uworld pediatrics

cooperative play

school aged children (ages 6-12) may involve a formal game or task (eg, building a castle from blocks).

an olive shaped mass is characteristic of

pyloric stenosis

3 risk factors of DDH developmental dysplasia of the hip

breech birth, large infant size, and family history

The nurse is assessing an infant with intussusception. Which of the following clinical findings should the nurse expect? Select all that apply. Palpable olive-shaped mass in epigastrium Palpable sausage-shaped abdominal mass Projectile vomiting without visualized blood Screaming and drawing of the knees up to the chest Stool mixed with blood and mucus

2,4,5 Classic symptoms of intussusception include sudden, crampy abdominal pain; a palpable sausage-shaped abdominal mass; "currant jelly" stools; inconsolable crying with the knees drawn up to the chest; and bilious, nonprojectile vomiting. An olive-shaped mass is characteristic of pyloric stenosis. Projectile vomiting is frequently associated with pyloric stenosis or increased intracranial pressure.

An overweight toddler is diagnosed with iron deficiency anemia. Which is the most likely explanation for the anemia? 1. Excessive intake of meat products 2. Excessive intake of milk 3. Gastrointestinal blood loss 4. Impaired iron transfer from the mother

2. iron deficiency anemia is most common chronic nutritional disorder in children. many risk factors include insificcient dietary intake, premature birth, delayed introduction of solid food, and consumption of cows milk before age 1 year. over 34 oz a day can cayse iron deficiency

If Compartment Syndrome Is Suspected what do u do

keep arm at torso level

4 manifestations of nephrotic syndrom

massive proteinurea hypoalbuminemis edema hyperlipidemia

valproate med used in pregnancy can cause what defect

neural tube defects such as spina bifida

A parent brings a 6-month-old child to the primary health care provider after the child abruptly started crying and grabbing intermittently at the abdomen. The client's stool has a red, currant jelly appearance. What intervention does the nurse anticipate? Administer epoetin alfa (erythropoietin) Give air (pneumatic) enema Have the parent give 2 ounces of extra juice a day for constipation Perform hemoccult test on stool

2. give air enema air enema is safer than barium enema Intussusception (the intestine telescoping into itself) causes intermittent cramping and progressive abdominal pain, inconsolable crying, and currant jelly stool (from blood or mucus). It is often treated successfully with an air enema.

Which assessment findings should the nurse anticipate in a child with suspected acute otitis media (AOM)? Select all that apply. 1. Frequent pulling on the affected ear 2. Refusal to eat 3. Restlessness and irritability 4. Retracted tympanic membranes 5. Severe pain with pressure on the tragus

1,2,3 Clinical manifestations of AOM include high fever (up to 104 F [40 C]), ear pain, irritability/restlessness, loss of appetite, and pulling on the affected ear. -bulging, very red

The clinic nurse supervises a graduate nurse who is teaching the parents of a 2-year-old with acute diarrhea about home management. The nurse would need to intervene when the graduate nurse provides which instruction? The clinic nurse supervises a graduate nurse who is teaching the parents of a 2-year-old with acute diarrhea about home management. The nurse would need to intervene when the graduate nurse provides which instruction? 1. "Do not administer antidiarrheal medications to your child." 2. "Follow the bananas, rice, applesauce, and toast diet for the next few days." 3. "Record the number of wet diapers and return to the clinic if you notice a decrease." 4. "Use a skin barrier cream such as zinc oxide in the diaper area until diarrhea subsides."

2. During bouts of acute diarrhea and dehydration, treatment focuses on maintaining adequate fluid and electrolyte balance. The first-line treatment is oral rehydration therapy, using oral rehydration solutions (ORSs) to increase reabsorption of water and sodium. Even if the diarrhea is accompanied by vomiting, ORS should still be offered in small amounts at frequent intervals. Continuing the child's normal diet (solid foods) is encouraged as it shortens the duration and severity of the diarrhea. The BRAT (bananas, rice, applesauce, and toast) diet is not recommended as it does not provide sufficient protein or energy. (Option 1) Use of antidiarrheal medications is discouraged as these have little effect in controlling diarrhea and may actually be harmful by prolonging some bacterial infections and causing fatal paralytic ileus in children. (Option 3) Parents should be taught to monitor their child for signs of dehydration by checking the amount of fluid intake, number of wet diapers, presence of sunken eyes, and the condition of the mucous membranes. (Option 4) Protecting the perineal skin from breakdown during bouts of diarrhea can be accomplished by using skin barrier creams (eg, petrolatum or zinc oxide). Educational objective: When a child is experiencing acute diarrhea, the priority is to monitor for dehydration. Treatment is accomplished with oral rehydration solutions and early reintroduction of the child's normal diet (usual foods).

The nurse is teaching the parents of a 4-month-old who has developed positional plagiocephaly (flat head syndrome). Which statement by the parents indicates a need for further teaching? 1. "I should alternate head positions when the infant is supine." 2. "I should place the infant in the prone position during naps." 3. "I will minimize the amount of time the infant is in a car seat." 4. "I will place interesting toys opposite the affected side."

2. Positional plagiocephaly (flat head syndrome) occurs when an infant's soft, pliable skull is placed in the same position for an extended time. Positional plagiocephaly has become common due to the Safe to Sleep (formerly Back to Sleep) campaign, which advocates for infants to sleep in the supine position to prevent sudden infant death syndrome (SIDS). The risk of SIDS outweighs the benefit of a shapely head; the infant should not be placed in the prone position to sleep, even for a daytime nap (Option 2). Plagiocephaly can usually be prevented or corrected by: Frequently alternating the supine infant's head position from side to side (Option 1) Minimizing the amount of time an infant's head rests against a firm surface (eg, car seat) (Option 3) Placing pictures and toys opposite the favored (affected) side to encourage turning the head (Option 4) Placing the infant in the prone position for 30-60 min/day ("tummy time")

The nurse is conducting a psychosocial developmental checkup on a 2-year-old child. What is the priority assessment finding that should be reported to the primary health care provider? 1. Does not talk or respond to being talked to or read to 2. Likes to imitate others by playing house and talking on the telephone 3. Rides a Big Wheel and plays with a softball and bat 4. Says "no" to everything and throws temper tantrums

Chest tubes may be placed during cardiac surgery to help drain fluid and air and to ensure room for lung expansion. The chest tube and chamber should be assessed every hour for color and quantity of drainage. Drainage >3 mL/kg/hr for 3 consecutive hours or >5-10 mL/kg in 1 hour should be reported immediately to the health care provider (Option 1). This could indicate postoperative hemorrhage and requires immediate intervention. Cardiac tamponade can develop rapidly in children and can be life-threatening. This child weighs 4 kg and an output of 50 mL in 1 hour is excessive. (Option 2) For infants age 1-12 months, the normal heart rate is 90-160/min. (Option 3) Hypothermia is common after surgery. Warmers may be used to correct the client's temperature. (Option 4) Hourly urine output should be measured in the postoperative infant. A urinary catheter is often placed during surgery, allowing for accurate measurement. Urine output should be 1-2 mL/kg/hr.

The nurse plans care for a 3-year-old who was admitted with suspected pertussis infection. Which instructions will the nurse include in the plan of care? Select all that apply. The nurse plans care for a 3-year-old who was admitted with suspected pertussis infection. Which instructions will the nurse include in the plan of care? Select all that apply. 1. Institute droplet precautions 2. Monitor for signs of airway obstruction 3. Offer small amounts of fluids frequently 4. Place the child in a negative-pressure isolation room 5. Request an order for cough suppressant

1,2,3 known as whooping sound. reatment consists of antibiotics and supportive measures. Humidified oxygen and adequate fluids will help loosen the thick mucus. Suction as needed is important in infants. Respiratory status should be monitored for obstruction. The client should be positioned on the left side to prevent aspiration if vomiting occurs. Vaccination against whooping cough is available, but some individuals will still develop the disease, although in a milder form. Cough suppressants are not used as they are not very effective for pertussis. In addition, the child needs to cough up any mucus plugs that might develop to keep the airway clear. Educational objective:Pertussis can occur despite vaccination. Characteristic features include a cough lasting ≥2 weeks with ≥1 of the following: paroxysms of cough, inspiratory whooping sound, and posttussive vomiting. Clients need oral antibiotics, droplet precautions, and supportive measures (humidified oxygen and oral fluids).

The nurse has assessed 4 children. Which finding requires immediate follow-up with the health care provider? Child who had a surgical repair of hypospadias earlier today with no urinary output in the past two hours Child who is awaiting a neurological consult for suspected absence seizures and is sleeping soundly Child who returned from a bronchoscopy an hour ago and coughed up a scant amount of blood-tinged sputum Child with gastroenteritis, serum sodium of 131 mEq/L (131 mmol/L), and temperature of 100 F (37.8 C)

1. Hypospadias is a congenital defect in which the urethral opening is on the underside of the penis. Except in very mild cases, the condition is typically corrected around age 6-12 months by surgically redirecting the urethra to the penis tip. Circumcision is delayed so the foreskin can be used to reconstruct the urethra. If not corrected, clients may have toilet-training difficulties, more frequent urinary tract infections, and inability to achieve erections later in life. Postoperatively, the client will have a catheter or stent to maintain patency while the new meatus heals. Urinary output is an important indication of urethral patency. Fluids are encouraged, and the hourly output is documented. Absence of urinary output for over an hour indicates that a kink or obstruction may have occurred and requires immediate follow-up (Option 1).

A child in the emergency department had a cast placed on the right arm for a nondisplaced fracture. The client is being discharged home with pain medications. Which statement by the parent indicates that additional teaching is required? 1. "A tingling or burning sensation within the first 24-48 hours is not a concern." 2. "An itching sensation under the cast for the first 24-48 hours is not a concern." 3. "I will call the doctor if pain is severe despite medications for the first 24 hours." 4. "My child should elevate the arm for the first 24-48 hours."

1. Parents of children with casts are taught to check for emergency signs of circulatory impairment, including changes in sensation and motor function, which could indicate early signs of compartment syndrome due to swelling within the confined space of the cast. However, some swelling is expected, so this symptom alone is not indicative of compartment syndrome. The 6 Ps of compartment syndrome include: Pain: Increasing despite elevation, analgesics, and ice. Pain will also increase with passive stretching/movement. Increasing pain is an early sign and indicates muscle ischemia (Option 3). Pressure: Affected extremity or digits are firm and tense; skin is tight and appears shiny. Paresthesia: Tingling, numbness, or burning sensation, which is also an early sign and indicates nerve ischemia (Option 1). Pallor: Skin appears pale; capillary refill is >3 seconds. These indicate poor perfusion. Pulselessness: Pulse distal to injury or compartment is impalpable. Absent pulses are a late sign. Paralysis: Loss of function or inability to move extremity or digits. Muscle weakness occurs before paralysis which is also a late sign and indicates dead muscle tissue.

A nurse is discussing the concept of parallel play with parents of toddlers. Which statement should the nurse include to describe this type of play? 1. "Children play near other children but without significant interaction." 2. "Children playing together are strongly influenced by each other's choice of toy." 3. "The child primarily plays alone or with familiar people, such as parents." 4. "When playing in a group, one child will take on a follower role."

1. parellel play occurs 12-36 months

A nurse is caring for a child who is receiving oxygen at 2 L/min by nasal cannula and observes the current oxygen saturation and pulse plethysmographic waveform on the pulse oximeter. Which intervention should be the nurse's initial action? Click the exhibit button for additional information. 1. Auscultate the child's lung fields 2. Have the child take slow, deep breaths 3. Increase the oxygen flow rate to 3 L/min 4. Verify the position and integrity of the finger probe

4. The first action of the nursing process is assessment. The nurse should first evaluate the accuracy of the reading by evaluating the pulse plethysmographic waveform. Waveforms that are irregular or erratic may contain artifact caused by a loose, misapplied, or damaged pulse oximeter or by client movement (Option 4). After ensuring that the probe has been properly applied and positioned to provide an accurate reading, th

solitary play

infants <12

A nurse is caring for a school-age client with fever, somnolence, and a skin rash from suspected meningococcal meningitis. Which of the following interventions should the nurse plan to implement for this client? Select all that apply. 1. Elevate head of bed at 30 degrees 2. Implement seizure precautions 3. Keep a mask on the client at all times 4. Minimize environmental stimuli 5. Place client in a room with negative-pressure air flow

1,2,4 Nursing care for a client with suspected meningococcal meningitis includes elevating the head of the bed at 30 degrees, implementing seizure precautions, and minimizing environmental stimuli. The nurse should implement droplet precautions that require the nurse (not the client) to wear a mask when caring for the client. The client wears the mask only if transported outside the room. Additional Information Physiological Adaptation NCSBN Client Need

A 3-month-old who weighs 8.8 lb (4 kg) has just returned to the intensive care unit after surgical repair of a congenital heart defect. Which finding by the nurse should be reported immediately to the health care provider? 1. Chest tube output of 50 mL in the past hour 2. Heart rate of 150/min 3. Temperature of 97.5 F (36.4 C) 4. Urine output of 8 mL in the past hour

1.

When monitoring an infant with a left-to-right-sided heart shunt, which findings would the nurse expect during the physical assessment? Select all that apply. 1. Clubbing of fingertips 2. Cyanosis when crying 3. Diaphoresis during feedings 4. Heart murmur 5. Poor weight gain

3,4,5 Congenital heart defects that cause blood to shunt from the higher pressure left side of the heart to the lower pressure right side (eg, patent ductus arteriosus, atrial septal defect, ventricular septal defect) increase pulmonary blood flow. Left-to-right shunting results in pulmonary congestion, causing increased work of breathing and decreased lung compliance. Compensatory mechanisms (eg, tachycardia, diaphoresis) result from sympathetic stimulation. Clinical manifestations of acyanotic defects may include: Tachypnea Tachycardia, even at rest Diaphoresis during feeding or exertion (Option 3) Heart murmur or extra heart sounds (Option 4) Signs of congestive heart failure Increased metabolic rate with poor weight gain (Option 5) (Option 1) Clubbing of the fingertips is associated with chronic hypoxia caused by decreased pulmonary circulation as occurs with right-to-left heart defects.

The pediatric nurse is educating a group of graduate nurses (GNs) about scoliosis screenings. Which statement by a GN indicates a need for further teaching? 1. "Assessment for scoliosis includes having the client bend forward at the waist." 2. "One shoulder is often more prominent than the other in clients with scoliosis." 3. "Scoliosis is an exaggerated inward curvature of the lumbar spine, or swayback." 4. "Scoliosis screenings are typically performed between age 10 and 14."

3. n exaggerated inward curvature of the lumbar spine (ie, swayback) is lordosis, not scoliosis (Option 3).

associative play

Preschoolers (age 3-5 years) are more likely to interact with each other and borrow each other's toys in associative play.

which type of diabetes is a complication of cystic fibrosis due to pancreatic changes

diabetes mellitus

A 1-year-old child who goes to day care is recovering from an episode of otitis media. Which intervention is most important for the nurse to recommend to the parents in order to prevent recurrence? 1. Exclusive breastfeeding 2. Not sending the child to day care 3. Preventing water from entering the ear 4. Smoking cessation by the parents

4. -eliminate smoke exposure, get immunizations, eliminateuse of a pacifier after 6 months

The nurse is conducting a psychosocial developmental checkup on a 2-year-old child. What is the priority assessment finding that should be reported to the primary health care provider? 1. Does not talk or respond to being talked to or read to 2. Likes to imitate others by playing house and talking on the telephone 3. Rides a Big Wheel and plays with a softball and bat 4. Says "no" to everything and throws temper tantrums

1. Toddlers experience a phenomenal growth of language skills. They have many ways of communicating, some of them nonverbal, but they enjoy and learn by being talked to and read to. When toddlers do not enjoy these interactions or are not expressing themselves verbally, speech and hearing deficits should be explored. Many deficits in speech and hearing are correctable, or therapy may enhance quality of life.

A 3-month-old child with developmental dysplasia of the hip (DDH) is being fitted for a Pavlik harness. Which statement made by the parent indicates a need for further instruction? 1. "I should leave the harness on during diaper changes." [14%] 2. "I will adjust the harness straps every 3-5 days." [67%] 3. "I will inspect the skin under the straps 2-3 times daily." [5%] 4. "The harness should keep my baby's legs bent and spread apart." [12%]

2. STRAPS ASSESSED EVERY 1 TO 2 WEEKS NOT DAILY. THIS SHOULD BE DONE BY HCP NOT PARENTS. Assess skin 2-3 times daily for redness or breakdown under the straps (Option 3) Dress the child in a shirt and knee socks under the harness to protect the skin Apply diapers underneath the straps to keep the harness clean and dry Leave the harness on at all times, unless otherwise indicated by the HCP (Option 1)

A nurse is discussing the fine motor abilities of a 10-month-old infant with the infant's parent. Which are developmentally appropriate skills for an infant of this age? Select all that apply. 1. Grasps a small doll by the arm 2. Stacks 3 wooden blocks 3. Transfers small objects from hand to hand 4. Turns single pages in a book 5. Uses a basic pincer grasp

1,3,5

What socioeconomic indicators would the nurse identify as risk factors for a 2-month-old infant to develop failure to thrive (FTT)? Select all that apply. 1. Both caregivers work outside the home 2. Infant lives only with mother, who is currently unemployed 3. Infant's primary caregiver has cognitive disabilities 4. Parents are socially and emotionally isolated 5. Parents live together but are not married

2,3,4 FTT, or growth failure, is a state of undernutrition and inadequate growth in infants and young children. Most cases of FTT are related to an inadequate intake of calories, which can be tied to many different etiologies. Physiologic risk factors for FTT include preterm birth, breastfeeding difficulties, gastroesophageal reflux, and cleft palate. Socioeconomic risk factors include: Poverty - most common Social or emotional isolation - parents may lack the support system needed to assist them with the problems of child rearing Cognitive disability or mental health disorder Lack of nutritional education - parents may not have knowledge of proper feeding techniques or appropriate calorie intake based on age and size of the child

The nurse is preparing for the admission of a 9-year-old client with new-onset tonic-clonic seizures. It is important for the nurse to ensure that what is in the room? Select all that apply. 1. Oral bite prevention device 2. Oxygen delivery system 3. Padding on the bed siderails 4. Soft arm and leg restraints 5. Suction equipment

2,3,5

A 6-month-old infant is brought to the emergency department after experiencing vomiting and diarrhea for 4 days. Which prescription from the health care provider is the priority? Click on the exhibit button for additional information. 1. IV acetaminophen 60 mg every 6 hours 2. IV ampicillin 240 mg every 12 hours 3. IV normal saline bolus 20 mL/kg over 1 hour 4. IV ondansetron 2 mg every 8 hours

3. Infants and young children have a higher percentage of body water than older children and adults. As a result, they become dehydrated quickly due to fluid losses caused by vomiting and diarrhea. Signs of severe dehydration include lethargy, sunken fontanel, increased capillary refill time, increased heart rate, and increased respiratory rate. When dehydration is severe enough to affect the client's hemodynamic status or to potentiate shock, the priority is intravenous rehydration (Option 3).

A distraught parent informs the nurse of bleeding in a 1-day-old girl. What is an appropriate response by the nurse after assessing a small amount of bloody mucus in the newborn's diaper? 1. "Laboratory work will need to be completed to determine your newborn's hormone levels." 2. "The health care provider will prescribe a dose of medication to stop the bleeding." 3. "We will continue to monitor the amount, color, and consistency of the drainage." 4. "What visitors have been present since the baby was born?"

3. Mammary gland enlargement, non-purulent vaginal discharge (leukorrhea), and mild uterine withdrawal bleeding (pseudomenstruation) are benign transient findings commonly seen in newborns; these are physiologic responses to transplacental maternal estrogen exposure. Reassurance should be provided. Monitoring the amount, color, and consistency is the appropriate action (Option 3). (Options 1 and 2) The blood-tinged mucus will cease within a few days after birth when hormone levels return to normal. No additional workup or medications are indicated. (Option 4) Pseudomenstruation is a physiological process and is not caused by trauma or abuse

A nurse in a clinic is talking with a parent about the onset of puberty in boys. What is the first sign of pubertal change that occurs? 1. Appearance of upper lip hair 2. Increase in height 3. Presence of axillary hair 4. Testicular enlargement

4. Sexual maturation in boys begins with an increase in testicular size, followed by changes in the scrotum, appearance of pubic, axillary, facial, and body hair, and voice changes.

The nurse is assessing an 8-month-old client during a well-child visit. Which assessment finding should the nurse report to the health care provider? 1. Client does not engage with others in interactive play such as peek-a-boo 2. Client is unable to support head weight while being raised to a sitting position 3. Posterior fontanel is not palpable when performing assessment of the head 4. Weekly weight gain decreased from 5 oz (140 g) at 6 months to 3 oz (84 g)

2.

A 10-year-old weighs 99 lb (44.9 kg) and has a BMI of 24.8 kg/m2 (>95th percentile). Which is the most important assessment for the nurse to make before initiating a weight loss plan? 1. Child's pattern of daily physical activity 2. Family's eating habits 3. Family's financial resources for purchasing healthy foods 4. Family's readiness for change

4. Before initiating a treatment plan for weight loss, it is most important to make certain that the child and family are ready for change. Attempting to engage the family and child in weight loss strategies and dietary changes before they are ready could easily result in frustration, treatment failure, and reluctance to try new approaches in the future. The nurse needs to explore the reasons and desire for weight loss by assessing: Motivation and confidence Willingness to change behaviors and food choices Perceived importance of a weight loss treatment plan Confidence in ability to take on healthier eating habits (Option 1) Physical activity is an important component of a weight loss treatment plan, but it is not the priority nursing assessment. (Option 2) The family's eating habits will have a strong influence on the child's ability to make changes and need to be assessed. However, it is more important to assess the family's readiness for change. (Option 3) Assessing the family's financial resources is important in planning education about healthy food choices, but it is not the priority nursing action. Educational objective: Before initiating a treatment program that requires a client and family to make major lifestyle and behavior changes, the nurse needs to assess readiness for change. Motivation and a desire for change are the keys to successful weight loss.

if an infant under age of what stops breathing where do you check there pulse at

BRACHIAL ARTERY To check a pulse on an infant, the nurse should palpate the brachial artery by placing 2 or 3 fingers halfway between the shoulder and elbow on the medial aspect of the arm. The pulse should be assessed for 5-10 seconds to determine its presence and quality before CPR is initiated. The brachial pulse is preferred in infants as the brachial artery is close to the surface and is easily palpable.

The nurse is caring for a 2-year-old who is receiving a saline enema for treatment of intussusception. Reporting which client finding to the health care provider (HCP) is most important? 1. Passed a normal brown stool 2. Passed a stool mixed with blood 3. Stopped crying 4. Vomited a third time

1. an expected finding of intussuscpetion is stools mixed with blood and mucus aka currant jelly vomiting is normal becuase intense pain causes spasms of the pyloric muscle that lead to vomiting. The HCP should be notified if there is passage of a normal stool as this indicates reduction of the intussusception. All plans for surgery should be stopped and the plan of care should be modified. pain is intermittent, occurs every 15-20 minuts causing screaming and drawing up of knees

The nurse is triaging a 7-year-old with sickle cell crisis. The client is short of breath and vomiting and has severe generalized body and joint pains. Which assessment finding requires the most immediate intervention? 1. Blood work showing anemia 2. Enlarged spleen on palpation 3. Right arm weakness 4. Swelling of hands and feet

2. This client is exhibiting signs and symptoms of sickle cell crisis, which occurs when the client's sickle-shaped cells block blood flow through the vessels. These clients tend to have a small spleen due to repeated small splenic infarctions (autosplenectomy). Splenic sequestration crisis occurs when a large number of "sickled" cells get trapped in the spleen, causing splenomegaly. This is a life-threatening emergency as it can lead to severe hypovolemic (hypotensive) shock. The classic assessment finding is a rapidly enlarging spleen. (Option 1) Normal red blood cells live about 120 days. Sickle cells break apart and die within less than 20 days; therefore, the client always has a shortage of red blood cells (anemia). Due to anemia, clients often report feeling fatigued. (Option 3) Right arm weakness could indicate new-onset stroke, a common complication of sickle cell disease that needs to be assessed. However, splenic sequestration is immediately life-threatening and a priority. (Option 4) Swelling of hands and feet (dactylitis) is another symptom of this disease due to the sickled red blood cells blocking blood flow to the hands and feet. This is often detected in babies as the first sign of the disease. Educational objective:Splenic sequestration crisis is a potentially life-threatening emergency of sickle cell disease. A rapidly enlarging spleen and hypotension are the characteristic assessment findings.

The nurse has been providing care for the past month to a 7-year-old client recently diagnosed with type 1 diabetes mellitus. Initially, the family seemed devastated about the diagnosis and the client's parent stated, "Our lives will never be the same." Which statement made by the parent indicates that nursing interventions and education have been effective? 1. "Our child will not be able to participate in any sporting events." 2. "Our whole family will have to make sacrifices to deal with this disease." 3. "We are working to manage this disease so that it cannot control our child's life." 4. "We have set aside a place in the pantry for our child's special foods."

3. The diagnosis of a chronic illness (eg, diabetes) in a child will have an impact on the entire family. When parents see themselves and the child as capable of being independent and in control of the disease, there is an increased likelihood that the disease will be managed and controlled and the child can have an independent life.

The school nurse assesses an 8-year-old with a history of asthma. The nurse notes mild wheezing and coughing. Which action should the nurse perform first? The school nurse assesses an 8-year-old with a history of asthma. The nurse notes mild wheezing and coughing. Which action should the nurse perform first? 1. Assess the client's peak expiratory flow 2. Call the health care provider (HCP) 3. Educate the client about avoiding triggers 4. Notify the client's parents

1. The nurse must determine the severity of a client's condition before implementing an intervention. By assessing this client's peak expiratory flow, the nurse can determine the severity of the asthma symptoms.

The triage nurse is assessing an unvaccinated 4-month-old infant for fever, irritability, and open-mouthed drooling. After the infant is successfully treated for epiglottitis, the parents wonder how this could have been avoided. Which response by the nurse would be most appropriate? "It's impossible to know for sure what could have caused this episode." "Most cases of epiglottitis are preventable by standard immunizations." \ "We are still waiting for the formal report from the microbiology laboratory." "There is nothing you could have done; the important thing is that your child is safe now."

"Most cases of epiglottitis are preventable by standard immunizations." The majority of cases of epiglottitis are caused by Haemophilus influenza type B (HiB), which is covered under the standard vaccinations given during the 2- and 4-month visits. Epiglottitis is rarely seen in vaccinated children. (Option 1) This statement is technically true, but it is not helpful to the parents and misses a critical teaching moment for them. (Option 3) It is reasonable to attribute the cause of the infant's epiglottitis to missing the vaccinations for Haemophilus influenza type B. (Option 4) This statement is both unhelpful and inaccurate as the child is still at risk for further preventable illness. Educational objective: Cases of epiglottitis are preventable, and parents should always be educated on the risks of foregoing vaccinations for their children.

The health care provider (HCP) prescribes a 10-day course of amoxicillin for a 1-year-old diagnosed with acute otitis media (AOM). Which instruction is most important for the nurse to review with the child's parents? 1. Return to the office if the child does not improve within 48-72 hours 2. Stop the antibiotic if the child develops diarrhea 3. Stop the antibiotic if the child feels better after 72 hours 4. Use over-the-counter decongestants to help with recovery

1. AOM is an infection of the middle ear. Potential complications of AOM include hearing loss and spread of the infection. To prevent permanent damage, severe cases of AOM are treated with antibiotics. Amoxicillin is the standard treatment in most cases. However, if AOM symptoms do not improve within 48-72 hours of initiating antibiotic therapy, the client should return for further assessment. The HCP will then assess for other causes of persistent symptoms and determine if a different antibiotic is required to treat drug-resistant organisms. Following treatment with antibiotics, clients with AOM should be evaluated for complete infection resolution and screened for hearing impairment. (Option 2) Diarrhea is a frequent side effect of amoxicillin therapy that does not warrant treatment discontinuation. If the client develops fever and abdominal pain associated with diarrhea, it may indicate Clostridium difficile superinfection; this should be reported to the HCP. The medication is stopped immediately if the child develops an allergic reaction (eg, rash, shortness of breath, throat tightness). (Option 3) Ear pain and fever often subside within the first few days of antibiotic treatment. However, the entire course should be completed as prescribed to treat the infection completely and prevent antibiotic resistance. (Option 4) Over-the-counter decongestants are ineffective for AOM treatment and may even delay the recovery process.

A child's arm is burned from accidentally spilling boiling water on it, and the parent calls the clinic. The nearest emergency department is an hour away. Which instructions would be appropriate to give the parent? Select all that apply. 1. "Apply antibiotic ointment to any open skin." 2. "Briefly soak the arm with cool water." 3. "Cover the area with a clean, dry cloth." 4. "Place ice on the arm to relieve pain." 5. "Remove clothing, if not stuck to skin, around the burn."

2,3,5 Soak area briefly in cool water to stop the burning process (Option 2). Remove any clothing or jewelry around the burn to avoid constriction as edema develops. This also allows for quick assessment of the burn by clinicians. Only a health care provider may remove clothing that is stuck to the burned area (Option 5). Cover with a clean, dry cloth to prevent contamination, further trauma, and hypothermia (Option 3).

In the emergency department, a pediatric client is placed on mechanical ventilation by means of an endotracheal tube. Several hours later, the nurse enters the room and finds the client in respiratory distress. It is most important for the nurse to take which of these actions? 1. Assess the client for intercostal retractions 2. Assess the client's blood pressure in both arms 3. Auscultate the client's lung sounds 4. Observe the color of the client's fingernail beds

3. A client experiencing respiratory distress while receiving mechanical ventilation should be assessed for proper ventilation first. The nurse needs to determine if the mechanical ventilation equipment is still properly placed in the trachea. An endotracheal tube (ET) can become displaced with movement. By assessing the client's lung sounds, the nurse can quickly determine if ET placement has been compromised (Option 3). Airway is the priority for this client. By auscultating the client's lung sounds, the nurse can determine if the client has an open airway.

The parent of a newborn is concerned about the possibility of the child developing hip dysplasia. Which intervention should the nurse encourage to help reduce the risk in this newborn? 1. Choose an infant carrier with a narrow seat 2. Place 2 diapers on the infant at all times 3. Swaddle the infant with hips flexed and abducted 4. Use an infant swing that keeps both legs straight

3. Key measures include: Proper swaddling technique - infants should be swaddled with their hips bent up (flexion) and out (abduction), allowing room for hip movement (Option 3) Choosing infant carriers or car seats with wide bases - infant seats should allow for proper hip positioning in an abducted manner Avoiding any positioning device, seat, or carrier that causes hip extension with the knees straight and together

The nurse assesses a pediatric client who was diagnosed with diarrhea caused by Escherichia coli. The nurse is most concerned with which finding? 1. Blood-streaked stools 2. Client drank fruit juice 3. Dry mucous membranes 4. Petechiae noted on the trunk

4. Hemolytic uremic syndrome (HUS) is a life-threatening complication of Escherichia coli diarrhea and results in red cell hemolysis, low platelets, and acute kidney injury. Hemolysis results in anemia, and low platelets manifest as petechiae or purpura. Therefore, the presence of petechiae in this client could indicate underlying HUS and needs further assessment. (Option 1) E coli bacteria infect people through contaminated food or water and attack the digestive system. Blood-streaked stool due to intestinal irritation is a common symptom associated with this illness. Treatment is aimed at preventing dehydration, and clients usually improve in about a week. (Option 2) Fruit juices are discouraged in acute diarrhea as they have high sugar (osmolality) and low electrolyte content. Continuing the client's normal diet (solid foods) is encouraged as it shortens the duration and severity of the diarrhea. (Option 3) Dry mucous membranes are a sign of dehydration, a common complication of any persistent diarrhea. Dehydration should be treated promptly, especially in children; however, as long as fluid is replenished, the condition is not life-threatening. Educational objective:Hemolytic uremic syndrome is a life-threatening complication of Escherichia coli diarrhea. Clinical features include anemia (pallor), low platelets (petechiae and purpura), and acute kidney injury (low urine output).

A school-age child is brought to the emergency department due to nausea, vomiting, and severe right lower quadrant pain. The child's white blood cell count is 17,000/mm3 (17.0 x 109/L). Which statement by the child is of most concern to the nurse? 1. "I am hungry and they will not let me eat." 2. "I don't like hospitals and I want to go home." 3. "I'm so tired." 4. "My belly doesn't hurt anymore."

A child with acute-onset right lower quadrant abdominal pain, nausea, and vomiting and a high white blood cell count likely has acute appendicitis. Appendicitis is a serious condition that usually requires emergency surgery due to the risk of appendix rupture. The pain results from swelling and inflammation of the appendix. However, once the appendix ruptures, pain is relieved only temporarily and will return with full-blown peritonitis and sepsis. ption 1) Clients diagnosed with appendicitis often need immediate surgery. The client will be placed NPO until surgery is performed to remove the appendix. (Option 2) This is a normal statement that will be made by many children. (Option 3) Tiredness is nonspecific and could be due to many reasons (eg, pain medication). Educational objective:Appendicitis is an acute condition that needs immediate surgical intervention to prevent appendix rupture and subsequent peritonitis and sepsis. Additional Information Physiological Adaptation NCSBN Client Need

The nurse is caring for an infant with osteogenesis imperfecta admitted with a new fracture. The client also has old fractures in multiple stages of healing but no bruising, abrasions, or redness of the skin. Which nursing intervention should be included in the plan of care? During diaper changes, carefully lift the infant by the ankles Lift from under the arms when picking up the infant Obtain blood pressure manually to avoid cuff over-tightening Request a social work consultation to assess for child abuse

Obtain blood pressure manually to avoid cuff over-tightening Osteogenesis imperfecta (OI) (brittle bone disease) is a rare genetic condition resulting in impaired synthesis of collagen by osteoblasts. Collagen allows bone to be somewhat flexible while still maintaining strength. Impaired collagen causes bones to be frail and easily fractured. Clinical manifestations can range from mild defects to lethal disease in utero. OI is usually transmitted by autosomal dominant inheritance. The nurse's priority for a client with OI is careful handling to minimize additional fractures. Care of the infant with OI includes: Checking blood pressure manually to avoid cuff over-tightening, which may occur with automatic blood pressure cuffs (Option 3) Lifting the infant by slipping a hand under the broadest areas of the body (eg, back, buttocks) so the pressure is distributed Repositioning the infant frequently using supportive devices and gel padding to avoid molding of the soft bones of the skull (Options 1 and 2) Lifting by the ankles or under the arms puts too much pressure on the delicate bones (eg, legs, ribcage). (Option 4) Nonaccidental traumas with fractures (eg, child abuse) are usually associated with soft-tissue injury (eg, bruising, abrasions, redness) from the force of an external source.

A 12-month-old client has a high blood lead level of 18 mcg/dL (0.87 µmol/L). The nurse educates the parents about lead poisoning. Which statements made by the parent indicate that teaching is successful? Select all that apply. 1. "I should get our home inspected for the source of the lead." 2. "I will vacuum our hard-surface floors daily." 3. "I will wash my child's hands often, especially before eating." 4. "We should use hot tap water for cooking." 5. We will have to return for a follow-up lead level."

1,3,5 Lead poisoning occurs from repeated lead exposure, either via ingestion of lead-based paints (eg, walls, toys), glazes (eg, pottery) or water from lead pipes, or by inhalation of contaminated dust or soil found around older homes. Elevated blood lead levels (BLLs) impair neural, blood, and renal development. A BLL screening is recommended between ages 1 and 2, or up to age 6 if the child was not previously screened. Clients with elevated BLLs (≥5 mcg/dL [0.24 µmol/L]) require follow-up blood work to ensure that levels decrease (Option 5). Chelation therapy may be required if levels remain elevated. The priority intervention for clients with elevated BLLs is preventing continued exposure. The home environment should be assessed for lead sources (Option 1). Pediatric and pregnant clients should not live in homes being renovated until the work is complete. Handwashing, especially before eating, is important to remove lead residue (Option 3). (Option 2) Vacuuming spreads lead dust in the air, which increases inhalation exposure. Hard surfaces should be wet-dusted or mopped at least weekly. (Option 4) Hot tap water dissolves lead from older pipes; therefore, cold water should be used for consumption if lead plumbing is present. Taps should be flushed for several minutes to clear out contaminated water before use.

The school nurse creates a cafeteria menu for a newly enrolled child with celiac disease. Which lunches would be appropriate for this child? Select all that apply. Beef barley soup with mixed vegetables and French bread Grilled chicken, baked potato, and strawberry yogurt Mexican corn tacos with ground beef and cheese Peanut butter and jelly on rice cakes with an oatmeal cookie Rice noodles with chicken and broccoli

2,3,5 Celiac disease (celiac sprue) is an autoimmune disorder in which the body is unable to process gluten, a protein found in most grains. Gluten consumption will damage the villi of the small intestine; this results in malabsorption of fats (steatorrhea, foul-smelling stools) and other nutrients, which can lead to malnutrition and failure to thrive. The child will need to adhere to a gluten-free diet for life. Rice, corn, and potatoes are gluten free and are allowed in the diet (Options 2, 3, and 5). A child with celiac disease cannot eat barley, rye, oats, or wheat (mnemonic - BROW). (Option 1) A child with celiac disease cannot consume barley or French bread as both contain gluten. (Option 4) Peanut butter and jelly on rice cakes are permitted but not the oatmeal cookie.

A 7-month-old infant is admitted to the unit with suspected bacterial meningitis after receiving an initial dose of antibiotics in the emergency department. Frequent assessment of which of the following is most important in the plan of care? 1. Babinski reflex 2. Fontanel assessment 3. Pulse pressure 4. Pupillary light response

2. Bacterial meningitis is inflammation of the meninges of the brain and spinal cord caused by infection. General manifestations in infants and children age <2 include fever, restlessness, and a high-pitched cry. One common acute complication of bacterial meningitis is hydrocephalus, an increase in intracranial pressure (ICP) resulting from obstruction of cerebrospinal fluid flow. Increased ICP can progress to permanent hearing loss, learning disabilities, and brain damage. Bulging/tense fontanels and increasing head circumference are important early indicators of increased ICP in children. Frequent assessment for developing complications is vital for any client with suspected bacterial meningitis.

The nurse provides discharge teaching for the parents of a child newly diagnosed with hemophilia A. Which statements by the parents indicate that teaching has been effective? Select all that apply. 1"A high-calorie, high-protein diet is best for our child." 2 "It is extremely important that we do not allow our child to become dehydrated." 3"Our child should wear a medical alert bracelet at all times." 4"We should avoid giving our child over-the-counter medicine containing aspirin." "5We should encourage a noncontact sport such as swimming."

3,4,5 Hemophilia is a hereditary bleeding disorder caused by a deficiency in coagulation proteins. Treatment consists of replacing the missing clotting factor and teaching the client about injury prevention, including: Avoid medications such as ibuprofen and aspirin that have platelet inhibition properties (Option 4). Avoid intramuscular injections; subcutaneous injections are preferred. Avoid contact sports and safety hazards; noncontact activities (eg, swimming, jogging, tennis) and use of protective equipment (eg, helmets, padding) are encouraged (Option 5). Dental hygiene is necessary to prevent gum bleeding, and soft toothbrushes should be used. MedicAlert bracelets should be worn at all times (Option 3).

A nurse is teaching the parent of a child who has a new diagnosis of absence seizures. Which statement by the parent indicates understanding of the teaching? 1. "My child may experience incontinence." [2%] 2. "My child may seem confused afterwards." [8%] 3. "My child may stare and seem inattentive." [84%] 4. "My child will notice unusual odors prior to the event." [4%]

3. Absence seizures occur in children age 4-12 and usually disappear at puberty. Clinical manifestations include a brief loss of consciousness and an appearance of inattention or daydreaming (the absence attack) without loss of postural body tone. However, slight loss of tone may lead to dropping objects held in hands. Most absence seizures last less than 10 seconds and often go unrecognized. Following an attack, behavior and awareness return immediately to normal. The child does not experience a postictal period but usually has no recollection that a seizure has occurred. A child may have multiple absence seizures each day. Treatment includes the use of anticonvulsant medication(s). (Options 1, 2, and 4) Altered sensory perceptions (eg, awareness of odors [aura]), postictal confusion, and incontinence are clinical manifestations of complex partial or tonic-clonic seizures. Educational objective: Absence seizures are characterized by a brief loss of consciousness and an appearance of inattention or daydreaming without loss of postural tone. Most absence seizures last less than 10 seconds. The seizures occur in children age 4-12, and multiple seizures may occur daily.

A nurse on a pediatric unit is admitting a school-aged child with suspected Reye syndrome. Which information obtained during the history taking is most consistent with this condition? 1. No history of varicella vaccine administration 2. Recent exposure to bats 3. Recent influenza infection 4. Recent use of acetaminophen for fever

3. Reye syndrome is characterized by fever, acute encephalopathy, and altered hepatic function. It often develops following a viral infection, especially varicella or influenza. The risk of developing Reye syndrome increases if aspirin therapy is used to treat fever.

The nurse taught the caregiver of a child with a ventriculoperitoneal (VP) shunt about when to contact the health care provider (HCP). The caregiver shows understanding of the instructions by contacting the HCP about which symptom? 1. A temperature of 99 F (37 C) that occurs during the evening [3%] 2. The child cannot recall items eaten for lunch the previous day [10%] 3. The child vomits after awakening from a nap and 1 hour later [78%] 4. The VP shunt is palpated along the posterior-lateral portion of the skull [7%]

3. The caregiver of a child with a VP shunt must understand symptoms of increased intracranial pressure (ICP), which indicate shunt malfunction. Vomiting may be a sign of increased ICP and would require that the HCP be contacted. (Option 1) Fever may indicate shunt infection, but a temperature of 99 F (37 C) remains within acceptable parameters. Contacting the HCP is not indicated. (Option 2) Memory lapse or changes in mental status may indicate increased ICP. The inability to remember one meal would not indicate a change of mental status. (Option 4) A VP shunt is tunneled under the scalp and can be palpated. Educational objective:

A nurse is reviewing the laboratory values for a 3-year-old client with nephrotic syndrome. The nurse interprets the results to most clearly reflect which physiologic process related to nephrotic syndrome? Click on the exhibit button for additional information. Glomerular injury Hepatic impairment Inherited hypercholesterolemia Malnutrition

glomerular injury Nephrotic syndrome is a collection of symptoms resulting from various causes of glomerular injury. Below are the 4 classic manifestations of nephrotic syndrome: Massive proteinuria - caused by increased glomerular permeability Hypoalbuminemia - resulting from excess protein loss in the urine Edema - specifically periorbital and peripheral edema and ascites; caused by low serum protein and albumin as fluid is pulled into interstitial spaces and body cavities Hyperlipidemia - related to increased compensatory protein and lipid production by the liver Additional symptoms include decreased urine output, fatigue, pallor, and weight gain.

what is hemolytic uremic syndrome and whatare 3 signs

life threatening complication of E coli diarrheaand results in red cell hemolysis, low platletes, and acute kidney injury. -anemia, low platelets, petehciae or purpura and accuge kidney injury.

A 5-year-old child is receiving morphine sulfate for pain. Which statement by the caregiver indicates that further teaching is necessary? "I will call the nurse if my child begins to act aggressively." "I'm concerned that my child thinks the pain is punishment." "My child is playing and so does not need pain medication." "The FACES pain scale seems to be working very well."

"My child is playing and so does not need pain medication."

The nurse prepares a 7-year-old client for an influenza injection. The nurse explains that the client will receive "medicine under the skin," and the client is visibly anxious. Which nursing intervention is appropriate? Ask the child to count to 10 during injection Ask the parent to hold the child's arms tightly Explain to the child that the injection will not hurt Keep the injection needle out of the child's view

Ask the child to count to 10 during injection Children are often fearful of injections, exhibiting unpredictable and/or uncooperative behavior. The nurse should explain the procedure to the child using simple, age-appropriate language (eg, "medicine under the skin") to reduce anxiety. According to Piaget's cognitive developmental stages, school-age children develop concrete thought and may fear a loss of control. To improve the child's sense of control, the nurse should offer a specific, task-based coping technique (eg, counting aloud, deep breathing) (Option 1). (Option 2) A caregiver should hold or embrace a child during the injection process, with the child on the caregiver's lap or standing in front of a seated caregiver. Tightly holding the child's arms is extreme and may distress the child and caregiver. (Option 3) The child should be told the truth about pain that accompanies an injection. The nurse should use appropriate language, such as "the skin may hurt for a minute," and emphasize that the pain is quick and transient. (Option 4) Keeping objects that may alarm the child out of view is an appropriate intervention for a toddler but not for a school-age child. Hiding a proc

A newborn has a large myelomeningocele. What nursing intervention is priority? Assess the anus for muscle tone\ Cover the area with a sterile, moist dressing Measure the occipital frontal circumference Place the newborn supine with the head of the bed elevated

Cover the area with a sterile, moist dressing Myelomeningocele occurs when the neural tube fails to fuse properly during fetal development. An outpouching of spinal fluid, spinal cord, and nerves covered by only a thin membrane occurs, typically in the lumbar area. The newborn is at high risk for infection at this area. A priority nursing intervention is to cover the area with a sterile, moist dressing to decrease the risk of infection until surgical repair can occur. (Option 1) Assessing for an anal wink will assist in the assessment of the level of neurologic deficit but is not a priority intervention. (Option 3) Myelomeningocele may decrease the absorption of cerebrospinal fluid, which would place the newborn at risk for hydrocephalus from the excess cerebrospinal fluid. An occipital frontal circumference is needed as a baseline measurement but is not a priority. (Option 4) The newborn would be placed in the prone position (with face turned to the side) to prevent rupture of the myelomeningocele.

The nurse is reviewing discharge instructions with the parents of a child who just had a tracheostomy. Which statement made by the parents indicates teaching has been effective? "I will always travel with two tracheostomy tubes, one of the same size and one a size smaller." "I will immediately change the tracheostomy tube if my child has difficulty breathing." "I will provide deep suctioning frequently to prevent any airway obstruction." "I will remove the humidifier if my child starts developing more secretions."

"I will always travel with two tracheostomy tubes, one of the same size and one a size smaller." n the event of an accidental decannulation or another urgent need to change a tracheostomy tube, the most important action is to quickly replace the tube as it is the client's only means to ventilate. Clients should always carry two spare tracheostomy tubes, one the same size and one a size smaller. If the tube is not easily replaced or is meeting resistance, the smaller tube should be used. (Option 2) Changing a tracheostomy tube is a high-risk procedure that should be done only if respiratory distress is noted and other interventions (eg, suctioning) have failed. Mucus plugs (ie, thickening and buildup of mucus due to dehydration) are one of the most common causes of respiratory distress. (Option 3) A tracheostomy should be suctioned frequently to maintain airway patency. However, deep suctioning should be reserved for clients in respiratory distress due to the risk of injury. Tracheostomy tubes should be suctioned to the specified depth using a measurement marked on the tube, to provide safe, effective suctioning. (Option 4) Humidification is crucial for clients with a tracheostomy as the upper airway, which provides natural humidity for inhaled air, is bypassed. Humidification helps keep secretions thin and reduces formation of mucus plugs. The humidifier should not be removed if the child develops more secretions as this is the intended effect.

A nurse is teaching the parents of an infant with tetralogy of Fallot. Which of the following actions should the nurse include to reduce the incidence of hypercyanotic spells? Select all that apply. 1. Encourage smaller, frequent feedings 2. Offer a pacifier when the infant begins to cry 3. Promote a quiet period upon waking in the morning 4. Swaddle the infant during procedures 5. Turn the infant frequently during sleep

1,2,3,4 Tetralogy of Fallot is a complex heart defect that results in decreased pulmonary blood flow, mixing of oxygenated and unoxygenated blood, and inadequate blood flow into the left side of the heart. Hypercyanotic episodes (ie, "tet" spell) occur when unoxygenated blood enters the systemic circulation, resulting in cyanosis and hypoxemia. Tet spells usually occur during stressful or painful procedures; on waking; and with hunger, crying, and feeding. Home interventions to reduce the incidence of tet spells include: Providing a calm environment, particularly on waking (Option 3) Soothing and quieting the infant when crying or distressed Offering a pacifier (Option 2) Swaddling or holding the infant during procedures or times of stress (Option 4) Providing frequent smaller feedings to reduce frustration due to hunger and limit sucking fatigue (Option 1)

The nurse is performing an assessment on a 2-year-old with otitis media. Which of the following actions would be appropriate? Select all that apply. 1. Do not insert the speculum into the bony interior part of the ear canal 2. Encourage the parents to have the child vaccinated against influenza and pneumonia 3. Inspect the tympanic membrane for redness, bulging, and perforation 4. Pull the pinna up and back during the otoscopic examination 5. Wait until the end of the assessment to perform the otoscopic examination

1,2,3,5 Acute otitis media is caused by a blocked eustachian tube, which leads to a buildup of purulent fluid and inflammation in the middle ear. Manifestations include a red and bulging tympanic membrane, inner ear pressure (which can rupture the tympanic membrane if not treated), pain, and fever (Option 3). Clients also may have rhinorrhea, nausea, or vomiting. When assessing a toddler (age 1-3), the nurse should use the otoscope last because it often distresses clients in this age group, especially when pain is present (Option 5). The nurse should insert the speculum only as far as the outer cartilaginous part of the external auditory canal. Advancing the speculum into the bony interior part causes pain and could damage the tympanic membrane (Option 1). The nurse should educate the parents on how to avoid future occurrences of acute otitis media, which includes recommending influenza and pneumococcal conjugate vaccinations (Option 2). (Option 4) Children age <3 have a more horizontal external auditory canal than older children and adults. The nurse should pull the pinna down and back in infants and toddlers.

A 6-year-old client was diagnosed with type 1 diabetes mellitus 2 years ago. The nurse would like to encourage the client to participate in disease management. Which of the following diabetes care tasks are appropriate for the child to perform? Select all that apply. 1. Choose insulin injection site with parental oversight of rotation schedule 2. Push plunger of insulin syringe after a parent inserts and stabilizes the needle 3. Select and clean the site for finger-stick blood glucose testing 4. Use a chart to determine insulin dose based on glucometer reading 5. Verbalize two or three signs and symptoms of hypoglycemia

1,2,3,5 The nurse should offer school-aged children (age 6-12) as much opportunity as possible to participate in care to promote psychosocial development (industry versus inferiority) and provide a sense of control. Parents should transfer management of care to the child in small steps based on the child's skill level and cognitive ability. School-aged children are in the concrete operational stage of development and are most successful performing simple, concrete tasks with a limited number of steps. Appropriate diabetes management tasks for school-aged children include: Choosing and cleaning a finger for blood glucose testing before a parent or caregiver performs the puncture (Option 3) Selecting the site for insulin injection, with a parent or caregiver verifying appropriate site rotation (Option 1) Pushing the syringe plunger to administer insulin after a parent or caregiver inserts the needle (Option 2) Identifying signs and symptoms of hypoglycemia and hyperglycemia (Option 5)

A nurse is caring for a 1-month-old client who is being evaluated for congenital hypothyroidism. The nurse should recognize which of the following as clinical manifestations of hypothyroidism in infants? Select all that apply. 1. Difficult to awaken 2. Dry skin 3. Frequent, loose stools 4. Hoarse cry 5. Tachycardia

1,2,4 Congenital hypothyroidism occurs when abnormal development of the thyroid gland causes complete or decreased secretion of thyroid hormone (TH). Untreated hypothyroidism can cause severe intellectual disability in infants if undetected. Screening occurs after birth for all infants in the United States and Canada to prevent disability and encourage early treatment (ie, levothyroxine). TH plays an important role in growth, development, and regulation of many bodily functions (eg, heat production, muscle tone, skin function, cardiac function, metabolism). Clinical manifestations in affected infants reflect the pathophysiology of decreased TH and may include: Difficulty awakening, lethargy, or hyporeflexia due to alterations in central nervous system function (Option 1) Dry skin due to alterations in skin function (Option 2) Hoarse cry caused by swelling of the vocal cords due to fluid retention (Option 4) Constipation due to slowed metabolism Bradycardia due to the effect of TH on cardiac function (Options 3 and 5) Hyperthyroidism (Graves disease) is an autoimmune condition related to increased production of TH. Neonatal Graves disease is uncommon and usually occurs secondary to maternal hyperthyroidism. Tachycardia and increased bowel motility (frequent or loose stools) are features of hyperthyroidism and are related to an increase in metabolic processes.

The nurse is reviewing anticipatory guidance with the parents of a 6-month-old infant with phenylketonuria. Which statements by the nurse are appropriate? Select all that apply. 1. "A low-phenylalanine diet is required." 2. "Meat and dairy products should not be introduced into the diet." 3. "Phenylketonuria is self-limiting and usually resolves by adulthood." 4. "Special infant formula is required." 5. "Tyrosine should be removed from the diet."

1,2,4 Phenylketonuria (PKU) is one of a few genetic inborn errors of metabolism. Individuals with PKU lack the enzyme (phenylalanine hydroxylase) required for converting the amino acid phenylalanine into the amino acid tyrosine. As unconverted phenylalanine accumulates, irreversible neurologic damage can occur. A low-phenylalanine diet is essential in the treatment of PKU (Option 1). Phenylalanine cannot be entirely eliminated from the diet as it is an essential amino acid and necessary for normal development. The diet must meet nutritional needs while maintaining phenylalanine levels within a safe range (2-6 mg/dL [120-360 µmol/L] for clients age <12). There is no known age at which the diet can be discontinued safely, and lifetime dietary restrictions are recommended for optimal health (Option 3). Management of the client with PKU includes: Monitoring serum levels of phenylalanine Including synthetic proteins and special formulas (eg, Lofenalac, Phenyl-Free) in the diet (Option 4) Eliminating high-phenylalanine foods (eg, meats, eggs, milk) from the diet (Option 2) Encouraging the consumption of natural foods low in phenylalanine (most fruits and vegetables) (Option 5) Restriction of dietary tyrosine is not necessary. Tyrosine levels in clients with PKU may be normal or slightly decreased.

The school nurse is teaching a class of 10-year-old children about prevention of dental caries. Which recommendations would be part of the nurse's teaching plan? Select all that apply.

1,2,4,5 Dental caries (ie, cavities) form when bacteria (eg, Streptococcus mutans) digest carbohydrates in the mouth, producing acids that break down tooth enamel and cause mineral loss. Oral hygiene and dietary intake are significant factors contributing to the development of caries. Clients should increase intake of cariostatic foods, which have an inhibitory effect on the progression of dental caries (eg, dairy products, whole grains, fruits and vegetables, sugar-free gum containing xylitol) (Options 1 and 3). Cariogenic foods increase the risk for cavities and should be avoided. These include refined, simple sugars; sweet, sticky foods such as dried fruit (eg, raisins) and candy; and sugary beverages (eg, colas and other carbonated beverages, fruit drinks/juices) (Option 4). Additional practices to prevent dental caries include: Brushing after meals Flossing at least twice a day Rinsing the mouth with water after meals or snacks (Option 5) Drinking tap water rather than bottled water (most tap water sources add fluoride to promote dental health, whereas most bottled water does not contain fluoride) Finishing meals with a high-protein food

A 2-year-old is diagnosed with atopic dermatitis (eczema). Which instructions should the nurse teach the parents? Select all that apply. 1. Apply emollient immediately after a bath 2. Dress child in wool pajamas 3. Give tepid baths with mild soap 4. Keep child's nails well-trimmed 5. Thoroughly rub the skin dry after baths

1,3,4 Atopic dermatitis (AD), also known as eczema, is a chronic skin disorder characterized by pruritus, erythema, and dry skin. The exact cause of AD is unknown, although it may be associated with an impaired skin barrier and resulting immune response to invading allergens. The primary goals of management are to alleviate pruritus and keep skin hydrated to reduce scratching. Scratching leads to formation of new lesions and potential secondary infections. Parents should be instructed to give tepid baths using gentle soap; hot water and long bubble baths dry skin and should be avoided (Option 3) Skin should be gently patted dry after bathing, followed by immediate application of an emollient (eg, Eucerin, Cetaphil) to seal in moisture (Option 1) Nails should be trimmed short and kept filed to reduce scratches (Option 4) Clothing should be soft (eg, cotton) and climate-appropriate to reduce perspiration, which can intensify pruritus. Long sleeves should be worn at night. Avoid trigger factors such as heat and low humidity (Option 2) Wool pajamas and other rough fabrics can cause itching and sweating. Soft cotton fabrics are a better choice. (Option 5) Rubbing or vigorously drying can damage the skin and lead to exacerbations or infection. Skin should be patted dry gently.

The parents of a 2-year-old client ask how they can help their child cope with hospitalization. Which of the following suggestions should the nurse give the parents? Select all that apply. Follow as many home routines as possible Organize a visit from a playgroup friend Sleep in the child's hospital room at night Take child on regular visits to the playroom Tell the child they did not cause the illness

1,3,4 Hospitalization for toddlers (ie, 12-36 months) is particularly difficult due to separation anxiety and a limited ability to cope with stress. Toddlers thrive on home rituals and routines, which bring stability and reassurance. Hospitalization can severely disrupt these routines, triggering frustration and temper tantrums. Caregivers should maintain as many home routines as possible (eg, sleeping, eating) to help the child cope with unfamiliar hospital surroundings and procedures (Option 1). Parents should also stay with the child as much as possible, including overnight (ie, rooming-in), to provide consistency and alleviate separation anxiety (Option 3). Play, an important part of a child's emotional and social well-being, is an effective coping mechanism for children of all ages to deal with the stress of being away from home. The playroom is a safe place for children to act out their fears and anxieties related to illness and hospitalization (Option 4). (Option 2) A visit from friends is not likely to provide much comfort to a toddler and may actually cause additional stress. Adolescents, who are driven by peer interaction, would be more likely to benefit from this strategy. (Option 5) Preschool-aged children (3-5 years) have egocentric and magical thinking, which may cause them to think that their illness is due to something they have done or thought. Toddlers do not think this way.

A home health nurse is managing care for an adolescent client with cystic fibrosis. Which of the following potential complications should the nurse consider when developing a nursing care plan? Select all that apply. Chronic hypoxemia Diabetes insipidus Frequent respiratory infections Obesity Vitamin deficiencies

1,3,5 Cystic fibrosis (CF) is an inherited disorder (autosomal recessive) characterized by thickened secretions due to impaired chloride and sodium channel regulation that causes exocrine gland dysfunction. Management of a client with CF should primarily address potential complications related to the following body systems: Pulmonary: Alterations in respiratory secretions (ie, thick sputum) make it difficult to clear the airway and can result in frequent respiratory infections and sinusitis (Option 3). Frequent infections and inflammation damage lung tissue and may lead to chronic hypoxemia (Option 1). Gastrointestinal: Thickened secretions obstruct the release of pancreatic enzymes, causing malabsorption of fat-soluble vitamins (eg, A, E, D, K) and other nutritional deficiencies (Option 5). High-protein, high-calorie foods and supplemental enzymes with meals are necessary. Reproductive: Thickened reproductive secretions (eg, seminal fluid, cervical mucus) or the absence of the vas deferens in men contributes to CF-related infertility. (Option 2) Diabetes mellitus, not diabetes insipidus, is a potential complication for clients with CF due to pathologic pancreatic changes (eg, fibrosis). (Option 4) Due to impaired gastrointestinal absorption, weight loss and failure to thrive are more common and a greater concern than obesity.

The nurse is assessing a 4-year-old boy in a pediatric clinic. Which behaviors by the client would concern the nurse for possible Duchenne muscular dystrophy? Select all that apply. 1. Frequently trips and falls at home 2. Has painful knees and elbows in the morning 3. Places hands on the thighs to push up to stand 4. Suddenly rigidly extends the arms and legs 5. Walks on tiptoes and has disproportionately large calves

1,3,5 Duchenne muscular dystrophy is an X-linked recessive disorder characterized by progressive replacement of muscle tissue with connective tissue. Classic signs include Gower sign/maneuver (placing hands on the thighs to push up to stand), enlarged calves, walking on tiptoes, and frequent tripping/falling.

The nurse is caring for a 7-month-old client during a well-child visit. Which of the following gross motor skills should the nurse expect to identify at this age? Select all that apply. 1. Bears full weight on feet with support 2. Moves from lying down to a sitting position 3. Pulls up into a standing position from sitting 4. Sits using hands for extra support 5. Walks while holding on to furniture

1,4 During infancy, gross motor development begins with head and neck control and progresses to skills such as turning over, bearing weight on the arms in a prone position, sitting with the head erect, standing, crawling (ie, abdomen touching floor), creeping (ie, abdomen lifted off floor), and walking. By age 7 months, infants should be able to bear their full weight while standing with caregiver support and sit with minimal support from their hands (ie, tripod sitting) (Options 1 and 4). (Option 2) By age 7 months, infants can roll over, but the ability to move from a prone to a sitting position is not expected until age 10 months. (Option 3) Some infants learn to pull themselves up into a standing position early, but this is not expected until age 9-10 months. (Option 5) Walking while holding on to furniture is not expected until age 11 months. Educational objective:Childhood development of gross motor skills usually follows a predictable pattern, with more complex skills being acquired as age increases. A 7-month-old client should be able to sit with minimal support and bear their full weight while standing with caregiver support.

The parent of a 21-day-old male infant reports that the infant is "throwing up a lot." Which assessments should the nurse make to help determine if pyloric stenosis is an issue? Select all that apply. 1. Assess the parent's feeding technique 2 Check for family history of gluten enteropathy 3 Check for history of physiological hyperbilirubinemia 4 Check if the vomiting is projectile 5 Compare current weight to birth weight

1,4,5 In pyloric stenosis, there is gradual hypertrophy of the pylorus until symptom onset at age 3-5 weeks. It is common in first-born boys and the etiology is unclear. Pyloric stenosis presents with postprandial projectile vomiting (ejected up to 3 feet) followed by hunger (eg, "hungry vomiter"). This is clearly distinguished from the "wet burps" infants have due to a weak lower esophageal sphincter. The emesis is nonbilious as the obstruction is proximal to the bile duct. Infants have poor weight gain and are often dehydrated (eg, sunken fontanelle, decreased skin turgor, delayed capillary refill). The amount of milk consumed (particularly with bottle feedings) along with the mother's technique (mainly adequate burping) should be assessed to ensure there is no excessive air swallowing or overfeeding as an etiology. (Option 2) At times, formula intolerance or allergy is suspected initially when the infant first starts vomiting. However, celiac disease or gluten enteropathy is related to intolerance to gluten, a protein in barley, rye, oats, and wheat (BROW). Clients with celiac disease cannot eat these foods. A 3-week-old infant would only consume milk; this history would not be a factor at this time. (Option 3) Physiological hyperbilirubinemia occurs due to the newborn's immature liver that is unable to metabolize hemoglobin byproducts. This is a "normal" finding that is unrelated to pyloric stenosis.

A school nurse is educating the parent of a young client with pediculosis capitis. Which statement by the parent indicates understanding of the teaching? 1. "I will launder recently worn clothing, sheets, and towels in hot water." 2. "I will make sure all eating utensils are placed in the dishwasher." 3. "I will spray the house with insecticide to control this problem." 4. "I will throw away stuffed animals and toys that cannot be washed."

1. Preventing the spread of pediculosis capitis (head lice) may be accomplished by using hot water to launder clothing, sheets, and towels in the washing machine; these items should then be placed in a hot dryer for 20 minutes. Treatment of head lice consists of the use of pediculicides and the removal of nits (eggs). (Option 2) Head lice are not spread by oral contact with eating utensils. Instead, they are spread by direct person-to-person contact or by nits that hatch in the environment and remain on clothing, combs, and pillows. (Option 3) Spraying insecticides around children and pets in the home is not recommended due to the risk of inhalation or skin contact. (Option 4) Items that cannot be washed or dry cleaned may be placed in sealed plastic bags for 14 days to kill active lice or lice that hatch from the nits in 7-10 days. Vacuuming of furniture, carpets, stuffed toys, rugs, and mattresses is also recommended to prevent the spread of lice and nits. Educational objective: Pediculosis capitis (head lice) is a common parasitic infestation of the scalp that is typically seen in school-aged children. It is spread by contact with personal items such as clothing, combs, and bedding.

The parents of a hospitalized 3-month-old have to leave the infant while they work. One parent fears that the baby will cry as soon as they walk out. The nurse teaches both parents about separation anxiety. Which statement by the parent indicates that the teaching has been effective? 1. "At this age, my baby will not cry because we are leaving." 2. "I know my baby will feel abandoned when we leave." 3. "My baby is too young to sense my anxiety about leaving." 4. "My baby understands that we will return later in the day."

1. Separation or stranger anxiety occurs when the primary caregivers leave the child in the care of others who are not familiar to the child. This behavior starts around age 6 months, peaks at age 10-18 months, and can last until age 3 years. Separation anxiety produces more stress than any other factor (eg, pain, injury, change in surroundings) for children in this age range. However, this reaction is normal and resolves as the child approaches age 3 years. A 3-month-old can be soothed by any comforting voice (Option 1). (Option 2) A 3-month-old is not developmentally capable of fearing abandonment. (Option 3) A 3-month-old might sense a parent's anxiety but is cognitively unable to process it. (Option 4) A 3-month-old cannot tell time and would not understand the concept of returning later in the day. Educational objective: Separation anxiety starts around age 6 months, peaks at age 10-18 months, and can last until age 3 years. It produces more stress than any other factor (eg, pain, injury, change in surroundings) for children in this age range. However, separation anxiety is normal and resolves by age 3 years. Copyright © UWorld. All rights reserved.

The clinic nurse is reviewing self-care management of acne vulgaris with an adolescent client. Which client statement indicates a need for further instruction? 1. "I have been scrubbing my face twice daily with antibacterial soap." 2. "I should buy skin care products that are labeled noncomedogenic." 3. "Maintaining a nutritious diet will help my skin heal." 4. "Picking or squeezing the lesions will worsen my acne."

1. Additional self-care measures include: Using noncomedogenic skin care products (ie, products that do not clog pores) to avoid creating new lesions (Option 2) Maintaining a healthy lifestyle (eg, moderate exercise, balanced diet, adequate sleep) to reduce stress and promote healing (Option 3) Refraining from squeezing, picking, and vigorously scrubbing lesions to prevent additional inflammation and worsening the acne (Option 4)

The nurse is reviewing teaching with the parents of a child who has tinea capitis (ringworm of the scalp) and is newly prescribed griseofulvin oral suspension and 1% selenium sulfide shampoo. Which statement by the child's parent requires the nurse to intervene? 1. "I will discontinue the griseofulvin once the ringworm stops itching and the scales go away." 2. "I will give the griseofulvin suspension to my child after consumption of high-fat food, like ice cream." 3. "I will monitor my child for increased sensitivity to sunlight while taking griseofulvin." 4. "I will wash my child's scalp a few times per week with the medicated shampoo."

1. Tinea capitis (ringworm of the scalp) is a contagious fungal infection that lives on the surface of the scalp, resulting in scaly, pruritic, erythematous, circular patches with hair loss. The infection is transmitted via direct contact with infected persons, pets, or objects (eg, hairbrushes, bedding, towels, hats). Treatment may include 1% selenium sulfide shampoo applied several times each week in combination with an antifungal medication (eg, griseofulvin oral suspension) that the client must take for several weeks to months. Keratin-producing cells absorb griseofulvin, causing resistance to the fungus; because the fungus requires keratin (protein in hair and skin cells) to live and grow, it is not able to reproduce. To ensure that infected keratin is shed completely, treatment with griseofulvin should not be discontinued early, even if symptoms (eg, itching, scaling) decrease (Option 1). (Option 2) The client will best absorb griseofulvin (ie, suspension, microsized tablets) when taken after/with high-fat foods (eg, ice cream). (Option 3) Photosensitivity is a common side effect of griseofulvin treatment, and the client should avoid prolonged exposure to the sun and use sunscreen. (Option 4) The client should apply medicated shampoo (eg, 1% selenium sulfide) to the scalp a few times each week.

A nurse receives report on a group of clients. Which client should the nurse assess first?A nurse receives report on a group of clients. Which client should the nurse assess first? 1. A preschool-age child with a harsh cough, expiratory wheezes, and mild intercostal retractions 2. A toddler playing with small toys who appears in distress, has circumoral cyanosis, and cannot speak 3. A toddler with a barking cough, infrequent inspiratory stridor, and oxygen saturation of 94% on room air 4. An infant with an axillary temperature of 100.1 F (37.8 C) who is tugging at the left ear

2 Aspiration of a foreign body occurs most often in the toddler age group. Swallowing of objects such as buttons, small parts of toys, or food particles can be life-threatening and result in airway obstruction due to the small diameter of the airway. Manifestations include choking, gagging, cyanosis, and inability to speak when the object is lodged in the larynx. (Option 1) Although the client has mild retractions with wheezing and a harsh cough, a patent airway is present. This client may be experiencing expected manifestations of asthma, but this is not a life-threatening condition. (Option 3) The client's manifestations are consistent with laryngotracheobronchitis (croup), which is generally caused by a parainfluenza virus. There is no respiratory challenge indicated by a 94% oxygen saturation on room air, and this not an emergency situation. (Option 4) Otitis media is an infection or inflammation of the middle ear with the highest incidence at age 6-36 months; it occurs during the winter months. Acute onset presents with ear pain, irritability, fever, and pulling on the affected ear. Fluid can accumulate in the middle ear and create an environment for bacterial growth. R

The nurse is performing visual acuity screenings on a group of students. Which of the following student comments does the nurse recognize as indicating possible myopia? Select all that apply. 1. "I can see my teacher better if I sit in the back of the classroom." 2. "I have to hold my book close to my face so that the words are clear." 3. "If I squint or close one eye, I can read the road signs when we travel." 4. "My parents always tell me that I am sitting too close to the television." 5. "Sometimes, I have to ask my parents if I've chosen socks that match."

2,3,4 2,3,4 Myopia, or nearsightedness, is reduced visual acuity when viewing objects at a distance. Myopia occurs when the eye structure causes images to focus before they arrive at the retina. Near vision is usually intact, and many clients with myopia report needing to hold objects near their face or sit near objects to see clearly (Options 2 and 4). Myopia in pediatric clients may first be discovered by the school nurse during routine visual acuity testing. Children often report headaches, dizziness, and the need to squint the eyes to see clearly (Option 3). School performance may be affected because of impaired ability to see class presentations. (Option 1) Reduced visual acuity when viewing objects up close with intact distance vision is associated with hyperopia. Clients with hyperopia may report having to hold materials far away to read or sit at a distance to have clear vision. (Option 5) Impaired ability to perceive and differentiate colors (eg, red and green, blue and yellow) is associated with color vision deficiency, a congenital impairment of cone function in the retina. Children with color deficiency may have difficulty selecting matching clothing or appropriate colors for school assignments.

A nurse is teaching the parent of a 6-year-old with a urinary tract infection (UTI) how to avoid repeat infections. Which statements by the parent indicate that the teaching has been effective? Select all that apply. 1. "I just bought my child new nylon panties." 2. "I will make sure my child does not hold urine." 3. "I will not give my child any more bubble baths." 4. "I will teach my child to wipe from the front to the back." 5. "I will use antibacterial soap for bathing my child."

2,3,4 UTIs are one of the most common conditions in children, with a higher occurrence in girls (due to the short urethra and its close proximity to the vagina and anus). Girls should be taught to wipe from front to back; this will help minimize the chances of bacteria entering the urethra from the perianal area (Option 4). - do not use antibacterials oap, bubble baths, or tught clothing bcuz this promots bacterial growht.

A nurse is caring for a 3-month-old infant who has bacterial meningitis. Which clinical findings support this diagnosis? Select all that apply. 1. Depressed anterior fontanelle 2. Frequent seizures 3. High-pitched cry 4. Poor feeding 5. Presence of the Babinski sign 6. Vomiting

2,3,4,6 Bacterial meningitis is an inflammation of the meninges in the brain and spinal cord that is caused by specific types of bacteria, including group B streptococcal, meningococcal, or pneumococcal pathogens. Clinical manifestations of bacterial meningitis in infants age <2 include: Fever or possible hypothermia Irritability, frequent seizures High-pitched cry Poor feeding and vomiting Nuchal rigidity Bulging fontanelle possible but not always present One of the most common acute complications of bacterial meningitis in children is hydrocephalus. Long-term complications include hearing loss, learning disabilities, and brain damage. Due to the severity of potential complications, prompt identification and immediate treatment are vital for any client with suspected bacterial meningitis. (Option 1) Infants with bacterial meningitis may have bulging fontanelles due to an increase in intracranial pressure. Depressed fontanelles indicate severe dehydration. (Option 5) The Babinski reflex can be present up to 1-2 years and is a normal expected finding; it does not indicate meningitis. Educational objective:Bacterial meningitis is inflammation of the meninges in the brain and spinal cord caused by bacterial infection. Key characteristics of bacterial meningitis in infants under age 2 include frequent seizures, a high-pitched cry, poor feeding, nuchal rigidity, and possible bulging fontanelles.

A nurse is performing an assessment of a 12-month-old child. Which of the following findings would the nurse expect? Select all that apply. 1. Approaches strangers with ease 2. Birth weight is tripled 3. Can skip and hop on one foot 4. Fully developed pincer grasp 5. Sits from a standing position

2,4,5 The first 12 months of life are characterized by rapid growth and development. By age 12 months, the child's birth weight should be about tripled (Option 2). A 12-month-old child should have mastered the gross motor skill of sitting down from a standing position without assistance (Option 5). The pincer grasp (ie, use of the thumb and forefingers to pick up objects) is an important fine motor skill that should also be fully developed by this age (Option 4). (Option 1) Stranger anxiety is well developed by age 8 months and continues into the toddler years. At age 12 months, the child typically prefers the parents and exhibits fear when separated. (Option 3) The gross motor skills of skipping and hopping on one foot do not usually occur until around age 4.

What communication strategies would the nurse have in place when establishing rapport with the caregiver and an 8-year-old during a health history interview? Select all that apply. Ask only closed-ended questions to obtain information Allow the child to describe their current issue Isolate the child from the parents and interview them separately Maintain an eye level position when speaking with the child Use language that both the child and caregiver can understand

2,4,5 The first step in effective communication is to establish trust between the nurse, the child, and the parent. By actively including a school-age child in the health history interview, the nurse shows respect to that child and obtains valuable insight into their health status. Allowing the child to describe how they feel or where they hurt gives the nurse a better understanding of the issue. Using clear, age-appropriate explanations will enhance communication with the child while maintaining the participation of the caregiver. Open-ended questions allow the child or caregiver to elaborate on the question, giving the nurse detailed information to guide further assessment. Non-verbal cues also play an important role in communication (eg, staying at eye level with the child to ease any potential nervousness). (Option 1) Closed-ended questions usually result in a "yes" or "no" answer. There are times in an interview that closed-ended questions are appropriate to gather specific information, but broader, more descriptive answers are generally desired when conducting a health history interview. (Option 3) The nurse should interview a school-age child together with their caregiver unless there is an indication of child abuse. The child may feel more at ease, and a more complete assessment may be obtained through answers from both the child and caregiver.

The pediatric nurse cares for a 16-year-old client who is scheduled for an appendectomy in the morning. Which of the following interventions are appropriate to support the client's psychosocial needs? Select all that apply. 1. Create a strict daily schedule for the client while hospitalized 2. Encourage the client to have peers visit while hospitalized 3. Ensure parental presence during any client procedure 4. Include the client as an active participant when planning care 5. Support the client in discussing concerns about body image changes

2,4,5 Pediatric clients are at increased risk for impaired psychosocial integrity during stressful experiences (eg, hospitalization, surgical procedures, medical treatment) and require developmentally appropriate care based on their age to assist with managing stress. Unaddressed or ineffectively managed developmental needs may lead to or worsen the client's anxiety, disobedient behavior, and/or social withdrawal. Developmentally appropriate nursing care for an adolescent client includes: Encouraging interaction with peers (eg, hospital visits, internet communication), which supports the developmental need for social connection and support and reduces stress and anxiety (Option 2) Involving the client in care planning to address the developmental needs for control and independence (Option 4) Assisting the client to discuss emotions or fears related to treatment (eg, changes in body image, disability, possibility of death) to improve coping, support the developmental need for understanding, and decrease anxiety (Option 5) (Option 1) Strict scheduling by the nurse reduces the adolescent's perception of control and independence, which may increase stress. Adolescents should be allowed to determine their daily schedule when possible. (Option 3) Loss of privacy (eg, forced parental presence) can increase anxiety in the adolescent client. Adolescents should be asked if they want parents present for procedures and what level of parental involvement they prefer.

The graduate nurse (GN) is caring for a 12-month-old client following a right-sided ventriculoperitoneal shunt revision. Which action by the GN would cause the precepting nurse to intervene? 1. Assesses pupillary dilation using a penlight 2. Elevates the head of the bed to 30 degrees 3. Measures the abdomen for distension 4. Positions the client onto the left side

2. A ventriculoperitoneal shunt is an intervention for the treatment of hydrocephalus; the shunt drains excess cerebrospinal fluid (CSF) from the brain to the peritoneum, decreasing pressure on the brain. Following shunt placement or revision in a client, the nurse should avoid elevating the head of the bed to prevent rapid decreases in CSF and ventricular size, which can result in a subdural hematoma (Option 2). Appropriate postoperative interventions include assessing neurological status (eg, pupillary dilation), measuring for abdominal distension to detect postoperative complications (eg, ileus, peritonitis), and positioning the client onto the nonsurgical side to avoid pressure on the shunt (Options 1, 3, and 4). Additional Information Physiological Adaptation NCSBN Client Need

A child is scheduled to have an electroencephalogram (EEG). Which statement by the parent indicates understanding of the teaching? 1. "I will let my child drink cocoa as usual the morning of the procedure." [7%] 2. "I will wash my child's hair using shampoo the morning of the procedure." [46%] 3. "My child may have scalp tenderness where the electrodes were applied." [35%] 4. "My child will not remember the procedure." [10%]

2. An electroencephalogram (EEG) is a diagnostic procedure used to evaluate the presence of abnormal electrical discharges in the brain, which may result in a seizure disorder. The EEG can be done in a variety of ways, such as with the child asleep or awake with or without stimulation. Teaching for the parent includes the following: Hair should be washed to remove oils and hair care products, and accessories such as ribbons or barrettes should be removed. Hair may need to be washed after the procedure to remove electrode gel. Avoid caffeine, stimulants, and central nervous system depressants prior to the test. The test is not painful, and no analgesia is required.

The nurse is assessing a 3-month-old during a well-child visit. Which developmental finding should the nurse expect to observe in the client? 1. Infant cries and clings to parent when members of the health team come near 2. Infant kicks legs, smiles, and coos when a familiar face comes into view 3. Infant transfers a ball from one hand to the other hand 4. Infant turns from the back to the abdomen

2. Developmental milestones (eg, motor, sensory, verbal, cognitive) are known patterns of growth and development noted in most children by a specific age. These milestones are used as a general assessment guide, although each child has a unique pattern of development. By age 3 months, the infant recognizes familiar items and faces (Option 2). Any 3-month-old who does not respond to familiar faces may have visual impairment or an underlying neurological disorder (eg, autism). (Option 1) Stranger anxiety is part of the infant's normal social and cognitive development and usually begins around age 6 months. (Option 3) Transferring objects from one hand to the other hand is a fine motor skill that usually develops between age 6 and 9 months. Failure to develop this skill may indicate neuromuscular or developmental delays. (Option 4) A 3-month-old is usually not strong enough to roll from the back to the front. Infants should be able to turn from the abdomen to the back at around age 4 months and then from the back to the abdomen by age 6 months. Failure to roll over by age 6 months may indicate slower-than-normal neck, leg, back, and arm muscle development and should be investigated.

The clinic nurse performs assessments on four infants. The nurse should alert the health care provider to see which client first? The clinic nurse performs assessments on four infants. The nurse should alert the health care provider to see which client first? 1. 3-month-old whose posterior occiput appears flattened [8%] 2. 4-month-old who has sclera visible above the iris (sunset eyes) [58%] 3. 6-month-old who has vomited twice and has had 8 wet diapers in the last 24 hours [22%] 4. 9-month-old whose toes fan out and big toe dorsiflexes when plantar surface is stroked [10%]

2. Hydrocephalus is an increase in intracranial pressure (ICP) that results from obstruction of cerebrospinal fluid flow. Increased ICP can progress to brain damage and death. Signs of increased ICP in children include bulging fontanelles, increasing head circumference, and sunset eyes (or setting-sun sign) (sclera visible above the iris). Sunset eyes occur when periaqueductal structures are compressed from increased ICP, paralyzing the upward gaze. This is a late sign of increased ICP that requires timely treatment (eg, shunt placement) and is the priority (Option 2).

A client diagnosed with acute glomerulonephritis has pitting edema in both lower extremities, blood pressure of 170/80 mm Hg, and proteinuria. When developing a plan of care for this client, the nurse should include which most accurate indicator of fluid loss or gain? 1. Blood pressure measurements 2. Daily weight measurements 3. Intake and output measurements 4. Severity of pitting edema

2. The most accurate indicator of fluid loss or gain in an acutely ill client is weight, as accurate intake and output and assessment of insensible losses may be difficult (Option 3). A 2.2-lb (1-kg) weight gain is equal to 1,000 mL of retained fluid. (Option 1) Blood pressure measures the amount of pressure exerted on the arterial walls due to factors such as peripheral artery constriction or dilation, not just fluid volume status. (Option 4) Pitting edema is not an accurate indicator as the fluid may shift from intravascular to interstitial spaces without an overall change in fluid gain or loss throughout the body. Educational objective: The most accurate indicator of fluid loss or gain in an acutely ill client is daily weight.

The nurse is caring for a 4-year-old who was hospitalized with influenza. Which nursing action would be most effective to maintain psychosocial integrity? 1. Encouraging use of puzzles for play 2. Offering the child stacking blocks for diversion 3. Providing crayons to draw noses on facemasks 4. Suggesting that playmates visit the child

3. Clients with influenza are maintained on droplet precautions, and anyone entering the room must wear a facemask. Medical play during the preschool period (age 3-5 years) facilitates psychosocial integrity. Crayons are age-appropriate toys. Drawing noses on facemasks will help the child feel more comfortable with procedures and provides a developmentally appropriate diversion. (Option 1) Puzzles would be more appropriate for the school-age child (6-12 years). (Option 2) Stacking blocks would be more appropriate for the toddler (age 1-3 years). (Option 4) Maintaining contact with peers would be more appropriate for the adolescent (age 12-19 years).

The nurse is caring for an infant diagnosed with Hirschsprung disease who is awaiting surgery. Which assessment finding requires the nurse's immediate action? 1. Abdominal distension with no change in girth for 8 hours 2. Did not pass meconium or stool within 48 hours after birth 3. Episode of foul-smelling diarrhea and fever 4. Excessive crying and greenish vomiting

3. Hirschsprung disease (HD) occurs when a child is born with some sections of the distal large intestine missing nerve cells, rendering the internal anal sphincter unable to relax. As a result, there is no peristalsis and stool is not passed. These newborns exhibit symptoms of distal intestinal obstruction. They have a distended abdomen and will not pass meconium within the expected 24-48 hours. They also have difficulty feeding and often vomit green bile. Surgical removal of the defective section of bowel is necessary and colostomy may be required. A potentially fatal complication is Hirschsprung enterocolitis, an inflammation of the colon, which can lead to sepsis and death. Enterocolitis will present with fever; lethargy; explosive, foul-smelling diarrhea; and rapidly worsening abdominal distension. (Option 1) Mild to moderate abdominal distension is an expected finding with a diagnosis of HD; however, increasing abdominal girth is a serious finding that must be reported. (Option 2) Failure to pass meconium or stool within 24-48 hours after birth is an expected finding of HD. (Option 4) Bilious vomiting and excessive crying are expected findings of HD. In enterocolitis, vomiting can occur more frequently and the client appears more ill. Educational objective: Enterocolitis, a potentially fatal complication of Hirschsprung disease, is characterized by explosive, foul-smelling diarrhea; fever; and worsening abdominal distension.

The school nurse is caring for 4 clients with type 1 diabetes mellitus. Which of these clients should the nurse assess first? 1. 5-year-old whose capillary blood glucose is 71 mg/dL (3.9 mmol/L) 2. 7-year-old who is busy drawing pictures and refusing to eat lunch 3. 9-year-old who is sweating after recess and irritably states, "I'm so hungry!" 4. 11-year-old whose prescribed dose of insulin glargine is 30 minutes overdue

3. Hypoglycemia (blood glucose <70 mg/dL [3.9 mmol/L]) presents an immediate danger to the client as life-threatening neurologic impairment (eg, lethargy, seizures, coma) can occur when the brain becomes glucose depleted. If a client with diabetes has symptoms of hypoglycemia (eg, sweating, irritability, tremor, tachycardia, hunger), the nurse should immediately assess the client, check capillary blood glucose, and provide a simple carbohydrate snack that can be digested rapidly (eg, juice, soft drink, candy) (Option 3).

A nurse is discussing parallel play with the parent of a 2-year-old. Which statement by the parent indicates understanding of the discussion? 1. "I encourage working in a group to build towers with large blocks." 2. "I have a chalk board available to teach the alphabet and numbers." 3. "I set out a basket of various balls in the backyard when other children come to play." 4. "I try to organize games that involve a team approach."

3. Parallel play is typical behavior of a toddler and involves activities focused on improving motor skills, imitative efforts, and the use of multiple senses. Toddlers play alongside, rather than with, other children. Having a variety of different balls for a group of children allows each child to be present with others and participate as they desire. Other examples of parallel play activities include pushing and pulling large toys; smearing paint; playing with dolls or toy cars; and digging in a sandbox. (Option 1) Working in groups is an appropriate play activity for children in the preschooler period. (Option 2) The classroom approach does not promote parallel play. Using large chalk to draw allows the child creative expression in an unstructured manner. (Option 4) A toddler is challenged by the concept of team games, which requires attention to the group's effort. Educational objective: Toddlers engage in parallel play, which involves playing alongside, not with, other children. Activities such as playing with dolls or toy cars, pushing and pulling large toys, smearing paint, and digging in a sandbox encourage parallel play.

A 10-year-old is implementing behavioral strategies to manage nocturnal enuresis. The client tells the nurse, "I want to go to sleep-away camp during the summer, but if I have an 'accident,' I'm afraid that other kids will tease me." What is the best response by the nurse? 1. "Don't worry. Your problem will be resolved by then." 2. "It would be better if you thought about going to day camp instead." 3. "We can ask your health care provider about a medication trial that may help." 4. "You could always wear a pull-up just in case."

3. Pharmacological interventions are often used as second-line treatment for nocturnal enuresis in children age >5 years; this is done when there has been little or no response to behavioral approaches and/or when short-term improvement of enuresis is desired for attending sleepovers or overnight camp. A trial run is usually done at least 6 weeks before camp to determine the appropriate drug dose and effectiveness. However, there is a high risk of relapse once the drug is discontinued.

The emergency nurse is admitting a 12-year-old client who reports palpitations. Which action should the nurse anticipate? Click the exhibit button for additional information. 1. Administering epinephrine by rapid IV push 2. Assisting the client to a tripod position 3. Instructing the client to hold their breath and bear down 4. Sedating the client for immediate asynchronous defibrillation

3. Supraventricular tachycardia (SVT) is the most common tachyarrhythmia of childhood and refers to a rapid heart rate of 200-300/min with no variation in rate during activity. It can lead to life-threatening congestive heart failure if left untreated. Symptoms in children may include palpitations, dizziness, or chest pain. Once an ECG confirms SVT, the nurse should anticipate nonpharmacological interventions (ie, vagal maneuvers) to convert SVT to sinus rhythm if the client is stable. Placing an ice bag to the client's face and instructing the client to hold their breath while bearing down (Valsalva) are vagal maneuvers that can slow electrical conduction through the heart's atrioventricular node (Option 3). If these maneuvers are ineffective, or if the client becomes unstable, administration of adenosine or synchronized cardioversion is indicated. (Option 2) The tripod position opens the airway and promotes airflow, particularly for clients with significant airway obstruction (eg, epiglottitis). The child with palpitations may assume any position of comfort. (Option 4) Asynchronous defibrillation is indicated for the treatment of lethal cardiac arrhythmias (eg, ventricular fibrillation, pulseless ventricular tachycardia). Educational objective: Supraventricular tachycardia refers to a rapid heart rate of 200-300/min with no variation in rate during activity. The nurse should anticipate instructing the client to perform vagal maneuvers (eg, Valsalva) first if the client is stable.

The nurse is admitting an infant who has severe growth deficiency and facial characteristics of indistinct philtrum, a thin upper lip, and short palpebral fissures. Which question should the nurse ask to assess the cause of these clinical findings? 1. "Is the mother of advanced age?" 2. "Is there a history of cigarette use during pregnancy?" 3. "Is there a history of exposure to alcohol in utero?" 4. "Is there a maternal history of valproate use?"

3. Fetal alcohol syndrome (FAS) is a leading cause of intellectual disability and developmental delay in the United States. Diagnosis includes history of prenatal exposure to any amount of alcohol, growth deficiency, neurological symptoms (eg, microcephaly), or specific facial characteristics (indistinct philtrum, thin upper lip, epicanthal folds, flat midface, and short palpebral fissures). Asking about alcohol use during pregnancy can identify newborns and infants who are at risk for FAS. Family support, early intervention, and prevention for subsequent pregnancies are important for families with an infant with this diagnosis.

A nurse is giving instructions related to antibiotic eye drops to the parent of a 5-year-old with bacterial conjunctivitis. Which instruction is most important? 1. Discard tissues used to blot excess medication from the eye immediately 2. Have your child lie down before you instill the eye drops 3. Use warm, moist compresses to remove crusting on eyelids 4. Wash hands before and after eye drop instillation

4. Bacterial conjunctivitis (pink eye) is highly contagious. The hands must be washed properly before and after instilling eye drops and after cleaning away eye drainage or crusting; this is the single best method to prevent the spread of infection to the other eye, the parents, other family members, or anyone else. Therefore, parents should ensure that affected children wash their hands frequently and discourage them from rubbing their eyes. Tissues used to clean the eye should be discarded. The child's washcloths and towels should be kept separate. Many schools and day care centers require that children be kept at home during the time when they are most contagious. (Option 1) These tissues should be thrown away immediately, but this step is not as critical as frequent and appropriate hand washing. Gentle wiping should be done from the inner canthus downward and outward, away from the other eye. (Option 2) Eye drops are easiest instilled in the eye when the child is lying down or sitting with the head tilted back. (Option 3) Warm, moist compresses help remove the crusting present on the eyelid and in the lashes. However, the compress should not be left for long periods as it may promote bacterial growth. Educational objective: Frequent and proper hand washing is necessary to prevent the spread of bacterial conjunctivitis to the other eye or to other individuals. Tissues used to wipe eye medication should be discarded, towels and washcloths should be kept separate, and the child should be discouraged from rubbing the affected eye.

A nurse in the neonatal intensive care unit discovers a cyanotic newborn with excessive frothy mucus in the mouth. What should be the nurse's first action? 1. Administer 100% oxygen 2. Auscultate the lungs 3. Place infant in knee-chest position 4. Suction the infant's mouth

4. The initial nursing action for a client experiencing cyanosis and excess oral secretions is suctioning the mouth (ie, oropharynx) to clear the airway (Option 4). Excessive frothy mucus and cyanosis in a newborn could be due to esophageal atresia (EA) and tracheoesophageal fistula (TEF). If EA/TEF is suspected, the infant should be kept supine with the head elevated at least 30 degrees to prevent aspiration. A nasogastric tube should be inserted and connected to continuous or intermittent suction until surgical repair. (Option 1) Oxygen cannot be delivered to the lungs if secretions obstruct the airway. Therefore, suctioning is a priority. (Option 2) This infant is aspirating and in immediate distress, which should be addressed without delay. After suctioning the excess saliva and ensuring a clear airway, the nurse may perform further assessments. (Option 3) This infant's cyanosis is a result of aspirating secretions and does not indicate a circulatory problem. The knee-chest position is appropriate to increase pulmonary blood flow in infants with a cyanotic heart defect (eg, tetralogy of Fallot). Educational objective:The initial nursing action for a client experiencing cyanosis and excess oral secretions is oropharyngeal suctioning to ensure airway patency. Additional Information Physiological Adaptation NCSBN Client Need

he nurse in a clinic is caring for an 8-month-old with a new diagnosis of bronchiolitis due to respiratory syncytial virus (RSV). Which instructions can the nurse anticipate reviewing with the parent? 1. Administering a cough suppressant and antihistamine 2. Prophylactic treatment of family members 3. Temporary cessation of breastfeeding 4. Use of saline drops and a bulb syringe to suction nares

4. cough sepressants antihistamins and other medications are NOT good for bronchiolitisRSV -prophylactic treatment of family members is good for pertussivs but not for RSV bronchiolitis breastfeeding should be continued and additional fluids givn monitor respiratory status and periodic nasal suctioning

The nurse is teaching a class on nutrition and feeding practices for young children. What should the nurse recommend as the best snack for a toddler? 1. ½ cup orange juice 2. Dry, sweetened cereal 3. Raw carrot sticks 4. Slices of cheese

4. When choosing foods for a toddler (age 1-3 years), parents should consider the following factors: Safety: Small, hard, sticky, or slippery foods (eg, hot dogs, whole grapes, nuts, raw carrot sticks, popcorn, peanut butter, hard candy, fruit snacks) pose a choking risk and should not be offered. Nutrient density: Foods should contain valuable nutrients (eg, protein, vitamins) rather than just "empty calories" (eg, sugars). Potential for foodborne illness: Children are at a higher risk for developing food-related infections, especially if given raw, unpasteurized foods (eg, partially cooked eggs, raw fish, raw bean sprouts). Healthy snacks for a toddler include pieces of cheese, whole-wheat crackers, banana slices, yogurt, cooked vegetables, and cottage cheese with thinly sliced fruit (Option 4). (Option 1) Although orange juice is a source of vitamin C, it contains a large amount of sugar and lacks fiber. Toddlers should have no more than 4-6 oz of 100% fruit juice per day. (Option 2) Sweetened cereals, especially those marketed toward children, can be high in sugar and low in nutrients. (Option 3) Raw carrot sticks are hard and pose a choking risk. Parents should serve carrots and other hard vegetables grated or cooked. Educational objective:Food for young children should contain valuable nutrients and pose little risk of choking or foodborne infection. An example of a healthy snack for a toddler is a slice of cheese.

The clinic nurse reviews teaching provided to the parent of a child being considered for growth hormone replacement therapy at home. Which statement by the parent indicates that teaching has been effective? "Treatment will be considered a success when my child grows at a rate equal to peers." "Treatment will be required throughout my child's life." "Treatment will begin when my child becomes an adolescent." "Treatment will require a daily injection under my child's skin."

4. daily injection A child who demonstrates a slow growth pattern will undergo diagnostic evaluation to determine the cause. If the cause is found to be growth hormone deficiency, the child may undergo growth hormone replacement therapy. The biosynthetic hormone is administered via subcutaneous injection on a daily basis. Despite replacement therapy, the child may still have a final height less than "normal." Treatment is most successful when diagnosis and replacement therapy begin early in the child's life. When to stop therapy is decided by the client, family, and provider. However, growth less than 1 inch (2.5 cm) per year and bone age of 14 years in girls and 16 years in boys are the criteria often used to stop therapy. (Option 1) Growth hormone replacement does not guarantee that a child will grow at a rate equal to peers. Treated children often remain shorter than their peers. (Option 2) Replacement therapy is not continued throughout a child's life. It is stopped when bone growth begins to cease or when the child, parents, and provider make the decision. (Option 3) Replacement therapy is most successful when treatment begins early, as soon as growth delays are noted.

A 2-year-old child is brought to the emergency department for a severe sore throat and fever of 102.9 F (39.4 C). The nurse notes that the child is drooling with distressed respirations and inspiratory stridor. What action should the nurse take first? Assess an accurate temperature with a rectal thermometer Directly examine the throat for the presence of exudates Obtain intravenous access for anticipated steroid administration Position the child in tripod position on the parent's lap

position child in tripod poisiton on parents lap This is a classic description of epiglottitis (supraglottitis). It is an inflammation by bacteria of the tissues surrounding the epiglottis, a long, narrow structure that closes off the glottis during swallowing. Edema can develop rapidly (as quickly as a few minutes) and obstruct the airway by occluding the trachea. There has been a 10-fold decrease in its incidence due to the widespread use of the Hib (Haemophilus influenzae type B) vaccine. The classic symptoms include a high-grade fever with toxic appearance, severe sore throat, and the 4 Ds—dysphonia (muffled voice), dysphagia (difficulty swallowing), drooling, and distressed respiratory effort. The tripod position opens the airway and helps air flow. The child should be allowed to assume a position of comfort (usually sitting rather than lying down). The priority nursing response is to protect the airway. (Option 1) No invasive procedure should be done that could cause the child to cry until the airway is secure. Knowing the temperature is not a priority. (Options 2 and 3) When drooling is present, the airway becomes the primary concern. No visual inspection, invasive procedure, or anxiety-provoking activity should be done until the airway is secure due to the risk of laryngospasm and respiratory arrest.

A 4-year-old boy is diagnosed with Duchenne muscular dystrophy. Which nursing teaching is most appropriate to reinforce for this child's parents? Increase intake of foods high in iron Lift weights to strengthen weak muscles Remove throw rugs from the home Take the muscle relaxant baclofen on time

remove throw rugs from home Duchenne muscular dystrophy (DMD) is the most common form of childhood MD. The condition is X-linked recessive (ie, carried by females and affects males) and is due to lack of a protein called dystrophin needed for muscle stabilization. Disease onset is age 2-5 years. Muscles of the proximal lower extremities and pelvis are affected first. Calf muscles hypertrophy (pseudohypertrophy) initially in response to proximal muscle weakness and are later replaced by fat and connective tissue. The Gower sign involves the use of one's hands to rise from a squat or from a chair to compensate for proximal muscle weakness. There is no effective cure. Most children are wheelchair bound by adolescence and die by age 20-30 from respiratory failure. It is important to avoid floor clutter (eg, throw rugs) and prevent falls/injury (Option 3). (Option 1) Iron deficiency is not related to MD. Diet should be assessed to ensure adequate fluid, whole grains, fruits, and vegetables to maintain bowel function to reduce the risk for constipation from immobility. (Option 2) Clients are encouraged to participate in regular gentle recreation-based exercises and swimming to avoid disuse muscle atrophy and social isolation. Overexertion such as weight lifting is not recommended due to the risk of muscle injury. (Option 4) Skeletal muscle relaxants such as baclofen (along with benzodiazepines) are used in cerebral palsy to control spasticity and seizures. Cerebral palsy is characterized by abnormal muscle tone and lack of coordination with spasticity. MD is characterized by weak muscles from the muscle tissue being replaced by connective tissue.