Nur 106- Module G2

A 9-year-old child has a fractured tibia, and a full leg cast is applied. Which assessment findings should the nurse immediately report to the health care provider? Select all that apply. 1. Inability to move the toes 2.Increased urine output 3.Pedal pulse of 90 beats/min 4.Tingling sensation in the foot 5.Fiberglass cast that is damp after 4 hours

1, 4 & 5 A cast is not flexible and can inhibit circulation. Cold toes, loss of sensation in toes, pain, and inability to move the toes should be reported immediately. A tingling sensation in the foot may indicate excessive pressure on the nerves and circulatory system in the casted extremity. A fiberglass cast dries within minutes; if it remains damp, it should be reported before 4 hours have elapsed. Increased urine output is not significant; it may be related to increased fluid intake. The expected pulse rate for a 9-year-old child ranges from 70 to 110 beats/min.

A child is being treated with oral ampicillin (Omnipen) for otitis media. What should be included in the discharge instructions that the nurse provides to the parents of the client? 1. Complete the entire course of antibiotic therapy. 2. Herbal fever remedies are highly discouraged. 3.Administer the medication with meals. 4.Stop the antibiotic therapy when the child no longer has a fever.

1. Complete the entire course of antibiotic therapy Once antibiotics therapy is initiated, the antibiotics start to destroy specific bacterial infections that the health care provider is trying to treat. Antibiotic therapy takes a specific dose and number of days to completely eliminate the bacteria. If the caregivers start a dose and stop it before the course is complete, the remaining bacteria has a chance to grow again, become resistant to antibiotic treatment, and multiply. The nurse should not discourage use of herbal fever remedies; however the herbal treatment should be reviewed to see if it is contraindicated. Ampicillin should be taken 1 to 2 hours after meals. Antibiotic therapy should be completed as prescribed. View Topics

A child with recently diagnosed idiopathic scoliosis has a mild structural curve. The child's mother asks whether the problem can be corrected with exercise. What should the nurse tell the mother concerning an exercise program? 1.Exercise is used in conjunction with a brace. 2.Exercise can be used if the child appears highly motivated. 3.Exercise might exaggerate the curvature if the curve is severe. 4.Exercise is needed to correct the curvature without the need for a brace.

1. Exercise is used in conjunction with a brace. An exercise program and a brace are the treatments of choice for mild structural scoliosis. Although compliance will affect the ultimate outcome of treatment, exercises alone are not helpful in this type of scoliosis. Exercises are to be encouraged, regardless of the type or extent of scoliosis. Exercises alone are used only with postural-related, not structural-related, scoliosis.

The parents of a 14-month-old boy with bilateral cryptorchidism ask the nurse in the pediatric clinic why it is important for him to have surgery before he is 2 years old. Before responding, the nurse takes into consideration the fact that uncorrected cryptorchidism can result in: 1.Infertility 2.Hydrocele 3.Varicocele 4.Epididymitis

1. Infertility Undescended testes (cryptorchidism) is the failure of the testes to move down the inguinal canal into the scrotum; this migration begins around the 25th to 30th week of gestation. Undescended testes are exposed to body heat that can destroy the sperm-producing ability of the testes, resulting in sterility. A hydrocele is an enlargement of the scrotum with fluid; it is not related to cryptorchidism. A varicocele is a dilation and tortuosity of the scrotal veins; it is not caused by undescended testicles. Inflammation of the epididymis may occur whether or not cryptorchidism is corrected.

An infant who has been found to have developmental dysplasia of the hip (DDH) is being examined in the pediatric clinic. What clinical finding does the nurse expect to identify during the physical assessment? 1.Limited abduction of the affected hip 2.Downward and inward rotation of the affected hip 3.Inability to flex and extend the hip on the affected side 4.Free abduction of the affected hip when placed in the frog position

1. Limited abduction of the affected hip Abduction of the hip is limited because the head of the femur slips out of the acetabulum and is unable to rotate. Rotation of the affected hip is unaffected in an infant with DDH. The hip can be flexed on the affected side. Free abduction of the affected hip is impossible; the frog position may be used in the treatment of DDH.

A nurse is helping a 7-year-old child with juvenile idiopathic arthritis (JIA) perform range-of-motion exercises. What outcome indicates that the exercises have been effective? 1.The knees are more mobile. 2.The pedal pulses become stronger. 3.Subcutaneous nodules at the joints recede. 4.The child states that the pain is diminished.

1. The knees are more mobile. The exercises are done to preserve function by mobilizing restricted joints. Circulation is not affected by the arthritic process. Exercises are done to restore joint function; they do not necessarily relieve pain. Exercise does not affect the subcutaneous nodules in the joints.

What should the nurse teach parents about their newborn's diagnosis of phenylketonuria (PKU)? 1.A low-phenylalanine diet is required. 2.Phenylalanine is not necessary for growth. 3.Phenylalanine can be administered to correct the deficiency. 4.A substitute for phenylalanine is an increased amount of other amino acids.

1.A low-phenylalanine diet is required Reducing dietary phenylalanine helps prevent brain damage. The PKU diet is planned to maintain the serum phenylalanine level at 2 to 8 mg/100 mL. Phenylalanine is essential for growth and development of the brain. Administering phenylalanine is contraindicated. There are no substitute for phenylalanine, which is one of the essential amino acids.

A 12-year-old child with Down syndrome is admitted to the hospital for intravenous antibiotics for pneumonia. Which clinical findings associated with Down syndrome should the nurse expect when performing a physical assessment? Select all that apply. 1. Saddle nose 2. Thin fingers 3. Inner epicanthic folds 4. Hypertonic musculature 5. Transverse palmar crease

1.Saddle Nose 2.Inner epicanthic folds 3.Transverse palmar crease Children with Down syndrome have a broad nose with a depressed bridge (saddle nose), as well as inner epicanthic folds, and oblique palpebral fissures; they also have speckling of the iris (Brushfield spots). Children with Down syndrome have a transverse palmar crease (simian crease) formed by fusion of the proximal and distal palmar creases. These children also have broad, short, stubby hands and feet. Children with Down syndrome have hypotonic, not hypertonic, musculature.

What clinical indicators should a nurse expect when assessing a client with hyperthyroidism? Select all that apply. 1. Dry Skin 2. Weight loss 3.Tachycardia 4.Restlessness 5.Constipation 6.Exophthalmos

2, 3, 4 & 6 Weight loss is associated with hyperthyroidism because of the increase in the metabolic rate. Muscle weakness and wasting also occur. Tachycardia, palpitations, increased systolic blood pressure, and dysrhythmias occur with hyperthyroidism because of the increased metabolic rate. Restlessness and insomnia are also associated with hyperthyroidism because of the increased metabolic rate. Protrusion of the eyeballs occurs with hyperthyroidism because of peribulbar edema. Dry, coarse, scaly skin occurs with hypothyroidism, not hyperthyroidism, because of decreased glandular function. Smooth, warm, moist skin occurs with hyperthyroidism. Constipation is associated with hypothyroidism. Increased stools and diarrhea are associated with hyperthyroidism.

A nurse plans to discuss childhood nutrition with a group of parents whose children have Down syndrome in an attempt to minimize a common nutritional problem. What problem should be addressed? 1.Rickets 2.Obesity 3.Anemia 4.Rumination

2. Obesity Obesity is a common nutritional problem of children with Down syndrome. It is thought to be related to excessive caloric intake and impaired growth. Rickets is a nutritional disorder related to vitamin D deficiency; it is usually not encountered in these children. Anemia is the most common nutritional problem in children with iron deficiency. Rumination is an eating disorder of infancy characterized by repeated regurgitation without a gastrointestinal illness.

The parents of an 18-month-old toddler are anxious to know why their child has experienced several episodes of acute otitis media. What should the nurse explain to the parents about why toddlers are prone to middle ear infections? 1.Immunological differences between adults and young children 2.Structural differences between eustachian tubes of younger and older children 3.Functional differences between eustachian tubes of younger and older children 4.Circumference differences between middle ear cavity size of adults and young children

2. Structural differences b/w Eustachian tubes of younger and older children. The eustachian tube in young children is shorter and wider, allowing a reflux of nasopharyngeal secretions. Immunological differences are not a factor in the development of otitis media. There is no difference in the function of the eustachian tube among age groups. The size of the middle ear does not play a role in the occurrence of otitis media in young children.

The mother of a 2-year-old child tells the nurse that she is concerned about her child's vision. What behavior when the child is tired leads the nurse to suspect strabismus? 1 One eyelid droops. 2Both eyes look cloudy. 3One eye moves inward. 4Both eyes blink excessively

3. One eye moves inward An inward moving eye (tropia) is one form of strabismus. A drooping eyelid is called ptosis; it may be congenital or caused by trauma. Cloudy eyes are associated with congenital cataracts. Blinking may be a tic.

A 2-year-old toddler is admitted to the pediatric unit with a diagnosis of bacterial meningitis. What is the most important safety measure for the nurse to institute immediately after the child has a seizure? 1.Monitoring the child's vital signs 2.Padding the side rails of the toddler's crib 3.Placing the child in the side-lying position 4.Bringing suction equipment to the bedside

3. Placing the child in the side-lying position The side-lying position promotes a patent airway; the tongue can move away from the back of the pharynx and saliva can flow out of the mouth by gravity. Although monitoring of vital signs is important, a patent airway is the priority. Suctioning may be unnecessary; the child should not be left alone while equipment is obtained. The crib sides should have been padded as a part of seizure precautions before the seizure. If the seizure was unexpected and seizure precautions were not previously instituted, they should be instituted after the immediate respiratory and safety needs of the toddler have been met.

A 9-year-old child who has had type 1 diabetes for several years is brought to the emergency department of a community hospital. The child is exhibiting deep, rapid respirations; flushed, dry cheeks; abdominal pain with nausea; and increased thirst. What blood pH and glucose level does the nurse expect the laboratory tests to reveal? 1.7.20 and 60 mg/dL 2.7.50 and 60 mg/dL 3.7.50 and 460 mg/dL 4.7.20 and 460 mg/dL

4. 7.20 and 460 mg/dL A pH of 7.20 and blood glucose level of 460 mg/dL are expected values in ketoacidosis; the pH of 7.20 indicates acidosis (metabolic) and the blood glucose level of 460 mg/dL is higher than the expected range of 90 to 110 mg/dL. Although the blood pH of 7.20 indicates acidosis, the blood glucose of 60 mg/dL is less than the expected range of 90 to 110 mg/dL, indicating hypoglycemia rather than hyperglycemia. Neither the pH of 7.50 nor the blood glucose value of 60 mg/dL is expected with ketoacidosis; with ketoacidosis, the pH is decreased and the blood glucose level is increased. Although the blood glucose is increased with ketoacidosis, the pH is decreased, not increased; a pH of 7.50 indicates alkalosis.

A 4-year-old child is admitted to the pediatric unit with a diagnosis of Wilms tumor. Considering the unique needs of a child with this diagnosis, the nurse should place a sign on the child's bed that states: 1.Keep NPO. 2.No IV medications. 3.Record intake and output. 4.Do not palpate the abdomen.

4. Do not palpate the abdomen. Palpation increases the risk of tumor rupture and is contraindicated. There are no data to indicate that surgery is scheduled; therefore there is no reason to maintain nothing-by-mouth (NPO) status. There is no contraindication to intravenous medication. Recording of intake and output may or may not be instituted; it is not specific to children with Wilms tumor.

A mother brings her 6-year-old child to the pediatric clinic, stating that the child has not been feeling well, is weak and lethargic, and has a poor appetite, headaches, and smoky-colored urine. What additional information should the nurse obtain that will aid diagnosis? 1.Rash on palms and feet 2.Shoulder and knee pain 3.Recent weight loss of 2 lb 4.Strep throat in the past 2 weeks

4. Strep throat in the past 2 weeks The smoky urine and the stated symptoms should lead the nurse to suspect glomerulonephritis, which usually occurs after a recent streptococcal infection. A rash on the hands and feet is associated with scarlet fever, not glomerulonephritis. Shoulder and knee pain is associated with rheumatic fever, not glomerulonephritis. Weight loss generally occurs in children who have type 1 diabetes, not those with glomerulonephritis

A 4-year-old child is admitted to the pediatric neurological service with a seizure disorder. Shortly after admission, while in bed, the child has a generalized seizure. What nursing actions are most appropriate? Select all that apply. 1. Assessing the seizure 2.Taking the child's vital signs 3.Turning the child on the side 4.Pulling the padded side rails up 5.Initiating oxygen administration

1, 3 & 4 Therapeutic management is based on an accurate description of the seizure. Turning the child on one side or the other allows drainage of secretions that cannot be swallowed during the seizure. The first safety precaution is to prevent injury by raising the padded side rails. It is impossible to take vital signs during a seizure. Administering oxygen is useless because the child does not breathe during a seizure.

An 8-year-old child is admitted to the pediatric unit with nephrotic syndrome. What measures should the nurse expect to include in the plan of care for this child? Select all that apply 1.Providing symptomatic care 2.Maintaining bedrest 3.Administering antibiotics 4.Eliminating high-sodium foods 5.Monitoring response to steroids

1, 4 & 5 Bedrest for children with nephrotic syndrome is generally no longer ordered. When there is gross edema, children usually prefer to remain in bed to conserve energy, but there are no ill effects of ambulating if they wish to do so. Nephrotic syndrome is a noninfectious disorder; however, these children are prone to infection, and if they contract an infection it is treated accordingly. Examples of symptomatic care are treating azotemia with a low-protein diet; encouraging bedrest if there is gross edema; restricting fluids if there is oliguria; and treating infection if it should occur. Foods that are high in sodium are restricted when there is gross edema; although restricting foods that are high in sodium does not lessen the edema, it seems to prevent it from worsening. A steroid is given to children with nephrotic syndrome because of its antiinflammatory properties. It is essential that the nurse monitor the child's response to steroids to determine the medication's effectiveness.

A nurse is assessing a 3-week-old infant who has been admitted to the pediatric unit with hydrocephalus. What finding denotes a complication requiring immediate attention? 1.Tense anterior fontanel 2.Uncoordinated eye/muscle movement 3.Larger head circumference than chest circumference 4.Inability to support the head while in the prone position

1. Tense anterior fontanel A tense or bulging fontanel is indicative of increased intracranial pressure, which is caused by the fluid accumulation associated with hydrocephalus. Conjugate gaze does not occur until 3 to 4 months of age, once the eye muscles have matured. The head is the largest part of the body at this age; the head circumference should be about 1 inch larger than that of the chest. An infant cannot support the head before 1 to 1½ months of age.

The nurse in the pediatric clinic is reviewing the health history of a 10-year-old girl with a diagnosis of juvenile idiopathic arthritis (JIA). Currently the child is experiencing recurrent pain and swelling of the joints, particularly her knees and ankles. What organ is commonly affected in children with this disorder? 1.Ears 2.Eyes 3.Liver 4.Brain

2. Eyes Juvenile idiopathic arthritis can cause inflammation of the iris and ciliary body of the eyes, which may lead to blindness. The ears are not affected. The liver may become enlarged, but this does not occur as frequently as visual problems do. The brain is not affected.