6500 Midterm

The nurse is assessing a 9-month-old's respirations. The nurse would assess this while the infant is doing which of the following?

Quiet in his mother's lap

The mother of a boy with asthma tells you that she smokes (but never around the boy), the family has a cat that comes inside sometimes, and she always gives her son the medication prescribed. She gives salmeterol and budesonide as soon as he starts to cough. When he is not having an episode, she gives him albuterol before his baseball games. Diphenhydramine helps his runny nose in the springtime. Based on this new information, what advice/instructions would you give the mother?

Salmeterol is a long-acting bronchodilator and is used for prevention of symptoms, not treatment when they occur. Budesonide is an inhaled steroid, also used for prevention, not acute treatment of symptoms. Salmeterol and budesonide should be given daily as prescribed (usually twice daily) in order to prevent the child from experiencing wheezing episodes. When wheeze or a cough does begin, then albuterol (short-acting bronchodilator) is the drug of choice. The mother may want to speak with the physician or nurse practitioner about whether a different type of antihistamine other than diphenhydramine might be helpful to prevent allergic response.

Parents of an 8-month-old girl express concern that she cries when left with the babysitter. How does the nurse best explain this behavior?

Separation anxiety is normal at this age; the infant recognizes parents as separate beings.

A nurse is assessing the heart sounds of a 4-year-old child and notes a murmur. Which of the following characteristics would the nurse interpret as indicating an innocent heart murmur?

Short duration Occurring during systole Medium pitch

The parents of an 11-year-old ask the nurse for suggestions about activities that they can encourage to help their child to be physically fit. Which of the following would be an appropriate suggestion?

Strength training Team sports Biking Brisk Walking

In an effort to control healthcare costs, what is the best recommendation by the nurse?

Stress primary prevention, using the healthcare system for check-ups."

A 5-month-old infant with RSV bronchiolitis is in respiratory distress. The baby has copious secretions, increased work of breathing, cyanosis, and a respiratory rate of 78. What is the most appropriate initial nursing intervention?

Suction secretions, provide 100% oxygen via mask, and anticipate respiratory failure.

The nurse is conducting an assessment of a 5-year-old boy. During the assessment, the nurse notes that the child does not maintain eye contract or speak. The nurse suspects an autism spectrum disorder. Which additional finding would help support the nurse's suspicion?

The child constantly opens and closes his hands.

The nurse is teaching a group of students about the possible effects of immigration on the health status of children. Which response by the group would indicate the need for additional teaching?

The children of immigrants have better access to preventive care.

A nurse is assessing a 15-month-old and his abilities. Which of the following would the nurse expect to assess?

Uses index finger to point Feeds self

When caring for children, how does the nurse best incorporate the concept of family-centered care?

Uses the concepts of respect, family strengths, diversity, and collaboration with the family

The father of a 2-month-old girl is expressing concern that his infant may be getting spoiled. The nurse's best response is:

"Consistently meeting the infant's needs helps promote a sense of trust."

The nurse is preparing to use biobehavioral interventions to control a child's pain. Which statement by the nurse would be most appropriate?

"Does your child have a favorite movie? We can play it in the room so he can focus on something other than the pain."

A 14-year-old boy and his mother are in the office for an annual visit and his mother jokes openly in front of the nurse about the changes in his voice and the hair under his armpits. While he is changing in another room, the nurse addresses the mother's statement. Which response by the nurse would be most appropriate when talking with the mother?

"Remember that he may be modest and self-conscious and become embarrassed with the teasing."

The nurse is assessing the vital signs of a child who is being evaluated in an urgent care center. The child is to be seen by the PNP. The mother asks, "Why is my child seeing the PNP and not the doctor?" What is the best response by the nurse?

"The PNP is an experienced RN with advanced education in the diagnosis and treatment of children."

The mother of a 3-month-old boy asks the nurse about starting solid foods. What is the most appropriate response by the nurse?

"The tongue extrusion reflex disappears at age 4 to 6 months, making it a good time to start solid foods."

The nurse is caring for a 2-year-old in the hospital, and the mother expresses concern that the toddler will be scared. Which response by the nurse would be most appropriate?

"We will do our best to minimize the stress that your child experiences."

The nurse is caring for a 15-year-old patient who was involved in a motor vehicle accident (MVA.. The patient is receiving patient-controlled analgesia via an epidural route for pain in the extremities caused by bilateral compound leg fractures. When teaching the adolescent about pain control, which statement by the nurse would be most appropriate?

"You may notice decreased sensation and ability to move your legs with this type of pain control."

The nurse caring for a 28-week preterm infant prepares to obtain a capillary blood specimen for a routine bilirubin test via heel stick. The parents are at the bedside and ask the nurse if their infant will feel pain when he is stuck. Which response by the nurse would be most appropriate?

"Your son will experience pain for a brief moment when his heel is stuck."

A 2 year old should have a time out that lasts 2 minutes and a 3 year old should have a time out that lasts ____ minutes.

3

The nurse is caring for a child with acute otitis media. The child weighs 22 lb. The medication order reads: amoxicillin 160 mg PO every 8 hours. Amoxicillin is supplied as 200 mg/5 mL. How many milliliters will the nurse administer with each dose? Round to the nearest whole number.

4

At a well-child visit, hydrocephalus may be suspected in an infant if upon assessment the nurse finds:

A rapid increase in head circumference

When performing a PEFR (peak expiratory flow rate) with a peak flow meter, put the following steps in correct order. A. Stand up straight. B. Blow out hard and fast C. Slide the arrow down to "zero." D. Take a deep breath and close the lips tightly around the mouthpiece. E. Note the number the arrow moves to.

C, A, D, B, E

The school nurse is planning a screening program. What items should be included to address issues related to the "new morbidity"?

Academic difficulties, violence, and other mental health issues

A nurse is conducting a comprehensive pediatric history of Rosie, an 8-year-old girl. Which of the following would the nurse most likely include?

Age, name, and date of birth Developmental milestones Allergies to food or medications Foods she likes to eat

A toddler has moderate respiratory distress, is mildly cyanotic, and has increased work of breathing, with a respiratory rate of 40. What is the priority nursing intervention?

Airway maintenance and 100% oxygen by mask.

The nurse is preparing to conduct a physical examination on an adolescent. Which of the following would be most important for the nurse to do?

Allow the adolescent to undress in private. Question the adolescent about any sexual changes.

A nurse is providing care for a child who will be undergoing a painful procedure. When developing the child's plan of care, which of the following be most appropriate?

Allow the child to participate when possible. Emphasize that pain is not a punishment. ell the child if pain is anticipated with a procedure.

When providing atraumatic care to a child, which action would be the most appropriate?

Allowing parents and children an informed choice about being together

The nurse is caring for a 7-year-old child who is displaying signs of separation anxiety when the parents need to leave for meals and showers. Which of the following nursing interventions will be the most helpful for this patient?

Ask the family to bring in photos and cards from friends at school.

When working with children and families, which is a critical strategy for promoting therapeutic communication?

Attentive listening

After teaching a group of parents about ensuring safety for their children, the nurse determines that the teaching was successful when the parents identify which of the following as appropriate?

Avoid honey in children < 1 year old Using a backward-facing car seat Applying sunscreen before the child goes out to play Making sure all pan handles are turned to the back of the stove

A 7-year-old presents with a history of recurrent nasal discharge. He sneezes every time he visits his cousins, who have pets. He lives in an older home that is carpeted. Tobacco smokers live in the home. His mother reports that he snores and is a mouth breather. She says he has symptoms nearly year-round, but they are worse in the fall and the spring. She reports that diphenhydramine is somewhat helpful with his symptoms, but she doesn't like to give it to him on school days because it makes him drowsy. Based on the history above, develop a teaching plan for this child.

Based on the history, it seems that the child may have allergies to pet dander, dust mites, tobacco smoke, and pollen. Teaching Guidelines 18.4 CONTROLLING EXPOSURE TO ALLERGENS Tobacco Avoid all exposure to tobacco smoke. No parental smoking inside the home or car. Dust Mites Use pillow and mattress covers. Wash bed linens once a week in 130°F water. Use blinds rather than curtains in bedroom. Remove stuffed animals from bedroom or minimize number and wash weekly. Reduce indoor humidity to <50%. Remove carpet from bedroom. Clean solid-surface floors with wet mop each week. Pet Dander Remove pets from home permanently. If unable to remove them, keep them out of bedroom and off carpet and upholstered furniture. Cockroaches Keep kitchen very clean. Avoiding leaving food or drinks out. Use pesticides if necessary but ensure that the asthmatic child is not inside the home when the pesticide is sprayed. Indoor Molds Repair water leaks. Use dehumidifier to keep basement dry. Reduce indoor humidity to <50%. Outdoor Molds, Pollen, and Air Pollution Avoid going outdoors when mold and pollen counts are high. Avoid outdoor activity when pollution levels are high.

The nurse is assessing a 2-month-old for signs and symptoms of increased intracranial pressure. Which of the following would the nurse expect to assess?

Bulging fontanel Resistance to being held

The nurse is providing anticipatory guidance to the mother of a 6-month-old infant. What is the best instruction by the nurse in relation to the infant's oral health?

Clean your baby's gums, then new teeth, with a washcloth."

The nurse is examining a child's skin for lesions and rashes. When documenting the findings, which of the following would the nurse include?

Color Location Size Distribution

The nurse is discussing with a parent the difference between a breath-holding spell and a seizure. Which of the following would the nurse include as characteristic of a seizure?

Convulsive activity occurs Crying is not typically noted

A 9-month-old infant's mother is questioning why cow's milk is not recommended in the first year of life as it is much cheaper than formula. What rationale does the nurse include in her response? Group of answer choices

Cow's milk is poor in iron and does not provide the proper balance of nutrients for the infant.

When planning education for a child and parents, what is the first step the nurse should take?

Determine the child's and family's learning needs and styles.

A boy with asthma is admitted to the pediatric unit for the fourth time this year. The mother expresses frustration that he is getting sick so often. Besides information about onset of symptoms and events leading up to this present episode, what other types of information would you ask for while obtaining the history?

Does the child experience episodes in relation to seasonal changes in pollen? Does the child also experience allergic rhinitis or atopic dermatitis? If so, what control measures are being used? Has the child been tested for allergies, and if these are known, what type of allergen control or prevention of exposure is being used? Is it on a consistent basis? Does the parent(s) smoke cigarettes, cigars, or a pipe? (Second-hand tobacco smoke is associated with an increase in asthma symptoms in children.) What is the child's socioeconomic status? (Poverty is a risk factor for increased asthma exacerbations.)

A nurse is assessing a 3-month-old at a well-child visit. Which of the following assessments would the nurse document as a normal finding?

Drooling noted Posterior fontanel closed

A child is diagnosed with bacterial meningitis. When reviewing the results of the cerebrospinal fluid evaluation, which of the following would the nurse expect to find?

Elevated CSF pressure Cloudy appearance

The nurse is caring for a 12-year-old child with cerebral palsy who is unable to communicate verbally. When assessing this child's pain, which assessment tool would the nurse most likely use?

Face, legs, activity, cry, and consolability (FLACC. descriptors)

A single mother asks the nurse for suggestions on disciplining her 2-year-old son. Which suggestion would be most appropriate?

Have the child spend 2 minutes in time-out.

A 10-year-old child is admitted to the hospital due to history of seizure activity. As his nurse, you are called into the room by his mother, who states he is having a seizure. What would be the priority nursing intervention?

Prevention of injury by placing the child on his side and opening his airway

The nurse is caring for an adolescent who says, "I'm sick of this. I wish I weren't alive anymore." What is the best response by the nurse?

Have you thought about hurting yourself?

A 6-month-old infant is admitted to the hospital with suspected bacterial meningitis. She is crying, irritable, and lying in the opisthotonic position. The priority nursing intervention would be:

Initiate appropriate isolation precautions and begin intravenous antibiotics.

A nurse is obtaining the history from a parent of a child who experiences absence seizures. Which of the following would the nurse expect the mother to describe?

Loss of motor activity accompanied by a blank stare

Which of the following are warning signs of autism? Select all that apply.

Not babbling by 12 months Not pointing or using gestures by 12 months No single words by 16 months Losing language or social skills at any age

The nurse is caring for a child with cystic fibrosis who receives pancreatic enzymes. Which statement by the child's mother indicates an understanding of how to administer the supplemental enzymes?

The enzymes should be given at the beginning of each meal and snack."

When compared with adults, why are infants and children at an increased risk of head trauma?

The head of the infant and young child is large in proportion to the body and the neck muscles are not well developed.

The nurse is caring for a 2-year-old child who has had surgery. When assessing this child's pain, which of the following development characteristics would the nurse need to keep in mind? Group of answer choices

Uses words for pain such as owie, boo-boo, or hurt

The nurse is providing care to an infant experiencing pain. Which of the following would be most appropriate for the nurse to implement?

Tightly wrapping in a blanket with extremities flexed and hands uncovered Coating a pacifier with an oral sucrose solution for sucking Using rhythmic, continuous horizontal motions while holding

When caring for an adolescent, in which case must the nurse share information with the parents no matter which state the care is provided in?

Tuberculosis

Which is the most appropriate treatment for epistaxis?

With the child sitting up and leaning forward, pinch the lower third of the nose closed.

A nurse is preparing to examine the ear of a 2-year-old. The nurse would pull the pinna in which direction?

down and back

Improvement of pain management and shortened recovery times are benefits of ____________________.

family-centered care

The nurse is developing a community outreach program to help reduce childhood mortality. What topic below would be essential to include?

motor vehicle accidents

Which of the following is a sign of Down's syndrome?

oblique palpebral fissures

A 4-year old complains of extreme pain when the tragus is touched. Though not diagnostic, this sign is most indicative of which disorder?

otitis externa

Family-centered care refers to caregivers working in _____________ with the family to determine goals and plans for the child's health care.

partnership

Family-centered care leads to better _____________ as well as a higher level of consumer satisfaction.

patient outcomes

Atraumatic care employs interventions that minimize physical and _______________ stress to the child and family.

psychological

Evidence-based practice can increase _______________ and standardize care

quality

Which of the following is a late sign of respiratory distress and impending respiratory failure?

slow irregular breathing

Which of the following would be included in the therapeutic management of a child with autism?

write a goal that the child will reach optimal functioning possible Individualize care Keep a highly structured environment Allow the use of music therapy and sensory integration techniques