Peds

The nurse reviews the results of a tuberculin skin test performed on a 3-year-old child. The results indicate an area of induration that measures 10 mm. How should the nurse interpret this result?

Positive

A 9-year-old child is diagnosed with chlamydial conjunctivitis. The nurse consults with the HCP regarding necessary follow-up because this infection can be associated with which finding?

Possible sexual abuse

After a tonsillectomy, a child is brought to the pediatric unit. The nurse places the child in which appropriate position?

Prone

The nurse assists to prepare a teaching plan regarding the administration of eardrops for the parents of a 2-year-old child. Which should be included in the plan?

Pull the earlobe down & back before instilling the eardrops

A hospitalized 2-year-old child with croup is receiving corticosteroid therapy. The mother asks the nurse why the HCP did not prescribe antibiotics. The nurse makes which response to the mother?

"Antibiotics are not indicated unless a bacterial infection is present."

A nursing instructor asks a nursing student about the use of bacillus Calmette-Guerin vaccine (BCG). Which response made by the nursing student is correct?

"BCG is administered to asymptomatic human immunodeficiency virus (HIV)-infected children who are at increased risk for developing TB."

The nurse is reinforcing instructions to the mother of an 8-year-old child who had a tonsillectomy. The mother tells the nurse that the child loves tacos & asks when the child can safely eat one. The nurse should make which response to the mother?

"In 3 weeks"

The nurse is told that a child with rheumatic fever (RF) will be arriving to the nursing unit for admission. Which question should the nurse ask the family to elicit information specific to the development of RF?

"Did the child have a sore throat or a fever within the past 2 months?"

The nurse reinforces instructions to parents regarding the methods that will decrease the risk of recurrent otitis media in infants. Which should the nurse include in the instructions?

"Feed the infant in an upright position."

The nurse is collecting data on a child with a diagnosis of rheumatic fever. Which question should the nurse initially ask the mother of the child?

"Has the child complained of a sore throat within the past few months?"

The nurse has reinforced home care instructions to the mother of a child who is being discharged after cardiac surgery. Which statement by the mother indicates the need for further teaching?

"I can apply lotion or powder to the incision if it is itchy."

The nurse reinforces discharge instructions to the mother of a child following a myringotomy with insertion of tympanostomy tubes. Which statement by the mother indicates a need for further teaching?

"I need to be sure my child uses soft tissues to blow his nose."

The nurse has provided instructions to the mother of a child who has been diagnosed with bacterial conjunctivitis. Which statement by the mother would indicate the need for further teaching?

"It is okay to share towels & washcloths."

A child with croup is placed in a cool-mist tent. The mother asks if the child may have her security blanket inside the tent. Which is the most appropriate response by the nurse?

"The child may have the security blanket inside the tent."

The nurse is reinforcing instructions to the mother of a child with cystic fibrosis regarding the immunization schedule for the child. Which statement should the nurse make to the mother?

"The child will receive the recommended basic series of immunizations along with a yearly influenza vaccination."

The mother of a child who had a myringotomy with insertion of tympanostomy tubes calls the nurse & tells the nurse that the "tubes" fell out. The nurse should make which response to the mother?

"This is not an emergency. I will speak to the HCP & call you right back."

The nurse is caring for a mother & her infant who was born 12 hours ago. Which statements made by the mother should prompt the nurse to have the baby evaluated for early heart failure? Select all that apply

- "I'm chilly but my baby's forehead is sweaty." - "I can feel my baby's heart rate when he's sleeping, it seems much faster than it did yesterday." - "My baby latches on to my nipple well & has a strong suck, but seems to get weak very quickly, then stops too soon."

The nurse is preparing for the admission of an infant with a diagnosis of bronchiolitis caused by the respiratory syncytial virus (RSV). Which interventions should be included in the plan of care? Select all that apply.

- Place the infant in a private room. - Place the infant in a room near the nurses' station

A mother of a child with cystic fibrosis asks the nurse when the postural drainage should be performed. The mother states that the child eats meals at 8:00 am, 12 noon, & at 6:00 pm. What times should the nurse tell the mother to perform postural drainage

10:00 am, 2:00 pm, & 8:00 pm

Acetylsalicylic acid (aspirin) is prescribed for a child with rheumatic fever (RF). The nurse should question this prescription if the child had documented evidence of which condition?

A viral infection

A 5-year-old child has been transferred to the pediatric unit after a cardiac catheterization. Which intervention has the highest priority in the care of this child immediately following the procedure?

Assess for any bleeding on the dressing

The nurse is instructing the mother of a child with cystic fibrosis (CF) about the appropriate dietary measures. Which meal best illustrates the most appropriate diet for a client with cystic fibrosis?

Chicken tenders & a baked potato with butter

A sweat test is performed on a child with a suspected diagnosis of cystic fibrosis (CF). Which test result is suggestive of cystic fibrosis & should require further assessment & investigation?

Chloride level of 40 mEq/L

The nurse is reinforcing discharge instructions to the mother of a child who had a myringotomy with insertion of tympanostomy tubes. The nurse instructs the mother that if the tubes fall out, she should take which action?

Contact the HCP

A 10-year-old child with asthma is treated for acute exacerbation. Which finding would indicate that the condition is worsening?

Decreased wheezing

The nurse is assigned to care for a child after a myringotomy with the insertion of tympanostomy tubes. The nurse notes a small amount of reddish drainage from the child's ear after the surgery. On the basis of this finding, which action should the nurse take?

Document the findings

A mother of a child being treated for right lower lobe pneumonia at home calls the clinic nurse. The mother tells the nurse that the child has discomfort on the right side & that the acetaminophen (Tylenol) is not very effective. Which is the best suggestion by the nurse?

Encourage the child to lie on the right side.

The nurse reviews the record of a child who was just seen by a HCP. The HCP has documented a diagnosis of suspected aortic stenosis. Which specific s/s of aortic stenosis should the nurse anticipate?

Exercise intolerance

The nurse is caring for a child with a diagnosis of Kawasaki disease. The mother of the child asks the nurse about the disorder. Which statement most accurately describes Kawasaki disease?

It is also called mucocutaneous lymph node syndrome & is a febrile generalized vasculitis of unknown cause.

A 3-year-old child has returned to his room following a tonsillectomy. Which finding needs immediate notification of the registered nurse?

Nasal flaring & rib retractions

A mother arrives at the emergency department with her child and a diagnosis of epiglottitis is documented. Which of the health care provider's prescription should the nurse question?

Obtain a throat culture

A child with a diagnosis of pertussis (whooping cough) is being admitted to the pediatric unit. As soon as the child arrives in the unit, which action should the nurse do first?

Place the child on a pulse oximeter

A HCP prescribes "eye patching" for a child with strabismus of the right eye. The nurse reinforces instructions to the mother to use which procedure for eye patching?

Place the patch on the left eye.

The nurse is caring for a hospitalized infant with bronchiolitis. Diagnostic tests have confirmed respiratory syncytial virus (RSV). On the basis of this finding, which should be the appropriate nursing action?

Plan to move the infant to a room with another child with RSV

The nurse is reviewing the laboratory results of a child scheduled for tonsillectomy. Which laboratory value would be significant to review?

Platelet count

The nurse is assisting in developing a plan of care for a child who will be returning from the operating room following a tonsillectomy. The nurse plans to place the child in which position on return from the operating room?

Side-lying

The nurse should place the child who had a tonsillectomy in which position?

Side-lying position

The nurse caring for an infant with congenital heart disease is monitoring the infant closely for signs of heart failure (HF). The nurse should observe for which early sign of HF?

Tachycardia

The nurse teaches a child with cystic fibrosis how to perform the "huff" maneuver. Which instructions should the nurse tell the child?

Take a deep breath & then exhale rapidly, whispering the word huff.

The day care nurse is observing a 2-year-old child & suspects that the child may have strabismus. Which observation may be indicative of this condition?

The child consistently tilts his or her head to see.

The nurse is working in the ER & is caring for a child who has been diagnosed with epiglottitis. Which is an indication that the child may be experiencing airway obstruction?

The child thrusts the chin forward & opens the mouth

A child is scheduled for a tonsillectomy. Which should present the highest risk of aspiration during surgery?

The presence of loose teeth

The nurse is assigned to care for an infant with a diagnosis of tricuspid atresia. The nurse plans care, knowing which is true regarding this diagnosis?

There is no communication from the right atrium to the right ventricle

The nurse is observing a nursing student preparing to suction a pediatric client through a tracheostomy. The nurse intervenes if the student verbalizes which intention?

To apply continuous suction when inserting the catheter

After a tonsillectomy, the child begins to vomit bright red blood. Which is the initial nursing action?

Turn the child to the side

After a tonsillectomy, which fluid or food item would be appropriate to offer to the child?

Yellow jell-o

The nurse reinforces instructions to the mother of a child who has been hospitalized with croup. Which statement made by the mother would indicate the need for further teaching?

"I will give my child cough syrup if a cough develops."

The nurse reinforces instructions to the mother of a child with croup about the measures to take if an acute spasmodic episode occurs. Which statement by the mother indicates the need for further teaching?

"I will place a steam vaporizer in my child's room."

A nursing student is assigned to care for an infant with a diagnosis of heart failure (HF). The student develops a plan of care for the child that is focused on monitoring for fluid overload. The student plans to best assess the urine output of the infant by taking which action?

Weighing the diapers

The nurse is preparing to administer digoxin (Lanoxin) to an infant with heart failure (HF). Before administering the med, the nurse double-checks the dose, counts the apical heart rate for 1 full minute, & obtains a rate of 88 bpm. Based on this finding, which is the appropriate nursing action?

Withhold the med