Nursing Care of Children VATI
A nurse is planning care for a child who has juvenile rheumatoid arthritis. Which of the following is an appropriate action for the nurse to take?
Maintain night splints to the affected joint
A nurse is caring for an adolescent client who has spina bifida and is paralyzed from the waist down. Which of the following statements made by the client indicates a need for further teaching?
" I only need to catheterize myself twice a day"
A nurse is caring for a 3yr old client who has persistent otitis media. To help identify contributing factors, the nurse should ask the parents which of the following questions?
"Does anyone smoke around or in the same house as your daughter?''
A nurse is reinforcing teaching with an adolescent who has type 1 DM. Which of the following statements by the client indicates an understanding of how to adjust his routine for sports activities?
"I should skip basketball practice if my blood sugar is too high"
A nurse is reinforcing teaching how to control a minor bleeding episode to a parent of a child with hemophilia. Which of the following statements by the parent indicates a need for further teaching?
"I will apply heat"
A school-age child is brought to the ED with a 2-day history of nausea, vomiting, and report of severe right lower quadrant pain. The child's WBC is 17,000/mm3 so appendicitis is suspected. Which of the following statements made by the child is most concerning to the nurse?
"My belly doesn't hurt anymore"
A nurse is reinforcing teaching with the parent of a school- age child who has a new diagnosis of asthma. Which of the following responses should the nurse make?
"Repeat back to me what to do if your child has trouble breathing"
A nurse is caring for a child who reports being physically abused by a family member. Which of the following statements should the nurse make?
"it is not your fault that this happened"
A nurse is caring for a child who is having a seizure. Which of the following is an appropriate action by the nurse?SATA
- Assess the client's airway patency - Place the bed in a low position
A nurse is preparing to apply a eutectic mixture of local anesthetics (EMLA) cream prior to inserting an intravenous catheter on a preschool-age child. Which of the following actions should the nurse plan to take?
- Cover the treated area with a transparent occlusive dressing - Apply the medication an hr before the procedure begins - Use a facial pain rating scale to evaluate effectiveness of the treatment
A nurse is assisting with the admission of a 6month old infant who has dehydration. When she tracks the client's urinary output, which of the following amounts should indicate to the nurse that the treatment has corrected the fluid imbalance?
2mL/kg/hr
An assistive personnel (AP) on a pediatric unit brings to the attention of the nurse several client measurements obtained with the morning vital signs. Which of the following clients should the nurse plan to visit first?
7 year old client with diabetes insipidus and a urine specific gravity of 1.002 - range 1.005-1.030
A nurse at a pediatrician's office answers a phone call from parent whose child just ingested 15 vitamins tablets with added ferrous sulfate. Which of the following instructions should the nurse give to the parent?
Contact the poison control center
A nurse is caring for a 3 year old child who weighs 33lb and has had 160mL of urine output during the past 8hr. Which of the following actions should the nurse take?
Continue to monitor the client - The child's urine output should be 1mL/kg/hr.
A nurse is collecting data from a child after a tonsillectomy. Which of the following is a clinical manifestation of a hemorrhage?
Continuous swallowing
A nurse is caring for a toddler who has laryngotracheobronchitis and is placed in a cool mist tent. Which of the following findings should the nurse expect as a result of the treatment?
Decreased stridor
A nurse is caring for an 8 year old child diagnosed with sickle cell anemia recovering from a vaso-occlusive crisis. Which of the following precautions should the nurse include in the discharge teaching?
Drink 8 - 10 glasses of fluid daily - Hydration will decrease the viscosity of the blood. A decreased viscosity helps lower the risk for sicking due to venous stasis.
A nurse is caring for a preschool child who has croup. Which of the following findings should the nurse report to the provider?
Drooling of saliva
A nurse is assisting with the care of a 3 month old infant following a surgical procedure. Which of the following pain scales should the nurse use to determine the infant's pain level
FLACC
A nurse is collecting data from a child. Which of the following is a clinical manifestation of nephrotic syndrome?
Facial edema
A nurse is checking a school-age child for pediculosis capitis. The nurse understands that which of the following manifestations is a definitive indication of this condition?
Firmly attached white particles on the hair
A nurse is caring for a 4yr old child who refuses to take his medication. Which of the following strategies should the nurse use to elicit the child's cooperation?
Offer the child a choice of crushed pills or elixir - While taking the medicine is not a choice, the child can decide what form of medication to take. This gives the preschoolers a sense of control over a stressful situation. The child may also choose the type of fluid to drink after taking the medication
A nurse is caring for a child who has acute diarrhea and reports that he is thirsty. Which of the following fluids should the nurse give the child?
Pedialyte
A nurse is caring for a child following an open reduction and internal fixation of a fractured femur and application of a cast. The cast has a window cut in it for viewing of the incision. Which of the following actions should the nurse take first?
Perform neurovascular checks of the affected extremity
A nurse is planning care for a child with suspected epiglottitis. Which of the following is an appropriate action for the nurse to take?
Place client in an upright position
A nurse is caring for a toddler scheduled to have a lumbar puncture (LP) to rule out meningitis. The nurse who is planning to assist with the procedure should
Place the toddler in a side-lying, knee-chest position
A nurse is collecting data from a 9 month old infant. Which of the following findings would require further intervention?
Positive Moro reflex
A hospital volunteer asks a nurse to suggest an appropriately play activity for a 12 month old client on contact precautions. Which of the following toys should the nurse suggest to meet the developmental needs of the client?
Push-pull toys
A nurse is caring for a 4 year old child who had hydrocephalus as an infant and is admitted with a malfunctioning ventriculoperitoneal shunt. Following new shunt placement, the nurse conducts a post-op check. Which of the following findings requires immediate action by the nurse ?
Sleepy and difficult to arouse
A nurse is collecting data from a 10 month old infant. Which of the following findings should the nurse report to the provider?
The infant does not sit steadily without support
A nurse is reinforcing teaching with the parent of a child scheduled for the initial surgery to treat Hirschsprung's disease. The nurse knows that the parent understands the goal of the surgery when the parent states,
" I'm glad that the ostomy is only temporary"
A nurse is caring for a 2 week old infant whose mother requests additional information about sudden infant death syndrome (SIDS). Which of the following responses should the nurse make?
" You should place your baby on her back when sleeping to decrease the risk of SIDS"
A school nurse is screening a 11 year old client for idiopathic scoliosis. Which of the following instructions should the nurse give the client for this examination?
"Bend forward from the waist with your head and arms downward"
A nurse working at a clinic speaks on the telephone with a parent of a 2 month old infant. The parent tells the nurse that the infant has projectile vomiting followed by hunger after meals. Which of the following responses by the nurse is appropriate?
"Bring your infant into the clinic today to be seen "
A nurse is preparing a 4 year old child for discharge following a bilateral myringotomy with tympanostomy tube placement. The mother asks what to do if the tubes fall out. The nurse should give the parent which of the following instructions ?
Call the health care clinic to report that the tubes have fallen out
A nurse is collecting data about a 2yr old client who has AIDS. Bases on the client's risk for opportunistic infections associated with this diagnosis, the nurse should inspect the inside of the child's mouth for
Candidiasis
A nurse is caring for a child with acute glomerulonephritis. Which of the following should be the first action by the nurse ?
Check the child's daily weight
A nurse is caring for a hospitalized 14-month-old child. Which of the following lunch choices is appropriate ?
Chicken nuggets and green beans
A nurse is caring for a child who has a tracheostomy. After suctioning the tracheostomy, the nurse determines that the procedure was effective with which of the followings?
Clear breath sounds
A nurse is collecting data from 15 yr old adolescent client who has a new diagnosis of DM in order to assist with reinforcing teaching about self-management skills. The nurse should expect the client to be in which of the following phases of cognitive development?
Formal operations phase
A nurse is reinforcing instructions with the parent of a toddler about foods that are included on a clear liquid diet. Which of the following foods suggested by the parent indicates understanding of the instructions?
Gelatin
A nurse is planning care for a child who is admitting with mumps. Which of the following is an appropriate action for the nurse to take ?
Initiate droplet precautions
A nurse is caring for a child who has idiopathic thrombocytopenic purpura and is experiencing a nose bleed. Which of the following is an appropriate action by the nurse ?
Insert cotton into each nostril
A nurse is caring for a toddler whose parent states while bathing the child she noticed a mass in his abdominal area and his urine is a pink color. Which of the following is the priority action the nurse should take?
Instruct the parent to avoid pressing on the abdominal area
A nurse is reviewing the serum laboratory results of four children. Which of the following values should the nurse report to the provider?
Iron 38mcg/dL
A parent expresses concern to the nurse about his 5 year old child's stuttering. Which of the following statements is an appropriate nursing response?
Look directly at your son when he is speaking
A nurse is collecting data from an infant. Which of the following is clinical manifestation of a large patent ductus arteriosus?
Machinery-like murmur
The nurse is reinforcing discharge instructions with the parent of a child who has cystic fibrosis (CF). Which of the following statements by the parent indicate a correct understanding of the child's nutritional needs? "I know it will be important for me to
make sure my child washes her hands well before eating."
A nurse is assisting with the discharge of a child who has a new prescription for an oral antibiotic. Which of following should the nurse include in the discharge instructions?
- Reason the child is taking the medication - Written information about the medication - Adverse effects of the medication
A nurse has accepted a position on a pediatric unit and is learning more about psychosocial development. Place Erikson's stages of psychosocial development in order from birth through age 18yrs.
- Trust vs. mistrust - Autonomy vs. shame and doubt - Initiative vs. guilt - Industry vs. inferiority - Identity vs. role confusion
A nurse is providing care to a group of adolescent clients. Which of the following client situations should be reported to the provider immediately?
A client's blood pressure changes from 112/60mm Hg to 90/54mmHg when standing
A nurse is caring for a child who has rheumatic fever. When obtaining the client's medical history from the parent, the nurse should recognize which of the following findings as significant?
A sibling had a sore throat 3 weeks ago
A nurse is collecting data from an adolescent client. Which of the following represents the greatest risk for suicide?
Active psychiatric disorder
A nurse is caring for a child with a suspected diagnosis of bacterial meningitis. Which of the following is the priority action by the nurse?
Administer antibiotics when available
A nurse is preparing to administer an IM injection to a preschool-age child. Which of the following actions should the nurse take?
Allow the child to hold a favorite toy
A nurse is planning care for a child that has severe diarrhea. Which of the following is the priority nursing action?
Assess fluid balance
A nurse is collecting data from a school age child who is undergoing a neurological assessment following a head injury. The nurse should document gross incoordination when walking as which of the following findings?
Ataxia
A nurse is caring for an infant after surgical repair of a cleft lip. The nurse should comfort the infant by
Rocking her with a favorite blanket
