Exam 8 Women and Children PrepU Chapters 36, 37, 21

A nurse is caring for a child who is experiencing heart failure. Which assessment data was most likely seen when initially examined? bradycardia tachycardia splenomegaly polyuria

tachycardia 37

In teaching home care to parents of a child with cystic fibrosis, the nurse will emphasize: methods to relieve chest pain. ways to limit fluid intake. how to provide a high-fat diet. techniques to clear the airway.

techniques to clear the airway. 36

The nurse is reviewing the health history and physical examination of a child diagnosed with heart failure. What does the nurse expect to find? Select all that apply. tiring easily when eating shortness of breath when playing crackles on lung auscultation bradycardia hypertension

tiring easily when eating shortness of breath when playing crackles on lung auscultation 37

Some children with iron-deficiency anemia may be prescribed iron dextran by injection. This should be injected: intradermally. subcutaneously. intramuscularly. via Z-track technique.

via Z-track technique. Iron dextran stains the skin unless it is given by a technique that does not allow it to flow back into the superficial skin. 37

A nurse is providing teaching to the parents of a child diagnosed with sickle cell anemia. The discussion is focused on precipitating factors for sickle cell crisis. Which statement by the parents requires the nurse to reinforce the teaching? "I make sure my child wears a good warm coat and gloves during winter." "Our family is taking a fun hiking trip up in the mountains next week." "We always take water along when we are on an outing." "I make sure our child is up to date on all immunizations."

"Our family is taking a fun hiking trip up in the mountains next week." High altitudes are a contributing factor for sickle cell crisis and should be avoided, as should flights in planes that are not pressurized. 37

Coarctation of the aorta demonstrates few symptoms in newborns. What is an important assessment to make on all newborns to help reveal this condition? Auscultating for a cardiac murmur Recording an upper extremity blood pressure Observing for excessive crying Assessing for the presence of femoral pulses

Assessing for the presence of femoral pulses 21

The 18-month-old client has had recurrent respiratory infections. The mother expresses concern that this child is having more complications from respiratory infections than her older children had. The nurse's best response would be: "Toddlers have more trouble with respiratory infections than older children." "Air passages become blocked with mucus and are difficult to clear in young children." "I'm sure your older children have just as many respiratory infections as this child." "Air passages are small in toddlers, and when inflamed they become smaller because of edema and are occluded with mucus."

"Air passages are small in toddlers, and when inflamed they become smaller because of edema and are occluded with mucus." 36

A community health nurse is conducting a parenting class on respiratory syncytial virus (RSV). What statement made by a parent indicates that the teaching has been successful? "RSV season occurs primarily April through September." "Exposure to second- or third-hand smoke increases the risk for developing RSV." "Infants are less affected by RSV than older children." "Early initiation of antibiotics can lessen the severity of the infection."

"Exposure to second- or third-hand smoke increases the risk for developing RSV." 36

A child with asthma has been monitoring his peak expiratory flow rate (PEFR) and has been maintaining it within 90% of his personal best. Today, the child is experiencing symptoms and his PEFR is at 40% of his personal best. The child's mother calls the office and asks the nurse what she should do. What would the nurse instruct the mother to do first? "Have him use his short-acting bronchodilator right away." "You need to take him to the emergency department right away." "Continue to watch his PEFR readings and call back if they go below 40%." "Have him use his low-dose steroid inhaler now and again in 15 minutes."

"Have him use his short-acting bronchodilator right away." 36

The parents of a 6-year-old child with idiopathic thrombocytopenic purpura (ITP) ask the nurse, "What causes this disease?" Which response by the nurse would be most appropriate? "ITP is primarily an autoimmune disease in that the immune system attacks and destroys the body's own platelets, for an unknown reason." "ITP is a serious bleeding disorder characterized by a decreased, absent, or dysfunctional coagulation." "ITP occurs when the body's iron stores are depleted due to rapid physical growth, inadequate iron intake, inadequate iron absorption, or loss of blood." "ITP is characterized by the loss of surface area on the red blood cell membrane."

"ITP is primarily an autoimmune disease in that the immune system attacks and destroys the body's own platelets, for an unknown reason." 37

A child is to receive oral iron therapy in liquid form three times per day. After teaching the parents about administering the iron, which statement indicates a need for additional teaching? "Our child's bowel movements will probably turn very dark." "We will try to give the medicine to our child in between meals." "We will have our child drink water or juice with the medicine." "Our child can drink the medicine from a medicine cup."

"Our child can drink the medicine from a medicine cup." Liquid iron can stain the teeth; therefore, the parents should give the liquid iron through a straw or syringe, placing it toward the back of the child's mouth. 37

An 8-year-old client is suffering from allergic rhinitis (hay fever). Which statement will the nurse include when providing education to the client's caregiver? "Pollen is a cause of these symptoms. Allergy medicine may help your child." "Penicillin is the treatment of choice. Be sure your child takes the entire prescribed amount." "Your child needs to avoid peanuts until further testing is completed." "When bathing, your child needs to use a mild soap, free of dye and fragrance."

"Pollen is a cause of these symptoms. Allergy medicine may help your child." 36

A mother asks the nurse why her infant who was born at 34 weeks' gestation is being prescribed ferrous sulfate. Which response by the nurse is most appropriate? "Infants with pyloric stenosis require ferrous sulfate." "Preterm infants are at risk for iron-deficiency anemia." "Your infant may have been having excessive diarrhea." "Ferrous sulfate helps improve red blood cell formation."

"Preterm infants are at risk for iron-deficiency anemia." 37

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."

The nursing instructor is discussing congenital heart disease with a group of students. Which statement indicates that students need further teaching? "The foramen ovale allows blood to pass from the right atrium to the left atrium during fetal life." "The ductus arteriosus carries deoxygenated blood from the aorta to the pulmonary artery during fetal life." "Oxygenated blood goes out to the body through the aorta." "Blood returns to the heart from the inferior vena cava."

"The ductus arteriosus carries deoxygenated blood from the aorta to the pulmonary artery during fetal life."

The nurse is teaching a group of parents the importance of immunizations. The nurse knows that her teaching has been most effective when the parents state: "The largest percentage of respiratory infections in children are caused by pneumococci." "The largest percentage of respiratory infections in children are caused by Haemophilus influenzae." "The largest percentage of respiratory infections in children are caused by viruses." "The largest percentage of respiratory infections in children are caused by streptococci."

"The largest percentage of respiratory infections in children are caused by Haemophilus influenzae." 36

A nurse is conducting a class to a group of parents on sickle cell anemia. Which statement by a parent indicates teaching has been effective? "This is a hereditary disease that is transmitted by one affected gene." "Sickle cell anemia is common in people of Asian descent." "The sickle shape of red blood cells decreases oxygen to tissues." "Fluid restriction is necessary to control sickle cell anemia."

"The sickle shape of red blood cells decreases oxygen to tissues." 37

A 2-year-old child is being seen at the clinic for nasopharyngitis; the nurse is teaching the parents how to prevent the spread of nasopharyngitis. Teaching has been effective when the parents state: "To prevent the spread of nasopharyngitis, we will wash our hands often and promptly immunize our child." "To prevent the spread of nasopharyngitis, we will wash our hands often and make sure our child has an adequate fluid intake." "To prevent the spread of nasopharyngitis, we will wash our hands often and use a mist vaporizer." "To prevent the spread of nasopharyngitis, we will wash our hands often and avoid contact with infected people."

"To prevent the spread of nasopharyngitis, we will wash our hands often and avoid contact with infected people." 36

The nurse is providing family education for the prevention or early recognition of vaso-occlusive events in sickle cell anemia. Which response by a family member indicates a need for further teaching? "We should call the doctor for any fever over 100°F (37.8°C)." "We need to seek medical attention for abdominal pain." "We must watch for unusual headache, loss of feeling, or sudden weakness." "We must be compliant with vaccinations and prophylactic penicillin."

"We should call the doctor for any fever over 100°F (37.8°C)."

A 5-year-old girl is diagnosed with iron-deficiency anemia and is to receive iron supplements. The child has difficulty swallowing tablets, so a liquid formulation is prescribed. After teaching the parents about administering the iron supplement, which statement by the parents indicates the need for additional teaching? "She needs to eat foods that are high in fiber so she doesn't get constipated." "We'll try to get her to drink lots of fluids throughout the day." "We will place the liquid in the front of her gums, just below her teeth." "We need to measure the liquid carefully so that we give her the correct amount."

"We will place the liquid in the front of her gums, just below her teeth." When giving liquid iron supplements, the liquid should be placed behind the teeth because it can stain the teeth. 37

The nurse is caring for a child with a hematologic disorder. When educating the family about oral corticosteroid administration at home, which education by the nurse is most important? "Once your child is better, you can stop giving the corticosteroid." "Some children think the medication can have an unpleasant taste." "Corticosteroids can cause a decreased immune system in children." "You will need to give this medication every day until discontinued."

"You will need to give this medication every day until discontinued." 37

An older infant is scheduled to have a cleft palate repair. The mother asks if she will still be able to breastfeed the baby during the postoperative phase. What is the best response by the nurse? "Yes, the surgery will not interfere with breastfeeding your child." "Yes, you will be able to breastfeed but will have to interrupt the feedings frequently." "You will not be able to breastfeed immediately after, but you can pump and feed the child with a cup." "No, you will have to put the baby on regular formula."

"You will not be able to breastfeed immediately after, but you can pump and feed the child with a cup."

A group of newly hired nurses who will be working on the pediatric unit are attending an in-service program about sickle cell disease. During the program, the nurse manager describes the steps for managing sickle cell pain. Place these steps in the sequence in which the nurse manager would describe them. Look for complications or cause of pain. Assess the pain. Believe the child's report of pain. Give medications and use distraction. Administer fluids. Provide rest in a quiet area.

1) Assess the pain. 2) Believe the child's report of pain. 3) Look for complications or cause of pain. 4) Give medications and use distraction. 5) Provide rest in a quiet area. 6) Administer fluids. 37

The nurse has assessed four clients. Which assessment finding warrants immediate action? 4-year-old child with enlarged tonsillar and adenoidal tissue 10-year-old child with extreme sinus pressure and headache 1-week old newborn with nasal congestion 6-year-old child who is consistently mouth breathing

1-week old newborn with nasal congestion Until 4 weeks of age, newborns are obligatory nose breathers and breathe only through their mouths when they are crying. 36

The nurse is caring for children at a local hospital. Which child warrants immediate attention from the nurse? 1-week-old newborn whose oxygenation is not improving with oxygen 2-year-old child with clubbing noted on the fingers 6-month-old infant with edema on the face and presacral area 1-year-old child with a temporal temperature of 101°F (38.3°C)

1-week-old newborn whose oxygenation is not improving with oxygen 37

The nurse is preparing a presentation for a local parent group about nutritional measures to prevent anemia. The group of parents have children between the ages of 4 and 8. The nurse would recommend a daily iron intake of which amount? 10 mg 6 mg 12 mg 15 mg

10 mg The recommended daily dietary iron intake for children 1 to 10 years of age is 10 mg. The recommended daily dietary iron intake for children 0 to 6 months of age is 6 mg. The recommended daily dietary iron intake for boys 11 to 18 years of age is 12 mg. The recommended daily dietary iron intake for girls 11 to 18 years of age is 15 mg. 37

The pediatric unit has multiple clients experiencing upper respiratory system complications. Which pediatric client is at the highest risk for respiratory distress? 3-year-old child with croup 11-month-old infant with nasopharyngitis 2-year-old child with epiglottitis 16-year-old adolescent with asthma

2-year-old child with epiglottitis 36

A school nurse is caring for a child with a severe sore throat and fever. What is the nurse's best recommendation to the parent? Give acetaminophen for the fever and pain, and have the child rest. Have the child drink fluids that contain electrolytes. Have the child go to the emergency room. Have the child be seen by the primary care provider.

Have the child be seen by the primary care provider. 37

A child is diagnosed with sickle cell anemia. Which test will the nurse expect the primary health care provider to prescribe for this client? Hemoglobin level Leukocyte level Thrombocyte level Metabolic screening test

Hemoglobin level 37

The nurse is reviewing the results of a sweat test done a child who is suspected of having cystic fibrosis. Which sweat chloride level would the nurse identify as a positive result? 65 mEq/L (65 mmol/L) 55 mEq/L (55 mmol/L) 45 mEq/L (45 mmol/L) 35 mEq/L (35 mmol/L)

65 mEq/L (65 mmol/L) The sweat test is the definitive test for CF. An elevated sweat sodium chloride level greater than 60 mEq/L (60 mmol/L) is a positive diagnostic result that should be confirmed by a second test at a CF center. 36

The nurse is developing a plan of care for an infant with heart failure who is receiving digoxin. The nurse would hold the dose of digoxin and notify the physician if the infant's apical pulse rate was: 140 beats per minute. 120 beats per minute. 100 beats per minute. 80 beats per minute.

80 beats per minute.

The nurse is developing a plan of care for an infant with heart failure who is receiving digoxin. The nurse would hold the dose of digoxin and notify the physician if the infant's apical pulse rate was: 140 beats per minute. 120 beats per minute. 100 beats per minute. 80 beats per minute.

80 beats per minute. (90-110 for infant) 37

A pediatric nurse who cares for newborns with congenital heart defects informs the precepting student nurse that cyanotic heart disease implies an oxygen saturation of the peripheral arterial blood of: 90% or less. 85% or less. 95% or less. 92% or less.

85% or less.

A nurse is preparing a 7-year-old girl for bone marrow aspiration. Which site should she prepare? Iliac crest Sternum Anterior tibia Femur

Iliac crest 37

A nurse is caring for an infant who is experiencing heart failure. What would be the most appropriate care for this infant? Administer antidiuretic. Provide large, less frequent feedings. Restrict fluids. Administer oxygen.

Administer oxygen. 37

A group of newly hired nurses who will be working on the pediatric unit are attending an in-service program about sickle cell disease. During the program, the nurse manager describes the steps for managing sickle cell pain. Place these steps in the sequence in which the nurse manager would describe them. Click an option, hold and drag it to the desired position, or click an option to highlight it and move it up or down in the order using the arrows to the left. 1Assess the pain. 2Believe the child's report of pain. 3Look for complications or cause of pain. 4Give medications and use distraction. 5Provide rest in a quiet area. 6Administer fluids.

Assess the pain. Believe the child's report of pain. Look for complications or cause of pain. Give medications and use distraction. Provide rest in a quiet area. Administer fluids.

Which nursing diagnosis would best apply to a child with rheumatic fever? Ineffective breathing pattern related to cardiomegaly Activity intolerance related to inability of heart to sustain extra workload Disturbed sleep pattern related to hyperexcitability Risk for self-directed violence related to development of cerebral anoxia

Activity intolerance related to inability of heart to sustain extra workload

Which nursing diagnosis would best apply to a child experiencing rheumatic fever? Disturbed sleep pattern related to hyperexcitability Ineffective breathing pattern related to cardiomegaly Risk for self-directed violence related to development of cerebral anoxia Activity intolerance related to increased cardiac workload

Activity intolerance related to increased cardiac workload 37

The nurse in the emergency department is caring for a 10-year-old female child with sickle cell crisis. Child rates pain 10 on a scale of 0 to 10. Vital signs: 99.8°F (37.6°C); heart rate, 122 beats/min; blood pressure, 92/50 mm Hg; respiratory rate, 26 breaths/min; oxygen saturation, 92% on room air. The nurse receives orders for the child. Click to highlight the order(s) that needs to be implemented immediately. Orders: Administer acetaminophen for headache or temperature greater than 101°F (38.3°C). Administer oxygen to maintain oxygen saturation greater than 95%. Start normal saline continuous intravenous (IV) infusion at 200 ml/hr. Administer 100 mcg/kg morphine IV for pain prn q4 hours. Initiate a regular diet as tolerated.

Administer oxygen to maintain oxygen saturation greater than 95%. Start normal saline continuous intravenous (IV) infusion at 200 ml/hr. Administer 100 mcg/kg morphine IV for pain prn q4 hours. 37

A 3-year-old child with asthma and a respiratory tract infection is prescribed an antibiotic and a bronchodilator. The nurse notes the following during assessment: oral temperature 100.2°F (37.9°C), respirations 52 breaths/minute, heart rate 90 beats/minute, O2 saturation 95% on room air. Which action will the nurse take first? Administer the bronchodilator via a nebulizer. Give the antibiotic as prescribed. Apply oxygen at 2 liters via a nasal cannula. Apply a cardiac monitor to the child.

Administer the bronchodilator via a nebulizer. The nurse would first administer the bronchodilator to open the child's airway and facilitate breathing. Once the airway was open, the nurse could administer oxygen, if indicated. At this time, the child's saturation level is normal but it should be monitored. The nurse would then administer the antibiotic medication. The heart rate is within normal range for a child of this age (65 to 110 beats/minute); therefore, a cardiac monitor is not needed at this time. 36

The nurse is preparing the room for a client admitted from the emergency department with suspected tuberculosis (TB). Which type of infection control precautions would the nurse anticipate? Standard precautions Airborne precautions Droplet precautions Contact precautions

Airborne precautions 36

A 4-year-old child has been admitted to the hospital with a diagnosis of pneumococcal pneumonia. The parents are extremely distraught over the child's condition and the fact that the child has not wanted to eat anything for the past 2 days. Which nursing approach would be most important to take to help alleviate the high anxiety level of the parents? Allow the parents to remain with the child as much as possible. Encourage the parents to return home and get some rest. Tell the parents that their child is receiving the best care possible. Avoid telling the parents unnecessary facts regarding the child's prognosis.

Allow the parents to remain with the child as much as possible. 36

An 8-month-old girl appears pale, irritable, and anorexic. On blood testing, the red blood cells are hypochromic and microcytic. The hemoglobin level is less than 5 g/100 mL, and the serum iron level is high. Which symptom should the nurse most expect as a result of excessive iron deposits? An enlarged spleen An enlarged heart Enlarged lymph nodes An enlarged thyroid gland

An enlarged spleen

A nurse is preparing a teaching plan for a child with hemophilia and his parents. Which information would the nurse be least likely to include to manage a bleeding episode? Apply heat to the site of bleeding. Apply direct pressure to the area. Elevate the injured area such as a leg or arm. Administer factor VIII replacement.

Apply heat to the site of bleeding. 37

Which measure would be most effective in aiding bronchodilation in a child with laryngotracheobronchitis? Urging the child to continue to take oral fluids Administering an oral analgesic Teaching the child to take long, slow breaths Assisting with racemic epinephrine nebulizer therapy

Assisting with racemic epinephrine nebulizer therapy Croup is a viral infection that causes inflammation and edema of the larynx, trachea, and bronchi. One form of treatment is the use of nebulized racemic epinephrine. Racemic epinephrine is an alpha adrenergic agent. It works on the mucosal vasoconstriction to reduce the edema. This increases the lumen of airways, allowing for better intake of air. 36

The nurse is caring for a 10-year-old boy with hemophilia. He asks the nurse for suggestions about appropriate physical activities. Which activity would the nurse most likely recommend? Baseball Football Wrestling Soccer

Baseball 37

Pancreatic enzymes are part of the treatment in cystic fibrosis. When should the nurse administer the enzymes? Once a day Three times a day with water Before meals and snacks with milk At night after dinner

Before meals and snacks with milk Enzymes should be administered before all meals and snacks to help in normal absorption of nutrients from the food. 36

The cardiac monitor of a child recovering from heart surgery alarms, and the nurse finds the child without a heartbeat. What should the nurse do first? Apply oxygen. Establish an airway. Begin rescue breathing. Begin cardiac compressions.

Begin cardiac compressions. 37

What information would be included in the care plan of an infant in heart failure? Encourage larger, less frequent feedings. Begin formulas with increased calories. Maintain child in the supine position. Administer digoxin even if the infant is vomiting.

Begin formulas with increased calories. Infants with heart failure need increased calories for growth. The infants are typically given smaller, more frequent feedings to decrease the amount given and to help conserve energy for feeding. They often are given a higher-calorie formula. The infant should be placed in an upright position or in a car seat to increase oxygenation. The infant should not have any pressure on the diaphragm while in this position. Vomiting is a sign of digoxin toxicity and this should be considered before administering. 37

The nurse finds that an infant has stronger pulses in the upper extremities than in the lower extremities, and higher blood pressure readings in the arms than in the legs. Which assessment will the nurse perform next on this infant? Pedal pulses Pulse oximetry level Hemoglobin and hematocrit values Blood pressure of the four extremities

Blood pressure of the four extremities Coarctation of the aorta can present with stronger pulses in the upper extremities than in the lower extremities and higher blood pressure readings in the arms than in the legs because of obstruction of circulation to the lower extremities. Blood pressure values of the four limbs should be the next assessment data collected. Pedal pulses, pulse oximetry, and labs themselves will not provide the data needed. 21

What will the nurse include in the feeding plan for a breastfed infant with congenital heart disease? Breastfeed with small, frequent feeds. Ensure output of a minimum 5 wet diapers daily. Assess weight gain monthly. Feed on schedule every 4 hours to promote rest.

Breastfeed with small, frequent feeds. 37

After teaching a group of students about acute rheumatic fever, the instructor determines that the teaching was successful when the students identify which assessment finding? Janeway lesions Jerky movements of the face and upper extremities Black lines Osler nodes

Jerky movements of the face and upper extremities 37

The nurse is caring for a child diagnosed with rheumatic fever. When addressing the child's pain, the nurse should perform which intervention(s)? Select all that apply. Carefully handle the child's knees, ankles, elbows and wrists when moving the child. Administer salicylates after meals or with milk. Teach the child how to use a patient-controlled analgesia system. Administer intravenous morphine as prescribed. Prioritize nonpharmacologic interventions over pharmacologic interventions.

Carefully handle the child's knees, ankles, elbows and wrists when moving the child. Administer salicylates after meals or with milk. Salicylates are administered in the form of aspirin to reduce fever but primarily to relieve joint inflammation and pain. 37

The nurse notices that a child is spitting up small amounts of blood in the immediate postoperative period after a tonsillectomy. What would be the best intervention? Suction the back of the throat. Encourage the child to cough. Continue to assess for bleeding. Notify the health care immediately.

Continue to assess for bleeding. Children will have a small amount of blood mixed with saliva following a tonsillectomy. 36

The nurse is administering medications to the child with congestive heart failure (CHF). Large doses of what medication are used initially in the treatment of CHF to attain a therapeutic level? Digoxin Albuterol sulfate Ferrous sulfate Spironolactone

Digoxin 37

An 8-year-old with cystic fibrosis has had a noted decline on the growth chart. Which nursing intervention is best for maintaining adequate nutrition? Provide high caloric meals to the client's liking. Delay pancreatic enzymes until food enters the small intestine. Encourage high calorie, high protein snacks. Limit sodium to a 2 gram sodium restricted diet

Encourage high calorie, high protein snacks. 36

The nurse is preparing a presentation for a local community parent group about measures to prevent the common cold. What would the nurse stress as a vital prevention measure? Frequent handwashing Antibiotic use for household members with colds Avoiding second-hand smoke Minimizing exposure to crowds, especially during the spring

Frequent handwashing 36

A child with hemophilia A is scheduled for surgery. Which precautions would the nurse institute with this client? Handle the child gently when transferring to a stretcher. Caution the child not to brush the teeth before surgery. Do not allow a dressing to be applied postoperatively. Mark the client's chart to receive no analgesia.

Handle the child gently when transferring to a stretcher. 37

A 3-year-old child is hospitalized with a diagnosis of sickle cell anemia and is experiencing a pain crisis. Using the FACES scale, the nurse assesses the child's pain to be a 10 on a scale of 1 to 10. The child is receiving intravenous fluids and oxygen at 2 L/min via nasal cannula. The parent is at the bedside holding the child's hand and has a concerned look. What is the nurse's priority in caring for the child? Ask the parent if he or she has questions about the plan of care. Provide diversional activities for the child. Implement strategies to address the child's pain. Contact the health care provider to meet with the parent.

Implement strategies to address the child's pain. 37

What measure at home could help a child with an upper respiratory infection breathe more easily? Increasing room humidity Limiting fluid intake Enforcing strict bed rest Playing "rapid breathing" games

Increasing room humidity A moist environment helps prevent respiratory secretions from drying and becoming difficult to raise. 36

Which nursing diagnosis would be most appropriate for a child with idiopathic thrombocytopenic purpura? Ineffective tissue perfusion related to poor platelet formation Risk for altered urinary elimination related to kidney impairment Risk for infection related to abnormal immune system Ineffective breathing pattern related to decreased white blood count

Ineffective tissue perfusion related to poor platelet formation

Which nursing diagnosis would be most appropriate for a child with idiopathic thrombocytopenic purpura? Ineffective tissue perfusion related to poor platelet formation Risk for altered urinary elimination related to kidney impairment Risk for infection related to abnormal immune system Ineffective breathing pattern related to decreased white blood count

Ineffective tissue perfusion related to poor platelet formation 37

A nurse is teaching the parents of a child with sickle cell disease about factors that predispose the child to a sickle cell crisis. The nurse determines that the teaching was successful when the parents identify what as a factor? Respiratory distress Infection Fluid overload Pallor

Infection

The nurse is caring for child who present to the emergency department with reports of a fever for 5 days. The nurse notes a diffuse maculopapular rash, reddened cracked lips, erythema of hands, and bilateral conjunctivitis and suspects Kawasaki disease. Which nursing action is priority? Place the child on a soft diet. Initiate intravenous access. Administer acetaminophen. Assess cervical lymph nodes.

Initiate intravenous access. A child with signs of Kawasaki disease is at risk for dehydration due to a prolonged fever and oral pain. 37

The nurse is caring for a child who has been admitted for a sickle cell crisis. What would the nurse do first to provide adequate pain management? Administer a nonsteroidal anti-inflammatory drug (NSAID) as ordered. Use guided imagery and therapeutic touch. Administer meperidine as ordered. Initiate pain assessment with a standardized pain scale.

Initiate pain assessment with a standardized pain scale. 37

A child is brought to the emergency department by his parents because he suddenly developed a barking cough. Further assessment leads the nurse to suspect that the child is experiencing croup. What would the nurse have most likely assessed? High fever Dysphagia Toxic appearance Inspiratory stridor

Inspiratory stridor 36

A group of students are reviewing the effects of sickle cell anemia on the various parts of the body. The students demonstrate a need for additional study when they identify what as an effect? High urine specific gravity Chest syndrome Pulmonary hypertension Cholelithiasis

Low urine specific gravity (hyposthenuria) occurs with sickle cell anemia. Chest syndrome is an acute manifestation of sickle cell anemia. Pulmonary hypertension is a chronic manifestation of sickle cell anemia. Cholelithiasis is a chronic manifestation of sickle cell anemia. 37

A school-aged child is admitted to the hospital with a vaso-occlusive sickle cell crisis. Which measure in the child's care plan should be given priority? Beginning active range-of-motion exercises Seeing that the child ingests a protein-rich diet Maintaining fluids through an intravenous line Encouraging the child to take deep breaths hourly

Maintaining fluids through an intravenous line 37

When providing care for a child immediately after a bone marrow aspiration, which nursing action is priority? Monitor the site dressing and vital signs. Evaluate pain and administer medication. Educate the family on proper handwashing. Allow the child to play with a doll and syringe.

Monitor the site dressing and vital signs. 37

Upon providing discharge instructions home after a tonsillectomy and adenoidectomy, which is most important? Provide acetaminophen for pain. Note any frequent swallowing. Allow the child an age-appropriate, quiet plan. Stress regular fluid consumption.

Note any frequent swallowing. 36

The nurse is caring for a school-age child with reports of generalized joint pain and a pharyngitis. During assessment, the nurse notes a cardiac murmur. Which action by the nurse is priority? Administer penicillin. Assess skin for a rash. Swab throat for culture. Evaluate C-reactive protein.

Swab throat for culture.

The 2-year-old child is seen in the emergency department (ED) with a sore throat and difficulty swallowing. The ED physician suspects acute epiglottitis. Which of the following interventions should be included in the child's immediate care? Select all that apply. Obtain a medical and immunization history. Use a tongue blade to look in the back of the mouth. Use a swab to culture the area. Assess vital signs and breath sounds. Obtain and put an endotracheal tray at the bedside.

Obtain a medical and immunization history. Assess vital signs and breath sounds. Obtain and put an endotracheal tray at the bedside. 36

A child presents to the health clinic with a temperature of 101.8°F (38.8°C), dysphagia, headache, and a sore, erythematous throat. Which collaborative intervention will the nurse complete first? Obtain a throat culture. Begin saltwater gargles. Assess the child for a rash. Administer oral antibiotics.

Obtain a throat culture. 36

The nurse is caring for a 6-week-old with symptoms of irritability, nasal stuffiness, difficulty drinking and occasional vomiting. Which assessment finding produces important information regarding the medical and nursing treatment plan? Obtain testing for respiratory syncytial virus. Screen for the "allergic salute." Obtain vital signs to determine an infection. Draw a blood count to see if the client is septic.

Obtain testing for respiratory syncytial virus. 36

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. Shake inhaler and hold close to mouth. Draw up in syringe and administer subcutaneously. Pour in medication cup and have the child drink.

Open capsule and sprinkle on food. 36

Which nursing diagnosis would best apply to a child with allergic rhinitis? Pain related to sinus edema and headache Ineffective tissue perfusion related to frequent nosebleeds Disturbed self-esteem related to inherited tendency for illness Risk for infection related to blocked eustachian tubes

Pain related to sinus edema and headache 36

The nurse is caring for a child with idiopathic thrombocytopenic purpura with a platelet count of 24,000/mm3. Which health care provider prescription will the nurse question? Transfuse 1 unit of platelets. Administer prednisone orally. Provide ibuprofen as needed for pain. Give intravenous immunoglobulin (IVIG).

Provide ibuprofen as needed for pain. 37

The nurse is caring for a 7-year-old boy who has just had a tonsillectomy. Which intervention is least appropriate for this child? Providing fluids by straw Applying an ice collar Placing the child on his side Discouraging the child from coughing

Providing fluids by straw 36

The nurse is examining an 8-year-old boy with tachycardia and tachypnea. The nurse anticipates which test as most helpful in determining the extent of the child's hypoxia? Pulmonary function test Pulse oximetry Peak expiratory flow Chest radiograph

Pulse oximetry 36

The nurse is caring for a school-age child with reports of generalized joint pain and a pharyngitis. During assessment, the nurse notes a cardiac murmur. Which action by the nurse is priority? Administer penicillin. Assess skin for a rash. Swab throat for culture. Evaluate C-reactive protein.

Swab throat for culture. 37

A worried mother calls the nurse and tells her that her son has developed a horrible croup cough and is having trouble breathing. What would be the best intervention for the nurse to recommend to the mother? Run a hot shower to fill the bathroom with steam and have the boy stay there. Administer cough syrup to the boy. Administer an analgesic to the boy. Have the boy drink a full glass of water to clear out the mucus.

Run a hot shower to fill the bathroom with steam and have the boy stay there. 36

Which electrolyte does the client with cystic fibrosis need in abundance? Potassium Sodium Chlorine Magnesium

Sodium

Which electrolyte does the client with cystic fibrosis need in abundance? Potassium Sodium Chlorine Magnesium

Sodium 36

When conducting a physical examination of a child with suspected Kawasaki disease, which finding would the nurse expect to assess? Hirsutism or striae Strawberry tongue Malar rash Café au lait spots

Strawberry tongue 37

The nurse is trying to pick a method to teach a 4-year-old with cystic fibrosis a good way to exercise her lungs. Which would be the developmentally correct strategy to help this client? Teach the client to jump rope. Teach the client to blow bubbles. Teach the client to ride a bike. Teach the client to hop on one foot.

Teach the client to blow bubbles. 36

The nurse has assessed a 6-year-old child as having respiratory distress due to swelling of the epiglottis and surrounding structures. Which signs and symptoms would support this assessment? The child is pale and has vomited. The child has pale, elevated patches on the skin. The child is irritable and tachycardiac. The child is in tripod position.

The child is in tripod position. 36

The nurse is evaluating teaching provided to a school-age child and parents about the medication pancrelipase for cystic fibrosis. Which observation indicates that the teaching has been effective? The child chews an enteric form of the medication. The child takes a dose before having an afternoon snack. The father tells the child that diarrhea is expected with this medication. The mother opens the capsule and some medication spills on the fingers.

The child takes a dose before having an afternoon snack. 36

The nurse sees a 3-year-old child in the ambulatory setting for localized wheezing on auscultation. Which statement by the parent would be most important to report to the health care provider? The child received the pneumococcal vaccine series within his or her first year. The child has two cousins who have many allergies. The parent has supervised the child in the same room for the past 24 hours. The child was eating peanuts yesterday.

The child was eating peanuts yesterday. Aspiration can cause airway mucosal inflammation. When aspiration from a small object occurs, the child may cough and gasp for a few seconds to a few minutes. Following that, the child may not be symptomatic for a day or longer. The aspiration of a foreign body may mimic an asthma attack, but an asthma attack would have generalized wheezing. Localized wheezing suggests only a small portion of a lung is involved, such as occurs following aspiration. 36

The nurse is assisting in the development of a plan of care for a child with asthma. In planning care, many goals would be appropriate for this child and/or family caregiver. Which two goals would be the highest priority for this child or family? The child will maintain a clear airway. The child will have adequate fluid intake. The child and family will connect with families living with the same diagnosis. The child and family will improve knowledge and understanding of varied pharmacologic options. The child will maintain adequate pain control.

The child will maintain a clear airway. The child will have adequate fluid intake.

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 will attain oxygen saturation of 90% on room air. The infant's airway will remain clear and free of mucus. The infant's breathing will be less labored. The infant will have decreased nasal stuffiness.

The infant's airway will remain clear and free of mucus. 36

A 2-year-old toddler is seen for acute laryngotracheobronchitis. What observation would lead the nurse to suspect airway occlusion? The toddler states being tired and wanting to sleep. The respiratory rate is gradually increasing. The cough is becoming harsher. The nasal discharge is increasing.

The respiratory rate is gradually increasing. 36

A 9-month-old infant with iron-deficiency anemia is given ferrous sulfate therapy. Which assessment would best help the nurse determine that the infant is actually taking it daily? The reticulocyte count will have decreased. The infant will develop diarrhea. The stools will appear black. The infant will be more irritable than at the last visit.

The stools will appear black. 37

A child with a congenital heart defect is to undergo an echocardiogram. When teaching the parent about this test, which of the following would the nurse use to explain the procedure? This is a test that will check how blood is flowing through the heart. This is a test that will check the electrical impulses in the heart. This test can only determine the size of the heart. This test is an invasive test that will measure the blockage in the heart.

This is a test that will check how blood is flowing through the heart. 37

A nurse is assessing a young child and suspects coarctation of the aorta based on which finding? Hypotension Excessive crying Diastolic murmur Unequal upper and lower extremity pulses

Unequal upper and lower extremity pulses 21

A school-age child with asthma has cromolyn sodium added to the medication regimen. What should the nurse include when teaching the child and parents about this medication? Select all that apply. Use this medication with a metered-dose inhaler. Take this medication before an inhaled bronchodilator. Repeat doses of this medication until symptoms subside. This medication is to be used for an acute asthma attack. Wait 1 to 2 minutes between puffs when taking this medication.

Use this medication with a metered-dose inhaler. Wait 1 to 2 minutes between puffs when taking this medication.

The nurse is admitting a child who is experiencing an asthma attack. Which clinical manifestation would likely be noted in this child? Wheezing Chest retractions Hoarseness Circumoral cyanosis

Wheezing 36

The nurse has received morning report on a group of pediatric clients. Which pediatric client will the nurse see first? a child with hemophilia reporting knee pain and edema a child with sickle cell anemia requesting a cool compress a child experiencing a palpable purpural rash and arthralgia a child reporting lethargy with a history of thalassemia major

a child with hemophilia reporting knee pain and edema

A 9-year-old female child was brought to the emergency department after experiencing wheezing and shortness of breath while playing soccer. The parents administered two puffs of albuterol metered dose inhaler (MDI) with little effect, and 911 was notified. Paramedics applied oxygen 2 liters by nasal cannula for oxygen saturation of 90% on room air, and administered an albuterol nebulizer treatment. Audible wheezing was heard, and a 20-gauge intravenous (IV) catheter was inserted. Vital signs upon arrival at the emergency room: temperature, 98.8°F (37.1°C); heart rate, 125 beats/min; blood pressure, 88/50 mm Hg; respiratory rate, 32 breaths/min; oxygen saturation, 92% on simple face mask. Child appears anxious. The emergency room nurse should first ______________________________, then __________________________

assess airway administer IV methylprednisolone The nurse should assess the child's airway first. Assessment should always be prioritized using the ABCs (airway, breathing, and circulation).Intravenous (IV) methylprednisolone should be administered promptly to decrease inflammation in the lungs, which will improve air flow. 36

After teaching a class about cystic fibrosis, the nursing instructor determines that the teaching was successful when the students identify the condition as which type of genetic condition? autosomal recessive autosomal dominant X-linked recessive X-linked dominant

autosomal recessive CF is an autosomal recessive genetic condition. In such conditions, the risk of disease transmission is 25% if both parents carry the gene, and the chance that the child will be a carrier of the disease is 50%. 36

The nurse is assessing a child with suspected rheumatic fever. Which assessment finding(s) is consistent with the disease process? Select all that apply. carditis involuntary limb movement macular rash on trunk tender, swollen joints nonpalpable subcutaneous nodules

carditis involuntary limb movement macular rash on trunk tender, swollen joints Signs and symptoms of rheumatic fever include carditis; involuntary limb movement; macular rash on the trunk; tender, swollen joints; and subcutaneous nodules. 37

The nurse will select which meal as the best choice for a child with iron-deficiency anemia? cheeseburger, broccoli, and fresh strawberries chicken breast, French fries, and sweetened tea peanut butter sandwich, cheese stick, and applesauce two slices of pepperoni pizza and a glass of skim milk

cheeseburger, broccoli, and fresh strawberries 37

After teaching the parents of a child diagnosed with sickle cell disease, the nurse determines that the teaching was successful when the parents state that they will contact the primary health care provider if the child develops which signs or symptoms? Select all that apply. chest pain severe dizziness sudden change in vision constipation irritability

chest pain severe dizziness sudden change in vision 37

A nurse is performing a newborn assessment and notes the blood pressures in the upper extremities are higher than the lower extremities. The nurse should suspect which congenital newborn abnormality? patent ductus arteriosus truncus arteriosus ventricular septal defect coarctation of the aorta

coarctation of the aorta

A nurse is caring for a 4-month-old male client brought to the emergency department by the parents. Click to highlight the finding(s) that will require follow-up. The client has had cold symptoms for the past few days including coughing, sneezing, and a runny nose. Today coughing has increased, with decreased appetite and increasing fussiness. Parents administered acetaminophen for a fever of 102.2°F (39°C) last night with effect . Lips and mucous membranes are dry and cracked; skin very warm, ruddy , and intact . Parents state they have only changed diapers once since last night with very little urine, no bowel movement. Physical assessment reveals lethargy, opens eyes to voice, nonproductive cough, rhinorrhea that is clear , and expiratory wheezes in bilateral upper lobes. Vital signs: temperature, 101.2°F (38.4°C); heart rate, 130 beats/min ; blood pressure , 82/42 mm Hg ; respiratory rate, 28 breaths/min ; oxygen saturations 96% on room air.

cold symptoms for the past few days including coughing, sneezing, and a runny nose. coughing has increased, with decreased appetite and increasing fussiness administered acetaminophen for a fever of 102.2°F (39°C) last night with effect Lips and mucous membranes are dry and cracked; skin very warm, ruddy have only changed diapers once since last night with very little urine, no bowel movement. lethargy, opens eyes to voice, nonproductive cough, rhinorrhea that is clear expiratory wheezes in bilateral upper lobes. 101.2°F (38.4°C); heart rate, 130 beats/min 36

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 administer oxygen notify the health care provider obtain oxygen saturation levels

elevate the head of the bed 36

Which of the following would the nurse be least likely to assess in a child with a hematologic disorder? fever abnormal hemostasis anemia neutropenia

fever 37

The nurse is providing care for a 13-year-old child diagnosed with iron-deficiency anemia. The client's current hemoglobin level is 11 g/dL (110 g/L). Which intervention will the nurse anticipate including in the client's care? giving ferrous sulfate with orange juice between meals packed red blood cell transfusions providing a high dose of intravenous immunoglobulin weekly increasing the daily intake of fresh fruits and vegetables

giving ferrous sulfate with orange juice between meals

The nurse is providing care for a 13-year-old child diagnosed with iron-deficiency anemia. The client's current hemoglobin level is 11 g/dL (110 g/L). Which intervention will the nurse anticipate including in the client's care? giving ferrous sulfate with orange juice between meals packed red blood cell transfusions providing a high dose of intravenous immunoglobulin weekly increasing the daily intake of fresh fruits and vegetables

giving ferrous sulfate with orange juice between meals 37

What evaluation best illustrates the effectiveness of furosemide therapy in a child diagnosed with congestive heart failure (CHF)? The child: does not become overly tired when awake. has a heart rate within acceptable limits for age. has appropriate weight gain for age. has clear breath sounds.

has clear breath sounds. 37

The nurse is teaching a 12-year-old with asthma about possible side effects of drug therapy. Which of the following would the nurse identify as a possible side effect of a beta-adrenergic agonist used for bronchodilation? jitteriness decreased heart rate sedation dry mouth

jitteriness 36

The nurse is providing care at a local clinic that treats children with hemophilia. The nurse understands that if bleeding is not treated effectively, the children are at high risk for development of chronic disabling disease involving the: joints. heart. liver. kidneys.

joints. 37

The nurse sees a school-aged child in an ambulatory setting because of rheumatic fever. Which of the following would the nurse expect to find revealed by the health history? knee pain, abdominal rash, subcutaneous nodules an elevated temperature, back pain, loss of hair fatigue, slow pulse, frequent urination loss of weight, abdominal pain, chest pain

knee pain, abdominal rash, subcutaneous nodules 37

To prevent further sickle cell crisis, the nurse would advise the parents of a child with sickle cell anemia to: notify a health care provider if the child develops an upper respiratory infection. prevent the child from drinking an excess amount of fluids per day. encourage the child to participate in school activities, such as long-distance running. administer an iron supplement daily.

notify a health care provider if the child develops an upper respiratory infection. 37

The nurse is assessing a child and notices pinpoint hemorrhages appearing on several different areas of the body. The hemorrhages do not blanch on pressure. The nurse documents this finding as: petechiae. purpura. ecchymosis. poikilocytosis.

petechiae. 37

A group of nursing students are reviewing information about cystic fibrosis. The students demonstrate understanding of the condition when they identify which of the following as a possible complication? Select all that apply. pneumothorax distal intestinal obstruction syndrome pancreatitis colon cancer renal calculi

pneumothorax distal intestinal obstruction syndrome pancreatitis 36

The nurse is assessing a school-aged child with sickle-cell anemia. Which assessment finding is consistent with this child's diagnosis? slightly yellow sclera enlarged mandibular growth increased growth of long bones depigmented areas on the abdomen

slightly yellow sclera In sickle-cell anemia, eye scleras become icteric or yellowed from the release of bilirubin from the destruction of the sickled cells. 37

A child is brought to the emergency department late one evening and is diagnosed with croup. The child was noted to have a shrill, harsh respiratory sound when breathing in. This symptom is referred to as: stridor. hoarseness. barking cough. wheezing.

stridor. 36

The nurse identifies a nursing diagnosis of Ineffective airway clearance related to inflammation and copious thick secretions. What action is the priority? suctioning secretions from the airway administering oxygen as ordered monitoring oxygen saturation by pulse oximeter administering analgesics as ordered

suctioning secretions from the airway 36

A nurse is conducting an in-service program for a group of pediatric nurses working in the community clinics. When discussing bronchitis in children, the nurse would identify which of the following as the peak season for this condition? winter/spring fall/spring summer/winter fall/summer

winter/spring 36

The nurse has administered an intradermal injection of 0.1 ml of purified protein derivative. During which time frame will the nurse evaluate the site for reactions?

within 48-72 hours Clients who have had a tuberculin skin test will need to return to the facility to have the site evaluated for a reaction within 48 to 72 hours. Redness, swelling, induration, and itching are signs of a positive reaction. 36