Ch. 19 Pediatric Problems

You are preparing to care for a 6-year-old who has just undergone allogeneic stem cell transplantation and will need protective environmental isolation. Which nursing tasks will you delegate to the UAP? (select all that apply) A. Stocking the patient's room with the needed personal protective equipment items B. Teaching the patient to perform thorough hand washing after using the bathroom C. Reminding visitors to wear a respirator mask, gloves, and gowns D. Posting the precautions for protective isolation on the door of the patient's room E. Talking to the family members about the reason for the isolation

A, C, D

The ED receives multiple individuals, mostly children, who were injured when the roof of a day-care center collapsed because of a heavy snowfall. Based on physiologic differences in children compared with adults, for which injuries and complications will the nurse assess first? (Select all that apply) A. Head injuries B. Bradycardia or junctional arrhythmias C. Hypoxemia D. Liver and spleen contusions E. Hypothermia F. Fractures of the long bones G. Lumbar spines injuries

A, C, D, E

You have just received a change-of-shift report about these pediatric patients. Which patient will you assess first? A. 1-year-old with hemophilia B who was admitted because of decreased responsiveness B. 3-year-old with von Willebrand disease who has a dose of desmopressin scheduled C. 7-year-old with acute lymphocytic leukemia who has chemotherapy-induced thrombocytopenia D. 16-year-old with sickle cell disease who reports acute right lower quadrant abdominal pain

A. 1-year-old with hemophilia B who was admitted because of decreased responsiveness

As the pediatric unit charge nurse, you are working with a newly-graduated RN who has been on orientation in the unit for 2 months. Which patient should you assign to the new RN? A. 2-yearold with ventricular septal defect for whom digoxin 90 mcg by mouth has been prescribed B. 4-year-old who had a pulmonary artery banding and has just been transferred in from the intensive care unit C. 9-year-old with mitral valve endocarditis who parents need teaching about IV antibiotic administration D. 16-year-old with a heart transplant who has admitted with a low-grade fever and tachycardia

A. 2-yearold with ventricular septal defect for whom digoxin 90 mcg by mouth has been prescribed

While working in the pediatric clinic, you receive a telephone call from the parent of a 13-year-old who is receiving chemotherapy for leukemia. The patient's sibling has chickenpox. Which action will your anticipate taking next? A. Administer varicella-zoster immune globulin to the patient B. Tach the parent about the correct use of acyclovir C. Educate the parent about contact and airborne precautions D. Prepare to admit the patient to a private room in the hospital

A. Administer varicella-zoster immune globulin to the patient

You have obtained this assessment information about a 3-year-old who has just returned to the pediatric unit after having a tonsillectomy. Which finding requires the most immediate follow-up? A. Frequent swallowing B. Hypotonic bowel sounds C. Reports of a sore throat D. Heart rate of 112 bpm

A. Frequent swallowing

You are teaching a group of day-care workers about how to avoid transmission of hepatitis A in day-care settings. What is the single most effective measure to emphasize? A. Hand hygiene should be performed often to prevent and control the spread of infection B. Children in whom hepatitis has been diagnosed should not share toys with others C. Children with episodes of fecal incontinence should be isolated form the others D. Immunizations are recommended before children are admitted into day-care settings

A. Hand hygiene should be performed often to prevent and control the spread of infection

You are the pediatric unit charge nurse working with a new RN. Which action by the new RN requires the most immediate action on your part? A. Placing a child who has chemotherapy-induced neutropenia into a negative-pressure room B. Wearing goggles to change the linens of a patient who has diarrhea caused by c. diff C. Instructing the UAP to use an N95 respiratory mask when caring for a child who has pertussis D. Admitting a new patient with RSV to a room with another child who has RSV

A. Placing a child who has chemotherapy-induced neutropenia into a negative-pressure room

Which intervention for the 5-year-old child who still wets the ebed would be best assigned to the UAP? A. Reminding the child to use the bathroom before going to bed B. Teaching the mother about moisture alarm devices C. Administering the prescribed dose of imipramine D. Discussing research related to the use of hypnosis with the mother

A. Reminding the child to use the bathroom before going to bed

A tearful parent brings a child to the ED after the child takes an unknown amount of children's chewable vitamins at an unknown time. The child is currently alert and asymptomatic. What information should be immediately reported to the physician? A. The ingested children's chewable vitamins contain iron B. The child has been treated previously for ingestion C. The child has been treated several times before for accidental injuries D. the child was nauseated and vomited once at home

A. The ingested children's chewable vitamins contain iron

A teenager arrives in the triage area alert and ambulatory, but his clothes are covered with blood. His friends are yelling, "We were goofing around and he got poked in the abdomen with a stick!" Which comment would be of most concern? A. "There was a lot of blood and we used three bandages." B. "He pulled the stick out, just now, because it was hurting him." C. "The stick was really dirty and covered with mud." D. "He's a diabetic, so he needs attention right away."

B. "He pulled the stick out, just now, because it was hurting him."

The health care provider has ordered cooling measure for a child with fever who is likely to be discharged when the temperature comes down. Which task will you delegate to the UAP? A. Providing explanations of nursing actions to the family B. Assisting the child in removing outer clothing C. Advising the parent to use acetaminophen instead of aspirin D. Monitoring the child's level of consciousness and orientation level

B. Assisting the child in removing outer clothing

Which pediatric pain patient should be assigned to a newly-graduated RN? A. Adolescent who has sickle cell disease and was recently weaned from morphine delivered via PCA to an oral analgesic; he has been continually asking for an increased dose. B. Child who needs premedication before reduction of a fracture; the child has been crying and is resistance to any touch to the arm or other procedures C. Child who is receiving palliative end-of-life care; the child is receiving narcotics around the clock to relieve suffering, but there is a progressive decrease in alertness and responsiveness D. Child who has chronic pain and whose medication and nonpharmacologic regimen has recently been changed; the mother is anxious to see if the new regimen is successful

B. Child who needs premedication before reduction of a fracture; the child has been crying and is resistance to any touch to the arm or other procedures

An excited mother calls you for advice. "My child got cleaning solution in her eyes and I rinsed her eyes with water for a few minutes. What should I do? She is still screaming!" What do you instruct the caller to do first? A. Comfort the child and check her vision B. Continue to irrigate the eyes with water C. Call the Poison Control Center D. Call 911 to request an ambulance

B. Continue to irrigate the eyes with water

You receive the following shift report on an adolescence with anorexia: The patient is 5 kg under her target weight. Her self-esteem has improved, but she continues to refer to herself as :fatty." She is able to appropriately verbalize a diet and exercise plan. What is the priority nursing diagnosis? A. Imbalanced Nutrition: Less than Body Requirements B. Disturbed Body Image C. Risk for Situational Low Self-Esteem D. Ineffective Health Maintenance

B. Disturbed Body Image

You are a public school nurse. Which action will you take to have the most impact on the incidence of infectious diseases in the school? A. Make soap and water readily available to the classrooms B. Ensure that students are immunized according to the national recommendations C. Provide written information about infection control to all parents D. Teach students how to cover their mouths when they cough or sneeze

B. Ensure that students are immunized according to the national recommendations

You are reviewing the CBC for a 3-year-old who has been diagnosed with idiopathic thrombocyopenic purport. Which information should you report immediately to the health care provider? A. Increased eosinophil level B. Hemoglobin level of 6.1 g/dL C. Platelet count of 40,000/mm3 D. Elevated reticulocyte count

B. Hemoglobin level of 6.1 g/dL

You are the charge nurse on the pediatric unit when a pediatrician calls wanting to admit a child with rubeola. which factor is of most concern in determining whether to admit the child yo your unit? A. The unit is staffed with fewer RNs than usual B. No negative-airflow rooms are available C. The infection control nurse liaison is not present today D. There are several children receiving chemotherapy

B. No negative-airflow rooms are available

A 2-year-old child who has abdominal pain is diagnosed with intussusception. A hydrostatic reduction has been performed, and the health care provider has informed the parents that surgery is the next step. Which finding should be reported immediately before surgery proceeds? A. Palpable sausage-shaped abdominal mass B. Passage of normal brown stool C. Passage of currant jelly-like stool D. Frequent nausea and vomiting

B. Passage of normal brown stool

You are the charge nurse on the pediatric neurologic unit when the health care provider calls with new medication prescriptions for several patients with seizure disorders. Which prescription is most important to verify with the provider? A. Ibuprofen 10 mg/kg for a 2-year-old having a febrile seizure B. Phenytoin 300 mg/day for a 6-year-old with tonic-clonic seizure C. Valproic acid 15 mg/kg/day for an 11-year-old with absence seizures D. Carbamazepine 100 mg every 8 hours for a 70-kg 17-year-old with complex seizures

B. Phenytoin 300 mg/day for a 6-year-old with tonic-clonic seizure

You are working with an LPN who is caring for a 10-year-old who has severe abdominal, hip, and knee pain caused by a sickle cell crisis. Which action taken by the LPN requires that you intervene immediately? A. Suggesting genetic counseling to the patient B. Positioning cold packs on the patient's knees C. Placing a "No Visitor" sign on the patient's door D. Checking the patient's temperature every 2 hours

B. Positioning cold packs on the patient's knees

You are assisting with the delivery of a 31-week gestational age premature newborn who requires intubation for RDS. Which medication will you anticipate will be needed first for the infant? A. Theophylline B. Surfactant C. Dexamethasone D. Albuterol

B. Surfactant

You are caring for a 3-year-old who has returned to the pediatric intensive care unit after insertion of a ventriculoperitoneal shunt to correct hydrocephalus. Which assessment finding is most important to communicate to the surgeon? A. The child is crying and saying it hurts B. The right pupil is 1 mm larger than the left pupil C. The cardiac monitor shows a heart rate of 130 bpm D. the head dressing has a 2-cm area of bloody drainage

B. The right pupil is 1 mm larger than the left pupil

You are caring for a 5-year-old child whose mother asks why he still wets the bed. What is your best response? A. "He is old enough that he should no longer be wetting the bed." B. "Most children outgrow bed-wetting by the time they start school." C. "His bed-wetting may be due to an immature bladder or deep sleep pattern." D. "He will probably stop once he realizes how embarrassing it is to wet the bed."

C. "His bed-wetting may be due to an immature bladder or deep sleep pattern."

In caring for a 2-year-old with pain, which assessment question would be the most useful? A. "Can you point to the pain with one finger and tell me what that pain feels like inside you?" B. "If number 1 were a little pain and number 10 were a big pain, what number would your pain be?" C. "The smiling face has 'no hurting'; the crying face has a 'really big hurting.' Which faces most like your hurting." D. "One chip is 'a little bit of hurt' and four chips are 'the most hurting.' How many chips would you take for your hurt?"

C. "The smiling face has 'no hurting'; the crying face has a 'really big hurting.' Which faces most like your hurting."

As the pediatric unit charge nurse, you are making patient assignments for the evening shift. Which patient is most appropriate to assign to an experienced LPN? A. 1-year-old with severe combined immunodeficiency disease who is scheduled to receive chemotherapy in preparation for a stem cell transplant B. 2-year-ld with Wiskott-Aldrich syndrome who has orders for a platelet transfusion C. 3-year-old who has chronic graft-versus-host disease and is incontinent of loose stools D. 6-year-old who received chemotherapy a week ago and is admitted with increasing lethargy and temperature of 101

C. 3-year-old who has chronic graft-versus-host disease and is incontinent of loose stools

After receiving the change-of-shift report, which patient should you assess first? A. 18-month-old with coarctation of the aorta who has decreased pedal pulses B. 3-year-old with thematic fever who reports severe knee pain C. 5-year-old with endocarditis who has crackles audible throughout both lungs D. 8-year-old with Kawasaki disease who has a temperature of 102.2

C. 5-year-old with endocarditis who has crackles audible throughout both lungs

You are caring for several children with cancer and are receiving morning laboratory results for all of your patients. Which of these patient conditions combined with the indicated laboratory result causes you the greatest immediate concern? A. Nausea and vomiting with a potassium level of 3.3. B. A nosebleed with a platelet count of 100,000/mm3 C. Fever with an absolute neutrophil count of 450/mm3 D. Fatigue with a hemoglobin level of 8g/dL

C. Fever with an absolute neutrophil count of 450/mm3

These medications have been prescribed for a 9-year-old with deep partial- and full-thickness burns. Which medication is most important to double-check with another licensed nurse before administration? A. Silver sulfadiazine ointment B. Famotidine 20 mg IV C. Lorazepam 0.5 mg PO D. Multivitamin 1 tablet PO

C. Lorazepam 0.5 mg PO

A 4-year-old with acute lymphocytic leukemia has these medications ordered. Which one is most important to double-check with another licensed nurse? A. Prednisone 1 mg PO B. Amoxicillin 250 mg PO C. Methotrexate 10 mg PO D. Filgrastim 5 mcg SubQ

C. Methotrexate 10 mg PO

A new nurse is caring for a child with a foreign body in the ear canal who has not yet been evaluated by the HCP. You would intervene if the new nurse performs which action? A. Inspects the pinna for trauma B. Obtains history for type of object C. Prepares to irrigate the canal with warm water D. Uses an otoscope an check for perforation

C. Prepares to irrigate the canal with warm water

A 16-year-old with CF is admitted with increased SOB and possible pneumonia. Which nursing activity is most important to include in the patient's care? A. Allowing the patient to decide whether she needs aerosolized medications B. Placing the patient in a private room to decrease the risk of further infection C. Scheduling postural drainage and chest PR every 4 hours D. Planning activities to allow for at least 8 hours of uninterrupted sleep

C. Scheduling postural drainage and chest PR every 4 hours

You are preparing a child for IV conscious sedation before repair of a facial laceration. What information should you immediately report to the HCP? A. The parent is unsure about the child's tetanus immunization status B. The child is upset and pulls out the IV C. The parent declines the IV conscious sedation D. The parent wants information about the IV conscious sedation

C. The parent declines the IV conscious sedation

You are providing nursing care for a newborn infant with RDS who is receiving nasal continuous positive airway pressure ventilation. Which assessment finding is most important to report to the HCP? A. Apical pulse rate of 156 bpm B. Crackles audible in both lungs C. Tracheal deviation to the right D. Oxygen sat 93%

C. Tracheal deviation to the right

A parent calls the ED, saying "I think my toddler might have swallowed a little tow. He is breathing okay, but I don't know what to do." What is the most essential question to ask the caller? A. "Has he vomited?" B. "Have you been checking his stools?" C. "What do you think he swallowed?" D. "Has he been coughing?"

D. "Has he been coughing?"

A 16-year-old int eh adolescent health clinic tells you that she has been sexually active for 6 months, "but only with my boyfriend." Screening for which STD will be most important for this patient? A. Syphilis B. Genital herpes simplex C. HPV D. Chlamydia

D. Chlamydia

A 6-year-old who received chemotherapy and had anorexia is now cheerfully eating peanut butter, yogurt, and applesauce. When the mother arrives, the child refuses to eat and throws the dish on the floor. What is your best response to this behavior? A. Remind the child that foods tasted good today and will help the body to get strong B. Allow the mother and child time alone to review and control the behavior C. Ask the mother to leave until the child can finish eating and then invite her back D. Explain to the mother that the behavior could be a normal expression of anger

D. Explain to the mother that the behavior could be a normal expression of anger

An 8-year-old child has stomatitis secondary to chemotherapy. Which task would be best to delegate to the UAP? A. Reporting evidence of severe mucosal ulceration B. Assisting the child in swishing and spitting an anesthetic mouthwash C. Assessing the child's ability and willingness to drink through a straw D. Helping the patient to eat a bland, moist, soft diet

D. Helping the patient to eat a bland, moist, soft diet

You are caring for a newborn with a myelonmeningocele who is awaiting surgical closure of the defect. Which assessment finding is of most concern? A. Bulging of the sac when the infant cries B. Oozing of stool from the anal sphincter C. Flaccid paralysis of both legs D. Temperature of 101.8

D. Temperature of 101.8

You are obtaining th emissary and physical information for a child who is recovering from Kawasaki disease and receives aspirin therapy Which information about this patient will concern you most? A. The child attends a day-care center 5 times a week B. The child's fingers have areas of peeling skin C. The child is very irritable and cries frequently D. The child has not received any immunizations

D. The child has not received any immunizations

You obtain this information when assessing a 3-year-old with uncorrected Tetralogy of Fallot who is crying. Which finding requires immediate action? A. The apical pulse rare is 118 B. A loud systolic murmur is heard in the pulmonic area C. There is marked clubbing of all of the child's nail beds D. The lips and oral mucosa are dusky in color

D. The lips and oral mucosa are dusky in color