radiation to a fetus can cause a malignancy" Rationale: Radiation during intrauterine life is a documented cause of leukemia. Radiation of the thyroid in infancy is known to cause thyroid cancer later in life. Asking a female patient about pregnancy status is not something that a nurse is expected to perform. Asking a female patient about being pregnant is not done to determine how much radiation the body can stand or determine how long the patient can be in the radiation room.

The mother of a child having myringotomy tubes placed asks, "Will my son lose his hearing while the tubes are in place?" What is the nurse's best answer?

"The tubes are inserted into a section of the eardrum in which the hearing is not affected" Rationale: Myringotomy tubes do not interfere with hearing because they are inserted into a portion of the tympanic membrane that is not instrumental to hearing.

A child having myringotomy tubes placed asks, "How and when will the tubes be removed?" What is your best response?

"The tubes remain in place for 6 to 12 months until they come out by themselves" Rationale: Because myringotomy tubes are foreign objects, the tympanic membrane will extrude them after a time.

A parent, distressed to learn that the school-age chid is diagnosed with type 2 diabetes mellitus, asks the nurse how this could happen because no one in the family has diabetes. What instruction is most accurate?

"This disorder is associated with overweight and eating a diet high in fats and carbohydrates" Rationale: Type 2 diabetes is now seen in overweight adolescents and those who eat a diet high in fats and carbohydrates and do not exercise regularly. Type 2 diabetes is not caused by the pancreas not making enough insulin. This disorder is not linked to an inadequate ingestion of daily calories. This disorder may have a genetic link, but environmental factors such as obesity, diet, and exercise can influence its development.

The mother of a child with cryptorchidism asks the nurse why having an undescended testis brought down is important. What is the most accurate response?

"This procedure will enable your son to examine the testis for malignant changes." Rationale: Returning undescended testes to the scrotum may not decrease the incidence of testicular cancer, but it will allow the boy to assess for this by self-exam. It will not cause an increase in urinary tract infections. It is not for cosmetic purposes.

A 9-year-old boy who is blind is admitted to the hospital. When serving him a meal in bed, which statement would be most appropriate to increase his self-esteem?

"You have a sandwich on your plate, a glass of milk to your right, and an apple to your left" Rationale: Helping children who are visually impaired remain as independent as possible increases self-esteem.

When explaining the procedure of bone marrow aspiration to a child with leukemia, what would be the best explanation?

"You will feel pressure on your hip from the needle" Rationale: Bone marrow aspiration requires hard pressure to allow the needle to puncture the bone. It is usually done under local anesthesia or conscious sedation.

A female child has been diagnosed with precocious puberty at the age of 8. Which of the following would be an important teaching priority to tell the parents?

"Your daughter is physically able to become pregnant" Rationale: Children who have gone through the changes of puberty are fully fertile and able to become pregnant.

The nurse calculates that a child with a burn injury is to receive 3,600 mL of intravenous fluid over the next 24 hours. How much fluid should the nurse provide to the patient during the first 8 hours?

1,800 Rationale: Fluid is administered rapidly for the first 8 hours after the injury or half of the 24-hour load and then more slowly for the next 16 hours or the second half. If the child is to receive 3,600 ml of fluid over 24 hours, half of the amount, or 1,800 ml, should be infused over the first 8 hours. The remaining 1,800 ml should be infused over the next 16 hours.

A school-age child is brought to the emergency department after being hit in the mouth with a baseball bat during Little League. The child has lost two deciduous teeth, and one permanent from tooth is loose. What care should the nurse prepare to provide this patient? (Select all that apply).

Administer prescribed oral antibiotic Explain that an x-ray may be done to make sure that the jaw was not fractured Rationale: With dental fractures, deciduous teeth may not be replaced. If the blow to the teeth was extensive, an X-ray may be done to ensure that the upper or lower jaw is not fractured. The patient will be prescribed an oral antibiotic. The jaw does not need to be wired shut unless it is fractured. A chest X-ray would be done if the missing teeth are unaccountable.

This nurse is caring for a client newly diagnosed with vulvovaginitis. Which nursing instruction is most helpful in relieving the symptoms of pain and itch?

Administering cornstarch to the perineum Rationale: Cornstarch can be soothing to irritated skin. Avoid talcum powder, which is often scented. Petroleum jelly and a heating pad are not recommended.

When discussing care of an infant with congenital hypothyroidism, you would stress that the infant will need:

Administration of levothyroxine for a lifetime Rationale: Hypothyroidism occurs because the thyroid is not producing adequate thyroxine. The child will need a supplemental source for a lifetime.

The nurse assists with the application of a full-body plaster cast to a child. The child immediately becomes diaphoretic and reports feeling hot. Which nursing intervention would be indicated?

Advise the child that this is to be expected Rationale: Plaster becomes hot as it sets. This effect is reduced with newer plastic casts. This is a normal expectation about which to educate the child before the application of the cast. If discomfort continues, notify the provider. Infection would not present in this way with a cast application. Never moisten a cast.

The nurse is caring for a 7-year-old who is in the second stage of recovery from a spinal cord injury. When evaluating the child's status, which is noted as the result of consistent care by the family?

All joints are movable without contractures Rationale: Without nerve innervation, muscles can become locked in a permanent contracted state. Range of motion exercises, consistently provided, prevent contractures.

When teaching a mother about amblyopia, it would be most important to explain that:

Amblyopia is correctable if the child is properly treated before 6 years of age Rationale: Amblyopia can be treated if discovered before 6 years of age; early recognition is therefore, important.

A preadolescent child sprains the right ankle while inline skating. What should the nurse instruct the child and parents about the care that the child will need at home? (Select all that apply).

Apply ice-pack for 20-minute intervals Apply ice pack on the ankle for 4 to 7 days Keep wrapped in an elastic bandage Remind to use crutches to walk for 3 to 4 days Rationale: Interventions to help with a sprain include applying ice pack for 20-minute intervals, applying ice pack on the site for 4 to 7 days, wrapping with an elastic bandage, and using crutches to walk for 3 to 4 days after the injury. Heat is not applied to a sprain.

The nurse will be administering edentate calcium disodium (EDTA) to a child with lead poisoning. Which nursing action is completed prior to medication administration?

Asses the specific gravity of the urine Rationale: Chelating agents like EDTA evacuate lead through urinary excretion. It is important to assess that urinary function is present before administration.

On the third week of hospitalization following a spinal cord injury, an adolescent reports that his face is bright red, and he is sweating profusely. Which nursing action is completed first?

Assess if his retention catheter is blocked Rationale: These are typical symptoms of autonomic dysreflexia, a response to an irritating factor, such as a full bladder. Relieving the irritation reduces the response. The other options are not indicated.

An adolescent recovering from a spinal cord injury calls out for help. The patient's face is bright red, and the patient is experiencing a severe headache. What is the first thing that the nurse should do for this patient?

Assess if the urinary retention catheter is blocked Rationale: The patient is demonstrating signs of autonomic dysreflexia, which include extreme hypertension, tachycardia, flushed face, and severe occipital headache. This can occur if the patient's bladder is allowed to fill. The resultant sensory stimulation relayed to the damaged cord can initiate a powerful sympathetic reflex reaction. The nurse should assess that the patient's urinary catheter is not obstructed, so urine can flow freely and reduce the sensory stimulation. The patient is talking, so mouth-to-mouth resuscitation is not necessary. Massaging the lower extremities and lowering the head of the bed will not relieve the sensory stimulation caused by the blocked urinary catheter.

The most important assessment of neurovascular status to make after surgical instrumentation is which?

Assess the legs for warmth Rationale: The edema that accompanies spinal instrumentation surgery can impair circulation to lower extremities. The lower extremities are affected and need to be assessed over the nail beds of the fingers; brachial pulse is in the arm. Most all children will have pain after surgery.

The nurse is caring for a child who is having a seizure. What is the appropriate action by the nurse?

Attempt to turn the child on their side to prevent aspiration Rationale: Safety measures include turning the child on their side or abdomen with their head turned to the side to prevent aspiration. Slight cyanosis may be noted but administration of oxygen is not needed due to the short time of the tonic clonic stage. Do not attempt to restrain or place objects into the child's mouth. These actions may further injure the child.

A boy is seen in the emergency room with tearing and pain in his right eye. To assess for a foreign body under the upper lid, which method would you use?

Avert the upper lid over an applicator stick Rationale: Averting the upper lid over an applicator stick offers a full view of the anterior globe.

An adolescent female is concerned about developing toxic shock syndrome. What teaching can the nurse provide to allay this patient's fears about the disorder? (Select all that apply).

Avoid feminine hygiene sprays Change tampons at least every 4 hours Rationale: Measures to prevent toxic shock syndrome include avoiding feminine hygiene sprays because these products can irritate the vaginal lining. Tampons should be changed at least every 4 hours. If a fever occurs during menstruation, the tampon should be removed and seek medical attention. A fever is a manifestation of toxic shock syndrome. The lowest absorbency tampon possible should be used. Anyone who has had an episode of toxic shock syndrome is advised to avoid all future tampon use.

A school nurse is preparing an educational presentation to a group of teens, parents, and teachers about how to prevent skin cancer. Which topics need to be included? (Select all that apply).

Avoid getting a severe sunburn It is important to avoid tanning beds Sunscreen application needs to include tops of ears and back of neck Children need to apply sunscreen if out in the sun for longer than 20 minutes There is a direct association between two or more episodes of sunburn and development of malignant melanoma Rationale: Apply a sunscreen or wear protective clothing if a child will be out in the sun for longer than 20 minutes. Avoid indoor tanning beds or ultraviolet light. If used, maintain the same precautions as with sunlight. Avoid sunburn because there is a direct association between two or more episodes of sunburn in adolescence and the development of malignant melanoma in young adulthood (ACS, 2012). Children in outdoor athletics need to apply sunscreen on areas of the body not covered by protective clothing.

A child being treated for leukemia is diagnosed with neutropenia. What nursing instructions directly prevent client infections? (Select all that apply).

Avoid large crowds Inspect the skin daily for scratches or scrapes Remove house plants, flowers, and goldfish from the home Stay away from people who have obvious colds, rashes, or other infections Rationale: Strategies to prevent infections in a child with neutropenia include avoiding large crowds; inspecting the skin daily for scratches or scrapes; removing house plants, flowers, and goldfish from the home environment; and staying away from people who have obvious colds, rashes, or other infections. The child's intake of fresh fruits and vegetables should be limited because this could be a source for bacteria.

The nurse is instructing the mother of a school-age child with a leg cast about cast care at home. What should the nurse include in this teaching? (Select all that apply).

Cover the cast with a plastic bag to bathe Remind that nothing is to be put down the cast Use the cool setting on a hair dryer to ease itchy skin Encourage usual activities but restrict strenuous actions Rationale: When teaching the mother about cast care at home, the nurse should include covering the cast with a plastic bag while bathing so the cast does not get wet, not placing anything down the cast, using the cool setting on a hair dryer to ease itching, and encourage usual activities but reducing strenuous activities while the cast is in place. Magic markers should not be used for autographs because the ink can seep into the cast material.

A 2-year-old girl is seen at a health maintenance setting for lead poisoning. She has been observed eating paint from a windowsill. What measure would you teach her parents?

Covering the windowsills with paneling to prevent her reaching them Rationale: The paint in older homes has a high lead base. Covering windowsills can help prevent lead poisoning from this. The child is 2 years old and would not understand the teaching. Milk in the daylight does not impact lead levels.

The nurse is teaching a child with type 1 diabetes mellitus to administer her own insulin. The child is receiving a combination of short-acting and long-acting insulin. The nurse knows that the child has appropriately learned the technique when she:

Draws up the short-acting insulin into the syringe first Rationale:Drawing up the short-acting insulin first prevents mixing a long-acting form into the vial of short-acting insulin. This maintains the short-acting insulin for an emergency. Insulin is given subcutaneously.

A school-age child comes into the emergency clinic complaining of knee pain that started while playing soccer. What will the nurse most likely observe when assessing the child's knee?

Edema Rationale: Participation in sports such as soccer is a frequent cause of knee injuries in children and usually involves the ligaments surrounding the knee. Immediately after the injury, the child reports severe pain in the knee, and localized edema becomes evident. Erythema, contusions, and mottled skin are not associated with a knee injury caused by participation in a sport.

A 16-year-old has suffered a thoracic-level spinal injury from a diving accident. To initiate CPR at the poolside, which measure would be most important?

Elevate the mandible to assess airway with the head in a neutral position Rationale: Not moving the child's neck to avoid further spinal cord injury is important.

A school-age child with pauciarticular juvenile arthritis has extreme pain upon walking in the morning. Which intervention should the nurse suggest the parents try to help the child with the pain?

Encourage a warm bath each morning before school Rationale: Heat reduces pain and inflammation in joints and increases comfort and motion. Heat can be applied by the use of a heating pad or warm water soaks for 20 to 30 minutes. Bed rest will not help reduce the pain. Isotonic exercises will not reduce the pain and could make the pain worse. Aspirin taken on an empty stomach could lead to gastric irritation. The dose of 325 mg may also be too high for the child.

A 7-year-old is seen with pauciarticular juvenile arthritis. She notices extreme pain when she wakes in the morning. The best advice you can give her parents would be to:

Encourage her to take a warm bath each morning before school Rationale: Warmth is soothing to arthritic joints. Taking aspirin on an empty stomach could lead to gastric irritation. Exercise may worsen the pain. Slow movement and warm moist heat are the best options to assist in relieving the pain.

A newborn girl is discovered to have congenital adrenal hyperplasia. When assessing her, the nurse would expect to find which physical characteristic?

Enlarged clitoris Rationale: Lack of production of cortisol by the adrenal gland leads to overproduction of androgen. This leads to female infants developing an enlarged clitoris.

The nurse is instructing a female adolescent about the medicationleuprolide acetate (Lupron Depot-Ped), which has been prescribed to reduce the level of testosterone. What should the nurse include when teaching the patient about this medication? (Select all that apply).

Ensure effective birth control if sexually active Mark on a calendar when the injections are needed every three months Rationale: The medication leuprolide acetate (Lupron Depot-Ped) is a pregnancy risk category X so pregnant should be avoided when taking this medication. Because injections are given only every 3 months, the patient should prepare a calendar to identify when the next injection is due. The injections should be varied to decrease local irritation. The medication should be administered in the syringe supplied. Nausea and vomiting are possible adverse effects of the medication and do not need to be reported to the health care provider.

A school-age child with a supracondylar fracture of the humerus has been placed in a partial cast with the elbow region wrapped with an elastic bandage. What should the nurse explain to the parents and child regarding the reason for this type of casting approach?

Ensures edema does not press on the nerves Rationale: With an elbow fracture, the arm will be flexed and put into a cast. In this position, the radial artery and nerve can be compressed at the elbow, causing nerve injury or severe impairment of circulation. In some situations, a cast is applied incompletely for 24 hours, the elbow portion being splinted and wrapped with elastic bandages. After 24 hours, when edema has subsided and the chance of compression is less, the rest of the arm is then casted. The use of an elastic wrap at the elbow is not used to encourage healing, keep the bones in alignment, or provide additional stability.

The nurse is planning care for a school-age child with a black eye. Which outcome would be the most appropriate for this patient?

Evidence of bleeding will be reabsorbed within 1 to 3 weeks

A parenting education program has invited you to present information on poisoning that is common to children. You begin your presentation by telling parents that an important factor associated with ingestion of poisoning is

Evidence of stress in the family system Rationale: Childhood poisoning is often associated with the presence of stress. Poisoning occurs in all socioeconomic levels and with parents of all education levels. Parents need to teach children the proper names and not call medication candy.

The most effective approach to prepare a school-aged boy for a myringotomy procedure is to:

Explain the procedure to the child using puppets Rationale: Young children respond best to concrete illustrations introduced as a fun activity or game.

A high-school football player has been diagnosed as having osteosarcoma of the femur. His mother is angry because she told him not to play football. Which health teaching points would you include in the teaching plan for the boy and his mother?

Football injuries do not contribute to the development of a tumor Rationale: Trauma does not contribute to developing bone cancer; a lesion may be discovered after a traumatic injury.

The nurse is discussing recommended immunizations with the mother of an adolescent female. Which immunization would be important for the nurse to include during this discussion?

Gardasil Rationale: The vaccine Gardasil is recommended as part of routine administration to both early teenage girls and boys to prevent human papillomavirus infections. The nurse should approach the subject of immunization with parents and teenagers with sensitivity because some parents and children are not ready to admit they might be or will soon become sexually active. Influenza vaccination should already be a part of the adolescent's routine vaccinations. Hepatitis B vaccination should have been completed at birth and during the first year of life. Pneumonia vaccination is indicated for those in high-risk groups with respiratory illnesses.

After hospital discharge, the mother of a child newly diagnosed with type 1 diabetes mellitus telephones you because her daughter is acting confused and very sleepy. Which emergency measure would the nurse suggest the mother carry out before she brings the child to see her doctor?

Give her a glass of orange juice Rationale: These are typical symptoms of hypoglycemia. Administering a form of glucose would help relieve them. Insulin cannot be absorbed when taken orally.

The nurse is concerned that a preschool-age child is demonstrating signs of Duchenne muscular dystrophy. What did the nurse assess in this child?

Gower sign Rationale: Children with Duchenne muscular dystrophy usually have a history of meeting motor milestones, but by about 3 years of age, symptoms are more acute and obvious. Rising from the floor is done by rolling onto the stomach and then pushing up to the knees. To stand, the hands are pressed against the ankles, knees, and thighs. This is Gower sign. Facial weakness and inability to whistle are manifestations of facioscapulohumeral muscular dystrophy. Inadequate use of respiratory muscles is a manifestation of congenital myotonic dystrophy.

A 4-year-old has developed acute lymphocytic leukemia (ALL). Nursing care for the child will ALL involves taking axillary, rather than rectal, temperatures because the child:

Has a low platelet count Rationale: Children with leukemia develop lesions of the gastrointestinal tract. If touched by a thermometer, these bleed easily; blood coagulation is poor because of a decreased platelet count.

An 8-month-old boy is diagnosed as having cerebral palsy. During physical assessment, the nurse notes which abnormal finding that is common in this disease process?

He has a strong Moro reflex when startled Rationale: A Moro (startle) reflex typically fades by 5 to 6 months. Retained newborn reflexes are suggestive of cerebral palsy.

A 6-month-old girl is seen with retinoblastoma. When taking a health history from her father, which symptom would you expect him to report he has noticed?

He has noticed one pupil appears white Rationale: As the tumor grows against the retina of the eye, the red reflex is no longer visible; the pupil appears white.

A 14-year-old girl is diagnosed as having scoliosis. When doing scoliosis screening with her, an important observation would be to note:

Her posterior spine when she bend forward Rationale: Wearing a body brace should not interfere with normal activities, which are necessary to maintain adolescent self-esteem. Sex changes continue with or without bracing; the provider will determine the length of time for wearing the brace each day.

When discussing congenital hyperplasia with a child's parents, the nurse would advise them that administration of which drug is anticipated?

Hydrocortisone Rationale: The basic defect in congenital adrenal hyperplasia is the lack of cortisol. Administering hydrocortisone supplements this.

The nurse is caring for a school-age child recovering from an open reduction for a fractured femur. Which assessment findings indicate that the child is developing an infection? (Select all that apply).

Lethargy Increased pulse rate Increased body temperature Rationale: Children with an open reduction are prone to infection. The nurse should suspect an infection if the systemic symptoms of increased pulse, increased temperature, and lethargy are present. Reduced pulse in the ankle and cyanosis of the casted foot are manifestations of compartment syndrome.

A 7-year-old is diagnosed as having type I diabetes. One of the first symptoms usually noticed by parents when this illness develops is:

Loss of weight Rationale: Lack of insulin reduces the ability of body cells to use glucose; this leads to starvation of cells and loss of weight as an early symptom.

A 2-year-old is diagnosed with osteomyelitis. Which of the following would you anticipate as a primary nursing intervention to include in the child's plan of care?

Maintaining intravenous antibiotic therapy Rationale: Osteomyelitis is a serious infection. It is treated vigorously with intravenous antibiotics. It would not require traction. The stem does not indicate the location of the infection, so the child may not need crutches. Fluid restriction does not help red blood cell production.

A school-age child is scheduled for a muscle biopsy. What should the nurse teach the patient about the procedure?

Medication will be given so pain is minimized Rationale: Muscle biopsies are usually done using conscious sedation and a local anesthetic. The amount of tissue taken is about the size of the lead in a pencil. There is no need for bed rest for several days after the procedure. This procedure does not cause long-term pain.

The physician of a child with juvenile arthritis asks you to telephone the school to arrange a new activity program for her. A change you would anticipate for her is to

Modify her physical program Rationale: Children with arthritis should be encouraged to maintain as near to normal of a school program as possible to maintain self-esteem. Some activities may need to be modified because of pain or joint contractures. She needs to participate in activities; an earlier start is not a good change and swimming might be one of the best activities to consider.

Any individual taking phenobarbital for a seizure disorder should be taught:

Never to discontinue the drug abruptly Rationale: Phenobarbital should always be tapered, not stopped abruptly, or seizures from the child's dependency on the drug can result.

You meet a child with a slipped capital femoral epiphysis. In what type of child does this usually occur?

Obese adolescent girls Rationale: A slipped capital epiphyseal femur injury most typically occurs in overweight preadolescent or adolescent boys. Stress increases the risk. A thin child would not have an increased risk, and the age range is past preadolescent and school age

The nurse receives report from the admission department that a child with a slipped femoral epiphysis is en route to the care area. For which type of child should the nurse begin to plan care?

Obese preadolescent male Rationale: A slipped femoral epiphysis is a slipping of the femur head in relation to the neck of the femur at the epiphyseal line. This disorder occurs most frequently in preadolescence and its highest incidence is in obese children. It is twice as frequent in boys as girls.

Fractures in children are always potentially serious injuries. Which child with a fracture would you observe most closely for complication?

One who has an elbow fracture Rationale: Elbow injuries are particularly dangerous because edema can interfere with blood vessels and nerves that pass beside the joint. The radius and ulna are long bones and would not be at increased risk for complications. The patella is the knee and can be maintained in a straight position for casting.

A child with a head injury is demonstrating signs of cognitive deficits. The parents are concerned about how well the child will recover. Which nursing diagnosis should the nurse identify as the most appropriate for the family at this time?

Parental fear related to outcome after head injury in child Rationale: The parents are concerned if the child will recover. The most appropriate nursing diagnosis would be parental fear related to outcome after head injury. The parents are not demonstrating anxiety related to the hospitalization. Even though the child is demonstrating cognitive deficits at this time, this can change. The recovery from a head injury is unpredictable so deficits can resolve. The parents are not providing care to the child at this time, so there is no evidence of ineffective coping related to the care of a child with a head injury.

The nurse is completing the health history for the parents of a school-age child admitted with a ruptured spleen. For which activity should the nurse assess as the possible cause for this child's injury?

Playing baseball Rationale: In children, the spleen is the most frequently injured organ when there is abdominal trauma. Frequent causes of injury can result from an object such as a base-ball bat, a high-speed motor vehicle accident without restraint or with a seat belt without a shoulder strap, child maltreatment, or a fall from a height greater than 20 ft Injuries to the spleen are not associated with shooting pool or skateboarding or playing basketball.

A 3-year-old is brought to the emergency department after swallowing batteries taken from a grandparent's hearing aids. The parents believe that two batteries were swallowed. What should the nurse explain to the parents regarding the care that the child will need at this time?

Preparation for an emergency endoscopy to remove the batteries Rationale: Objects that do not digest such as batteries need to be removed by endoscopy as soon as possible because they can lead to bowel perforation or volvulus from the acid within the object. Activated charcoal is used for accidental poisoning. The child is not demonstrating signs of respiratory distress and will not need oxygen or emergency intubation.

The nurse is caring for a child with a broken wrist that has just been placed in a cast. The nurse would elevate the arm to:

Prevent edema Rationale: Edema tends to be dependent. Elevating the arm, therefore, would reduce swelling from the injury. Elevation of the arm would not promote healing or discourage infection. The cast will maintain proper bone alignment.

A child with burns requires daily whirlpool with debridement treatment. The purpose of this treatment is to

Prevent infection Rationale: Debridement following whirlpool reduces the amount of dead tissue present, thus reducing the possibility for infection. The treatments are very painful and do not improve mobility; the need for skin grafts depends on the percentage of burn, not the treatments.

In the emergency room, the nurse is asked to administer a histamine-2-receptor antagonist to a child with extensive burns. Which therapeutic outcome is desired?

Prevention of a stress ulcer Rationale: The child with extensive burns is subject to a high level of stress from pain and physiologic measures and may develop a gastric stress ulcer unless precautions are taken. Histamine-2 antagonist does not directly impact pain and would not impact the electrolyte balance nor the inflammation of burns in the esophagus.

The nurse reviews the 2020 National Health Goals for sexual health prior to preparing a presentation for high school students. On what should the nurse focus when preparing this teaching for the students?

Prevention of sexually transmitted infections Rationale: The 2020 National Health Goals for sexual health focus on the prevention and early treatment of sexually transmitted infections. This is the topic in which the nurse should focus during the presentation with adolescent students. The 2020 National Health Goals for sexual health do not address communication with primary care physicians, immunizations, or creating a work-life balance.

A child with ALL is given leucovorin, a folinic acid, after high-dose methotrexate therapy. It is important to administer this drug because leucovorin:

Prevents methotrexate that is not incorporated into leukemia cells from entering normal cells Rationale: Leucovorin "rescue" prevents methotrexate from entering normal cells.

When assisting a child while she is having a tonic-clonic seizure, it would be important to:

Protect the child from hitting her arms against furniture Rationale: In the hospital or home setting, keeping the child safe during a seizure is the highest priority.

When a child with extensive burns starts eating after being burned, it is particularly important that the diet have a high content of

Protein Rationale: Protein is needed for rebuilding all the tissue that has been destroyed by the burn. Other nutrients are needed, but protein is the most important for healing and tissue repair.

While assessing a school-age child with a brain tumor, the child has an episode of projectile vomiting. What nursing intervention is most helpful?

Provide a snack until the breakfast tray returns Rationale: In a child with a brain tumor, vomiting most commonly occurs on arising. The child with a brain tumor is not usually nauseated and will eat immediately afterward. The vomiting pattern occurs morning after morning. Vomiting eventually will become projectile. The nurse should provide the child with a snack until the morning breakfast tray arrives. The child will be hungry and can eat after an episode of projectile vomiting. The child does not need an antiemetic or a cool compress.

A preadolescent child with ataxia-telangiectasia is demonstrating an exacerbation of choreoathetosis. What should the nurse do to help this patient?

Provide comfort measures Rationale: Ataxia-telangiectasia is a primary immunodeficiency disorder that results in progressive cerebellar degeneration. Telangiectasia or red vascular markings appear on the conjunctiva and skin at the flexor creases. Neurologic symptoms caused by the degeneration process can usually be detected in early infancy when developmental milestones are not met. Children develop an awkward gait when they begin to walk. Choreoathetosis or rapid, purposeless movements may develop. Unfortunately, there is no effective treatment, and children with this disorder often die in late adolescence of infection, respiratory failure, or a malignant brain tumor. The nurse should provide comfort measures when caring for this child. The patient may not be able to walk. It is an unrealistic expectation for this child to increase independence. A rehabilitation facility is not going to help with the long-term prognosis of this disorder.

The school nurse is planning a presentation to be given during the next parent/teacher conference to include the 2020 National Health Goals to prevent unintentional injuries in children. What should the nurse include in this presentation? (Select all that apply).

Recognize signs of self-injury Provide information on home safety Ways to determine intentional injuries Emphasize safety with sports activities Rationale: Nurses can help the nation achieve the 2020 National Health Goals to prevent unintentional injuries in children by providing counseling on safety precautions to parents and children and always help assess whether injuries were unintentional or could be child maltreatment or self-injury. The legal aspects of child abuse would not be appropriate for this presentation.

The nurse is caring for a 4-year-old with meningitis. A primary goal would be to:

Reduce the pain related to nuchal rigidity Rationale: Irritation of the meninges causes pain on forward flexion of the neck.

The nurse is planning care for a preschool-age child diagnosed with meningitis. What should the nurse identify as priority goal for this patient's care?

Reduce the pain related to nuchal rigidity Rationale: Meningitis is an infection of the cerebral meninges. Pathologic organisms spread to the meninges. Once organisms enter the meningeal space, they multiply rapidly and then spread throughout the CSF to invade brain tissue through the meningeal folds, which extend down into the brain itself. A child with meningitis usually has an upper respiratory tract infection prior to the development of meningitis. Then the child will become increasingly irritable because of an intense headache with sharp pain when bending the head forward. Reducing the pain caused by neck pain would be the priority goal for this patient's care. Inspecting the teeth, providing opportunities for play, and increasing stimulation would not be priority goals for this patient.

A 5-year-old is diagnosed with acute otitis media. Which nursing intervention would be primary?

Relief of pain Rationale: Acute otitis media is painful. Children need pain relief until the antibiotic also prescribed reduces the inflammation and pressure.

The nurse is caring for a child diagnosed with scoliosis. What actions by the child would indicate a need for intervention by the nurse? (Select all that apply).

Removal of the brace at bedtime The child loosens the straps on the brace prior to bedtime Rationale: Placement of the brace over a t-shirt helps to prevent skin excoriation. The brace should only be removed 1 hour a day, during showering and participating in a sports activity. Straps should never be loosened on the braces. Children may state they feel taller with the brace on.

The nurse is planning care for a preschool-aged child with spastic cerebral palsy. Which nursing diagnosis should the nurse identify to guide care for this patient's muscoskeletal status?

Risk for disuse syndrome related to spasticity of muscle groups Rationale: Children with cerebral palsy need promotion of any function that is not already impaired to prevent further loss of function and allow them to master the highest level of self-care. Learning to be ambulatory is an important part of self-care because it pays a large role in determining how independent the child can become. Walking can be difficult for the child to master because of lack of muscle coordination. Preventing contractures is also important to maintain motor function. Risk for self-care deficit focuses on self-care measures such as dressing, toothbrushing, bathing, and toileting, so the child can not only gain self-esteem by accomplishing these tasks but also achieve optimal independence. Impaired verbal communication addresses focuses on speech and not necessary the entire musculoskeletal status. The risk for delayed growth and development focuses on the child's potential inability to pursue stimulating activities and surroundings because of not being fully mobile.

A child with ALL is receiving methotrexate for therapy. Which nursing diagnosis would best apply to him during therapy?

Risk for impaired skin integrity related to oral ulcerations associated with chemotherapy Rationale: Many chemotherapy agents cause oral ulcerations that interfere with nutrition because of pain and leave a portal of infection.

The nurse is planning care for a toddler who is diagnosed with a profound hearing loss. Which nursing diagnosis should the nurse identify as the priority once the child is discharge?

Risk for injury related to hearing loss Rationale: The child is a toddler and will be exploring areas throughout and outside of the home. With a hearing deficit, the child will not be able to hear any warnings from the parents. This increases the child's risk of injury related to the hearing loss. The child may or may not experience social isolation from the hearing loss. It is too soon to determine if the child will have impaired verbal communication, and it is unknown if the hearing deficit is congenital. The parents will be challenged to care for a sensory impaired child; however, the child's risk for injury would be the priority.

The nursing diagnosis most applicable to a child with growth hormone deficiency would be:

Risk for situational low self-esteem related to short stature Rationale: Children who are short in stature can develop low self-esteem from their altered appearance.

The nurse is caring for a school-age child newly diagnosed with type I diabetes mellitus. Which nursing action supports the 2020 National Health Goals to reduce the long-term complications from this disease process?

Schedule the child and parents to attend diabetes education classes Rationale: Endocrine disorders tend to be long-term with lifetime consequences. Reducing the incidence of consequences or improving care has long-term implications. A 2020 National Health Goal related to endocrine disorders includes increasing the proportion of persons with diabetes who receive formal diabetes education. To support this goal, the nurse should schedule the child and parents to attend diabetes education classes. There are no 2020 National Health Goals to address alteration in physical abilities, homeschooling with type 1 diabetes mellitus, or the need to be admitted to a rehabilitation facility to learn self-care.

Which measure would help an adolescent relax best during a pelvic examination?

Show her a speculum prior to the exam Rationale: Distraction and information about the procedure are effective measures to promote relaxation. Holding her breath tenses the abdomen; a pelvic exam in not necessarily pain-free.

Dexamethasone is often prescribed for the child who has sustained a severe head injury. Dexamethasone is a(n):

Steroid Rationale: A steroid may be prescribed to reduce inflammation and pressure on vital centers.

The nurse is caring for a child recovering from surgery to correct strabismus. Which interventions should the nurse include when planning the child's care? (Select all that apply).

Support for nausea and vomiting Provide pain medications as prescribed Apply antibiotic ointment as prescribed Rationale: After eye surgery for strabismus, the patient may experience nausea and vomiting and pain on eye movement. The patient will also be prescribed antibiotic ointment. An eye patch is not usually required. The child will not need to be on bed rest for 3 days.

A 16-year-old tells you she has terrible dysmenorrhea. Which action would be the best health teaching measure regarding this?

Take over-the-counter ibuprofen for its prostaglandin action Rationale: An anti-inflammatory medication is most helpful in reducing the discomfort of dysmenorrhea.

The nurse is caring for a preschool-age child recovering from a lumbar puncture. What should the nurse do to ensure the patient does not develop a spinal headache?

Take the pillow away and have the patient lie flat in bed Rationale: A child may develop a headache after a lumbar puncture as a result of the reduction in CSF volume or invasion of a small air pocket during the puncture. The nurse should encourage the child to lie flat for at least 30 minutes. The child's blood pressure, pulse, and respirations should be assessed for changes that indicate an increase in intracranial pressure. The child should drink a glass of fluid after the procedure to help prevent cerebral irritation caused by air rising in the subarachnoid space and to help increase the amount of CSF. The head of the bed should be flat and not elevated to a 30-degree angle.

The community health nurses are planning an open-house presentation on cancer prevention actions to support the 2020 National Health Goals. Which topics are most pertinent? (Select all that apply).

Teaching testicular self-examination Explaining the reasons to avoid excess sun exposure The importance of frequent health assessments to identify the symptoms of leukemia Rationale: Nurses can help the nation achieve the 2020 National Health Goals for cancer prevention in children by careful history taking at health assessments to reveal the symptoms of leukemia and by active teaching of self-screening measures such as testicular examination and preventive measures such as avoiding excessive sun exposure. Vitamin supplementation, rest, and exercise are not identified as actions to prevent cancer in children.

The nurse instructs a hearing-impaired school-age child on how to self-inject a prescribed medication. Which observation indicates to the nurse that additional teaching is required?

The child places the filled syringe and uncapped needle, on the bed to open the alcohol wipe Rationale: Children who are unable to hear may need additional time for explanations and support. By placing the syringe and uncapped needle on the bed, the child is contaminating the needle. This would indicate that additional teaching is necessary. Pinching the skin, injecting air, and slowly pushing on the plunger all indicate that teaching has been effective.

Which symptom would lead the nurse to suspect that a child is developing a common side effect of vincristine?

The child says the fingertips feel numb Rationale: A common side effect of vincristine is numbness of extremities.

An 8-year-old child is being treated for tonic-clonic seizures. What should the nurse emphasize when teaching the parents about this disorder?

The child should maintain an active lifestyle Rationale: As a rule, children with seizures should attend regular school and participate in physical education classes and active sports. Antiseizure medication is ineffective during a seizure because most medication needs to achieve a therapeutic level to be effective. Padded tongue blades are not used in people with a seizure disorder. There is no specific time of day when a seizure can occur.

Which finding from the history of a child with extensive burns would make you most alert to assess for respiratory complications?

The child was trapped in a closed burning bedroom Rationale: When a child is confined in a closed space during a fire, he or she can inhale a great deal of smoke, causing respiratory tract burns or irritation.

A mother asks the nurse if there is any way to prevent acute otitis media. What would the nurse state to the mother?

The frequency of otitis media is reduced in breast-fed infants Rationale: Acute otitis media tends to occur less often in breast-fed than bottle-fed infants, probably because of the more upright position in which they are fed.

A common cause of poisoning in the young family is the ingestion of iron pills. You would inform parents that

The ingestion of iron can cause serious problems if the child is not treated immediately Rationale: Iron leads to severe gastric irritation. The bleeding from this can be extensive.

The nurse is planning outcomes for an adolescent diagnosed with Hodgkin disease. Which outcome should the nurse use to address feelings of powerlessness with the disease?

The patient attends recommended appointments Rationale: An outcome that would support feelings of powerlessness would be the patient attends recommended appointments. Reducing extracurricular activities, reducing the number of work hours, and spending time with elderly grandparents and other family members do not support feelings of powerlessness.

A school-aged girl with seizures is prescribed phenytoin sodium, 75 mg four times a day. An instruction the nurse would give her parents regarding this is:

Their chid will have to practice good tooth brushing Rationale: A side effect of phenytoin sodium is hypertrophy of the gumline. Good tooth brushing helps prevent inflammation under the hypertrophied tissue.

An infant is diagnosed as having cerebral palsy. When planning care, which would the nurse stress to the parents?

Their child probably will benefit from early schooling to increase ability for self-care Rationale: Cerebral palsy is not a progressive disorder. It cannot be predicted by pregnancy studies. Early schooling gives the child a "head start."

A baby is born with ambiguous genitalia. When discussing this with her parents, you could accurately assure them that

Their child's true sex can be determined by a genetic karyotype Rationale: Ambiguous genitalia may occur in either sex. The child's true gender can be determined by a chromosome (karyotype) analysis.

An 8-year-old girl is diagnosed as having tonic-clonic seizures. The nurse would want to teach her parents that:

Their daughter should maintain an active lifestyle Rationale: It is important for children with seizures to maintain as near normal a lifestyle as possible to maintain self-esteem and achievement. Most seizure medications must create a therapeutic level before they are effective.

The nurse is preparing teaching materials for a family whose child is prescribed somatropin for a growth hormone deficiency. What should the nurse instruct the parents about the administration of this medication?

This medication must be given by injection Rationale: Somatropin is administered by injection. It is best given at hour of sleep because that is when growth hormone is released. Hip or knee pain could indicate a slipped capital epiphysis and should be reported to the health care provider. The nurse should urge the parents to inform all health care providers that the child is receiving this medication to avoid medication interactions.

The nurse is evaluating a school-age child's ability to crutch walk so that no weight is placed on an injured leg. Which walking technique indicates that teaching has been effective?

Three-point swing-through gait Rationale: A three-point swing-through gait is used when no weight bearing is allowed on one foot. A two-point gait is used when a child needs support for weakened muscles or balance but may bear weight on both lower extremities. Walking gait and single-crutch support gait are not identified crutch walking approaches.

A 10-year-old boy develops bacterial conjunctivitis of the right eye. The eye is inflamed and drains a thick, yellow discharge. An important measure you would want to teach him is:

To clean the discharge away from the inner to outer canthus Rationale: Preventing the infection from spreading to the other eye is important.

A female adolescent is diagnosed with polycystic ovary syndrome. Which information should the nurse prepare to instruct the patient about the treatment for this disorder? (Select all that apply).

Use of antiandrogen medication Eating plan to reach appropriate weight Use of oral combines estrogen/progesterone contraceptive Rationale: Treatment is aimed at relieving symptoms so teaching should be about symptom management. Antiandrogen medication may be used to reduce hair growth and acne. An eating plan may be used to reduce obesity. Oral combined estrogen/progesterone contraception is used to better regulate menstrual cycles. Exercise is not identified as a specific treatment. Fertility medication is used if the patient desires to become pregnant and not to regulate menstrual cycles.

The nurse is planning a program for a community that focuses on the 2020 National Health Goals for neurologic health. Which topics should the nurse include in this presentation? (Select all that apply).

Use of helmets for bicycle and motorcycle safety Practicing good hand washing technique and infection control Importance of proper emergency care to protect the head and neck Rationale: Nurses can help the nation achieve the 2020 National Health Goals through helping prevent neurologic injury by educating children and parents about the use of helmets for bicycle and motorcycle safety, by administering and teaching paramedical personnel to administer safe care at accident scenes so children's heads and necks are protected, and by decreasing the possible spread of bacterial meningitis through good hand washing and infection control precautions in hospitals. Interventions about diet and manifestations of inflammatory disorders will not help achieve the 2020 National Health Goals.

The outpatient care clinic receives the 2020 National Health Goals that focus on prevention, early detection, treatment, and rehabilitation of vision problems. What should the nurse remind each patient to do to ensure eye health?

Use personal protective eyewear during recreation and hazardous situations Rationale: Nurses can help the nation achieve the 2020 National Health Goals that focus on prevention, early detection, treatment, and rehabilitation of vision problems by reminding all patients to use personal protective eyewear in recreational activities and hazardous situations around the home. This goal will not be met by instructing patients to flush the eyes with water, use artificial tears, or cleanse the eyes with soap and warm water.

An adolescent girl has spinal instrumentation surgery at 16 years of age. Immediately after this procedure, you would teach her to

Wait to be log rolled before turning from one side to the other Rationale: Spinal instrumentation means rods are placed beside the spine, and the vertebrae are fused. Log rolling is necessary to prevent injury until the fusion is complete. She will be flat for a specific period of time depending on the amount of fusion in the surgery; she will be allowed to sleep in different positions, and the hospital stay is not 6 months.

A mother is concerned that her toddler is diagnosed with amblyopia. What should the nurse explain as possible treatments for this eye condition? (Select all that apply).

Wearing corrective eye glasses Covering the good eye with a patch Using a patch and corrective eye glasses Applying eye drops prior to applying an eye patch Rationale: Treatment for amblyopia can consist of wearing correcting glasses, covering the good eye with a patch, or a combination of the two. An additional option is using the medication levodopa and an eye patch. LASIK surgery might be considered, which corrects the refractive error but does not cut the eye muscle.