Pediatrics - NCLEX

The parents of a 4 year old child have recently had a new baby and the parents report that the 4 year old had been dry all night for 8 months and is now wetting the bed again. What should the nurse assess first?

-U/A Always assess the physiologic problem first to rule out a urinary tract infection (UTI). Once a physiologic cause is removed as the cause other assessment should be performed. If a UTI is present, treatment should start immediately.

The nurse assessing clients in a pediatric clinic would refer which child for further assessment?

-a 20 month old who only says "no" By 18 months of age, a child should be able to speak 10 or more words.

Which clients should the nurse recommend receive the human papillomavirus (HPV) vaccine?

-12 yr old male, 25 yr old bisexual male, 22 yr old female w/compromised immune system The HPV vaccine is recommended for preteen boys and girls at age 11 or 12 so they are protected before ever being exposed to the virus. Young women can get HPV vaccine through age 26, and young men can get vaccinated through age 21. The HPV vaccine is recommended for any man who has sex with men through age 26 and for men with compromised immune systems through age 26 if they did not get HPV vaccine when they were younger. The HPV vaccine is recommended for men and women with compromised immune systems through age 26.

The emergency department nurse is assigned to care for four pediatric clients with varying symptoms. Which client should the nurse examine first?

-6 month old w/RR of 68/min while sleeping Normal respiratory rate for a 6 month old is 30-50 breaths a minute. A 6 month old who is sleeping is not exerting themselves, and the respiratory rate should be within normal limits. A rate of 68 should alert the nurse to a problem that needs to be addressed.

An infant has been prescribed Bryant's traction for a diagnosis of developmental dislocated hips (DDH). At what degree of hip flexion should the nurse maintain the infant's hip for proper traction alignment?

-90 Bryant's traction is used for DDH. The child's body and the weights are used as tension to keep the end of the femur in the hip socket. Traction helps position the top of the femur into the hip socket correctly. This is accomplished with 90 degrees of hip flexion.

A child diagnosed with gastroenteritis is being given fluids in the emergency room for severe dehydration. Prior to discharge, the nurse instructs the mother how to prepare a BRATT diet. The nurse knows the teaching was successful when the mother selects what foods for the child?

-Bannanas, toast, rice, tea, apple sauce The Bratt diet is useful for children following any type of gastroenteritis which included nausea, diarrhea or severe vomiting. This bland diet is used in the first 24 hours to allow the gut to rest and readjust slowly to foods that are low protein, low fat and low fiber. The BRATT diet is for short term use only and consists of bananas, rice, apple sauce, toast and tea.

A nurse is working in a walk-in clinic where a mother brings in her 6 year old child stating, "My child is just not right." The nurse notes an unusual odor to the child's breath, new onset of bed-wetting, and lethargy. What prescription by the primary healthcare provider should be performed first?

-Blood glucose Type I diabetes usually has a sudden onset and many times diabetic ketoacidosis (DKA) is the first encounter. The symptoms in the stem: unusual odor to the breath, bed wetting, and lethargy are symptoms of DKA. The blood glucose is one of the most important tests for the diagnosis of DKA.

The nurse working on a pediatric unit is reviewing morning laboratory results. What client's lab result should be immediately reported to the primary healthcare provider?

-client w/IV fluids for sickle cell Though many of the laboratory results are abnormal, the most concerning is the urine specific gravity in Client three, treated for sickle cell crisis. This result indicates the client is extremely dehydrated, which could lead to more complications, further exacerbating the crisis.

What discharge instructions should the nurse provide to the parents of a child diagnosed with sickle cell anemia?

-deferasirox helps prevent liver damage from iron deposits -avoid high altitudes Deferasirox is an orally administered iron chelation agent shown to reduce the liver iron concentration due to repeated RBC transfusions. It binds iron. Low oxygen environments such as airplanes and high altitudes should be avoided.

A pediatric nurse is providing anticipatory guidance to a group of parents who have children nearing the age of 1 year old. What milestones should the nurse teach the parents to expect to see in their 1 year old child?

-gets to a standing position w/o help -puts out arm or leg to help w/dressing

A pediatric nurse notes a "chubby" toddler who is pale. According to the parent, the toddler is easily fatigued. Based on this data, what initial question should the nurse ask the parent?

-how much milk does your toddler drink a day? Paleness and easily fatigued are common signs of anemia. Drinking large amounts of milk puts the child at increased risk for iron deficiency anemia. Breast milk and cow's milk are poor sources of iron. Milk also inhibits absorption of iron.

Which comment by the mother indicates understanding of the diet needed to maintain health and adequate nutrition in the toddler?

-i try to provide whole grains, fruits, vegetables, and meat daily Depending on their age, size, and activity level, toddlers need about 1,000-1,400 calories a day. A health promotion strategy to help meet the nutritional needs of the toddler includes offering a wide variety of healthy foods and from all food groups based on the "my plate" food guide.

he nurse is instructing the mother of a pre-school child newly diagnosed with cystic fibrosis (CF). What statement by the mother indicates to the nurse that further teaching will be necessary?

-i will prepare a low fat, low protein diet for meals Children diagnosed with cystic fibrosis have difficulty getting enough nutrients because of an inherited defect that impairs the body's ability to absorb fats or protein. This child needs high calorie meals and snacks, ideally with extra calcium and salt. In addition, the child will take supplemental fat-soluble vitamins like A, D, E and K. This statement indicates the need for further teaching.

What information should be included in the health promotion plan for parents regarding the promotion of adequate bowel elimination in their toddler?

-increase adequate fiber in the diet thru whole grains and fruits -increase intake of water daily -provider toileting opportunities that are free from distractions Fiber is important for achieving adequate bowel elimination. Fruits and whole grains may help. Water intake is important, coupled with adequate fiber. Distractions at toileting times may result in poor elimination results.

A child is admitted to the emergency department due to suspected ruptured appendicitis with perforation. What would be the priority nursing assessment for this client?

-mont for increasing pain and rigidity of the abdomen Increasing pain and rigid, board-like abdomen are signs that the appendix may have ruptured, with resulting peritonitis developing.

A community health nurse is presenting a seminar to teen parents on the topic of infant safety. What priority topic presented by the nurse represents the leading cause of injury or death among infants?

-placing the infant in rear-facing, approved car seat The leading cause of death among infants under the age of one year is motor vehicle accidents. When instructing first time or young parents, it is vital to teach the need to have the infant snuggly restrained in an appropriately sized, approved infant car seat in the back seat and rear-facing.

The home care nurse, working with an infant in the home, is concerned about the infant developing diaper rash from wearing cloth diapers. Which strategies should the nurse teach to the parents to prevent skin irritation?

-wash diapers w/hypoallergenic detergent -rince diapers twice when washing -apply a protective ointment to diaper area w/each diaper change -check infant at least hourly for wet or soiled diapers Hypoallergenic detergent will remove skin bacteria as well as urine from the diaper. Detergents can be irritating to the skin and may cause dryness; therefore, adequate rinsing is important. Double rinse the diapers in cold water to remove traces of chemicals and soap. A protective ointment is even more important to use with cloth diapers, as they do not have the same wicking properties of the disposable diapers. Frequently checking the diaper for wetness and soiling will limit the contact time for urine or feces to be in contact with the skin. Whether using cloth diapers, disposables or both kinds, always change the baby as soon as possible after wetting or soiling the diaper to keep the bottom as clean and dry as possible.

A child receiving chemotherapy via a Port-a-cath needs blood cultures collected. In what order should the nurse complete this procedure?

1. wash hands and don gloves 2. clean diaphragm w/alcohol 3. access port with huber needle 4. w/draw 10 mL blood into vial 5. Flush w/NS 6. Flush w/heparin solution

The nurse should assess for what signs of toxicity in a child who is admitted with salicylate overdose?

vomiting, tinnitus, diaphoresis, dehydration Nausea and vomiting are the most common toxic effects. This can be caused by CNS toxicity or by direct damage to the gastric mucosa. Salicylates can be neurotoxic, and this is manifested by ringing in the ears. Ototoxicity can also lead to hearing loss. Diaphoresis results in the early phase of toxicity. Serious dehydration can result from insensible losses due to hyperventilation and fever, as well as active losses due to vomiting.