Psych Preschooler exam 3
A nurse is obtaining the history of a child, age 4. Which question best evaluates the child's developmental status? "Can you draw your school?" "Do you like your brother?" "Can you ride a tricycle?" "What's your mommy's first name?"
"Can you ride a tricycle?" Explanation: Asking the child if he can ride a tricycle best helps evaluate the child's developmental status because a 4-year-old child should be able to perform such an action. A child may draw stick-like figures, but wouldn't be able to draw complicated pictures such as a school. A 4-year-old child may not be aware of his feelings, so asking whether he likes his brother wouldn't be appropriate. A 4-year-old child may not know his mother's first name, so asking it wouldn't evaluate developmental status.
Which measure would be best to help prepare a preschool-aged child for an injection? Help the child to imagine she is in a different place. Give the child a pounding board to encourage expressions of anger. Give the child a play syringe and a bandage to give a doll injections. Have an older child explain that shots do not hurt.
Give the child a play syringe and a bandage to give a doll injections. Explanation: Allowing the preschool-aged child to give play injections can help to prepare the child to receive an injection. Preschoolers have a limited vocabulary and express their feelings through play. They also use play to help cope with stress.Having an older child explain that shots do not hurt is inappropriate because preschool-aged children know that injections hurt. Misrepresenting would instill mistrust in the child.Imagery is appropriate with an older child during an injection.
hemarthrosis
blood within a joint
Hypoxia
deficiency in the amount of oxygen reaching the tissues
When instilling ear drops on a 2-year-old child, the nurse should pull the pinna in which directions? down and slightly forward down and back up and forward up and back
down and back Explanation: When instilling ear drops on child younger than age 3 years, the nurse should pull the pinna down and back. This helps open the ear canal to ensure drops reach the tympanic membrane. For an older child, the nurse should pull the pinna up and back.
A parent of a child with hemophilia states that she worries whenever the child has a bump or cut. The nurse should explain that after the area is cleansed, the wound should be treated by applying which measure? a tourniquet above the injured area a wet-to-dry dressing warm, moist compresses gentle pressure
gentle pressure Explanation: In children with hemophilia (an inherited bleeding disorder), a bump or cut can cause serious bleeding. After the injured area is cleansed, gentle pressure should be applied to allow clot formation, which will help stop the bleeding. In addition, the area should be immobilized and elevated.Cold applications, instead of warm moist compresses, are commonly used to promote vasoconstriction and help control the bleeding.A tourniquet should not be used because of the high risk of tissue hypoxia and resulting necrosis.Wet-to-dry dressings should be avoided because they could be irritating to the area.
A parent tells the nurse that the parent's preschool-aged child with spina bifida sneezes and gets a rash when playing with brightly colored balloons, and that recently the child had an allergic reaction after eating kiwi fruit and bananas. Based on the parent's report, the nurse suspects that the child may have an allergy to? kiwi fruit. bananas. color dyes. latex.
latex. Children with spina bifida commonly develop an allergy to latex and shouldn't be exposed to it Explanation: If a child is sensitive to bananas, kiwi fruit, and chestnuts, she's likely to be allergic to latex. . Some children are allergic to dyes in foods and other products, but dyes aren't a factor in a latex allergy.
A 4-year-old child is admitted to the hospital for surgery. The nurse applies interventions to address what major stressor for a child of this age? loss of control fear of pain separation from family fear of bodily injury
separation from family Explanation: For infants through preschoolers, separation from the family is the major stressor posed by hospitalization. To minimize the effects of separation, the nurse may suggest that a family member stay with the child as much as possible. Reducing this stressor may help a young child withstand other possible stressors of hospitalization, such as fear of bodily injury, loss of control, and fear of pain
A 4-year-old child is admitted for a cardiac catheterization. Which is most important to include as the nurse teaches this child about the cardiac catheterization? the parents a catheter that will be inserted into the artery a plastic model of the heart other children undergoing a catheterization
the parents Explanation: The most important aspect of teaching a preschooler is to have the family members there for support. Preschoolers are able to understand information that is individualized to their level. Including a plastic model of the heart and a catheter as part of the preoperative preparation may be helpful. The other family members will understand the heart model and catheter better than the preschooler will.
When assessing a child with muscular dystrophy, the nurse expects which finding? pain waddling gait limited range of motion (ROM) joint swelling
waddling gait Explanation: A waddling, wide-based gait is a sign of muscular dystrophy. A nurse wouldn't expect pain, joint swelling, and limited ROM because they are rare with this disease.
The nurse is discussing postoperative care with the parents and their 5-year-old child who is going to have a tonsillectomy and adenoidectomy. The nurse should emphasize which measures? ability to have ice cream right after surgery need for frequent coughing use of aspirin for pain, as needed use of sips of clear liquids when awake and alert
use of sips of clear liquids when awake and alert Explanation: Once the child is alert, he may have sips of clear liquids. Once the child is able to tolerate clear liquids, he can progress to a full liquid diet that would include ice cream. Eating enhances the blood supply to the throat, which promotes rapid healing. Coughing is discouraged because it disrupts the suture line and may cause bleeding.Aspirin is contraindicated because it interferes with platelet aggregation and promotes bleeding.
An initial bolus of crystalloid fluid replacement for a child in shock is 20 ml/kg. The nurse is preparing to administer how many milliliters of fluid for a child weighing 30 kg? 900 mL 600 mL 300 mL 700 mL
600 mL
A child with hemophilia is hospitalized after falling. Now the child complains of severe pain in the left wrist. What should the nurse do first? Perform passive range-of-motion (ROM) exercises on the wrist. Elevate the affected arm and apply ice to the injury site. Notify the health care provider. Massage the wrist and apply a warm compress.
Elevate the affected arm and apply ice to the injury site. Explanation: Severe joint pain in a child with hemophilia indicates bleeding; therefore, the nurse should first elevate the affected extremity and apply ice to the injury site to promote vasoconstriction. ROM exercises may worsen discomfort and bleeding. Massage and warm compresses also may increase bleeding. The nurse should notify the health care provider only after taking measures to stop the bleeding.
Which concept should the nurse incorporate into the plan of care for a 4-year-old child to psychologically prepare the child for cardiac catheterization? Preschoolers are unable to understand the procedure. Little psychological preparation can be given to preschoolers. Preparation is a joint responsibility of the primary care provider, parents, and nurse. Anxiety decreases when a preschooler is protected from learning about unpleasant events.
Preparation is a joint responsibility of the primary care provider, parents, and nurse. Explanation: For a preschooler, psychological preparation for events is the joint responsibility of the primary care provider, parents, and nurse, each playing a major role in caring for the child and meeting specific needs.Overprotecting a preschooler from unpleasant events can increase anxiety rather than decrease it because the child needs to learn how to cope with stress.Preschoolers are ready to understand information that is individualized to their level.Little psychological preparation can be given to infants and toddlers.
A nurse is deciding whether to report a suspected case of child abuse. Which criterion is the most important for the nurse to consider? inappropriate parental concern for the degree of injury absence of parents to question about the injury incompatibility between the child's history and the injury inappropriate response of the child to the injury
incompatibility between the child's history and the injury Explanation: Incompatibility between the history and the injury is the most important criterion on which to base the decision to report suspected child abuse. For example, the child may have a skull fracture but the parents state that the child fell off of the sofa. The other criteria also may suggest child abuse but are less reliable indicators.
When assessing a client with hemophilia, the nurse identifies which condition as an early sign of hemarthrosis? hematuria active bleeding decreased peripheral pulses joint stiffness
joint stiffness Explanation: Joint stiffness is an early sign of hemarthrosis. Hemarthrosis doesn't affect pulses and bleeding into the joints can't be observed directly. Hematuria is incorrect because this sign indicates bleeding in the urinary tract.
The nurse is calculating drug dosages for a child. What is the most important measurement for the nurse to consider? weight in kilograms body mass index body surface area height
weight in kilograms Explanation: To calculate drug dosages for a child, most formulas involve the child's weight in kilograms. Therefore, this measurement is most important for the nurse to consider. A second recommended method involves the child's body surface area, but this would be calculated by the health care provider. Body mass index and height are not typically considered when calculating drug dosages.
A parent of a child with sickle cell anemia confides in the nurse that the parent feels guilty about letting the child run and play with the neighborhood children and that if the parent had been a better parent, the child wouldn't have suffered a sickle cell crisis. Which response would be most appropriate? "Tell me more about how you feel." "You shouldn't be so protective." "But you know that children with sickle cell anemia often have crises." "The child is just fine now. Don't worry."
"Tell me more about how you feel." Explanation: Many parents feel guilty when their child is sick. Therefore, it's most appropriate to encourage parents to talk more about their feelings because doing so provides support and helps to develop a therapeutic relationship. Giving a stereotyped answer, such as "Don't worry," shows a lack of interest in what the parent is feeling. Commenting on the course of the disease doesn't address the parent's feelings. Being judgmental or offering an opinion can also block therapeutic communication by inhibiting the parent from discussing feelings and developing solutions.
The nurse is caring for a lethargic but arousable preschooler who is a victim of a near-drowning accident. What should the nurse do first? Start an IV infusion. Prepare for intubation. Administer oxygen. Institute rewarming.
Administer oxygen. Explanation: Near-drowning victims typically suffer hypoxia and mixed acidosis. The priority is to restore oxygenation and prevent further hypoxia. Here, the client has blunted sensorium, but is not unconscious; therefore, delivery of supplemental oxygen with a mask is appropriate. Warming protocols and fluid resuscitation will most likely be needed to help correct acidosis, but these interventions are secondary to oxygen administration. Intubation is required if the child is comatose, shows signs of airway compromise, or does not respond adequately to more conservative therapies.
During the acute stage of meningitis, a 3-year-old child is restless and irritable. Which intervention would be most appropriate to institute? performing treatments quickly keeping extraneous noise to a minimum allowing the child to play in the bathtub limiting conversation with the child
keeping extraneous noise to a minimum Explanation: A child in the acute stage of meningitis is irritable and hypersensitive to loud noise and light. Therefore, extraneous noise should be minimized and bright lights avoided as much as possible. There is no need to limit conversations with the child. However, the nurse should speak in a calm, gentle, reassuring voice. The child needs gentle and calm bathing. Because of the acuteness of the infection, sponge baths would be more appropriate than tub baths. Although treatments need to be completed as quickly as possible to prevent overstressing the child, they should be performed carefully and at a pace that avoids sudden movements to prevent startling the child and subsequently increasing intracranial pressure.
A child with sickle cell anemia is admitted to the healthcare facility in vaso-occlusive crisis after developing a fever and joint pain. What is the nurse's highest priority when caring for this child? administering antipyretics as ordered providing fluids maintaining protective isolation applying cool compresses to affected joints
providing fluids Explanation: During a vaso-occlusive crisis, sickle-shaped red blood cells (RBCs) clump together and obstruct blood vessels, causing ischemia and tissue damage. Therefore, the highest priority is providing I.V. and oral fluids, which promotes hemodilution and aids the free flow of RBCs through blood vessels. The client must be kept away from known infection sources but doesn't require protective isolation. Warm compresses may be applied to painful joints to promote comfort; cool compresses would cause vasoconstriction, which exacerbates sickling. Antipyretics may be administered to reduce fever but don't play a crucial role in resolving the crisis.
muscular dystrophy (MD)
hereditary condition causing progressive degeneration of skeletal muscles
A mother who is visibly upset tells the nurse she wants to take her child home because the child is dying. What would be the nurse's best response? "Can you tell me why you want to take your child home now?" "I know how you feel, but the medication will make your child feel better." "I can't let you do this without calling your health care provider (HCP) first." "I can imagine how hard this is for you, but it's not what is best for the child."
"Can you tell me why you want to take your child home now?" Explanation: With a parent who is visibly upset, it is best to try to determine the cause. Therefore, asking the mother about why she wants to take the child home can provide insight into the problem. The nurse cannot stop the mother from taking her child home. However, the HCP should be notified about the mother's decision and efforts are needed to explain the ramifications of taking the child home. It is inappropriate for the nurse to say "I know how you feel" or "I can imagine how hard this is" unless the nurse has had the same experience.
The nurse is teaching the parents of a young child who had surgery to form a colostomy what to expect when the child goes home. The parents express concern about the appearance of the stoma. Which of the following is the most appropriate response by the nurse? "Children have a difficult time accepting a stoma." "The stoma will change to a flesh color after three months." "The size of the new stoma should stabilize in 6-8 weeks." "You can use a skin barrier to cover the appearance of the stoma."
"The size of the new stoma should stabilize in 6-8 weeks." Explanation: Stomas in children will change in size over a period of 6-8 weeks. The stoma may appear healthy and function in less time, but it is not stable. The stoma will not change to a flesh color, but will be a dark pink or red color. Skin barrier is used to help fit an appliance to the stoma, not to hide the stoma. Children generally have an easier time accepting a stoma because they grow up with it.
The nurse is inspecting the child's throat (see figure). How should the nurse proceed with the throat exam? Remove the tongue blade from the child's hands after he has experienced what it feels like in his mouth. Ask the child to hold the tongue blade with both hands in his lap while the nurse uses another tongue blade. Guide the tongue blade while the child is holding it to depress the tongue to visualize the throat. Have the parent hold the child with arms restrained.
Guide the tongue blade while the child is holding it to depress the tongue to visualize the throat. Explanation: If the child does not stick out his tongue so the nurse can visualize the throat, it is appropriate to use a tongue blade. Having the child participate by holding the tongue blade while the nurse guides it to facilitate visualization of the throat is appropriate technique. It is not useful to remove the tongue blade or have the child hold it because the nurse will need to use the tongue blade to depress the tongue. It is preferable to engage the child's cooperation before asking the parent to restrain the child.
A preschool child immobilized in a hip spica cast has trouble breathing after meals. Which action would be best? Give the child a laxative after meals. Teach the child pursed-lip breathing. Offer the child small feedings several times a day. Encourage the child to drink more between meals.
Offer the child small feedings several times a day. Explanation: A hip spica cast extends up over the abdomen. Because the abdomen is in a fixed space, abdominal distention secondary to eating pushes the abdominal contents against the diaphragm, resulting in decreased chest expansion and subsequent possible respiratory distress. The child's problems are associated with meals, so offering small, frequent meals provides nutritional support while minimizing distention. Encouraging increased drinking would increase abdominal distention, thus increasing the child's respiratory distress. Pursed-lip breathing would prevent air trapping, not decreased chest expansion.. Administering a laxative with meals would not relieve the decreased chest expansion.
The emergency department nurse is obtaining a history from the parents of a 4-year-old child. Multiple bruises and abrasions are noted. The nurse highly suspects child abuse based on which finding? The parents appear unkempt and have low socioeconomic status. The history is consistent with the child's injuries. The stories about the accident or injury from the parents conflict. The parents have a flat affect and appear emotionally detached from the child.
The stories about the accident or injury from the parents conflict. Explanation: Conflicting stories about the accident or injury from the parents is a warning sign of abuse. A history consistent with the child's injuries, an unkempt appearance, and low socioeconomic status are not indicators of expected or potential abuse. While the emotional response of the parents may be concerning, it is not a warning sign of abuse.
A child with tetralogy of Fallot and a history of severe hypoxic episodes is to be admitted to the pediatric unit. What would be most important for the nurse to have at the bedside? blood pressure cuff and stethoscope oxygen tubing and flow meter plugged in morphine sulfate in a syringe ready to administer suction tubing and equipment
oxygen tubing and flow meter plugged in Explanation: Because the child has a history of severe hypoxic episodes, having oxygen readily available at the bedside is most important. Should the child experience another hypoxic episode, oxygen could be administered easily and quickly. Although morphine causes peripheral dilation, which causes the blood to remain in the periphery, decreasing system volume and oxygen administration is the priority. Also morphine is a controlled substance and must be stored securely at all times. Typically, a child with tetralogy of Fallot with episodes of hypoxia does not require suctioning.
A healthcare provider diagnoses leukemia in a 4-year-old child who complains of being tired and sleeps most of the day. Which nursing diagnosis should the nurse use to best reflect this physiologic effect of leukemia? activity intolerance related to lack of normal blood cell production ineffective airway clearance related to inability to have an effective cough ineffective cerebral tissue perfusion related to central nervous system infiltration by leukemic cells imbalanced nutrition: less than body requirements related to decreased appetite
activity intolerance related to lack of normal blood cell production Explanation: A nursing diagnosis of activity intolerance related to abnormal blood cell production reflects the nurse's understanding of leukemia's physiologic effects; a child with leukemia may experience weakness and hypoxia as a result of the anemia commonly associated with the disease. The nurse's findings don't support the other diagnoses of ineffective airway clearance related to the inability to have an effective cough, imbalanced nutrition: less than body requirements related to decreased appetite, or ineffective cerebral tissue perfusion related to central nervous system infiltration by leukemic cells.
A 4-year-old child with suspected leukemia is admitted to the hospital for diagnosis and treatment. What tests will the nurse teach the parents are used in diagnosing leukemia? Select all that apply. bone marrow aspiration and analysis complete blood count blood type and crossmatch chest radiography lumbar puncture
bone marrow aspiration and analysis complete blood count lumbar puncture Explanation: Bone marrow aspiration and analysis are necessary to confirm leukemia. The bone marrow of a child with leukemia is characterized by hypercellularity, lack of fat globules, and blast cells (immature white cells). Complete blood counts show thrombocytopenia and neutropenia in clients with leukemia. Lumbar puncture is performed to detect meningeal involvement. Chest radiography verifies the presence of a mediastinal mass in those with suspected Hodgkin's disease. Blood type and crossmatch may be needed for treatment, but they are not diagnostic of leukemia.
A 4-year-old child continues to come to the nurses' station after being told children are not allowed there. What behavior is the child exhibiting? resistive behavior aggressive behavior exaggerated stress behavior attention-seeking behavior
attention-seeking behavior Explanation: The child wants attention from the nurse, even if the behavior is met by a negative response. Aggression, resistance against authority, and exaggerated stress are behaviors that can be associated with a 4-year-old. However, coming to the nurses' station after being told not to do so is not an example of these behaviors.
The nurse in an outpatient clinic is conducting a follow-up assessment on a child who had a severe streptococcal infection 1 week ago. The client is doing better, and the nurse is providing teaching to the parents about continuing to monitor the client for possible complications of the infection. Which information is most important for the nurse to discuss with the parents? "The infection may cause the child to have some burning with urination." "Expect the child's weight to decrease over the next 2 weeks." "Return immediately if acute flank or mid-abdominal pain occurs." "Fevers may continue to occur as the body recovers from the infection."
"Return immediately if acute flank or mid-abdominal pain occurs." Explanation: Acute glomerulonephritis is a major complication of streptococcal infections in children. The onset is often marked by a sudden occurrence of acute flank or mid-abdominal pain. The child may show signs of fluid retention, such as weight gain and edema. Hypertension also commonly occurs.
A nurse manager in a pediatric intensive care unit notices an increase in healthcare-associated infections. What should the nurse manager do next? Contact infection control to obtain infection rates of other units in the facility. Report the issue to the Centers for Disease Control and Prevention. Gather data on possible reasons for this increase. Talk with the hospital administrator about the concerns.
Gather data on possible reasons for this increase. Explanation: Gathering data about the reasons for infection or injury is within the scope of nursing practice. After gathering supporting data, the nurse manager should speak with the hospital administrator about concerns and findings. It wouldn't be appropriate for the nurse manager to contact infection control or the Centers for Disease Control and Prevention at this time.
A mother tells the nurse that her 4-year-old boy has developed some strange eating habits, including not finishing meals and eating the same food for several days in a row. She would like to develop a plan to correct this situation. When developing such a plan, what should the nurse and mother do? Decide on a good reward for finishing the meal. Restrict the availability of foods to those served at meal times. Do not allow him to leave the table until he has eaten the food. Allow him to make some decisions about the foods he eats.
Allow him to make some decisions about the foods he eats. Explanation: Allowing a child to make some decisions about the foods he eats and not insisting that he finish meals can avoid power struggles. Refusing to finish meals and to eat certain foods is normal behavior for a preschool-aged child. It is important to avoid tension at mealtime and to avoid confrontation about food, which should not be used as a bribe or a reward.Rewarding a child for what is eaten can lead to power struggles between the parent and child over food.Restricting foods should be avoided; restriction can provoke power struggles and confrontation, thereby increasing tension.Not allowing the child to leave the table until finished can provoke power struggles and confrontation, thereby increasing tension.
After the nurse has taught the parents of a 5-year-old boy who has leukemia how to talk with their child about death and dying, which statement would indicate that the parents have age-appropriate expectations about their child's reaction to his impending death? "He's too young to understand what is happening to him." "He'll accept his death as caused by his disease." "He'll understand how much his siblings will miss him." "He might think he's caused his death because he's misbehaved."
"He might think he's caused his death because he's misbehaved." Explanation: A 5-year-old child is in the preoperational stage of cognitive development and commonly thinks about behavior as magical; thus, the child may think that his behavior can cause death.Generally, children under 3 years of age are unable to differentiate death from temporary separation and are unable to understand what is happening, but by age 5 to 7 children understand that death means a body can no longer function.Logical thinking, evidenced by accepting death due to his disease, would occur during Piaget's stage of concrete operations, which occurs between ages 6 and 12 years.Although a 5-year-old child will be able to understand that he will be missed, he lacks the cognitive development to understand the extent of how much his siblings will miss him.
The parents of a preschooler are refusing a blood transfusion to treat severe hypovolemia because they are Jehovah's Witnesses. The parents are aware of the potential consequences of refusing the treatment. What is the priority nursing intervention at this time? Ask the healthcare provider about alternative treatments to blood transfusion. Notify the hospital ethics committee to overrule the parents' decision. Ask the parents to explain the reason for the refusal of the treatment. Provide additional teaching regarding the safety of blood transfusions.
Ask the healthcare provider about alternative treatments to blood transfusion. Explanation: Jehovah's Witnesses believe that a blood transfusion is the same as oral intake of blood, which they regard as a sin. The nurse caring for the child should seek alternative therapies. Jehovah's Witnesses will accept fluid replacement, biomedical hemostats, and medications or surgical interventions to stop the bleeding causing the hypovolemia. The reason for the refusal is not related to the safety of the therapy, therefore it is inappropriate to provide teaching in this regard. It is not appropriate for the nurse to call the ethics committee, because the parents are acting in what they consider to be their child's best interest, and their religious decisions are supported by law. Nurses should be aware of the religious beliefs of a Jehovah's Witness and should not require an explanation of the refusal of treatment.
A preschooler with a fractured femur of the left leg in traction tells the nurse that his leg hurts. It is too early for pain medication. The nurse should: assess the feet for signs of neurovascular impairment. place a pillow under the child's buttocks to provide support. remove the weight from the left leg. reposition the pulleys so the traction is looser.
assess the feet for signs of neurovascular impairment. Explanation: The nurse should assess the client frequently for signs of neurovascular impairment of the feet, such as pallor, coldness, numbness, or tingling. Pillows are not placed under the buttocks because the pillows would alter the alignment of the traction. Weights provide traction and should not be removed. Pulleys help to maintain optimal alignment of the traction and therefore should be left alone.
A father of a child with a urinary tract infection calls the clinic and explains, "My wife and I are concerned because our child refuses to obey us concerning the preventions you told us about. Our child refuses to take the medication unless we buy a present. We do not want to use discipline because of the illness, but we are worried about the behavior." Which response by the nurse is best? "I sympathize with your difficulties, but just ignore the behavior for now." "I understand it's hard to discipline a child who is ill, but things need to be kept as normal as possible." "I understand your concern, but this type of behavior happens all the time; your child will get over it when feeling better." "I understand that things are difficult for you right now, but your child is ill and deserves special treatment."
"I understand it's hard to discipline a child who is ill, but things need to be kept as normal as possible." Explanation: To ensure appropriate psychosocial development, a child needs to have normal patterns maintained as much as possible during illness. It is tempting to give ill children special treatment and to relax discipline. However, family routines and discipline should be kept as normal as possible. The child needs to know the limits to ensure feelings of security. When they are ill, children commonly attempt to stretch the rules and limits. If this occurs, returning to the previous well-behavior patterns will take time.
A 4-year-old who weighs 40 lb (18 kg) is brought to the emergency department with sudden onset of a temperature of 103° F (39.4° C), sore throat, and refusal to drink. The child will not lie down and prefers to lean forward while sitting up. What should the nurse do next? Have equipment to secure the airway available. Obtain a specimen for a throat culture. Give 600 mg of acetaminophen rectally, as prescribed. Inspect the child's throat for redness and swelling.
Have equipment to secure the airway available. Explanation: The child is exhibiting signs and symptoms of possible epiglottitis. As a result, the child is at high risk for laryngospasm and airway occlusion. Therefore, the nurse should have intubation equipment and tracheostomy tube and setup readily available should the child experience an airway occlusion. Although acetaminophen is an antipyretic, the dosage of 600 mg to be administered rectally is too high. A typical 4-year-old weighs approximately 40 lb (18 kg). The recommended dose is 125 mg. When any type of respiratory illness, and especially epiglottitis, is suspected, putting any object, including a tongue depressor for inspection or a cotton-tipped applicator to obtain a throat culture, in the back of the mouth or throat or having the child open the mouth is inappropriate because doing so may predispose the child to laryngospasm or occlusion of the airway by a swollen epiglottis.
A nurse on the pediatric unit is caring for a group of preschool children. Which situation takes priority? a physician waiting on the telephone to give the nurse a verbal order a child admitted from the postanesthesia care unit who has a blood-saturated surgical dressing a child with asthma who is wheezing with an oxygen saturation level of 96% a child who develops a fever during a blood transfusion
a child who develops a fever during a blood transfusion In this scenario, the most critical situation is the blood transfusion reaction, which requires the quickest intervention to stop potential complications Explanation: A fever indicates an adverse reaction to the blood transfusion and requires immediate intervention. The post-surgical child is losing blood through the surgical incision, which also requires attention. However, managing the bleeding may take significant time. Between these two priorities, stopping the transfusion and beginning normal saline should be accomplished first and takes minimal time. Postponing stopping the blood to manage the bleeding from the post-op patient will cause potentially life threatening complications for the blood transfusion patient. The telephone call is important for medication changes and to prevent a delay in treatment. Airway management is also a high priority. At this point, the child is compensating with a reasonable oxygen saturation. .
A preschool-age child scheduled for surgery in the morning is admitted to the facility for the first time. Which nursing action would ease the child's anxiety? beginning preoperative teaching as soon as possible explaining preoperative and postoperative procedures step by step explaining that the child will be "put to sleep" during the operation and will feel nothing having the child act out the surgical experience using dolls and medical equipment
having the child act out the surgical experience using dolls and medical equipment Explanation: Having the child act out the surgical experience using dolls and medical equipment would ease anxiety and give the nurse an opportunity to clarify the child's misconceptions. Preschoolers have a limited concept of time, so the nurse should provide preoperative teaching just before surgery rather than starting it as soon as possible; also, a delay between teaching and surgery may heighten anxiety by giving the child a chance to worry or fantasize. The nurse should avoid using such phrases as "put to sleep" because these may have a dual or negative meaning to a young child. Long explanations are inappropriate for the preschooler's developmental level and may increase anxiety.
