16, 17 ,18
A child diagnosed with acute otitis media has been given a prescription for benzocaine. The nurse is correct when she makes which statement? "Benzocaine drops should be placed in your eye to numb it and reduce pain." "Benzocaine is an antibiotic for your eye infection." "Benzocaine drops should be placed in your ear to numb it and reduce pain." "Benzocaine is an antibiotic for your ear infection."
"Benzocaine drops should be placed in your ear to numb it and reduce pain." Explanation: Benzocaine numbing eardrops can be prescribed for acute otitis media to help with severe pain. Benzocaine is not an antibiotic and when prescribed for otitis media should be placed in the ear.
The nurse is teaching parents of a 6-year-old child about otitis media (OM). What predisposes the child to OM infections? The use of cotton swabs, which can damage the eardrum Eustachian tubes that are long and narrow in children Swimming and other water activities Bacteria entering through the eustachian tube
Bacteria entering through the eustachian tube Explanation: Organisms that cause otitis media gain entrance to the middle ear through the eustachian tubes. A cotton swab may damage the eardrum but will not cause otitis media. A child's eustachian tube is shorter, wider, and more horizontal than an adult's. Swimming and other water activity are associated with "swimmer's ear" and not otitis media.
The nurse is caring for a 14-month-old boy with cystic fibrosis. Which sign of ineffective family coping requires urgent and immediate intervention?
Compliance with therapy is diminished. Explanation: Until the family adjusts to the demands of the disease, they can become overwhelmed and exhausted, leading to noncompliance, resulting in worsening of symptoms. Typical challenges to the family are becoming overvigilant, the child feeling fearful and isolated, and the siblings being jealous or worried, but these are not a priority over the noncompliance.
The nurse is caring for an 11-year-old child with pneumonia who is exhibiting an increased work of breathing. Which intervention is the priority? positioning the child in Fowler position administering intravenous fluids as prescribed providing supplemental oxygen as prescribed administering analgesics as prescribed
positioning the child in Fowler position Explanation: Positioning the child in Fowler position helps to open the airway and provide more room for lung expansion, resulting in more effective breathing patterns while supplemental oxygen and intravenous fluids are administered. Administering intravenous fluids and administering oxygen are appropriate actions after the child is placed in a comfortable position. Analgesics may be prescribed and administered if the child is experiencing pain from coughing.
The nurse is teaching the parent of a child with cystic fibrosis about nutrition requirements for the child. What should be included in this teaching? "Give your child high-calorie foods and snacks." "Feed your child foods that are high in protein." "Administer water soluble vitamins." "Give pancreatic enzymes with meals." "Give your child foods high in fat."
"Give your child high-calorie foods and snacks." "Feed your child foods that are high in protein." "Give pancreatic enzymes with meals." Explanation: Children with cystic fibrosis (CF) have trouble digesting and absorbing nutrients. They tend to be underweight. For optimal health, their diets should be high in calories and high in protein, with the supplementation of fat soluble vitamins and pancreatic enzymes. This diet helps with growth and the optimal nutrients. The fat soluble vitamins (vitamins A, D, E and K) are needed, because children with CF have trouble absorbing fat and need the vitamin supplementation to aid in fat absorption. Water soluble vitamins (the B vitamins and vitamin C) do not aid in fat absorption. The child should not have a high-fat diet because the extra fat is difficult to digest and be absorbed. Pancreatic enzymes are necessary because they are missing due to the disease process. They are necessary to aid in digestion. They should be ingested with meals.
A 4-week-old infant is diagnosed with acute bronchiolitis. The parent states, "I do not know how the baby got this!" How should the nurse respond?
"Has your infant been around any crowds?" Explanation: Acute bronchiolitis is caused by a viral infection, most often, respiratory syncytial virus. Viruses are often spread between groups of people in close contact. Hereditary and environmental complications do not relate to this disorder.
The nurse is obtaining a health history of a child suspected of tuberculosis. What question would the nurse ask first about the child's cough? "How long has your child had a cough?" "Does your child cough only at night?" "Does your child cough up anything when coughing?" "Has your child been around anyone who is coughing?"
"How long has your child had a cough?" Explanation: Tuberculosis is a highly contagious disease. Most children contract it from an infected immediate household member. When taking the health history, the nurse should ask about symptoms such as malaise, weight loss, anorexia, chest tightness and a cough. The child's cough from tuberculosis is described as progressing slowly over several weeks and months rather than having an acute onset. Asking about the production from the cough is a way to determine if hemoptysis has occurred. Asking about being around anyone coughing is a way to determine if the child has been exposed to anyone with tuberculosis. Coughing only at night could be related to other respiratory disorders such as asthma.
An otherwise healthy 18-month-old child with a history of febrile seizures is in the well-child clinic. Which statement by the father would indicate to the nurse that additional teaching should be done? "I have ibuprofen available in case it's needed." "My child will likely outgrow these seizures by age 5." "I always keep phenobarbital with me in case of a fever." "The most likely time for a seizure is when the fever is rising."
"I always keep phenobarbital with me in case of a fever." Explanation: Anticonvulsants, such as phenobarbital, are administered to children with prolonged seizures or neurologic abnormalities. Ibuprofen, not phenobarbital, is given for fever. Febrile seizures usually occur after age 6 months and are unusual after age 5. Treatment is to decrease the temperature because seizures occur as the temperature rises.
Gabapentin has been prescribed for a pediatric client. Which statement by the client indicates an understanding of teaching related to the medication? "This medication can be sprinkled on my food." "This medication should be taken in the evening before I go to bed." "I can't take this medication within 2 hours of taking my antacid medication." "This medication will make me extremely hungry."
"I can't take this medication within 2 hours of taking my antacid medication." Explanation: Gabapentin is used in the treatment of seizure disorders. It is rapidly absorbed. It cannot be taken within 2 hours of the administration of antacid medications.
The nurse is caring for a child who has suffered a febrile seizure. While speaking with the child's parents, which statement by a parent indicates a need for further education? a. "The next time he has a fever, I need to make sure I read the dosage on the acetaminophen bottle carefully." b. "I need to set an alarm to wake up and check his temperature during the night when he is sick." c. "I hate to think that I will need to be worried about my child having seizures for the rest of his life." d. "When he gets his next set of immunizations, I need to make sure I give him some ibuprofen so he doesn't spike a fever."
"I hate to think that I will need to be worried about my child having seizures for the rest of his life." Explanation: Febrile seizures occur most often in preschool children but can occur as late as 7 years of age. They occur when the child has a rapid rise in temperature and are not associated with the development of seizures later in life. Administering correct dosages of acetaminophen and ibuprofen, checking temperatures at night, and anticipating fevers associated with the administration of live vaccines are all ways to prevent the development of febrile seizures.
The nurse is providing teaching to the parents of a child recently prescribed carbamazepine for a seizure disorder. Which statement by a parent indicates successful teaching? "I will give the medication to him when I first wake him up in the morning." "This medication may cause him to have trouble sleeping. He may need something else to help him sleep." "I need to watch for any new bruises or bleeding and let my health care provider know about it." "I'm glad to know he will only need this medication for a short time to stop his seizures."
"I need to watch for any new bruises or bleeding and let my health care provider know about it." Explanation: Carbamazepine is an antiseizure medication. It can cause bone marrow depression, so parents need to watch for any signs of bruising, bleed, or infection and notify their health care provider if this happens. Administer this medication with food to minimize GI upset. This medication can cause drowsiness, so do not give any sleep-inducing or other sedative type medications. Antiseizure medication does not cure seizures; it only controls the seizures. Lifelong antiseizure medication may be needed.
The nurse has finished teaching the parents of a 10-month-old male ways to prevent another acute otitis media (AOM) infection. Which statement by the mother indicates she has the correct understanding of the information provided? "I should continue to smoke in the house." "I should continue to breastfeed my son because it lowers the incidence of acute otitis media." "Immunizations will not help prevent another otitis media infection." "Because the infection is in my son's ear, hand washing is not important."
"I should continue to breastfeed my son because it lowers the incidence of acute otitis media." Explanation: Parents should be encouraged to quit smoking; however, if that is not possible they should not smoke inside the house or automobile. The Prevnar and influenza vaccines can help prevent ear infections. Breastfed infants have a lower incidence of AOM than formula-fed infants so mothers should be encouraged to continue breastfeeding for at least 6 to 12 months. Handwashing helps prevent the common cold, which often leads to AOM.
The nurse is caring for a 10-year-old girl with cystic fibrosis who receives pancreatic enzymes. Which comment by a parent demonstrates understanding of the instructions regarding the medication? "I should give the enzymes before each meal or snack." "I should stop the enzymes if my child is taking antibiotics." "I should reduce the dose if she has large, malodorous stools." "Between meals is the best time to give the enzymes."
"I should give the enzymes before each meal or snack." Explanation: The enzymes are necessary for appropriate digestion and absorption of food and nutrients. There is no interaction between enzymes and antibiotics. Large, malodorous stools are a sign of no pancreatic enzyme activity. Pancreatic enzymes must be given each time the child eats, usually in smaller doses for snacks than for meals.
A toddler has been diagnosed with otitis media with effusion. The parents tell the nurse, "We really don't understand what that diagnosis means." How should the nurse respond?
"The diagnosis means unwanted fluid is within the middle ear space, and there may or may not be an infection present." Explanation: Otitis media with effusion refers to the presence of fluid within the middle ear space, without signs or symptoms of infection. It may occur independent of acute otitis media (AOM) or may persist after the infectious process of AOM has resolved.
A toddler has been diagnosed with otitis media with effusion. The parents tell the nurse, "We really don't understand what that diagnosis means." How should the nurse respond? "The diagnosis means unwanted fluid is within the middle ear space, and there may or may not be an infection present." "It's just a medical term that means an infection of the middle ear." "There is an infection somewhere in the ear canal and their is fluid in the canal." "It would probably be best if you talked to the doctor again about the diagnosis."
"The diagnosis means unwanted fluid is within the middle ear space, and there may or may not be an infection present." Explanation: Otitis media with effusion refers to the presence of fluid within the middle ear space, without signs or symptoms of infection. It may occur independent of acute otitis media (AOM) or may persist after the infectious process of AOM has resolved.
A child who has been having seizures is admitted to the hospital for diagnostic testing. The child has had laboratory testing and an EEG, and is scheduled for a lumbar puncture. The parents voice concern to the nurse stating, "I don't understand why our child had to have a lumbar puncture since the EEG was negative." What is the best response by the nurse? a. "The lumbar puncture can help rule out any infection in fluid surrounding the brain and spinal cord as the cause of the seizures." b. "Since the EEG was negative there must be some other cause for the seizures. The lumbar puncture is necessary to determine what the cause is." c. "I know it must be frustrating not having a diagnosis yet, but you have to be patient. Seizure disorders are difficult to diagnose." d. "A lumbar puncture is a routine test that is performed anytime someone has a seizure disorder."
"The lumbar puncture can help rule out any infection in fluid surrounding the brain and spinal cord as the cause of the seizures." Explanation: Lumbar punctures are performed to analyze cerebrospinal fluid (CSF) to rule out meningitis or encephalitis as a cause of seizures. A normal EEG does not rule out epilepsy because seizure activity rarely occurs during the actual testing time. A 24-hour or longer EEG can help in diagnosing a seizure disorder. Just telling the parents that it needs to be done, to be patient, or it is a routine does not address the parents' concerns.
The parent of a child having myringotomy tubes placed asks, "Will my child lose hearing while the tubes are in place?" What is the nurse's best answer? "The tubes are inserted into a section of eardrum in which the hearing is not affected." "There is some risk of permanent deafness, but the benefit of decreasing the infection is worth it." "Your child's hearing will decrease while the tubes are in place." "Have you asked your child's surgeon about that?"
"The tubes are inserted into a section of eardrum in which the hearing is not affected." Explanation: Myringotomy tubes do not interfere with hearing because they are inserted into a portion of the tympanic membrane that is not instrumental to hearing. There is no risk of permanent deafness and hearing will be increased while the tubes are in place, not decreased. The nurse should answer the parent's question honestly without dismissing it or referring to another health care provider. This indicates to the parent that something may be wrong or serious. The nurse can refer the parent to the surgeon if the parent's questions have not been adequately addressed.
A child having myringotomy tubes placed asks, "How and when will the tubes be removed?" What is the nurse's best response? "You will have them replaced every 2 months until you reach age 18." "The tubes remain in place for 6 months and then are dissolved by vinegar." "The tubes remain in place for 6 to 12 months until they come out by themselves." "The tubes are not removed; they grow permanently into place."
"The tubes remain in place for 6 to 12 months until they come out by themselves." Explanation: The standard treatment for persistent otitis media with effusion is the placement of pressure-equalizing (PE) tubes via a myringotomy. These tubes stay in place for several months and fall out on their own. They are not replaced after they fall out nor are they meant to be a permanent solution to the child's frequent ear infections. Vinegar should not be placed in the ears.
A 7-year-old client has been complaining of headache, coughing, and an aching chest. The care provider makes a diagnosis of a viral infection. The child's mother tells the nurse that when she first said she had a headache, the child's father gave her half of an adult aspirin. The mother has heard of Reye syndrome and asks the nurse if her child could get this. Which statement would be the best response by the nurse? "This might or might not be a problem. Watch your daughter for signs of lethargy, unusual irritability, confusion, or vomiting. If you notice any of these, bring her to the emergency room immediately so she can be checked for Reye syndrome." "This is a serious problem. Aspirin is likely to cause Reye syndrome, and she should be admitted to the hospital for observation as a precaution." "This is unlikely to be a problem. Half an aspirin is not enough to cause harm. Reye syndrome generally only develops from prolonged use of aspirin in connection with a virus." "This might or might not be a problem. Watch your daughter for signs of nasal discharge, sneezing, itching of the nose, or dark circles under the eyes. If you notice any of these, bring her to the emergency room immediately so she can be checked for Reye syndrome."
"This might or might not be a problem. Watch your daughter for signs of lethargy, unusual irritability, confusion, or vomiting. If you notice any of these, bring her to the emergency room immediately so she can be checked for Reye syndrome." Explanation: Reye syndrome usually occurs after a viral illness, particularly after an upper respiratory infection or varicella (chickenpox). Administration of aspirin during the viral illness has been implicated as a contributing factor. As a result, the American Academy of Pediatrics recommends that aspirin or aspirin compounds not be given to children with viral infections. The symptoms appear within 3 to 5 days after the initial illness: The child is recuperating unremarkably when symptoms of severe vomiting, irritability, lethargy, and confusion occur. Immediate intervention is needed to prevent serious insult to the brain, including respiratory arrest.
The nurse is educating the family of a 7-year-old with epilepsy about care and safety for this child. What comment will be most valuable in helping the parent and the child cope? "If he is out of bed, the helmet's on the head." "Bike riding and swimming are just too dangerous." "Use this information to teach family and friends." "You'll always need a monitor in his room."
"Use this information to teach family and friends." Explanation: Families need and want information they can share with relatives, child care providers, and teachers. Wearing a helmet and having a monitor in the room are precautions that may need to be modified as the child matures. The child may be able to bike ride and swim with proper precautions.
The nurse is educating the parents of a 7-year-old boy who has hearing loss due to otitis media with effusion. Which statement by the parents indicates that further education is needed? "We need to raise the volume of our voices significantly so he can hear us." "We need to make sure we are speaking clearly." "We need to face our son when we are speaking." "Using hand gestures as visual cues should help our child understand a little better."
"We need to raise the volume of our voices significantly so he can hear us." Explanation: It is not necessary for the parents to raise their voices more than slightly in order to be heard. Speaking clearly is an appropriate technique for communicating with the child. Facing the child when speaking is an effective method for communicating with the child. Using visual clues, such as hand gestures, is an effective technique for communicating with this child.
The nurse works in a pediatrician office. Which children, who have been diagnosed with acute otitis media, does the nurse expect the physician to treat with antibiotics? Select all that apply. 12-year-old child who reports he has some mild ear pain with a temperature of 101.4 F (38.6 C) 8-year-old child who is crying due to ear pain and has a temperature of 103 F (39.4 C) 2-month-old child who is having difficulty sleeping and has a fever of 102.6 F (39.2 C) 5-month-old child who is fussy and pulling at her ears 22-month-old child who is irritable with the presence of purulent drainage from her right ear
8-year-old child who is crying due to ear pain and has a temperature of 103 F (39.4 C) 2-month-old child who is having difficulty sleeping and has a fever of 102.6 F (39.2 C) 5-month-old child who is fussy and pulling at her ears 22-month-old child who is irritable with the presence of purulent drainage from her right ear Explanation: Children who are 2 years old or younger and have a severe form of acute otitis media with a temperature of 102.2 F (39 C) or higher will most likely receive antibiotics to treat the infection. Children who are older than 2 years of age with severe otalgia and a fever higher than 102.2 F (39 C) typically receive antibiotics. Children who are older than 2 years of age and have mild otalgia and a fever lower than 102.2 F (39 C) have a nonsevere illness. In these cases, the physician may just observe the children to see if their symptoms persist over time or get worse.
An infant is born with congenital glaucoma. The infant is scheduled for surgery to relieve this condition at age 2 days. Which prescription should the nurse question for the infant? Nothing by mouth (with intravenous therapy) prior to surgery A preoperative injection of atropine A preoperative antibiotic Arm restraints to be applied after surgery
A preoperative injection of atropine Explanation: Glaucoma is caused by the obstruction of the aqueous humor flow and causes increased intraocular pressure. Atropine is a drug that causes pupil dilation and further narrows the exit of fluid. It would be contraindicated for this child. The other prescriptions would be appropriate for the child prior to surgery and in the postoperative period.
Which nursing action should be included in the care plan to promote comfort in a 4-year-old child hospitalized with meningitis? a. Avoid making noise when in the child's room. b. Rock the child frequently. c. Have the child's 2-year-old brother stay in the room. d,Keep the lights on brightly so that he can see his mother.
Avoid making noise when in the child's room Explanation: Meningeal irritation may cause seizures and heightens a child's sensitivity to all stimuli, including noise, lights, movement, and touch. Frequent rocking, presence of a younger sibling, and bright lights would increase stimulation.
What is the most common debilitating disease of childhood among those of European descent?
Cystic fibrosis Explanation: Cystic fibrosis is the most common debilitating disease of childhood among those of European descent. Medical advances in recent years have greatly increased the length and quality of life for affected children, with median age for survival being the late 30s.
A preschool-age child has just been admitted to the pediatric unit with a diagnosis of bacterial meningitis. The nurse would include which recommendation in the nursing plan?
Decrease environmental stimulation Explanation: A child with the diagnosis of meningitis is much more comfortable with decreased environmental stimuli. Noise and bright lights stimulate the child and can be irritating, causing the child to cry, in turn increasing intracranial pressure. Vital signs would be taken initially every hour and temperature monitored every 2 hours. Children with bacterial meningitis are usually much more comfortable if allowed to lie flat because this position doesn't cause increased meningeal irritation.
A preschool-age child has just been admitted to the pediatric unit with a diagnosis of bacterial meningitis. The nurse would include which recommendation in the nursing plan? Take vital signs every 4 hours Monitor temperature every 4 hours Decrease environmental stimulation Encourage the parents to hold the child
Decrease environmental stimulation Explanation: A child with the diagnosis of meningitis is much more comfortable with decreased environmental stimuli. Noise and bright lights stimulate the child and can be irritating, causing the child to cry, in turn increasing intracranial pressure. Vital signs would be taken initially every hour and temperature monitored every 2 hours. Children with bacterial meningitis are usually much more comfortable if allowed to lie flat because this position doesn't cause increased meningeal irritation.
The nurse is planning care for a child with a pneumothorax. The nurse adds the nursing diagnosis, "Risk for injury related to potential dislodgement of chest tube" to the care plan. When writing the care plan, what should the nurse be sure to include as interventions? Keep dry gauze at the bedside. Ensure a pair of hemostats are at the bedside. Monitor pulse oximetry readings. Assess lungs as directed by the physician or as the client's condition warrants. Maintain chest tube bottle in an upright position and below the level of the chest.
Ensure a pair of hemostats are at the bedside. Monitor pulse oximetry readings. Assess lungs as directed by the physician or as the client's condition warrants. Maintain chest tube bottle in an upright position and below the level of the chest. Explanation: If the tube becomes dislodged from the child's chest, the nurse must apply Vaseline gauze and an occlusive dressing to prevent air leakage into the pleural space. A pair of hemostats should be kept at the bedside to clamp the tube should it become dislodged from the drainage container. Pulse oximetry and lung assessments help ensure proper placement of the chest tube. To maintain proper drainage, the bottle must be kept upright and below the level of the chest.
The parents of a 17-year-old adolescent diagnosed with bacterial meningitis tell the nurse, "We just do not understand how this could have happened. Our adolescent has always been healthy and just received a booster vaccine last year." How should the nurse respond? "I understand your frustration. Unfortunately, immunizations are not 100% effective in preventing the infection." "Meningococcal conjugate vaccine covers only two types of bacterial meningitis." "Your child may have been exposed to the type of meningitis that is not covered by the vaccine received." "Maybe your child's immune system is not strong enough to fight off the infection, even with having received the vaccine."
I understand your frustration. Unfortunately, immunizations are not 100% effective in preventing the infection." Explanation: Showing empathy while letting the parents know that vaccines are not 100% effective is the best response. Meningococcal conjugate vaccine protects against four types of meningitis. There is nothing in the scenario to lead the nurse to believe that a different strain of bacteria caused the infection, or that the adolescent's immune system is compromised.
A 6-month-old infant is admitted with suspected bacterial meningitis. She is crying, irritable, and lying in the opisthotonic position. Which intervention should the nurse take initially? Institute droplet precautions in addition to standard precautions. Encourage the mother to hold and comfort the infant. Educate the family about preventing bacterial meningitis. Palpate the child's fontanels (fontanelles).
Institute droplet precautions in addition to standard precautions. Explanation: Bacterial meningitis is a medical emergency. The child must be placed on droplet precautions until 24 hours of antibiotics have been given. Encouraging the mother to hold and comfort the child is an intervention but not the priority one; the focus is to get the infant the appropriate medications to fight the infection and to prevent its spread. Educating the family about preventing bacterial meningitis would be appropriate later once the initial infection has been controlled. Palpating the fontanels (fontanelles) is used to assess for hydrocephalus.
The nurse is caring for a child who has conductive hearing loss. What is true regarding this type of hearing loss? It is caused by chronic otitis media or another infection. It is caused by maternal rubella. It is generally severe and unresponsive to medical treatment. It is often undetected until the child goes to school.
It is caused by chronic otitis media or another infection. Explanation: In conductive hearing loss, the transmission of sound through the middle ear is disrupted. Structures fail to carry sound waves to the inner ear. Fluid fills the ear so the tympanic membrane is unable to move properly. This type of impairment most often results from chronic serious otitis media or other infection. Infants have hearing tests before being discharged from the hospital to determine hearing loss, especially premature infants. Hearing loss can be detected early because language development will be impaired. This type of hearing loss is treatable with the use of hearing aids, cochlear implants and communication devices. Rubella causes sensorineural hearing loss.
A child returns to the clinic after an episode of external otitis (acute otitis externa or swimmer's ear) that has resolved. What would the nurse emphasize as the priority for preventing future Keeping ear canals dry Performing handwashing Avoiding upper respiratory tract infections Adhering to regular follow-up to assess for hearing loss
Keeping ear canals dry Explanation: Since moisture contributes to external otitis (acute otitis externa or swimmer's ear), the priority is to keep the ear canals dry. Handwashing would be a priority for preventing infections such as conjunctivitis. Upper respiratory tract infections are associated with otitis media, not external otitis (acute otitis externa or swimmer's ear). Hearing loss is not associated with otitis externa.
The nurse is collecting data from a child who may have a seizure disorder. Which nursing observations suggest an absence seizure? a. Sudden, momentary loss of muscle tone, with a brief loss of consciousness b. Muscle tone maintained and child frozen in position c. Brief, sudden contracture of a muscle or muscle group d. Minimal or no alteration in muscle tone, with a brief loss of responsiveness or attention
Minimal or no alteration in muscle tone, with a brief loss of responsiveness or attention Explanation: Absence seizures are characterized by a brief loss of responsiveness with minimal or no alteration in muscle tone. They may go unrecognized because the child's behavior changes very little. A sudden loss of muscle tone describes atonic seizures. A frozen position describes the appearance of someone having akinetic seizures. A brief, sudden contraction of muscles describes a myoclonic seizure.
The nurse is administering medications to a child with cystic fibrosis. Which method would the nurse most likely use to give medications to treat the pancreatic involvement seen in this disease?
Open capsule and sprinkle on food. Explanation: Pancreatic enzymes should be administered at all meals and snacks to promote adequate digestion and absorption of nutrients. They are supplied in capsule form. For the infant and young child, they can be opened and sprinkled on foods such cereal, pudding, or applesauce. They also can be swallowed whole. They are not supplied in liquid form, so the child could not take them in a medication cup. They are not supplied for injection or inhalation, only oral use.
The caregivers of a child who was diagnosed with cystic fibrosis 5 months ago report that they have been following all of the suggested guidelines for nutrition, fluid intake, and exercise, but the child has been having bouts of constipation and diarrhea. The nurse tells the caregiver to increase the amount of which substance in the child's diet?
Pancreatic enzymes Explanation: Adequate nutrition helps the child resist infections. Pancreatic enzymes must be administered with all meals and snacks. If the child has bouts of diarrhea or constipation, the dosage of enzymes may need to be adjusted. The child's diet should be high in carbohydrates and protein with no restriction of fats. The child may need 1.5 to 2 times the normal caloric intake to promote growth. Low-fat products can be selected if desired. The child also may require additional salt in the diet. Increased caloric intake compensates for impaired absorption.
A nurse is assessing a 3-year-old child for possible bacterial meningitis. Which sign would indicate irritation of the meninges? Positive Kernig sign Negative Brudzinski sign Positive Chadwick sign Negative Kernig sign
Positive Kernig sign Explanation: A positive Kernig sign can indicate irritation of the meninges. A positive Brudzinski sign also is indicative of the condition. A positive Chadwick sign is a bluish discoloration of the cervix indicating pregnancy.
A 10-year-old boy has been experiencing complex partial seizures and has not responded well to medication. Surgery is planned to remove brain tissue at the seizure foci. Which diagnostic test would be the most accurate in identifying the seizure foci? Positron emission tomography (PET) Brain scan Echoencephalography Myelography
Positron emission tomography (PET) Explanation: The diagnostic technique of positron emission tomography (PET) involves imaging after injection of positron-emitting radiopharmaceuticals into the brain. These radioactive substances accumulate at diseased areas of the brain or spinal cord. PET is extremely accurate in identifying seizure foci. Brain scans identify possible tumor, subdural hematoma, abscess, or encephalitis. Echoencephalography is often used in neonatal ICUs to monitor intraventricular hemorrhages and other problems frequently encountered by preterm infants. Myelography is the x-ray study of the spinal cord following the introduction of a contrast material into the CSF by lumbar puncture to reveal the presence of space-occupying lesions of the spinal cord.
While in a pediatric client's room, the nurse notes that the client is beginning to have a tonic-clonic seizure. Which nursing action is priority? Administer lorazepam rectally to the client. Refer the client to a neurologist. Discuss dietary therapy with the client's caregivers. Protect the child from hitting the arms against the bed.
Protect the child from hitting the arms against the bed. Explanation: Keeping the child safe during a seizure is the highest priority. The nurse will protect the child from hitting the arms on the bed or other nearby objects. If the seizure continues, lorazepam may be indicated to stop the seizure. The client would be referred to a neurologist for follow-up care; however, this is not a priority. Dietary therapy is considered for clients with chronic seizure disorders who do not respond to medication therapy
Which test in a child with cystic fibrosis would help monitor airway function? Pulmonary function Bronchoprovocation Peak flow measurement Pulse oximetry
Pulmonary function Explanation: The pulmonary function tests help measure airway function, lung volumes, and gas exchange. Bronchoprovocation provokes bronchospasms to determine airway constriction. Peak flow measurement measures lung velocity. Pulse oximetry monitors blood level oxygen saturation.
The nurse is caring for a child who has been admitted with a possible diagnosis of tuberculosis. Which laboratory/diagnostic tools would most likely be used to help diagnose this child? Purified protein derivative test Sweat sodium chloride test Blood culture and sensitivity Pulmonary functions test
Purified protein derivative test Explanation: Purified protein derivative tests are used to detect TB. Sweat sodium chloride tests are used for determining the diagnosis of cystic fibrosis. Blood culture and sensitivity is done to determine the causative agent as well as the anti-infective needed to treat an infection. Pulmonary function tests are diagnostic tools for the child with asthma and indicate the amount of obstruction in the bronchial airways, especially in the smallest airways of the lungs.
The nurse is preparing a care plan for a child who has a seizure disorder. The child experiences tonic-clonic seizures. Which nursing diagnosis will the nurse identify as having the highest priority? Risk for delayed development Risk for injury Risk for ineffective tissue perfusion: cerebral Risk for self-care deficit: bathing and dressing
Risk for injury Explanation: A seizure disorder is caused by a disruption in the electrical impulses in the brain. Tonic-clonic seizures are the most dramatic seizure disorder. It is characterized by a loss of consciousness, along with the entire body experiencing tonic contractions followed by rhythmic clonic contractions alternating with relaxation of all muscle groups. Cyanosis may be noted due to apnea, and saliva may collect in the mouth due to an inability to swallow. All of these symptoms would make Risk for injury the highest priority.
the nurse is reinforcing teaching about medications with the parents of a 2-year-old who has cystic fibrosis. The nurse suggests that pancreatic enzymes may be given by which method?
Sprinkled onto the food Explanation: Pancreatic enzymes are used in the treatment of cystic fibrosis and are given by opening the capsule and sprinkling the medication on the child's food. If the child with cystic fibrosis has an infection, IV medications may be given, but this is not on a daily basis. Most children do not have a gastrostomy tube. Many of these drugs used in the treatment of asthma can be given either by a nebulizer (tube attached to a wall unit or cylinder that delivers moist air via a face mask) or a metered-dose inhaler [MDI], which is a hand-held plastic device that delivers a premeasured dose.
The nurse is caring for a child who has been admitted with a possible diagnosis of cystic fibrosis. Which laboratory/diagnostic tools would most likely be used to help determine the diagnosis of this child? Purified protein derivative test Sweat sodium chloride test Blood culture and sensitivity Pulmonary functions test
Sweat sodium chloride test Explanation: Sweat sodium chloride tests are used for determining the diagnosis of cystic fibrosis. Purified protein derivative tests are used to detect TB. Blood culture and sensitivity is done to determine the causative agent as well as the anti-infective needed to treat an infection. Pulmonary function tests are diagnostic tools for the child with asthma and indicate the amount of obstruction in the bronchial airways, especially in the smallest airways of the lungs.
A 9-year-old boy is suffering from headaches but has no signs of physical or neurologic illness. Which intervention would be most appropriate? Teach the child and his parents to keep a headache diary. Review the signs of increased intracranial pressure with parents. Have the child sleep without a pillow under his head. Have the parents call the doctor if the child vomits more than twice.
Teach the child and his parents to keep a headache diary. Explanation: A headache diary can help identify any triggers so that the child can avoid them. Triggers can include foods eaten, amount of sleep the night before, or activities at home or school that might be causing stress. Reviewing signs of increased intracranial pressure would be inappropriate because increased intracranial pressure is not associated with headaches. Having the child sleep without a pillow is an intervention to reduce pain from meningitis. Vomiting more than twice is an indication that the parents should notify the physician or nurse practitioner when the child has a head injury.
The nurse is taking a health history for a 3-year-old girl suspected of having pneumonia who presents with a fever, chest pain, and cough. Which information places the child at risk for pneumonia?
The child attends day care. Explanation: Attending day care is a known risk factor for pneumonia. Being a triplet is a factor for bronchiolitis. Prematurity rather than postmaturity is a risk factor for pneumonia. Diabetes is a risk factor for influenza.
The nurse is performing a physical assessment for an 8-year-old child with an earache. Which sign or symptom indicates external otitis (acute otitis externa or swimmer's ear)? The tympanic membrane reacts to a puff of air. Symptoms of upper respiratory infection are present. The ear canal is devoid of cerumen. The child cries out when the ear is grasped.
The child cries out when the ear is grasped. Explanation: External otitis (acute otitis externa or swimmer's ear) is an infection and inflammation of the skin of the external ear canal. The classic sign of external otitis is pain on movement of the pinna or pain on pressure over the tragus. Upon examination, the ear canal is red and swollen. Many times the tympanic membrane cannot be visualized because the swelling does not allow the insertion of an otoscope. Symptoms of upper respiratory infection many times accompany otitis media but are not seen in external otitis. The tympanic membrane reacting to a puff of air is a sign that there is no fluid buildup in the middle ear. The absence of cerumen in the ear canal is not related to external otitis.
The nurse is caring for a child admitted with focal onset motor seizures (simple partial motor seizures). Which clinical manifestation would likely have been noted in the child with this diagnosis? a. The child had jerking movements and then the extremities stiffened. b. The child had shaking movements on one side of the body. c. The child was rubbing the hands and smacking the lips. d. The child was dizzy and had decreased coordination.
The child had shaking movements on one side of the body. Explanation: Focal onset aware seizures (formerly called simple partial seizures) can either have motor or sensory symptoms. A focal onset motor seizure causes a localized motor activity such as shaking of an arm, leg, or other body part. A focal onset sensory seizure may include sensory symptoms called an aura, which signals an impending attack. Myoclonic seizures are characterized by a sudden jerking of a muscle or group of muscles, often in the arms or legs, without loss of consciousness. Complex partial seizures may cause nonpurposeful movements, such as hand rubbing and lip smacking. During the prodromal period of the tonic-clonic seizure, the child might have a lack of coordination.
The nurse is caring for a newly admitted 3-year-old child who has been diagnosed with tuberculosis. When reviewing the child's records which finding(s) is consistent with this disease? Select all that apply. The child currently lives at home with parents and one sibling. The child has been experiencing a sore throat for the past few weeks. The child has been experiencing night sweats. The child and the family were homeless for a period of time in the past 3 months. The child has had recent weight loss.
The child has been experiencing night sweats. The child and the family were homeless for a period of time in the past 3 months. The child has had recent weight loss. Explanation: Tuberculosis is a highly contagious respiratory infection. A child who has been living in crowded locations, who is impoverished, or homeless is at an increased risk. Signs and symptoms of the disease include weight loss, night sweats, anorexia and pain. A child living in a household with parents and one sibling does not have an increased risk for infection. A sore throat is not associated with tuberculosis.
During the trial period to determine the efficacy of an anticonvulsant drug, which caution should be explained to the parents? Plasma levels of the drug will be monitored on a daily basis Drug dosage will be adjusted depending on the frequency of seizure activity The drug must be discontinued immediately if even the slightest problem occurs The child shouldn't participate in activities that could be hazardous if a seizure occurs
The child shouldn't participate in activities that could be hazardous if a seizure occurs Explanation: Until seizure control is certain, clients shouldn't participate in activities (such as riding a bicycle) that could be hazardous if a seizure were to occur. Plasma levels need to be monitored periodically over the course of drug therapy; daily monitoring isn't necessary. Dosage changes are usually based on plasma drug levels as well as seizure control. Anticonvulsant drugs should be withdrawn over a period of 6 weeks to several months, never immediately, as doing so could precipitate status epilepticus.
The nurse is caring for a child admitted with focal onset impaired awareness seizure (complex partial seizure). Which clinical manifestation would likely have been noted in the child with this diagnosis?
The child was rubbing the hands and smacking the lips. Explanation: With the focal onset impaired awareness seizure, formerly called complex partial seizure, the child is confused or their awareness is affected during the seizure. The seizure begins in a small area of the brain and changes or alters consciousness. These seizures can have motor and non-motor symptoms. They cause memory loss and staring and nonpurposeful movements, such as hand rubbing, lip smacking, arm dropping, and swallowing. In the tonic phase of tonic-clonic seizures, the child's muscles contract, the child may fall, and the child's extremities may stiffen. During the prodromal period of the tonic-clonic seizure, the child might have a lack of coordination.Focal onset aware seizures (formerly called simple partial seizures) can either have motor or sensory symptoms. A focal onset motor seizure causes a localized motor activity such as shaking of an arm, leg, or other body part.
The nurse is preparing discharge education for the caregivers of a child with a seizure disorder. Which goal of treatment is priority for this client? The caregivers will be prepared to care for the child at home. The child will have an understanding of the disorder. The family will understand seizure precautions. The child will remain free from injury during a seizure.
The child will remain free from injury during a seizure. explain: Keeping the child free from injury is the priority goal. The other choices are important, but keeping the child safe is higher than preparing for home care or knowledge deficit concerns. The physical concerns are always priority over the psychological concerns when caring for clients.
A parent with a child who has cystic fibrosis asks the nurse how to determine if the child is receiving an adequate amount of pancreatic enzymes. How should the nurse respond? Select all that apply. "The dose is adequate when your child is only having 1 to 2 stools per day." "The dose is adequate when your child's weight is improving." "The dose prescribed is based on your child's pancreatic laboratory values so it should be correct." "When your child starts to eat more quantities of food you will need to adjust the amount of enzyme pills." "You will need to give your child less enzyme pills when high-fat foods are eaten."
The dose is adequate when your child is only having 1 to 2 stools per day." "The dose is adequate when your child's weight is improving." "When your child starts to eat more quantities of food you will need to adjust the amount of enzyme pills." Explanation: Pancreatic enzymes are required for the child with cystic fibrosis (CF) to help absorb nutrients from the diet and to aid in digestion. They are given with each meal and snack the child eats. The number of capsules required at each dose depends upon the diagnosis of how the pancreas is functioning and the amount of food needed to be digested. The pancreatic laboratory values may determine a baseline for the number of pills to start with, but the dosage is adjusted regularly. The dosage of pancreatic enzymes is adjusted until an adequate growth pattern is established and the child is having no more than 1 to 2 stools per day. The child should be given an increased number of enzyme pills when a meal with high-fat content is consumed, not fewer.
A parent of a newborn asks the nurse if there is any way to prevent acute otitis media. What would the nurse state to the parent? Prophylactic acetic acid instillations may be helpful. The frequency of otitis media is reduced in breastfed infants. Prophylactic myringotomy tubes can be inserted at birth. Starting immunizations at birth rather than age 2 months might help.
The frequency of otitis media is reduced in breastfed infants. Explanation: Breastfeeding is a way to help prevent acute otitis media in infants. Acute otitis media tends to occur less often in breastfed than bottle-fed infants. One reason is the immunologic benefits from the breast milk. An infant should not start immunizations until 2 months of age, because the organs and immune system are not mature enough at birth. Placing medications and tubes are never done prophylactically.
A nurse is caring for an infant admitted with a diagnosis of bronchiolitis. After completing an assessment, the nurse creates a plan of care for the infant. Which client goal would be priority in the plan of care?
The infant's airway will remain clear and free of mucus. Explanation: Keeping the infant's airway clear is the top priority. An O2 saturation of 90% on room air is minimally acceptable. It is important that the infant's breathing be less labored and that there is decreased nasal stuffiness, but having the airway clear and free of mucus is most important.
The NICU nurse is caring for a preterm neonate with respiratory distress syndrome on mechanical ventilation. Which assessment data would alert the nurse that a pneumothorax might have developed? Select all that apply
The neonate's respiratory rate is 68. Neonate is exhibiting nasal flaring and grunting. The neonate's chest is asymmetrical with decreased breath sounds on one side. Explanation: Signs of pneumothorax include respiratory rate of 68, nasal flaring and grunting, asymmetrical chest rise with decreased breath sounds on one side. Infants with a pneumothorax exhibit signs of respiratory distress, including tachypnea (>60 breaths/minute) and nasal flaring and grunting. On examination the chest is asymmetrical, with decreased breath sounds on the affected side. In the case of a large pneumothorax, the nurse should observe for hypotension (systolic blood pressure<30), hypoxemia (<90%), and bradycardia (<120 beats/minute) that may occur due to an increase in pressure inside the thorax, which in turn leads to decreased cardiac output. Blood pressure of 80/50 is within normal limits. Oxygen saturation of 92% and heart rate of 130 are also within normal limits. Chest radiography revealing low lung volume and a ground glass appearance are expected in newborn respiratory distress syndrome, but is not diagnostic of a pneumothorax. A chest X-ray of a pneumothorax will show a darkened area over the collapsed lung.
The nurse is educating the parents of a 7-year-old girl with epilepsy about managing treatment of the disorder at home. Which intervention is most effective for eliminating breakthrough seizures?
Understanding the side effects of medications Explanation: The most common cause of breakthrough seizures is noncompliance with medication administration, which may occur if the parents do not understand what side effects to expect or how to deal with them. Treating the child as though she did not have epilepsy helps improve her self-image and self-esteem. Placing the child on her side on the floor is an intervention to prevent injury during a seizure. Instructing the teacher on how to respond when a seizure occurs will help relieve anxiety and provide a sense of control.
The nurse is educating the parents of a 7-year-old girl with epilepsy about managing treatment of the disorder at home. Which intervention is most effective for eliminating breakthrough seizures? Understanding the side effects of medications Treating the child as though she did not have epilepsy Placing the child on her side on the floor Instructing her teacher how to respond to a seizure
Understanding the side effects of medications Explanation: The most common cause of breakthrough seizures is noncompliance with medication administration, which may occur if the parents do not understand what side effects to expect or how to deal with them. Treating the child as though she did not have epilepsy helps improve her self-image and self-esteem. Placing the child on her side on the floor is an intervention to prevent injury during a seizure. Instructing the teacher on how to respond when a seizure occurs will help relieve anxiety and provide a sense of control.
The nurse is preparing a child experiencing new-onset seizures for an electroencephalogram (EEG) test. How can the nurse best explain this procedure to the child?
Use a doll with electrodes attached to the head. Explanation: An electroencephalogram (EEG) is a test to measure the electrical activity of the brain. It is conducted by attached electrodes over sections of the head and obtains an electrical reading via a monitor. There is no pain involved in the procedure, but the child must lie still. The best way for the nurse to explain the procedure to the child is via a doll with attached electrodes that the child can play with, feel, and manipulate. This helps to reduce the child's anxiety and aids in cooperation. Videos can help with the education process but they do not allow for interaction and physical touching. The child can take a nap during the procedure but this does not prepare the child for the procedure. Assuring the child that the procedure will not hurt is not the best way to prepare the child.
The nurse is preparing a child experiencing new-onset seizures for an electroencephalogram (EEG) test. How can the nurse best explain this procedure to the child? Use a doll with electrodes attached to the head. Show the child a video of the procedure. Tell the child he or she can take a nap during the procedure. Assure the child the procedure will not hurt.
Use a doll with electrodes attached to the head. Explanation: An electroencephalogram (EEG) is a test to measure the electrical activity of the brain. It is conducted by attached electrodes over sections of the head and obtains an electrical reading via a monitor. There is no pain involved in the procedure, but the child must lie still. The best way for the nurse to explain the procedure to the child is via a doll with attached electrodes that the child can play with, feel, and manipulate. This helps to reduce the child's anxiety and aids in cooperation. Videos can help with the education process but they do not allow for interaction and physical touching. The child can take a nap during the procedure but this does not prepare the child for the procedure. Assuring the child that the procedure will not hurt is not the best way to prepare the child.
A 10-year-old client has just been treated for external otitis (acute otitis externa or swimmer's ear) and now the nurse is teaching the boy and his parents about prevention. Which recommendation should the nurse include? Using alcohol and vinegar for soreness. Using cotton swabs to keep the inner ear dry. Using a hair dryer on cool to dry the ears. Washing the hair only when necessary.
Using a hair dryer on cool to dry the ears. Explanation: A mixture of 50% rubbing alcohol and 50% vinegar squirted into the canal and then allowed to run out is a good preventive measure, but not when inflammation is present. Cotton swabs should not be placed in the ears to dry them. The child can wash his hair as needed. Using a hair dryer on a cool setting to dry the ears works well as long as the vent is clean and free from dust that may have accumulated.
When assessing a child for the probable cause of acute bronchiolitis, the nurse focuses on which factor? Bacterial infections Environmental allergies Prenatal complications Viral infections
Viral infections Explanation: Acute bronchiolitis is caused by a viral not bacterial infection. Neither allergies nor prenatal complications contribute to the development of this disorder.
The nurse is caring for a child with a history of cystic fibrosis (CF). Which finding will the nurse report to the primary health care provider?
Wheezing Explanation: The nurse would report wheezing, as this indicates respiratory distress. Clubbing occurs with chronic respiratory illness. It is the result of increased capillary growth as the body attempts to supply more oxygen to distal body parts. Barrel chest refers to the shape the chest takes on in chronic respiratory illness. It takes the shape as chronically the lungs fill with air but are unable to fully expel the air. Delayed puberty is common in clients with cystic fibrosis and does not require reporting at this time.
The nurse is caring for a 20-month-old girl with equivocal bacterial otitis media, a severe earache, and a temperature of 39°C (102.2°F). Which intervention would the nurse expect to implement? administering antibiotics as soon as they're available obtaining a culture of fluid from the middle ear determining if the girl's balance is shaky when walking administering antivirals to ensure broad coverage of all organisms
administering antibiotics as soon as they're available Explanation: Because of the severity of the symptoms, the child will be treated with antibiotics immediately. This decision is based on the clinical practice guideline developed by the American Academy of Pediatrics and American Academy of Family Physicians. This clinical practice guideline helps to eliminate the need for obtaining middle ear fluid for culture. It is unreasonable to obtain a culture of middle ear fluid with every episode of acute otitis media to determine the specific cause. A 20-month-old's gait would most likely appear as swaying from side to side while moving forward. It is not until the toddler is around 3 years of age that he or she demonstrates walking in a heel-to-toe fashion with a steady gait. Antiviral medications would be used if the diagnosis of a viral cause was confirmed and the child was older than age 2 years.
The student nurse is collecting data on a child diagnosed with cystic fibrosis and notes the child has a barrel chest and clubbing of the fingers. In explaining this manifestation of the disease, the staff nurse explains the cause of this symptom to be:
chronic lack of oxygen. Explanation: In the child with cystic fibrosis the development of a barrel chest and clubbing of fingers indicate chronic lack of oxygen. Impaired digestive activity may occur due to a lack of pancreatic enzymes. The high sodium concentration makes the child taste salty, but is not related to the barrel chest and clubbing of the fingers. Respiratory issues are a concern, but the barrel chest and clubbing of the fingers are not because of the child's respiratory capacity.
The student nurse is collecting data on a child diagnosed with cystic fibrosis and notes the child has a barrel chest and clubbing of the fingers. In explaining this manifestation of the disease, the staff nurse explains the cause of this symptom to be: impaired digestive activity. high sodium chloride concentration in the sweat. chronic lack of oxygen. decreased respiratory capacity.
chronic lack of oxygen. Explanation: In the child with cystic fibrosis the development of a barrel chest and clubbing of fingers indicate chronic lack of oxygen. Impaired digestive activity may occur due to a lack of pancreatic enzymes. The high sodium concentration makes the child taste salty, but is not related to the barrel chest and clubbing of the fingers. Respiratory issues are a concern, but the barrel chest and clubbing of the fingers are not because of the child's respiratory capacity.
The nurse and an adolescent are reviewing the adolescent's record of her headaches and activities surrounding them. What activity would the nurse identify as a possible trigger? drinking three cans of diet cola swimming twice a week use of nonaccented soap 11 p.m. bedtime; 6:30 a.m. wake-up
drinking three cans of diet cola Explanation: Cola contains caffeine, which is an associated trigger. Intense activity, not regular exercise, may be a trigger. Odors, such as strong perfumes, may be a trigger. Changes in sleeping patterns may be a trigger.
A child is hospitalized with pneumonia. The nurse assesses an increase in the work of breathing and in the respiratory rate. What intervention should the nurse do first to help this child?
elevate the head of the bed Explanation: The child who is experiencing increased work of breathing should be placed in a position to better open the airway and provide more room for lung expansion. Generally this is accomplished by elevating the head of the bed. If this does not improve the work of breathing, then administering oxygen should be done. The oxygen saturation should be measured because it will provide information as to the severity of the respiratory problem, but this measurement will not directly help the child. The health care provider should be notified if the child continues to deteriorate.
The nurse is developing a teaching plan for the parents of a 12-year-old boy with cystic fibrosis. For which piece of equipment should the nurse prioritize education? flutter valve device. metered dose inhaler. nebulizer. peak flow meter.
flutter valve device. Explanation: A flutter valve device is used to assist with mobilization of secretions for older children and adolescents with cystic fibrosis. While some medications may be administered via nebulizer, not all older children with cystic fibrosis may use them. Meter dosed inhalers and peak flow meters are typically used for asthma therapy.
A child has been admitted to the pediatric unit with pneumonia. The nurse is preparing to administer the prescribed medication to the child to help reduce the viscosity of the child's secretions. Which medication would the nurse most likely give? guaifenesin albuterol dextromethorphan ipratropium
guaifenesin Explanation: An expectorant, such as guaifenesin, reduces viscosity of thickened secretions by increasing respiratory tract fluid. Albuterol is a short-acting beta-adrenergic agonist that acts as a bronchodilator. Dextromethorphan is a cough suppressant. Ipratropium is an anticholinergic agent that acts as a bronchodilator.
A toddler is diagnosed with acute otitis media and prescribed antipyretics and numbing ear drops. Which instruction is most important to teach the parents about treatment? how to administer the ear drops option of administering acetaminophen or ibuprofen as needed option of using heat or cool compresses for comfort importance of administering antibiotics as prescribed
how to administer the ear drops Explanation: Acute otitis media is diagnosed when there is an acute onset of fever and ear pain. The fluid in the middle ear can be infected by either viruses or bacteria. It occurs more often in younger children due to the short length and the horizontal positioning of the Eustachian tube, the limited response to antigens, and the lack of exposure to pathogens. Treatment includes acetaminophen or ibuprofen for pain or fever, warm or cool compresses, and numbing ear drops. When giving instructions about treatment, it is most important for the nurse to teach the parent the correct way to position the pinna to administer the drops. Most parents know how to administer oral medications or apply a cool compress; however, it is rare for parents to know how to pull the pinna to place the ear drops correctly. Depending on the child's age and the severity of the infection, antibiotics may or may not be used.
After teaching a group of students about neural tube disorders, the instructor determines that additional teaching is needed when the students identify which condition as a neural tube defect? hydrocephalus anencephaly encephalocele spina bifida occulta
hydrocephalus Explanation: Hydrocephalus results from an imbalance in the production and absorption of cerebrospinal fluid. In hydrocephalus, cerebrospinal fluid accumulates within the ventricular system and causes the ventricles to enlarge and increases in intracranial pressure. Anencephaly, encephalocele and spina bifida occulta are all neural tube defects.
The nurse is caring for a child who has had persistent otitis media effusions and is scheduled to have pressure equalizing tubes placed in 3 days. What should the parents observe after the tubes have been placed? improvement of the child's language and speech development constant fluid draining from the child's ears decreased ability for the child to hear slow increases in language development
improvement of the child's language and speech development Explanation: Pressure equalizing tube placement allows for adequate hearing resulting in improvement of speech development and rapid increases in language acquisition. The drainage should not be constant, and parents should be instructed to call their health care provider if drainage is noted.
A hospitalized toddler being treated for pneumonia requires supplemental oxygen. The respiratory rate is 44 breaths/min and the oxygen saturation is 90% on room air. Which oxygen delivery device would be best for this toddler nasal cannula simple face mask nonrebreather partial rebreather
nasal cannula Explanation: The best form of oxygen delivery for this toddler is a nasal cannula. The nasal cannula is the most comfortable and the most likely to stay in place. The nasal cannula provides up to 44% more oxygen delivery than room air. Oxygen can be delivered up to 4 liters via nasal cannula. The child can eat or talk with the nasal cannula in place. Oxygen delivered should be humidified. The simple face mask can provide 35% to 60% of oxygen via a flow rate of 6 to 10 liters. It is used when there is increasing respiratory difficulty. Children have difficulty keeping it in place. A nonrebreather is used for serious respiratory problems. It can deliver 95% oxygen via 10 to 12 liters flow. A partial rebreather is also needed when an increased amount of oxygen delivery is needed. This mask can provide 50% to 60% oxygen set at 10 to 12 liters flow.
Any individual taking phenobarbital for a seizure disorder should be taught: to brush his or her teeth four times a day. never to discontinue the drug abruptly. never to go swimming. to avoid foods containing caffeine.
never to discontinue the drug abruptly. Explanation: Phenobarbital should always be tapered, not stopped abruptly, or seizures from the child's dependency on the drug can result.
A child with a seizure disorder is being admitted to the inpatient unit. When preparing the room for the child, what should be included? Select all that apply. oxygen gauge and tubing suction at bedside tongue blade padding for side rails smelling salts
oxygen gauge and tubing suction at bedside padding for side rails Explanation: When planning the client's environment it is imperative that both safety items and those to manage the seizure are present. The side rails should be padded to prevent injury during seizure activity. Oxygen setup should be provided. Suction may be needed. Tongue blades and smelling salts are not employed.
When preparing the room for an infant with bronchiolitis, which equipment is most important? a tracheostomy set a metered dose inhaler IV antibiotics oxygen tubing and facemask
oxygen tubing and facemask Explanation: Bronchiolitis is an acute inflammatory process in the bronchioles and small bronchi. The treatment is supportive oxygen therapy, suctioning, and hydration. Rarely is a tracheostomy set needed for care. An infant is not able to use a metered dose inhaler but nebulized bronchodilators may occasionally be needed. Bronchiolitis is most commonly associated with the respiratory syncytial virus (RSV), thus antibiotics would not be warranted in the treatment plan.
What is a complication of cystic fibrosis?
pneumothorax Explanation: Cystic fibrosis (CF) is a genetic disorder causing thickened tenacious secretions of the sweat glands, gastrointestinal tract, pancreas, respiratory tract and exocrine tissues. The treatment is aimed at minimizing pulmonary complications, maximizing lung function, preventing infection, and facilitating growth. A pneumothorax is a complication of CF. A rupture of the subpleural blebs through the visceral pleura takes place. There is also a high reoccurrence rate and incidence increases with age. Crohn disease is a gastrointestinal disorder that is not associated with cystic fibrosis. Urinary tract infection and kidney disease are also not associated with CF. Most of the problems and complications associated with CF relate to the respiratory system, the gastrointestinal system, and infectious disorders.
The nurse is educating the parents of a 6-year-old child about preventing hearing loss. Which topic will be included in the discussion? suddenly doing poorly in school tendency to act silly in the classroom playing the radio loudly prevention and treatment of otitis media
prevention and treatment of otitis media Explanation: The most common cause of conductive hearing impairment is otitis media. Hearing loss can be associated with intermittent bouts of acute otitis media and can hinder language development. Suddenly doing poorly in school, acting silly in the classroom, and playing the radio loudly are symptoms of hearing loss in children but they are symptoms after loss has occurred. The preventive education would include helping the child not develop otitis media.
The nurse is caring for a 3-year-old boy who is experiencing seizure activity. Which diagnostic test will determine the seizure area in the brain?
video electroencephalogram Explanation: A video electroencephalogram can determine the precise localization of the seizure area in the brain. Cerebral angiography is used to diagnose vessel defects or space-occupying lesions. Lumbar puncture is used to diagnose hemorrhage, infection, or obstruction in the spinal canal. Computed tomography is used to diagnose congenital abnormalities such as neural tube defects.
The nurse is caring for a 3-year-old boy who is experiencing seizure activity. Which diagnostic test will determine the seizure area in the brain? cerebral angiography lumbar puncture video electroencephalogram computed tomography
video electroencephalogram Explanation: A video electroencephalogram can determine the precise localization of the seizure area in the brain. Cerebral angiography is used to diagnose vessel defects or space-occupying lesions. Lumbar puncture is used to diagnose hemorrhage, infection, or obstruction in the spinal canal. Computed tomography is used to diagnose congenital abnormalities such as neural tube defects.
