Pediatrics Review

Which room assignment would be most therapeutic for the nurse to make for a client with bipolar disorder in manic phase who is hyperactive and has difficulty sleeping? 1. A private bedroom. 2. A semi private room with a roommate who has a similar problem. 3. Either a private or a semi private room. 4. Direct admission to the seclusion room until his activity level becomes more subdued.

1. Correct: A private room will help to decrease stimulation. The client with bipolar disorder needs a calm environment especially when in the manic phase. Avoid excessive stimulation. 2. Incorrect: Don't put two manics together. This room assignment will not help to decrease stimulation which is what the manic client needs. 3. Incorrect: They need a private room. The client with psychosis maybe suspicious and have delusion or hallucinations. 4. Incorrect: There's no need for this right now. The client is hyperactive and has difficulty sleeping. A seclusion room is needed for severe agitation and acute aggression.

The parents of a 4 year old child have recently had a new baby and the parents report that the 4 year old had been dry all night for 8 months and is now wetting the bed again. What should the nurse assess first? 1. Urinalysis 2. Normal urination habits. 3. Adjustment to the new baby. 4. Fluid intake after 6 pm.

1. Correct: Always assess the physiologic problem first to rule out a urinary tract infection (UTI). If a UTI is present, treatment should start immediately. *Once a physiologic cause is removed as the cause other assessment should be performed. 2. Incorrect: Assessing the normal urination habits is not first. Assessing the urinalysis is priority. 3. Incorrect: Regression is the likely cause but the physiologic problems should be assessed first. 4. Incorrect: The child's fluid intake may be too high after 6 pm, but ruling out a urinary tract infection is the first assessment and requires immediate treatment if there is an infection.

Parents of school-aged children are working toward a goal of healthy family TV viewing. Which parental statement indicates adequate understanding of appropriate use of TV in the family? 1. I don't allow my kids to watch violent TV shows. 2. They usually watch the kid shows on the kids' networks. 3. I don't usually worry about the time watching TV on weekends. 4. They can choose one TV show per day without my input.

1. Correct: Violent TV shows are not recommended for school-aged children. They may be disturbing and may desensitize them to violence. 2. Incorrect: Even shows on kids' networks may demonstrate values that are not congruent with the healthy family. Input from the parents is needed here as well. 3. Incorrect: TV time should be limited each day to allow time for physical activity, social interaction, and development of hobbies and other skills. 4. Incorrect: The child needs the input of the parents. Parents and children may have an agreed upon list of shows that the child may watch.

What interventions would be appropriate for the nurse to make for a child who is in Bryant's traction? Select all that apply 1. Perform neurovascular checks every 2 hours. 2. Maintain hip flexion at 90 degrees with buttocks raised 1 inch (2.54 cm) off the bed. 3. Reposition child infrequently so that traction is maintained. 4. Place child prone for one hour daily to prevent contractures. 5. Remove adhesive traction straps daily to prevent skin breakdown. 6. Use wrist restraints to keep child from turning over.

1.& 2. Correct: Both legs are extended in a vertical position in order to maintain hip flexion at 90 degrees. This helps to keep the femur in the hip socket. Traction will help position the top of the femur into the hip socket correctly. Because the legs are extended upward the circulation and nerves can be affected. The feet should be assessed for color, pulses, warmth, and sensation every 2-4 hours. Traction interventions: neurovascular checks, elimination, safety, immobility issues, and nutrition. 3. Incorrect: The child should be repositioned slightly every 1-2 hours to avoid skin breakdown. 4. Incorrect: The child cannot be placed prone while in Bryant's traction. 5. Incorrect: Traction should not be relieved, which is what would happen if straps are removed. 6. Incorrect: A jacket restraint is used to keep the child from turning over in the bed.

The home health nurse is assessing the home environment for threats to the safety of the toddler who lives in the home. Which observations should be included in this assessment? Select all that apply 1. Do stairs have guard gates? 2. Are safety covers on electrical outlet plugs? 3. Is the swimming pool inaccessible to the toddler? 4. Are cleaning supplies located out of the toddler's reach? 5. Are stairs brightly lit?

1., 2., 3. & 4. Correct: Toddlers may fall if left unsupervised around stairs. Make sure that gates are in place and that they are used. Toddlers are at risk for exploring the outlets by putting metal objects into the outlets or putting their fingers in them. They should be covered unless in use. Toddlers can drown in small amounts of water and they may try to explore swimming pools if they are accessible. Pools should have fences or locking stairs and the child should never be left unsupervised around the pool. Toddlers are curious and may get into cabinets containing harmful substances. 5. Incorrect: This assessment would be important for the visually impaired or elderly, but not specifically for toddlers. The guard gates should be in place so that the toddler does not have access to the stairs.

What signs and symptoms will the nurse look for when caring for an infant with severe dehydration? Select all that apply 1. Dark, yellow urine 2. Lethargic 3. Bulging fontanels 4. Tachypnea 5. Decreased urine output

1., 2., 4., & 5. Correct: These would be signs and symptoms of dehydration in an infant. Amber or dark urine is an indication of dehydration. Urine should be a clear, pale yellow. Fussiness and irritability are seen in infants when they do not feel well. As dehydration worsens, lethargy and unresponsiveness can develop. Tachypnea or rapid respiration along with tachycardia and low blood pressure are present with severe dehydration. With severe dehydration, there will be decreased urine output. The body is trying to conserve volume. 3. Incorrect: The fontanels will be sunken rather than bulging. Bulging fontanels indicate brain swelling or fluid build up in the brain. Sunken fontanels are related to dehydration.

What should the nurse teach the mother about appropriate sleep in teenagers? 1. Teens need about 8 to 10 hours of sleep each night. 2. Biological sleep patterns shift toward earlier wakening. 3. Typically do not require as much sleep as adults. 4. Teenagers do not exhibit the normal signs of sleep deprivation.

1. Correct: Teens need approximately 8 to 10 hours of sleep per night. 2. Incorrect: Teens tend to go to bed later and wake up later. A natural shift in a teens circadian rhythm is called "sleep phase delay". The need for sleep is delayed about two hours. They naturally get sleepy later in the evening. 3. Incorrect: Teens need adequate sleep. The adolescent period is a time of biological, psychological, and social change. Sleep is necessary to support this important stage of growth and development. The sleep deprivation can affect brain and bodily development. 4. Incorrect: When teens are deprived of sleep, they become irritable, fall asleep in class, or experience anxiety. Teens may display even more signs of sleep deprivation than adults. Depression, issues with learning and behavior, substance use or abuse and obesity can be long term effects on a teenager's health.

A nurse is working in a walk-in clinic where a mother brings in her 6 year old child stating, "My child is just not right." The nurse notes an unusual odor to the child's breath, new onset of bed-wetting, and lethargy. What prescription by the primary healthcare provider should be performed first? 1. Blood glucose 2. Urinalysis for white blood cells (WBC) 3. Oxygen saturation 4. Toxicology screen

1. Correct: Type I diabetes usually has a sudden onset and many times diabetic ketoacidosis (DKA) is the first encounter. The symptoms in the stem: unusual odor to the breath, bed wetting, and lethargy are symptoms of DKA. The blood glucose is one of the most important tests for the diagnosis of DKA. 2. Incorrect: A urinalysis to assess WBC will not support the diagnosis of DKA. 3. Incorrect: In this case, oxygen saturation is not the priority. This child is not in respiratory distress. 4. Incorrect: A toxicology screen will not support a diagnosis of DKA; however, if the blood glucose was not elevated, it could provide further assessment data.

The nurse is planning care for a preschool child who is being treated in the hospital for respiratory syncytial virus (RSV). What should the nurse recognize as the child's likely view of this illness in order to properly plan care? 1. Punishment 2. Disturbance to body image 3. Rejection from parents 4. Change in routine with friends Hint: If age, sex, nationality are identified in the stem, it is important to the question and will generally direct you to an answer. Remember Erickson's stages of growth and development and common stressors related to hospitalization. So, what can be expected from a preschooler?

1. Correct: Yes, the preschool child views illness as punishment. The preschooler may believe that the illness occurred because of some personal deed or thought or perhaps just because the child touched something or someone. 2. Incorrect: To the adolescent, appearance is crucial. Illness or injury that changes an adolescent's self-perception can have a major impact. 3. Incorrect: The adolescent fears rejection and criticism from parents. 4. Incorrect: Friends are important to the school aged child and fear that friends will forget them while they are ill. They fear a change in routine.

What should the nurse include about transmission of the chickenpox virus while teaching a group of parents about the importance of vaccination? Select all that apply 1. Direct contact 2. Indirect contact 3. Airborne 4. Droplet 5. Common vehicle

1., 2., & 3. Correct: Chickenpox is transmitted from person to person by directly touching the blisters, saliva or mucus of an infected person (Direct contact). Chickenpox can be spread indirectly by touching contaminated items freshly soiled, such as clothing, from an infected person (Indirect contact). The virus can also be transmitted through the air by coughing and sneezing (Airborne). Airbone transmission of infectious agents occurs either by: Airborne droplet nuclei (small particles of 5 mm or smaller in size); Dust particles containing infectious agents. Microoganisms carried in this manner remain suspended in the air for long periods of time and can be dispersed widely by air currents. Because of this, there is risk that all the air in a room may be contaminated. Some examples of microorganisms that are transmitted by the airborne route are: M. tuberculosis, rubeola, varicella, and hantaviruses. 4. Incorrect: Transmission occurs when droplets containing microorganisms generated during coughing, sneezing and talking are propelled through the air. However, these infected droplets may linger on surfaces for long periods of time, so these surfaces (within the range of the coughing/sneezing person) will need additional cleaning. 5. Incorrect: Applies to microorganisms that are transmitted by contaminated items such as food, water, medications, medical devices, and equipment.

A pediatric nurse is teaching a group of new parents about what to expect regarding their infants eyes and vision. What points should the nurse include? Select all that apply 1. At 4 weeks of age, the infant should be able to gaze at objects. 2. Infants should have tears by the age of 1 month. 3. Visual acuity is about 20/300 at 4 months of age. 4. During the first 2 months of life, infant's eyes may appear to be crossed. 5. Depth perception begins around the 5th month of age.

1., 3, 4, & 5. These statements are correct. At birth the baby's vision is limited best to 8-10 inches from their face. The eyes are not well coordinated and may appear crossed. Babies learn to see over a period of time, much like they learn to walk and talk. They are not born with all the visual abilities they need in life. The ability to focus their eyes, move them accurately, and use them together as a team must be learned. Also, they need to learn how to use the visual information the eyes send to their brain in order to understand the world around them and interact with it appropriately. At birth, babies have not yet developed the ability to easily tell the difference between two targets or move their eyes between the two images. Their primary focus is on objects 8 to 10 inches from their face or the distance to parent's face. During the first months of life, the eyes start working together and vision rapidly improves. Eye-hand coordination begins to develop as the infant starts tracking moving objects with his or her eyes and reaching for them. By eight weeks, babies begin to more easily focus their eyes on the faces of a parent or other person near them. For the first two months of life, an infant's eyes are not well coordinated and may appear to wander or to be crossed. This is usually normal. However, if an eye appears to turn in or out constantly, an evaluation is warranted. Babies should begin to follow moving objects with their eyes and reach for things at around three months of age. When taking photos, the parent will begin to notice the baby blinking at the flash. Visual acuity is still in the 20/200 to 20/400 range. Infants are beginning to recognize familiar people, and by 3 months they should be reaching for things. By 4 months the child's eyes should be working together. He or she should begin to follow objects and people, recognize familiar objects, as well as watch parents' faces when being talked to. 2. Incorrect: Infants do not have tears until about 3 months of age.

A child diagnosed with AIDS is scheduled for grade school immunizations. Which immunizations are safe for the nurse to administer to the child? Select all that apply 1. MMR (measles, mumps, rubella) 2. DTaP (diphtheria, tetanus, pertussis) 3. VAR (varicella) 4. HiB (haemophilus influenza) 5. OPV (oral polio virus)

2 & 4. Correct: Children with AIDS are immunocompromised because of HIV. Vaccines are crucial to provide protection against common childhood diseases. However, only vaccines which contain synthetic or inactivated viral components are acceptable for children with active AIDS. Diphtheria, tetanus, pertussis is inactive and is provided in multiple doses, starting at 2 months of age, with a booster at age 6. Haemophilus influenza is critically important since this flu virus can lead to meningitis, pneumonia or epiglottitis. This vaccine is also administered in multiple injections over a period of months, starting at 2 months, and then yearly throughout life. Recall that HIV is the virus that ultimately leads to the disease AIDS. Many children are HIV+ and relatively healthy, but once diagnosed with AIDS, vaccines which contain live viruses could be deadly. Primary healthcare providers must weigh the benefits of protecting against a deadly childhood disease or risking. That decision is based on frequent blood work to check CD4 levels. Remember the CD4 is a type of white blood cell, often referred to as T-cell, designed to fight off bacteria and viruses that attack the human body. However, the HIV virus attacks these "fighters", destroying the ability of the body to fight diseases. When the CD4 count drops below 200, the client is severely immunocompromised. Also remember the primary healthcare provider considers many factors, such as whether the child is actively receiving an antiviral AIDS treatment, the CD4 count, and general health before determining appropriate vaccinations. The client in this question is the mother and the only clue provided is this child needs vaccinations for school, indicating the child is around 5 or 6 years old. What vaccines would be required, and appropriate, for an AIDS child just before starting grade school? While it is true the primary healthcare provider will decide which injections are safest for the child, it is important for the parents to also be aware of the risks and potential outcomes. You must ask yourself, which vaccines contain a live virus, and should not be administered to the child? This is a high difficulty level question, so read carefully. 1: Incorrect. The MMR (measles, mumps, and rubella) immunization definitely contains a live virus. These childhood diseases could prove deadly to an immunocompromised child but so could the vaccine. Though the healthcare provider may weigh many factors, in general this is not an acceptable vaccine for the child with AIDS. 2: Correct! The DTaP (diphtheria, tetanus, pertussis) is a combination vaccine with NO live virus components. This highly valuable protection is safe for a child with AIDS. The vaccine is provided in scheduled multiple doses over time with tetanus boosters throughout life every ten years. 3: Incorrect. We know now that chicken pox is not the harmless inconvenience it was once thought to be! The virus remains dormant in the human body for life, often returning as the painful and serious disorder of shingles. Research has demonstrated the long-term effects, damaging effects on the nervous system and other organs caused by the shingles virus. However, children with AIDS could develop chickenpox from the live virus with very serious consequences. 4: Correct.. You are aware the flu is not just a nasty illness, but a potentially deadly disease even in healthy individuals. In children with AIDS, haemophilus influenza can be lethal because there is no immune system to fight off the effects of that virus. Because this vaccine is inactive, the injection is safe to administer to AIDS children in the suggested series, and then yearly throughout life. (Special note: AIDS children should NOT be given this vaccine in the nasal, or inhaled form since that particular form does contain the live virus.) 5: Incorrect.. The oral form of the polio vaccine does contain a live virus, and cannot be administered to AIDS children. However, the IPV (inactivated polio vaccine) is not live and is not only safe, but highly recommended for children with AIDS.

A child diagnosed with gastroenteritis is being given fluids in the emergency room for severe dehydration. Prior to discharge, the nurse instructs the mother how to prepare a BRATT diet. The nurse knows the teaching was successful when the mother selects what foods for the child? Select all that apply 1. Raisins 2. Bananas 3. Apples 4. Toast 5. Rice 6. Tea

2, 4, 5 and 6. CORRECT: The BRATT diet is useful for children following any type of gastroenteritis which included nausea, diarrhea or severe vomiting. This bland diet is used in the first 24 hours to allow the gut to rest and readjust slowly to foods that are low protein, low fat and low fiber. The BRATT diet is for short term use only and consists of bananas, rice, applesauce, toast and tea. Bananas are an excellent source of potassium and other nutrients. Bananas are soft, easily digested and will not irritate the intestinal tract. Rice is considered a bland cereal grain that will provide vitamins and nutrients for recovery without straining a weakened digestive system. Boiled rice is considered the best way to eat rice during recovery. Toast is a bland food source most appropriate for those recovering from any gastric distress. Dry toast may not taste the best but it is well tolerated and provides some nourishment without overloading an already compromised digestive system. 1. INCORRECT: Although raisins are normally a natural source of healthy fruit, they have too much fiber for an irritated gastric tract. They are not part of the BRATT diet. 3. INCORRECT: Apples are not appropriate because they are full of fiber! As a raw fruit, they will create gas and increase peristalsis, which is counterproductive in gastroenteritis. However, APPLESAUCE is part of the BRATT diet and is an excellent source of nutrition without stressing a weakened gastrointestinal system.

What information would be included when a disaster relief nurse counsels parents of young clients who have experienced a disaster? Select all that apply 1. Act as if things are normal. 2. Understand young children may exhibit separation fears and clinging. 3. Sedate the client until the crisis is resolved. 4. Understand nightmares and sleep disturbances may occur in young children. 5. Refrain from talking about the disaster.

2. & 4. Correct: Following a disaster, children exhibit a range of emotional and physiological reactions including separation, fear, and sleep issues. They may also appear confused, passive, fearful, and have somatic symptoms. They have difficulty talking about the event or identifying feelings. 1. Incorrect: Acting as if nothing happened is a non-therapeutic parental response. The parents should recognize and acknowledge the child's feelings. 3. Incorrect: Sedation may be an emergency need, but more therapeutic responses are quickly warranted. 5. Incorrect: Refraining from talking about the disaster would be non-therapeutic. Again, allowing the child to discuss their feelings will assist the child in working through their fear and worry.

The parents of a child admitted with rheumatic fever (RF) ask why the child has been placed on bedrest. The nurse explains that bedrest serves what primary purpose for the client? 1. Prevents permanent joint damage. 2. Decreases workload on the heart. 3. Helps regulate body temperature. 4. Reduces joint pain and body aches.

2. Correct: During this illness, decreasing the workload on the heart is vital to help prevent cardiac complications. Rheumatic fever is a multi-system illness occurring several weeks after a strep infection. A client infected with Group A beta-hemolytic strep can develop fever, muscle aches, and painful, swollen joints sometimes accompanied by a red torso rash. The greatest concern is that the infection can cause inflammation and scarring within the heart, damaging the valves. The resulting thickening with fibrosis damages heart muscle and function, ultimately resulting in chronic heart failure. Although RF is not as common these days, the diagnosis and treatment must be immediate to prevent the development of long term rheumatic heart disease that leads to chronic heart failure. Treatment includes corticosteroids, anti-inflammatory drugs, antibiotics and bedrest. Knowing the possible complications of this illness, what do you think should be the nurse's main focus? The parents are concerned about treatment and prognosis, providing the perfect opportunity for the nurse to initiate teaching. 1. Incorrect: Rheumatic fever causes increased body temperature, muscle aches and swollen painful joints, particularly knees, ankles and wrists. Although clients may need ibuprofen for pain and swelling, there is no permanent damage to the joints. Bedrest serves another purpose for this client. 3. Incorrect: It is true that these clients can run a high fever at times and even develop a red rash over the torso. However, the purpose of bedrest is not related to controlling body temperature. 4. Incorrect: It may seem logical that bedrest would decrease joint pain and body aches, but this is not the primary purpose for bedrest.

The emergency department nurse is assigned to care for four pediatric clients with varying symptoms. Which client should the nurse examine first? 1. 12 year old reporting a severe headache 2. 6 month old with respiratory rate of 68/min while sleeping 3. 2 year old with a broken arm who is crying and appears in pain 4. 8 year old with cellulitis of the left leg and an elevated body temperature Hint: look for abnormal data that would make that client a priority.

2. Correct: Normal respiratory rate for a 6 month old is 30-50 breaths a minute. A 6 month old who is sleeping is not exerting themselves, and the respiratory rate should be within normal limits. A rate of 68 should alert the nurse to a problem that needs to be addressed. 1. Incorrect: This client does not prioritize higher than one experiencing a respiratory problem. 3. Incorrect: This client's findings are expected behavioral responses to a broken bone. Remember that pain does not prioritize higher than a respiratory problem. Pain never killed anyone! 4. Incorrect: Elevated body temperature is an expected physiological response to cellulitis. This problem does not prioritize higher than a respiratory problem.

Four clients arrive at the emergency department. Which client should the nurse triage as the highest priority for care? 1. Adult with severe upper gastric pain. 2. Child with stridor and excessive drooling. 3. Adult with an open fracture to the right radius. 4. Child with fever of 103ºF (39.44 °C) and blood-streaked sputum.

2. Correct: The child with stridor and excessive drooling is in respiratory distress from epiglottis. Epiglottis is a potential life-threatening condition and should be seen first. This client is exhibiting signs of respiratory distress. 1. Incorrect: Pain important, but not before airway. This client is not exhibiting any life-threatening symptoms. The severe pain should be assessed but not prior to an airway complication. Pain has never killed anyone. 3. Incorrect: The open fracture needs to be evaluated as soon as possible due to the potential of compression syndrome and infection. The child has an airway complication which takes priority over this client. 4. Incorrect: Fever and blood-streaked sputum significant, but not before airway. Children with an axillary fever should be examined. The client has blood-streaked sputum as well. But the priority client is still the child with the life-threatening airway obstruction.

A new mother asks the clinic nurse why her baby should receive recommended vaccinations. What is the best response by the nurse concerning vaccinations? 1. "Vaccinations give antibodies to your baby to protect them from disease." 2. "Vaccinations will help your baby produce antibodies against disease causing organisms." 3. "Federal law requires that your baby receive recommended vaccinations." 4. "There is no reason not to vaccinate your baby since only mild, uncomfortable reactions can occur."

2. Correct: Vaccines are suspensions of antigen preparations intended to produce a human immune response to protect the person from future encounters with the organism. 1. Incorrect: Vaccines will cause the body to produce antibodies. Vaccines give possible immunity to the baby. 3. Incorrect: Vaccines are required for admittance into public school. If a child is home-schooled, the parent may not have the child vaccinated. 4. Incorrect: It is true that the vaccination may cause a mild reaction, but this is not the best response. This answer does not address the mother's question.

A community health nurse is presenting a seminar to teen parents on the topic of infant safety. What priority topic presented by the nurse represents the leading cause of injury or death among infants? 1. Monitoring the infant for food allergies. 2. Placing the infant in rear-facing, approved car seat. 3. Never propping bottle to feed when infant is alone. 4. Positioning infant prone when sleeping or napping.

2. Correct: When instructing first time or young parents, it is vital to teach the need to have the infant snuggly restrained in an appropriately sized, approved infant car seat in the back seat and rear-facing. 1. Incorrect: While discussing the signs or symptoms of food allergies is an important topic for new parents, this is not the most vital information the nurse could present to the teen parents. 3. Incorrect: An infant should never be left unattended while feeding, and propping a bottle could lead to aspiration or respiratory distress. This is a dangerous practice that needs to be discussed by the nurse; however, there is another topic that is more urgent. 4. Incorrect: The research studies to date indicate the safest sleeping position for newborns and infants is supine, not prone. Positioning is always a nursing concern, and teaching new parents about the potential for sudden infant death syndrome (SIDS) would be crucial. However, another topic presents more important information.

A child is being discharged home following a bone marrow transplant. When providing discharge instructions to the parents, what information is most important for the nurse to include? 1. Clean toothbrush weekly with alcohol. 2. Avoid eating raw fruits and vegetables. 3. Drink bottled water the day. 4. Apply heating pad to bruised areas of the skin.

2. Correct:The greatest risk to clients following a transplant is the chance of infection from any source since the client is severely immune-compromised for an extended period of time. There are numerous precautions necessary to avoid bacteria, but one area of concern is food storage, preparation, and consumption. Raw fruits with no skin to peel, such as strawberries, and raw vegetables like broccoli and cauliflower, present a serious risk for bacterial contamination and should not be consumed by new transplant clients. 1. Incorrect: Precise mouth care is vital following a bone marrow transplant; however, rinsing a toothbrush in alcohol is unsafe. Any residual alcohol would cause irritation and trauma to gum tissue, placing the client at risk for mouth inflammation and infection. Clients are instructed to brush teeth twice daily with a soft bristle brush, using a fluoride toothpaste. Some clients are instructed to soak the toothbrush once weekly in a special bleach solution, then rinse in hot water, while others need to replace the toothbrush weekly, based on lab test results. 3. Incorrect: Standing water of any type quickly builds up bacteria, including flower vases and vaporizers. Although bottled water may seem a safe choice, after that bottle is opened, bacteria begins to quickly build up, even if the bottle is recapped. Any water standing more than 15 minutes is considered old and must be thrown out. 4. Incorrect: With bone marrow transplant clients, it will be months before the body begins to stabilize and produce normal blood cells. Bruising and low platelet counts are to be expected for a period of time. When clients develop bruising, the approved treatment is cold compresses or ice packs applied for 15 minutes a couple times per day, and never a heating pad. Additionally, the healthcare provider should be notified so that a current platelet count can be obtained.

The home care nurse, working with an infant in the home, is concerned about the infant developing diaper rash from wearing cloth diapers. Which strategies should the nurse teach to the parents to prevent skin irritation? Select all that apply 1. Change diapers every four hours. 2. Wash diapers with hypoallergenic detergent. 3. Rinse diapers twice when washing. 4. Apply a protective ointment to diaper area with each diaper change. 5. Check infant at least hourly for wet or soiled diapers.

2., 3., 4. & 5. Correct: Hypoallergenic detergent will remove skin bacteria as well as urine from the diaper. Detergents can be irritating to the skin and may cause dryness; therefore, adequate rinsing is important. Double rinse the diapers in cold water to remove traces of chemicals and soap. A protective ointment is even more important to use with cloth diapers, as they do not have the same wicking properties of the disposable diapers. Frequently checking the diaper for wetness and soiling will limit the contact time for urine or feces to be in contact with the skin. Whether using cloth diapers, disposables or both kinds, always change the baby as soon as possible after wetting or soiling the diaper to keep the bottom as clean and dry as possible. 1. Incorrect: The child should be checked more frequently to prevent irritation to the skin from soiling. At least every 2 hours is recommended.

The nurse is talking with the mom of a preschooler at the well-child visit. The mom reports that her 3 year old has a lot of energy and sleeps 9 hours per night. What assessment questions should the nurse ask in response to this comment? Select all that apply 1. Nothing, as this is normal for preschoolers. 2. Does your child take naps during the day? 3. Does your child wake up spontaneously or do you wake her? 4. Does your child appear rested upon awakening? 5. Does your child have trouble settling down for sleep?

2., 3., 4. & 5. Correct: Preschoolers typically require 11 - 13 hours of sleep per day. The child may be supplementing nighttime sleep with long naps. It is important to determine if the child has to be awakened after nine hours or if the child awakens spontaneously. The child may have to be awakened due to mom's work schedule. The adequacy of rest should be determined, as the child is sleeping less than is typical. The nurse should determine if the child has difficulty falling asleep. If so, perhaps more restful nighttime rituals should be implemented. 1. Incorrect: Preschoolers typically require 11-13 hours of sleep per day. Nine hours is not enough.

A high school nurse is assessing multiple students reporting general flu-like symptoms. Which additional symptoms reported by a student would prompt the nurse to immediately call an ambulance? 1. Blurred vision and Trousseau's sign. 2. Vomiting and a Murphy's sign. 3. Sensitivity to light and Kernig's sign. 4. Fever and a Chvostek's sign.

3. Correct: Flu-like symptoms, sensitivity to light , especially without a migraine, and a positive Kernig's sign, often accompanied by neck stiffness, suggests possible meningitis, a serious inflammation of the brain and meninges. It is important to isolate the student until the type of meningitis is diagnosed. Because bacterial meningitis is contagious, the student should be transported to the emergency room immediately to initiate definitive diagnosis and treatment. Kernig's sign is elicited by placing the client in a supine position with one leg flexed up toward the abdomen. The lower leg is then gently extended upward, producing severe pain in the presence of meningitis. 1. Incorrect: Blurred vision in the presence of flu-like symptoms could indicate a number of non-life threatening factors, including dehydration or fatigue. Trousseau's sign is used to assess for tetany with suspected hypocalcemia. It is elicited by applying and inflating a blood pressure cuff while observing for hand spasms. These symptoms would not require immediate transport to the hospital. 2. Incorrect: Although vomiting is unusual in cases of the flu, Murphy's sign is an indication of possible gallbladder inflammation. Placing fingers under the right rib cage and asking the client to take a deep breath causes intense pain that indicates diseased gallbladder. The presence of either of these signs would not require urgent transport to a hospital. 4. Incorrect: Fever is not uncommon for those with the flu. However, Chvostek's sign is an assessment tool used to determine possible hypocalcemia. To elicit this sign, the client's cheek is tapped gently, which causes muscle spasms on the opposite cheek. Neither of these symptoms would require immediate transport to the hospital.

A client is seeing the obstetrician for a monthly checkup at 35 weeks. Vital signs are within normal limits but the nurse notes bilateral pedal edema. What statement by the nurse provides the most appropriate information to the client? 1. "Do not use any salt for your food." 2. "Cut your daily fluid intake in half." 3. "Sit and elevate feet above your heart." 4. "Request a prescription for a diuretic."

3. Correct: In the third trimester of pregnancy, it is common for clients to complain about edema of hands and feet, usually at the end of the day. The client should sit for short periods of time, with feet elevated above the level of the heart, to decrease the edema. 1. Incorrect: The type of edema the nurse has noted is not caused by salt intake, but rather is caused by walking or standing too long during the day. Removing sodium from the diet will not affect the amount of edema the client develops. 2. Incorrect: Pregnant females need to stay well hydrated, particularly in the third trimester, to avoid complications such as Braxton Hicks contractions. Cutting daily fluid intake has no effect on the presence of edema, but may cause other problems. 4. Incorrect: Staying well hydrated is important in all stages of pregnancy, particularly the third trimester. Unless the mother has cardiac issues, a diuretic would be contraindicated.

A 12 year old female, with a history of juvenile rheumatoid arthritis, is being admitted for re-evaluation. The child reported these symptoms for the last week: temperature of 102.9ºF/39.4ºC at 4:00 pm every day, increased pain in joints, loss of appetite, and fatigue. What would be an appropriate room assignment by the charge nurse? 1. Private room only. 2. Rooming with a 12 year old male in skeletal traction due to a fractured femur. 3. Rooming with a 10 year old female that has been admitted for sickle cell disease. 4. Rooming with a 14 month old female that has been admitted for orthopedic surgery.

3. Correct: The appropriate answer is to room her with the 10 year old being worked up for sickle cell disease. This is an acceptable age/sex to pair as roommates. Each has a chronic illness and this allows them to see how another person with limitations adjusts. 1. Incorrect: It is not necessary for this child to be in a private room. The fever at a particular time of the day is a symptom of juvenile rheumatoid arthritis and does not mean an infection. 2. Incorrect: It would be inappropriate to room her with a 12 year old male due to opposite sex and age. 4. Incorrect: The 12 year old who is in pain, feverish, and fatigued would be unable to rest as needed in a room with a 14 month old who is postoperative.

What would be the nurse's priority for a child who has arrived at the emergency department after sustaining a severe burn? 1. Start intravenous fluids. 2. Provide pain relief. 3. Establish airway. 4. Place an indwelling catheter.

3. Correct: This stem does not tell you where the child's burns are, however, you are told that the burns are severe. So assume the worse. What are you most worried about the child losing? Yes, the airway. So we want to assess, establish, and maintain an airway. 1. Incorrect: Not before airway. This child will need IV fluid resuscitation within the first 24 hours. But if you can only pick one action to complete first, it better be to make sure the airway is patent. Then you can start the IV or delegate the task to someone else. 2. Incorrect: Give pain med after starting the IV, not before airway. The best pain relief method for a severe burn is going to be through the IV route. But we must make sure the airway is patent first. 4. Incorrect: Give the pain medication before placing the indwelling catheter but not before establishing the airway. Intake and output will need to be closely monitored in the client who is severely burned. But again, it will need to be done after establishing a patent airway.

What should the nurse include in the plan of care for a child who is receiving chemotherapy for a diagnosis of leukemia? 1. Place the child in a negative pressure isolation room. 2. Administer prophylactic intravenous (IV) antibiotics. 3. Avoid high protein food intake. 4. Teach family and visitors handwashing techniques.

4. Correct: Any client on chemotherapy should have good infection control measures in place such as handwashing by all who they encounter. 1. Incorrect: If the client is immune suppressed, place them in a positive pressure isolation room. A negative pressure room primarily keeps its air inside the room with controlled venting only; whereas a positive pressure room keeps unfiltered air from outside the room out of the room all together. In a hospital, clients with communicable diseases, especially airborne ones, are kept in isolation rooms. In order to ensure the safety of other clients, staff and visitors, it is important that the isolation room contain negative air pressure. This will keep any germs from entering the general airflow and infecting other people. Positive pressure isolation rooms are designed to keep a vulnerable client in isolation safe from contamination from the outside. The air pressure in the room is greater than that outside of it, so it pushes potential infection agents or chemicals away from the client. The most common application is in rooms for client who have compromised immune systems. For these individuals, it is important that no common pathogens, even those that are harmless to healthy people, enter the room. For positive pressure isolation rooms, an anteroom is recommended and incoming air is filtered through both HEPA filters and ultraviolet germicidal irradiation systems, which kill bacteria by exposing them to ultraviolet light. 2. Incorrect: This would be appropriate if there was evidence of a bacterial infection. Just because chemotherapy is being administered does not mean the client has an infection. 3. Incorrect: This client would likely need a high protein diet to meet the nutritional demands of the body during chemotherapy. We need protein for growth, to repair body tissue, and to keep our immune systems healthy. When the body doesn't get enough protein, it might break down muscle for the fuel it needs. This makes it take longer to recover from illness and can lower resistance to infection. People with cancer often need more protein than usual. After surgery, chemotherapy, or radiation therapy, extra protein is usually needed to heal tissues and help fight infection.​

The parents of a child hospitalized with cystic fibrosis have been given discharge instructions. The nurse knows that teaching has been successful when the parents make what statement? 1. "Our child will need to have a gluten free diet." 2. "The enzymes should be given at bedtime daily." 3. "Salt needs to be decreased in our child's diet." 4. "We need to prepare high calorie, high fat meals."

4. Correct: Cystic fibrosis is an inherited disorder in which abnormally viscous secretions affect the respiratory and digestive systems. Because the client is unable to absorb nutrients, several dietary adaptations are crucial, including frequent small meals along with digestive enzymes to help the client process food. The meals should be high calorie, high fat with increased amounts of sodium to help stabilize fluids. 1. Incorrect: A gluten free diet is not associated with cystic fibrosis. This special diet is generally required for clients with Celiac disease and certain food allergies, although clients with either of these diseases will need the addition of fat soluble vitamins A, D, E and K. This statement by the parents indicates the need for further teaching. 2. Incorrect: Pancreatic digestive enzymes, such as Creon or Pancreaze, must be given with every meal or snack in order to help the digestive system absorb nutrients properly. Because clients with cystic fibrosis need frequent small meals throughout the day, digestive enzymes must also be provided throughout the day with any food. 3. Incorrect: Clients with cystic fibrosis lose abnormally large amounts of salt in sweat, and the glands are unable to reabsorb needed sodium into the body system. Rapid dehydration is common due to decreased sodium levels, which are exacerbated during exercise or hot weather. These clients are encouraged to increase salt intake.

Which comment by the mother indicates understanding of the diet needed to maintain health and adequate nutrition in the toddler? 1. "It is important to give my child low fat milk after one year of age". 2. "If the child won't eat new foods after three tries, he is not going to eat it". 3. "I think that the sooner one starts to give vitamins to children, the better". 4. "I try to provide whole grains, fruits, vegetables, and meat daily".

4. Correct: Depending on their age, size, and activity level, toddlers need about 1,000-1,400 calories a day. A health promotion strategy to help meet the nutritional needs of the toddler includes offering a wide variety of healthy foods and from all food groups based on the "my plate" food guide. 1. Incorrect: Fat should not be limited in the child under two years of age. In general, kids ages 12 to 24 months old should drink whole milk to help provide the dietary fats they need for normal growth and brain development. 2. Incorrect: Learning to eat new foods is a process that requires many attempts. Keep offering the food. 3. Incorrect: If children eat a wide variety of foods, it is unlikely that vitamin supplementation will be needed.

A nurse is triaging a 2 year old child in the pediatric emergency department. The nurse notes that the child will not lie down and is consistently drooling. A croaking sound is heard on inspiration. What is the priority nursing intervention? 1. Examine the oral pharynx using a tongue depressor. 2. Administer a sedative so the child can be examined. 3. Have a second nurse hold the child down for the assessment. 4. Notify the primary healthcare provider immediately.

4. Correct: This is the safest answer. The child could suddenly obstruct the airway upon examination of throat. 1. Incorrect: If it looks like epiglottitis, do not examine as this could cause sudden airway obstruction which could be fatal. 2. Incorrect: The client is having trouble breathing, so do not sedate the client. Sedatives would depress the respirations more and potentially cause the client to go into respiratory arrest. Remember, the NCLEX® lady does not want you to be a killer nurse. 3. Incorrect: This will cause more respiratory and emotional distress to the child. This is an unsafe answer.

What discharge instructions should the nurse provide to the parents of a child diagnosed with sickle cell anemia? Select all that apply 1. Provide high-calorie, low protein diet. 2. Inheritance is by autosomal dominate genes. 3. Restrict all activities for 3 months. 4. Deferasirox helps prevent liver damage from iron deposits. 5. Avoid high altitudes.

4., & 5. Correct: Deferasirox is an orally administered iron chelation agent shown to reduce the liver iron concentration due to repeated RBC transfusions. It binds iron. Low oxygen environments such as airplanes and high altitudes should be avoided. 1. Incorrect: Provide a diet that is high-calorie and high-protein to promote growth and health. 2. Incorrect: Sickle cell anemia is an autosomal recessive disease. 3. Incorrect: Activities are not generally restricted. The client may not be able to tolerate vigorous exercise or exertion. Encourage children to participate in physical activities.

The pediatric nurse is planning an educational seminar for new parents. The seminar will focus on tips for administering medication to children. Which points should the nurse include? Select all that apply 1. Demonstrate proper measuring techniques for liquid medications. 2. Put crushed medications into the child's favorite food. 3. Place liquid medication in an 8-ounce bottle of formula. 4. Call medication "candy" to encourage children to take the medicine. 5. Do not place medications in a container other than the original container.

1. & 5. Correct: Demonstration with return demonstration by the parent is an appropriate teaching strategy. Give clear examples and demonstrations and speak in layman's terms. Never put medications in dishes, cups, bottles, or other household containers that children or other family members may be unaware of. 2. Incorrect: Do not place crushed drugs into the child's favorite food or snack. The medication can change the taste of the food, and the child may refuse, therefore missing part or all of the dose. Additionally, the effectiveness of some medications may be harmed by the crushing of the drugs. 3. Incorrect: Do not place liquid drugs in a large bottle of formula. Unless the child drinks the entire amount, he or she will not receive the correct dose. 4. Incorrect: Don't refer to drugs as candy. Children may try to take more candy leading to overdose.

A 3-year-old child refuses to take a prescribed medication. Which statements by the mother, regarding the child's refusal, indicate to the nurse that parental education is needed? Select all that apply 1. "My child is trying to make me angry". 2. "I feel like such a bad mother when my child acts this way". 3. "I promise my child a reward for taking medicine". 4. "I am unfazed by my child's actions". 5. "My child doesn't have to take medicine if he doesn't want to".

1., 2. & 5. Correct: If the mother feels the child is trying to "make her angry" she may respond with inappropriate discipline. The nurse can help the mother understand that developing independence is one of the developmental tasks of a child this age, and that the movement toward independence reflects good, not bad, parenting. The child must take the prescribed medicine in order to get well. 3. Incorrect: Rewarding the client for taking medication is not contraindicated. 4. Incorrect: Being "unfazed" by the child's actions does not reflect bad parenting.

The nurse assessing clients in a pediatric clinic would refer which child for further assessment? 1. A 20 month old who only says "no." 2. A 1 year old who says three words 3. A 9 month old who says "dada" and "mama" 4. A 4 month old who laughs out loud

1. Correct: By 18 months of age, a child should be able to speak 10 or more words. 2. Incorrect: By 1 year of age, a child should be able to say "mama," "dada," and an additional 3 to 5 words. 3. Incorrect: By 9 months of age, a child should be able to say "mama" and "dada." 4. Incorrect: By 4 months of age, a child should be able to laugh out loud.

What interventions should the nurse plan to implement when admitting a client diagnosed with measles? Select all that apply 1. Admit to a semi-private room with a client diagnosed with tuberculosis (TB). 2. Place a surgical mask on the client when transferring to x-ray. 3. Initiate airborne precautions. 4. Wear surgical mask when entering the client's room. 5. Assign a nurse who has received the measles vaccine to take care of this client.

2., 3., & 5. Correct: If the client must leave the room, a surgical mask should be worn to prevent transmission to others. Measles can be transmitted via contact, droplet, and airborne methods, so airborne precautions are needed. Healthcare providers who are not immune to measles should not care for a client with measles. 1. Incorrect: The client should be placed in a private room with negative air pressure when airborne precautions are necessary. TB and measles are not like illnesses and should not be placed in the same room. 4. Incorrect: A particulate or N95 respirators should be worn by staff entering the room of a client on airborne precautions. N95 respirators filter particles that you may inhale. A surgical mask prevents the spread of particles during exhalations.

Based on expected growth and development for a 7 month old infant, what would the nurse anticipate that the mother would report at the infant's well-baby visit? 1. Has slight head lag when pulled to sitting position. 2. Walks holding onto furniture. 3. Able to sit, leaning forward on both hands. 4. Has neat pincer grasp.

3. Correct: A 7 month old is not expected to be able to sit fully unsupported but is able to sit by leaning forward on both hands. 1. Incorrect: No head lag should be seen when pulled to a sitting position. Head lag should end around 5 months of age. 2. Incorrect: The 7 month old is expected to be able to bear full weight on feet but generally does not walk holding onto furniture until around 11 months of age. 4. Incorrect: A neat pincer grasp does not usually develop until around 11 months of age. A 7 month old would only be expected to rake small objects with the fingers.

A school nurse is caring for a child who fell on the playground. Upon examination of the child, the nurse notes multiple bruises in various stages of healing. What is the nurse's initial intervention? 1. Ask the parents who hit the child on the back. 2. Notify the child's primary healthcare provider. 3. Contact the Department of Health and Human Services. 4. Document the findings and observe the child over the next we

3. Correct: Unless there is a policy to direct otherwise, the nurse who suspects child abuse is obligated to report it to the Department of Health and Human Services (DHS). 1. Incorrect: This is confrontational and will warn the parents that you suspect abuse. This may lead to greater harm for the child. 2. Incorrect: Unless there is a policy to direct otherwise, the nurse who suspects child abuse is obligated to report it to the Department of Health and Human Services. DHS, rather than the primary healthcare provider can intervene to maintain the child's safety. 4. Incorrect: This is delaying care. If the child is being abused, not reporting it could lead to serious injury or even death.

A child is admitted to the emergency department due to suspected ruptured appendicitis with perforation. What would be the priority nursing assessment for this client? 1. Monitor for the Rovsing sign. 2. Assess for an increase in temperature. 3. Check for rebound tenderness at McBurney's point. 4. Monitor for increasing pain and rigidity of the abdomen.

4. Correct: Increasing pain and rigid, board-like abdomen are signs that the appendix may have ruptured, with resulting peritonitis developing. 1. Incorrect: The Rovsing Sign results in RLQ pain that occurs with palpation of the LLQ. This suggests peritoneal irritation due to palpation of a remote location and would indicate appendicitis. 2. Incorrect: Although children with appendicitis may have an elevated temperature, the priority would be assessing for the signs of peritonitis which include increasing pain and rigidity of the abdomen. Children can have an increased temperature with many different types of inflammation and infections. 3. Incorrect: Although rebound tenderness at McBurney's point is indicative of appendicitis, the nurse should not check for this due to the possibility of rupturing the appendix.

A nurse is caring for a pediatric client who has been diagnosed with hypothyroidism. What is essential for the nurse to teach the parents of this child? 1. Administer the liquid medication with soy milk. 2. Notify primary healthcare provider of slow heart rate. 3. Monitor glucose before meals and at bedtime. 4. Wait 4 hours after giving medication before giving iron supplements.

4. Correct: Wait for 4 hours before giving child iron supplements, antacids that contain calcium or aluminum hydroxide, or calcium supplements as it interferes with medication. 1. Incorrect: Give the medication with a liquid, except soy milk, which interferes with the ability to absorb the thyroid hormone. 2. Incorrect: Bradycardia is seen with hypothyroidism. When taking thyroid medication, we want to watch for signs of hyperthyroidism such as tachycardia, rapid weight loss, sweating, restlessness. 3. Incorrect: Hypothyroidism does not affect glucose.

What actions would be appropriate for a nurse who is administering ear drops to a six year old child? Select all that apply 1. Position supine with affected ear up. 2. Administer ear drops immediately upon removing from the refrigerator. 3. Open ear canal by drawing back on the pinna and slightly downward. 4. Allow prescribed number of drops to fall along inside of ear and flow into ear by gravity. 5. Have client remain supine for several minutes.

1., 4., & 5. Correct: Supine with affected ear up allows for proper administration of medication. Never attempt to put drops directly on the eardrum. Administer along inside of ear so that drops flow by gravity into ear. Remaining supine for several minutes permits the fluid to be absorbed. 2. Incorrect: If medication is not instilled at room temperature, the client may experience vertigo, dizziness, pain, and nausea. Additionally, cold ear drops cause discomfort. 3. Incorrect: This is the method for a child less than 3 years of age. For older than 3 years, open canal of ear by drawing back on the pinna and slightly upward.

An elderly client diagnosed with terminal cancer is the sole caregiver to a developmentally delayed adult child. The client is worried that the child, with a developmental age of seven years old, will need permanent placement in a long term care facility. What statement by the nurse is most accurate? 1. "Your child will need to be under constant supervision." 2. "A supervised group home would be an ideal setting." 3. "Maybe we could find someone to take in your child." 4. "We should start getting the child used to living alone."

2. Correct: With a developmental age of seven years old, group home supervision would be ideal. The adult child can complete most activities of daily living and will only need minimal assistance with such tasks as cooking, laundry or shopping. Think about the client in this question: who actually has the problem? The terminal parent is the client and is caring for a developmentally delayed adult child. The issue is how to provide care for the adult child once the client dies. So what should you consider first? Review Erikson's stages, because knowledge of skills at age seven is vital in order to determine what suggestion by the nurse would most likely assist the client. You know two very important facts: the client is terminal and is the caretaker of an adult child whose developmental age is only seven years old. Recall what you learned about Erikson's stages of development. Age seven places this individual's mental functioning in the "school-age" category, which is 'Industry verses Inferiority'. At this age, a child would have accomplished gross motor skills as well as some fine motor skills. Erikson indicated this group also enjoys cooperative socialization, particularly with positive rewards. This is an age of collecting objects and classifying into categories. Creativity is beginning and consistency with activities is important to managing outbursts or frustrations. Those in this age group no longer require constant parental supervision, but since accidents can occur because of limited cognitive skills, a certain degree of periodic supervision is crucial. When considering these limitations, what type of living environment would safely suit this developmentally delayed adult? Imagine how difficult this situation must be for the terminal client, having cared for this adult child since birth. Knowing there is no alternative because of a terminal diagnosis, the client needs some assistance to determine what environment might be best for the adult child. The nurse can help by first providing the appropriate suggestion and then follow through providing either needed information or social services referral. 1. Incorrect: This comment is inaccurate, based on Erikson's stages. Even a seven year old can manage most ADLs without assistance, such as bathing, dressing, and grooming. Constant supervision would not be necessary. 3. Incorrect: Take in implies the child would need a private individual to provide care round the clock in a home, which is not necessary for this individual's developmental age. There are many activities the adult child can complete without supervision, so private home placement is not needed. 4. Incorrect: An adult with a mental age of seven is not capable of living completely alone. While able to complete ADLs and many small tasks, this individual would not be able to be live independently.

A concerned mother is asking the nurse about activities that would be best for her child who has been diagnosed with asthma. In order to minimize the risk of exercise induced asthma, which activity would be best for the nurse to suggest? 1. Track 2. Basketball 3. Baseball 4. Soccer

3. Correct: Baseball is an activity that is considered "asthma friendly". It requires short, intermittent periods of exertion and is therefore tolerated better by children with asthma. 1, 2, &4. Incorrect: This activity requires extended periods of exertion and is not considered "asthma friendly" and often not tolerated by clients with asthma.

What is the first intervention the emergency department (ED) nurse should implement when caring for a lethargic toddler with a diagnosis of near-drowning? 1. Torso warming 2. Start intravenous infusion 3. Administer oxygen 4. Prepare for nasogastric intubation

3. Correct: Hypoxia is the primary problem because it results in brain cell damage 1. Incorrect: While warming protocols will likely be needed, hypoxia is the first priority 2. Incorrect: Fluid resuscitation will most likely be needed, hypoxia is the first priority 4. Incorrect: Nasogastric intubation may be needed but hypoxia is the first priority

The nurse is presenting a seminar to expectant teen parents regarding infant car seat safety. What statement from a teen parent indicates to the nurse that teaching was successful? 1. "It's okay to place the car seat up front as long as it faces backwards." 2. "The baby has to stay rear facing until at least 40 pounds or 40 inches." 3. "Regular seat belts can be used if the child does not like the booster seat." 4. "An infant must stay in the backseat, facing backward, till at least a year old."

4. CORRECT: The nurse is looking for a statement that indicates the teen parents understand the proper use of infant car seats. Although there are some variations from state to state, the National Safety Council advises that infants should be in a rear-facing car seat in the back seat of a vehicle until at least age one year. This comment indicates the parents understand the teaching clearly. 1. INCORRECT: An infant or child car seat can never be placed in the front seat at any time, regardless of what direction it may face. Further teaching is definitely indicated. 2. INCORRECT: A child of 40 pounds or forty inches is of pre-school age, usually around 3 to 4 years old. This is too old for a rear-facing car seat. The issue of height and weight is more useful when determining whether a child can safely move from a car seat to a booster seat. The parents did not understand the instruction. 3. INCORRECT: The choice of booster seat versus regular car seat belts is not based on whether the child likes, or is comfortable, in using either type of restraints. The most accepted guideline for child safety is that children under the age of 8 years old should be in either a child's car seat or booster seat. Further teaching is needed.

The nurse is caring for a 5 year old client who is 12 hours post tonsillectomy. The client is pain free and has advanced to a soft diet. What is the priority nursing intervention? 1. Apply warm compresses to the throat. 2. Encourage gargling to reduce discomfort. 3. Position the child supine. 4. Monitor for frequent clearing of the throat.

4. Correct: Continuous swallowing and frequent clearing of the throat are signs of bleeding. 1. Incorrect: This would increase blood flow, causing edema and bleeding, so this should not be done. 2. Incorrect: Gargling increases motion of throat and may cause bleeding. This is also something that could be a developmental challenge for a 5 year old. 3. Incorrect: The blood can drip down into the stomach and the client will wake up and vomit the old blood while lying flat. This puts the client at risk for aspiration so the nurse should place the client in a side lying position.

A child receiving chemotherapy via a Port-a-cath needs blood cultures collected. Obtaining blood from a Port-a-cath decreases other needle sticks to an immunocompromised client. In what order should the nurse complete this procedure? Hint: Drawing blood cultures is a slightly different process than obtaining blood for other lab work. Wash hands and don non-sterile gloves. Flush the port with a heparinized solution. Access with the Huber needle. Flush the port with NS. Withdraw 10 mL of blood. Cleanse the port diaphragm with an alcoholprep pad.

First: Wash hands and don non-sterile gloves. As a nurse, you know that any procedure begins with hand washing! Since there is no option for sterile gloves, this option must be the first step. Second: If the nurse has donned gloves, prepping the client would be the next logical step. Cleaning the port, in this case with an alcohol wipe, is all that is necessary. However, if port access is completed as a sterile technique, you may observe a nurse cleaning the diaphragm with chlorhexidine. Again, this question does not provide you that choice. Third: Now that the diaphragm is clean, it is accessed with the Huber needle. The needle would already be primed and connected to the adapter (small tubing with a vacutainer) into which the blood vial is inserted to withdraw the sample. Fourth: The nurse will withdraw 10 mL of blood into the appropriate blood vial or tube for the blood cultures. For blood cultures, the first vial of blood is not discarded, as with other types of laboratory tests. Fifth: The port is flushed with normal saline to rinse the inner catheter and clear any remaining blood out of the diaphragm. In some situations, the process may end with the saline flush. But not in this example. Sixth: The final step is to flush the port and inner tubing with heparin to prevent blood clots or occlusion from occurring inside the port itself. Again, this step is dependent upon the type of port and the sample needed.

A nine year old child with attention deficit hyperactivity disorder (ADHD) is being admitted to the pediatric unit. Who should the charge nurse assign this client to room with? 1. Ten year old with Crohn's disease. 2. Eight year old with a history of seizures. 3. Six year old admitted with asthma. 4. Seven year old with a urinary tract infection.

4. Correct: It would be best to pair this child with the child with a urinary tract infection. They are close to the same age and this child's condition does not require a quiet environment that could be interrupted by a hyperactive child. 1. Incorrect: The ADHD clients behavior could be detrimental to the client's Crohn's disease. Crohn's disease is not caused by stress but it can make signs and symptoms worse and may trigger flare-ups. 2. Incorrect: You want to decrease stimulation when you have a client with seizures not increase it. Seizures can be precipitated by sensory stimuli. 3. Incorrect: Again, the client with asthma does not need any stimuli that could cause agitation and stress. Stress can trigger the release of chemicals like histamine and leukotrienes which can trigger narrowing of the airways.

Which clients should the nurse recommend receive the human papillomavirus (HPV) vaccine? Select all that apply 1. Twelve year old male. 2. Nine year old female. 3. Twenty-five year old bisexual male. 4. Twenty-two year old female with compromised immune system. 5. Twenty-six year old male who has not received the HPV vaccine.

1., 3, & 4. Correct: The HPV vaccine is recommended for preteen boys and girls at age 11 or 12 so they are protected before ever being exposed to the virus. Young women can get HPV vaccine through age 26, and young men can get vaccinated through age 21. The HPV vaccine is recommended for any man who has sex with men through age 26 and for men with compromised immune systems through age 26 if they did not get HPV vaccine when they were younger. The HPV vaccine is recommended for men and women with compromised immune systems through age 26. 2. Incorrect: The HPV vaccine is recommended for preteen boys and girls at age 11 or 12 so they are protected before ever being exposed to the virus. Young women can get HPV vaccine through age 26, and young men can get vaccinated through age 21. 5. Incorrect: Catch up vaccines are recommended for males through age 21 and for females through age 26 if they did not get vaccinated when they were younger.