PrepUs for Pediatrics Chapter 35

A school-age child who is blind is hospitalized for another health problem. What should the nurse say when providing the child with a meal tray?

"You have a sandwich on your plate, a glass of milk to your right, and an apple to your left."

Put the following events of a generalized epileptic seizure in correct order:

Prodromal period Tonic stage Clonic stage Postictal period A tonic-clonic seizure is characterized by the following events: 1) prodromal period, 2) tonic stage, 3) clonic stage, and 4) postictal period.

The nurse is caring for an 8-month-old baby diagnosed with spastic cerebral palsy. Which assessment finding supports this medical diagnosis?

The child has a strong Moro reflex when startled

A 6-year-old has had a viral infection for the past 5 days and is having severe vomiting, confusion, and irritability, although he is now afebrile. During the assessment, the nurse should ask the parent which question?

"Did you use any medications like aspirin for the fever?" Severe and continual vomiting, changes in mental status, lethargy, and irritability are some of the signs and symptoms of Reye syndrome, which can occur as a result of ingesting aspirin or aspirin-containing products during a viral infection. Tylenol (acetaminophen) is allowed for viral infections in the school-age child. The type of fluids consumed during the illness has nothing to do with Reye syndrome. The temperature rise would be important for a much younger child because of the chance of febrile seizures, but not in this age child.

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 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

During the physical assessment of a 2½-month-old infant, the nurse suspects the child may have hydrocephalus. Which sign or symptom was observed?

Dramatic increase in head circumference A dramatic increase in head circumference is a symptom of hydrocephalus, suggesting that there is a build-up of fluid in the brain. Only one pupil that is dilated and reactive is a sign of an intracranial mass. Vertical nystagmus indicates brain stem dysfunction. A closed posterior fontanel would be frequently seen by this age.

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. Not moving the child's neck to avoid further spinal cord injury is important.

A child diagnosed with conjunctivitis is being seen in the pediatric clinic. Which statements are correct regarding conjunctivitis? Select all that apply.

It is highly contagious. Warm compresses are used to remove crusts that form on the eyes. Purulent drainage is a common symptom. Most commonly, conjunctivitis is caused by bacteria. The purulent drainage, a common characteristic, can be cultured to determine the causative organism. Conjunctivitis is treated with ophthalmic antibacterial agents. Warm, moist compresses can be used to remove the crusts that form on the eyes. The child who has bacterial conjunctivitis is infectious and should be kept separate from other children until the condition has been treated because of the large danger of spreading the infection.

The nurse is preparing an ongoing assessment plan for a child with multiple sensory disorders. Which of the following will contribute most to the detection and intervention of problems?

Ongoing parental assessments of their child's capabilities Parental observations of the child's abilities and responses are very important for accurate cognitive and behavioral assessment and prevention of problems. Making assessments only when the child is sick, hurt, or is experiencing problems is not a preventive measure. Behavioral assessments should be made on a regular basis, not just when they are provided by schools.

The nurse is caring for a 3-year-old boy with amblyopia. Which intervention would be most appropriate to include in the child's plan of care?

Promoting eye safety Promoting eye safety is extremely important for the child with amblyopia; if the better eye suffers a serious injury, both eyes may become blind. Rinsing the eye with cool water, educating the family about the disorder, and encouraging frequent hand washing are interventions for infectious conjunctivitis.

A parent of a newborn asks the nurse if there is any way to prevent acute otitis media. What would the nurse state to the parent?

The frequency of otitis media is reduced in breastfed infants. Breastfeeding is a way to help prevent acute otitis media in infants. Acute otitis media tends to occur less often in breastfed than bottle-fed infants. One reason is the immunologic benefits from the breast milk. An infant should not start immunizations until 2 months of age, because the organs and immune system are not mature enough at birth. Placing medications and tubes are never done prophylactically.

The nurse is educating the parents of a 7-year-old girl with epilepsy about managing treatment of the disorder at home. Which intervention is most effective for eliminating breakthrough seizures?

Understanding the side effects of medications

A nurse is providing information to the parents of a child diagnosed with absence seizures. What information would the nurse expect to include when describing this type of seizure? Select all that apply

You might see a blank facial expression after a sudden stoppage of speech. This type of seizure is usually short, lasting for no more than 30 seconds. You might have mistaken this type of seizure for lack of attention. This type of seizure is more common in girls than it is in boys.

Parents request help from the nurse in managing their young child's "poor behavior." They describe "loud talk and play, not coming when called, seldom following directions, 'blasting' the volume on the TV set, and difficulty understanding spoken words." The appropriate nursing action is:

arranging for an evaluation of the child's hearing. The behaviors the child displays are common in children who have a hearing deficit. Loud talk and play and turning the TV set to a high volume may occur because the child cannot hear lower levels of sound. The child may not understand directions he or she is given because of poor hearing and, therefore, cannot follow them. Articulation of words is likely not clear because the child cannot hear the sounds and then imitate them. Evaluation of this child's hearing is appropriate.

A nursing instructor is working with a student caring for an 18-month-old client. In order to ascertain that the tympanic membrane is optimally visualized, the faculty will assess that the student pulls the pinna of the ear:

down and back. The eardrum of the infant and young child is best visualized by utilizing an otoscope and pulling the pinna of the ear down and back.

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

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

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 conversation and above.

A nurse is caring for an infant who has just undergone a ventricular tap. In what position should the nurse place the infant immediately after the procedure?

semi-Fowler's position with a parent at the bedside

What is a true statement regarding status epilepticus?

It is a common neurologic emergency in children.

An infant is born with congenital glaucoma. The infant is scheduled for surgery to relieve this condition at age 2 days. Which prescription should tehe nurse question for the infant?

A preoperative injection of atropine Glaucoma is caused by the obstruction of the aqueous humor flow and causes increased intraocular pressure. Atropine is a drug that causes pupil dilation and further narrows the exit of fluid. It would be contraindicated for this child. The other prescriptions would be appropriate for the child prior to surgery and in the postoperative period.

The nurse is caring for a 6-year-old boy with sensorineural hearing loss. Which is the least likely cause of the child's hearing loss?

Acute otitis media Acute otitis media can cause damage to the middle ear, bringing about conductive hearing loss. Ototoxic medications can damage the hair cells of the cochlea or along the auditory pathway, in turn causing sensorineural hearing loss. Intrauterine infection with rubella causes damage to the hair cells in the cochlea or along the auditory pathway, which in turn causes sensorineural hearing loss. Excess noise exposure causes damage to the hair cells in the cochlea or along the auditory pathway, which in turn causes sensorineural hearing loss.

The nurse is teaching parents of a 6-year-old child about otitis media (OM). What predisposes the child to OM infections?

Bacteria entering through the eustachian tube Organisms that cause otitis media gain entrance to the middle ear through the eustachian tubes. A cotton swab may damage the eardrum but will not cause otitis media. Children's eustachian tubes are shorter, wider, and more horizontal than adults. Swimming and other water activity is associated with "swimmer's ear" and not otitis media.

Absence seizures are marked by what clinical manifestation?

Loss of motor activity accompanied by a blank stare An absence seizure consists of a sudden, brief arrest of the child's motor activity accompanied by a blank stare and loss of awareness. A tonic seizure consists of a brief onset of increased tone or muscle. A myoclonic seizure is characterized by sudden, brief jerks of muscle groups. An atonic seizure involves a sudden loss of muscle tone and loss of consciousness.

The school nurse is instructing the classroom teacher regarding a student newly diagnosed with amblyopia. To prepare for classroom instruction, which concept is most important to understand?

Student placement in the room is important but all other teaching methods may remain the same. Amblyopia is when the vision in one of the eyes is reduced because the eye and the brain are not working together properly. The eye itself looks normal, but it is not being used normally because the brain is favoring the other eye. This condition is also sometimes called lazy eye. The student can still see and, in some cases, has limited impairment due to brain compensation. It is associated with other conditions such as poor refraction, ptosis, cataracts or strabismus. The child should be placed where he or she can be in direct view of the teacher or board but the other teaching methods may remain the same. The methods do not need to be shortened nor does the child require a large percentage of the learning to be hands on.

The mother of a 12-year-old with Reye syndrome approaches the nurse wanting to know how this happened to her child, saying, "I never give my kids aspirin!" Which response by the nurse would be most appropriate?

"Sometimes it's hard to tell if a product contains aspirin." Although warning labels are placed on containers of salicylates, salicylates are in a wide variety of products, so consumers must read the small print very carefully or they will miss the warning. The parent needs to be receptive to further education. Don't state the obvious, but also don't minimize the situation. Encourage the mother to ask for information, and be sure to explain in terms she will understand.

The nurse in the acute care setting is caring for a child with deafness. Which nursing intervention is appropriate for this child?

Allow the child to see the nurse prior to touching or completing any assessments or procedures. Always allow a deaf child to see you prior to touching or attempting to complete any assessments or procedures. The child should have a night light on at nighttime since sight is their best sense. The parents should be encouraged to stay with the child to help the child express himself/herself, not to make things easier for the nursing staff.

Which measures should receive priority when planning care for the child who is having surgery to remove a cataract?

Evaluation of intraocular pressure (IOP) and adherence to the occlusive patch regimen The patch and eye protector are made for post surgery. During the follow-up visit the physician looks for increased intraocular pressure, redness, swelling, and drainage.

A nurse is talking with the parents of a child who has had a febrile seizure. The nurse would integrate an understanding of what information into the discussion?

Febrile seizures are benign in nature. Parents need reassurance that febrile seizures, although frightening, are benign in nature. Children who experience one or more febrile seizures are at no greater risk of developing epilepsy than the general population. No evidence exists that febrile seizures cause structural damage or cognitive declines

A 6-month-old infant is admitted with suspected bacterial meningitis. She is crying, irritable, and lying in the opisthotonic position. Which intervention should the nurse take initially?

Institute droplet precautions in addition to standard precautions. Bacterial meningitis is a medical emergency. The child must be placed on droplet precautions until 24 hours of antibiotics have been given. Encouraging the mother to hold and comfort the child is an intervention but not the priority one: the focus is to get the infant the appropriate medications to fight the infection and to prevent its spread. Educating the family about preventing bacterial meningitis would be appropriate later once the initial infection has been controlled. Palpating the fontanels is used to assess for hydrocephalus.

At 36 weeks' gestation a client is scheduled for a biophysical profile. Before the client has the ultrasound examination, which component of the biophysical profile does the nurse complete?

Nonstress test A nonstress test is the one component of a biophysical profile not performed during the ultrasound examination. Fetal movement evaluation is performed by the client, at home on a daily basis. A contraction stress test involved the induction of uterine contractions and is not part of a biophysical profile. Doppler flow studies are performed during an ultrasound examination, but are not part of a biophysical profile.

A 15-year-old adolescent is brought to the emergency department by his parents. The adolescent is febrile with chills that started suddenly. He states, "I had a sinus infection and sore throat a couple of days ago." The nurse suspects bacterial meningitis based on which findings? Select all that apply.

Complaints of stiff neck Photophobia Vomiting In addition to the adolescent's complaints and history, other findings suggesting bacterial meningitis include complaints of a stiff neck, photophobia, headache, positive Brudzinski sign, and vomiting

The nurse is providing immediate postoperative care for a 3-month-old who had a cataract removed. Which intervention would be the priority?

Ensuring the protective eye patch is securely in place

The nurse is providing teaching to the parent of a 4-year-old child being treated for otits media. When discussing the condition, the parent indicates an understanding of the information provided when making which statement?

"Swelling behind my child's ears is a normal occurrence as the infection resolves." Otitis media may develop with a complication known as mastoiditis. This presents as a lump behind the ear. It is a serious complication and must be reported and treatment sought. Aspirin should not be administered to children with afebrile illness. Decongestant drops may be used for 2 to 3 days but not after that point in the treatment of the condition. Hearing loss may result from the disorder for a period of time.

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 For an eye contusion or a black eye, an appropriate outcome would be for evidence of the bleeding to be reabsorbed within 1 to 3 weeks. The swelling should be reduced much sooner than a month. The child should not experience any double vision with a black eye. The child will not need to be prescribed corrective lenses because of a black eye.

The nurse is caring for a 6-year-old visually impaired boy and is about to begin the physical examination. Which intervention would be most appropriate to promote effective communication with the child?

Use his name before touching him. When interacting with a visually impaired child, it is a good communication technique to use his name to gain his attention before touching him. Letting him listen to his heart with the stethoscope, describing the examination room, and promoting exploration by touch are sound ways to interact, but are not specific to communicating with the child at the beginning of the assessment

A group of students are reviewing the various causes of bacterial conjunctivitis in children. The students demonstrate understanding of this condition when they identify what as the most common cause?

Staphylococcus aureus S. aureus is the most common bacterial cause of conjunctivitis. Although a common cause, S. pneumoniae is not the most common cause of bacterial conjunctivitis. Although a common cause, H. influenzae is not the most common cause of bacterial conjunctivitis. Although a common cause, C. trachomatis is not the most common cause of bacterial conjunctivitis.

The nurse is caring for an 8-year-old boy who has chronic epilepsy. What would be most important to address when teaching the child and parents about living with this condition?

Support for maintaining self-esteem because of his altered lifestyle The effects of living with a seizure disorder can be devastating, and it is essential for the child to receive support to maintain self-esteem. While corrective surgery is possible, it would only be performed once. Physical, occupational, speech, and hyperventilation therapy are not indicated for treatment of epilepsy.

The nurse instructs a hearing-impaired school-age child on to how 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. 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.

A nurse develops a plan of care for a child that includes patching the eye. This plan of care would be most appropriate for which condition?

Amblyopia Eye patching is used for amblyopia or any condition that results in one eye being weaker than the other. Corrective lenses would be appropriate for astigmatism, hyperopia, and myopia.

The school nurse is educating the parents of a child with infectious conjunctivitis. Which comment provides the most value for prevention?

"Don't use anything that touches her face." Warning the parents how infectious conjunctivitis is spread is most valuable for preventing infection within the family. Directing the parents to use a full course of medication is very important to help prevent a recurrence in the child, but not the most valuable for prevention. Telling of a possible cause or proper administration of medication has little preventive value

The nurse is caring for a child who has suffered a febrile seizure. While speaking with the child's parents, which statement by a parent indicates a need for further education?

"I hate to think that I will need to be worried about his having seizures for the rest of his life." Febrile seizures occur most often in preschool children but can occur as late as 7 years of age. They occur when the child has a rapid rise in temperature and are not associated with the development of seizures later in life. Administering correct dosages of acetaminophen and ibuprofen, checking temperatures at night, and anticipating fevers associated with the administration of live vaccines are all ways to prevent the development of febrile seizures.

The nurse is providing teaching to the parents of a child recently prescribed carbamazepine for a seizure disorder. Which statement by a parent indicates successful teaching?

"I need to watch for any new bruises or bleeding and let my health care provider know about it." Carbamazepine is an antiseizure medication. It can cause bone marrow depression, so parents need to watch for any signs of bruising, bleed, or infection and notify their health care provider if this happens. Administer this medication with food to minimize GI upset. This medication can cause drowsiness, so do not give any sleep-inducing or other sedative type medications. Antiseizure medication does not cure seizures; it only controls the seizures. Lifelong antiseizure medication may be needed.

.While caring for a child who will be undergoing a lumbar puncture, the nurse explains the procedure to the infant's mother. Which statement by the mother would indicate a need for further education?

"I will cradle her in my arms after the procedure for at least 30 minutes."

While caring for a child who will be undergoing a lumbar puncture, the nurse explains the procedure to the infant's mother. Which statement by the mother would indicate a need for further education?

"I will cradle her in my arms after the procedure for at least 30 minutes." During the procedure, typically 3 tubes of cerebral spinal fluid (CSF) are removed for testing. After the procedure, the child is encouraged to lay flat for at least 30 minutes. During that time, the child is also encouraged to drink a glass of fluid to help prevent cerebral irritation. Even when all proper procedures are followed, some children develop a headache following the test. An analgesic may be given for pain relief.

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

"The tubes are inserted into a section of eardrum in which the hearing is not affected." Myringotomy tubes do not interfere with hearing because they are inserted into a portion of the tympanic membrane that is not instrumental to hearing. There is no risk of permanent deafness and hearing will be increased while the tubes are in place, not decreased. The nurse should answer the parent's question honestly without dismissing it or referring to another health care provider. This indicates to the parent that soemthing may be wrong or serious. The nurse can refer the parent to the surgeon if the parent's questions have not been adequately addressed.

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

"The tubes remain in place for 6 to 12 months until they come out by themselves." The standard treatment for persistent otitis media with effusion is the placement of pressure-equalizing (PE) tubes via a myringotomy. These tubes stay in place for several months and fall out on their own. They are not replaced after they fall out nor are they meant to be a permanent solution to the child's frequent ear infections. Vinegar should not be placed in the ears.

A child having myringotomy tubes placed asks, "How and when will the tubes be removed?" How should the nurse respond to this patient?

"The tubes remain in place for 6 to 12 months until they come out by themselves." Tubes tend to be extruded or come out by themselves after 6 to 12 months. The tubes do not grow permanently into place. They will not need to be replaced every 2 months, and they are not dissolved by vinegar.

The nurse is educating the family of a 7-year-old with epilepsy about care and safety for this child. What comment will be most valuable in helping the parent and the child cope?

"Use this information to teach family and friends." Families need and want information they can share with relatives, childcare providers, and teachers. Wearing a helmet and having a monitor in the room are precautions that may need to be modified as the child matures. The boy may be able to bike ride and swim with proper precautions.

The nurse is educating the parents of a 7-year-old boy who has hearing loss due to otitis media with effusion. Which statement by the parents indicates that further education is needed?

"We need to raise the volume of our voices significantly so he can hear us." It is not necessary for the parents to raise their voices more than slightly in order to be heard. Speaking clearly is an appropriate technique for communicating with the child. Facing the child when speaking is an effective method for communicating with the child. Using visual clues, such as hand gestures, is an effective technique for communicating with this child.

The parents of an 8-year-old child report that the child's teachers noted the child is having problems seeing the board in school but state they do not understand this since the child is able to read from the computer with no difficulty. Which response from the nurse is most appropriate?

"What you are describing may be what is called myopia." Myopia (nearsightedness) occurs when light rays focus anterior to the retina, causing objects that are far away to be unfocused. Typically, this develops around age 8 years and then progresses. These children can read a book or a computer screen immediately in front of them but are unable to read the blackboard clearly from a distance. There is no indication that the child is experiencing issues with paying attention. This suggestion does not address the parent's initial complaint. Accommodation disorders present with complaints of diplopia and headaches. Hyperopia (farsightedness) presents with vision that is blurry at a close range and clear at a far range,1500012326 which is opposite of what is being reported for this child.

A 7-month-old is scheduled for surgical correction of strabismus. The child's mother says to the nurse, "I'm glad my child will never have to wear that patch again." Which of these responses would be most appropriate for the nurse to make?

"Your child will need to wear the patch for a few days to keep him/her from rubbing or putting pressure on the eye." Strabismus refers to a misalignment of the eyes, if the strabismus persists past 6 months of age this warrants referral to an ophthalmologist for further evaluation. Clinical therapy involves occlusion therapy (patching of the good eye) for 1-2 hours a day to force use of the weak eye. The child may have to wear the patch intermittently, no restraints are needed if the patch is left in place, and the surgery on the muscle is what puts the eye back into alignment.

The nurse is caring for a 20-month-old girl with equivocal bacterial otitis media, a severe earache, and a temperature of 39°C (102.2°F). Which intervention would the nurse expect to implement?

Administering antibiotics as soon as they're available Because of the severity of the symptoms, the child will be treated with antibiotics immediately. This decision is based on the clinical practice guideline developed by the American Academy of Pediatrics and American Academy of Family Physicians. This clinical practice guideline helps to eliminate the need for obtaining middle ear fluid for culture. It is unreasonable to obtain a culture of middle ear fluid with every episode of acute otitis media to determine the specific cause. A 20-month-old's gait would most likely appear as swaying from side to side while moving forward. It is not until the toddler is around 3 years of age that he or she demonstrates walking in a heel-to-toe fashion with a steady gait. Antiviral medications would be used if the diagnosis of a viral cause was confirmed and the child was older than the age of 2 years.

A 10-month-old is brought to the emergency department by her parents after they found her face down in the bathtub. The mother said, "I just left the bathroom to answer the phone. When I came back, I found her." Which assessment would be the priority?

Airway, breathing, and circulation With a submersion injury, hypoxia is the primary problem. Therefore, assessment of airway, breathing, and circulation are the priority assessments for which the nurse would institute resuscitative measures. Other assessments such as level of consciousness, vital signs, and papillary response would be done once the child's airway, breathing, and circulation are assessed and emergency interventions are instituted.

The nurse is screening a 4-year-old girl for vision problems. What problem could result in loss of vision?

Amblyopia Amblyopia, if untreated, will get worse in the poorer eye and will cause strain on the better eye, which may also lead to worsening of acuity in that eye. Eventually blindness will result in one or both eyes. Exotropia can develop into amblyopia but not lead to a loss of vision. Diplopia can cause vision impairment but not loss of vision. Nystagmus can cause vision impairment but not lead to a loss of vision.

The 12-year-old child has developed a stye. Which may be included in the child's care?

Apply hot, moist compresses to the affected area. The stye is an infection of a ciliary gland (a modified sweat gland) that enters the hair follicle at the lid margin, most commonly caused by Staphylococcus. Management of the stye includes the use of hot, moist compresses. Manual expression is not indicated. Petroleum jelly will not be appropriate nor will it reduce inflammation. Cool, dry compresses will not be therapeutic. Heat provides for vasodilation, which will be useful in the resolution of the inflammation.

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

The child has conjunctivitis with much mattering of the eyes. What instruction should the nurse give the family? Select all that apply.

Avoid sharing towels, clothing, pillow cases and other personal items with others. All family members should use frequent and proper hand hygiene. Consider the child contagious until treated with prescribed medication for 24 hours. Use measures (such as distraction) to keep the child from rubbing the eyeS

The nurse should know that the most common infectious organisms that cause neonatal conjunctivitis are which bacteria? Select all that apply.

Chlamydia trachomatis Neisseria gonorrhoeae In the United States newborn conjunctivitis is usually caused by an infection the mother caught during sex. The most common organisms that cause it are chlamydia and gonorrhea. Enterobacter aerogenes is most commonly the cause of urinary tract infections; klebsiella pneumoniae is most commonly the cause of respiratory tract infections; clostridium difficile is most commonly the cause of colitis.

The nurse is in the room when a child with a seizure disorder is having a seizure. The child is exhibiting generalized jerking muscle movement, and the nurse notes the bed appears to be wet with urine. The child is in which stage of the generalized seizure?

Clonic

A 15-year-old adolescent is brought to the emergency department by his parents. The adolescent is febrile with chills that started suddenly. He states, "I had a sinus infection and sore throat a couple of days ago." The nurse suspects bacterial meningitis based on which findings? Select all that apply.

Complaints of stiff neck Photophobia Vomiting

Parents report that their preschool child's eyes are not always "straight." What test/procedure can the nurse use to validate the parents' observations?

Corneal light reflex

Parents report that their preschool child's eyes are not always "straight." What test/procedure can the nurse use to validate the parents' observations?

Corneal light reflex The corneal light reflex, which consists of a light held about 16 inches from the face, should shine symmetrically in each pupil. If not, the eyes are likely misaligned. The Snellen E and the home test (kit) both check visual acuity. The red reflex indicates light has reached and is being reflected from the retina.

The nurse is caring for a 12-month-old infant diagnosed with Haemophilus influenzae meningitis. Which clinical manifestation would likely have been noted in this child?

High-pitched cry and nuchal rigidity Children with meningitis may have a characteristic high-pitched cry, fever, and irritability. Other symptoms include headache, nuchal rigidity (stiff neck) that may progress to opisthotonos (arching of the back), and delirium.

The nurse is teaching the family of a 6-year-old boy with allergic conjunctivitis how to minimize his exposure to allergens. What action would the nurse anticipate as being most difficult for the family to implement?

Encouraging the child to keep his hands away from his eyes Keeping a 6-year-old child's hands away from his face is a difficult task, particularly when he is playing by himself or is at school. Washing his hands and face when returning from outdoors is something the parents can supervise and ensure occurs and thus would be less difficult to implement. Rinsing the child's eyelids is an activity that the parents can supervise and ensure occurs and thus would be less difficult to implement. Showering and shampooing before bedtime is an activity that the parents can supervise and ensure occurs and thus would be less difficult to implement.

A nurse is developing a plan of care for a child who is admitted to the hospital for surgery. The child is visually impaired. What would be most appropriate for the nurse to include in the child's plan of care? Select all that apply.

Explaining instructions using simple and specific terms the child understands Allowing the child to explore the postoperative equipment with his hands Using the child's body parts to refer to the area where he may have postoperative pain

A 4-year-old boy has a history of seizures and has been started on a ketogenic diet. Which food selection would be most appropriate for his lunch?

Fried eggs, bacon, and iced tea The ketogenic diet involves a high intake of fats, adequate protein intake, and a very low intake of carbohydrates, resulting in a state of ketosis. The child is kept in a mild state of dehydration. Eggs and bacon are high in fat; the tea does not contain any carbohydrates. Therefore, this is the best choice. The hamburger is fat and protein, the bun is a carbohydrate, and the French fries and the milk both contain fat and protein, but both contain a lot of carbohydrates. The pasta and the sauce for the spaghetti are carbohydrates, the meatballs are protein, and the garlic bread is a carbohydrate, as is the cola drink. The grilled cheese sandwich has the fat and protein from the cheese, but the bread and chips are primarily carbohydrates, and the milkshake has fat, protein, and carbohydrates. Only the selection in A contains a ketogenic meal.

The nurse is preparing a room for a child being admitted with meningitis. What is the appropriate action by the nurse?

Gather appropriate equipment and signage for respiratory isolation precautions. Children with meningitis are placed on respiratory precautions for 24 hours after the start of antibiotic therapy to prevent transmission of the infection to other family members or health care providers. While a child is on respiratory isolation, they will typically not be allowed out of their rooms to play. Due to pain when their neck is flexed, most children are most comfortable without a pillow. Reducing stimulation can help to promote rest for the child.

The nurse knows that the heads of infants and toddlers are large in proportion to their bodies, placing them at risk for what problem?

Head trauma A larger head size in relation to the rest of their body size gives young children a higher center of gravity, which causes them to hit their head more readily, thus placing them at risk for head trauma. Fragile capillaries in the periventricular area of the brain put preterm infants at risk for intracranial hemorrhage. Congenital hydrocephalus may be caused by abnormal intrauterine development or infection. Positional plagiocephaly is caused by an infant's head remaining in the same position for too long.

The nurse is caring for a child hospitalized with Reye syndrome who is in the acute stage of the illness. The nurse would assess the child most carefully for what finding?

Indications of increased intracranial pressure Reye syndrome is characterized by brain swelling, liver failure, and death in hours if treatment is not initiated. Therefore, increased intracranial pressure could occur. Liver enzyme levels typically increase. Blood glucose levels and protein in the urine are not characteristic of this illness.

The nurse is caring for a child who has suffered a head injury and has had an ICP monitor placed. Which prescription by the health care provider would the nurse question?

Initiate an IV of 0.9% NS to run at 250 mL/hr. Rapid administration of IV fluids may increase ICP. An IV rate of 250 mL/hr can be considered a rapid infusion. Corticosteroids such as dexamethasone can reduce cerebral edema. Osmotic diuretics, such as mannitol, can reduce pressure. Because of the administration of the osmotic diuretic, indwelling urinary catheters are typically inserted.

The physician has ordered rectal diazepam for a 2-year-old boy with status epilepticus. Which instruction is essential for the nurse to teach the parents?

Monitor their child's level of sedation. Diazepam is useful for home management of prolonged seizures and requires that the parents be educated on its proper administration. Monitoring the child's level of sedation is key when giving diazepam because it slows the central nervous system. Parents need to monitor the overall health of the child, including temperature when needed, but that has nothing to do with the diazepam. When the use of an anticonvulsant is stopped, gradual reduction of the dosage is necessary to prevent seizures or status epilepticus. This is not done without a physician's order. Monitoring for allergic reactions is necessary when any medications have been prescribed, but is not specific to diazepam.

A child is brought to the clinic because of complaints of not being able to see the blackboard at school. The nurse also notes that the child holds a book very close to the eyes. The nurse suspects which of the following?

Myopia The child most likely has myopia or nearsightedness in which involves an inability to see distant objects clearly. If severe, the child holds a printed page very close to the eyes. Hyperopia is farsightedness and involves the ability to see clearly at a distance but experience eyestrain and headache with close work. Astigmatism is an asymmetric shape and curvature of the cornea leading to eyestrain, headache and blurring or distortion of images. Anisometropia involves refractive errors in both eyes that are considerably different; the two eyes are unable to work together.

The nurse is reinforcing teaching with the caregivers of a child being discharged from the urgent care setting following a mild head injury that occurred in a roller skating accident. What should the caregivers be instructed to do? Select all that apply.

Observe and report any vomiting that occurs within 6 hours. Observe for and report to provider any double or blurred vision. Wake the child every 1 to 2 hours to check level of consciousness. A child with a concussion should be observed for at least 24 hours and the caregiver should be prepared to bring the child to the hospital if symptoms worsen. The child should be awakened every 2 hours to assess that the child wakes easily and has not developed neurological symptoms. The child should be brought back to the hospital if the child vomits within 6 hours of the injury or more than two times. Other instructions for parents to observe for are an increased sleepiness, a worsening headache, confusion or poor balance or walking. No analgesics or sedatives should be administered during this period of observation. In the home the parents would not be checking pupil reaction.

A nurse identifies a child who has otitis media. The child is demonstrating irritability, fever, and tugging at the affected ear. These findings would help substantiate a priority nursing diagnosis of:

Pain related to inflammatory process. According to Maslow's hierarchy, pain is one of the basic needs to be met first.

When caring for a child having a tonic-clonic seizure, the nurse will perform which action?

Protect the child from hitting the arms against the bed Keeping the child safe during a seizure is the highest priority. The nurse will protect the child from hitting the arms on the bed or other near by objects. The nurse would not place anything in the child's mouth due to the risk of aspiration. Extremities should not be held down as this could result in injury to them as the muscles are contracting during the seizure. The nurse would not place the child on the back for risk of aspiration.

A 4-year-old boy has a febrile seizure during a well-child visit. What action would be a priority?

Protecting the child from harm during the seizure During a seizure, the child should not be held down in a specific position. Protecting the child's head and body during the seizure is the priority. Ensuring a patent airway is an important intervention but is not accomplished by loosening the child's clothing or hyperextending his head. The child should be placed on his side and nothing should be inserted into his mouth to forcibly open the jaw.

A panicked mother calls the health care provider's office and reports that her 5-year-old has a high fever and just had a seizure. The mother asks the nurse what she should do. Which is the nurse's best response?

Report to the emergency room for medical evaluation When a child has a febrile seizure associated with a high fever, it is important to seek medical evaluation. Medical evaluation will identify the source of the high fever. If the fever is viral, the child may be able to be managed at home. Advise them not to put the child in a bathtub of water to do this because it would be easy for the child to slip under water should a second seizure occur. Caution them not to apply alcohol or cold water as extreme cooling causes shock to an immature nervous system. Parents should not attempt to give oral medications such as acetaminophen, because the child will be in a drowsy, or postictal, state after the seizure and might aspirate the medicine. It is appropriate to remove heavy clothing but not the best response.

A 9-year-old child has been diagnosed with impaired accommodation. When reviewing the child's responses during the assessment, the nurse understands that which finding is consistent with this disorder? Select all that apply.

The child reports having frequent headaches. The child's mother shares that her child has difficulty reading. When reading a selected passage, the child reports seeing double letters. Accommodation is the adjustment the eye makes to focus on a close image. To do this, the eyes converge (look medially), and the pupils constrict. To test for accommodation, ask a child to follow a penlight as you move it in toward the nose, if developmentally appropriate. Children who cannot accommodate are unable to fuse their vision to follow a penlight toward their nose this way; instead, they demonstrate double vision (diplopia). Poor accommodation is important to recognize because it can lead to headaches, poor reading ability, and difficulty achieving in school. Fatigue or eye strain are not associated with accommodation disorders. Tearing does not occur with accommodation disorders.

The nurse is educating the parents of a 7-year-old girl with epilepsy about managing treatment of the disorder at home. Which intervention is most effective for eliminating breakthrough seizures?

Understanding the side effects of medications The most common cause of breakthrough seizures is noncompliance with medication administration, which may occur if the parents do not understand what side effects to expect or how to deal with them. Treating the child as though she did not have epilepsy helps improve her self-image and self-esteem. Placing the child on her side on the floor is an intervention to prevent injury during a seizure. Instructing the teacher on how to respond when a seizure occurs will help relieve anxiety and provide a sense of control.

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

amblyopia is correctable if the child is properly treated before 6 years of age. Amblyopia is poor vision which develops in an otherwise structurally normal eye. With this condiditon the vision in one eye is decreased because the eye and the brain are not working together. The condition is known as lazy eye because one eye is stronger than the other. Amblyopia can be treated if discovered before 6 years of age. This is the reason early detection is so important. Strabismus is the rapid movement of the eye, not amblyopia. Amblyopia is not caused by a refractive error in the eye. Telling the parent that if the child does not get treated, the child will resent it is not educating the parent. It is the nurse forcing judgement onto the parent, which should not happen.

The nurse will help parents of a child with amblyopia understand that occluding vision in the unaffected eye is therapeutic because:

use of the affected eye promotes vision development. When lack of convergence of an image creates unclear vision in a child, vision is suppressed in one eye resulting in disuse and lack of visual development. Occluding the unaffected eye forces use of the affected eye and development of vision. Occlusion does not impact eye strain, pain or pupil size.