Peds: Immunity & Infection, Peds- Chapter 44, Mobility, Neuromuscular Disorder peds, Peds: Shock & trauma, SIDS, Emergencies

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A group of students are reviewing information about bone healing in children. The students demonstrate understanding of this information when they state:

A child's bones heal more quickly than those of an adult. Bone healing occurs in the same fashion as in the adult, but it occurs more quickly in children because of the rich nutrient supply to the periosteum. The closer a fracture is to the growth plate, the more quickly the fracture heals. The capacity for remodeling (the process of breaking down and forming new bone) is increased in children compared with adults. Children's bones produce callus more rapidly and in larger quantities than do adults' bones.

An HIV positive woman has asked about breastfeeding her son. What response by the nurse is appropriate?

"Breastfeeding will increase your child's risk of contracting HIV."

A nurse is caring for an 11-year-old with an Ilizarov fixator and is providing teaching regarding pin care. The nurse should provide which instruction?

"Cleansing by showering should be sufficient." The Ilizarov fixator uses wires that are thinner than ordinary pins, so simply cleansing by showering is usually sufficient to keep the pin site clean.

A higher-pitched "click" may occur with flexion or extension of the hip. When assessing for DDH, DO NOT confuse this benign, adventitial sound with a true " __________"

"Clunk"

The nurse is caring for 2-year-old with myelomeningocele. When teaching about care related to neurogenic bladder, what response by the parent would indicate that additional teaching is required? 1. "Routine catheterization will decrease the risk of infection from urine staying in the bladder." 2. "I know it will be important for me to catheterize my child for the rest of his life." 3. "I will make sure that I always use latex-free catheters." 4. "I will wash the catheter with warm soapy water a

"I know it will be important for me to catheterize my child for the rest of his life."

The nurse is conducting a wellness examination of a 6-month-old child. The mother points out some dimpling and skin discoloration in the child's lumbosacral area. How should the nurse respond? a) "This can be considered a normal variant with no indication of a problem; however, the doctor will want to take a closer look." b) "This is often an indicator of spina bifida occulta as opposed to spina bifida cystica." c) "This could be an indicator of spina bifida; we need to evaluate this furth

"This can be considered a normal variant with no indication of a problem; however, the doctor will want to take a closer look."

The parents of a infant born with an abnormality on the back are told by the neonatologist that their child has a myelomeningeocele. They ask the nurse what exactly that means. Which would be the nurse's best reply?

"It is a herniation through the skin of the back of your child with both the spinal cord and nerve roots involved." A myelomeningocele is the more severe form of spina bifida cystica, in which the spinal cord and nerve roots herniate into the sac through an opening in the spine, compromising the meninges and usually resulting in neurological impairment. A meningocele includes the meninges and spinal fluid only. A myelomeningocele usually contains the bowel and bladder innervation but involves many more nerves also. A myelomeningocele is not just a cyst that resolves within a year.

The nurse is caring for a 6-year-old boy with myelomeningocele. The nurse is teaching the mother how to promote appropriate bowel elimination and avoid constipation. Which response from the mother indicates a need for further teaching? a) "I can palpate his abdomen to assess for constipation" b) "My son's activity is too limited to stimulate his bowels." c) "He must have an adequate amount of fluid." d) "I need to figure out his usual pattern for passing stool."

"My son's activity is too limited to stimulate his bowels."

The child with a surgically repaired myelomeningocele has a neurogenic bladder. How will the nurse best explain this problem to the parents? a) "Your child cannot properly control holding urine or emptying the bladder. " b) "While your child is young, urine leaking from the bladder will not be a problem because diapering is expected." c) "Your child dribbles urine because the bladder either is overactive, pushing urine out, or is not active enough, becoming overfilled and causing urine to le

"Old urine remains in the bladder because of poor emptying or overfilling, putting your child at risk for urinary tract infection."

A nurse is providing instructions for home cast care. Which response by the parent indicates a need for further teaching?

"Pale, cool, or blue skin coloration is to be expected." It is very important to teach parents to identify the signs of neurovascular compromise (pale, cool, or blue skin) and tell them to notify the physician immediately. The other statements are correct.

A nurse is caring for a child with spina bifida. The child's mother asks the nurse what she did to cause the birth defect. Which statement would be the nurse's best response? a) "Older age at conception is one of the major causes of the defect." b) "It has been linked to maternal alcohol consumption during pregnancy." c) "It's a common complication of amniocentesis." d) "The cause is unknown and there are many environmental factors that may contribute to it."

"The cause is unknown and there are many environmental factors that may contribute to it."

The nurse is administering nevirapine to an adolescent client diagnosed with HIV. The client asks the nurse how this medication helps fight HIV. How should the nurse respond?

"The medication disrupts the virus life cycle of HIV. This prevents the disease from progressing."

A nurse is teaching the parents of a boy with a neurogenic bladder about clean intermittent catheterization. Which response indicates a need for further teaching? a) "We must be careful to use latex-free catheters." b) "My son may someday learn how to do this for himself." c) "We need to soak the catheter in a vinegar and water solution daily." d) "The very first step is to apply water-based lubricant to the catheter."

"The very first step is to apply water-based lubricant to the catheter."

The nurse is planning care for a baby born to a mother who smoked during the pregnancy. The mother states that she believes in bed sharing. Which nursing diagnosis would be appropriate for this baby? A) Risk for Sudden Infant Death Syndrome (SIDS) B) Readiness for Enhanced Parenting C) Anxiety D) Deficient Knowledge

The nurse is caring for an infant girl in an outpatient setting. The infant has just been diagnosed with developmental dysplasia of the hip (DDH). The mother is very upset about the diagnosis and blames herself for her daughter's condition. Which response best addresses the mother's concerns?

"This is not your fault and we will help you with her care and treatment." Because the mother is crying and experiencing the initial shock of the diagnosis, the nurse's primary concern is to support the mother and assure her that she is not to blame for the DDH. While education is important, the nurse should let the mother adjust to the diagnosis and assure her that the baby and her family will be supported now and throughout the treatment period.

A mother calls the nurse and reports that her child has ingested a toxin. Which statement by the nurse explains why inducing vomiting is contraindicated? "Vomiting can increase the toxicity of the agent." "Vomiting may cause additional damage to the esophagus." "Vomiting can increase the absorption in the oral mucosa." "Vomiting may cause bowel rupture due to the increase in pressure."

"Vomiting may cause additional damage to the esophagus." As the ingested agents makes a second trip through the esophagus, it may cause additional damage or burning of the tissue.

The nursing is caring for a hospitalized child diagnosed with varicella-zoster virus. The child's parents ask how to prevent the child's siblings from contracting the virus. Which response by the nurse is best? "Vaccinating your other children is the only way to prevent them from contracting the virus." "Since this is a virus, there is nothing you can do to prevent your other children from getting it." "We will place your child on contact and airborne precautions. It is best for the other c

"We will place your child on contact and airborne precautions. It is best for the other children not to visit."

Which immune cells are disrupted when a child is infected with human immunodeficiency virus (HIV)? Select all that apply.

t cells b cells phagocytes

Tdap vaccine

11-12 years

Meningococcal vaccine

11-12 years, 16 years

MMR vaccine

12-15 months, 4-6 years

Varicella vaccine

12-15 months, 4-6 years

An adolescent female client is diagnosed with systemic lupus erythematosus (SLE). Which action by the client indicates acceptance of the body changes that occur because of SLE? 1. Attends school but does not stay for after-school activities 2. Discusses the body changes with healthcare providers only 3. Discusses the body changes with her best friend 4. Only attends small parties at friends' homes

3.Peer interaction is important to the teen. Being able to discuss the changes to her body with a peer indicates acceptance of the changes in her body image.

A preschool child who was admitted to the hospital for a minor surgery develops a rash on the second day after hospitalization and is diagnosed with chicken pox (varicella). The nurse should take which action to provide safety for all children on the unit? 1.Place only the infected child in isolation. 2.Keep siblings from visiting the infected child. 3.Place the child and any other children who were exposed in isolation. 4.Place the infected child and any immunocompromised children in isolatio

A nursing instructor is describing the progression of signs and symptoms associated with varicella from earliest to latest. Place the signs and symptoms below in the sequence that the instructor would describe them. 1. Vesicle formation 2. Papular rash 3. Crusting 4. Low-grade fever 5. Macular rash

4, 5, 2, 1, 3

The nurse is caring for an infant exposed to HIV. The polymerase chain reaction (PCR) test was negative at birth. The nurse tells the mother that the child should be tested again at what age? 4 to 7 weeks 8 to 10 weeks 2 to 3 months 12 months

4-7wks they normally test positive after 1 month old

A 5-year-old girl is cyanotic, dusky, and anxious when she arrives in the emergency department. Which of the following would be most appropriate? A) Ventilating the child with a bag-valve-mask B) Estimating the child's weight using a Broselow tape C) Providing therapy using automated external defibrillation D) Using rescue breathing and chest compressions

The nurse is providing care to a child experiencing shock. Which of the following intravenous solutions would the nurse expect to administer? A) Ringer lactate B) Dextrose 5% and water C) Dextrose 5% and normal saline D) Dextrose 10% and water

The student nurse attends a workshop on culture and diversity with regard to sudden infant death syndrome (SIDS) and is now aware that the rate of occurrence is highest among which group of infants? A) American Indians B) Caucasians C) Asians D) Hispanics

Which of the following would the nurse do first for a 5-year-old girl with profound bradycardia? A) Provide oxygen at 100% B) Administer epinephrine as ordered C) Use warming blankets D) Perform gastric lavage

An adolescent female with systemic lupus erythematosus (SLE) is trying to learn how to live with her illness. What teaching by the nurse is priority? A. Use protection against the sun whenever she is outside, regardless of the season. B. Maintain a high-protein diet to maintain healthy skin integrity and muscle fibers. C. Plan her schedule so she gets at least 10 hours of solid, deep sleep each night. D. Keep a diary so she can document her thoughts and feelings as she adjusts.

A Using protection against the sun whenever she is outside, regardless of the season, is a must to avoid triggers that cause exacerbations.

The nurse is caring for a group of children on the pediatric unit. The nurse should collect further data and explore the possibility of child abuse in which situation?

A 7-year-old with a spiral fracture of the humerus, which the caregiver reports as having been caused when the child was hit by a bat swung by a Little League teammate. Spiral fractures, which twist around the bone, are frequently associated with child abuse and are caused by a wrenching force. When a broken bone penetrates the skin, the fracture is called compound, or open. A simple, or closed, fracture is a single break in the bone without penetration of the skin. In a greenstick fracture, the bone bends and often just partially breaks.

The nurse is caring for an 8-month-old in Bryant traction for developmental dysplasia of the hip and is monitoring for complications. Which assessment finding would alert the nurse to a possible complication?

A weak pedal pulse A diminished pedal pulse could be a sign of neurovascular compromise caused by pressure from the elastic bandages. Brisk capillary refill is a normal finding. Mild fussiness is to be expected and is nonspecific when an infant is immobilized and has both legs extended vertically. Bryant traction is a type of skin traction and does not use pins.

The nurse is providing postoperative care for a 14-month-old girl who has undergone a myelomeningocele repair. The girl's mother is extremely anxious and tells the nurse she is afraid she will never learn how to care for her daughter at home. Which response by the nurse would be most appropriate? A) "I will help you become comfortable in caring for your daughter." B) "You must learn how to care for your daughter at home." C) "You will need to learn to collaborate with all the caregivers." D) "T

A) "I will help you become comfortable in caring for your daughter." Rationale: The nurse needs to empower families to become the experts on their child's needs and conditions via education and participation in care. The most positive approach is to let the mother know the nurse will support her and help her become an expert on her daughter's care. Telling the mother that she must learn how to care for her daughter or that she must have a positive attitude is not helpful. Telling her that she needs to collaborate with the caregivers is true, but does not address her fears. Reference: p. 1611

Common drugs for neuromuscular disorders include which of the folllowing? SATA A) Benzodiazepines (diazepam, lorazepam) B) Baclofen (oral or intrathecal) C) Corticosteroids D) Botulin toxin E) Acetaminophen F) Narcotic analgesics G) NSAIDS (ibuprofen, ketorlac) H) Bisphosphonate I) Oxytocin

A) Benzodiazepines (diazepam, lorazepam) B) Baclofen (oral or intrathecal) C) Corticosteroids D) Botulin toxin E) Acetaminophen F) Narcotic analgesics G) NSAIDS (ibuprofen, ketorlac) H) Bisphosphonate

Physical assessment of DDH includes: SATA A) Inspection B) Observation C) Palpation D) Percussion

A) Inspection B) Observation C) Palpation

Which initial assessment made by the triage nurse suggests that a child requires immediate intervention? a. The child has thick yellow rhinorrhea. b. The child has a frequent nonproductive cough. c. The child's oxygen saturation is 95% by pulse oximeter. d. The child is grunting.

ANS: D One of the initial observations for triage is respiratory rate and effort. Grunting is a sign of hypoxemia and represents the body's attempt to improve oxygenation by generating positive end-expiratory pressure. Rhinorrhea, coughing, and a normal SaO2do not need immediate intervention.

Influenza vaccination

Annually

The nurse is caring for a 7-year-old boy experiencing respiratory distress who is scheduled to have a chest radiograph. Which of the following would be most important for the nurse to include in the child's plan of care? A) Administering a sedative to help calm the child B) Assisting the child to lie still during the chest radiograph C) Accompanying the child to continue observation D) Informing the child that he might hear a loud banging noise

The nurse is evaluating care provided to a new mother whose infant is at risk for sudden infant death syndrome (SIDS). Which statement by the mother indicates teaching has been effective? A) "I need to purchase loose-fitting sheets and blankets for the bed." B) "I plan to quit smoking." C) "I will place my baby in a side-lying position for sleep." D) "I will bottle-feed my baby since breastfeeding is a risk factor for SIDS."

The nurse is providing parenting teaching regarding reducing the risk of sudden infant death syndrome (SIDS). Which teaching point is a priority for the nurse to include? A) Instruct on side-lying and face-down positions when in the crib. B) Instruct on face-up position when in the crib. C) Ensure adequate nutritional intake for the mother and newborn. D) Encourage good hand washing.

Anatomic areas of growing bone include: SATA A) Metatarsal B) Metaphysis C) Diaphysis D) Growth plate (physis) E) Epiphysis

B) Metaphysis C) Diaphysis D) Growth plate (physis) E) Epiphysis

The nurse is conducting a physical examination of a child with suspected developmental dysplasia of the hip. Which finding would help confirm this diagnosis? A) Abduction occurs to 75 degrees and adduction to within 30 degrees (with stable pelvis). B) A distinct "clunk" is heard with Barlow and Ortolani maneuvers. C) A high-pitched "click" is heard with hip flexion or extension. D) The thigh and gluteal folds are symmetric.

B. A distinct "clunk" is heard with Barlow and Ortolani maneuvers. Rationale: A distinct "clunk" while performing Barlow and Ortolani maneuvers is caused as the femoral head dislocates or reduces back in to the acetabulum. A higher-pitched "click" may occur with flexion or extension of the hip. This is a benign, adventitious sound that should not be confused with a true "clunk" when assessing for developmental dysplasia of the hip. Abduction to 75 degrees, adduction within 30 degrees, and symmetric thigh and gluteal folds are normal findings. Reference: p. 1616

Hep B vaccine

Birth or 2months 4 months 6months

The nurse is caring for a child with a rapid breathing, headache, and the smell of wintergreen on the skin and clothes. Which additional signs and symptoms would the nurse assess for? Select all that apply. Bleeding Vomiting Confusion Diaphoresis Hyperglycemia Peripheral edema

Bleeding Wintergreen is a salicylate and is often used as a safe alternative to aspirin. The nurse would assess for bleeding and bruising related to the inhibition of prothrombin, decreased platelets levels, and capillary fragility. Correct Vomiting Wintergreen is a salicylate and is often used as a safe alternative to aspirin. Oral poisoning typically manifests nausea and vomiting related to GI irritation. Correct Confusion Wintergreen is a salicylate and is often used as a safe alternative to aspirin. Confusion, seizures, and coma are all related to the CNS effects of salicylate poisoning. Correct Diaphoresis Wintergreen is a salicylate and is often used as a safe alternative to aspirin. Dehydration, sweating, and decreased urine production are typical in salicylate poisoning.

A 1-month-old infant admitted to the emergency department in respiratory distress exhibits a regular pattern of breathing followed by brief periods of apnea, then tachypnea for a short time, eventually returning to a normal respiratory rate. The nurse documents this finding as which of the following? A) Hypoventilation B) Hyperventilation C) Periodic breathing D) Stridor

A group of students are working on a presentation for a local health fair about safety for children. When developing this presentation, the students would address which of the following as the most common cause of pediatric injury? A) Sports B) Firearm use C) Falls D) Automobile accidents

After teaching a group of nursing students about shock in children, the instructor determines that the teaching was successful when the students identify which type of shock as most common? A) Septic B) Cardiogenic C) Hypovolemic D) Distributive

The pediatric nurse is providing education to a new mother regarding ways to decrease the risk of sudden infant death syndrome (SIDS). Which statement by the nurse is appropriate? A) "You should keep the baby with you at all times to assess for apnea." B) "Make sure the baby has a soft blanket and pillow when sleeping." C) "It is recommended that you place your baby on his back for sleep." D) "SIDS has been linked to immunizations. I recommend that you avoid immunizing your baby."

The nurse is caring for a pediatric patient admitted with severe nausea and vomiting for several days. Which finding will help the nurse quickly evaluate peripheral tissue perfusion? Oral temp 102.3 F Flat anterior fontanel Bowel sounds hyperactive Capillary refill greater than 5 seconds

Capillary refill greater than 5 seconds Capillary refill is the best assessment method to quickly assess tissue perfusion.

A nursing instructor is teaching students about normal childhood infectious diseases. Which disease does the teacher tell students is transferred by the varicella-zoster virus?

Chickenpox

The nurse caring for an infant with myelomeningocele before surgical intervention will prioritize care in what way? a) Change position from side to side hourly b) Cover the sac with a saline-moistened dressing c) Keep the mass uncovered and dry d) Prevent cold stress using an Isolette and blankets

Cover the sac with a saline-moistened dressing

The nurse is preparing the plan of care for a child experiencing respiratory distress. Which of the following would be the priority? A) Providing supplemental oxygen B) Monitoring for changes in status C) Assisting ventilation D) Maintaining a patent airway

The nurse is providing supportive care for the parents of an infant who died from sudden infant death syndrome (SIDS). Which action by the nurse is appropriate? A) Advising the parents that an autopsy is not necessary B) Refraining from recommending support groups until after the investigation C) Interviewing the parents to determine the cause of the SIDS incident D) Contacting the family's spiritual leader for support

Which clinical manifestations are likely to develop in a 3-year-old child after initial stabilization for bleach ingestion? Select all that apply. Development of metabolic acidosis Development of esophageal strictures Development of liver necrosis and jaundice Development of hypokalemia and dehydration Development of organ perforation and vascular complications

Development of esophageal strictures As the damaged esophagus begins to heal, the child may have continued difficulty swallowing due to the development of strictures. Development of organ perforation and vascular complications When a child has a severe burn, the damage can lead to eventual perforation of an organ. This can lead to vascular collapse and shock.

The mother of a 3-year-old with a myelomeningocele is thinking about having another baby. The nurse should inform the woman that she should increase her intake of which acid? a) Folic acid above 0.4 mg/day b) Ascorbic acid to 4 mg/day c) Folic acid to 0.4 mg/day d) Ascorbic acid to 0.4 mg/day

Folic acid above 0.4 mg/day

A nurse is preparing a presentation for a health fair focusing on prevention of congenital neuromuscular disorders. What would the nurse emphasize as most important in preventing neural tube defects? a) Ultrasound screening at 16 weeks' gestation b) Folic acid supplementation c) Maternal serum α-fetoprotein levels screening d) Genetic testing for gene identification

Folic acid supplementation

how do rashes spread in measles

Head->trunk->red->brown->very puritic

Vaccines given routinely at 15 months.

Hib & DTaP

The student nurse is developing a care plan for a child who suffered a fractured tibia and will have a cast on his lower leg for approximately 6 weeks. Which nursing diagnosis would be the priority for this client?

Impaired physical mobility related to a cast on the leg Impaired physical mobility would be the priority need for this client. Basic comfort, food, fluid, and other basic needs are considered a higher priority than diversional activities and self-esteem. Pain would be the normally be the highest priority in this list, but this client would have acute inflammation rather than chronic inflammation.

goal of management of shock

Improvement of mental status, cardiovascular status (BP), and urine output

During this part of the assessment for the child with DDH the nurse should: - Ensure the infant is on a flat surface and is relaxed - Note asymmetry of thigh or gluteal folds w/infant in prone position - Document shortening of affected femur observed as limb-length discrepancy. - Older children may exhibit Trendelenburg gait- due to weakness of hip abductors, child's trunk is shifted over the affected hip during ambulation

Inspection and Observation

An infant has been born and diagnosed with a meningocele. Which action will the nurse incorporate into each contact with this infant? a) Inspection of the cystic sac on the child's back for leakage b) Auscultation for bowel sounds c) Listening for a shrill cry d) Careful supine positioning

Inspection of the cystic sac on the child's back for leakage

Which characteristic is true of cerebral palsy? a) It's progressive. b) It's reversible. c) It results in mental retardation. d) It appears at birth or during the first 2 years of life.

It appears at birth or during the first 2 years of life.

Most pediatric arrests are related to what?

airway and breathing

An adolescent girl with scoliosis is refusing to wear the prescribed body brace. Which instruction is best to progress her to the treatment goals?

It is important to wear the brace now to improve your spinal alignment, decreasing your symptoms . It is important to have the adolescent understand the treatment and how the treatment will benefit them currently. Body bracing helps to hold the spine in alignment and prevent further curvature decreasing symptoms. The brace will not correct the problem. Herniation and torticollis are not associated with scoliosis.

most common cause of cardiac arrest in children?

Lack of oxygenation and ventilation

A ___________ free environment should be created for all procedures performed on children with myelomeningocele to prevent allergy.

Latex

Sensitivity to __________ or natural rubber is very common among children with myelomeningocele.

Latex

the difference between adults and children is that for kids what is the least reliable v/s vs the most reliable when having to do with SHOCK

Least reliable would be blood pressure and the most reliable would be heart rate

The most severe form of neural tube defect. This is a type of spina bifida cystica, and may be diagnosed in utero w/ an ultrasound (otherwise it's visually obvious at birth) The child w/ this is at increased risk for meningitis, hypoxia, and hemorrhage. Usually require multiple surgical procedures Usually develop latex allergy

Myelonmeningocele

A 2-year-old child comes to the emergency department with a substantial acetaminophen overdose. Which drug-specific medication should the nurse anticipate administering to this patient? Naloxone N-acetylcysteine Activated charcoal Diluted oil of wintergreen

N-acetylcysteine N-acetylcysteine is an antidote used for significant acetaminophen ingestion.

The nurse is assessing a preadolescent client reporting pain and swelling just below the knee. The client states it hurts worse after running. What treatment would the nurse expect to be prescribed for this client?

NSAIDs, ice, and limiting exercise The child's symptoms suggest Osgood-Schlatter disease, which is a thickening and enlargement of the tibial tuberosity probably from overuse. Treatment includes administration of NSAIDS, ice, and limiting strenuous activity. Ankle and knee strengthening exercises, applications of ice, and use of acetaminophen is not indicated for this disorder.

The nurse is caring for a child who has been struck by a car. The nurse notes a patent airway, labored breathing, and active bleeding from an open leg fracture. Which assessment should the nurse perform next? Neurologic assessment Auscultate bowel sounds Assess the cervical spine Head to toe skin assessment

Neurologic assessment After completing the primary survey, including the airway, breathing, and circulation, the nurse should assess the patient's neurologic status.

The nurse is caring for a patient in hypovolemic shock. The patient has a patent airway, unlabored breathing, and capillary refill less than 4 seconds. Which prescription should the nurse anticipate receiving first from the health care practitioner? Obtain vascular access Administer oral antibiotics Prepare patient for surgery Begin hemodynamic monitoring

Obtain vascular access Once the airway, breathing, and circulation are established, the next priority for the nurse is adequate vascular access.

the emergency department calls to discuss admission of a 4-month-old, former premature 37 week infant, who presents with an unprovoked episode of apnea, hypotonia, and decreased responsiveness. The episode is estimated to have lasted 35 seconds and resolved when the mother blew in the infant's face. The infant has a normal physical exam with a reassuring mental status, respiratory status, and hemodynamic status. Which of the following is recommended for this infant?

Offer resources about cardiopulmonary resuscitation training

A 5-year-old child presents to the emergency department and begins to exhibit neurological side effects after ingesting an unknown poison at home. Which action should the nurse take after assessing that the airway is stable? Gastric lavage Administer naloxone Initiate IV fluid resuscitation Prepare for seizure precautions

Prepare for seizure precautions Patients with neurological or metabolic side effects are prone to seizures and precautions are necessary.

The nurse is providing presurgical care for a newborn with myelomeningocele. Which action is the central nursing priority? a) Maintain infant in prone position b) Maintain infant's body temperature c) Keep lesion free from fecal matter or urine d) Prevent rupture or leaking of cerebrospinal fluid

Prevent rupture or leaking of cerebrospinal fluid

Note sluggish or brisk deep tendon reflexes. Note persistence of primitive reflexes in the older infant or child, such as Moro or tonic neck.

Reflexes

whats an early sign of respiratory distress?

Restlessness abnormal airway noise (wheezing

Which nursing diagnosis will the nurse prepare for the infant who is placed prone to protect the myelomeningocele repair site? a) Risk for impaired skin integrity b) Disorganized infant behavior c) Peripheral neurovascular dysfunction d) Risk for activity intolerance

Risk for impaired skin integrity

what does the elisa vaccine stand for

Test for antibodies to HIV

An infant born to a mother who was HIV positive was tested at birth and found to be negative. The infant is scheduled for follow-up testing. Which test would the nurse expect to be performed? 1. Polymerase chain reaction (PCR) test 2. Enzyme-linked immunosorbent assay (ELISA) 3. Platelet count 4. CD4 counts

The PCR is the preferred test to determine HIV infection in infants over 1 month of age. The ELISA is positive in infants of HIV-infected mothers because of transplacentally received antibodies.

0. A parent of a newborn asked the nurse, When will my baby get the hepatitis B vaccine? The nurse bases a response on the knowledge that the first dose of Comvax should be given to infants born to a hepatitis B-negative mother at: 2 months 4 months 6 months 1 year

The american academy of peds recommends that comvax the only thimerosal free hep B vaccine, should be used for infants born to HBsAg-negative mother beginning at the 2 month well child visit

The nurse is administering a chicken pox vaccination to a 12-month-old girl. Which concern is unique to varicella?

The disease can reactivate years later and cause shingles.

What is the most vulnerable portion of the child's bone and is frequently the site of injury?

The growth plate

The nurse is caring for a child diagnosed with Legg-Calvé-Perthes disease. What is the most important nursing intervention for the nurse to include in working with this child and his caregivers?

The nurse should help the caregivers to understand and help the child to effectively use the corrective devices. Nursing care focuses on helping the child and caregivers to manage the corrective device and on the importance of compliance to promote healing and to avoid long-term disability.

In caring for a child in traction, which intervention is the highest priority for the nurse?

The nurse should monitor for decreased circulation every 4 hours. Any child in traction must be carefully monitored to detect any signs of decreased circulation or neurovascular complications. Cleaning pin sites is appropriate for a child in skeletal traction. Providing age-appropriate activities and monitoring intake and output are important interventions for any ill child but would not be the highest priority interventions for the child in traction.

A child who has no recent history of illness suddenly appears cyanotic and cannot speak after playing with a small toy. You should: A. perform abdominal thrusts. B. visualize the child's airway. C. perform a blind finger sweep. D. give oxygen and transport at once.

A nurse is assessing a child who was recently adopted from a foreign country and has not yet received any immunizations. The child has a high fever, rhinitis, and sore throat. The nurse also notes small, irregular, bright red spots on the buccal membrane. What would the nurse suspect? a) Rubeola b) Variola c) Rubella d) Varicella

A nurse is providing teaching about immunization schedules to the parents of a newborn who is 1 week old. Which of the following pieces of information should the nurse include in the teaching? A. "Initial vaccines should be administered between birth and 2 weeks of age." B. "Your child will need to begin the vaccination series over again if subsequent doses in the series are missed." C. "An allergic reaction to a vaccine is due to the active ingredient in the vaccine." D. "A vaccination shou

What condition begins as an upper respiratory illness and progresses to a persistent cough characterized by an inspiratory whoop? a) Pertussis b) HIV c) Sepsis d) TB

When developing the plan of care for a 10-month-old infant in septic shock, which of the following would the nurse most likely include? a) Administering intravenous dopamine as ordered b) Giving blood if saline provides inadequate response c) Administering intravenous saline as ordered d) Inserting a urinary catheter for monitoring urinary output

What information should be included in the teaching plan for a child with varicella? a) Remind the child not to scratch the lesions. b) Utilize salt solutions to assist in healing oral lesions. c) Place the child in a warm bath for skin discomfort. d) Administer aspirin for fever.

a d is wrong bc you dont want to give that person reyes syndrome

What would you expect to observe about the rash associated with chickenpox (varicella)? a) Various stages of lesions present at the same time b) Dark red color (red hen marks) c) Noticeable crusts but no pruritus d) Dark red, macular, very pruritic lesions

a d: is for measles

A 13-year-old boy has had a near-drowning experience. The nurse notices he has labored breathing and a cough. Which of the following would be the priority? Administer 100% oxygen by mask. Have the child sit up straight in a chair. Check his capillary refill time. Provide sedation as ordered.

administer 100% O2

The nurse is discussing food allergies with parents of a young child, explaining that a very effective way to determine which foods a child may be allergic to is to implement:

an elimination diet.

Death caused by shaken baby syndrome is usually the result of:

bleeding in the brain

The nurse is caring for a 2-year-old who has been rushed to the clinic immediately after swallowing an unknown number of acetaminophen tablets. Which of the following is the priority intervention? a) Administer N-acetylcysteine. b) Start IV fluid replacement. c) Perform a gastric lavage. d) Initiate chelation therapy.

c) Perform a gastric lavage. If the child ingested the pills within the last 60 minutes, a gastric lavage and administration of activated charcoal would be the preferred treatment. If the acetaminophen is in the bloodstream, N-acetylcysteine may be administered. Chelation therapy is meant for metal poisoning. IV fluid replacement is used to treat hypovolemic shock.

A young client in the clinic has a rash, cough, and fever that the mother says spiked on day 5 of the rash. The client also had conjunctivitis. What would the nurse expect the physician to tell the family that the child has? a) Rubella b) Chickenpox c) Scarlet fever d) Measles

d Measles are diagnosed based on the symptoms. Measles is a viral illness. The prodromal period includes 2 to 4 days of rising fevers, cough, coryza, and conjunctivitis. Following this, Koplik spots develop followed by an erythematous maculopapular rash. The rash starts on the head and spreads downward and outward. Rubella, also viral, begins with the rash starting first and the child will have a low-grade fever

Intercranial pressure signs

decrease HR Increase BP Pupils react to light

what should you not do if someone has an obsructed airway

do not do a blind sweep

A nurse correctly identifies which data as needing to be obtained from an injured child in relation to his or her respiratory status? Select all that apply. Quality of respirations Rate of respirations Pulse rate Skin color Sound of obstruction

everything but heart rate

How do rashes spread in rubella

face--> trunk--> extremity

What are the the associated symptoms of lupus?

fatigue fever weight loss lymphadenopathy hepatosplenomegaly

The closer the fracture is to the growth plate (epiphysis), the more quickly the fracture _______________.

heals

The nurse is caring for a school-age child recently diagnosed with an allergy to peanuts. Which nursing action is a priority? Advise parents the child may benefit from skin testing. Include the child when discussing foods that contain peanuts. Offer the parents information about a community support group. Remind parents to report the allergy to the child's school teacher.

include the child

Goal of circulation

minimal interruptions of chest compressions aka minimal air thru lungs

What is the most common cutaneous manifestation in SLE?

photosensitivity malar or "butterfly" rash

The most accurate screening test for the presence of HIV antigen in young children is: a. polymerase chain reaction (PCR). b. enzyme-linked immunosorbent assay (ELISA). c. Western blot. d. CD4 count.

polymerase chain reaction (PCR).

The type of traction in which a pin, wire, tongs, or other device is surgically inserted through a bone is:

skeletal traction. Skeletal traction exerts pull directly on skeletal structures by means of a pin, wire, tongs, or other device surgically inserted through a bone. Skin traction applies pull on tape, rubber, or a plastic material attached to the skin, which indirectly exerts pull on the musculoskeletal system. Examples of skin traction are Bryant traction, Buck extension traction, and Russell traction.

A nurse is performing a newborn assessment and notices a small dimple on the sacral area. The infant has a normal neurological assessment and moves all extremities well. What does the nurse suspect that the dimple indicates?

spina bifida occulta

how do the rashes spread in varicella

starts at the center trunk--> face--> extremities

A nurse is giving a talk to high school students about preventing the spread of human immunodeficiency virus (HIV). What does the nurse identify as ways in which HIV is spread? Select all that apply. Exposure to blood and body fluids through sexual contact Sharing contaminated needles Sharing the same bathroom Transfusion of contaminated blood Perinatally from mother to fetus Through breastfeeding

all except sharing the same bathroom

A school-aged child, who is allergic to bee stings, states, "I think I was stung by a bee outside." Which intervention by the school nurse is most appropriate? a. Assess the client for signs of anaphylactic shock Administer epinephrine Determine if the client was stung Apply an ice compress to the site

assess the client for signs of

A 3-week-old infant is diagnosed with pertussis. Which antimicrobial agent would the nurse expect the physician to prescribe? a) Clarithromycin b) Azithromycin c) Erythromycin d) Trimethoprim-sulfamethoxazole

The current immunization for tetanus and diphtheria toxoids and pertussis, Tdap, is administered to people in which age range? A. Younger than 6 years of age B. 11 years of age and older C. Any age range D. In the first 2 years of life

A nurse is preparing a plan of care for an infant who has undergone surgery to repair a myelomeningocele. The nurse would include placing the infant in which positions postoperatively? Select all that apply. a) Supine b) Prone c) Left side lying d) Right side lying e) Semi-Fowler

• Prone • Left side lying • Right side lying

The nurse reviews the home care instructions with a parent of a 3-year-old with pertussis. Which statement by the parent indicates a need for further teaching? 1."I know that my child will make a loud whooping sound." 2."I understand this whooping cough is viral and I have to let it run its course." 3."I understand that I need to watch for respiratory distress signs with pertussis." 4."I can reduce the environmental factors that can trigger coughing, like dust and smoke."

2."I understand this whooping cough is viral and I have to let it run its course." Pertussis is caused by the bacteria Bordetella pertussis and treatment requires antimicrobial therapy. Symptoms of pertussis consist of a respiratory infection followed by increased severity of cough with a loud whooping on inspiration. The child may experience respiratory distress, and the parents should be instructed on reducing environmental factors that cause coughing spasms, such as dust, smoke, and sudden changes in temperature.

An adolescent female client is diagnosed with systemic lupus erythematosus (SLE). Which should the nurse include in the teaching session regarding an activity that should be avoided? 1. Receiving a manicure and a pedicure 2. Washing the hair with shampoo daily 3. Using a tanning bed 4. Attending late night parties and dances

3 Individuals with SLE have photosensitivity, and tanning beds can lead to exacerbations as well as skin damage from sun burns.

A mother brings her 4-month-old infant to the well-baby clinic for immunizations. Which immunizations should be administered to this infant? 1.Diphtheria, tetanus, acellular pertussis (DTaP), Measles, mumps, rubella (MMR), inactivated poliovirus vaccine (IPV) 2.Varicella and hepatitis B vaccines 3.MMR, Hib, DTaP 4.DTaP, Hib, IPV, pneumococcal vaccine (PCV)

4.DTaP, Hib, IPV, pneumococcal vaccine (PCV) DTaP, Hib, IPV, and PCV are administered at 4 months of age. DTaP is administered at 2 months, 4 months, 6 months, between 12 and 18 months, and between 4 and 6 years of age. Hib is administered at 2 months, 4 months, 6 months, and between 12 and 15 months of age. IPV is administered at 2 months, 4 months, 6 months, and between 4 and 6 years of age. The first dose of MMR is administered between 12 and 15 months of age; the second dose is administered at 4 to 6 years of age (if the second dose was not given by 4 to 6 years of age, it should be given at the next visit). The first dose of hepatitis B vaccine is administered between birth and 2 months, the second dose is administered between 1 and 4 months, and the third dose is administered between 6 and 18 months of age. Varicella zoster vaccine is administered between 12 and 18 months of age. PCV is administered at 2, 4, and 6 months of age and between 12 and 15 months of age

What is included in inspection/observation of child? SATA A) Motor function B) Reflexes C) Speech D) Sensory Function

A) Motor function B) Reflexes D) Sensory Function

A nurse is preparing to educate a group of parents on sudden infant death syndrome (SIDS). Which variables should the nurse highlight as contributing to increased risk of SIDS? Select all that apply. A) Prone sleeping B) Side sleeping C) Loose bedding D) Bed sharing E) Supine sleeping

A, B, C, D

A group of students are reviewing information about the skeletal development in children. The students demonstrate understanding of the information when they identify that ossification is complete by what age?

Adolescence Ossification and conversion of cartilage to bone continue throughout childhood and are complete at adolescence.

The nurse assists with the application of a full-body plaster cast to a child. The child immediately becomes diaphoretic and reports feeling hot. Which nursing intervention would be indicated?

Advise the child that this is to be expected. Plaster becomes hot as it sets. This effect is reduced with newer plastic casts. This is a normal expectation about which to educate the child before the application of the cast. If discomfort continues, notify the provider. Infection would not present in this way with a cast application. Never moisten a cast.

A 6-year-old child comes to the emergency department and presents with respiratory distress from gasoline skin exposure. Which action should the nurse take if the child becomes unconscious? Administer naloxone Administer activated charcoal Assess and support CNS function Assess and support cardiorespiratory function

Assess and support cardiorespiratory function If the child loses consciousness, assessment of the cardiorespiratory functions is necessary. If deficits are noted, provide proper support.

A nurse is caring for a 14-year-old girl following myelography. What is the priority nursing action? A) Monitoring for a decrease in spasticity B) Observing for signs of meningeal irritation C) Assessing motor function D) Observing for mental confusion or hallucinations

B) Observing for signs of meningeal irritation Rationale: Following myelography, the nurse should carefully observe for signs of meningeal irritation because of what is involved in this procedure. Monitoring for a decrease in muscle spasticity, assessing motor function, and observing for mental confusion or hallucinations is appropriate following an intrathecal test dose of baclofen. Reference: p. 1594

A nurse is applying a cast to a 12-year-old boy with a simple fracture of the radius in the arm. What is most important for the nurse to do when she has finished applying the cast?

Assess the fingers for warmth, pain, and function Assess fingers or toes carefully for warmth, pain, and function after application of a cast to be certain a compartment syndrome is not developing. Before a cast is applied, not after, a tube of stockinette is stretched over the area, and soft cotton padding is placed over bony prominences. A "window" may be placed in a cast for an open fracture or if an infection is suspected—not to prevent an infection—so that the area can be observed; however, a window is not indicated in this case. The x-ray should be performed before casting, to diagnose the fracture, not afterward.

During this stage of assessment the nurse should listen to the child's lungs; adventitious sounds are often present when respiratory muscle function is impaired.

Auscultation

A nurse is performing a physical examination of a child with a suspected fracture. Which assessment technique would the nurse assume would not be used?

Auscultation The physical examination specific to fractures includes inspection, observation, and palpation. The nurse may assume that auscultation is not used; however, auscultation of the child's lungs may reveal adventitious sounds that are often present when respiratory muscle function is impaired.

The nurse is providing teaching about food substitutions when cooking for the child with an allergy to eggs. Which response indicates a need for further teaching? A. "I must not feed my child eggs in any form." B. "I can use the egg white when baking, but not the yolk." C. "1 tsp yeast and 1/4 cups warm water is a substitute in baked goods." D. "1.5 Tbsp each water and oil plus 1 tsp baking powder equals one egg in a recipe."

B. "I can use the egg white when baking, but not the yolk."

As part of their orientation to their pediatric clinical rotation, an instructor is teaching a group of students how to perform cardiopulmonary resuscitation (CPR) on a child. Two students return demonstrate the skill using an infant manikin. Which of the following indicates the proper technique? A) Compressing 30 times for every 2 breaths B) Placing the heel of the hand on the midsternum C) Giving 2 breaths followed by 15 compressions D) Using two hands to perform chest compressions

Sudden infant death syndrome is diagnosed A) when an autopsy reveals a brainstem defect. B) when an infant dies after being shaken violently. C) when an autopsy fails to find a cause of death. D) when an infant is found dead in their crib.

When caring for an 8-year-old boy injured in an automobile accident, the nurse demonstrates understanding of the principles of Pediatric Advanced Life Support (PALS) by which action? A) Assisting ventilation with a bag-valve-mask (BVM) device B) Treating ventricular fibrillation using a defibrillator C) Managing compensated shock to prevent decompensated shock D) Treating supraventricular tachycardia using cardioversion

The nurse is instructing new parents on ways to decrease the risk of sudden infant death syndrome (SIDS) with their newborn son. What should be included in these instructions? Select all that apply. A) There is nothing that can be done, so requirements for toys and bedding are of no consequence. B) Instruct that it is more common in babies from ages 6 months to 18 months. C) Avoid placing the baby in the prone or side-lying position for sleep. D) Remind the parents that the syndrome is more comm

C, E

A child is born with a talipes disorder. The child later receives a cast on the affected leg to correct the problem. Which measure should the nurse mention to the mother to ensure good circulation in the affected leg?

Check the infant's toes for coldness or blueness. Review with parents how to check the infant's toes for coldness or blueness and how to blanch a toenail bed and watch it turn pink to assess for good circulation. The other answers are other interventions pertaining to caring for a child with a talipes disorder but are not associated specifically with ensuring good circulation.

The pediatric nurse knows that there are a number of anatomic and physiologic differences between children and adults. Which statement about the immune systems of infants and young children is true?

Children have an immature immune response.

The nurse is working with a group of caregivers of school-aged children discussing fractures. The nurse explains that if the fragments of fractured bone are separated, the fracture is said to be:

Complete If the fragments of fractured bone are separated, the fracture is said to be complete. If fragments remain partially joined, the fracture is termed incomplete. Greenstick fractures are one kind of incomplete fracture, caused by incomplete ossification, common in children. Spiral fractures twist around the bone.

A nurse is caring for an infant with a meningocele. Which finding alerts the nurse that the lesion is increasing in size? a) Increasing ICP b) Leaking cerebrospinal fluid c) Increasing head circumference d) Constipation and bladder dysfunction

Constipation and bladder dysfunction

The nurse is developing a teaching plan for the parents of a child with a myelomeningocele who will require clean intermittent catheterization. What information would the nurse include? A) Applying petroleum jelly to lubricate the catheter B) Cleaning the reusable catheter with peroxide after each use C) Storing the reusable cleaned catheter in a brown paper bag D) Soaking the catheter in a vinegar and water solution to sterilize

D) Soaking the catheter in a vinegar and water solution to sterilize When teaching parents how to perform clean intermittent catheterization, the nurse would instruct the parents to apply a water-based lubricant to the catheter, clean the reusable catheter with soap and water after each use, store the reusable clean catheter in a zip-top bag or other clean storage container, and soak the catheter in a 1:1 vinegar and water solution for about 30 minutes weekly, rinsing well before the next use or placing the catheter in boiling water for 10 minutes.

The nurse is planning care for a new mother who smoked during the pregnancy and whose sister lost a child to sudden infant death syndrome (SIDS). Which interventions are appropriate for the nurse to include in the plan of care for the new mother and baby? Select all that apply. A) Information on bottle-feeding the infant B) Reasons why the child should sleep with others C) Ages at which the child should receive immunizations D) Using bedding that is firm E) Smoking cessation information

D, E

Significant swelling may occur initially after immobilization with a splint. ______________ casting for a few days provides time for some of the swelling to subside, allowing for successful casting a few days after the injury.

Delaying

The nurse is caring for a child who is obtunded after being struck in the head by a baseball during a game. Which artificial airway should be used to maintain airway patency? Bag, valve, mask Oropharyngeal airway Endotracheal intubation Nasopharyngeal airway

Endotracheal intubation Endotracheal intubation is a single type of artificial airway that would suffice for an unconscious child or a child who has altered mental status.

The nurse is assisting with skin testing on a pediatric client with allergies. What will the nurse do first?

Ensure the child has not taken diphenhydramine in the past week.

The nurse is receiving a pediatric patient in shock who was just involved in an accident and has lost a large amount of blood. The patient should be assessed for which type of shock first? Septic shock Distributive shock Cardiogenic shock Hypovolemic shock

Hypovolemic shock This patient should be first assessed for hypovolemic shock because this is characterized by an overall decrease in circulating blood or fluid volume.

A nurse is providing teaching about immunizations to the parents of a severely immunocompromised child who has human immunodeficiency virus (HIV). Which of the following statements should the nurse include in the teaching? A. "Your child's immunizations today will be half-doses." B. "The pneumococcal and influenza vaccines are recommended for your child." C. "Immunizations will be delayed until your child tests HIV-negative." D. "Your child will need to restart the immunization schedule on

Immunization against common childhood illnesses including influenza and pneumococcal disease is recommended

The nurse will teach parents of children with myelomeningocele to maintain an environment free of what element?

Latex A latex-free environment is important because research shows that up to 73% of children with repeated surgeries for spina bifida are sensitive to latex. Those with known sensitivity must be managed in a latex-free environment in the health care setting and in the home, in the school, and beyond. Children at risk for latex sensitivity should wear medical alert identification. The other options may present risks to individual children but are not a threat to those with spina bifida as a group.

The nurse is caring for a child who has a depressed immune system due to chemotherapy treatments. The child is due for scheduled immunizations according to CDC recommendations. The nurse must ensure that the child does not receive which type of immunization?

Live vaccines

During this part of the assessment for the child with DDH the nurse should: - Note limited hip abduction while performing passive range of motion. - Abduction should normally= 75 degrees; adduction= 30 degrees w/child's pelvis stabilized - Perform Barlow and Ortolani tests, feeling for, or noting a "clunk" as the femoral head dislocates (positive Barlow) or reduces (positive Ortolani) back into the acetabulum. - Force is NOT necessary when performing the Barlow and Ortolani maneuveurs.

Palpation

A nurse is caring for a 10-year-old who is in skeletal traction following injuries sustained in a car accident. Which statement accurately describes a recommended nursing measure for this type of traction?

Perform pin-site care on a daily or weekly basis after the first 48 to 72 hours. At sites with mechanically stable bone-pin interfaces, pin-site care should be done on a daily or weekly basis (after the first 48 to 72 hours). The nurse should never remove or add traction weights without specific physician orders, or allow weights to touch the floor or drag on the bed parts; weights should hang free. A chlorhexidine 2 mg/mL solution may be the most effective cleansing solution for pin care.

What is the most common mode of transmission of human immunodeficiency virus (HIV) in the pediatric population? Perinatal transmission Sexual abuse Blood transfusions Poor handwashing

Perinatal transmission accounts for highest %. Infected women can transmit the virus to the babies

What is more accurate in detecting HIV infection in infants and toddlers?

Polymerase chain reaction (PCR) test. Positive in infected infants older than 1 month of age

A positive outcome for a child with multiple traumas depends mainly on which two factors? Rescue breathing and cardiopulmonary resuscitation (CPR) Family support and age of child Rapid assessment and intervention Administering antibiotics and hemodynamic monitoring

Rapid assessment and intervention A positive outcome for a child who has sustained multiple trauma depends on rapid assessment and intervention, which begin at the scene of the accident and continue through the trauma center emergency department, the critical care and acute care units, and the rehabilitation phase.

What will be the nurse's next action after noting dimpling and a tuft of hair located in the lumbosacral area of the preschool child during examination? a) Inspect for precocious hair growth in the genital and underarm areas b) Record and refer the finding for follow-up to the pediatrician c) Move on to other assessments without calling attention to the difference d) Snip the tuft of hair off close to the skin for hygienic reasons

Record and refer the finding for follow-up to the pediatrician

The capacity for ________________ (the process of breaking down and forming new bone) is increased in children as compared with adults. This means the straightening of the bone over time occurs more easily in children.

Remodeling

A 3-year-old boy has been brought to the doctor's office with symptoms of anorexia and abdominal pain. A blood test reveals a lead level of 20 μg/100 mL. The child is prescribed an oral chelating agent. On discharge, the nurse should counsel the parents regarding which of the following? a) Placing house plants out of reach of children b) Putting child safety locks on kitchen cabinets c) Removal or covering of flaking paint on the walls of the home d) Putting medicine away where children cannot

Removal or covering of flaking paint on the walls of the home The usual sources of ingested lead are paint chips or paint dust, home-glazed pottery, or fumes from burning or swallowed batteries.

The nurse is instructing a group of women of childbearing age about human immunodeficiency virus (HIV) during pregnancy. What would be a priority recommendation in this setting?

Screening for HIV

The nurse is discussing types of treatment used when working with children who have orthopedic disorders. Which form of treatment covers the lower part of the body, usually from the waist down, and either one or both legs while leaving the feet open?

Spica cast The hip spica cast covers the lower part of the body, usually from the waist down, and either one or both legs while leaving the feet open. The cast maintains the legs in a frog-like position. Usually, there is a bar placed between the legs to help support the cast.

Which type of spinal neural tube defect does the nurse recognize as common and usually benign? a) Meningocele b) Spina bifida c) Spina bifida occulta d) Myelomeningocele

Spina bifida occulta

The priority nursing diagnosis for a hospitalized infant who is HIV-positive would be: Risk for injury Altered nutrition Impaired skin integrity Risk for infection

The infant who is HIV+ has impaired immunologic functioning and is at high risk for infection

A young child who has been reporting fatigue and running a low-grade fever for 4 days begins to have pustules over the entire body. The physician diagnoses chickenpox. The period before the pustules developed is referred to as the: a) prodromal period b) incubation period c) convalescent period d) active infection

Parents usually ask when their child can return to school after having chickenpox. The correct answer would be: a) as soon as all lesions are crusted. b) as soon as the temperature is normal. c) not until all lesions have completely faded. d) 10 days after the initial lesions appear.

A nurse at a clinic is preparing to administer immunizations to a 5-year-old child. Which of the following immunizations should the nurse plan to give? A. Diphtheria, tetanus, and pertussis (DTaP) B. Pneumococcal (PCV) C. Haemophilus influenzae type B (Hib) D. Hepatitis B (Hep B)

a. Dtap btw 4 and 6. Titres drop due to dec antibodies

Which collaborative intervention will the nurse provide when caring for an infant diagnosed with pertussis? Select all that apply. Have suction available in the room. .. Encourage small, frequent feedings... Administer erythromycin for 10 days. .. Utilize droplet and standard precautions. .. Restrict visitors for 48 hours of hospitalization

abcd

The nurse is reinforcing teaching with the caregivers of a child being discharged from the urgent care setting following a mild head injury that occurred in an in-line skating accident. What should the caregivers be instructed to do? Select all that apply. a) Check the pupil reaction to light every 15 minutes for two hours. b) Observe and report any vomiting that occurs within six hours. c) Administer acetaminophen for headache. d) Observe for and report to provider any double or blurred vision

b) Observe and report any vomiting that occurs within six hours. d) Observe for and report to provider any double or blurred vision. e) Wake the child every one to two hours to check level of consciousness. The caregiver should observe the child for at least six hours for vomiting or a change in the child's level of consciousness. If the child falls asleep, he or she should be awakened every one to two hours to determine that the level of consciousness has not changed. No analgesics or sedatives should be administered during this period of observation. The child's pupils are checked for reaction to light every four hours for 48 hours.

The nurse is examining a 10-month-old girl who has fallen from the back porch. Which assessment will directly follow evaluation of the "ABCs?" a) Palpating the abdomen for soreness b) Palpating the anterior fontanel c) Auscultating for bowel sounds d) Observing skin color and perfusion

b) Palpating the anterior fontanel Once the ABCs have been evaluated, the nurse will move on to "D" and assess for disability by palpating the anterior fontanel for signs of increased intracranial pressure. Observing skin color and perfusion is part of evaluating circulation. Palpating the abdomen for soreness and auscultating for bowel sounds would be part of the full-body examination that follows assessing for disability.

Which of these age groups has the highest actual rate of death from drowning? a) Infants b) Toddlers c) School-age children d) Preschool children

b) Toddlers Toddlers and older adolescents have the highest actual rate of death from drowning.

The nurse teaching safety to teens knows that which of these is the leading cause of death among adolescents? a) Diseases b) Unintentional injuries, MVA, blunt trauma c) Drowning d) Poisoning

b) Unintentional injuries Unintentional injuries are the leading causes of death in adolescents (U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, 2008). Injuries kill more adolescents than all diseases combined, with 46% of injury-related deaths due to motor vehicle accidents (U.S. Department of Health and Human Services, 2007). Unintentional injury accounts for about 48% of adolescent injury deaths, violence and homicide for 15.2%, and suicide for 11.8% of adolescent injury deaths (U.S. Department of Health and Human Services, 2007). Males are more likely than females to die of any type of injury.

A child is having an anaphylactic response. Place in order the interventions a nurse should perform beginning with the initial (highest priority) intervention and ending with the lowest priority intervention. Use the following format for your answers: a. Administer steroids and antihistamines as prescribed. b. Ensure an adequate airway. c. Administer epinephrine as prescribed. d. Administer oxygen. e. Determine the cause of the reaction.

b. Ensure an adequate airway. c. Administer epinephrine as prescribed D Administer oxygen A Administer steroids and antihistamines as prescribed. E Determine the cause of the reaction.

bde

A 6-month-old boy is brought to the doctor's office with a high fever. The physician diagnoses the child as having a viral infection of some kind and recommends acetaminophen to reduce the fever. After 3 days, the mother returns with the child. The fever is gone, but a rash of discrete, rose-pink macules approximately 2 to 3 mm and flat with the skin surface appears. Which condition should the nurse suspect? a) Chickenpox (varicella) b) Rubella (German measles) c) Roseola d) Measles (rubeola)

The nurse is educating parents of a child admitted to the hospital with rubella (German measles). Which statement by the parents indicates the further education is needed? a. "Our child is contagious for 1 week after the rash appeared." b."Acetaminophen or ibuprofen can be given to help with pain." c. " Antibiotics are needed to help our child recover from rubella." d. "Family members should wear a mask when coming to visit us."

c: antivirals are needed not antibiotics

A 9 month old is admitted to the ED with bilateral rib fractures, seizures, and difficulty staying awake. Further testing shows the infant has a subdural hematoma and retinal hemorrhage. What is a possible diagnosis? A) Amniotic Band Syndrome B) Klinefelter's Syndrome C. SIDS (Sudden Infant Death Syndrome) D. shaken baby syndrome

A nurse is caring for a stable toddler diagnosed with accidental poisoning due to the ingestion of cleaning solution. What must be included in teaching parents about how to protect a toddler from accidental poisoning? a) Closely monitor the toddler's activity. b) Label poisonous solutions. c) Do not leave the toddler alone. d) Keep cleaning solutions locked up.

d) Keep cleaning solutions locked up. The parents should keep cleaning solutions locked up to protect the toddler from accidental poisoning. Accidental poisonings usually occur among toddlers and commonly involve substances located in bathrooms or kitchens. Labeling poisonous substances may not help as toddlers are unable to read. Not leaving the child alone and closely monitoring the child are important, but not feasible all the time.

Young children leading cause of death

drowning, MVA, Blunt trauma

An allergy to which substance is a contraindication to the administration of an immunizing drug? A. Soy B. Egg C. Corn D. Wheat

egg

The nurse is assessing a child who is experiencing renal complications as a result of lupus. Which finding is of greatest concern?

elevated blood pressure

A nurse is providing education to pregnant women diagnosed with HIV. Which statement indicates the need for further teaching? Pregnancy will accelerate the progression of the disease. It is not safe to breastfeed my baby, so I will use formula. Antiretroviral treatment is effective in reducing maternal-fetal transmission. My health care provider may want me to have a cesarean birth.

pregnancy will accelerate the progression of the disease

The nurse is providing preoperative care for a newborn with myelomeningocele. Which action is the central nursing priority?

prevent rupture or leaking of cerebrospinal fluid worrying about prone position isnt first priority

Infants leading cause of death

suffocation

The nurse is preparing to administer acetaminophen to a 4-year-old girl to provide comfort to the child. Which precaution is specific to antipyretics? a) Check for medicine allergies b) Take entire course of medication c) Warn of possible drowsiness d) Ensure proper dose and interval

The nurse is caring for a 16-year-old child with a diagnosis of acquired immunodeficiency syndrome (AIDS). What treatment goal has the highest priority for this child? a) Preventing spread of infection b) Maintaining skin integrity c) Improving nutrition d) Promoting comfort

HPV vaccine

2 shots series under 15

A nurse is preparing to educate a group of parents on sudden infant death syndrome (SIDS). Which intervention is appropriate to decrease an infant's risk for SIDS? A) Using firm bedding B) Ensuring the room temperature is at least 80°F at all times C) Recommending bed sharing D) Placing the infant in a prone position for sleeping

Which cutaneous manifestation of systemic lupus erythematosus (SLE) is shown in the image?

Malar rash

The nurse is placing a newborn baby in the nursery crib with the baby's back down. The mother tells the nurse that she doubts the baby will be able to sleep that way, as all the family members sleep on their stomachs. Which action by the nurse is appropriate? A) Instruct the mother that placing the baby on the back will reduce the risk of sudden infant death syndrome (SIDS) and it will not interfere with sleep. B) Place the baby on the stomach. C) Suggest the mother place the baby on the stomach

Hep A vaccine schedule

2 doses 12-24 months at least 6 months apart

The nurse is taking the history of a 4-year-old boy. His mother mentions that he seems weaker and unable to keep up with his 6-year-old sister on the playground. Which question should the nurse ask to elicit the most helpful information? a) "Has he achieved his developmental milestones on time?" b) "Has his pace of achieving milestones diminished?" c) "Do you think he is simply fatigued?" d) "Would you please describe the weakness you are seeing in your son?"

"Would you please describe the weakness you are seeing in your son?"

Laboratory testing for (SLE)

- CBC (decreased Hgb, Hct) - Platelet count (decreased) - WBC (decreased) - Complement levels (C3 and C4 decreased) - ANA titer (nonspecific, but usually positive)

DTaP vaccine Diphtheria,tetnas, acellular pertussis

2, 4, 6 months

An 18-month-old was brought to the emergency department by her mother, who states, "I think she broke her arm." The child is sent for a radiograph to confirm the fracture. Additional assessment of the child leads the nurse to suspect possible child abuse. Which type of fracture would the radiograph most likely reveal? A) Plastic deformity B) Buckle fracture C) Spiral fracture D) Greenstick fracture

C. Spiral fracture Rationale: A spiral fracture is very rare in children. A spiral femoral or humeral fracture, particularly in a child younger than 2 years of age, should always be thoroughly investigated to rule out the possibility of child abuse. Plastic, buckle, and greenstick fractures are common in children and do not usually suggest child abuse. Reference: p. 1640

Which type of poisoning might the nurse expect for a 6-year-old who has presented with a cherry-red mucosa and a history of altered mental status after playing in the garage with the car running? Lead Corrosives Hydrocarbons Carbon monoxide

Carbon monoxide Carbon monoxide (CO) binds tightly to hemoglobin, preventing the binding of oxygen. The CO makes the hemoglobin appear bright red, causing the patient to look rosy-cheeked and to have cherry-red lips.

Fracture of the femur typically occurs when a small child is lifted by one hand, as happens when a parent pulls on one arm to lift the child over a curb or up a step.

False If a small child is lifted by one hand, as happens when a parent pulls on one arm to lift the child over a curb or up a step, the head of the radius may escape the ligament surrounding it and become dislocated (nursemaid's elbow). Fracture of the femur is rare and is typically caused by an automobile accident, a fall from a considerable height, or child maltreatment.

The nurse is teaching a health and wellness course to young women of childbearing age. Which vitamin will the nurse encourage all to take daily? a) Folic acid b) Niacin c) Ascorbic acid d) Calcium

Folic acid

During palpation, a ________________ infant will feel as though he/she is slipping through the examiner's hands.

Hypotonic

What is the primary nursing concern for a hospitalized child with HIV infection?

Maintaining growth and development

Which finding will the nurse expect to see in a 5-year-old child whom the mother suspects to have ingested the acetaminophen 3 hours ago? Jaundice Malaise, pallor, weakness Right upper quadrant (RUQ) pain Recovery from physical symptoms

Malaise, pallor, weakness During the first 24 hours, the nurse would expect to see malaise, nausea, vomiting, sweating, pallor, and weakness.

A 2-year-old boy is in respiratory distress. Which nursing assessment finding would suggest the child aspirated a foreign body? a) Hearing dullness when percussing the lungs b) Noting absent breath sounds in one lung c) Hearing a hyperresonant sound on percussion d) Auscultating a low-pitched, grating breath sound

Noting absent breath sounds in one lung

In order to terminate ocular exposure, which interventions should the nurse provide to a patient who has experienced exposure to a powdered poison? Select all that apply. Administer a chelating agent Remove contaminated clothing Irrigate the eyes with warm water or saline Induce vomiting to reduce absorbed poison levels Eliminate powder from skin and clothing; wash skin

Remove contaminated clothing Remove any contaminated clothes; residual powder could endanger the child and health care workers. Irrigate the eyes with warm water or saline Irrigation of the eyes with water or normal saline is crucial for terminating ocular exposure of any poison. Eliminate powder from skin and clothing; wash skin Brush off chemical powders from the skin, and wash the skin. Residual powdered poison is dangerous for both the child and health care workers.

Alterations in what function accompany many neuromuscular disorders? -Assess similarly to adults- light touch, pain, vibration, heat, cold, all should be distinguishable by a child. -Usually child should withdrawal from the stimulus.

Sensory function

A 5-year-old girl, diagnosed with myelomeningocele, is admitted to the hospital for a corrective surgical procedure. Choose four questions below that the nurse shouls ask when obtaining the health history that would assist in planning the child's care? 1. What is the child's current mobility status? 2. Is there a family hx of myelomeningocele? 3. What is the child's genitorurinary and bowel function and regimen? 4. Does this child have a hx of hydrocephalus with presence of shunt? 5. Does she h

What is the child's current mobility status? What is the child's genitorurinary and bowel function and regimen? Does this child have a hx of hydrocephalus with presence of shunt? Does she have kown latex sensitivity? (These questions will help develop a plan of care for the girl)

The nurse observes a red rash that spreads across the childs cheeks and nose. This assessment finding is characteristic of which of the following conditions? a. Systemic lupus erythematosus (SLE) b. Rheumatic fever c. Kawasaki disease d. Anaphylactic reaction

A 9-year-old boy nearly drowned when he fell through the ice while skating on a pond. The child is exhibiting bradycardia. Which of the following would the nurse expect to implement to resolve the child's bradycardia? a) Providing 100% oxygen via face mask b) Administering epinephrine as ordered c) Giving intravenous isotonic fluids d) Using a convective air warming blanket

d only bc he fell thru ice and maybe all he needs is to not be hypothermic anymore

The charge nurse is observing a student nurse perform skeletal traction pin care. What action by the student nurse would indicate a need for intervention by the charge nurse?

unhooking a weight while providing pin care Weights should never be moved or unhooked during skeletal traction. Pin care is a sterile procedure. Pins are cleaned with half-strength hydrogen peroxide and then typically covered with sterile cotton gauze.

How to assess for neurologic assessment

use a glasgow coma sale check eyes (pupils) LOC awarness INTREST IN ENVIORNMENT HEAD

if a child has suffered head or neck trauma and cervical spine instabilty is a concern, what method do you use to open the airway

use the jaw-thrust maneuver by placing three fingers under the childs lower jaw and lifting the jaw upward and outward

When assessing the risk of a newborn for sudden infant death syndrome (SIDS), which are risk factors that the nurse should consider? Select all that apply. A) Race B) Gender C) Father's age D) Age E) Eye color

A, B, D

whats the first sign of shock and whats one of the last signs of shock

tachycardia late: hypotension

A nurse is teaching the parents of a child who has been diagnosed with spina bifida. Which statement by the nurse would be the most accurate description of spina bifida? a) "It's a complex neurologic disability that involves a collaborative health team effort for the entire first year of life." b) "It's a simple neurologic defect that's completely corrected surgically within 1 to 2 days after birth." c) "It has little influence on the intellectual and perceptual abilities of the child." d)

"Its presence indicates that many areas of the central nervous system (CNS) may not develop or function adequately."

The caregiver of a child who has had a cast applied to the leg observes the nurse putting adhesive tape strips around the edge of the cast. The caregiver asks the nurse why she is doing this. The best response by the nurse would be:

"These make a smooth edge on the cast so the skin is better protected." If the cast has no protective edge, it should be petaled with adhesive tape strips. These help keep the skin protected from the rough edge of the cast. If the cast is near the genital area, plastic should be taped around the edge to prevent wetting and soiling of the cast; petaling the cast does not provide protection to keep the cast dry.

The nurse is triaging patients after a mass casualty. Place the patients in the order in which they should be seen. Select all that apply. 9 year old with 74 mm Hg systolic BP 5 year old with 76 mm Hg systolic BP 8 year old with 84 mm Hg systolic BP 10 year old with 90 mm Hg systolic BP

9 year old with 74 mm Hg systolic BP Children older than 24 months: 70 mm Hg plus the number that is double the child's age in years. (9-year-old child: 70 + 18 = 88 mm Hg) Correct 5 year old with 76 mm Hg systolic BP Children older than 24 months: 70 mm Hg plus the number that is double the child's age in years. (5-year-old child: 70 + 10 = 80 mm Hg) Correct 8 year old with 84 mm Hg systolic BP Children older than 24 months: 70 mm Hg plus the number that is double the child's age in years. (8-year-old child: 70 + 16 = 86 mm Hg)

A child is brought to the emergency department after ingesting an acidic substance. What action by the nurse is best? a. Induce vomiting in the child. b. Give syrup of ipecac. c. Ensure a patent airway. d. Attach the child to a cardiac monitor.

ANS: C Ensuring a patent airway is always the priority. Since the child ingested an acid that causes corrosive damage, inducing vomiting (which is what syrup of ipecac does) is not advised. The child may need a cardiac monitor, but airway is the priority

Which statement made by a parent indicates incorrect information about intervention for a child's fever? a. "I should keep her covered lightly when she has a fever." b. "I'll give her plenty of liquids to keep her hydrated." c. "I can give her acetaminophen for a fever." d. "I'll look for over-the-counter preparations that contain aspirin."

ANS: D

What is the leading cause of unintentional death in children younger than 19 years of age in the United States? a. Drowning b. Airway obstruction c. Pedestrian injury d. Motor vehicle injuries

ANS: D The Centers for Disease Control and Prevention (CDC) has consistently found that motor vehicle injuries are the leading cause of unintentional death in children younger than 19 years of age in the United States. Drowning, airway obstruction, and pedestrian injury do cause death but not at the rate of motor vehicle crashes.

The nurse is caring for a young child with HIV. Which nursing intervention is a priority for this child?

Administer prescribed medications.

The nurse is assessing a 10-year-old girl recently fitted with a cast on her wrist. Which assessment finding would alert the nurse to a possible infection?

Drainage on the cast Drainage on the cast could indicate an infection. Pale fingers would suggest impaired circulation. Delayed capillary refill would suggest impaired circulation. Diminished pulse would suggest impaired circulation.

A child is brought to the emergency department with a suspected poisoning. Which of the following would the nurse least likely expect to be used? A) Gastric lavage B) Syrup of ipecac C) Activated charcoal D) Whole bowel irrigation

When assessing a child for slipped capital femoral epiphysis, what would the nurse identify as possible risk factors? Select all answers that apply. A) Age younger than 8 years B) African American ethnicity C) History of cystic fibrosis D) Excessive activity E) Obesity

B) African American ethnicity (black race) E) Obesity Rationale: Risk factors associated with slipped capital femoral epiphysis include age between 9 and 16 years, black race, sedentary lifestyle, and being overweight or obese. A history of cystic fibrosis may contribute to rickets. Reference: p. 1631

What should the nurse expect to observe in the prodromal phase of rubeola? a. Macular rash on the face b. Koplik spots c. Petechiae on the soft palate d. Crops of vesicles on the trunk

The nurse is teaching the mother of a 5-year-old boy with a myelomeningocele who has developed a sensitivity to latex. Which response from his mother indicates a need for further teaching? A) "He needs to get a medical alert identification." B) "I will need to discuss this with his caregivers." C) "A product's label indicates whether it is latex-free." D) "He must avoid all contact with latex."

C) "A product's label indicates whether it is latex-free." Rationale: The Food and Drug Administration (FDA) requires that all medical supplies be labeled if they contain latex, but this is not the case with consumer products. The mother must be familiar with products that contain latex. The Spina Bifida Association of America maintains an updated list of latex-containing products. Getting a medical alert identification, talking with his caregivers, and avoiding all contact with latex are correct. Reference: p. 1610

The nurse caring for a client in a body cast knows that immobility can cause contractures, loss of muscle tone, or fixation of joints. Which nursing interdisciplinary intervention is recommended to help prevent these adverse conditions?

Encourage active and passive range-of-motion activities to prevent ineffective tissue perfusion. The nurse should turn the client and encourage active and passive range-of-motion activities to prevent ineffective tissue perfusion. The client should be instructed to cough and breathe deeply to prevent respiratory complications. Normal capillary refill is 1 to 3 seconds. The client should be given small, frequent meals with increased fiber, protein, and vitamin C to prevent malnutrition.

After the patient's respiratory status is stable, which action is appropriate for the nurse to perform on an unresponsive, nonverbal trauma patient? Ensure Foley catheter is patent Ensure chest tube placement secure Maintain IV fluids at maintenance therapy Ensure cervical spine protection until definitive diagnosis is made

Ensure cervical spine protection until definitive diagnosis is made All unresponsive and nonverbal trauma patients should have cervical spine protection until definitive diagnosis can be made.

A nurse is caring for an infant whose mother is human immunodeficiency (HIV) positive. The nurse knows that which diagnostic test result will be positive even if the child is not infected with the virus? A) Erythrocyte sedimentation rate B) Enzyme-linked immunosorbant assay (ELISA) C) Immunoglobulin electrophoresis D) Polymerase chain reaction test

Enzyme-linked immunosorbent assay (ELISA)

with severe SLE or frequent flare ups what is the therapeutic management

High-dose corticosteroid therapy Immunosuppressive drugs When end-stage renal failure develops as a result of glomerulonephritis, dialysis becomes necessary Renal transplant

The nurse is caring for a patient who has a penetrating chest wound. The patient is unresponsive, with labored breathing and delayed capillary refill. Which factor would the nurse consider during the initial assessment in addition to the patient's signs and symptoms? Name of the patient Mechanism of injury Time of day when injury occurred Geographic location when injury occurred

Mechanism of injury Nursing intervention depends on knowing the mechanism of injury, as well as the manifesting signs and symptoms.

Children who are at high risk for latex sensitivity should wear a _____________ alert identification.

Medical

Which suggestion is appropriate to teach a mother who has a preschool child who refuses to take the medications for HIV infection?

Mix meds w/ choco syrup or follow with choco candy

Assess muscle tone and strength in infant/child, compare bilaterally -Evaluate neck tone by pulling infant from a supine position to a sitting position.

Palpation

Which diagnostic measure is most accurate in detecting neural tube defects? a) Flat plate of the lower abdomen after the 23rd week of gestation b) Significant level of alpha-fetoprotein present in amniotic fluid c) Presence of high maternal levels of albumin after 12th week of gestation d) Amniocentesis for lecithin-sphingomyelin (L/S) ratio

Significant level of alpha-fetoprotein present in amniotic fluid

A nurse is conducting a physical examination on an 11-year-old boy with Legg-Calvé-Perthes disease. Which assessment finding would be expected?

Trendelenburg gait The nurse would expect to note a Trendelenburg gait due to pain. Lordosis is an excessive curvature of the spine and is not associated with Legg-Calvé-Perthes disease. Kyphosis is an excessive curvature of the spine and is not associated with Legg-Calvé-Perthes disease. Loss of strength in ankle dorsiflexion is associated with some neuromuscular disorders but not this condition.

A nursing instructor is teaching the students about the standard and transmission-based precautions. What type of precautions require placing a client in an isolated room with limited access, wearing gloves during contact with the client and all body fluids or contaminated items, wearing two layers of protective clothing, and avoiding sharing equipment between clients? a) Contact precautions b) Standard precautions c) Droplet precautions d) Airborne precautions

Which of the following nursing diagnoses would be appropriate for teaching interventions for a single mother who leaves her toddler unattended in the bathtub? a) Noncompliance b) Risk for Suffocation c) Risk for Falls d) Risk for Imbalanced Body Temperature

The parents of a 3-year-old child report he was exposed to pertussis 2 days ago. They are concerned and ask the nurse how long it will take until he becomes ill if he indeed contracted the infection. What response by the nurse is indicated? a) "It normally takes about 3 weeks before symptoms begin." b) "The signs of disease will be noted in 1 to 3 weeks." c) "If your child had contracted the disease symptoms would have be noted by this time." d) "If you child has contracted the illness he will b

b 6-20 days

What therapeutic management for the patient with systemic lupus erythematosus (SLE) would the nurse expect to include? A. A high-protein, low-sodium diet. B. Corticosteroids to control inflammation. C. Gold salts to suppress the inflammatory process. D. An exercise regimen to build up muscle strength and endurance.

b Corticosteroids to control inflammation is the current primary mode of therapy.

A nurse in the emergency department is admitting a child who has full-thickness burns over 45% of his body. Which of the following actions should the nurse take first? A. Administer IV morphine B. Administer topical antimicrobials C. Administer IV fluid replacement D. Administer tetanus prophylaxis

A nurse is providing education to the parent of a toddler who is about to receive an MMR (measles, mumps and rubella) immunization. Which of the following statements by the parent indicates an understanding of the teaching? A. "My child should not play with other children for 2 days." B. "I will need to return in 2 weeks for my child to receive the varicella immunization." C. "I will help my child to blow bubbles during the injection." D. "My child may have some drainage from the injection site.

The mother of a an 8-year-old boy with mumps tells the nurse that she does not understand how her son could have gotten mumps since he was immunized according to her physician's recommendations. What is the best response by the nurse? a) "I am wondering if your physician followed the immunization schedule correctly?" b) "I am sure it must be frustrating. Where did you have the immunizations performed?" c) "While immunizations are highly effective they aren't 100% effective at preventing infectio

The nurse is administering a chicken pox vaccination to a 12-month-old girl. Which concern is unique to varicella? a) Children with this disease need to avoid pregnant women. b) Vitamin A is indicated for children younger than 2 years. c) This disease can reactivate years later and cause shingles. d) Dehydration is caused by mouth lesion

The nurse is caring for a 10-year-old child with a skin rash. The nurse should include which intervention to manage the associated pruritis? a) Apply hot compresses b) Rub powder on the pruritic area c) Press the pruritic area d) Encourage warm baths

What is a true statement regarding measles? a) It is not contagious. b) It is transmitted by the fecal-oral route. c) The incubation period is 10 to 12 days. d) Peak outbreaks are in the summer.

What is the drug of choice the nurse would administer in the acute treatment of anaphylaxis? a. Diphenhydramine (Benadryl) b. Cimetidine (Tagamet) c. Epinephrine (Adrenaline) d. Albuterol (Ventolin)

A child is brought to the emergency department with a suspected poisoning. What treatment would the nurse least likely expect to be used? a) Activated charcoal b) Gastric lavage c) Syrup of ipecac d) Whole bowel irrigation

c) Syrup of ipecac Ipecac is rarely used in the health care setting to induce vomiting and is no longer recommended for use in the home setting. Gastric lavage, administration of activated charcoal (binds with the chemical substance in the bowel), or whole bowel irrigation with polyethylene glycol electrolyte solutions may be used.

The pediatric nurse knows that there are a number of anatomic and physiologic differences between children and adults. Which statement about the immune systems of infants and young children is true? a) Children have an increased inflammatory response. b) Passive immunity overlaps immunizations. c) Cellular immunity is not functional in children. d) Children have an immature immune response.

The parents bring their 3-year-old son to the emergency department after he ingested some of his mother's medicine. Which assessment would be of critical importance for this child? a) Evaluating the effectiveness of the child's breathing b) Noting the child's pulse rate and quality c) Auscultating all lung fields for signs of edema d) Assessing mental status and skin moisture and color

d) Assessing mental status and skin moisture and color In cases of poisoning, clinical manifestations vary widely depending on the medication or chemical ingested. Therefore, it is important to pay particular attention to the child's mental status, skin moisture and color, and bowel sounds. Evaluating the effectiveness of the child's breathing and noting the child's pulse rate and quality are basic to any rapid cardiopulmonary assessment. Auscultating all lung fields for signs of pulmonary edema would be critically important for a child who is a near-drowning victim.

The nurse is conducting a physical examination of a toddler with suspected lead poisoning. Lab results indicate blood lead level 52 mcg/dL. Which action would the nurse expect to happen next? a) Repeat testing within 1 week with education to decrease lead exposure. b) Prepare to admit child to begin chelation therapy. c) Confirm with repeat testing in 1 month and referral to local health department. d) Repeat testing within 2 days and prepare to begin chelation therapy as ordered.

d) Repeat testing within 2 days and prepare to begin chelation therapy as ordered. The recommendation for blood lead levels of 45 to 69 mcg/dL is to confirm the level with a repeat laboratory test within 2 days and educate the parents to decreased lead exposure. She should also expect to begin chelation therapy as ordered and refer the case to the local health department for investigation of home lead reduction with referrals for support services. Repeat testing in 1 week with parent education is appropriate for lead levels between 20 and 44 mcg/dL. Repeat testing in 1 month and education would be appropriate for levels between 15 and 19 mcg/dL. Preparing to admit the child to begin chelation therapy immediately would be appropriate for lead levels greater than 70 mcg/dL

pneumococcal conjugate vaccine (prevnar)

2 months 4 months 6 months 12-15 months

Rotovirus vaccine

2, 4, 6 months

Hib vaccine schedule Haemophilus

2, 4, 6, 12-18 months

inactivated polio vaccine

2, 4, 6-18 months, 4-6 years

The nurse is assessing the neuromusculoskeletal system of a newborn. What is an abnormal assessment finding? A) Sluggish deep tendon reflexes B) Full range of motion in extremities C) Absence of hypotonia D) Lack of purposeful muscular control

A. Sluggish deep tendon reflexes Rationale: Deep tendon reflexes are present at birth and are initially brisk in the newborn and progress to average over the first few months. Sluggish deep tendon reflexes indicate an abnormality. The newborn is capable of spontaneous movement but lacks purposeful control. Full range of motion is present at birth. Healthy infants and children demonstrate normal muscle tone; hypertonia or hypotonia is an abnormal finding. Reference: p. 1588

What is the goal of the initial intervention for a child in cardiopulmonary arrest? a. Establishing a patent airway b. Determining a pulse rate c. Removing clothing d. Reassuring the parents

ANS: A The first intervention for a child in cardiopulmonary arrest, as for an adult, is to establish a patent airway. Assessment of pulse follows establishment of a patent airway. Clothing may be removed from the upper body for chest compressions after a patent airway is established. Reassuring the parents is important, but the primary survey and associated interventions come first.

The nurse is teaching the parents of a female child with a myelomeningocele how to perform clean intermittent catheterization. The nurse determines that the teaching was effective when the parents return demonstrate the procedure and state: a) "Before inserting the catheter, we need to wipe her labia with normal saline from back to front." b) "We need to insert the catheter about 6 inches so that we make sure the catheter is in the bladder." c) "We need to apply some petroleum jelly to her l

"When the urine stops flowing, we should press on the lower belly to ensure the bladder is empty."

The parents bring their 3-year-old son to the emergency department after having found that he has ingested some of his mother's medicine. Which assessment would be of critical importance for this child? A) Assessing mental status and skin moisture and color B) Evaluating the effectiveness of the child's breathing C) Noting the child's pulse rate and quality D) Auscultating all lung fields for signs of edema

A (check this though) assess the mental status bc of LOC and loopy and sometimes they start turning pale bc of it. Some kids come in breathing perfectly fine

The nurse is caring for a 14-year-old boy in Buck traction for a slipped capital femoral epiphysis (SCFE). What information would the nurse include when completing a neurovascular assessment of the affected leg? Select all that apply.

- Color - Sensation - Pulse - Capillary refill A neurovascular assessment includes assessing for color, movement, sensation, edema, and quality of pulses. Vital signs are not a component of a neurovascular assessment.

The nurse is caring for a child who fractured his harm in an accident. A cast has been applied to the child's right arm. Which actions should the nurse implement? Select all that apply.

- Document any signs of pain. - Check radial pulse in the both arms. - Monitor the color of the nail beds in the right hand. Monitoring for signs of pain, decreased circulation, or change or variation in pulses in the extremity is important for the child in a cast. Pain can indicate serious complications, such as compartment syndrome. Wearing a gown or sterile gloves is unnecessary. Checking posterior pulses would be appropriate when a lower extremity is casted.

A 9-year-old girl who has fallen from a second-story window is brought to the emergency department. Which assessment would be a priority? A) Evaluating pupils for equality and reactivity B) Monitoring oxygen saturation levels C) Asking the child if she knows where she is D) Using the appropriate pain assessment scale

The nurse is caring for a 10-month-old infant with signs of respiratory distress. Which is the best way to maintain this child's airway? a) Inserting a small towel under shoulders b) Using the head tilt chin lift technique c) Placing the hand under the neck d) Employing the jaw-thrust maneuver

The nurse is examining a 10-year-old boy with tachypnea and increased work of breathing. Which finding is a late sign that the child is in shock? a) Significantly decreased skin elasticity b) Delayed capillary refill with cool extremities c) Blood pressure slightly less than normal d) Equally strong central and distal pulses

The nurse is providing teaching to the parents of a child with varicella. Which statement indicates that the parents have understood the instructions? a) "We need to make sure that he washes his hands frequently." b) "If he has a fever, we can give him some aspirin." c) "The lesions should eventually form soft crusts that drain." d) "We should apply alcohol to the lesions every four hours."

A nurse in an emergency department is assisting with the care of a 4-year-old child who ingested toilet bowl cleaner. The child has hemoptysis, is crying, and states, "It burns." Which of the following actions should the nurse perform? (Select all that apply.) aIdentify how much cleaner was in the bottle bAdminister activated charcoal cPerform gastric lavage immediately dInsert IV for morphine eApply a pulse ox

ade

A nurse is caring for an 18-year-old adolescent who is up-to-date on immunizations and is planning to attend college. The nurse should recommend which of the following immunizations prior to moving into a campus dormitory? A. Pneumococcal polysaccharide B. Meningococcal polysaccharide C. Rotavirus D. Herpes zoster

How should the nurse respond to a parent who asks, "How can I protect my baby from whooping cough?" a. "Don't worry; your baby will have maternal immunity to pertussis that will last until they are approximately 18 months old." b. "Make sure your child gets the pertussis vaccine." c. "See the doctor when the baby gets a respiratory infection." d. "Have your pediatrician prescribe erythromycin."

The most common complication of varicella is: a) encephalitis. b) secondary bacterial infections. c) pneumonia. d) scarring.

what's the purpose of a shunt in a patient with hydrocephalus

they minimize intercranial pressure

The young boy has fractured his left leg and has had a cast applied. The nurse educates the boy and his parents prior to discharge from the hospital. The parents should call the physician when which incidents occur? Select all that apply.

- The boy has had a fever of greater than 102° F (38.9°C) for the last 36 hours. - New drainage is seeping out from under the cast. - The boy's toes are light blue and very swollen. The parents should call the physician when the following things occur: The child has a temperature greater than 101.5F° (38.7° C) for more than 24 hours, there is drainage from the casted site, the site distal to the casted extremity is cyanotic, or severe edema is present.

What allows for the visualization of the femoral head and the outer edge of the acetabulum? -This falls into lab/diagnostic testing for children with DDH What also can be used in the infant or child older than 6 months of age to determine DDH?

-Ultrasound -Plain Hip X-rays

The nurse of a well-baby clinic prepares to administer an immunization to a child. The mother of the child tells the nurse that the child has had a fever and is taking antibiotics. The nurse takes the child's temperature and notes that it is 101.5° F rectally. The nurse plans to take which action? 1.Delay the immunization. 2.Administer the immunization. 3.Administer one of the three scheduled immunizations. 4.Administer one half of the prescribed dose of each scheduled immunization.

The nurse is providing care to a child who experienced an anaphylactic reaction to an unknown allergen. Which high-risk foods should the nurse question the family about regarding recent consumption? 1. Peanut butter 2. Shrimp 3. Eggs 4. Milk 5. Soda

123

Any type of fracture can be the result of child abuse, but which types particularly in the child younger than 2 years of age, should ALWAYS be investigated to rule out the possibility of abuse? A) Rib Fractures B) Humerus fractures C) Arm fractures D) Spiral Femur fractures

A) Rib Fractures B) Humerus fractures D) Spiral Femur fractures

Which nursing action facilitates care being provided to a child in an emergency situation? a. Encourage the family to remain in the waiting room. b. Include parents as partners in providing care for the child. c. Always reassure the child and family. d. Give explanations using professional terminology.

ANS: B Include parents as partners in the child's treatments. Parents may need direct guidance in concrete terms to help distract the child. Allowing the parents to remain with the child may help calm the child. Telling the truth is the most important thing. False reassurance does not facilitate a trusting relationship. Professional terminology may not be understood. Speak to the child and family in language that they will understand.

A nurse is conducting a physical examination of a 12-year-old girl with suspected systemic lupus erythematosus (SLE). How would the nurse best interview the girl? A. "Do you notice any wheezing when you breathe or a runny nose?" B. "Do you have any shoulder pain or abdominal tenderness?" C. "Have you noticed any new bruising or different color patterns on your skin?" D. "Have you noticed any hair loss or redness on your face?"

D. "Have you noticed any hair loss or redness on your face?"

A group of nursing students are reviewing information about the type of skin and skeletal traction. The students demonstrate understanding of this information when they identify which of these as a type of skeletal traction? A) Russell traction B) Bryant traction C) Buck traction D) Side arm 90-90 traction

D. Side arm 90-90 traction Rationale: Side arm 90-90 traction is a type of skeletal traction with force applied through a pin in the distal femur. Russell traction, Bryant traction, and Buck traction are types of skin traction. Reference: p. 1604

A nurse has 25 years of experience working in the emergency department (ED) treating and managing pediatric patients. Treating which area of the pediatric patient should she have most experience? Arm Leg Head Wrist

Head The head makes up a large proportion of the child's body relative to the rest of the body. An experienced ED nurse should be used to treating head injuries because this area of the body is injured more than other areas.

The nurse is obtaining a health history on a woman of child-bearing age who wants to become pregnant. What information in her health history places her at high-risk for having a child with a myelomeningocele? a) History of a previous abdominal surgery. b) History of asthma taking montelukast. c) History of scoliosis. d) History of a seizure disorder and taking phenobarbital.

History of a seizure disorder and taking phenobarbital.

The ________________ infant will feel rigid, extending the trunk and legs.

Hypertonic

A patient comes to the emergency department and is being treated for distributive shock. Which patient presentation corresponds to this diagnosis? Select all that apply. A patient suffering from profuse diarrhea Inability of a patient to maintain vascular tone A patient with septic shock who has a bacterial infection A patient with an overall decrease in circulating blood volume A patient with myocardial fluid accumulation causing insufficiency in meeting the body's demands

Inability of a patient to maintain vascular tone This patient scenario corresponds to a patient diagnosed with distributive shock, and therefore the nurse should recognize septic shock as a form for distributive shock. A patient with septic shock who has a bacterial infection This patient scenario corresponds to a patient diagnosed with distributive shock, and therefore the nurse should recognize septic shock as a form of distributive shock.

During observation of what, you should observe spontaneous activity, posture, and balance, and assess for asymmetric movements? -Infant's posture should be slightly flexed, and should be able to extend extremitites to a normal stretch.

Motor function

The nurse is caring for a child who is unresponsive after being struck by a vehicle. The child sustained multiple injuries and was diagnosed with cardiogenic shock. The child's parents are tearful and refuse to speak with the provider about the child's prognosis. Which action would the nurse take to enhance family coping? Select all that apply. Ask the parents to refrain from staying at the child's bedside Provide concise, accurate information to the parents at frequent intervals Give infor

Provide concise, accurate information to the parents at frequent intervals The nurse's action of providing concise, accurate information to parents at frequent intervals enhances family coping. Correct Give information in a calm, relaxed, and empathetic manner The nurse's action of giving information in a calm, relaxed, and empathetic manner enhances family coping. Correct Encourage parents to participate in the child's care as appropriate The nurse's action of encouraging parents to participate in the child's care as appropriate provides them with some degree of control. Correct Provide simple explanations to the child and parents of procedures before initiating them The nurse's action of providing simple explanations to the child and parents before initiating them enhances family coping.

The nurse is caring for a 10-year-old child in traction. After performing a skin assessment, she notices that the skin over the calcaneus appears slightly red and irritated. What should be the first intervention?

Reposition the child's foot on a pressure-reducing device. The nurse's first action is to remove continuous pressure from this area. The other actions can help decrease potential for skin breakdown, but the pressure must be relieved first.

Which nursing diagnosis will the nurse prepare for the infant who is placed prone to protect the myelomeningocele repair site?

Risk for impaired skin integrity The skin of the infant's knees and elbows is exposed to both pressure and friction. Leakage of urine and stool makes skin cleanliness a challenge. Should voluntary movement of the legs be affected, they become more vulnerable to skin integrity problems. The neuromuscular dysfunction the infant experiences is neither peripheral nor vascular. Disorganized infant behavior does not reflect the reality of the situation, and risk for activity intolerance is not appropriate because little activity occurs.

Which nursing diagnosis is most relevant in the first 12 hours of life for a neonate born with a myelomeningocele? a) Impaired physical mobility b) Delayed growth and development c) Risk for infection d) Constipation

Risk for infection

What classification system is used to describe fractures involving the growth plate?

Salter-Harris

The nurse is caring for a 3 year old diagnosed with pneumonia one week previously. The parents report the child has become lethargic and appears to have more difficulty breathing. The nurse notes delayed capillary refill, tachycardia, and tachypnea. Which prescription should the nurse implement first? Supplemental oxygen Hemodynamic monitoring IV fluid bolus of normal saline Parenteral antibiotic therapy

Supplemental oxygen Supplemental oxygen should be initiated first for a patient with signs of shock, hypoxia, and poor tissue perfusion.

The nurse is caring for a child who presents with blunt force trauma to the head and face, which the parents say was sustained during a fall. The nurse also notes the child is lethargic and confused and has bruises on the legs, arms, and abdomen in multiple stages of healing. Which area of body will be of most concern to the nurse? Kidneys and renal system Lungs and respiratory system The cervical spine and neurologic system Heart and cardiovascular system

The cervical spine and neurologic system The nurse should verify the stability of the cervical spine for a patient with blunt force trauma to the head and face.

A nurse is caring for a 15-month-old client who requires droplet precautions. Which of the following actions should the nurse take? A. Have the toddler wear a disposable gown when in the unit's playroom. B. Wear sterile gloves when changing the toddler's diapers. C. Wear a mask when assisting the toddler with meals. D. Ask visitors to wear an N-95 mask when entering the toddler's room.

The influenza vaccine should not be given to kids who are allergic to eggs

A child with systemic lupus erythematosus is receiving hydroxychloroquine sulfate. Which instruction would the nurse emphasize when teaching the child and parents about this drug? a. importance of yearly eye examinations b. need to gradually taper the drug dosage over time c. avoiding grapefruit juice when taking the drug d. giving with foods to minimize gastrointestinal upset

When hydroxychloroquine is given, the child should have a fundoscopic eye exam and visual field testing every year.

The mother of a 10-year-old child diagnosed with rubella asks what can be done to help her child feel better during her illness. What information can be provided? a) Encourage rest and relaxation. b) Antibiotic therapy may be initiated. c) Range of motion to prevent contractures. d) Antiviral medications can be prescribed.

The nurse is assessing the respiratory status and lungs of a 6-year-old child. Which of the following would the nurse report immediately? a) Minimal air movement through the lungs b) High-pitched breath sounds over the trachea c) Resonance over the lungs on percussion d) Low-pitched bronchial sounds over the periphery

A child is brought to the clinic with fever, cough, and coryza. The nurse inspects the child's mouth and observes what look like tiny grains of white sand with red rings. How would the nurse document these findings? a) Nits b) Slapped cheek appearance c) Lymphadenopathy d) Koplik spots

A nurse in a pediatric clinic is caring for a 3-year-old child who has a blood lead level of 3 mcg/dL. When teaching the toddler's parent about the correlation of nutrition with lead poisoning, which of the following pieces of information is appropriate for the nurse to include? A. Decrease the child's vitamin C intake until the blood lead level decreases to zero B. Administer a folic acid supplement to the child each day C. Give pancreatic enzymes to the child with meals and snacks D. Ensure th

The appearance of which hallmark clinical manifestation occurs in measles? a) Cough b) Fever c) Conjunctivitis d) Koplik spots

The nurse is assessing the neurologic status of an infant. Which of the following would the nurse identify as a nonreassuring finding? a) Vigorous crying b) Making eye contact with the nurse c) Soft flat anterior fontanel d) Lack of interest in surroundings

The nurse is caring for a child hospitalized with pertussis. Which nursing intervention would be the highest priority for this child? a) The nurse will encourage bed rest. b) The nurse will monitor caloric intake. c) The nurse will administer antibiotics. d) The nurse will administer oxygen.

A child seen in the clinic is found to have rubeola (measles) and the mother asks the nurse how to care for the child. Which instruction should the nurse provide to the mother? 1.Keep the child in a room with dim lights. 2.Give the child warm baths to help prevent itching. 3.Allow the child to play outdoors because sunlight will help the rash. 4.Take the child's temperature every 4 hours and administer 1 baby aspirin for fever.

1.Keep the child in a room with dim lights.

A nurse is providing discharge teaching to the parent of a child hospitalized after experiencing respiratory arrest. The parent expresses concerns about the child's well-being. Which action(s) is appropriate for the nurse take? Select all that apply. 1Encourage the parent to discuss specific concerns about the child. 2Review signs and symptoms of respiratory distress with the parent. 3Tell the parent that the child's provider will address any concerns during the follow-up visit. 4Reassure th

1,2,5

A child has a tracheal tube in place and will be receiving medications via this tube. Which of the following medications would the nurse expect to be administered in this manner? Select all answers that apply. A) Lidocaine B) Adenosine C) Atropine D) Dopamine E) Epinephrine F) Naloxone

A,C,E,F

The nurse is developing a teaching plan for a child who is to have his cast removed. What instruction would the nurse most likely include? A) Applying petroleum jelly to the dry skin B) Rubbing the skin vigorously to remove the dead skin C) Soaking the area in warm water every day D) Washing the skin with dilute peroxide and water

C. Soaking the area in warm water every day Rationale: After a cast is removed, the child and family should be instructed to soak the area in warm water every day to help soften and remove the dry flaky skin. Moisturizing lotion, not petroleum jelly, should be applied to the skin. Vigorous rubbing would traumatize the skin and should be avoided. Warm soapy water, not dilute peroxide and water, should be used to wash the area. Reference: p. 1602-1603

Refers to abnormalities of the developing hip that include dislocation, subluxation, and dysplasia of the hip joint. In DDH, the femoral head has an abnormal relationship to the acetabulum. -May affect just one or both hips.

Developmental Dysplasia of the Hip (DDH)

The nurse is caring for an infant with vomiting and diarrhea for the past week. The nurse notes a depressed anterior fontanel, decreased urine output, and lack of tears. Which prescription should the nurse complete first? Initiate oxygen Give an IV fluid bolus Administer oral antiemetic Apply barrier cream to the buttocks

Give an IV fluid bolus The patient's symptoms are indicative of hypovolemic shock. IV fluid resuscitation is the most important action.

A neonatal nurse examines an infant and notes decreased hip motion that causes pain upon movement. This nurse suspects Legg-Calvé-Perthes disease, a common pediatric hip disorder that causes pain and decreased hip motion, possibly leading to a femoral head deformity.

True Legg-Calvé-Perthes disease is a common pediatric hip disorder that causes pain and decreased hip motion, possibly leading to a femoral head deformity. It has an incidence of 1 per 1,200 live births, with some hereditary factors influencing incidence.

The nurse is caring for a child who has had an open reduction with cast placement on the forearm. While assessing the cast, the nurse notes serosanguineous fluid on the cast. What action by the nurse is appropriate?

Using a ballpoint pen, outline the fluid stain. Mark the time it is outlined. Although oozing of serosanguineous fluid after an open reduction is a common, it does need to be noted and documented. The nurse should outline the stain with a ballpoint pen or crayon rather than a marker, mark the time so it can be determined how rapidly the spot is increasing. If the stain is small, notification of the health care provider and replacement of the cast is not necessary.

The nurse is teaching a first-time mother with a 14-month-old boy about child safety. Which is the most effective overall safety information to provide guidance for the mother? a) "Never let him out of your sight when outdoors." b) "Don't smoke in the house or car." c) "Put chemicals in a locked cabinet." d) "Place a gate at the top of each stairway."

a) "Never let him out of your sight when outdoors." Because they are curious and mobile, toddlers require direct observation and cannot be trusted to be left alone, especially when outdoors. The priority guidance is to never let the child be out of sight. Gating stairways, locking up chemicals, and not smoking around the child are excellent, but specific, safety interventions.

The nurse would delay the administration of DTaP when the mother says that her infant: a Has diarrhea b Had a temperature of 105 F from the previous inoculation c Is teething d Is traveling with her to Europe in a week

A child is diagnosed with chicken pox. The nurse collects data regarding the child. Which finding is characteristic of chicken pox? 1.Macular rash on the trunk and scalp 2.Pseudomembrane formation in the throat 3.Maculopapular or petechial rash on the extremities 4.Small, red spots with a bluish-white center and red base

1. start at center of the trunk, spreading to the face and proximal extremities 3.rubella 4.koplik

A nursing student is asked to discuss human immunodeficiency virus (HIV) during a clinical conference. The nursing student should include which correct item in the discussion? 1.HIV primarily attacks the hematological system. 2.HIV virus attacks the immune system by destroying T lymphocytes. 3.Most newborns of HIV-positive women test positive for HIV virus. 4.In HIV, the B cells are depleted and cannot signal T4 cells to form protective antibodies.

What may cause hypovolemic shock in children? (Select all that apply.) a. Hyperthermia b. Burns c. Vomiting or diarrhea d. Hemorrhage e. Skin abscesses

ANS: A, B, C, D Hypovolemic shock is due to decreased circulating volume and can be caused by fluid loss due to hyperthermia, burns, vomiting or diarrhea, and hemorrhage. An abscess will not cause hypovolemia.

what is the most common neurological injury and caused of death resulting from child abuse

shaken baby syndrome

The nurse is concerned that the child is developing septic shock. Which findings are consistent with this condition? Select all that apply. a) White blood cell count is elevated. b) The child is pale and lethargic. c) C-reactive protein is decreased. d) The child's blood pressure is reduced. e) The child's respiratory rate is elevated.

A, B, D, E

A preschool child in the emergency department has a respiratory rate of 10 breaths per minute. How should the nurse interpret this finding? a. The child is relaxed. b. Respiratory failure is likely. c. This child is in respiratory distress. d. The child's condition is improving.

ANS: B Very slow breathing in an ill child is an ominous sign, indicating respiratory failure. Although the respiratory rate slows when an individual is relaxed, a rate of 10 breaths per minute in an ill preschool child is not a normal finding and is cause for concern. A rapid respiratory rate indicates respiratory distress. Other signs of respiratory distress may include retractions, grunting, and nasal flaring. A respiratory rate of 10 breaths per minute is not a normal finding for a preschool child nor does it demonstrate improvement.

What is the best response to a parent of a 2-month-old infant who asks when the infant should first receive the measles vaccine? a. "Your baby can get the measles vaccine now." b. "The first dose is given any time after the first birthday." c. "She should be vaccinated between 4 and 6 years of age." d. "This vaccine is administered when the child is 11 years old."

ANS: B Feedback A Some immunizations are initiated at 2 months of age, but not the measles Vaccine. B The first measles, mumps, rubella (MMR) vaccine is recommended routinely at 1 year of age. C The second dose of MMR is recommended at 4 to 6 years of age. D Children should receive their second MMR dose no later than 11 to 12 years of age.

he Center for Disease Control (CDC, 2009) recommendation for immunizing infants who are HIV positive is a Follow the routine immunization schedule. bRoutine immunizations are administered; assess CD4+ counts before administering the MMR and varicella vaccinations. cDo not give immunizations because of the infants altered immune status. dEliminate the pertussis vaccination because of the risk of convulsions.

ANS: B; CD4 are monitored when deciding whether to provide live virus vaccines. If kid is severely immunocompromised the MMR vaccine isnt given.

The nurse is assessing a child with spina bifida occulta. During the assessment, the parents say, "It's going to be so difficult taking care of our child. He'll never be able to walk." The nurse identifies which nursing diagnosis as the priority? a) Risk for injury related to lack of muscle control b) Ineffective coping related to diagnosis of chronic condition c) Impaired physical mobility related to spinal cord defect d) Deficient knowledge related to diagnosis and condition

Deficient knowledge related to diagnosis and condition

The nurse is caring for a 7-year-old patient who reports sustaining a leg injury while falling down the stairs three days ago. The nurse notes abrasions to the left elbow and a right tibia fracture. Which indicator may raise the suspicion of child maltreatment? Patient has abrasion on his elbow Delay in seeking treatment for the trauma Patient has never broken his tibia previously The patient was alone when the injury occurred

Delay in seeking treatment for the trauma Delay in seeking treatment for the trauma is an important indicator that might raise the suspicion of child maltreatment in the emergency setting.

The nurse is caring for a 10-year-old girl in traction. The girl is experiencing muscle spasms associated with the traction. What would the nurse expect to administer if ordered?

Diazepam Diazepam is an antianxiety drug that also has the effect of skeletal muscle relaxation; it is used for the treatment of muscle spasm associated with traction or casting. Narcotic analgesics are used for pain relief. Alendronate increases bone mineral density for children with osteogenesis imperfecta. Pamidronate increases bone mineral density for children with osteogenesis imperfecta.

A nurse is teaching a group of parents about assessing the ABCDE's in children with toxic exposure. Which two assessment components should the nurse discuss in addition to the traditional ABC's of CPR? Select all that apply. Diuresis Disability Exposure Exudates Diaphoresis

Disability Seizure precautions should be implemented in poison exposures with neurological or metabolic side effects. The child's mental status should be assessed frequently. Exposure Treating toxic exposures and ingestions may include removal of dermal and ocular toxins, dilution of the toxin, administration of activated charcoal, and administration of an antidote. Gastric lavages are no longer recommended.

The type of fracture often seen in young children is one in which there is not complete ossification of the bone, and the bone bends and just partially breaks. What type of fracture is this?

Greenstick Greenstick fractures are one kind of incomplete fracture, caused by incomplete ossification, common in children. The bone bends and often just partially breaks.

The nurse is caring for a child who had a cast on his lower leg placed two hours ago. When assessing the child's foot, the nurse notes that the toes are cool and the child reports extreme pain. What is the best action by the nurse?

Notify the health care provider of the findings immediately. Cool fingers or toes, extreme pain, and impaired movement are symptoms of compartment syndrome. Compartment syndrome can severely decrease blood flow to the area causing damage and necrosis to the surrounding area. If compartment syndrome occurs, the cast needs to be released immediately; therefore, the health care provider must be notified of these assessment findings immediately. Administration of pain medication, positioning, and ice are interventions that may be prescribed after a cast is placed, but they are not the first treatment for compartment syndrome.

The nurse is caring for an infant with a myelomeningocele who has paralysis of the lower extremities. Which action would be most appropriate to help reduce friction resulting from this paralysis? a) Place the child on a special care mattress. b) Place a pad beneath the diaper area and change frequently. c) Place a folded diaper in between the legs. d) Place synthetic sheepskin under the infant's chest.

Place a folded diaper in between the legs.

The nurse is caring for an infant brought in with a high fever, cough, labored breathing, and tachypnea. Which general appearance finding would be most concerning for the nurse? Diarrhea Poor feeding Weak, continuous cry Skin is cool and mottled

Skin is cool and mottled Cool, mottled skin is a sign of poor tissue perfusion and can indicate shock in an infant with labored breathing and tachypnea.

A mother brings in her 4-year-old child to the health care provider, stating that the child has marked constipation and describing the child as "sluggish." Which patient's social history is most significant? The family has recently moved into a historic house. The child has recently attended an outdoor day camp. The family has just returned from a vacation to the ocean. The child has recently started attending preschool at a newly built facility.

The family has recently moved into a historic house. A historic home may have lead paint and leaded glass which can lead to toxicity causing constipation. Exposure to lead can cause the symptoms described in this scenario.

An 18-month-old infant has Pneumocystis carinii pneumonia. Results of enzyme-linked immunosorbent assay (ELISA) testing indicate that she is HIV positive. When planning care, the nurse should consider which of the following factors? The infants mom is likely HIV + Infants ELISA test result is probably A FALSE positive Amtiretroviral meds are inappropriate for infants who have HIV Hiv + status is contraindication for measles mumps, n rubella immunizations

The infants mom is likely HIV +

A nurse is preparing to administer routine immunizations to a 6-year-old child. In addition to the diphtheria, tetanus, and pertussis (DTaP) vaccine; the measles, mumps, and rubella (MMR) vaccine; and the varicella vaccine, which of the following immunizations should the nurse plan to administer? A. Inactivated poliovirus vaccine (IPV) B. Haemophilus influenzae type B vaccine (Hib) C. Pneumococcal conjugate vaccine (PCV) D. Hepatitis B vaccine (HBV)

The nurse should plan to administer the fourth dose of the IPV vaccine btw 4 and 6 years of age. The first 3 doses are administered between 2 and 18 months of age

When a poison has been ingested by a child, what should the parents do first? a) Call the local poison control center. b) Induce vomiting. c) Get the child to an emergency facility. d) Administer an emetic.

a) Call the local poison control center. Not all poisons should be vomited. Strong acids, for example, could cause as much destruction of tissue being vomited as being swallowed. The poison control center will provide the most accurate information on the next steps for the client.

The nurse is reviewing the immunization schedule with the parent of a child who is HIV positive. What information should the nurse provide? Select all that apply. a. Pneumococcal vaccination can be given. b. The child should receive live vaccines only. c. The human papillomavirus vaccine should not be given. d. The varicella vaccine should not be given if the child is symptomatic. e. If the CD4 count is low, the measles, mumps, and rubella vaccine should not be given.

a,d,e

What would the nurse include in the teaching plan for parents and their child with a pruritic rash? Select all that apply. a) Making sure the child's hands are clean b) Keeping fingernails trimmed short c) Using warm baths to soothe the skin d) Encouraging pressure on the skin rather than scratching e) Using distraction to prevent scratching

abde

What is the major nursing concern for a child having an anaphylactic reaction? a. Identifying the offending allergen b. Ineffective breathing pattern c. Increased cardiac output d. Positioning to facilitate comfort

A 14-year-old girl arrives at the hospital in a comatose state. Her father, who found her comatose in her room, tells you that she has an opiate addiction. Which of the following would confirm that the coma was caused by opiate intoxication? a) One pupil dilated and the other normal b) Both pupils are dilated c) Both pupils are pinpoints d) One pupil dilated and the other deviated downward

c) Both pupils are pinpoints Observe the child's eyes for signs of dilated pupils from increased ICP. If both pupils are dilated, irreversible brainstem damage is suggested, although such a finding may also be present with poisoning with an atropine-like drug. Pinpoint pupils suggest barbiturate or opiate intoxication. One pupil dilated or the eye deviated downward or laterally more than the other suggests third cranial nerve compression or a tentorial tear (laceration of the membrane between the cerebellum and cerebrum) with herniation of the temporal lobe into the torn membrane.

A child has been brought to the pediatric clinic. The assessment reveals the child has a temperature of 100.9 F (38.3 C), as well as a rash that is pink and has raised areas. When the area is palpated the skin blanches. Which disease is most associated with these findings? a) Varicella zoster b) Rubella c) Rubeola d) Exanthem subitum

d is another name for roseola

The nurse is monitoring the CD4 count of an infant who has contracted HIV from the mother in utero. The nurse is concerned that treatment with antiretroviral therapy is not effective when noting which CD4 level? 1900/mm3 1700/mm3 1500/mm3 1300/mm3

1300 bc normal would be 1500

he nurse is providing discharge instructions to the family of a child who experienced an anaphylactic reaction. Which parental statements indicate accurate understanding of the action that histamine plays during this type of reaction? Select all that apply. 1. "Histamine releases IgE antibodies, which help to stop the reaction." 2. "Histamine causes smooth muscle contraction, which causes the wheezing." 3. "Histamine causes increased capillary permeability, which is what causes difficulty breath

2 3 Smooth muscle contraction causes the constriction of the bronchioles, which causes the wheezing and respiratory distress. Increased capillary permeability causes the plasma to leak into surrounding tissues, including the lungs, leading to pulmonary edema.

3. The nurse observes a red butterfly-shaped rash that spreads across the childs cheeks and nose. This assessment finding is characteristic of which condition? Systemic lupus erythematosus (SLE) Rheumatic fever. Kawasaki disease Anaphylactic reaction

ANS: A: A red flat or raised malar butterfly rash over the cheeks and bridge of the nose

Preventing complications for children confined to bed in traction includes: SATA A) Ensure that unaffected extremities are exercised to prevent contractures (shortening and hardening of muscles, tendons, or tissues leading to fixated and stiff joints) and atrophy may result from disuse of muscles. B) Assist child to exercise the unaffected joints and to use the unaffected extremity if this does not disrupt traction alignment. C) Place age-appropriate toys w/in child's reach D) Encourage visits

A) Ensure that unaffected extremities are exercised to prevent contractures (shortening and hardening of muscles, tendons, or tissues leading to fixated and stiff joints) and atrophy may result from disuse of muscles. B) Assist child to exercise the unaffected joints and to use the unaffected extremity if this does not disrupt traction alignment. C) Place age-appropriate toys w/in child's reach D) Encourage visits from friends E) Provide diversional activities such as drawing, coloring, or video games

Preventing Infection for the child with Myelonmeningocele includes: SATA A) Prevent rupture/leakage of CSF from the sac B) Use sterile saline-soaked nonadhesive gauze or antibiotic soaked gauze to keep sac moist C) Immediately report any seepage of clear fluid from lesion (could indicate an opening in sac/provide portal of entry for microorganisms) D) To keep infant warm, place infant in warmer or isolette to avoid use of blankets, which could exert too much pressure on the sac. E) Keep lesio

A) Prevent rupture/leakage of CSF from the sac B) Use sterile saline-soaked nonadhesive gauze or antibiotic soaked gauze to keep sac moist C) Immediately report any seepage of clear fluid from lesion (could indicate an opening in sac/provide portal of entry for microorganisms) D) To keep infant warm, place infant in warmer or isolette to avoid use of blankets, which could exert too much pressure on the sac. E) Keep lesion free of feces and urine to help avoid infection. F) Position infant so that urine and feces flow away from the sac (prone position, or place a folded towel under abdomen) to help prevent infection G) Place piece of plastic wrap below the meningocele can also prevent feces from coming into contact with lesion H) After surgery, position infant in the prone or side-lying position to allow the incision to heal.

What condition does the nurse recognize as an early sign of distributive shock? a. Hypotension b. Skin warm and flushed c. Oliguria d. Cold, clammy skin (septic shock)

ANS: B An early sign of distributive shock is extremities that are warm to the touch. The child with distributive shock may have hypothermia or hyperthermia. Hypotension is a late sign of all types of shock. Oliguria is a manifestation of hypovolemic shock. Cold, clammy skin is a late sign of septic shock, which is a type of distributive shock.

The nurse is planning care for the parents of an infant who died as the result of sudden infant death syndrome. Which collaborative interventions does the nurse plan for when providing care to these parents? Select all that apply. A) A psychosocial assessment B) A grief counselor referral C) A psychotherapist referral D) A visit from the chaplain E) A respiratory therapist referral

A, B, C, D

A nurse is caring for a child diagnosed with septic shock. He develops a dysrhythmia and hemodynamic instability. Endotracheal intubation is necessary. The physician feels that cardiac arrest may soon develop. What drug do you anticipate the physician will order? a. Atropine sulfate b. Epinephrine c. Sodium bicarbonate d. Inotropic agentsA nurse is caring for a child diagnosed with septic shock. He develops a dysrhythmia and hemodynamic instability. Endotracheal intubation is necessary. The phys

ANS: B Epinephrine is the drug of choice for the management of cardiac arrest, dysrhythmias, and hemodynamic instability. Atropine sulfate is used to treat symptomatic bradycardia. Sodium bicarbonate is given to treat severe acidosis associated with cardiac arrest. Inotropic agents are indicated for hypotension or poor peripheral circulation in a child.

An 8-year-old boy with a fractured forearm is to have a fiberglass cast applied. What information would the nurse include when teaching the child about the cast? A) The cast will take a day or two to dry completely. B) The edges will be covered with a soft material to prevent irritation. C) The child initially may experience a very warm feeling inside the cast. D) The child will need to keep his arm down at his side for 48 hours.

C. The child initially may experience a very warm feeling inside the cast. Rationale: A fiberglass cast usually takes only a few minutes to dry and will cause a very warm feeling inside the cast. Therefore, the nurse needs to warn the child that this will occur. Fiberglass casts usually have a soft fabric edge so they usually do not cause skin rubbing at the edges and don't require petaling. The child should be instructed to elevate his arm above the level of the heart for the first 48 hours. Reference: p. 1599

The nurse is caring for a patient hospitalized after a crushing chest injury, leading to development of blood surrounding the pericardium. The nurse notes tachycardia, tachypnea, muffled heart sounds, weakened peripheral pulses, and delayed capillary refill. Which form of shock is the patient likely experiencing? Septic shock Cardiogenic shock Distributive shock Hypovolemic shock

Cardiogenic shock Cardiogenic shock results when the patient's heart cannot pump effectively to meet the patient's metabolic needs. In the early stages of cardiogenic shock, the child is able to compensate with tachycardia, tachypnea, and vasoconstriction to maintain cardiac output.

A child has undergone surgery using steel bar placement to correct pectus excavatum. What position would the nurse instruct the parents to avoid? A) Semi-Fowler B) Supine C) High Fowler D) Side-lying

D. Side-lying Rationale: After surgery to correct pectus excavatum, the nurse would instruct the parents to avoid positioning the child on either side because this could disrupt the bar's position. Semi- or high Fowler's position and the supine position would be appropriate. Reference: p. 1612

The nurse is caring for a 10-year-old child in hypovolemic shock after a liver laceration from a bicycle injury. The nurse notes delayed capillary refill, lethargy, BP 74/48, and SpO2 88%. Which orders are most important for the nurse to complete first? Select all that apply. Administer IV antibiotics Give IV normal saline bolus Provide oxygen via nasal cannula Refer parents to hospital chaplain Perform range-of-motion exercises

Give IV normal saline bolus The nurse should administer IV fluid to replace fluid volume loss. Provide oxygen via nasal cannula The nurse should provide supplemental oxygen to help maintain the patient's tissue perfusion. Refer parents to hospital chaplain Referring patients to the hospital chaplain can help provide the emotional support necessary to cope with the child's condition. Perform range-of-motion exercises Range-of-motion exercises can help maintain muscle function in patients who are hospitalized, but it is not a priority action.

A child accidentally aspirated lighter fluid after playing with a lighter. Which roles does the nurse have in managing this patient? Select all that apply. The nurse will administer IV fluids. The nurse will utilize measures to prevent emesis. The nurse will administer oxygen and support ventilation. The nurse will administer chelators and anti-coagulant medications. The nurse will monitor vital signs and observe for signs of CNS depression.

The nurse will administer IV fluids. Administration of IV fluids supports circulatory function and prevents dehydration. Correct The nurse will utilize measures to prevent emesis. Prevention of emesis will decrease the likelihood of additional aspiration of the low-density hydrocarbons. Correct The nurse will administer oxygen and support ventilation. Administration of oxygen and support of ventilation are essential due to potential damage to the lungs. The nurse will monitor vital signs and observe for signs of CNS depression. Vital signs and changes in CNS function are critical. This should be assessed regularly.

The nurse is caring for a 7-year-old child in droplet precautions due to the diagnosis of pertussis. While visiting the child, which actions by the parents require the nurse to intervene? Select all that apply. a. The parents state, "We should postpone immunizing our 5-year-old since there has been contact with the infection.".. b The parents remove their personal protective equipment (PPE) at the door before exiting, then wash their hands. c The parents wear a respiratory mask when entering

ad All close contacts who are younger than 7 years of age and who are unimmunized or under immunized should have pertussis immunization initiated or the series completed according to the recommended dosing schedule. Fluids should be increased in order to help thin secretions and prevent dehydration during the infection. The parents are correct in removing their PPE at the door and washing their hands when leaving the room, and wearing a mask. All antibiotics should be finished in order to treat the infection adequately and prevent immunity to antibiotics.

The child has a meningocele and a neurogenic bladder. Which of the following topics should the nurse include in the teaching plan when educating the child and the child's caregivers? Select all that apply. a) Signs and symptoms of a urinary tract infection b) Different types of surgeries used to treat this condition c) The importance of antibiotic use to prevent urinary tract infections from occurring d) How and when to perform clean intermittent urinary catheterization e) How and when

• How and when to administer oxybutynin chloride • How and when to perform clean intermittent urinary catheterization • Signs and symptoms of a urinary tract infection • Different types of surgeries used to treat this condition

The nurse is obtaining a health history and assessment for a child being admitted who is suspected of having measles. What signs and symptoms does the nurse expect to find during the assessment? Select all that apply. a) Fever b) Upper respiratory infection symptoms c) Clear, fluid-filled vesicles d) Erythematous flushing e) Maculopapular rash that began on the face and has spread to the rest of the body

ABE e: Head->trunk->red->brown->very puritic

A 5-year-old child is in cardiopulmonary arrest, and the nursing staff is performing CPR. One of the nurses is doing compressions at the rate of 90 per minute. What action by the charge nurse is best? a. Take over compressions. b. Tell the nurse to speed up. c. Tell the nurse to slow down. d. Have the nurse compress more deeply.

ANS: B The rate of compressions for a child is at least 100/minute. The charge nurse tells the compressing nurse to speed up. If the compressor is fatigued, someone should take over, but that is not indicated in the question. The depth of compressions is not the issue.

Educating parents for children with muscular dystrophy includes which of the following? SATA A) Teach parents the use of positioning, exercises, orthoses, and adaptive equipment. B) Use of a wheelchair full time typically by age 12 C) Administer corticosteroids and calcium supplements as ordered D) Encourage at least minimal weight bearing in a standing position to promote improved circulation, healthier bones, and a straight spine. E) Perform passive stretching/strengthening exercises as rec

A) Teach parents the use of positioning, exercises, orthoses, and adaptive equipment. B) Use of a wheelchair full time typically by age 12 C) Administer corticosteroids and calcium supplements as ordered D) Encourage at least minimal weight bearing in a standing position to promote improved circulation, healthier bones, and a straight spine. E) Perform passive stretching/strengthening exercises as recommended by physical therapist. F) Position child for maximum chest expansion usually in upright position. G) Teach family deep-breathing exercises to strengthen/maintain respiratory muscles and encourage coughing to clear the airways. H) Develop a schedule for diversional activities that provide appropriate developmental stimulation but avoid overexertion or frustration. I) Administer antidepressants as ordered; managing depression may increase the child's desire to participate in activities and self-care.

A group of students are reviewing information about respiratory arrest in children. The students demonstrate understanding of this information when they identify which of the following as a common cause involving the upper airway? Select all answers that apply. A) Croup B) Asthma C) Pertussis D) Epiglottitis E) Pneumothorax

A,D

A child is brought to the clinic after tripping over a rock. The child states "I twisted my ankle" and is given a diagnosis of a sprain. What intervention is most important for the nurse to include in the discharge instructions for this child? A. For the first 24 hours apply ice for 20 minutes and remove for 60 minutes B. Bedrest with leg elevated for 36 hours C. May take an NSAID for pain as prescribed D. Use compression dressing for 72 hours

A. For the first 24 hours apply ice for 20 minutes and remove for 60 minutes Rationale: A sprain results from twisting or a turning motion of the affected body part. Usually that is an ankle or a knee. The tendons and ligaments stretch excessively and may tear slightly. Edema, bruising and the inability to bear weight are the most common symptoms. Interventions for care include RICE (rest, ice, compression, elevation), activity restrictions and/or splints or crutches. The most important intervention is the use of RICE. In this process the ice is applied for 20-30 minutes and then removed for 60 minutes. This can be done for up to 48 hours. This causes vasoconstriction to decrease the pain and swelling. Bedrest is not required, only limiting activities. Compression dressings, such as an elastic wrap are used, but there is no time limit as to how long they are needed. It depends upon the amount of swelling decreases. NSAIDs may be taken for pain if needed but the ice will produce a bett

An 8-year-old girl was diagnosed with a closed fracture of the radius at approximately 2 p.m. The fracture was reduced in the emergency department and her arm placed in a cast. At 11 p.m. her mother brings her back to the emergency department due to unrelenting pain that has not been relieved by the prescribed narcotics. Which action would be the priority? A) Notifying the doctor immediately B) Applying ice C) Elevating the arm D) Giving additional pain medication as ordered

A. Notifying the doctor immediately Rationale: The nurse should notify the doctor immediately because the girl's symptoms are the classic sign of compartment syndrome. Immediate treatment is required to prevent excessive swelling and to detect neurovascular compromise as quickly as possible. The ice should be removed and the arm brought below the level of the heart to facilitate whatever circulation is present. Giving additional pain medication will not help in this situation. Reference: p. 1640

The nurse is caring for a 10-year-old in traction. While performing a skin assessment, the nurse notices that the skin over the calcaneus appears slightly red and irritated. Which action would the nurse take first? A) Reposition the child's foot on a pressure-reducing device. B) Apply lotion to his foot to maintain skin integrity. C) Make sure the skin is clean and dry. D) Gently massage his foot to promote circulation.

A. Reposition the child's foot on a pressure-reducing device. Rationale: The nurse's first action is to remove continuous pressure from this area. The other actions can help decrease the potential for skin breakdown, but the pressure must be relieved first. Reference: p. 1590

The nurse is providing care to a child with a long-leg hip spica cast. What is the priority nursing diagnosis? A) Risk for impaired skin integrity due to cast and location B) Deficient knowledge related to cast care C) Risk for delayed development related to immobility D) Self-care deficit related to immobility

A. Risk for impaired skin integrity due to cast and location Rationale: Although deficient knowledge, risk for delayed development, and self-care deficit may be applicable, the child is at increased risk for skin breakdown due to the size of the cast and its location. In addition, the cast has an opening, which allows for elimination. Soiling of cast edges or leakage of urine or stool can lead to skin breakdown. Reference: p. 1597-1598

The school nurse has performed scoliosis screening. Based on this assessment, which children require the nurse to implement a referral to the healthcare provider? Select all that apply. A. The child with asymetric shoulder elevation B. The child with a limb length discrepancy C. The child with a lateral curve of the spine D. The child with a one-sided hump upon bending over E. The child who's sibling had scoliosis surgically corrected F. The child who has uneven balance

A. The child with asymetric shoulder elevation B. The child with a limb length discrepancy C. The child with a lateral curve of the spine D. The child with a one-sided hump upon bending over Rationale: Scoliosis is defined by a lateral curve of the spine greater than 10 degrees. This curve causes displacement of the ribs. The nurse would first inspect the back in a standing position and note any asymmetric shoulder elevation, the prominence of one scapula, an uneven curve at the waistline, or a rib hump on one side. While standing the nurse could also assess for leg length discrepancy and this could be measured. The nurse would then have the child bend over and observe for a pronounced hump on one side. The nurse should notify the parents and refer the child to the healthcare provider for evaluation if any of these symptoms are found. The sibling with a scoliosis repair would not be a concern unless it was known the family had a genetic diagnosis. Most scoliosis is idiopathic. Uneven

The nurse is caring for a child with HIV. The doctor will most likely order which test to monitor the child's progress? a. lymphocyte immunophenotyping T-cell quantification b. complement assay (C3 and C4)

A: shows progressive depletion of CD4 T lymphocytes in HIV B: is used for SLE

Physical examination on children with scoliosis include which of the following? SATA A) Observe child at rest, sitting, and standing for evidence of poor posture B) Inspect child's back in standing position. C) Note asymmetries such as shoulder elevation, prominence of scapula, uneven curve at waistline, or a rib hump on one side. D) Measure shoulder levels from floor to the acromioclavicular joints. E) With child bending forward, arms hanging freely, note asymmetry of back (pronounced hip o

ALL OF THE ABOVE! A) Observe child at rest, sitting, and standing for evidence of poor posture B) Inspect child's back in standing position. C) Note asymmetries such as shoulder elevation, prominence of scapula, uneven curve at waistline, or a rib hump on one side. D) Measure shoulder levels from floor to the acromioclavicular joints. E) With child bending forward, arms hanging freely, note asymmetry of back (pronounced hip on one side) F) Note leg-length discrepancy if present G) During neurological exam- balance, motor strength, sensation, and reflexes should all be normal.

Which is the most critical element of pediatric emergency care? a. Airway management b. Prevention of neurologic impairment c. Maintaining adequate circulation d. Supporting the child's family

ANS: A Airway management is the most critical element in pediatric emergency care. The other elements are important, but airway is always the priority.

What should be the emergency department nurse's next action when a 6-year-old child has a systolic blood pressure of 58 mm Hg? a. Alert the physician about the systolic blood pressure. b. Comfort the child and assess respiratory rate. c. Assess the child's responsiveness to the environment. d. Alert the physician that the child may need intravenous fluids.

ANS: A Hypotension is a late sign of shock in children. The lower limit for systolic blood pressure for a child more than 1 year old is 70 mm Hg plus two times the child's age in years. A systolic blood pressure of 58 mm Hg calls for immediate action. The nurse should be direct in relaying the child's condition to the physician. Comforting the child and assessing respiratory rate are not priorities. Assessing the child's responsiveness is included in a neurologic assessment. It does not address the systolic blood pressure of 58 mm Hg. Although this child most likely requires intravenous fluids, the physician must be apprised of the systolic blood pressure so that appropriate intervention can be initiated.

A nurse is working triage in the emergency department. A school-age child is brought in for treatment, carried by her mother. What assessment takes priority? a. Assess airway patency. b. Obtain a health history. c. Obtain a full set of vital signs. d. Evaluate for pain.

ANS: A The primary assessment consists of assessing the child's airway, breathing, circulation, level of consciousness, and exposure (ABCDEs). Airway always comes first. History, vital signs, and pain assessment are all part of the secondary survey

A 2-year-old child is in the playroom. The nurse observes him picking up a small toy and putting it in his mouth. The child begins to choke. He is unable to speak. Which intervention is appropriate? a. Heimlich maneuver b. Abdominal thrusts c. Five back blows d. Five chest thrusts

ANS: A To clear a foreign body from the airway, the American Heart Association recommends the Heimlich maneuver for a conscious child older than 1 year of age. Abdominal thrusts are indicated when the child is unconscious. Back blows are indicated for an infant with an obstructed airway. Chest thrusts follow back blows for the infant with an obstructed airway.

Which intervention is appropriate for a hospitalized child who has crops of lesions on the trunk that appear as a macular rash and vesicles? a. Place the child in strict isolation; airborne and contact precautions. b. Continue to practice Standard Precautions. c. Pregnant women should avoid contact with the child. d. Screen visitors for immunity to measles.

ANS: A Feedback A The child's skin lesions are characteristic of varicella. Varicella is transmitted through direct contact, droplets, and airborne particles. In the hospital setting, children with varicella should be placed in strict isolation, and on Contact and Airborne Precautions

An emergency department nurse is making a general appearance assessment on a preschool child just admitted to the emergency department. Which general assessment findings indicate the child "looks bad"? (Select all that apply.) a. Color pale b. Capillary refill less than 2 seconds c. Unwilling to separate from parents d. Cold extremities e. Lethargic

ANS: A, D, E Signs of a child "looking bad" on a general appearance assessment include pale skin, cold extremities, and lethargy. A capillary refill of less than 2 seconds is a "good sign" as well as a child who is unwilling to separate from parents (separation anxiety, expected).

A child has been brought to the emergency department with carbon monoxide poisoning. After the child is stabilized, what action by the nurse is best? a. Have all family members tested for carbon monoxide poisoning. b. Help family determine source of the carbon monoxide. c. Prepare to administer syrup of ipecac. d. Notify social services about the child's condition.

ANS: B After the child has been stabilized, the nurse should help the family brainstorm about the source of the carbon monoxide poisoning, which must be eliminated before the child goes home. The nurse may need to offer assistance to find companies that can help in this search or notify the local fire department for assistance. There is no indication that other family members need to be tested, but those who show signs of carbon monoxide poisoning should be. Syrup of ipecac is no longer used after an oral ingestion. Social services may or may not need to be notified.

Which observations made by an emergency department nurse raises the suspicion that a 3-year-old child has been maltreated? a. The parents are extremely calm in the emergency department. b. The injury is unusual for a child of that age. c. The child does not remember how he got hurt. d. The child was doing something unsafe when the injury occurred.

ANS: B An injury that is rarely found in children or is inconsistent with the age and condition of the child should raise suspicion of child maltreatment. The nurse should observe the parents' reaction to the child but must keep in mind that people behave very differently depending on culture, ethnicity, experience, and psychological makeup. The child may not remember what happened as a result of the injury itself, for example, sustaining a concussion. Also, a 3-year-old child may not be a reliable historian. The fact that the child was not supervised might be an area for health teaching. The nurse needs to gather more information to determine whether the parents have been negligent in the care of their child.

A child is brought to the emergency department. When he is called to triage, which vital sign should be measured first? a. Temperature b. Heart rate c. Respiratory rate d. Blood pressure

ANS: C When taking children's vital signs, the nurse observes the respiratory rate first. Temperature and blood pressure should be measured after respiratory and heart rate because it can be upsetting for children. Heart rate is measured after respiratory rate.

The nurse observes abdominal breathing in a 2-year-old child. What does this finding indicate? a. Imminent respiratory failure b. Hypoxia c. Normal respiration d. Airway obstruction

ANS: C Young children normally exhibit abdominal breathing. When measuring respiratory rate, the nurse should observe the rise and fall of the abdomen. A very slow respiration rate is an indicator of respiratory failure. Nasal flaring with inspiration and grunting on expiration occurs when hypoxia is present. The child with an airway obstruction will use accessory muscles to breathe.

Why will it be necessary for the nurse to be very supportive of parents' attempts to feed the infant with recently repaired myelomeningocele? a) The infant will have a poor sucking reflex. b) Pain will interfere with the feeding process. c) Assuming the usual feeding position will be difficult. d) Nausea and vomiting often follow repair of the cystic mass.

Assuming the usual feeding position will be difficult.

A home care nurse provides health education to parents regarding the care of their toddler. Which of the following precautions should the nurse suggest the parents take to protect the toddler from drowning? a) Instruct the toddler not to go near the pool. b) Teach the child that water is dangerous. c) Avoid unattended baths for the toddler. d) Provide only partial baths to the toddler.

Avoid unattended baths for the toddler.

The nurse is assessing an 11-year-old girl with scoliosis. What would the nurse expect to find? Select all answers that apply. A) Complaints of severe back pain B) Asymmetric shoulder elevation C) Even curve at the waistline D) Pronounced one-sided hump on bending over E) Diminished motor function F) Hyperactive reflexes

B) Asymmetric shoulder elevation D) Pronounced one-sided hump on bending over Assessment findings associated with scoliosis include asymmetric shoulder elevation, uneven curve at the waistline, rib hump on one side, and a pronounced hump on one side when bending over. Typically, only mild back discomfort is found and balance, motor strength, sensation, and reflexes are normal.

A 10-year-old girl is brought to the emergency department by her father after tripping over a rock while running in the yard. She tells the nurse, "I think I twisted my ankle." When assessing the child, what would the nurse most likely assess? A) Bruising B) Edema C) Limited range of motion D) Absent pulse

B) Edema The girl is describing a sprain, which is frequently accompanied by edema. Bruising may or may not be present. The nurse should not attempt to perform passive range of motion on the affected body part. A pulse should be present; if one is not, neurovascular compromise is present.

An adolescent client has just been diagnosed with systemic lupus erythematosus (SLE). Following client education about the disease, which statement by the client demonstrates understanding of SLE? A. "SLE is a rheumatic disease that mostly affects my joints." B. "SLE is an autoimmune disorder that I will always have, with times of flare- ups and times of minimal to no symptoms." C. "If my SLE has been found early enough in the disease process, there is a good chance that medication can cure it."

B. "SLE is an autoimmune disorder that I will always have, with times of flare- ups and times of minimal to no symptoms."

A nurse is providing instructions to the parents of a 3-month-old with developmental dysplasia of the hip who is being treated with a Pavlik harness. Which statements by the parents demonstrate understanding of the instructions? Select all that apply. A) "We need to adjust the straps so that they are snug but not too tight." B) "We should change her diaper without taking her out of the harness." C) "We need to check the area behind her knees for redness and irritation." D) "We need to send the

B. "We should change the diaper without taking our infant out of the harness." C. "We need to check the area behind our infant's knees for redness and irritation." E. "We need to call the health care provider if our infant is not able to actively kick the legs." Rationale: Instructions related to use of a Pavlik harness include changing the child's diaper while in the harness; checking the areas behind the knees and diaper area for redness, irritation, or breakdown; and calling the health care provider if the child is unable to actively kick the legs. The straps are not to be adjusted without checking with the health care provider first. The harness can be washed with mild detergent by hand and air dried. A hair dryer can be used to dry the harness but only if the air fluffing setting (no heat) is used. Reference: p. 1617

When teaching a group of students about the skeletal development in children, what information would the instructor include? A) The growth plate is made up of the epiphysis. B) A young child's bones commonly bend instead of break with an injury. C) The infant's skeleton has undergone complete ossification by birth. D) Children's bones have a thin periosteum and limited blood supply.

B. A young child's bones commonly bend instead of break with an injury. Rationale: A young child's bones are more flexible and more porous with a lower mineral count than adults. Thus, bones will often bend rather than break when an injury occurs. The growth plate is composed of the epiphysis and physis. The infant's skeleton is not fully ossified at birth. Children's bones have a thick periosteum and an abundant blood supply. Reference: p. 1589

What information would the nurse include in the preoperative plan of care for an infant with myelomeningocele? A) Positioning supine with a pillow under the buttocks B) Covering the sac with saline-soaked nonadhesive gauze C) Wrapping the infant snugly in a blanket D) Applying a diaper to prevent fecal soiling of the sac

B. Covering the sac with saline-soaked non adhesive gauze Rationale: For the infant with a myelomeningocele, saline-soaked non adhesive gauze or antibiotic-soaked gauze is used to keep the sac moist. The infant is positioned prone, with a folded towel under the abdomen, so that the urine and feces flow away from the sac. A warmer or isolette is used to keep the infant warm. Blankets are avoided because they could place excess pressure on the sac. Diapering may be contraindicated to avoid placing pressure on the sac. Reference: p. 1608

A nurse is preparing a presentation for a parent group about musculoskeletal injuries. When describing a child's risk for this type of injury, the nurse integrates knowledge that bone growth occurs primarily in which area? A) Growth plate B) Epiphysis C) Physis D) Metaphysis

B. Epiphysis Rationale: Growth of the bones occurs primarily in the epiphyseal region. This area is vulnerable and structurally weak. Traumatic force applied to the epiphysis during injury may result in fracture in that area of the bone. The growth plate refers to the combination of the epiphysis, the end of a long bone, and the physis, a cartilaginous area between the epiphysis and the metaphysis. Reference: p. 1589

The nurse is assessing a newborn who was delivered after a prolonged labor due to an abnormal presentation. The newborn sustained a cranial nerve injury. The nurse would most likely expect to assess deficits related to which cranial nerve? A) Optic B) Facial C) Acoustic D) Trigeminal

B. Facial Rationale: The most common cranial nerve injury occurring during birth trauma involves facial nerve palsy. The optic, acoustic, and trigeminal nerves are not typically injured during birth trauma. Reference: p. 1592

The nurse is assessing a child with a possible fracture. What would the nurse identify as the most reliable indicator? A) Lack of spontaneous movement B) Point tenderness C) Bruising D) Inability to bear weight

B. Point tenderness Rationale: Point tenderness is one of the most reliable indicators of a fracture in a child. Neglect of an extremity, inability to bear weight, bruising, erythema, and pain may be present, but these findings can also suggest other conditions. Reference: p. 1593

The nurse is teaching a group of students about myelinization in a child. Which statement by the students indicates that the teaching was successful? A) Myelinization is completed by 4 years of age. B) The process occurs in a head-to-toe fashion. C) The speed of nerve impulses slows as myelinization occurs. D) Nerve impulses become less specific in focus with myelinization.

B. The process occurs in a head-to-toe fashion. Rationale: Myelinization occurs in a cephalocaudal, proximodistal manner and is completed by 2 years of age. As myelinization proceeds, nerve impulses become faster and more accurate. Reference: p. 1588

A nursing instructor is preparing for a class discussion on spinal muscular atrophy (SMA). When describing type 2 SMA, which information would the instructor include? Select all answers that apply. A)Onset before 6 months of age B) Weakness most severe in shoulders and hips C) Difficulty with swallowing D) Slowly progressing condition E) Genetic disease with autosomal recessive inheritance

B. Weakness most severe in shoulders and hips D. Slowly progressing condition E) Genetic disease with autosomal recessive inheritance Rationale: Any type of spinal muscular atrophy is a genetic motor neuron disease due to autosomal recessive inheritance. Type 2 SMA usually occurs between 6 and 18 months of age, with weakness that is most severe in the shoulders, hips, thighs, and upper back. It is slower in progression than type 1. Survival into adulthood is common if respiratory status is maintained appropriately. Type 1 SMA occurs before birth to 6 months of age and the child usually has difficulty swallowing, sucking, and breathing. Reference: p. 1624

A nurse is preparing a program for a group of parents about injury prevention. What would the nurse include as an important contributing factor for cervical spine injury in a child? A) Exposure to teratogens while in utero B) Immaturity of the central nervous system C) Increased mobility of the spine D) Incomplete myelinization

C) Increased mobility of the spine Rationale: Compared to the adult, a child's spine is very mobile, especially in the cervical spine region, resulting in a higher risk for cervical spine injury. Exposure to teratogens in utero may lead to altered growth and development of the brain or spinal cord. Immaturity of the central nervous system places the infant at risk for insults that may result in delayed motor skill attainment or cerebral palsy. Incomplete myelinization reflects the lack of motor control. Reference: p. 1588

The nurse is caring for a 13-year-old boy in traction prior to surgery for slipped capital femoral epiphysis. He has been in an acute care setting for 2 weeks and will require an additional 10 days in the hospital. He is complaining that he feels isolated and is resisting further treatment. Which response by the nurse would be most appropriate? A) "I know it is boring, but you must remain immobile for 2 more weeks." B) "If there are no complications, you only have 2 more weeks here." C) "Let's

C. "Let's come up with things for you to do and see if your friends can come visit." Rationale: After 2 weeks in traction, an adolescent can become easily bored and isolated from usual peer interaction. The most helpful intervention would be to engage the help of the client to develop a list of books, games, movies, and other activities the client would enjoy. The nurse should also encourage visitation and phone calls from friends. Telling the client friends can come spend the night in the hospital is not most appropriate as minors are not typically encouraged to stay overnight. Telling the adolescent the condition will worsen if the client resists treatment is threatening and inappropriate. Reference: p. 1590-1591

The nurse is caring for an active 14-year-old boy who has recently been diagnosed with scoliosis. He is dismayed that a "jock" like himself could have this condition, and is afraid it will impact his spot on the water polo team. Which response by the nurse would best address the boy's concerns? A) "If you wear your brace properly, you may not need surgery." B) "The good news is that you have very minimal curvature of your spine." C) "Let's talk to another boy with scoliosis, who is winning trop

C. "Let's talk to another boy with scoliosis, who is winning trophies for his swim team." Rationale: Because this boy is concerned about limiting his participation in water polo and perceives scoliosis as a disease that does not affect "jocks," putting the child in contact with someone with the same problem would be helpful. Telling the adolescent about not needing surgery if he wears his brace or that his curvature is minimal may or may not be true in his case and thus would be false reassurance. Although these suggestions and also the suggestion about talking to the doctor about treatment options could be helpful by engaging his input in the treatment, these do not address his specific concerns about his body image. Reference: p. 1635-1636

The nurse is caring for a 2-year-old girl in a bilateral brace with tibia vara. Her parents are upset by their toddler's limited mobility. Which response by the nurse would be most appropriate? A) "If you don't follow the therapy, your daughter could develop severe bowing of her legs." B) "It's important to use the brace or your daughter may need surgery." C) "You are doing a great job. Let's put our heads together on how to keep her busy." D) "You'll need to accept this since treatment may be

C. "You are doing a great job. Let's put our heads together on how to keep her busy." Rationale: The nurse should support the parents by encouraging and praising their compliance with bracing. It is also important to work with the parents to help develop age-appropriate diversions to promote normal growth and development. Telling the parents that they must be compliant or their daughter could develop severe bowing does not teach, does not offer solutions, and does not address the parents' concerns. Telling the parents that they must simply accept this and that the treatment could take years is likely to upset them and does not teach. It also does not address their concerns. Reference: p. 1619

A school-aged child is recovering from varicella. The parent calls the school nurse and states, "my child is feeling much better" and asks when the child can return to school. What information does the nurse provide the parent? a. "Your child may return to school when all of the lesions have crusted over." b. "Your child may return to school when a health care provider has given written permission." c."Your child may return to school when free of any lesions." d."Your child may return to scho

A 4-year-old girl has been admitted to the emergency department after accidently ingesting a cleaning product. Which treatment is most likely appropriate in the immediate treatment of the girl's poisoning? a) Gastric lavage b) Administration of activated charcoal c) Inducing vomiting d) Intravenous rehydration

b) Administration of activated charcoal Activated charcoal is the most common treatment for many poisonings and is more effective and safe than induced vomiting or gastric lavage. Rehydration is likely necessary, but this does not actively treat the girl's poisoning.

The nurse is caring for an 11-year-old presenting with tenderness in the shoulder. He is the pitcher for his baseball team and reports shoulder pain with active internal rotation but is able to continue past the pain with full range of motion. Based on these reported symptoms, the nurse is aware that the disorder is most likely to be:

epiphysiolysis of the proximal humerus. Epiphysiolysis of the proximal humerus is an overuse disorder that occurs with rigorous upper extremity activity such as pitching and causes tenderness in the shoulder. Osgood-Schlatter disease causes knee pain and painful swelling or prominence of the anterior portion of the tibial tubercle. Sever disease causes pain over the posterior aspect of the calcaneus. Epiphysiolysis of the distal radius is an overuse disorder that causes wrist pain. It is common in gymnasts.

Peds: Immunity & Infection, Peds- Chapter 44, Mobility, Neuromuscular Disorder peds, Peds: Shock & trauma, SIDS, Emergencies

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