Chapter 31 PREP U women and children.

A school-aged child with seizures is prescribed phenytoin sodium, 75 mg four times per day. What instruction would the nurse give the parents regarding this medication?

The child will have to adhere to good tooth brushing

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?

"I hate to think that I will need to be worried about my child having seizures for the rest of his life."

The nurse is educating the parents of a 4-year-old boy who has been diagnosed with amblyopia ("lazy eye"). Which comment provides information most helpful for the parents to know?

"Give him a prize when he wears the patch."

The nurse is taking a health history for a 9-year-old with conjunctivitis. Which statement by the parents leads the nurse to suspect that the child is experiencing allergic conjunctivitis?

"He recently helped clean the basement."

A parent of a child diagnosed with seizures states, "I've heard about a special diet that may control seizures, I think it's called ketogenic. What can you tell me about it?" Which are appropriate responses by the nurse? Select all that apply.

"About 40% to 50% of children who follow the diet have really good results." "The diet consists of high fat foods. "Protein is limited in this diet."

The school nurse is educating the parents of a child with infectious conjunctivitis. Which comment provides the most value for prevention?

"Don't use anything that touches her face."

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 need to watch for any new bruises or bleeding and let my health care provider know about it."

The nurse is educating the parents of a child with otitis media. Which statement made by the parents indicates a need for further teaching?

"I will be certain to dry the outer ear well after each time we go swimming."

A 4-month-old child underwent cataract surgery 3 hours ago. The parents ask why they are only allowed to give the child small amounts of fluid now. How does the nurse respond?

"Introducing fluids slowly reduces the risk of vomiting, which can increase intraocular pressure."

The parent of a 4-year-old child with acute otitis media in the right ear asks the nurse "Why won't they treat the infection? When my child was younger and had an ear infection, my child needed antibiotics to get better." How does the nurse best respond?

"Most cases of ear infection are caused by viruses, not bacteria, so antibiotics do not work. Most ear infections will get better without antibiotics."

The nurse is caring for an infant who is at risk for increased intracranial pressure. What statement by the parent would alert the nurse to further assess the child's neurological status?

"She has been irritable for the last hour....seems like she is just upset for some reason."

The mother of a 12-year-old with Reye syndrome approaches the nurse wanting to know how this happened to her child, saying, "I never give my kids aspirin!" Which response by the nurse would be most appropriate?

"Sometimes it's hard to tell if a product contains aspirin."

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?

"Use this information to teach family and friends."

A child is brought to the emergency department after sustaining a concussion. The child is to be discharged home with his parents. What would the nurse include in the child's discharge instructions?

"Wake him every 2 hours to check his movement and responses."

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."

The parents of an 8-year-old child report that the child's teachers noted the child is having problems seeing the board in school but state they do not understand this since the child is able to read from the computer with no difficulty. Which response from the nurse is most appropriate?

"What you are describing may be what is called myopia."

A nurse is conducting a class for a group of parents with school-age children who have refractive errors. During the class, one of the parents asks, "It is such a pain for our child to have to deal with glasses. At what age could we consider using contact lenses?" Which age would the nurse likely recommend?

12 years old

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.

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?

A preoperative injection of atropine

The parents of a newborn with congenital hearing loss ask the nurse if they should take sign language lessons to learn to communicate with their newborn. How does the nurse best respond?

Introducing sign language early is controversial; some people believe it will improve communication and others feel that it delays learning to speak.

What is a true statement regarding status epilepticus?

It is a common neurologic emergency in children

The nurse is educating the parents of an 18-month-old child being prepared to receive cochlear implants. Which statement by the parents requires further teaching?

After the implant surgery our child will have normal hearing.

A nurse develops a plan of care for a child that includes patching the eye. This plan of care would be most appropriate for which condition?

Amblyopia

The nurse is screening a 4-year-old girl for vision problems. What problem could result in loss of vision?

Amblyopia

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.

The nurse is preparing a nursing care plan for a 2-year-old child with hearing impairment. Which intervention will be part of the plan?

Assess the child's ability to convey information.

The nurse is teaching parents of a 6-year-old child about otitis media (OM). What predisposes the child to OM infections?

Bacteria entering through the eustachian tube

While caring for a child who will be undergoing a lumbar puncture, the nurse explains the procedure to the infant's mother. Which statement by the mother would indicate a need for further education?

I will cradle her in my arms after the procedure for at least 30 minutes."

A 15-year-old adolescent is brought to the emergency department by his parents. The adolescent is febrile with chills that started suddenly. He states, "I had a sinus infection and sore throat a couple of days ago." The nurse suspects bacterial meningitis based on which findings? Select all that apply.

Complaints of stiff neck Photophobia Vomiting

The nurse is caring for a child who has suffered a head injury and has had an ICP monitor placed. Which prescription by the health care provider would the nurse question?

Initiate an IV of 0.9% NS to run at 250 ml/hr.

During the physical assessment of a 2½-month-old infant, the nurse suspects the child may have hydrocephalus. Which sign or symptom was observed?

Dramatic increase in head circumference

A 16-year-old has suffered a thoracic-level spinal injury from a diving accident. To initiate CPR at the poolside, which measure would be most important?

Elevate the mandible to assess airway with the head in a neutral position.

The nurse is planning care for a school-age child with a black eye. Which outcome would be the most appropriate for this client?

Evidence of bleeding will be reabsorbed within 1 to 3 weeks.

A parent brings the child to the emergency department. The family was camping in the woods and the child has an unknown object stuck in the eye. The child is crying in pain. What will the nurse include in this child's plan of care? Select all that apply.

Examine the eye with specialized eye equipment. Assess the level of pain Determine whether the child's vision is present.

An infant is diagnosed with infantile glaucoma. When developing the plan of care for the infant, for what would the nurse expect to prepare the infant and family?

Goniotomy

The nurse refers a 2-year-old child to a speech-language pathologist because of limited vocabulary and delayed speech. The speech therapy program requires hearing screening to be completed prior to admission into the program. How does the nurse explain the reason for this to the parents?

Hearing loss can be a cause of delayed speech, so we want to assess this and treat both the hearing and the speech delays if needed.

In examining the vision of a 9-year-old girl, the nurse notices that she frequently reaches either too far or not far enough when attempting to take an object from the nurse's hand. Which condition does the nurse suspect?

Lack of depth perception (stereopsis)

Absence seizures are marked by what clinical manifestation?

Loss of motor activity accompanied by a blank stare

The nurse is assessing a child with an eye problem. Which symptom, if present, would rule out a hordeolum?

Reddened conjunctiva

After performing eye tests, the school nurse notes a child has symptoms of myopia. Which recommendation will the nurse make to the child's teacher?

Place the child close to the blackboard

A child diagnosed with conjunctivitis is being seen in the pediatric clinic. Which statements are correct regarding conjunctivitis? Select all that apply.

Purulent drainage is a common symptom. It is highly contagious. Warm compresses are used to remove crusts that form on the eyes.

The nurse is planning care for a preschool-age child diagnosed with bacterial meningitis. What should the nurse identify as a priority goal for this client's care?

Reduce the pain related to nuchal rigidity.

The nurse is caring for a preschooler who has developed a high fever and has just had a seizure. What is the best action by the nurse?

Remove any blankets or heavy clothing and replace with a thin sheet

The nurse is caring for a 6-month-old infant diagnosed with otitis media. Which clinical manifestation would likely have been noted in this child?

Shaking the head and pulling the ear

A group of students are reviewing the various causes of bacterial conjunctivitis in children. The students demonstrate understanding of this condition when they identify what as the most common cause?

Staphylococcus aureus

The school nurse is instructing the classroom teacher regarding a student newly diagnosed with amblyopia. To prepare for classroom instruction, which concept is most important for the nurse to convey to the teacher?

Student placement in the room is important but all other teaching methods may remain the same.

A 16-year-old boy reports to the school nurse with headaches and a stiff neck. Which sign or symptom would alert the nurse that the child may have bacterial meningitis?

Sunlight is "too bright"

A father asks why his preschool-age child was not prescribed an antibiotic for pain in his right ear that was described as a "possible ear infection." The nurse's explanation would include which rationale?

The condition is likely to self-resolve, which will avoid unnecessary antibiotic use.

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?

The frequency of otitis media is reduced in breastfed infants.

After teaching a group of parents about ear infections in children, which statement indicates that the teaching was successful?

The shorter and wider eustachian tubes of an infant increase the risk.

An infant is diagnosed as having cerebral palsy. When planning care, which would the nurse stress to the parents?

Their child probably will benefit from early schooling to increase ability for self-care.

The nurse is caring for a child with a suspected head injury. The nurse observes for what response to the child's eye reflex examination that would indicate potential increased intracranial pressure (ICP)?

While assessing the child's pupils, there is no change in diameter in response to a light.

The nurse is caring for a 10-year-old child with bacterial conjunctivitis of the right eye. The eye is inflamed and drains a thick, yellow discharge. What should the nurse teach the parents about the care of the eye?

Wipe the drainage away from the inner to the outer canthus of the eye.

The nurse admits a 13-year-old client with possible appendicitis to the hospital, accompanied by the parent. The client and parent are both deaf and use sign language to communicate. The nurse needs to assess baseline vital signs and the intake assessment. What should the nurse do while awaiting the arrival of the sign language interpreter?

Write a note to explain the need to assess vital signs.

A 7-month-old is scheduled for surgical correction of strabismus. The child's mother says to the nurse, "I'm glad my child will never have to wear that patch again." Which of these responses would be most appropriate for the nurse to make?

Your child will need to wear the patch for a few days to keep him/her from rubbing or putting pressure on the eye."

An infant born with congenital glaucoma is scheduled for surgery. Which preoperative order should the nurse question for this client?

a preoperative injection of atropine

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

Parents request help from the nurse in managing their young child's "poor behavior." They describe "loud talk and play, not coming when called, seldom following directions, 'blasting' the volume on the TV set, and difficulty understanding spoken words." The appropriate nursing action is:

arranging for an evaluation of the child's hearing.

During a routine hearing test, a school-age boy is discovered as having a hearing level of 60 dB. What does this finding indicate to the nurse about the child's ability to hear?

difficulty with normal conversation

A nursing instructor is working with a student caring for an 18-month-old client. In order to ascertain that the tympanic membrane is optimally visualized, the faculty will assess that the student pulls the pinna of the ear:

down and back

The nurse is teaching the family of a 6-year-old boy with allergic conjunctivitis how to minimize his exposure to allergens. What action would the nurse anticipate as being most difficult for the family to implement?

encouraging the child to keep his hands away from his eyes

The nurse is providing immediate postoperative care for a 3-month-old who had a cataract removed. Which intervention would be the priority?

ensuring the protective eye patch is securely in place

Which measures should receive priority when planning care for the child who is having surgery to remove a cataract?

evaluation of intraocular pressure (IOP) and adherence to the occlusive patch regimen

The nurse caring for a client with a cranial injury knows that broad spectrum antibiotics are used to reduce cerebral edema.

false

The nurse knows that children have larger heads in relation to the body and a higher center of gravity. When developing a teaching plan for parents, the nurse includes information about an increased risk for which problem?

head trauma

The nurse is caring for a 12-month-old infant diagnosed with Haemophilus influenzae meningitis. Which clinical manifestation would likely have been noted in this child?

high-pitched cry and nuchal rigidity

The nurse assesses a 5-year-old child with a severe hearing impairment before creating a care plan. The care plan focuses on psychosocial interventions. Which behavior did the nurse identify?

immature emotional behavior

The nurse is caring for a child who has an intellectual disability. Of the following factors, which is a cause of postnatal intellectual disability?

lead poisoning

The nurse is teaching the parents of a visually impaired baby about the developmental potential for their child. Which of the following learning functions would the nurse explain as being unique to visually impaired children?

learning to use facial expressions

A nurse is reviewing the medical record of a child with hearing loss and notes that the child's hearing loss is in the range 40 to 60 decibels (dB). The nurse interprets this as indicating what level of hearing loss?

moderate loss

A child is brought to the clinic because of complaints of not being able to see the blackboard at school. The nurse also notes that the child holds a book very close to the eyes. The nurse suspects which of the following?

myopia

Any individual taking phenobarbital for a seizure disorder should be taught:

never to discontinue the drug abruptly.

A school nurse knows that most of the students in the community's elementary school have not received routine vision screening because the families live below the federal poverty threshold. What is the most effective method to promote vision screening for this client population?

offering vision screening to all students in kindergarten

What symptom(s) in an 8-year-old child will alert the nurse to screen for myopia? Select all that apply.

rubbing the eyes difficulty reading the blackboard squinting

A 9-year-old child is brought to the urgent care center by the parent. Based on assessment findings, the nurse suspects external otitis (acute otitis externa or swimmer's ear). Which finding on otoscopic examination supports this suspicion?

swollen, inflamed ear canal

An 8-year-old child is diagnosed as having tonic-clonic seizures. The nurse would want to teach the parents that:

their child should maintain an active lifestyle.

The nurse will help parents of a child with amblyopia understand that occluding vision in the unaffected eye is therapeutic because:

use of the affected eye promotes vision development.