School-aged Child NCLEX Review
Which leisure activity does the nurse include in the care plan for a school-age child with hemophilia? A. swimming B. baseball C. cross-country running D. football
A. swimming Swimming is a noncontact sport with low risk of traumatic injury. Baseball, cross-country running, and football all involve a risk of trauma from falling, sliding, or contact.
A nurse is reinforcing education with a class of fifth-graders on personal health. Which statement related to growth should be included? A. "Intensive physical activity that begins before puberty might stunt growth." B. "There's nothing that you can do to influence your growth." C. "Children who are short in stature also have parents who are short in stature." D. "Because this is a time of tremendous growth, being concerned about calorie intake isn't important."
A. "Intensive physical activity that begins before puberty might stunt growth." Intensive physical activity (greater than 18 hours per week) that begins before puberty may stunt growth so that the child does not reach full adult height. During the school-age years, growth slows and does not accelerate again until adolescence. Children who are short in stature do not necessarily have parents who are short in stature. Nutrition and environment influence a child's growth.
A child, age 8, reports leg pain shortly after being admitted with a fractured tibia sustained in a fall. The nurse uses which approach to best assess the severity of the pain? A. Ask the child to rate the pain using a pain scale B. Ask the child what makes the leg hurt more. C. Ask the child what makes the leg feel better. D. Ask the child what the pain feels like.
A. Ask the child to rate the pain using a pain scale Asking what the pain feels like and what makes the pain better or worse assesses the quality of the child's pain, but these questions do not address severity. Having the child rate the pain on an age-appropriate scale is the most effective way to assess pain severity because it quantifies the pain objectively.
An 8-year-old child is brought to the clinic with watery eyes and clear nasal drainage that has lasted more than 10 days, without fever. The nurse observes that the child has dark circles under the eyes and a crease above the tip of the nose. Which intervention should be the nurse's priority? A. Collect data about potential environmental allergy triggers. B. Prepare to administer amoxicillin 25 mg/kg. P.O. every 12 hours. C. Prepare to administer trivalent inactivated influenza vaccine 0.5 mL P.O. D. Prepare the child for sinus x-rays.
A. Collect data about potential environmental allergy triggers. Cold symptoms that last longer than 10 days without fever, dark circles under the eyes (from increased blood flow near the sinuses), and a crease near the tip of the nose (from upward nose wiping) are all signs and symptoms of perennial allergic rhinitis. The nurse's priority is to collect data about potential indoor and outdoor environmental allergen triggers. Amoxicillin is used to treat bacterial infections, not allergies. Additionally the nurse will not prepare medication for administration without the appropriate orders from the health care provider. Influenza vaccination is indicated annually. Sinus x-rays may be necessary to check for structural abnormalities, but they are not the priority at this time.
Which of the following would be an effective relaxation strategy for a school- age child to use during a painful procedure? A. Having the child take a deep breath and blow it out until told to stop B. Having the child keep his eyes shut at all times C. Being honest with the child and telling him the procedure will hurt a lot D. Having the child hold his breath and not yell
A. Having the child take a deep breath and blow it out until told to stop Having the child take a deep breath, then blow it out is a form of distraction and will help the child cope better with the procedure. A child may prefer to keep his eyes open during a procedure so he can see what is going on and can anticipate what is going to happen. Letting a child yell during a procedure is a form of distraction. Holding the breath isn't beneficial and could have adverse effects (such as feeling dizzy or faint). The nurse should prepare a child for a procedure by using non-pain descriptors and not suggesting pain. For example, the nurse might say, "Sometimes this feels like pushing or sticking, and sometimes it doesn't bother children at all."
Which health care team members are necessary to ensure a pediatric approach that combines physical, emotional, social, and spiritual issues? A. Social worker, chaplain, nurses, nursing assistants, child life specialist, and physicians B. Physicians, nurses, and child protective services C. Nurses, physicians, and child life specialists D. Hospital nurses, community nurses, and social workers
A. Social worker, chaplain, nurses, nursing assistants, child life specialist, and physicians A social worker, chaplain, nurses, nursing assistants, child life specialist, and physicians should be involved in pediatric client care to ensure that physical, emotional, social, and spiritual issues are addressed. Other health care team members should be added to the client care team according to the client's needs. Child protective services should be involved only in cases of abuse. Options C. and D. don't fulfill all of the client's needs.
The parents report that their school-age child has been reprimanded for daydreaming during class. This is a new behavior, and the child's grades are dropping. The nurse should suspect which problem? A. The child may be having absence seizures and needs to see the primary health care provider for evaluation. B. The child may have a hearing problem and needs to have the ears checked. C. The child may have attention deficit hyperactivity disorder (ADHD) and needs medication. D. The child may have a learning disability and needs referral to the special education department.
A. The child may be having absence seizures and needs to see the primary health care provider for evaluation. Absence seizures are commonly misinterpreted as daydreaming. The child loses awareness, but no alteration in motor activity is exhibited. A mild hearing problem usually is exhibited as leaning forward, talking louder, listening to louder TV and music than usual, and a repetitive "what?" from the child. There isn't enough information in the question scenario to indicate a learning disability. ADHD is characterized by episodes of hyperactivity, not quiet daydreaming.
A school-age child's family asks the nurse to describe palliative care. Which statement best describes palliative care? A. Total care given when disease doesn't respond to curative treatment B. Intervention to hasten the death and dying process C. Action of a person to end a client's life because he's suffering from a terminal illness D. A means provided to end life
A. Total care given when disease doesn't respond to curative treatment The World Health Organization describes palliative care as the total care given to a client who doesn't respond to curative treatment. Intervening to hasten the death and dying process describes mercy killing. Assisting a client to end his life is assisted suicide. Euthanasia is described as the action of a person to end a client's life because he has a terminal illness.
Parents of a 6-year-old child tell a physician that the child has been having periods of unawareness with short periods of staring. Based on his history, the child is probably having which type of seizure? A. Typical absence B. Myoclonic C. Complex partial D. Tonic
A. Typical absence A typical absence seizure has an onset between ages 4 and 8. It's exhibited by an abrupt loss of consciousness, amnesia, or unawareness characterized by staring and a 3-cycle/second spike and waveform on an EEG. The attack lasts from 10 to 30 seconds and may occur as frequently as 50 to 100 times a day. No postictal or confused state follows the attack. A complex partial seizure most commonly occurs in older children and adults, causing a brief impairment of consciousness. A myoclonic seizure occurs in older children and is exhibited by lightning jerks without loss of consciousness. An abrupt increase in muscle tone, loss of consciousness, and marked autonomic signs and symptoms characterize the tonic seizure.
The nurse is planning care for a school-age client. Which action is most appropriate for the nurse to include? A. teaching the client about procedures and conditions using basic medical language B. assigning multiple nurses to the client to help reduce boredom C. asking caregivers to leave during procedures to allow privacy D. restricting the client to quiet activities such as reading instead of playing video games
A. teaching the client about procedures and conditions using basic medical language School-age clients can be taught about procedures and conditions using correct, basic medical language and should be encouraged to ask questions. Assigning multiple nurses will impede the continuity of care and should be avoided. Caregivers should be permitted to remain with their child during procedures to comfort the child if they so desire. The child should be permitted to engage in distracting activities such as age-appropriate video games and not be restricted to only quiet activities. Suggested diversions should be based on an individual assessment as well as client and caregiver preferences.
A school-age child has a fever, joint inflammation, and a nonpruritic rash. Knowing that these are signs of rheumatic fever, the nurse should ask the parents: A. "Is your child's Haemophilus influenzae vaccine up to date?" B. "Has your child had strep throat recently?" C. "Does your child have a congenital heart defect?" D. "Has your child recently been exposed to other children with rheumatic fever?"
B. "Has your child had strep throat recently?" Group A beta-hemolytic streptococcal infection typically precedes rheumatic fever. An inflammatory disease, rheumatic fever affects the heart, joints, and central nervous system. It isn't infectious and can't be transmitted from one person to another. Congenital heart defects don't play a role in the development of rheumatic fever. H. influenzae vaccine doesn't prevent streptococcal infection or rheumatic fever.
A 10-year-old child with a concussion is admitted to the pediatric unit. The nurse would place this child in a room with which roommate? A. A 6-year-old child with osteomyelitis B. A 12-year-old child with a fractured femur C. A 10-year-old child with rheumatic fever D. An 8-year-old child with gastroenteritis
B. A 12-year-old child with a fractured femur A child with a concussion should be placed with a roommate who's free from infection and close to the child's age. Osteomyelitis, gastroenteritis, and rheumatic fever involve infection.
A nurse is caring for a school-age child who's dying of brain cancer. The parents have requested information about a do-not-resuscitate (DNR) order. Which of the following is the nurse's most appropriate response? A. DNR orders are not written for children. B. A DNR order does not mean withholding treatment while the child is alive. It involves not initiating treatment after the child has died. C. Once a DNR order is chosen, it may not be revoked. D. Pediatric care typically focuses on curable illnesses, not terminal illnesses.
B. A DNR order does not mean withholding treatment while the child is alive. It involves not initiating treatment after the child has died. Parents will likely have difficulty dealing with end-of-life decisions for their child, but they must be informed of all available treatment options. The health care team members need to educate family members regarding the possible choices, and encourage them to discuss their feelings and explore their wishes for their child. A DNR order does not mean withholding treatment while the child is alive. It involves not initiating treatment after the child has died. Parents are reminded that if a DNR order is chosen, they may revoke the order at any time. The health care providers should assure the family that their child will be cared for and comfort will be maintained regardless of the presence or absence of a DNR order.
The nurse is caring for a 10-year-old client with cardiac failure who is on bed rest. The client is crying because of boredom. Based on the client's developmental growth, which appropriate action would the nurse implement to eliminate this client's boredom? A. Delegate another nurse to sit with the client. B. Play a game of checkers with the client. C. Give the client a stuffed animal to cuddle. D. Provide pens, papers, and glue to make an object.
B. Play a game of checkers with the client. The 10-year-old client has a sense of industry that is fostered by playing board games, playing a musical instrument, and starting hobbies. A nurse cannot delegate to another nurse. Pens, papers, and glue are appropriate for a preschooler, whereas a stuffed animal is appropriate for a toddler.
Where should the nurse instill an ophthalmic medication in a 6-year-old child? A. The sclera B. The lower conjunctival sac C. The upper conjunctival sac D. The outer canthus
B. The lower conjunctival sac Ophthalmic medication is best instilled in the lower conjunctival sac. Eyedrops are not instilled in the sclera, upper conjunctival sac, or outer canthus.
When collecting data on a girl, age 10, the nurse keeps in mind that the first sign of sexual maturity in girls is: A. menarche. B. breast bud development. C. pubic hair. D. axillary hair.
B. breast bud development. Breast bud development — elevation of the nipple and areola to form a breast bud — is the first sign of sexual maturity in girls. Sexual maturation continues with the appearance of pubic hair, axillary hair, and menarche, consecutively.
A 10-year-old child is in the hospital for the first time. The nurse has provided support and teaching to help the family and child adjust and to reduce their anxiety related to the child's hospitalization. Which of the following would the nurse view as unexpected? A. The parents relate readily with the staff and calmly with the child. B. The child discusses procedures and activities without evidence of anxiety. C. The parents choose to leave to let the child build a relationship with the staff. D. The child accepts and responds positively to comforting measures.
C. The parents choose to leave to let the child build a relationship with the staff. The parents of an adolescent might leave to help the teen maintain a fragile identity, but a 10-year-old would prefer to have his parents with him. Expected outcomes for a child and parents new to the hospital would include the parents relating readily to the staff and calmly with the child, the child accepting and responding positively to comforting measures, and the child discussing procedures and activities without evidence of anxiety.
When attempting to facilitate spiritual support for a school-age child with a life-threatening disease and the child's family, which action would hinder the nurse-client relationship? A. becoming familiar with the family's spiritual beliefs and practices B. seeking assistance or referrals to the facility chaplain or other resources C. promoting the nurse's personal values and beliefs if the nurse considers the family's to be inappropriate D. being open to the family's and the child's expressions of spiritual concerns
C. promoting the nurse's personal values and beliefs if the nurse considers the family's to be inappropriate If the nurse attempts to force beliefs on the family, the family may interpret this as a lack of understanding, which could lead to distrust of the nurse. Becoming familiar with the family's spiritual beliefs and practices, seeking assistance or referrals to the facility chaplain or other resources, and being open to the family's and the child's expressions of spiritual concerns are all ways to help children and their families cope with a life-threatening illness.
An 8-year-old is admitted to a health care facility. During data collection, the nurse discovers that the child is experiencing the anxiety of separation from the caregivers. Which nursing intervention is most likely to help the child cope with the fear of separation? A. Explain to the child that it is normal to have fear when in a health care facility. B. Ask the caregivers what approaches are used to calm the child at home. C. Calmly explain to the child why staying in the health care facility is necessary. D. Let the caregivers stay with the child and participate in the child's care.
D. Let the caregivers stay with the child and participate in the child's care. Allowing the caregivers to stay and participate in the child's care can provide support to both the caregivers and the child and help alleviate the child's fear of separation. The nurse could also ask the caregivers about what calms the child, normalize the child's feelings, and explain why staying is needed, but none of these will facilitate the child's comfort and reduce fear as effectively as allowing the caregivers to participate in the child's care.
