Peds Respiratory & Musculoskeletal

The nurse explains to the parents of a child with developmental hip dysplasia that the application of a Pavlik harness is necessary. In what position will the harness hold the child's femurs?

Abduction

The nurse checks the vital signs of an infant with a respiratory infection and notes that the respiratory rate is 50 breaths per minute. Which action is appropriate?

Document the findings

A 10-year-old child with asthma is treated for acute exacerbation. Which finding would indicate that the condition is worsening?

Decreased wheezing

What is the main characteristic of cystic fibrosis?

Excessive, thick mucus

The nurse reinforces instructions to the parents of an infant with hip dysplasia regarding care of the Pavlik harness. Which instruction provided by the nurse is accurate?

The harness needs to be removed to check the skin and for bathing.

The nurse is working in the emergency department and is caring for a child who has been diagnosed with epiglottitis. Which is an indication that the child may be experiencing airway obstruction?

Tripod positioning and dyspnea

After a tonsillectomy, the child begins to vomit bright red blood. Which is the initial nursing action?

Turn the child to the side.

The nurse is assigned to care for a child with a spica cast. Which action would be avoided when caring for the child?

Using pillows to elevate the head and shoulders

A newborn has talipes and is wearing casts. How often should the casts be changed?

Weekly

The nurse is reviewing the laboratory results of a child scheduled for tonsillectomy. Which laboratory value would be significant to review?

platelet count

A child with a tracheal obstruction is brought to the emergency department by emergency medical services. The child aspirated a grape, and the foreign body was removed by direct laryngoscopy. Following the procedure, which information does the nurse plan to give to the parents of the child?

the child will need to be hospitalized for observation

A nurse discussing options with a mother of a child with cystic fibrosis (CF) asks if she understands the education. Which statement by the mother indicates a need for further teaching?

"I can give my child whatever foods he likes to eat, since he gets enzymes anyway."

A hospitalized 2-year-old child with croup is receiving corticosteroid therapy. The mother asks the nurse why the primary health care provider did not prescribe antibiotics. The nurse makes which response to the mother?

"Antibiotics are not indicated unless a bacterial infection is present."

A nursing instructor asks a nursing student about the use of bacillus Calmette-Guerin vaccine (BCG). Which response made by the nursing student is correct?

"BCG is administered to asymptomatic human immunodeficiency virus (HIV)-infected children who are at increased risk for developing TB."

The nurse provides instructions to the parents of an infant with hip dysplasia regarding care of the Pavlik harness. Which statement, if made by one of the parents, indicates an understanding of the use of the harness?

"I can remove the harness to bathe my infant."

The nurse is reinforcing home care instructions to the mother of a child diagnosed with pneumonia. Which statement by the mother indicates the need for further teaching?

"I can use a warm mist humidifier to keep the secretions loose"

The mother of an infant newly diagnosed with cystic fibrosis is being taught proper nutritional needs for the infant. The nurse determines that the mother understands nutritional needs when the mother gives which response?

"I know I need to monitor my infant's stools, and if there are more than four stools a day, I will increase the pancreatic enzyme."

The nurse reinforces instructions to the mother of a child who has been hospitalized with croup. Which statement made by the mother would indicate the need for further teaching?

"I will give my child cough syrup if a cough develops."

The nurse reinforces instructions to the mother of a child with croup about the measures to take if an acute spasmodic episode occurs. Which statement by the mother indicates the need for further teaching?

"I will place a steam vaporizer in my child's room."

The nurse is reinforcing instructions to the mother of an 8-year-old child who had a tonsillectomy. The mother tells the nurse that the child loves tacos and asks when the child can safely eat one. The nurse would make which response to the mother?

"In 3 weeks"

A child is brought to the emergency department, and a fracture of the left lower arm is suspected. The mother states that the child was rollerblading and attempted to break a fall with an outstretched arm. The child receives diagnostic x-rays, from which it has been determined that a fracture is present. A plaster of Paris cast is applied to the arm, and the nurse reinforces instructions to the mother regarding cast care at home. Which instructions would the nurse provide to the mother?

"The cast needs to be kept dry because when wet it will begin to disintegrate."

A 4-year-old child sustains a fall at home and is brought to the emergency department by the mother. Following x-ray examination, it has been determined that the child has a fractured arm, and a plaster cast is applied. The nurse reinforces instructions to the mother regarding cast care for the child. Which statement by the mother indicates a need for further teaching?

"The cast will feel warm when it is dried."

The nurse is reinforcing instructions to the mother of a child with cystic fibrosis regarding the immunization schedule for the child. Which statement would the nurse make to the mother?

"The child will receive the recommended basic series of immunizations along with a yearly influenza vaccination."

The nurse has reinforced prior teaching of a school-age child who was given a brace to wear for the treatment of scoliosis. The child needs further teaching if which statement is made?

"This brace will correct my curve."

A nursing student is asked to discuss juvenile idiopathic arthritis (JIA) at a clinical conference scheduled for the end of the clinical day. Which statement by the nursing student indicates the need for further research of this disorder?

"This disease is twice as likely to occur in boys as in girls."

The nurse is providing instructions to a child with cystic fibrosis regarding how to perform the "huff" maneuver. The child asks the nurse about the purpose of this type of breathing. Which nursing response is appropriate?

"This type of breathing is used to mobilize secretions so that they can be easily coughed out."

The nurse is collecting data from a child suspected of having juvenile idiopathic arthritis (JIA). Which findings would the nurse expect to note if JIA were present? Select all that apply.

- Malaise, fatigue, and lethargy* - Painful, stiff, and swollen joints* - Limited range of motion of the joints - History of late afternoon temperature, with temperature spiking up to 105° F

A mother of a child with cystic fibrosis asks the nurse when the postural drainage should be performed. The mother states that the child eats meals at 8:00 a.m., 12 noon, and at 6:00 p.m. What times would the nurse tell the mother to perform postural drainage?

10:00 am, 2:00 pm, and 8:00 pm

The nurse is observing a nursing student preparing to suction a pediatric client through a tracheostomy. The nurse intervenes if the student verbalizes which intention?

To apply continuous suction when inserting the catheter

The nurse is assigned to care for a child with a compound (open) fracture of the arm that occurred as a result of a fall. The nurse plans care knowing that this type of fracture involves which specific characteristic?

A greater risk of infection than a simple fracture

An adolescent is seen in the emergency department following an athletic injury, and it is suspected that the child sprained an ankle. X-rays are taken, and a fracture has been ruled out. The nurse reinforces instructions to the adolescent regarding home care for treatment of the sprain and provides the adolescent with which information?

Apply ice to the injured area for a period of 30 minutes every 4 to 6 hours for the first 24 hours.

The nurse employed in the emergency department is collecting data on a 7-year-old child with a fractured arm. The child is hesitant to answer questions that the nurse is asking and consistently looks at the parents in a fearful manner. The nurse suspects physical abuse and continues with the data collection procedures. Which finding would most likely assist in verifying the suspicion?

Bald spots on the scalp

A child is scheduled for a tonsillectomy. Which would present the highest risk of aspiration during surgery?

Bleeding during surgery

The nurse caring for an infant with bronchiolitis is monitoring for signs of dehydration. The nurse monitors which method as reliable for determining fluid loss?

Body weight

The nurse is checking the capillary refill of a child with a cast applied to the left arm. The nurse compresses the nail bed of a finger, and it returns to its original color in 2 seconds. Which action would be taken by the nurse?

Document the findings

A child with Duchenne muscular dystrophy rises from the floor by walking up the thighs with the hands. How should the nurse record this observation?

Gower's sign

A child has epistaxis. The nurse understands that which treatment is appropriate for epistaxis?

Have the child sit up and lean forward.

The nurse is reviewing the health care record of an infant suspected of having unilateral hip dysplasia. Which finding would the nurse expect to note documented in the infant's record regarding this condition?

Hip joint laxity

A child with croup is placed in a cool-mist tent. The mother becomes concerned because the child is frightened, consistently crying, and tries to climb out of the tent. Which is the appropriate nursing action?

Let the mother hold the child and direct the cool mist over the child's face

A 3-year-old child has returned to his room following a tonsillectomy. Which finding needs immediate notification of the registered nurse?

Nasal flaring and rib retractions

A child who has undergone spinal fusion for scoliosis complains of abdominal discomfort and begins to have episodes of vomiting. On further assessment, the nurse notes abdominal distention. On the basis of these findings, the nurse would take which action?

Notify the registered nurse

The nurse is performing a neurovascular check on a hospitalized child who had a cast applied to the lower leg. The child complains of tingling in the toes distal to the fracture site. Which action would the nurse take?

Notify the registered nurse (RN)

A mother arrives at the emergency department with her child and a diagnosis of epiglottitis is documented. Which of the primary health care provider's prescription would the nurse question?

Obtain a throat culture

A child with a diagnosis of pertussis (whooping cough) is being admitted to the pediatric unit. As soon as the child arrives in the unit, which action would the nurse do first?

Place the child on a pulse oximeter

A child with cerebral palsy (CP) is working to achieve maximum potential for locomotion, self-care, and socialization in school. To meet these goals, which action would the nurse take when working with the child?

Place the child on a wheel chair scooter board

A teenage girl has been placed in a brace for the treatment of scoliosis, the most common skeletal deformity of adolescence. The family asks what they can do to be more supportive. What suggestion of the nurse is the most appropriate?

Purchasing clothes to disguise the cast

The nurse is monitoring a child following a tonsillectomy. Which finding would indicate that the child is bleeding?

Restlessness

The nurse is assisting in developing a plan of care for a child who will be returning from the operating room following a tonsillectomy. The nurse plans to place the child in which position on return from the operating room?

Side-lying

The nurse is caring for a pediatric client in skin traction. To prevent skin breakdown, which nursing intervention for this child is best?

Stimulate circulation with gentle massage over pressure areas

When conducting a class for parents about sudden infant death syndrome (SIDS), the nurse instructs the class that the infant should be placed in which position to sleep?

Supine

A mother arrives at the clinic with her child. The mother tells the nurse that the child has had a fever and a cough for the past 2 days, and this morning the child began to wheeze. Viral pneumonia is diagnosed. Which component of the treatment plan would the nurse anticipate?

Supportive treatment

The nurse teaches a child with cystic fibrosis how to perform the "huff" maneuver. Which instructions would the nurse tell the child?

Take a deep breath and then exhale rapidly, whispering the word huff

An 8-year-old boy is being treated with percussion treatments for cystic fibrosis. Which indicates that the treatment is effective?

The child has a productive cough of thick sputum.

The nurse is assisting a primary health care provider (PHCP) during an examination of an infant with hip dysplasia. The PHCP performs the Ortolani maneuver. Which data would the nurse expect to note during the examination?

The dislocated femoral head pops back into the acetabulum

The nurse is providing information to the family of a child about a synthetic cast that has been applied to the child for the treatment of a clubfoot. Which information would the nurse provide to the mother?

The synthetic cast allows for greater mobility than a plaster cast

The mother of a child with juvenile idiopathic arthritis calls the nurse because the child is experiencing a painful exacerbation of the disease. The mother asks the nurse if the child should perform range-of-motion (ROM) exercises at this time. The nurse would make which response to the mother?

"Have the child perform simple isometric exercises during this time."

What could suddenly occur in a child with acute epiglottitis?

Airway obstruction

An infant is seen in a clinic and is diagnosed with unilateral hip dysplasia. Which finding is associated with this condition?

Asymmetry of the gluteal skin folds when the infant is placed prone and the legs are extended against the examining table

The nurse is monitoring a child with a cast on the forearm for signs of compartment syndrome. The nurse understands that which data collection technique is unlikely to provide information about this complication?

Checking the child's ability to perform range of motion to the shoulder area of the affected extremity

The nurse educates the family of a newly admitted child with cystic fibrosis that the treatment will be centered on what therapy?

Chest physiotherapy

The nurse is instructing the mother of a child with cystic fibrosis (CF) about the appropriate dietary measures. Which meal best illustrates the most appropriate diet for a client with cystic fibrosis (CF)?

Chicken tenders and baked potato with butter

The nurse is assigned to care for a child who is in skeletal traction. The nurse needs to avoid which action when caring for the child?

Placing the bed linens on the traction ropes

After a tonsillectomy, a child is brought to the pediatric unit. The nurse places the child in which appropriate position?

Prone

The nurse is caring for a hospitalized infant with a diagnosis of bronchiolitis. The nurse places the infant in which position?

Prone, with the head of the bed elevated 15 degrees

The nurse is caring for a child with a fracture who is placed in skeletal traction. The nurse monitors for the most serious complication associated with this type of traction by checking for which?

An elevated temperature

A child is scheduled for a tonsillectomy in the day-stay surgical unit. On the day following surgery, the mother calls the surgical unit and expresses concern because the child has a very bad mouth odor. The nurse would make which response to the mother?

"Bad mouth for is normal and may be relieved by drinking more liquids."

Following a tonsillectomy, which of the primary health care provider's prescriptions would the nurse question?

Allow ice cream when awake

The nurse employed in an emergency department is instructed to monitor a child diagnosed with epiglottitis. The nurse notes that the child is leaning forward with the chin thrust out. The nurse interprets this observation as indicating which finding?

An airway obstruction

What most influences the severity of respiratory distress syndrome (RDS)?

The gestational age at birth

The nursing instructor asks a nursing student about sudden infant death syndrome (SIDS). Which statement by the student indicates further teaching is needed?

"The incidence of SIDS has been found to be higher in breastfed infants and infants that use a pacifier."

A 13-year-old child is diagnosed with osteogenic sarcoma of the femur. Following a course of chemotherapy, it is decided that leg amputation is necessary. Following the amputation, the child becomes very frightened because of aching and cramping felt in the missing limb. Which statement made by the nurse will best assist in alleviating the child's fear?

"This aching and cramping is normal and temporary and will subside."

When interacting with the parents of a SIDS infant, the nurse should attempt to assist the parents with:

Allaying feelings of guilt and blame

A child with a fractured femur is placed in Buck's skin traction, and the nurse is planning care for the client. Which information about this type of traction is correct?

Is a type of skin traction that pulls the hip and leg into extension

A child is to be admitted to the orthopedic unit following a Harrington rod insertion for the treatment of scoliosis. The nurse is assisting in preparing a plan of care for the child. The nurse plans to monitor which priority item in the immediate postoperative period?

Capillary refill, sensation, and motion in all extremities

A 2-year-old child with laryngotracheobronchitis (LTB) is fussy and restless in the oxygen tent. The oxygen level in the tent is 25%, and blood gases are normal. What would be the correct action by the nurse?

Increase the oxygen concentration in the tent

The nurse is reinforcing instructions to the parents of a child with scoliosis regarding the use of a brace. Which statement by a parent indicates the need for further teaching?

"I will apply lotion under the brace to prevent skin breakdown."

The nurse provides information to the parent of a 2-week-old infant who was diagnosed with clubfoot at the time of birth. Which statement by the parent indicates the need for further teaching regarding this disorder?

"I need to bring my child back to the clinic in 1 month for a new cast."

The nurse has provided instructions to the mother of an infant with viral pneumonia. Which statement by the mother would indicate the need for further teaching?

"I understand I will need to have my baby on antibiotics for this pneumonia."

The nurse reinforces home care instructions to the parents of a child with a brace for scoliosis. Which statement by a parent indicates a need for further teaching?

"I understand that my child needs to wear this brace for 12 hours a day."

The nurse is assisting in preparing a plan of care for a child who will be returning from surgery following the application of a hip spica cast. Which would be the priority action in the plan of care for this child on return from the procedure?

Check circulation in the feet.

The emergency department nurse is gathering initial data on a child suspected of epiglottitis. Which is the nurse's highest priority?

Check for a patent airway.

The mother of a child with acute laryngotracheobronchitis (LTB) asks why her child must be kept NPO. Which responses would be the most correct?

The child's rapid respirations pose a risk for aspiration

The nurse is preparing to administer beractant to a premature infant who has respiratory distress syndrome. The nurse plans to administer the medication by which route?

Intratracheal

When reinforcing instructions to the caregiver of a child about cast care, the nurse anticipates the need for further teaching when the caregiver makes which statement?

"I will allow my child to put cotton balls inside the cast to relieve pressure."

A mother of a child with cystic fibrosis asks the clinic nurse about the disease. How would the nurse respond to the mother about the disease?

Cystic fibrosis is a chronic multisystem disorder affecting the exocrine glands

The nurse is reinforcing instructions to the mother of a child with juvenile idiopathic arthritis regarding measures to take if a painful exacerbation of the disease occurs. Which statement by the mother indicates the need for further teaching?

"The full range-of-motion (ROM) exercises must be performed every day, even during the exacerbations."

A mother of a child being treated for right lower lobe pneumonia at home calls the clinic nurse. The mother tells the nurse that the child has discomfort on the right side and that the acetaminophen is not very effective. Which is the best suggestion by the nurse?

Encourage the child to lie on the right side.

A child with croup is being discharged from the hospital. The nurse reinforces home care instructions to the mother and advises the mother to bring the child to the emergency department if the child develops which symptom?

Stridor

A child with croup is placed in a cool-mist tent. The mother asks if the child may have her security blanket inside the tent. Which is the most appropriate response by the nurse?

"The child may have the security blanket inside the tent."