Pediatric Practice Question 1 - Samper

A nurse is planning care for 2-month-old infant following a surgical procedure. Which of the following pain rating scales should the nurse plan to use to determine the infant's level of pain? FACES scale OUCHER scale FLACC scale PANAD scale

FLACC scale The FLACC scale is used for children 2 months to 7 years. It uses facial expressions, leg movement, activity, cry, and consolability to assess the client's level of pain.

A nurse is caring for a child who was admitted with suspected rheumatic fever. The provider prescribes an anti-streptolysin O (ASO) titer. The parent asks the nurse the purpose of the test. Which of the following responses should the nurse make? "This test will indicate if your child has rheumatic fever." "This test will confirm if your child had a recent streptococcal infection." "This test will indicate if your child has a therapeutic blood level of an aminoglycoside." "This test will confirm if your child has immunity to streptococcal bacteria."

"This test will confirm if your child had a recent streptococcal infection." An ASO titer is a blood test that measures anti-streptolysin O antibodies in the blood. The test determines if the client has recently been infected with Group A streptococcus. The ASO antibody can be detected in the blood for weeks or months after the primary source of the infection has been eradicated.

A nurse is providing teaching to the parents of a child who has streptococcal pharyngitis about ways to prevent disease transmission. Which of the following responses by the parents indicates an understanding of the teaching? "We'll continue to encourage him to drink lots of fluids." "We'll take his temperature every 4 hours." "We'll give him Tylenol for the pain." "We'll discard his toothbrush and buy another."

"We'll discard his toothbrush and buy another." Children who have positive throat cultures for streptococcal infection should replace their toothbrush after they have been taking antibiotics for 24 hr. Using a contaminated toothbrush can re-introduce the bacteria and spread it to others if others handle the toothbrush.

A nurse is caring for a school-age child who was involved in a motor-vehicle crash. Nurses' Notes 1845: Client is awake, alert, oriented to person, place, and time. Skin warm and dry. Capillary refill less than 2 seconds. Heart rate regular. Scattered rhonchi bilateral bases. Respirations even and non-labored. Bowel sounds hypoactive in all four quadrants. Right lower extremity in skeletal traction related to femur fracture with 5 pounds of weight hanging freely. Toe movement noted to right foot. Pedal pulse +2 bilateral. +1 edema noted to right lower extremity. Rates pain as 4 on pain scale from 0 to 10. 2125: Skin warm and dry. Respirations even and slightly labored. Nonproductive cough noted. Bowel sounds hypoactive in all four quadrants. Last bowel movement two days ago soft, formed. Pedal pulse +2 bilateral. +2 edema noted to right lower extremity. Rates pain as 5 on pain scale from 0 to 10. Capillary refill to lower extremities less than 2 seconds. Voided 200 mL clear, yellow urine. Vital Signs 1845: Temperature: 37.2°C (99.9°F) Pulse rate: 95/min Respiratory rate: 25/min Blood pressure: 112/68 mm Hg Oxygen saturation: 95% room air 2125: Temperature: 37.1°C (98.8°F) Pulse rate: 94/min Respiratory rate: 23/min Blood pressure: 110/64 mm Hg Oxygen saturation: 93% room air Complete the following sentence by using the list of options. The child is at highest risk for developing Select... as evidenced by the client'sSelect....

Dropdown 1 Pulmonary embolism is correct. Immobility from traction decreases venous return and causes pooling of blood, which increases the risk of clot formation. The child is receiving traction therapy for management of femur fracture and is experiencing a change in respiratory status with their respirations being slightly labored. These findings put the child at great risk for developing an embolus. Dropdown 2 Oxygen saturation level is correct. The child's oxygen saturation level has decreased, which indicates hypoxia. This finding can be related to pulmonary embolism.

A nurse is caring for a 3-year-old child whose parents report that she has an intense fear of painful procedures, such as injections. Which of the following strategies should the nurse add to the child's plan of care? (Select all that apply.) Have a parent stay with the child during procedures. Cluster invasive procedures whenever possible. Perform the procedure as quickly as possible. Allow the child to keep a toy from home with her. Use mummy restraints during painful procedures.

Have a parent stay with the child during procedures is correct. Maintaining parent-child contact is one of the most supportive interventions for toddlers and preschoolers undergoing painful procedures. Perform procedures as quickly as possible is correct. Moving quickly through the steps of a painful procedure is a supportive intervention for children undergoing painful procedures. Allow the child to keep a toy from home with her is correct. Having familiar and cherished objects nearby is therapeutic for children during their hospitalization.

A nurse is preparing to administer vaccines to a 1-year-old child. Which of the following vaccines should the nurse give? (Select all that apply.) Measles, mumps rubella (MMR) Diphtheria, tetanus and acellular pertussis (DTaP) Varicella (VAR) Rotavirus (RV) Human papillomavirus (HPV4)

Measles, mumps rubella (MMR) is correct. A 1-year-old child should receive the first of two doses of the MMR vaccine. Varicella (VAR) is correct. A 1-year-old child should receive the first of two doses of the VAR vaccine.

A nurse is caring for a toddler who presents to the emergency department. Vital Signs 1800: Axillary temperature 37.2° C (99° F) Apical heart rate 120/min Respiratory rate 26/min Oxygen saturation 98% on room air Nurses' Notes 1800: Parents report toddler has been having episodes of suddenly crying and vomiting over the past 12 hr. Parents also report toddler is pleasant and plays between these episodes. Toddler is alert and active and in no apparent distress. Mucus membranes and nailbeds pink. Respirations easy and unlabored. Abdomen appears non-distended. Toddler appeared uncomfortable with light palpation of abdomen. 1830: Toddler suddenly began crying loudly and pulling their knees up toward their chest. Vomited small amount of bile-colored fluid. Episode lasted a few minutes. Passed a soft stool that contained blood and mucus, resembling currant jelly. Diagnostic Results 1900: Ultrasound of abdomen Findings consistent with presence of intussusception. Which of the following actions should the nurse plan to take? (Select all that apply.) Monitor color of stools. Educate the parents to increase the toddler's daily fiber intake. Administer intravenous antibiotics. Collect a urine specimen for culture and sensitivity. Initiate contact precautions. Administer pancreatic enzymes before meals. Insert an NG tube

Monitor color of stools is correct. The passage of a normal brown stool indicates resolution of the intussusception. The nurse should notify the provider of this occurrence. Insert an NG tube is correct. An intussusception is a bowel obstruction caused by the intestines telescoping in on itself. The nurse should plan to insert an NG tube to provide gastric decompression until the obstruction is resolved. Administer intravenous antibiotics is correct. Children who are experiencing an intussusception are at risk for developing bowel necrosis and a resulting perforation. The nurse should plan to administer intravenous antibiotics until the intussusception has resolved.

A nurse is planning care for an adolescent client. Nurses Notes Child is alert and oriented to person, place, time, and situation. Client reports pain in the extremities as 9 on a scale of 0 to 10. Skin warm and dry. Swelling noted at hand joints. Capillary refill less than 3 seconds. Respirations even and non-labored. Client denies shortness of breath. Heart rate regular. Abdomen soft, non-distended. Pedal pulses are +3 bilateral. Medical History History of sickle cell anemia History of otitis media during childhood Diagnostic Results Hemoglobin 5 g/dL (10 to 15.5 g/dL) Hematocrit 30% (32% to 44%) RBC count 3.3 (4 to 5.5) WBC count 12,000/mm3 (5,000 to 10,000/mm3) Platelets 148,000/mm3 (150,000 to 400,000/mm3) Potassium 4.2 mEq/L (3.5 to 5 mEq/L) Vital Signs Oral temperature: 38.8° C (101.8° F) Pulse: 110/min Respiratory rate: 20/min Blood pressure: 100/80 mm Hg Oxygen saturation: 96% on room air Which of the following actions should the nurse plan to take? (Select all that apply.) Obtain consent for a blood transfusion. Administer IV fluids. Provide oxygen at 6 L/min via nasal cannula. Perform passive range-of-motion exercises. Apply cold compresses to the joints. Encourage bedrest. Administer meperidine IV. Restrict fluid intake to 1,400 mL/day.

Perform passive range-of-motion exercises is correct. Clients who are experiencing a sickle cell crisis should limit activity to decrease energy demands. The client should be on bedrest and passive range-of-motion exercises should be performed daily to increase circulation. Administer IV fluids is correct. Clients who are experiencing a sickle cell crisis should receive adequate hydration, both orally and peripherally, to treat the sickle cell crisis. Obtain consent for a blood transfusion is correct. Clients who are experiencing a sickle cell crisis may need a blood transfusion to raise their hemoglobin level to 10 g/dL Encourage bedrest is correct. Bedrest minimizes oxygen consumption and promotes comfort.

A nurse is teaching the mother of a 5-year-old child who has cystic fibrosis about pancreatic enzymes. The nurse should understand that further teaching is necessary when the mother states which of the following? "I will give my son the enzymes between meals." "The enzymes probably won't cause many adverse effects." "The enzymes help him digest fat." "I will put the enzyme crystals in his applesauce."

"I will give my son the enzymes between meals." The parent should give the child pancreatic enzymes with every meal and snack.

A nurse is assessing a toddler at a well-child visit. At what point in the physical examination should the nurse examine the child's tympanic membrane? At the end At the beginning Before examining the head and neck Before auscultating the chest and abdomen

At the end When examining a toddler, the nurse should follow a modified head-to-toe approach, starting at the head but deferring anything that the toddler is likely to view as invasive and traumatic to the very end. The toddler is likely to resist not only having the ears examined, but also anything that follows.

A nurse is obtaining a health history from a child who has suspected acute rheumatic fever. Which of the following questions should the nurse ask? "Has your son had a sore throat recently?" "Was your son born with this cardiac defect?" "Has your child had any injuries recently?" "Have you given your child aspirin in the past 2 weeks?"

"Has your son had a sore throat recently?" Rheumatic fever typically develops 2 to 6 weeks after an untreated or ineffectively treated streptococcal infection of the respiratory tract. It is appropriate to determine whether the child previously had a sore throat.

A nurse receives a call from a parent of a child who has von Willebrand disease and has having a nosebleed. Which of the following instructions should the nurse give to the parent? "Place your child in a sitting position with her head tilted back." "Apply ice at the base of the nose for 5 min and then check for bleeding." "Place your child in a supine position with a pillow under her back." "Have your child sit with her head tilted forward and hold pressure on her nose for 10 minutes."

"Have your child sit with her head tilted forward and hold pressure on her nose for 10 minutes." The nurse should instruct the parent to have the child sit up with her head tilted forward to reduce the risk of aspiration. The parent should apply pressure with the thumb and forefinger to the child's nose for 10 min and then check for further bleeding.

A nurse is providing discharge teaching to the parents of a child who has a new diagnosis of diabetes mellitus. Which of the following statements by the parents indicates an understanding of the teaching? "The onset of low blood glucose usually occurs slowly." "My son might complain of feeling shaky when he has a low blood glucose level." "Sweating can occur with hyperglycemia." "My son might have nausea and vomiting with hypoglycemia."

"My son might complain of feeling shaky when he has a low blood glucose level." A shaky feeling is a consistent finding of hypoglycemia.

A nurse is obtaining vital signs from 2-month-old infant. The infant's heart rate is 190/min and his temperature is 40° C (104° F). The father asks the nurse why the infant's heart is beating so fast. Which of the following responses by the nurse is appropriate? "This is within the expected range for your baby." "The fever is causing an increase in your baby's heart rate." "As your baby begins to fall asleep, his heart rate will decrease." "Your baby's heart is beating fast in an attempt to cool down his body."

"The fever is causing an increase in your baby's heart rate." The expected reference range for the temperature of an infant from birth to 1 year is 36.5° C (97.7° F) to 37.2° C (98.9° F). This infant has a fever that is causing the infant's heart rate to increase. The expected reference range for heart rate in a 2 month-old infant is 121 to 179/min.

A nurse is caring for a 4-year-old child who has a new diagnosis of diabetes mellitus and is distressed after an insulin injection. Which of the following play activities should the nurse recognize is therapeutic in helping the child deal with the injection? A needle-less syringe and a doll A video game A story book about a child who has diabetes A period of play in the playroom

A needle-less syringe and a doll Playing with a needle-less syringe and a doll is an appropriate therapeutic activity for the child, because they will allow the child to act out feelings of anger and helplessness.

A nurse is caring for a child who has rheumatic fever. When obtaining the child's medical history from the parent, the nurse should recognize the significance of which of the following data as the possible source of the child's infection? A classmate who has fifth disease A sibling who had a sore throat 3 weeks ago The father who had gastritis 2 weeks ago A neighbor's child who has chickenpox

A sibling who had a sore throat 3 weeks ago Rheumatic fever typically develops 2 to 6 weeks after an untreated or ineffectively treated streptococcal infection of the respiratory tract. If the sibling had a respiratory infection, it is likely the client also has a streptococcal respiratory infection.

A nurse in an emergency department is caring for a child who is experiencing an acute asthma attack. Which of the following medications should the nurse expect to administer first? Fluticasone Budesonide Montelukast Albuterol

Albuterol Albuterol is considered a "rescue" medication due to its rapid onset of action. Asthma is a chronic inflammatory disorder of the airways. Asthmatic episodes are associated with airflow limitation or reversible obstruction. Albuterol is a beta2 adrenergic agonist used for the treatment of acute exacerbations of asthma by promoting bronchodilation and suppressing histamine release in the lungs. This medication can be given by inhalation, orally, or as a parenteral preparation. The inhaled medication has a more rapid onset of action than the oral form and also reduces the risk for the adverse effects of irritability, tremor, nervousness, and insomnia.

A nurse is caring for an infant on a pediatric unit. Nurse's Notes 1500: Infant admitted with bronchiolitis. Parent states infant has had "a runny nose, cough, and fever over the last few days that keeps getting worse." Parent also reports poor oral intake for the past 24 hr. Infant fussy in parent's arms with frequent cough noted. Moderate yellow nasal drainage present. Bilateral wheezing noted on auscultation. Respirations rapid, but unlabored. 1630: Copious nasal secretions noted. Audible wheezing noted with substernal and intercostal retractions. Infant crying and clinging to parent. Parent reports infant has not voided for 12 hr. Vital Signs 1500: Temperature 37.6° C (99.7° F) Apical pulse 145/min Respiratory rate 36/min Blood pressure 86/50 mm Hg Oxygen saturation 97% on oxygen on room air 1630: Temperature 38.3° C (101° F) Apical pulse 156/min Respiratory rate 56/min Blood pressure 86/52 mm Hg Oxygen saturation 92% on room air Medical History Born at 34 weeks of gestation via vaginal birth. History of frequent upper respiratory infections since birth. The nurse reassesses the infant at 1630. Which of the following assessment findings should the nurse report to the provider? Select the 4 findings that the nurse should report to the provider. Wheezing Nasal secretions Oxygen saturation Temperature Respiratory rate Apical pulse Retractions

Apical pulse is incorrect. The infant's apical pulse is within the expected reference range, even with the infant crying; therefore, this finding does not need to be reported to the provider. Respiratory rate is correct. The infant's respiratory rate is higher than the expected reference range and the infant is displaying retractions, which indicates the infant's respiratory condition is worsening; therefore, the nurse should report this finding to the provider. Oxygen saturation is correct. The infant's oxygen saturation is lower than the expected reference range and indicates the infant's respiratory condition is worsening; therefore, the nurse should report this finding to the provider. Wheezing is correct. The infant is wheezing, which is an indication that the disease has progressed to the lower respiratory tract, causing altered air exchange; therefore, the nurse should report this finding to the provider. Retractions is correct. The infant is displaying retractions, which indicates the infant is using a strong force to pull air into the respiratory system. This requires immediate assistance; therefore, the nurse should report this finding to the provider.

A nurse is providing teaching about iron deficiency anemia to the parents of a toddler. Which of the following should the nurse recommend as a method of preventing iron deficiency anemia? Avoid a diet that consists primarily of milk. Administer fat-soluble vitamins daily. Include fluoridated water in the toddler's diet. Limit intake of high-protein foods.

Avoid a diet that consists primarily of milk. Milk is a poor source of iron and a diet that consists primarily of milk places the toddler at risk for iron deficiency anemia.

A nurse is admitting a child who has leukemia and a critically low platelet count. Which of the following precautions should the nurse initiate? Neutropenic Bleeding Contact Droplet

Bleeding The nurse should initiate bleeding precautions for a child who has a low platelet count. Bleeding precautions involve specific measures to reduce the risk of bleeding, such as using soft-bristled toothbrushes, avoiding IM injections, and preventing constipation.

A nurse is planning care for an adolescent who has scoliosis and requires surgical intervention. Which of the following behaviors by the adolescent should the nurse anticipate because it is most common reaction? Identity crisis Body image changes Feelings of displacement Loss of privacy

Body image changes Body image changes are the most common behaviors observed in adolescents who have scoliosis and require surgery.

A nurse is caring for a child who has Kawasaki disease. Which of the following systems should the nurse monitor in response to this diagnosis? Cardiovascular Gastrointestinal Integumentary Respiratory

Cardiovascular Cardiovascular changes occur in children who have Kawasaki disease due to inflammation of the arterioles, venules, and capillaries.

A nurse is caring for a school-age child who has full-thickness burns to 30% of the total body surface area (TBSA). Vital Signs Oral temperature 38⁰ C (100.2⁰ F) Respiratory rate 34/min Heart rate 115/min Blood pressure 86/54 mm Hg SaO2 94% Nurses' Notes Awake, alert, oriented x 3 for age. Lung sounds clear to auscultation. Tachypnea, rate 34/min. Oxygen infusing at 2 L/min bi-nasal cannula. Telemetry intact. Sinus tachycardia, rate 118/min. Lactated Ringer's infusing to left forearm at 88 mL/hr. Bowel sounds hypoactive in all four quadrants. Abdomen soft, non-tender. Nasogastric tube intact to right nare with low intermittent suction, small amount of bile noted. Bilateral lower extremities with full-thickness burns noted anteriorly and posteriorly. Skin dry with white coloring anteriorly to thighs with erythema noted on shins anteriorly and posterior legs. No blanching. 4+ edema noted to bilateral lower extremities. Pedal pulses nonpalpable. FACES scale rating of 8 for lower extremity pain. Urinary catheter intact draining 35 mL/hr. Weight 27.2 kg (60 lb). Medication Administration Record Lactated Ringer's IV to maintain urine output of 30 mL/hr. Fentanyl 28 mcg IV every hour prn severe pain. Apply thin layer silver sulfadiazine topically to burns twice per day Physical Examination Skin: Approximately 30% of TBSA full-thickness burns to bilateral lower extremities sustained in house fire. 4+ edema noted to bilateral lower extremities. Capillary refill sluggish to bilateral lower extremity nailbeds. Pedal pulses nonpalpable. HEENT: Head normocephalic. No tenderness. PERRLA. No soot noted to nares. No singed nasal hair noted. Nares are patent bilaterally. Oral mucosa is pink and moist. Pharynx within normal limits in appearance. Neck: Neck is supple, no adenopathy. Thyroid gland has no palpable masses. Trachea midline. Carotid pulse palpated bilaterally. Cardiac: Cardiac monitoring in progress revealing sinus tachycardia, rate 115/min, regular in rhythm. Respiratory: Airway is patent. No singed nasal hairs noted. No soot noted to nares. No laryngeal edema noted. Respiratory rate 34/min. Lung sounds clear to auscultation. No cough noted. No sputum noted. No accessory muscle use noted. Abdomen: Abdominal soft, nondistended. Bowel sounds present and hypoactive in all four quadrants. No masses, splenomegaly, or hepatomegaly noted. Renal: Urinary catheter intact draining 35 mL/hr. Neurological: Awake, alert, and oriented for age. Genital/Rectal: Within normal limits. A nurse is initiating the client's plan of care. Complete the following sentence by using the list of options. The client is at highest risk for developing Select... as evidenced by the client's Select....

Dropdown 1: Compartment syndrome is correct. Compartment syndrome is caused by severe edema following burns that decreases blood supply distally. The client has 4+ edema to bilateral lower extremities, nonpalpable pedal pulses, and sluggish capillary refill. Dropdown 2: Edema is correct. The client's assessment reveals 4+ edema noted to lower extremities, sluggish capillary refill to lower extremities, and nonpalpable pedal pulses. These are manifestations of compartment syndrome, which are very concerning. This is the highest risk for this client.

A nurse is caring for a preschooler. Medical History Child was diagnosed with standard risk Acute Lymphoblastic Leukemia (ALL) last month and is in consolidation phase of treatment. Last chemotherapy was cyclophosphamide 10 days ago. Child struggling to adapt to hospitalization, has shown some developmental regression. Diagnostic Results White blood cell count: 2,000/mm³ (5,000 to 10,000/ mm³) Absolute Neutrophil Count (ANC): 1,000/mm³ (less than 1,000/mm³) Hemoglobin: 11 g/dL (9.5 to 14 g/dL) Platelets: 120,000/mm³ (150,000 to 400,000/mm³) Urine dipstick: + scant RBCs Physical Examination Neurological: Awake and alert Cardiac: Regular rate and rhythm, no murmur Respiratory: Lung sounds clear in all fields, no work of breathing Gastrointestinal: Emesis x2 last evening. Loss of appetite for past 3 days. Genitourinary: Adequate output, complains of mild burning when voiding Integumentary: Clear, no rashes Musculoskeletal: Moves all extremities without difficulty Psychosocial: Family involved in care and at bedside. Child's life therapist providing services 3x/week. Child asking for fluids in bottle, clinging to stuffed animal when providers enter room. Vital Signs Temperature: 37.8°C (100°F) Heart rate:110/min Respiratory rate: 22/min Blood Pressure: 96/51 mm Hg Which of the following findings should the nurse report to the health care provider immediately? (select all that apply.) Hemoglobin Urine dipstick Platelet count Loss of appetite Developmental regression Emesis Slight burning on urination Absolute neutrophil count

Emesis is correct. Children are at risk for nutritional compromise during treatment for cancer. Nausea and vomiting may prevent the child from taking in adequate calories. Loss of appetite is correct. Children are at risk for nutritional compromise during treatment for cancer. Decreased appetite needs to be further investigated to prevent weight loss and nutritional intake that is less than required. Slight burning is correct. This is a sign of hemorrhagic cystitis, which is an adverse effect of cyclophosphamide and is an emergency. Urine dipstick is correct. This is a sign of hemorrhagic cystitis, which is an adverse effect of cyclophosphamide and is an emergency.

A nurse in a pediatric clinic is talking with the mother of a preschool-age child. The mother tells the nurse that her son is a "picky eater." Which of the following instructions should the nurse include in the teaching? Have the child remain at the table after meals to increase food intake. Add fruit juice to the child's diet to increase vitamin intake. Emphasize the quantity, rather than the quality, of food consumed. Expect that food consumption might not decrease significantly.

Expect that food consumption might not decrease significantly. Food consumption varies and most preschool-age children consume an adequate quantity of food despite their fads and preferences.

A nurse is caring for a 6-month-old infant. Which of the following findings indicates to the nurse that the infant may be experiencing pain? Dry palms and feet Decreased muscle tone Furrowed brow Eyes wide open

Furrowed brow A furrowed brow may indicate that the infant is in pain or distress. Pain indicators for an infant include a change in facial expressions, such as a furrowed brow and grimacing. The nurse should assess the infant for pain using an age-appropriate scale and provide appropriate pain relief as prescribed.

A nurse is providing discharge instructions to the parent of a 10-year-old child following a cardiac catheterization. Which of the following instructions should the nurse include? Keep the child home for 1 week. Give the child acetaminophen for discomfort. Offer the child clear liquids for the first 24 hr. Assist the child to take a tub bath for the first 3 days.

Give the child acetaminophen for discomfort. The child might have minor discomfort at the puncture site. The parent should offer either acetaminophen or ibuprofen due the risk of Reye syndrome associated with taking aspirin.

A nursing is planning care for an adolescent who is postoperative following scoliosis repair with Harrington rod instrumentation. Which of the following interventions should the nurse include in the plan of care? Keep the head of the bed at a 30° angle. Reposition the client by log rolling every 4 hr. Place the client in protective isolation. Initiate the use of a PCA pump for pain control.

Initiate the use of a PCA pump for pain control. The nurse should initiate the use of a PCA pump for an adolescent who is postoperative following scoliosis repair. The PCA pump allows the client to control the delivery of pain medications.

A nurse is caring for a 12-month-old toddler who is hospitalized and confined to a room with contact precautions in place. Which of the following toys should the nurse recommend in order to meet the developmental needs of the client? Large building blocks Hanging crib toys Modeling clay Crayons and a coloring book

Large building blocks Large building blocks are age-appropriate toys for a 12-month-old toddler.

A nurse is assessing a school-age child whose blood glucose level is 280 mg/dL. Which of the following findings should the nurse expect? Lethargy Pallor Tremors Shallow respirations

Lethargy A blood glucose of 280 mg/dL is above the expected reference range indicating hyperglycemia. The nurse should expect the child to appear lethargic, leading to a decreased level of consciousness and confusion.

A nurse preparing to collaborate with interdisciplinary team about the child's care. Medical History Child presented to provider's office 3 days ago. Guardians were concerned that the child had decreased energy for the past 2 weeks, low grade fevers that they treated with acetaminophen. The guardians also noticed a red rash to the child's chest and right upper extremity Child was admitted to pediatric oncology unit and has been diagnosed with Acute Lymphoblastic Leukemia (ALL) standard risk. Child was full term, no birth complications. No other past medical or surgical history. Child has not received recommended 4-year-old immunizations. Physical Examination Cardiovascular: Mild tachycardia, regular rhythm, no murmur. Respiratory: Lungs clear in all fields, adequate air movement, no work of breathing. Gastrointestinal: Abdomen soft, active bowel sounds in all quadrants. Genitourinary: Adequate urine output. Last bowel movement 6 hr ago. Musculoskeletal: Moves all extremities against mild resistance. Neurological: Alert when awake, follows simple commands, responds appropriately for age. Integumentary: Small area of petechiae to chest. Patient received platelet and packed red blood cell transfusions 1 day ago. Guardians report rash looks "Much improved." Psychosocial: Guardians involved in care and at bedside. They report child has been more "clingy" than usual and has not seemed eager to play with toys. Vital Signs Temperature: 38 C (100.5°F) Heart rate: 130/min Respiratory rate: 24/min Blood Pressure: 95/50 mm Hg Diagnostic Results Bone marrow aspirate and biopsy: monotonous infiltrate of blast cells Cytogenetic Studies: high hyperdiploidy Immunophenotype: B cell involvement Peripheral blood smear: blast cells Provider's office: Hemoglobin: 7.6 g/dL (9.5 to 14 g/dL) Platelets: 120,000/mm³ (150,000 to 400,000/mm³) White blood cell count: 3,200/mm³ (5,000 to 10,000/ mm³) A nurse is preparing to collaborate with interdisciplinary team about the child's care. After reviewing the child's information, which of the following potential provider's prescriptions should the nurse identify as anticipated, nonessential, or contraindicated? For each potential provider's prescription, click to specify if the potential prescription is anticipated, nonessential, or contraindicated for the child. Potential Prescription Anticipated Nonessential Contraindicated Cranial radiation Varicella vaccine Viscous lidocaine oral rinse Ondansetron Oral steroids Fluid restriction

Oral steroids is anticipated. Steroids are indicated in the treatment of ALL. Cranial radiation is contraindicated. Cranial radiation is only indicated for those patients with high risk ALL. Fluid restriction is contraindicated. Children with ALL require aggressive IV hydration to prevent tumor lysis syndrome. Viscous lidocaine oral rinse is contraindicated. Viscous Lidocaine may increase the risk of aspiration in children. Varicella vaccine is contraindicated. Children with any cancer diagnosis should not receive any live vaccines during treatment. Ondansetron is anticipated. Ondansetron is commonly administered to assist in the prevention of chemotherapy-induced nausea and vomiting during cancer treatments.

A nurse is preparing to develop a plan of care for a school-aged child who has been hospitalized Nurses' Notes 0630: Client is awake, alert, oriented to person, place, and time. Lung clear bilateral anterior and posterior. Heart rate regular without murmurs or gallops. Abdomen soft and nondistended. Bowel sounds hyperactive in all 4 quadrants. Client reports recurrent epigastric pain and rates it as 3 on a pain scale of 0 to 10. Tenderness with light palpation. Skin warm and dry to touch. Skin turgor without tenting. Pedal pulses 2+ bilaterally. Client's parents deny recent weight loss. 0830: Vomited 250 mL of yellowish- red emesis. Client reports abdominal pain as a 4 on 0 to 10 pain scale. 1000: Passed 1 large melena stool. Diagnostic Results 0600: Hemoglobin: 9 g/dL (10 to 15.5 g/dL) Hematocrit: 30% (32 to 44%) RBC: 3.5/mm3 (4.0 to 5.5/mm3) WBC: 8,000 mm3 (5,000 to 10,000 mm3) Platelets: 350,000 mm3 (150,000 to 400,000mm3) Potassium: 3.0 mEq/L (3.4 to 4.7 mEq/L) Sodium: 140 mEq/L (136 to 145 mEq/L) Chloride: 98 mEq/L (90 to 110 mEq/L) Calcium: 9.2 mg/dL (8.8 to 10.8 mg/dL) Carbon Dioxide: 24 mEq/L (20 to 28 mEq/L) Blood, Urea, Nitrogen (BUN): 12 mg/dL (5 to 18 mg/dL) Blood Creatinine: 0.8 mg/dL (0.4 to 1.0 mg/dL) Blood Glucose (fasting): 84 mg/dL (70 to 110 mg/dL) 1000: Helicobacter pylori antigen, Stool: Detected (reference range - not detected) Vital Signs Oral temperature: 36.6° C (97.8° F) Heart rate: 88/min Respiratory rate 24/min Blood pressure 102/68 mm Hg Drag 1 condition and 1 client finding to fill in each blank in the following sentence. A nurse should identify that the child has developed Word Choices due to Word Choices . Word Choices peptic ulcer disease acute kidney injury bacterial pneumonia celiac disease intussusception Word Choices platelet level blood pressure bUN level Helicobacter pylori

Peptic ulcer disease is correct. The child has abdominal tenderness, vomiting that is red in color, melena stools, and a hemoglobin level that is below expected reference range, which can indicate anemia. These findings are associated with peptic ulcer disease. Helicobacter pylori is correct. According to the diagnostic test results, Helicobacter pylori was detected. H. pylori weakens the mucosal barrier, which allows acid to damage the mucosa. H. pylori infection is often the cause of peptic ulcer disease.

A nurse is caring for a child who is experiencing a seizure. Which of the following actions should the nurse take? Attempt to stop the seizure. Restrain the child's arms. Use a padded tongue blade. Position the child laterally.

Position the child laterally. Positioning the child laterally facilitates airway patency.

A nurse in an emergency department is caring for an adolescent following a suicide attempt. After reviewing the client's history, the nurse should determine that which of the following is the priority risk factor for suicide completion? Active psychiatric disorder Previous suicide attempt Loss of a parent History of substance abuse

Previous suicide attempt A prior suicide attempt is found in as many as half of the adolescents who attempt suicide.

A nurse is caring for a 6-week-old infant who has a pyloric stenosis. Which of the following clinical manifestations should the nurse expect? Red currant jelly stools Distended neck veins Projectile vomiting Ridged abdomen

Projectile vomiting Pyloric stenosis is a narrowing of the pylorus, the outlet from the stomach to the small intestine. The narrowing does not allow for emptying of the stomach contents. Vomiting, which is usually mild at first, becomes more forceful and progresses to projectile vomiting.

A nurse is caring for a toddler who is having difficulty sleeping during hospitalization. Which of the following actions should the nurse take to promote sleep? Explain the source of the toddler's fears. Turn off the room light. Provide bedtime rituals. Encourage play exercises in the evening.

Provide bedtime rituals. Establishing a bedtime routine is important. Reading a familiar book or providing a favorite stuffed toy or blanket will help decrease the child's insecurity and fears.

A nurse is planning care for a 4-year-old child who requires airborne precautions. Which of the following activities should the nurse plan for child? Putting a large-piece puzzle together Watching a video game in the playroom Pulling a wagon with toys in the hallway Constructing a model airplane

Putting a large-piece puzzle together A child who requires airborne precautions must remain in her room. Appropriate activities for a 4-year old child include putting together large-piece puzzles, using paints and crayons, playing ball, riding tricycles, playing pretend and dress up, sewing cards and beads, and reading books.

A nurse is providing teaching to a parent of a child who has celiac disease. The nurse should include which of the following food choices for this child? Barley Rye Rice Wheat

Rice Because rice is naturally gluten-free, it is an acceptable food choice for a child who has celiac disease.

A nurse is providing anticipatory guidance about child development to the parents of a toddler. Which of the following developmental tasks should the nurse include as expected of a toddler? Explains the difference between right and wrong Prints letters and numbers Separates easily from primary care giver for short periods of time Cooperates in doing simple chores

Separates easily from primary care giver for short periods of time By 3 years of age, a toddler's psychosocial development should include the ability to accept separating from a primary care giver for short periods of time. A toddler should also be able to express likes and dislikes and begin to play with children and others outside the family.

A nurse is caring for a child who has a suspected diagnosis of cystic fibrosis. Which of the following diagnostic tests will confirm the diagnosis? Sweat chloride test A sputum culture A stool fat content analysis Pulmonary function tests

Sweat chloride test Clients who have cystic fibrosis have an increase of sodium and chloride in both saliva and sweat. Therefore, a sweat chloride test can definitively confirm a diagnosis of cystic fibrosis.

A school nurse is assessing an adolescent who reports feeling shaky and is having difficulty speaking and concentrating on the questions the nurse is asking. The nurse checks the adolescent's blood glucose level and identifies a value of 55 mg/dL. Which of the following findings should the nurse expect? Dry, flushed skin Deep, rapid respirations Tachycardia Polyuria

Tachycardia A blood glucose level of 55 mg/dL is below the expected reference range and an adolescent with this blood glucose level is likely to have tachycardia due to increased circulating catecholamines and increased adrenergic activity.

A nurse is caring for a 7-year-old child. Nurses' Notes 0830: Child was brought in by parents for unexplained bruising and red spots on the child's shoulders, thighs, and back. Parents report child has had a cold for more than 2 months and over-the-counter medications have not helped relieve the cold symptoms. Lung sounds clear. Child moves all extremities well with some swelling noted in knees and elbows. Abdomen soft with active bowel sounds. 1000: Parents report child had small nosebleed "a few minutes ago," and the child reports "my arms and legs hurt all over." Child's nosebleed has been resolved with only a small amount of blood noted on tissues. Vital Signs 0830: Temperature 38° C (100.4° F) Heart rate 100/min Respiratory rate 20/min Blood pressure 102/64 mm Hg Oxygen saturation 98% on room air 1000: Temperature 38.3° C (101° F) Heart rate 112/min Respiratory rate 24/min Blood pressure 104/62 mm Hg Oxygen saturation 97% on room air Diagnostic Results WBC count 15,000/mm³ (5,000 to 10,000/mm³) Hgb 8 g/dL (10 to 15.5 g/dL) Hct 32% (32% to 44%) The nurse is reviewing the assessment findings and diagnostic results. For each assessment finding, click to specify if the finding is consistent with leukemia, sickle cell anemia, or hemophilia. Each finding may support more than one disease process. Assessment Finding Leukemia Sickle Cell Anemia Hemophilia Bruising WBC count Reported pain Temperature Bleeding

Temperature is consistent with leukemia and sickle cell anemia. The child has an elevated temperature. A child who has leukemia can present with a fever and a persistent mild infection. A low-grade fever can be present in a child experiencing a sickle cell crisis due to inflammation. Bruising is consistent with leukemia and hemophilia. A child who has leukemia often presents with bruising and petechia related to a low production of platelets. A child who has hemophilia can present with bruising related to an alteration in clotting from a factor VIII deficiency. Bleeding is consistent with leukemia and hemophilia. Due to low platelet production, children who have leukemia can have increased bleeding. Hemophilia can result in excessive bleeding from even slight trauma due to a deficiency of the clotting factor VIII. WBC count is consistent with leukemia and sickle cell anemia. The child's WBC count is elevated. A WBC count greater than 10,000/mm³ is a typical manifestation of leukemia. It is related to infiltration of the bone marrow by immature WBCs. WBC count in a child who has sickle cell anemia can be as high as 12,000 to 20,000/mm³ due to chronic inflammation. Pain is consistent with leukemia, sickle cell anemia, and hemophilia. The child reported generalized pain of the extremities. Children who have leukemia might report bone pain related to infiltration of the bones with nonfunctional immature WBCs. During a sickle cell crisis, a child could experience painful bones and joints of the hands and feet due to decreased blood flow. With hemophilia, hemorrhages can occur into the joints, which causes stiffness and aching in the affected joints.

A nurse is assessing a preschooler. Which of the following findings should indicate to the nurse a need for speech therapy? (Select all that apply.) The preschooler stutters when speaking. The preschooler mispronounces words. The preschooler speaks in three word sentences. The preschooler talks to himself when reading. The preschooler speaks in a nasally tone.

The preschooler mispronounces words is correct. Language begins to increase with toddlers as development progresses towards two to three word phrases. Mispronounced vowels and consonants occur between ages 24 and 36 months. The nurse should expect a toddler to mispronounce words. Speaking in a nasally tone is correct. A child who speaks with a nasally tone might have a neurogenic speech disorder that is caused by weakened muscles of the tongue, soft palate, and face. A speech therapist can evaluate the child and determine exercises to improve the articulation, voice, pitch quality, and volume.

A nurse has accepted a position on a pediatric unit and is learning about psychosocial development. Place Erikson's stages of psychosocial development in order from birth to adolescence. (Move the steps into the box on the right, placing them in the selected order of performance. Use all the steps.) Autonomy vs. shame and doubt Industry vs. inferiority Identity vs. role confusion Initiative vs. guilt Trust vs. mistrust

Trust vs. mistrust is the first stage of psychosocial development, and is typically experienced between birth and one year of age. Between the ages of 1 and 3 years, children experience the stage of autonomy vs. shame and doubt. Initiative vs. guilt is the stage of psychosocial development experienced between the ages of 3 and 6 years. School-age children experience the industry vs. inferiority stage. Finally, between the ages of 12 and 18 years, the identity vs. role confusion stage of psychosocial development occurs.

The nurse is caring for a 4-month-old infant in the emergency department. Nurses' Notes 1100: Infant was very difficult to arouse. Pupils slightly sluggish. Flow Sheet Growth chart from pediatric clinic: Birth Weight 3.18 kg (7 lb; 25-50th percentile) Birth Length 50 cm (19.75 in; 50th percentile) Head circumference 34.2 cm (13.5 in; 50th percentile) 2-month Weight 4.8 kg (10 lb 9 oz; 10-25th percentile) 2-month Length 58 cm (22.75 in; 50th percentile) 2-month Head circumference 40 cm (15.75 in; 75th percentile) 1030: Weight 5.9 kg (13 lb; 10th percentile) Length 64 cm (25.25 in; 50th percentile) Head circumference 43.6 cm (17.2 in; 95th percentile) Vital Sign 1030: Temperature 37.4 °C (99.3 °F) Heart rate 148/min Respiratory rate 34/min Blood pressure 78/36 mm Hg (right leg) 1100: Heart rate 110/min Respiratory rate 26/min Blood pressure 72/32 mm Hg (right leg) History and Physical 1030: Caregiver reports infant is more difficult to awaken this morning, after crying a great deal last night. Formula fed. All immunizations are current. Lethargic, difficult to console when awakened. Anterior fontanel bulging, somewhat tense. Bilateral retinal hemorrhages observed. HEENT otherwise negative. Heart rate regular without murmur; respirations unlabored with clear breath sounds throughout. Abdomen soft, non-distended with positive bowel sounds. Lumbar puncture completed, fluid clear. Admit to pediatric unit for further workup. Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress. Actions to Take 1 Actions to Take 2 Potential Condition Parameters to Monitor 1 Shunt malfunction Actions to Take Obtain an order for acetaminophen Perform a thorough physical examination noting deformity, bruises, or other marks Institute isolation precautions Elevate head of crib slightly Prepare family for ventriculoperitoneal shunt placement Potential Condition Meningitis Hydrocephalus Abusive head trauma Brain tumor Parameters to Monitor Heart rate and respiratory rate Temperature Observe caregiver-infant interactions

Upon recognizing and analyzing the infant cues of signs of increased intracranial pressure and retinal hemorrhage, the nurse's priority hypothesis is that this infant is most likely experiencing abuse head trauma. It is important for the nurse to generate solutions and take actions that will determine if the infant exhibits any other signs of physical abuse and minimize the effects of increased intracranial pressure. Therefore, the nurse should elevate the head of the crib slightly, observe caregiver-infant interactions for cues related to abuse, as well as monitor for decreasing heart rate and respiratory rate as these may indicate worsening of increased intracranial pressure. To evaluate these interventions the nurse would continue to assess for further manifestations of increased intracranial pressure. Other physical signs of abuse may or may not be found, yet caregiver behaviors may be indicative, though not diagnostic, of maltreatment.

A nurse is caring for a 3-year-old child who was admitted with acute diarrhea and dehydration. Which of the following findings indicates that oral rehydration therapy has been effective? Heart rate 130/min Respiratory rate 24/min Urine specific gravity 1.015 Capillary refill greater than 3 seconds

Urine specific gravity 1.015 The expected reference range for urine specific gravity is 1.010 to 1.025. A result of 1.015 indicates the child is hydrated. A result greater than 1.025 indicates dehydration. Dehydration results when the total output of fluid exceeds the total intake. Infants and children who have diarrhea and dehydration should be treated first with oral rehydration therapy, such as Pedialyte and Infalyte. After rehydration, oral rehydration therapy can be alternated with a low-sodium solution, such as water, breast milk, lactose-free formula, or half-strength lactose-containing formula.

A nurse is preparing to administer a vaccine to a 4-year-old child. Which of the following vaccines should the nurse administer? Haemophilus influenza type b (Hib) Hepatitis B (HepB) Varicella (VAR) Meningococcal (MCV4)

Varicella (VAR) The child should have received the first dose between 12 to 15 months of age. The child should then receive a second dose between 4 and 6 years of age.

A nurse is caring for a child who has acute appendicitis. Which of the following results should the nurse anticipate when reviewing this client's laboratory values? WBC 17,000/mm3 Neutrophils 3,000/mm3 RBC 4.2 million/mm3 Lymphocytes 3,000/mm3

WBC 17,000/mm3 The expected reference range for a WBC count for a child is 5,000 to 10,000/mm3. A WBC count of 17,000/mm3 is elevated. The nurse should expect to see an elevated WBC count because appendicitis is an acute bacterial infection.

A nurse on a pediatric unit is preparing to admit a preschooler after receiving transfer report from a nurse in the emergency department. Nurses' Notes 2100: Child brought into the emergency department by their guardians. The child has Acute Lymphoblastic Leukemia (ALL) and is currently in the induction phase of treatment for standard risk. The child received chemotherapy with vincristine 8 days ago and is taking daily oral steroids. Child is alert, crying, and clinging to guardian. Guardians report the child has not had a bowel movement for 5 days. 2120: Child now asleep in guardian's arms. Respirations unlabored, heart rate regular. Child has a double-lumen central line catheter in the left chest wall. Insertion site is erythematous with a scant amount of purulent drainage. Vital Signs 2100: Pulse rate 120/min Respiratory rate 25/min Temperature 38.8° C (101.9°F) tympanic SaO2 96% on room air The nurse on the pediatric unit is reviewing the preschooler's medical record. Click to highlight the findings in the medical record that require follow-up by the nurse upon the child's admission to the pediatric unit. To deselect a finding, click on the finding again. 2100: Child brought into the emergency department by their guardians. The child has Acute Lymphoblastic Leukemia (ALL) and is currently in the induction phase of treatment for standard risk. The child received chemotherapy with vincristine 8 days ago and is taking daily oral steroids. Child is alert, crying, and clinging to guardian. Guardians report the child has not had a bowel movement for 5 days. 2100:Pulse 120/minRespiratory rate 25/minTemperature 38.8° C (101.9° F) tympanicSaO2 96% on room air 2120: Child now asleep in guardian's arms. Respirations unlabored, heart rate regular. Child has a double-lumen central line catheter in the left chest wall. Insertion site is erythematous with a scant amount of purulent drainage.

When analyzing cues, the nurse should identify that a temperature of 38.8°C (101.9° F), no bowel movement for 5 days, and erythema with purulent drainage at the central line insertion site are findings that require follow-up. Fever, purulent drainage, and erythema are all indications of infection. This child is at high risk for severe infection due to receiving chemotherapy. Lack of a bowel movement for 5 days may be due to vincristine, which can cause constipation. The child is at risk for an ileus if the constipation is left untreated.

A nurse is preparing to assist with applying a cast to a preschooler's arm. Which of the following actions should the nurse take? Wrap the arm of the child's doll or toy prior to the procedure. Tell the child, "This will make your arm feel better." Place a heated fan at the bedside to facilitate drying. Support the casted arm with a firm grasp.

Wrap the arm of the child's doll or toy prior to the procedure. The nurse should consider the developmental age before the cast is applied. A preschooler might fear bodily harm and fantasize about the loss of an extremity. Using a doll or stuffed animal helps to explain the procedure. During this stage of development, the child is a "magical thinker" and might believe stuffed animals are alive. This action shows the child that it does not hurt the doll or stuffed animal, and, in turn, will not hurt the child.