School Age
17s What is the most appropriate method to use when drawing blood from a child with hemophilia?
Schedule all labs to be drawn at one time.
25s A mother brings her child to the emergency department after the child has taken "some white pills just a short while ago." When assessing the child, what should lead the nurse to determine that the pills taken were most probably acetaminophen?
nausea and vomiting
A nurse is counseling a mother with young children after the mother left her abusive husband 6 months ago. The mother says, "My 6-year-old is starting to act just like his father. I just do not know how to handle this." Which response by the nurse is most appropriate?
"Counseling for your son would be helpful."
A 7 year old has been admitted for a tonsillectomy. The parents are concerned because the child has started thumb sucking again. Which of the following is the nurse's best response?
"This is a normal coping mechanism."
A 7 year old has been admitted for a tonsillectomy. The parents are concerned because the child has started thumb sucking again. Which of the following is the nurse's best response?
"This is a normal coping mechanism." Any child of any age may regress to any previous stage of development while hospitalized. This is a coping mechanism and is acceptable. The child will quit thumb sucking as the stress and need for comfort and coping resolve.
When obtaining the initial health history from a 10-year-old child with abdominal pain and suspected appendicitis, which question would be most helpful in eliciting data to help support the diagnosis?
"Where did the pain start?"
1m 49s A nasogastric tube is prescribed to be inserted for a child with severe head trauma. Diagnostic testing reveals that the child has a basilar skull fracture. What should the nurse do next?
Ask for the prescription to be changed to an oral gastric tube.
When teaching a parent of a school-age child about signs and symptoms of fever that require immediate notification of the physician, which description should the nurse include?
Complaints of a stiff neck
When caring for a child, age 12, who's diagnosed with osteomyelitis of the left femur, the nurse should take which action first?
Draw blood for cultures as ordered.
A 7-year-old child is brought to the clinic by a parent for a school physical. When the child is prepared for examination, which of the following interventions should the nurse provide to ensure the the child's comfort?
Explain the purpose of the equipment being used during the examination At this age in the early school-age years, the child is still comfortable with a parent's presence in the examination room and is not generally given the option. It is important for the child's comfort and to decrease anxiety to explain the use of each piece of equipment prior to using it. During the school-age years, the child should be allowed to keep their underpants on along with the gown. Gaining distraction with bright objects would be used for an infant.
A 6-year-old child with a history of varicella and aspirin intake is brought to the emergency department. The nurse suspects Reye's syndrome. Which assessment findings are consistent with this syndrome?
Fever, decreased level of consciousness (LOC), and impaired liver function
When teaching parents about fifth disease (erythema infectiosum) and its transmission, the nurse should provide which information?
Fifth disease is transmitted by respiratory secretions.
According to Erikson's psychosocial theory of development, an 8-year-old child would be in which stage?
Industry versus inferiority
A school nurse assesses that an 8-year-old child is preoccupied with sexual comments and activities. The nurse is concerned that the child may have been sexually abused at home. What is the nurse's best response to this situation?
Notify the local Child Protective Services. If a nurse suspects abuse of any nature, it must be reported to the appropriate authorities, such as Child Protective Services. The other options are incorrect because they do not demonstrate the required action of the nurse in this situation.
A child is receiving amoxicillin for otitis media. Which action should the nurse recommend the mother do when the child develops diarrhea?
Offer yogurt several times a day. Diarrhea is a common adverse effect of amoxicillin because the drug kills normal intestinal bacteria. Yogurt with live cultures helps restore the normal intestinal flora. Restricting the child to clear fluids will not help stop the diarrhea or recolonize the intestine. Withholding food and fluids for 2 hours is suggested when a child vomits. Pizza tends to be spicy and aggravates the diarrhea, but restricting its intake will not help the underlying problem.
Which behavior exhibited by parents of a chronically ill child may indicate feelings of guilt about the child's illness?
Overindulgence Parents who feel guilty about a child's illness may overindulge the child. Anger, sadness, and shock are common in parents of chronically ill children but don't necessarily indicate feelings of guilt.
32s In a family with a 7-year-old child with a chronic illness, which family members feel jealousy, resentment, embarrassment, shame, fear of becoming ill, and guilt at causing the illness?
Siblings
The school nurse learns that at least one of the children in the school has a new diagnosis of erythema infectiosum (human parvovirus) after developing a bright red facial rash. What interventions should be implemented to prevent a possible spread of the infection to other students in the school?
Teach everyone to implement hand hygiene
Which action should the nurse do first when noting clear drainage on the child's dressing and bed linen after a craniotomy for a brain tumor?
Test the fluid for glucose. Glucose in this clear, colorless fluid indicates the presence of cerebrospinal fluid. Excessive fluid leakage should be reported to the HCP. The nurse should not change the dressing of a postoperative craniotomy client unless instructed to do so by the surgeon. Ordinarily, the head of the bed would not be elevated because this would put pressure on the sutures. The nurse should notify the HCP after testing the fluid for glucose.
One day after an appendectomy, a 9-year-old child rates his pain at 4 out of 5 on the pain scale but is playing video games and laughing with his friend. What should the nurse document on the child's chart?
The child rates pain at 4 out of 5. Administered pain medication as ordered.
16s A nurse is teaching the parents of a 7-year-old child about the use of protective restraints in the car to help avoid spinal cord injuries in car accidents. The child weighs 20 kg (44 lbs). Which of the following information should the nurse emphasize in the teaching?
Using a booster seat
A school nurse is examining a student at an elementary school. Which findings would lead the nurse to suspect impetigo?
Vesicular lesions that ooze, forming crusts on the face and extremities
Nurses on a pediatric unit have developed a program to decrease the infection rate on the unit. What is an expected outcome of this quality improvement program?
evaluation of the system and client outcomes
An 8-year-old child with severe cerebral palsy is underweight and undersized for his age. He is being fed a diet of pureed foods and liquids through a syringe. The nurse determine's his biggest nutritional risk factor is:
impaired oral motor control.
A nurse evaluates discharge teaching as successful when the parents of a school-age child with a ventriculoperitoneal shunt insertion identify which sign as signaling a blocked shunt?
irritability and increasing difficulty with eating
The nurse is planning interventions for a school-aged child hospitalized with acute poststreptococcal glomerulonephritis in need of diversional activity. Which activity should the nurse expect to include?
playing a card game with someone the same age Generally, school-age children enjoy activities with their peers first, then family members, and lastly younger children. School-age children like to be busy but also to accomplish something. This helps to meet their task of industry versus inferiority, feeling good about what they are able to accomplish.
The nurse is evaluating a child's skills in self-administering insulin (see figure). The nurse should:
remind the child to rotate sites The child is using correct injection technique, and the nurse can remind the child to rotate sites. The nurse should also reinforce that the child has used correct technique and praise the child for doing so. If the child can manipulate the plunger of the syringe with one hand, this is appropriate. Insulin is administered at a 90-degree angle as shown. The child should identify appropriate sites on the thighs as one handbreadth below the hip and above the knee; the child is using appropriate sites.
Upon the child's return from the postanesthesia recovery unit (PACU) after a tonsillectomy, the nurse should place the child in which position?
side lying Placing the child in a side-lying position facilitates drainage of secretions and helps prevent aspiration.
When teaching the child with scoliosis being treated with a Boston brace about exercises, the nurse explains that the exercises are performed primarily for what reason?
to strengthen the back and abdominal muscles
23s Which laboratory test results should the nurse review in a child with nephrotic syndrome who is receiving cyclophosphamide?
white blood cell (WBC) count
The clinic nurse is teaching parents of a 6-year-old child how to administer eye drops for bacterial conjunctivitis. Which of the following will the nurse include in the plan of care? Select all that apply.
Remove any drainage from the eye prior to administration of the eye drops. After administration of the eye drops, keep the eye lid closed for several seconds.
14s A 10-year-old with scoliosis has to wear a brace. The nurse should develop a teaching plan with the client to include which instruction?
Wear a form-fitting t-shirt under the brace.
A school-age child presents to the office for a routine examination. Given the child's developmental level, a nurse should give highest priority to:
allowing the child to change into a gown while she isn't in the room. School-age children tend to be very modest. The nurse should allow them to change into gowns while she isn't in the examination room. Children shouldn't have to take off their underwear for routine medical examinations. Playing with medical equipment is characteristic of younger children. The nurse shouldn't ask parents to leave the room unless the child requests that they not be present. A school-age child may feel too old to hold a stuffed animal during the examination.
After teaching the parent of a child with a spica cast about skin care, which parental action would indicate the need for additional teaching?
application of powder to the skin under the cast
A child is receiving total parenteral nutrition (TPN). During TPN therapy, the most important nursing action is:
monitoring the blood glucose level closely. Most TPN solutions contain a high glucose content, placing the client at risk for hyperglycemia. Therefore, the most important nursing action is to monitor the child's blood glucose level closely. A child receiving TPN isn't likely to require vital sign assessment every 30 minutes or elevation of the head of the bed. A daily bath isn't a priority.
When preparing to give a child with insulin-dependent diabetes his dose of regular insulin and isophane insulin suspension, which of the following actions is most appropriate?
Withdrawing the regular insulin first, then withdrawing the isophane insulin suspension into one syringe. Using only one syringe is recommended for the child taking regular insulin along with an intermediate- or long-acting insulin. Additionally, insulin types, such as protamine zinc, globin zinc, and isophane insulin suspension, contain an additional modifying protein that slows absorption. Therefore, a vial of insulin that does not contain the protein (such as, regular insulin) should never be contaminated with insulin that does have the added protein. Premixing is rarely recommended because isophane insulin suspension does not remain stable for extended periods when mixed with regular insulin. Using two syringes is not recommended because the insulin types can be mixed. Also, using two syringes is more expensive. Insulin types, such as protamine zinc, globin zinc, and isophane insulin suspension, contain an additional modifying protein that slows absorption. A vial of insulin that does not contain the protein (i.e., regular insulin) should never be contaminated with insulin that does have the added protein.
The nurse caring for a 7-year-old child who has undergone a cardiac catheterization 2 hours ago finds the dressing and bed saturated with blood. The nurse should first:
apply pressure just above the catheter insertion site. Direct pressure is the first measure that should be used to control bleeding. Taking the vital signs will not control the bleeding. This should be done while another person is being sent to notify the HCP. The dressing can be reinforced after the bleeding has been contained.
