Final Ill Child

The nurse is caring for a child with a new diagnosis of diabetes. The nurse teaches blood glucose monitoring by allowing the child to practice checking the blood sugar of a toy bear dressed in a hospital gown. The nurse recognizes this approach to be appropriate for what age level? A. preschool age (3 to 5 years) B. adolescence (10 to 19 years) C. school age (5 to 10 years) D. toddler (1 to 3 years)

A. preschool age (3 to 5 years)

Assessment of a term neonate at 2 hours after birth reveals a heart rate of less than 100 bpm, periods of apnea approximately 25 to 30 seconds in length, and mild cyanosis around the mouth. The nurse notifies the health care provider (HCP) based on the interpretation that these findings may lead to which condition? A. respiratory arrest B. bronchial pneumonia C. intraventricular hemorrhage D. epiglottitis

A. respiratory arrest

A child is admitted to the emergency department with an acute asthma attack. Which early assessment finding does the nurse expect? A. decreased respiratory rate B. expiratory wheezing C. inspiratory stridor D. cyanosis

B. expiratory wheezing

A nurse is caring for an infant being treated for an upper respiratory infection. The physician would like to order a series of x-rays for the infant who has been in a foster home for four months. How should the nurse obtained consent? A. Obtain consent from the foster parents B. Call child protective services C. Contact the child's biological parent D. Contact the units director of nursing

A. Obtain consent from the foster parents

What should the nurse do first when admitting a toddler with croup? A. Monitor vital signs. B. Assess respiratory status. C. Ensure adequate fluid intake. D. Place a tracheostomy set at the bedside.

B. Assess respiratory status.

A 14-year-old client in skeletal traction for treatment of a fractured femur is expected to be hospitalized for several weeks. When planning care, the nurse should take into account the client's need to achieve what developmental milestone? A. autonomy B. initiative C. industry D. identity

D. identity

The nurse is teaching a group of parents about the risk of airway obstruction in young children. What information is most appropriate for the nurse to share regarding the risk of airway obstruction? A. "Sleeing with a blanket is safe for the child after the child can roll over on one's own." B. "A small airway makes it easier for for an objects to cause obstruction." C. "A flat diaphragm makes it easier to expel objects obstructing the airway." D. "After the child start school the risk for the child getting an obstruction decreases."

B. " A small airway makes it easier for foreign objects to cause obstruction."

A nurse is teaching the parents of an infant with cystic fibrosis about chest percussion therapy. Which statement by the nurse is most accurate in explaining the rationale for using chest percussion on infants with cystic fibrosis? A. "Chest percussion is used as an adjunct to nebulizer treatments." B. "Chest percussion helps clear secretions out of the lungs." C. "Chest percussion is needed everyday to prevent infection." D. "Chest percussion is needed only when the child is ill."

B. "Chest percussion helps clear secretions out of the lungs."

The nurse assesses a 2-month old infant with hydrocephalus with a ventriculoperitoneal shunt. The nurse obtains the infant's vital signs. In order to obtain the most significant information about the child's status, which assessment should the nurse make next? A. status of posterior fontanelle B. pupillary reaction to light C. occipital frontal head circumference D. presence of the primitive reflex

C. occipital frontal head circumference

A child has just returned to the pediatric unit following placement of a ventriculoperitoneal shunt for hydrocephalus. The child is placed in a supine position. What is the nurse's priorityintervention? A. Assess intake and output. B. Place the child on the side opposite the shunt. C. Teach on ventriculoperitoneal shut location. D. Administer oral pain medication as ordered.

B. Place the child on the side opposite the shunt.

The nurse reviews with the parents how to care for their child with sickle cell anemia at home. The nurse determines that the parents understand the basic principles of home care when they state that they will implement which intervention? A. keeping the child with them at all times B. restricting the child's fluids at night C. encouraging their child to drink as much liquid as possible D. not allowing their child to play with other children

C. encouraging their child to drink as much liquid as possible

A 4-year-old child is having a sickle cell crisis. The initial nursing intervention should be to A. place ice packs on the client's painful joints. B. administer antibiotics. C. provide oral and I.V. fluids. D. administer folic acid supplements.

C. provide oral and I.V. fluids.

A toddler with croup is given a racemic epinephrine treatment because of increasing respiratory distress. Which finding indicates that the treatment has been effective? A. Color is normal. B. Retractions are less severe. C. Heart rate is 100 bpm. D. Pulse oximeter reads 90.

B. Retractions are less severe.

A child with cystic fibrosis does not like taking a pancreatic enzyme supplement with meals and snacks. The parent does not like to force the child to take the supplement. What is the mostimportant reason for the child to take the pancreatic enzyme supplement with meals and snacks? A. The child will become dehydrated if the supplement is not taken with meals and snacks. B. The child needs these pancreatic enzymes to help the digestive system absorb fats, carbohydrates, and proteins. C. The child needs the pancreatic enzymes to aid in liquefying mucus to keep the lungs clear. D. The child will experience severe diarrhea if the supplement is not taken as prescribed.

B. The child needs these pancreatic enzymes to help the digestive system absorb fats, carbohydrates, and proteins.

The nurse is caring for a child with cystic fibrosis who is admitted to the floor with an upper respiratory tract infection. The child has labored breathing and a congested, nonproductive cough. What is the immediate priority for the nurse? A. infection B. airway C. nutrition D. family coping

B. airway

A 4-year-old child who has been ill for 4 hours is admitted to the hospital with difficulty swallowing, a sore throat, and severe substernal retractions. The child's temperature is 104° F (40° C), and the apical pulse is 140 bpm. The white blood cell count is 16,000/mm3 (16,000 X 109/L). What is priority for nursing intervention? A. infection B. airway obstruction C. difficulty breathing D. potential for aspiration

B. airway obstruction

The nurse assessment of a 6-month-old infant brought to the outpatient clinic reveals a respiratory rate of 52 breaths/min, retractions, and wheezing. The mother states that her infant was doing fine until yesterday. Which action would be the most appropriate? A. Administer a nebulizer treatment B. Send to the infant for a chest radiograph C. Refer the infant to the emergency department D. Provide teaching about cold care to the mother

C. Refer the infant to the emergency department

The nurse is educating a group of parents about respiratory disorders in young children. One of the mothers tells the nurse that she has noticed her child's nostrils flaring when a child has a respiratory infection. The mother asked the nurse if she should be concerned. What is the most appropriate response by the nurse? A. "nasal flaring occurs when a child has to work hard to breathe." B. "A child exhibiting nasal flaring should be seen by a physician." C. "When a child is breathing deeply, nasal flaring will occur." D. "Nasal flaring is a common respiratory symptoms in children and adults."

A. Nasal flaring occurs when a child has to work hard to breathe.

The triage nurse in the emergency department must prioritize the care of children waiting to be seen. Which child is in the greatest need of emergency medical treatment? A. a 6-year-old with a fever of 104° F (40° C), a muffled voice, no spontaneous cough, and drooling B. a 3-year-old with a fever of 100° F (37.8° C), a barky cough, and mild intercostal retractions C. a 4-year-old with a fever of 101° F (38.3° C), a hoarse cough, inspiratory stridor, and restlessness D. a 13-year-old with a fever of 104° F (40° C), chills, and a cough with thick yellow secretions

A. a 6-year-old with a fever of 104° F (40° C), a muffled voice, no spontaneous cough, and drooling

Which factor, if described by the parents of a child with cystic fibrosis (CF), indicates that the parents understand the underlying problem of the disease? A. an abnormality in the body's mucus-secreting glands B. formation of fibrous cysts in various body organs C. failure of the pancreatic ducts to develop properly D. reaction to the formation of antibodies against streptococcus

A. an abnormality in the body's mucus-secreting glands

The parents of a child with cystic fibrosis express concern about how the disease was transmitted to their child. What information should the nurse give to the clients? A. A disease carrier also has the disease. B. Two parents who are carriers may produce a child who has the disease. C. A disease carrier and an affected person will never have children with the disease. D. A disease carrier and an affected person will have a child with the disease.

B. Two parents who are carriers may produce a child who has the disease.

A 7-year-old has been diagnosed with bacterial meningitis. Who should receive chemoprophylaxis? A. all children at the school B. all household contacts and close contacts C. the entire community D. household contacts only

B. all household contacts and close contacts

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? A. burning or pain with urination B. complaints of a stiff neck C. fever disappearing for longer than 24 hours, then returning D. history of febrile seizures

B. complaints of a stiff neck

A 4-year-old child with hydrocephalus is scheduled to have a ventroperitoneal shunt in the right side of the head. When developing the child's postoperative plan of care, the nurse should place the preschooler off of the operative site with the head of the bed in which position immediatelyafter surgery? A. high Fowler's B. semi-Fowler's C. flat D. Trendelenburg

C. flat

A nurse at a community event is called to an unresponsive 3-year-old. The parent states the child was eating a hot dog. The nurse determines the child has an obstructed airway. After instructing an observer to call 911, what intervention should happen first? A. performing the Heimlich maneuver until the child starts choking or coughing B. opening the child's mouth and attempting to give 2 breaths C. delivering five back blows followed by five chest thrusts D. performing chest compressions with the heel of one hand 30 times

D. performing chest compressions with the heel of one hand 30 times

Which signs and symptoms would lead the nurse to suspect a child has tetralogy of Fallot (TOF)? Select all that apply. -murmur -history of squatting -bounding pulse -cyanosis -faint pulse -tachypnea

-history of squatting -cyanosis -tachypnea -murmur

The nurse is teaching a parent and child with iron deficiency anemia. The parent asks the nurse why the ferrous sulfate needs to be mixed with citrus juice. What is the best response by the nurse? A. "The vitamin C in the citrus juice helps with iron absorption." B. "Having food and juice in the stomach helps with iron absorption." C. "The citrus juice counteracts the unpleasant taste of the iron." D. "The child will take the iron mixed with juice better than water."

A. "The vitamin C in the citrus juice helps with iron absorption."

The nurse is preparing a treatment plan for a child with sickle cell anemia in vaso-occlusive crisis. What is the most important nursing intervention to include? A. Managing pain B. Providing a cool environment C. Immobilizing the affected part D. Restricting fluids

A. Managing pain

A nurse is taking a history from the parents of a 11-year-old child admitted with Reye's syndrome. Which illness should the nurse expect the parents to report their child having the previous week? A. chickenpox B. bacterial meningitis C. strep throat D. Lyme disease

A. chickenpox

A physician orders corticosteroids for a child with systemic lupus erythematosus (SLE). The nurse knows that the purpose of corticosteroid therapy for this child is to: A. combat inflammation. B. prevent infection. C. prevent platelet aggregation. D. promote diuresis.

A. combat inflammation.

A parent of a child with sickle cell anemia confides in the nurse that the parent feels guilty about letting the child run and play with the neighborhood children and that if the parent had been a better parent, the child wouldn't have suffered a sickle cell crisis. Which response would be most appropriate? A."The child is just fine now. Don't worry." B. "Tell me more about how you feel." C. "But you know that children with sickle cell anemia often have crises." D. "You shouldn't be so protective."

B. "Tell me more about how you feel."

After teaching the parents about the urethral catheter placed after surgical repair of their son's hypospadias, the nurse determines that the teaching was successful when the mother states that the catheter in her child's penis accomplishes which goal? A. decreases pain at the surgical site B. keeps the new urethra from closing C. measures his urine correctly D. prevents bladder spasms

B. keeps the new urethra from closing

The mother of a child with tetralogy of Fallot asks the nurse why her child has clubbed fingers. The nurse bases the response on the understanding that clubbing is due to which factor? A. chronic anemia B. peripheral hypoxia C. delayed physical growth D. destruction of bone marrow

B. peripheral hypoxia

A two-year-old child comes to the emergency department with inspiratory stridor and a barking cough. A preliminary diagnosis of croup has been made. What is the nurse's mostimportant intervention? A. administer I.V. antibiotics B. provide oxygen by face mask C. establish and maintain the airway D. ask the parent to go to the waiting room

C. establish and maintain the airway

A 2-year-old client is brought to the emergency department with suspected croup. The client appears frightened and cries as the nurse approaches him. The nurse needs to assess the client's breath sounds. The best way to approach the client is to" A. expose the client's chest quickly and auscultate breath sounds as quickly and efficiently as possible. B. ask the caregiver to wait briefly outside until the assessment is over. C. tell the client the nurse is going to listen to the chest with the stethoscope. D. allow the client to handle the stethoscope before the nurse listens to the client's lungs.

D. allow the client to handle the stethoscope before the nurse listens to the client's lungs.

A 10-month-old infant with tetralogy of Fallot (TOF) experiences an cyanotic episode. To improve oxygenation during such an episode, the nurse should place the infant in which position? A. knee-to-chest B. Fowler's C. Trendelenburg's D. prone

A. knee-to-chest

A 9-year-old child is admitted to the pediatric unit for treatment of cystic fibrosis. A nurse assessing the child's respiratory status should expect to identify: A. production of thick, sticky mucus. B. harsh, nonproductive cough. C. stridor. D. unilateral decrease in breath sounds.

A. production of thick, sticky mucus.

A nurse is caring for a toddler in respiratory distress requiring endotracheal intubation. When gathering supplies, which item should the nurse obtain that is most important for this child? A. uncuffed endotracheal tube B. curved blade laryngoscope C. pain medication D. nasogastric tube

A. uncuffed endotracheal tube

A nurse is reviewing an infant's progress notes.Progress notes10/15/160800Four-month-old infant admitted last evening. Wt: 4.95 kg. (10%) Ht: 66 cm (95%), Frequent episodes of bradycardia, tachypnea. Breastfeeding every 4 hours for 30 minutes on each side.What notations would lead the nurse to suspect that this infant has a ventricular septal defect? Select all that apply. -tachypnea -plots at 95th percentile for height on growth chart -plots at the 10th percentile for weight on growth chart -bradycardia -increased length of time to finish breastfeeding

-tachypnea -plots at the 10th percentile for weight on growth chart increased length of time to finish breastfeeding

A client with iron deficiency anemia was prescribed ferrous sulfate. Which statement by the caregiver would indicate a need for further instruction on proper administration? A. "I mix the medication in milk to make it taste better." B. "I give the medication in the morning before breakfast." C. "I give the ferrous sulfate at a different time than my child's other medications." D. "I encourage my child to drink lots of fluids."

A. "I mix the medication in milk to make it taste better."

The nurse is caring for a term neonate who is diagnosed with patent ductus arteriosus. While performing a physical assessment of the neonate, the nurse anticipates that the neonate will exhibit which signs? A. decreased cardiac output with faint peripheral pulses B. profound cyanosis over most of the body C. loud cardiac murmurs through systole and diastole D. harsh systolic murmurs with a palpable thrill

C. loud cardiac murmurs through systole and diastole

Parents bring a 10-month-old boy with myelomeningocele and hydrocephalus with a ventriculoperitoneal shunt to the emergency department. His symptoms include vomiting, poor feeding, lethargy, and irritability. What interventions by the nurse are appropriate? Select all that apply. -Weigh the child. -Listen to bowel sounds. -Palpate the posterior fontanel. -Obtain vital signs. -Assess pitch and quality of the child's cry.

-Weigh the child. -Listen to bowel sounds. -Obtain vital signs. -Assess pitch and quality of the child's cry.

A mother asks the nurse how to handle her 4-year-old child, who recently has had episodes of urinary incontinence after being completely toilet-trained. What is the best response by the nurse? A. "What have you done to prevent this from happening?" B. "Have your other children experienced this same thing?" C. "Has your child experienced any recent changes in routine?" D. "Is your child angry with you about something?"

C. "Has your child experienced any recent changes in routine?"

An emergency department nurse is caring for a child diagnosed with moderately severe croup. The nebulizer treatment of choice for a child with moderate to severe croup is: A. albuterol. B. budesonide. C. epinephrine. D. ipratropium bromide.

C. epinephrine.

An overweight adolescent has been diagnosed with type 2 diabetes. What should the nurse do to increase the client's self-efficacy to manage the disease? A. Provide the client with a written daily food and exercise plan. B. Discuss eliminating junk food in the home with the parents. C. Arrange for the school nurse to weigh the child weekly. D. Utilize a peer with type 2 diabetes to role model lifestyle changes.

D. Utilize a peer with type 2 diabetes to role model lifestyle changes.

The nurse is assessing breath sounds of a child admitted to the unit. Based on the following progress notes, which respiratory illness would the nurse suspect?Progress notes10/152030Seven-year-old child admitted from ER. Oxygen via mask at 4 L/min. Frequent, tight cough. A/Ox3. Shortness of breath noted while talking to mom. HEENT normal. Lungs with wheezing in bases. Heart RRR, no murmur. Abdomen soft, flat. Active bowel sounds. Moving all extremities well. A. pneumonia B. croup C. pulmonary edema D. asthma

D. asthma

A nurse is deciding whether to report a suspected case of child abuse. Which criterion is the most important for the nurse to consider? A. inappropriate parental concern for the degree of injury B. absence of parents to question about the injury C. inappropriate response of the child to the injury D. incompatibility between the child's history and the injury

D. incompatibility between the child's history and the injury

When assessing a child with bronchiolitis, which finding does the nurse expect? A. clubbed fingers B. barrel chest C. barking cough and stridor D. productive cough

D. productive cough

An adolescent with well-controlled type 1 diabetes has assumed complete management of the disease and wants to participate in gymnastics after school. To ensure safe participation, the nurse should instruct the client to adjust the therapeutic regimen by: A. eating a snack before each gymnastics practice. B. measuring urine glucose level before each gymnastics practice. C. measuring blood glucose level after each gymnastics practice. D. increasing morning dosage of intermediate-acting insulin.

A. eating a snack before each gymnastics practice.

The nurse is monitoring an infant with meningitis for signs of increased intracranial pressure (ICP). The nurse should assess the infant for which signs and symptoms? Select all that apply. -irritability -headache -mood swings -bulging fontanel -emesis

-irritability -bulging fontanel -emesis

A nurse is caring for a 3-year-old child with viral meningitis. Which signs and symptoms does the nurse expect to find during the initial assessment? Select all that apply. -bulging anterior fontanel -fever -nuchal rigidity -petechiae -irritability -photophobia

-fever -nuchal rigidity -irritability -photophobia

A nurse is teaching the parents of a child with cystic fibrosis about proper nutrition. Which instruction should the nurse include? A. Encourage a high-calorie, high-protein diet. B. Restrict fluids to 1,500 ml per day. C. Limit salt intake to 2 g per day. D. Encourage foods high in vitamin B.

A. Encourage a high-calorie, high-protein diet.

The nurse assesses a child with fever, sensitivity to light, and a red rash on the back. How will the nurse assess for Kernig's sign? A. Have the child lie supine with flexed knees, then ask the child to extend the knees. B. Have the child sit, and tap the child's face over the facial nerve area. C. Place the child in the supine position, and inflate a blood pressure cuff on the arm. D. Have the child stand, and ask the child to flex the neck by bringing the chin to the chest.

A. Have the child lie supine with flexed knees, then ask the child to extend the knees.

A child with meningococcal meningitis is being admitted to the pediatric unit. In preparation for the child's arrival, what should the nurse do first? A. Institute droplet precautions. B. Obtain the child's vital signs. C. Ask the parent about medication allergies. D. Inquire about the health of siblings at home.

A. Institute droplet precautions.

A 2-year-old child is brought to the emergency department with a history of upper airway infection that has worsened over the last 2 days. The nurse assesses the child and finds a hoarse voice, inspiratory stridor, fever, and a barking cough. What would the nurse anticipate for admission orders? A. cool mist humidification B. expectorant cough syrup C. antibiotics D. inhaled bronchodilator

A. cool mist humidification

The nurse is providing teaching to the parents of a young child with a urinary tract infection. The nurse's goal is to help the parents understand their role in the treatment of the infection. Which statement by the parents lets the nurse know that the teaching has been successful? A. "We can treat the infection by increasing oral fluid intake." B. "We need to encourage cranberry juice to treat the infection." C. "We need to administer the oral antibiotics as prescribed." D. "We need to come to the emergency department for IV fluids."

C. "We need to administer the oral antibiotics as prescribed."

Which assessment findings should lead the nurse to suspect that a toddler is experiencing respiratory distress? Select all that apply. -coughing -respiratory rate of 35 breaths/minute -heart rate of 95 beats/minute -restlessness -malaise -diaphoresis

-coughing -respiratory rate of 35 breaths/minute -restlessness -diaphoresis

The nurses discusses appropriate iron-rich food selections with the parent of an 11-month-old infant with iron deficiency anemia. The nurse determines that teaching has been successful when the parent verbalizes that she will include which foods in the child's diet? A. eggs, fortified cereals, meats, and green vegetables B. fruits, cereals, milk, and yellow vegetables C. eggs, fruits, milk, and mixed vegetables D. juices, fruits, fortified cereals, and milk

A. eggs, fortified cereals, meats, and green vegetables

A 4-year-old child is seen at the clinic for a mild iron deficiency anemia caused by a poor diet. The parents ask the nurse what type of treatment to expect. What is the most appropriate response by the nurse? A. iron replacement and change of diet B. transfusion of packed red blood cells C. preparation for bone marrow transplant D. splenectomy and steroid therapy

A. iron replacement and change of diet

A nurse working in the triage area of an emergency department sees several pediatric clients arrive simultaneously. Which client should be treated first? A. a crying 4-year-old child with a laceration on the scalp B. a 3-year-old child with a barking cough and flushed appearance C. a 3-year-old child with Down syndrome who's pale and asleep D. a 2-year-old child with stridorous breath sounds, sitting up and drooling

D. a 2-year-old child with stridorous breath sounds, sitting up and drooling

The nurse at the clinic is assessing a toddler and notices retractions while the child is breathing. The parents state that they began to notice the retractions a few days ago and wondered if it was significant. What is the best response by the nurse? A. "Retractions occur normally when children are very active." B. "This is very serious; you should have brought your child in sooner." C. "Your child is having difficulty breathing and we need to determine why." D. "This is an indication that your child has a respiratory infection."

C. "Your child is having difficulty breathing and we need to determine why."

A parent brings her 6-year-old daughter to the pediatrician's office for evaluation. The child recently started wetting the bed and running a low-grade fever. A urinalysis is positive for bacteria and protein. A urinary tract infection (UTI) is diagnosed, and the child is prescribed antibiotics. Which nursing interventions are appropriate? Select all that apply. -Limit fluids for the next few days to decrease the frequency of urination. -Assess the parent's understanding of UTI and its causes. -Instruct the parent to administer the antibiotic as prescribed, even if the symptoms diminish. -Provide instructions only to the parent, not the child. -Tell the parent to have the child wipe the back to the front after voiding and defecation.

-Assess the parent's understanding of UTI and its causes. -Instruct the parent to administer the antibiotic as prescribed, even if the symptoms diminish.