FINAL PEDS EXAM PREP U

A child who suffered a blow to the abdomen while snowboarding comes to the emergency department with severe abdominal pain, especially on inspiration. The child is tachycardic, hypotensive, anxious, and very pale. The hematocrit is falling quickly. The health care provider indicates a liver rupture. What is the initial nursing action?

Begin an intravenous line

A 14-year-old girl arrives at the hospital in a comatose state. Her father, who found her comatose in her room, tells you that she has an opiate addiction. What pupil assessment would confirm that the coma was caused by opiate intoxication?

Both pupils are pinpoints Observe the child's eyes for signs of dilated pupils from increased ICP. If both pupils are dilated, irreversible brainstem damage is suggested, although such a finding may also be present with poisoning with an atropine-like drug. Pinpoint pupils suggest barbiturate or opiate intoxication. One pupil dilated or the eye deviated downward or laterally more than the other suggests third cranial nerve compression or a tentorial tear (laceration of the membrane between the cerebellum and cerebrum) with herniation of the temporal lobe into the torn membrane.

A 12-year-old female client has been diagnosed with scoliosis with a curvature of 30 degrees. What type of treatment would the nurse anticipate being started on this client?

Bracing For spinal curvatures of 25 to 40 degrees, the usual treatment is bracing. Curvatures greater than 40 degrees may be treated with traction or spinal instrumentation and fusion. Exercise may be implemented for very mild curvatures to strengthen the back muscles.

The nurse is caring for a 24-month-old boy with regressed retinopathy of prematurity. Which intervention is priority for this child? a. Teaching the parents to check how the child's glasses fit b. Referring the child to the local district of early intervention c. Assessing the child for asymmetric corneal light reflex d. Observing for rubbing, shutting the eyes, or squinting

C Assessing for asymmetric corneal light reflex is the priority intervention as strabismus may develop in the child with regressed retinopathy of prematurity. Observing for signs of visual impairment is not be critical for this child, nor is teaching the parents to check how the glasses fit the child. Referral to early intervention would be appropriate if the child was visually impaired. Reference:

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? a. Administering antivirals to ensure broad coverage of all organisms b. Determining if the girl's balance is shaky when walking c. Administering antibiotics as soon as they're available d. Obtaining a culture of fluid from the middle ear

C Because of the severity of the symptoms, the child will be treated with antibiotics immediately. This decision is based on the clinical practice guideline developed by the American Academy of Pediatrics and American Academy of Family Physicians. This clinical practice guideline helps to eliminate the need for obtaining middle ear fluid for culture. It is unreasonable to obtain a culture of middle ear fluid with every episode of acute otitis media to determine the specific cause. A 20-month-old's gait would most likely appear as swaying from side to side while moving forward. It is not until the toddler is around 3 years of age that he or she demonstrates walking in a heel-to-toe fashion with a steady gait. Antiviral medications would be used if the diagnosis of a viral cause was confirmed and the child was older than the age of 2 years.

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? a. Prophylactic myringotomy tubes can be inserted at birth. b. Prophylactic acetic acid instillations may be helpful. c. The frequency of otitis media is reduced in breastfed infants. d. Starting immunizations at birth rather than age 2 months might help.

C Breastfeeding is a way to help prevent acute otitis media in infants. Acute otitis media tends to occur less often in breastfed than bottle-fed infants. One reason is the immunologic benefits from the breast milk. An infant should not start immunizations until 2 months of age, because the organs and immune system are not mature enough at birth. Placing medications and tubes are never done prophylactically.

A 1-year-old female has been diagnosed with her 4th ear infection since birth. The nurse understands that children are more at susceptible to ear infections than adults because of which anatomical difference? a. Infants have narrow Eustachian tubes b. The Eustachian tubes of infants are in a slanted position c. Infants have horizontally placed Eustachian tubes d. Infants have long Eustachian tubes

C Infants' Eustachian tubes are relatively short, wide, and horizontally placed, which allows bacteria and viruses to enter the middle ear more easily, resulting in increased number of ear infections. As a child matures the tubes assume a slanted position.

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? a. "We need to make sure we are speaking clearly." b. "Using hand gestures as visual cues should help our child understand a little better." c. "We need to raise the volume of our voices significantly so he can hear us." d. "We need to face our son when we are speaking."

C It is not necessary for the parents to raise their voices more than slightly in order to be heard. Speaking clearly is an appropriate technique for communicating with the child. Facing the child when speaking is an effective method for communicating with the child. Using visual clues, such as hand gestures, is an effective technique for communicating with this child.

In children with otitis media, a procedure known as a myringotomy may be performed. Which statement is most accurate regarding this procedure? a. A small incision is made in the earlobe during this procedure. b. This procedure is performed as soon as otitis media is diagnosed. c. During this procedure, small tubes are inserted into the tympanic membrane. d. The purpose of this procedure is to decrease or stop the drainage.

C Myringotomy (incision of the eardrum) may be performed to establish drainage and to insert tiny tubes into the tympanic membrane to facilitate drainage. The procedure is done for children with chronic otitis media, not as soon as the child is diagnosed.

A 10-year-old child comes to the emergency department as a victim of abuse. The child's parent reports that the child was hit repeatedly with a baseball bat a few hours prior. The initial assessment indicates the child's blood pressure is 84/40 mm Hg. The nurse would further assess the child for what finding?

injuries resulting in ongoing blood loss

The nurse is assessing a 10-year-old girl recently fitted with a cast on her wrist. Which assessment finding would alert the nurse to a possible infection?

Drainage on the cast Drainage on the cast could indicate an infection. Pale fingers would suggest impaired circulation. Delayed capillary refill would suggest impaired circulation. Diminished pulse would suggest impaired circulation.

A child who has been having seizures is admitted to the hospital for diagnostic testing. The child has had laboratory testing and an EEG, and is scheduled for a lumbar puncture. The parents voice concern to the nurse stating, "I don't understand why our child had to have a lumbar puncture since the EEG was negative." What is the best response by the nurse?

"The lumbar puncture can help rule out any infection in fluid surrounding the brain and spinal cord as the cause of the seizures."

The nurse is speaking with a parent of a child diagnosed with scoliosis. The parent states, "I hate to think about my child having to wear a huge brace to treat this disorder. My best friend growing up had to wear one and she hated it." What is the best response by the nurse?

"The newer type of braces fit under the arms and are made to fit under clothing. They aren't nearly as big as they used to be." Bracing is the primary treatment for scoliosis. The braces used today are designed by computer-aided techniques and fit under the arms rather than extending to the neck. Braces must be worn 23 hours a day. Surgical intervention is only performed in severe cases.

c) Acetylcysteine Pg. 1480 Acetylcysteine is utilized for acetaminophen toxicity. Sodium bicarbonate is used for metabolic toxicity. Naloxone is used for opioid overdose. Activated charcoal is used for salicylate toxicity such as aspirin.

18. Which treatment is the antidote for acetaminophen toxicity? a) Activated charcoal b) Naloxone c) Acetylcysteine d) Sodium bicarbonate

The nurse helps position a child for a lumbar puncture. Which statement describes the correct positioning for this procedure?

"For a lumbar puncture, the child will be placed in a side-lying position with knees bent and neck flexed to assist with arching the back."

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."

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."

The nurse is caring for a school-age child diagnosed with juvenile arthritis (JA). Currently, the child's hips and knees are inflamed and painful. What statement by the parent would indicate a need for further education?

"I will keep my child home from school when there is a flare up to help reduce the amount of time my child is in pain." Children with JA should be encouraged to attend school, even if it is a shortened day because this increases activity. Using an elevated toilet seat may help decrease pain in the knees. A daily exercise program should be completed, and incorporating exercises into a game or dance can make them more enjoyable for the child. Warm baths can help can help reduce pain and increase movement in the involved joints.

The nurse is caring for an adolescent who has suffered a first-degree partial thickness burn to their forearm. Which statement by the parent indicates a need for further education?

"If feeling better, going to a friend's house and swimming will be a good distraction."

Parents bring their infant to the clinic for evaluation. They report that the child has been vomiting for the past several hours. The nurse determines that the parents' report is accurate when they describe the vomiting as what?

"It seems to be quite forceful." "It is really sour & curdled." "He seems to cry just before it occurs."

An adolescent client who has scoliosis and is wearing a Milwaukee brace tells the nurse that she is ugly and cannot wear the same clothing as her friends. Which response by the nurse best addresses this client's altered self-image?

"Let's look at some clothing that you can wear with the brace that will look like everyone else's clothes but cover it." A positive self-image is very important for adolescents wearing a brace. They want to look like their peers and wear the same clothing, but often that is not possible when wearing a brace. Assisting the adolescent in selecting clothing that looks stylish but still hides the brace is one of the best ways to help this client. Telling her she looks fine, to be confident, or bringing up the times she has been embarrassed does not help the client.

A nurse is providing instructions for home cast care. Which response by the parent indicates a need for further teaching?

"Pale, cool, or blue skin coloration is to be expected." It is very important to teach parents to identify the signs of neurovascular compromise (pale, cool, or blue skin) and tell them to notify the physician immediately. The other statements are correct.

The nurse is observing a child walk down stairs using a swing-through gait. What action by the child would indicate a need for intervention by the nurse?

"The child places the crutches on the lower step before placing the good foot down." To walk downstairs using a swing-through gait, the child places the crutches on the lower step, and then the good foot is placed on the step between the crutches. Both crutches should be moved at the same time. The good foot should not be placed on a lower step than the crutches when going down stairs.

The novice nurse is discussing the diagnosis of intussusception with a group of peers. What statement demonstrates the nurse's appropriate understanding regarding this disorder?

"The stools of the infant are called currant jelly stools and consist of blood and mucus." Explanation: In the child with intussusception, the stools consist of blood and mucus, thereby earning the name currant jelly stools. There is a telescoping of the upper portion of the bowel slipping over the lower portion. The condition occurs more often in boys than in girls and the highest incidence occurs in infants between the ages of 4 and 10 months. The infant who previously appeared healthy and happy suddenly becomes pale, cries out sharply, and draws up the legs in a severe colicky spasm of pain. This spasm may last for several minutes, after which the infant relaxes and appears well until the next episode, which may occur 5, 10, or 20 minutes later.

A nurse is caring for a 13-year-old boy with Duchenne muscular dystrophy. He says he feels isolated and that there is no one who understands the challenges of his disease. How should the nurse respond?

"There are a lot of kids with the same type of muscular dystrophy you have at the MDA support group." The best response would be to remind the boy that there are many children with muscular dystrophy that could be found at the local support group. Teenagers do not like to be told that they "have" to do anything. Telling the boy that he needs to be active or simply suggesting activities does not address his concerns.

The caregiver of a child who has had a cast applied to the leg observes the nurse putting adhesive tape strips around the edge of the cast. The caregiver asks the nurse why she is doing this. The best response by the nurse would be:

"These make a smooth edge on the cast so the skin is better protected." If the cast has no protective edge, it should be petaled with adhesive tape strips. These help keep the skin protected from the rough edge of the cast. If the cast is near the genital area, plastic should be taped around the edge to prevent wetting and soiling of the cast; petaling the cast does not provide protection to keep the cast dry.

The nurse is caring for a 14-year-old boy in Buck traction for a slipped capital femoral epiphysis (SCFE). What information would the nurse include when completing a neurovascular assessment of the affected leg? Select all that apply.

- Color - Sensation - Pulse - Capillary refill A neurovascular assessment includes assessing for color, movement, sensation, edema, and quality of pulses. Vital signs are not a component of a neurovascular assessment.

The nurse is caring for a child who fractured his harm in an accident. A cast has been applied to the child's right arm. Which actions should the nurse implement? Select all that apply.

- Document any signs of pain. - Check radial pulse in the both arms. - Monitor the color of the nail beds in the right hand. Monitoring for signs of pain, decreased circulation, or change or variation in pulses in the extremity is important for the child in a cast. Pain can indicate serious complications, such as compartment syndrome. Wearing a gown or sterile gloves is unnecessary. Checking posterior pulses would be appropriate when a lower extremity is casted.

The nurse is providing teaching about the disease to a client newly diagnosed with juvenile idiopathic arthritis (JIA) and his family. Which facts are accurate and should be shared with this family? Select all that apply.

- JIA can affect any number of joints. - The client will need to take several medications, including NSAIDS. - Administer NSAIDS with food to decrease the incidence of gastric irritation. Patients with JIA have painful swollen joints in varying numbers from one to more than five. The most common age is from 1 to 3 years and from 8 to 10 years. NSAIDS are the drug of choice for reduction of inflammation. Clients are encouraged to exercise as long as it does not increase the pain of the disease. Since NSAIDS are very irritating to the GI tract, it is recommended that NSAIDS be taken with food or milk.

The nurse is assessing a young boy who has been brought to the physician for mobility and balance issues by his parents. Which findings are positively associated with the presence of Duchenne muscular dystrophy? Select all that apply.

- Serum creatine kinase levels are elevated. - An electromyogram demonstrates the problem is within the nerves, not the muscles. - The child is unable to rise easily into a standing position when placed on the floor. Significant muscle wasting is associated with this diagnosis. Creatine kinase levels increase with muscle wasting. A muscle biopsy will show an absence of dystrophin. Gowers sign will be positive. An electromygoram will indicate the problem is with the muscles, not the nerves. Genetic testing will reveal the presence of the gene associated with Duchenne muscular dystrophy.

The young boy has fractured his left leg and has had a cast applied. The nurse educates the boy and his parents prior to discharge from the hospital. The parents should call the physician when which incidents occur? Select all that apply.

- The boy has had a fever of greater than 102° F (38.9°C) for the last 36 hours. - New drainage is seeping out from under the cast. - The boy's toes are light blue and very swollen. The parents should call the physician when the following things occur: The child has a temperature greater than 101.5F° (38.7° C) for more than 24 hours, there is drainage from the casted site, the site distal to the casted extremity is cyanotic, or severe edema is present.

An infant is brought to the emergency department after falling off the parents' bed and hitting the head. The infant is diagnosed with a concussion and is safe to return home. Which instruction(s) does the nurse provide the parents for home care of this infant? Select all that apply

-"Have someone in the home with your infant for the next 24 hours." -"Return to the emergency department if your infant vomits more than 2 times." -"Return to the emergency department if you notice your infant's pupils are different sizes."

The nurse is caring for a 3-year-old child who experienced a febrile seizure for the first time. What statements by the parents of the child should the nurse address further? Select all that apply

-"I am afraid that our 10-year-old will start having febrile seizures." -"It is so scary to think that our child will likely develop epilepsy now."

The meningococcal vaccine should be offered to high-risk populations. If never vaccinated, who has an increased risk of becoming infected with meningococcal meningitis? Select all that apply

-18-year-old student who is preparing for college in the fall and has signed up to live in a dormitory with two other suite mates -12-year-old child with asthma -5-year-old child who routinely travels in the summer with her parents on mission trips to Haiti -9-year-old child who was diagnosed with diabetes mellitus when he was 7 years old

A 12-year-old child has suffered a concussion after being in an automobile accident. What will be included in the plan of care/treatment? Select all that apply.

-Observation of level of consciousness -Rest

The nurse caring for a 3-year-old child with a history of seizures observes the child having a seizure. What information should the nurse document concerning the event? Select all that apply.

-Time the seizure started -Incontinence of urine or stool -Eye position and movement -Factors present before seizure started

The nurse is reinforcing teaching with the caregivers of a child being discharged from the urgent care setting following a mild head injury that occurred in a roller skating accident. What should the caregivers be instructed to do? Select all that apply.

-Wake the child every 1 to 2 hours to check level of consciousness. -Observe and report any vomiting that occurs within 6 hours. -Observe for and report to provider any double or blurred vision.

A nurse is reviewing the results of a lumbar puncture of a child. The nurse identifies which results as being abnormal? Select all that apply.

-specific gravity of 1.011 -cloudy in color -granulocytes are present Rationale: Normal appearance of cerebrospinal fluid (CSF) is clear and colorless. The presence of granulocytes suggests a cerebrospinal fluid infection. Normal specific gravity is 1.004 to 1.008. Trace amounts of protein, glucose, lymphocytes, and body salts are normal.

The child's palm represents approximately which percentage of the TBSA?

1% A quick assessment technique is to compare the client's palm with the size of the burn wound. The palm is approximately 1% of a person's TBSA.

d) Glasgow scale Pg. 1473 The Glasgow Coma Scale is used to grade comas according to level of consciousness. The Apgar score is assigned immediately after birth to determine how the infant tolerated the birth. Wong-Baker FACES and the visual analogue scales are used to rate pain.

17. A young client in the intensive care unit is in a coma after a severe head injury. The primary nurse is teaching a nursing student how to assess the client's level of consciousness using a coma scale. What type of scale could be used for this purpose? a) Wong-Baker FACES scale b) Apgar scale c) Visual analogue scale d) Glasgow scale

a) Neck stabilization with brace Pg. 1468 All children with head trauma need to have their neck stabilized with a brace until cervical trauma has been ruled out. Intracranial pressure monitoring, mannitol administration, and dexamethasone therapy may also be required, but these should not be anticipated first.

19. The nurse is caring for a 4-year-old client with head trauma. Which intervention should the nurse anticipate first? a) Neck stabilization with brace b) Intracranial pressure monitoring c) Dexamethasone therapy d) Mannitol administration

The nurse is assessing a child with a suspected head injury. The child opens the eyes only in response to the nurse placing pressure in the child's nail bed. What score on the Glasgow coma scale for eye opening should the nurse assign based on this assessment finding?

2 In the eye opening section of the Glasgow coma scale, eye opening only in response to painful stimuli would be a score of 2. Spontaneous eye opening is a 4, opening in response to speech is a 3, and no eye opening in response to painful stimuli is a 1.

d) The child and parent have conflicting stories on what caused the injury Pg. 1468 Conflicting descriptions of the event or how the injuries occurred is a hallmark sign of maltreatment. Nurses are mandated to report child maltreatment. Bruising to multiple parts of the body may occur with accidents. Greenstick fractures are fractures in which the bone is not completely broken; these fractures are not always associated with maltreatment.

2. The nurse is assessing a child who has been injured. What assessment finding would support the need to initiate a notification to the abuse registry so that child protection specialists can investigate? a) The child has a greenstick fracture b) The child and both parents' descriptions of the accident are the same c) There is bruising to various parts of the body after reported fall from a swing d) The child and parent have conflicting stories on what caused the injury

c) Syrup of ipecac Pg. 1479-1481 Ipecac is rarely used in the health care setting to induce vomiting and is no longer recommended for use in the home setting. Gastric lavage, administration of activated charcoal (binds with the chemical substance in the bowel), or whole bowel irrigation with polyethylene glycol electrolyte solutions may be used.

27. A child is brought to the emergency department with suspected poisoning. What treatment would the nurse least likely expect to be used? a) Whole bowel irrigation b) Activated charcoal c) Syrup of ipecac d) Gastric lavage

b) Stabilize the cervical spine Pg. 1468 If head or spine injuries are suspected, then after the airway is opened, the cervical spine must be stabilized to prevent damage. Checking the mouth for debris is part of securing an airway. Administering oxygen and IV access occur after the C-spine is stabilized.

31. A 3-year-old child has sustained injuries from a fall. Once the airway is secured, what interventions would be next? a) Administer 100% oxygen b) Stabilize the cervical spine c) Set up antecubital IV access d) Check mouth for debris

b) 2 Pg. 1475 In the eye opening section of the Glasgow coma scale, eye opening only in response to painful stimuli would be a score of 2. Spontaneous eye opening is a 4, opening in response to speech is a 3, and no eye opening in response to painful stimuli is a 1.

34. The nurse is assessing a child with a suspected head injury. The child opens the eyes only in response to the nurse placing pressure in the child's nail bed. What score on the Glasgow coma scale for eye opening should the nurse assign based on this assessment finding? a) 3 b) 2 c) 4 d) 1

b) "I just can't believe my baby is going to have brain surgery. It's so scary" Pg. 1470 Treatment of a subdural hematoma in an infant is to drain the blood by a subdural puncture, not surgery. A needle is inserted through the anterior fontanel (fontanelle) to drain the blood. The infant receives conscious sedation and must be held very still during the procedure. This may need to be repeated daily to empty the subdural space.

35. The nurse is caring for an infant who was injured and developed a subdural hematoma that is to be drained. Which statement by the infant's parent indicates a need for further education about the procedure? a) "The medication will help my child sleep during the procedure so my child won't feel anything" b) "I just can't believe my baby is going to have brain surgery. It's so scary" c) "So they will just stick a needle in the soft spot on my child's head and drain the blood" d) "I hope that they won't need to do this more than a couple of times to get all of the blood out"

b) Water immersions c) Falls d) Burns e) Motor vehicles Pg. 1477-1487 Accidents such as those involving motor vehicles, falls, burns, and water immersions cause more deaths in the 1- to 4-year-old age group than many other types of injuries. Hyperthermia in children is not common.

37. The nurse is providing community education regarding accidents in the infant, toddler, and preschool population. When designing educational materials, which types of accidents would be included? Select all that apply. a) Hyperthermia b) Water immersions c) Falls d) Burns e) Motor vehicles

a) The fluid is clear and watery Pg. To confirm if the fluid is CSF or rhinitis from nasal secretions, the nurse would test the fluid with a glucose reagent strip. CSF will test positive for glucose, whereas the clear, watery drainage from an upper respiratory tract infection or allergy will not. The color of the fluid does not confirm if it is CSF. Cerebrospinal fluid is thin and watery, not thick.

38. A nurse is providing care to a child with a depressed skull fracture. The child has fluid draining from the nose. The nurse confirms the fluid is cerebrospinal fluid based on which finding? a) The fluid is clear and watery b) The fluid is thick with red specks c) The fluid tests positive for glucose d) The fluid is light yellow in color

c) Keep cleaning solutions in a locked area Pg. 1478-1779 The most essential instruction at discharge is to keep cleaning solutions locked up to protect the toddler from accidental poisoning. Above all, this protects from a reoccurrence. Accidental poisonings usually occur among toddlers and commonly involve substances located in bathrooms or kitchens. Labeling poisonous substances may not help, because most toddlers are unable to read. Not leaving the child alone and closely monitoring the child are important, but not feasible all the time. Posting the number for the Poison Control Center (or saving it in a cellphone) is important but will not prevent the poisoning.

9. A nurse is caring for a toddler in stable condition after being diagnosed with accidental poisoning due to the ingestion of cleaning solution. What teaching point is essential prior to discharge? a) Label poisonous solutions with a red X b) Post the number for the Poison Control Center in your home and store the number in your cellphone c) Keep cleaning solutions in a locked area d) Closely monitor the toddler's activity

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? a. Encouraging the child to keep his hands away from his eyes b. Washing the child's hands and face when returning from outdoors c. Making sure the child showers and shampoos before bedtime d. Rinsing the child's eyelids with a clean washcloth and cool water

A Keeping a 6-year-old child's hands away from his face is a difficult task, particularly when he is playing by himself or is at school. Washing his hands and face when returning from outdoors is something the parents can supervise and ensure occurs and thus would be less difficult to implement. Rinsing the child's eyelids is an activity that the parents can supervise and ensure occurs and thus would be less difficult to implement. Showering and shampooing before bedtime is an activity that the parents can supervise and ensure occurs and thus would be less difficult to implement.

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 mostappropriate? a. "What you are describing may be what is called myopia." b. "This may signal your child is having difficulty paying attention rather than a visual disorder." c. "These reports are consistent with hyperopia." d. "Your child will need to be evaluated for an accommodation disorder."

A Myopia (nearsightedness) occurs when light rays focus anterior to the retina, causing objects that are far away to be unfocused. Typically, this develops around age 8 years and then progresses. These children can read a book or a computer screen immediately in front of them but are unable to read the blackboard clearly from a distance. There is no indication that the child is experiencing issues with paying attention. This suggestion does not address the parent's initial complaint. Accommodation disorders present with complaints of diplopia and headaches. Hyperopia (farsightedness) presents with vision that is blurry at a close range and clear at a far range, which is opposite of what is being reported for this child.

The nurse is educating the parents of a 5-year-old girl with infectious conjunctivitis about the disorder. Which information is most important to provide to prevent the spread of the disorder? a. Washing hands frequently b. Properly applying the prescribed antibiotic c. Staying home from school d. Keeping hands away from eyes

A Proper hand washing is the single most important factor to reduce the spread of acute infectious conjunctivitis. Proper application of the antibiotic is important for the treatment of the infection, not prevention of transmission; keeping the child home from school until she is no longer infectious and encouraging the child to keep her hands away from her eyes are sound preventative measures, but not as important as frequent hand washing.

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? a. Staphylococcus aureus b. Streptococcus pneumoniae c. Chlamydia trachomatis d. Haemophilus influenzae

A S. aureus is the most common bacterial cause of conjunctivitis. Although a common cause, S. pneumoniae is not the most common cause of bacterial conjunctivitis. Although a common cause, H. influenzae is not the most common cause of bacterial conjunctivitis. Although a common cause, C. trachomatis is not the most common cause of bacterial conjunctivitis.

A child having myringotomy tubes placed asks, "How and when will the tubes be removed?" What is the nurse's best response? a. "The tubes remain in place for 6 to 12 months until they come out by themselves." b. "You will have them replaced every 2 months until you reach age 18." c. "The tubes remain in place for 6 months and then are dissolved by vinegar." d. "The tubes are not removed; they grow permanently into place."

A The standard treatment for persistent otitis media with effusion is the placement of pressure-equalizing (PE) tubes via a myringotomy. These tubes stay in place for several months and fall out on their own. They are not replaced after they fall out nor are they meant to be a permanent solution to the child's frequent ear infections. Vinegar should not be placed in the ears.

The nurse is caring for a group of children on the pediatric unit. The nurse should collect further data and explore the possibility of child abuse in which situation?

A 7-year-old with a spiral fracture of the humerus, which the caregiver reports as having been caused when the child was hit by a bat swung by a Little League teammate. Spiral fractures, which twist around the bone, are frequently associated with child abuse and are caused by a wrenching force. When a broken bone penetrates the skin, the fracture is called compound, or open. A simple, or closed, fracture is a single break in the bone without penetration of the skin. In a greenstick fracture, the bone bends and often just partially breaks.

A child with a severe head injury arrives in the emergency department. Parents inform the nurse that after the injury, they have not been able to rouse the child. This nurse provides a report to the healthcare provider and suggest that the client may be experiencing what?

A coma

A child returns to the clinic after an episode of external otitis (acute otitis externa) that has resolved. What would the nurse emphasize as the priority for preventing future episodes? a. Performing handwashing b. Keeping ear canals dry c. Avoiding upper respiratory tract infections d. Adhering to regular follow-up to assess for hearing loss

B Since moisture contributes to external otitis (otitis externa), the priority is to keep the ear canals dry. Handwashing would be a priority for preventing infections such as conjunctivitis. Upper respiratory tract infections are associated with otitis media, not otitis externa. Hearing loss is not associated with otitis externa.

The nurse is teaching an in-service program to a group of nurses on the topic of GI disorders. The nurses in the group make what statement that is accurate r/t the diagnosis of plyoric stenosis?

A thickened, elongated muscle causes an obstruction at the end of the stomach

The nurse is teaching an in-service program to a group of nurses on the topic of gastrointestinal disorders. The nurses in the group make the following statements. Which statement is most accurately related to the diagnosis of pyloric stenosis?

A thickened, elongated muscle causes an obstruction at the end of the stomach. Explanation: Pyloric stenosis is characterized by hypertrophy of the circular muscle fibers of the pylorus, with a severe narrowing of its lumen. The pylorus is thickened to as much as twice its size, is elongated, and has a consistency resembling cartilage. As a result of this obstruction at the distal end of the stomach, the stomach becomes dilated. Congenital aganglionic megacolon is characterized by persistent constipation resulting from partial or complete intestinal obstruction of mechanical origin. Colic consists of recurrent paroxysmal bouts of abdominal pain. Gastroesophageal reflux (GER) occurs when the sphincter in the lower portion of the esophagus is relaxed and allows gastric contents to be regurgitated back into the esophagus

The nurse is caring for a child who has been diagnosed with acute otitis media three times in the past year. Which factors noted in the medical record would be considered contributing factors to this condition? Select all that apply. a. The child's older siblings have been diagnosed with acute otitis media in the past. b. The family home is occupied by 10 family members. c. The child shares a bedroom at home with 3 siblings. d. The child's father smokes. e. Breastfeeding after birth limited to the first 6 months of life.

A, B, C, D Acute otitis media may be linked to a series of factors in a child's medical / social history. Exposure to secondhand smoke is associated with acute otitis media. Additional factors include a family history, crowding in the home environment, and a large family size. Breastfeeding is considered a factor that reduced the incidence of acute otitis media.

The nurse is caring for a patient who has sustained a deep partial-thickness burn injury. In prioritizing the nursing diagnoses for the plan of care, the nurse will give the highest priority to what nursing diagnoses?

Acute pain

A 13-year-old adolescent has had a near-drowning experience. The nurse notices the client has labored breathing and a cough. What is the priority intervention?

Administer 100% oxygen by mask.

A 13-year-old boy has had a near-drowning experience. The nurse notices he has labored breathing and a cough. What is the priority intervention?

Administer 100% oxygen by mask.

A 3-year-old child who is breathing very rapidly and shallowly has an oxygen saturation level of 90%. The child is also very apprehensive. What would be most appropriate?

Administer oxygen via a mask made out of a paper cup. For any child showing respiratory distress or desaturation on pulse oximetry, administer oxygen to keep saturation above 95% using a method tolerated by the child; in the instance of a child with extreme apprehension, the nurse can fashion a nonthreatening oxygen mask made with a styrofoam or paper cup and an oxygen cannula

The nurse is preparing to administer oral acetylcysteine to a 9-year-old child with acetaminophen toxicity exhibiting nausea and abdominal tenderness. Which age-appropriate action should the nurse take when administering this medication?

Administer the medication in a small amount of a carbonated beverage.

A 4-year-old girl has been admitted to the emergency department after accidently ingesting a cleaning product. What treatment is most likely appropriate in the immediate treatment of the girl's poisoning?

Administration of activated charcoal Activated charcoal is the most common treatment for many poisonings and is more effective and safe than induced vomiting or gastric lavage. Rehydration is likely necessary, but this does not actively treat the girl's poisoning.

An 8-year-old child is brought to the emergency department by paramedics who report the child has second-degree (partial-thickness) burns on the chest and legs. The child has also suffered smoke inhalation. What is the nursing priority in the care of this child?

Airway management

The nurse completes a 1-month-old's feeding and sits the infant up to burp. The infant vomits back the feeding. Which is the nurse's primary concern?

Aspiration Explanation: The primary concern for the nurse is that the infant aspirates vomit into the lungs. Aspiration after vomiting may lead to respiratory concerns such as apnea and pneumonia. Nutritional deficiencies may occur if the vomiting continues. This is a concern but not the primary concern. Stomach irritation and stunted growth is not a typical concern at this time.

A child has fallen off of a swing at the playground and her father states that she became groggy. After assessing a child's airway, breathing, and circulation (ABCs), what would the nurse do next?

Assess level of consciousness.

A nurse is applying a cast to a 12-year-old boy with a simple fracture of the radius in the arm. What is most important for the nurse to do when she has finished applying the cast?

Assess the fingers for warmth, pain, and function Assess fingers or toes carefully for warmth, pain, and function after application of a cast to be certain a compartment syndrome is not developing. Before a cast is applied, not after, a tube of stockinette is stretched over the area, and soft cotton padding is placed over bony prominences. A "window" may be placed in a cast for an open fracture or if an infection is suspected—not to prevent an infection—so that the area can be observed; however, a window is not indicated in this case. The x-ray should be performed before casting, to diagnose the fracture, not afterward.

A 9-year-old client who suffered a head injury has strabismus. The nurse assesses the client for intracranial pressure (ICP). Which additional intervention is most important for the nurse to perform?

Assess the level of consciousness (LOC).

A child has fallen from a swing at the playground and the parent states that the child became groggy. After assessing a child's airway, breathing, and circulation (ABCs), what would the nurse do next?

Assess the level of consciousness.

A 5-year-old child is diagnosed with acute otitis media. Which nursing intervention would be priority? a. Administering a mydriatic b. Relieving the child's pain c. Cautioning the child not to pull on the ear d. Cautioning the child not to blow the nose

B Acute otitis media is caused by a bacterial or viral infection of fluid in the middle ear. The fluid behind the eardrum has difficulty draining back out because of the horizontal positioning of the eustachian tube. This causes increased pain. Antibiotics are prescribed to cure the infection. Children need pain relief until the antibiotic prescribed reduces the inflammation and pressure. Children pull on the ear as an attempt to reduce the pain and equalize the pressure. Pulling on the ears, especially in an infant, is one of the first signs the parent sees to warn of the ear infection. Blowing the nose is also an attempt by the child to equalize the pressure in the ear and help reduce the pain. A mydriatic is a drug that induces dilation of the pupils.

A young child in the clinic has watery eyes and reddened conjunctiva. The child keeps the eyes closed a lot, because it hurts to have them open. Which problem does the nurse suspect for this client? a. Stye b. Conjunctivitis c. Chalazion d. Blepharitis marginalis

B Conjunctivitis is inflammation of the conjunctiva and is demonstrated by watery eyes with reddened conjunctiva and sensitivity to light. Sticking of eyelids with pustular drainage is also a sign. It is very contagious and requires antibiotics for treatment. Blepharitis is a chronic scaling with discharge along the eyelid margin. A stye is a localized infection of the sebaceous gland of the eyelid. A chalazion is a chronic painless infection of the meibomian gland. The stye and blepharitis will require antibiotic treatment. A chalazion will clear on its own.

The nurse is taking a health history for a 9-year-old child with conjunctivitis. Which finding would suggest that this is allergic conjunctivitis? a. Recent upper respiratory infection b. Recently helped clean the basement c. Family history of conjunctivitis d. Exposure to infective agents

B Conjunctivitis may be classified as allergic, infectious or chemical. Allergic conjunctivitis may be induced by animal dander, dust mites, or some other ever-present antigen as might be found when cleaning unused spaces. Exposure to infective agents is related to infectious conjunctivitis. Recent upper respiratory infection and a family history of conjunctivitis are not contributing factors for allergic conjunctivitis.

The nurse is performing a physical assessment for an 8-year-old child with an earache. Which sign or symptom indicates external otitis (acute otitis externa or swimmer's ear)? a. The ear canal is devoid of cerumen. b. The child cries out when the ear is grasped. c. Symptoms of upper respiratory infection are present. d. The tympanic membrane reacts to a puff of air.

B External otitis (acute otitis externa or swimmer's ear) is an infection and inflammation of the skin of the external ear canal. The classic sign of external otitis is pain on movement of the pinna or pain on pressure over the tragus. Upon examination, the ear canal is red and swollen. Many times the tympanic membrane cannot be visualized because the swelling does not allow the insertion of an otoscope. Symptoms of upper respiratory infection many times accompany otitis media but are not seen in external otitis. The tympanic membrane reacting to a puff of air is a sign that there is no fluid buildup in the middle ear. The absence of cerumen in the ear canal is not related to external otitis.

The caregiver of a 2-year-old child tells the nurse, "They told me my daughter has an eye disorder called hyperopia." Which statement made by the mother indicates she has an understanding of this child's current condition? a. "At least by the time she gets married maybe she can have contacts." b. "Now I know why when she is working on puzzles she says her eye is sleepy." c. "She can see better close up than at a distance." d. "She has to have glasses right away."

B Hyperopia is farsightedness in which a person sees objects better at a distance than close up. Considerable eye fatigue may result from efforts at accommodation for close work. It is common in young children and often persists into the first grade or even later. Usually correction is not needed in a preschooler.

The nurse is caring for a child who has conductive hearing loss. What is true regarding this type of hearing loss? a. It is often undetected until the child goes to school. b. It is caused by chronic otitis media or another infection. c. It is caused by maternal rubella. d. It is generally severe and unresponsive to medical treatment.

B In conductive hearing loss, the transmission of sound through the middle ear is disrupted. Structures fail to carry sound waves to the inner ear. Fluid fills the ear so the tympanic membrane is unable to move properly. This type of impairment most often results from chronic serious otitis media or other infection. Infants have hearing tests before being discharged from the hospital to determine hearing loss, especially premature infants. Hearing loss can be detected early because language development will be impaired. This type of hearing loss is treatable with the use of hearing aids, cochlear implants and communication devices. Rubella causes sensorineural hearing loss.

The nurse is providing teaching to the parent of a 4-year-old child being treated for otitis media. When discussing the condition, the parent indicates an understanding of the information provided when making which statement? a. "Aspirin may be taken to relieve my child's fever during this time." b. "A brief hearing loss after the infection is an abnormal development." c. "My child can use the decongestant drops for up to 2 weeks." d. "Swelling behind my child's ears is normal as the infection resolves."

B Otitis media may develop with a complication known as mastoiditis. This presents as a lump behind the ear. It is a serious complication and must be reported and treatment sought. Aspirin should not be administered to children with afebrile illness. Decongestant drops may be used for 2 to 3 days but not after that point in the treatment of the condition. Hearing loss may result from the disorder for a period of time.

A toddler has been diagnosed with otitis media with effusion. The parents of a toddler tell the nurse, "We really don't understand what that diagnosis means." How should the nurse respond? a. "It would probably be best if you talked to the doctor again about the diagnosis." b. "The diagnosis means unwanted fluid is within the middle ear space, and there may or may not be an infection present." c. "There is an infection somewhere in the ear canal and their is fluid in the canal." d. "It's just a medical term that means an infection of the middle ear."

B Otitis media with effusion refers to the presence of fluid within the middle ear space, without signs or symptoms of infection. It may occur independent of AOM or may persist after the infectious process of AOM has resolved.

The nurse is caring for an 8-year-old boy with otitis media with effusion. Which situation may have caused this disorder? a. He had recent bacterial conjunctivitis. b. He is experiencing recurrent nasal congestion. c. He has good attendance at school. d. He frequently goes swimming.

B Recurrent nasal congestion contributes to the presence of otitis media with effusion. Frequent swimming would put the child at risk for otitis externa. Attendance at school is a risk factor for infective conjunctivitis. Although otitis media is a risk factor for infective conjunctivitis, infective conjunctivitis is not a risk factor for otitis media with effusion.

During physical assessment of a 2-year-old child, the nurse becomes concerned that the child may have a cataract in one eye. Which sign or symptom suggests the child has a cataract? a. Excess watering of the eyes b. Absence of the red reflex c. Edema of the eyelids d. Sclera appears to be blue

B The absence of the red reflex and a white, opaque appearance of the lens are telltale signs of a cataract. A blue tinge to the sclera and excess watering of the eyes are signs of glaucoma. Edema of the eyelids is a sign of allergic conjunctivitis.

A toddler has been diagnosed with otitis media with effusion. The parents of a toddler tell the nurse, "We really don't understand what that diagnosis means." How should the nurse respond? a. "There is an infection somewhere in the ear canal and their is fluid in the canal." b. "It would probably be best if you talked to the doctor again about the diagnosis." c. "The diagnosis means unwanted fluid is within the middle ear space, and there may or may not be an infection present." d."It's just a medical term that means an infection of the middle ear."

C Otitis media with effusion refers to the presence of fluid within the middle ear space, without signs or symptoms of infection. It may occur independent of AOM or may persist after the infectious process of AOM has resolved.

The nurse is educating the parents of a 6-year-old child about preventing hearing loss. Which topic will be included in the discussion? a. tendency to act silly in the classroom b. playing the radio loudly c. prevention and treatment of otitis media d. suddenly doing poorly in school

C The most common cause of conductive hearing impairment is otitis media. Hearing loss can be associated with intermittent bouts of acute otitis media and can hinder language development. Suddenly doing poorly in school, acting silly in the classroom, and playing the radio loudly are symptoms of hearing loss in children but they are symptoms after loss has occurred. The preventive education would include helping the child not develop otitis media.

A nurse is assessing a child's vision. Which test should the nurse use to test for accommodation? a. Performing a Weber test b. Performing Hirschberg test c. Moving a penlight toward the client's nose and observing whether his eyes can follow it d. Having the child touch the fly's wings in an image constructed of colored dots

C To test for accommodation, ask a child (over 6 months of age) to follow a penlight as you move it in toward the nose. Children who cannot accommodate are unable to fuse their vision to follow a penlight toward their nose this way; instead, they demonstrate double vision (diplopia). The Stereo-Fly dot test, a test where the image of a fly is constructed from a series of colored dots, is used to test stereopsis. When asked to touch the fly's wings, a child with good depth perception touches them accurately. A child with poor depth perception touches a spot 2 or 3 inches above the pattern. Hirschberg test is used to detect true strabismus. The Weber test is a test for hearing.

The school nurse is educating the parents of a child with infectious conjunctivitis. Which comment provides the most value for prevention? a. "Place the ointment inside the lower eyelid." b. "Use all the medication as directed." c. "Don't use anything that touches her face." d. "This could have started with a head cold."

C Warning the parents how infectious conjunctivitis is spread is most valuable for preventing infection within the family. Directing the parents to use a full course of medication is very important to help prevent a recurrence in the child, but not the most valuable for prevention. Telling of a possible cause or proper administration of medication has little preventive value.

The parent of a 7-year-old child reports having difficulty cleaning the child's ears with a cotton swab. What information should be provided to the parent? Select all that apply. a. Encourage the parent use a few drops of hydrogen peroxide each evening to help keep the ear wax softened. b. Encourage the parent to consider using a few drops of normal saline solution each evening to help keep the ear canal clean and free from wax buildup. c. Advise the parent that swabs can force the ear wax further down into the ear canal. d. Suggest that the parent try a smaller swab to clean the ears. e. Teach the parent that cleaning the ears with the swab may scratch the ear canal.

C, E Cerumen (earwax) serves the important function of cleansing the external ear canal as it gradually moves outward, bringing with it shed epithelial cells and any foreign object. Parents are often concerned that earwax will lead to a loss of hearing (or they view it as dirty) and so ask health care professionals to have it removed. Wax accumulation rarely is extensive enough in children that it interferes with hearing, and removing it can diminish its protective function, so it should not be removed routinely. Using cotton-tipped applicators to clean ears as a regular practice can also scratch the ear canal, creating a site for a secondary infection. This practice may also push accumulated cerumen farther into the ear canal, resulting in plugging of wax. Commercial softeners are available if cerumen accumulates to such an extent that hearing is affected. In some instances, a dilute solution of hydrogen peroxide may be necessary to dissolve cerumen. Again, this should not be done regularly because this will keep the ear canal constantly moist, an environment that leads to external otitis.

A child is born with a talipes disorder. The child later receives a cast on the affected leg to correct the problem. Which measure should the nurse mention to the mother to ensure good circulation in the affected leg?

Check the infant's toes for coldness or blueness. Review with parents how to check the infant's toes for coldness or blueness and how to blanch a toenail bed and watch it turn pink to assess for good circulation. The other answers are other interventions pertaining to caring for a child with a talipes disorder but are not associated specifically with ensuring good circulation.

The nurse is caring for a child with an external ventricular drainage device. The nurse is concerned about the minimal drainage in the past few hours. What action(s) by the nurse should be performed now? Select all that apply.

Check tubing clamps to ensure they are open. Ensure the tubing is not kinked.

Antibiotic therapy to treat meningitis should be instituted immediately after which event?

Collection of cerebrospinal fluid (CSF) and blood for culture

The nurse is working with a group of caregivers of school-aged children discussing fractures. The nurse explains that if the fragments of fractured bone are separated, the fracture is said to be:

Complete If the fragments of fractured bone are separated, the fracture is said to be complete. If fragments remain partially joined, the fracture is termed incomplete. Greenstick fractures are one kind of incomplete fracture, caused by incomplete ossification, common in children. Spiral fractures twist around the bone.

The nurse caring for a client diagnosed with muscular dystrophy would expect which laboratory values to be most abnormal?

Creatine kinase Serum creatine kinase levels are elevated early in the disorder, when significant muscle wasting is actively occurring. Bilirubin is a by-product of liver function. Potassium and sodium levels can change due to various factors and aren't indicators of muscular dystrophy.

The nurse is providing care to a child with an intussesception. The child has a bowel movement and the nurse inspects the stool. The nurse would document the stool's appearance most like as what?

Currant jelly-like

The nurse is teaching a group of parents about eyes and eye concerns. The nurse tells these caregivers about a condition that occurs when unequal curvatures in the cornea bend the light rays in different directions and this causes images to be blurred. The condition the nurse is referring to is: a. Hyperopia b. Refraction c. Myopia d. Astigmatism

D Astigmatism is caused by unequal curvatures in the cornea that bend the light rays in different directions and produce a blurred image. Refraction is the way light rays bend as they pass through the lens to the retina. Myopia is nearsightedness; hyperopia is farsightedness.

A child diagnosed with acute otitis media has been given a prescription for benzocaine. The nurse is correct when she makes which statement? a. "Benzocaine drops should be placed in your eye to numb it and reduce pain." b. "Benzocaine is an antibiotic for your ear infection." c. "Benzocaine is an antibiotic for your eye infection." d. "Benzocaine drops should be placed in your ear to numb it and reduce pain."

D Benzocaine numbing eardrops can prescribed for acute otitis media to help with severe pain. Benzocaine is not an antibiotic and when prescribed for otitis media should be placed in the ear

The vision impairment in which the child can see objects at close range but not at a distance is known as: a. Esotropia b. Hyperopia c. Exotropia d. Myopia

D Myopia is nearsightedness, which means that the child can see objects clearly at close range but not at a distance. It occurs because the light entering the eye focuses in front of the retina. Hyperopia is farsightedness. Esotropia is better known as "cross-eyed." It is a form of strabismus in which one or both eyes focus inward. Exotropia is a form of strabismus where the eyes are deviated outward.

The nurse is educating the parents of a 4-year-old boy with strabismus. Teaching for the parents would include the: a. possibility that multiple operations may be necessary. b. need for ultraviolet-protective glasses postoperatively. c. importance of completing the full course of oral antibiotics. d. importance of patching as prescribed.

D Teaching the parents the importance of patching the child's eye as prescribed is most important for the treatment of strabismus. The need for ultraviolet-protective glasses postoperatively is a subject for the treatment of cataracts. The possibility of multiple operations is a teaching subject for infantile glaucoma. Teaching the importance of completing the full course of oral antibiotics is appropriate to periorbital cellulitis.

The nurse has finished teaching the mother of a 5-year-old male diagnosed with bacterial conjunctivitis how to manage her son's infection at home. Which statement by the mother would indicate a need for further education? a. "I will use a warm compress to help loosen crust that accumulated on his eyelid overnight." b. "I will wash my hands immediately after caring for him." c. "I will encourage my son to not touch his eyes." d. "I will use Visine drops in his infected eye to help reduce redness."

D Using a warm compress to remove crust from eyelids, washing hands frequently, and refraining from touching infected eyes are all ways to help manage bacterial conjunctivitis and prevent spreading the infection. Visine should not be used as it does not treat the cause of the infection and can cause rebound redness.

The nurse is talking with the mother of a 4-year-old boy who will soon be going to a pre-kindergarten program. The child has had the Snellen vision test done at home, and he was unable to distinguish the pictures at the distance that would indicate his vision is normal. The child's mother asks the nurse if he will need glasses. Which statement made by the nurse would be most appropriate regarding the child's vision? a. "He is likely to have a slight astigmatism, which almost always needs to be corrected by glasses." b. "He might be suffering from hyperopia and probably will need glasses now." c. "His vision problem will get in the way of his learning, so he will probably have to have glasses before he starts school." d. "A child's vision is not completely developed by this age. Your child might outgrow this nearsightedness."

D Visual acuity of children gradually increases from birth, when the visual acuity is usually between 20/100 and 20/400, until about 5 years of age, when most children have 20/20 vision. Hyperopia (farsightedness) is a refractive condition in which the person can see objects better at a distance than close up. Astigmatism is caused by unequal curvatures in the cornea that bend the light rays in different directions.

A child has been diagnosed with bacterial conjunctivitis. Which statements by the child's parent indicate the need for further education? Select all that apply. a. "All of us at home need to wash our hands really well." b. "This is really contagious." c. "We should not use a towel that he has used." d. "He can go back to school in 4 hours after that thick yellow drainage is gone." e. "I'll continue to use eye drops to help with the redness."

D, E Eye drops are not appropriate to use because rebound vasoconstriction may occur and it is not actually treating the infection. The child can go back to school 24 to 48 hours after the mucopurulent drainage is no longer present.

A preschool-age child has just been admitted to the pediatric unit with a diagnosis of bacterial meningitis. The nurse would include which recommendation in the nursing plan?

Decrease environmental stimulation

A 7-year-old boy is brought to the emergency room by his parents following an accident in which he was struck in the back of the head with a baseball bat. The nurse is assessing him. What vital signs would indicate increased intracranial pressure in this child?

Decrease in pulse and respiratory rate and increase in temperature and pulse pressure

The nurse is planning to teach the parents of a child with newly diagnosed muscular dystrophy about the disease. Which definition should she use to best describe this condition?

Degeneration of muscle fibers Degeneration of muscle fibers with progressive weakness and wasting best describes muscular dystrophy. Demyelination of myelin sheaths is a description of multiple sclerosis. Lesions within the brain cortex and the upper motor neurons suggest a neurologic, not a muscular, disease.

The nurse is observing a 3-year-old boy who is sitting and playing in the waiting area of his pediatrician's office. The nurse calls the boy and his mother back for the boy's appointment. The boy rolls onto his stomach and pushes himself to his knees. Then he presses his hands against his ankles, knees, and thighs, walking up the front of his body, to stand. Which condition should the nurse suspect in this client?

Duchenne muscular dystrophy By age 3, children with Duchenne muscular dystrophy can rise from the floor only by rolling onto their stomachs and then pushing themselves to their knees. To stand, they press their hands against their ankles, knees, and thighs (they "walk up their front"); this is a Gower sign. Symptoms of facioscapulohumeral muscular dystrophy begin after the child is 10 years old, and the primary symptom is facial weakness. The child becomes unable to wrinkle the forehead and cannot whistle. Congenital myotonic dystrophy begins in utero and typically leads to death before age 1 year because of inability to sustain respiratory function. The symptoms of juvenile arthritis are primarily stiff and painful joints.

A nurse who is discussing Duchenne muscular dystrophy characterizes it correctly using which descriptors?

Duchenne muscular dystrophy causes progressive muscular weakness that ends in death. Duchenne muscular dystrophy is the most common of several muscular dystrophies and is a progressive, fatal disorder. It involves mainly skeletal muscles, but other muscles are affected over time. Onset occurs in early childhood. The disorder is X-linked recessive. An enzyme is lacking that is necessary for the maintenance of muscle cells. No structural abnormalities of the spinal cord or peripheral nerves are noted.

The nurse receives a report on a child admitted with severe muscular dystrophy. The nurse suspects the child has been diagnosed with the most severe form of the disease, known as:

Duchenne. Studies have shown that Duchenne is the most severe form of muscular dystrophy. Myotonia isn't a form of the disease; it's a symptom.

The nurse caring for a client in a body cast knows that immobility can cause contractures, loss of muscle tone, or fixation of joints. Which nursing interdisciplinary intervention is recommended to help prevent these adverse conditions?

Encourage active and passive range-of-motion activities to prevent ineffective tissue perfusion. The nurse should turn the client and encourage active and passive range-of-motion activities to prevent ineffective tissue perfusion. The client should be instructed to cough and breathe deeply to prevent respiratory complications. Normal capillary refill is 1 to 3 seconds. The client should be given small, frequent meals with increased fiber, protein, and vitamin C to prevent malnutrition.

The nurse is preparing an 18-month-old for discharge after treatment for dehydration following diarrhea. What would the nurse most likely include in the discharge teaching?

Encourage bananas, applesauce, and crackers.

An infant is diagnosed with pyloric stenosis. While observing the parents interacting with the child, the nurse notes that the parents are becoming frustrated bc they are having difficulty feeding their infant. The nurse identifies a nursing diagnosis of risk for impaired parents r/t frustration & difficulty feeding their infant. What would be appropriate for the nurse to include in the plan of care?

Encouraging rooming in with the infant Assisting the parents in holding and feeding their infant Pointing out positive aspects about their infant

A child is brought to the Emergency Department (ED) from the site of a chemical fire. The paramedics report that the patient has a burn that involves the epidermis, dermis, and the muscle and bone of the right arm. During assessment the child verbalizes no pain in the right arm and the skin appears charred. Based on these assessment findings, what is the depth of the burn on the patient's right arm?

Full-thickness A full-thickness burn involves total destruction of the epidermis and dermis and, in some cases, underlying tissue as well. Wound color ranges widely from white to red, brown or black. The burned area is painless because the nerve fibers are destroyed. The wound can appear leathery; hair follicles and sweat glands are destroyed. Edema may also be present. Superficial partial-thickness burns involve the epidermis and possibly a portion of the dermis and the patient will experience pain that is soothed by cooling. Deep partial-thickness burns involve the epidermis, upper dermis and portion of the deeper dermis and the patient will complain of pain and sensitivity to cold air.

The nurse is preparing a room for a child being admitted with meningitis. What is the appropriate action by the nurse?

Gather appropriate equipment and signage for respiratory isolation precautions.

The nurse is conducting a physical examination of a 10-year-old boy with a suspected neuromuscular disorder. Which finding is a sign of Duchenne muscular dystrophy?

Gowers sign A sign of Duchenne muscular dystrophy (DMD) is Gowers sign, or the inability of the child to rise from the floor in the standard fashion because of weakeness. Signs of hydrocephalus are not typically associated with DMD. Kyphosis and scoliosis occur more frequently than lordosis. A child with DMD has an enlarged appearance to their calf muscles due to pseudohypertrophy of the calves.

The type of fracture often seen in young children is one in which there is not complete ossification of the bone, and the bone bends and just partially breaks. What type of fracture is this?

Greenstick Greenstick fractures are one kind of incomplete fracture, caused by incomplete ossification, common in children. The bone bends and often just partially breaks.

The parents of a 6-week-old boy come to the clinic for evaluation bc the infant has been vomiting. The parents report that the vomiting has been increasing in frequency and forcefulness over the last week. The mother says, "Sometimes, it seems like it just bursts out of his mouth." A diagnosis of hypertrophic pyloric stenosis is suspected. When performing the physical examination, what would the nurse most likely find?

Hard, moveable, olive-shaped mass in the right upper quadrant

Which congenital condition leads to the infant being hungry, irritable, losing weight and rapidly becoming dehydrated with the potential of metabolic alkalosis?

Pyloric stenosis Explanation: This clinical picture includes assessment findings consistent with pyloric stenosis. Theses infants are very hungry yet once they eat, regurgitate the feeding leading to the infant being irritable, losing weight, and decoming dehydrated. The infant with aganglionic megacolon has a main symptom of constipation. Intussusception is a painful telescoping of the bowel. Colic has similar symptoms but primarily includes bouts of abdominal pain.

The parents of a 6-week-old boy come to the clinic for evaluation because the infant has been vomiting. The parents report that the vomiting has been increasing in frequency and forcefulness over the last week. The mother says, "Sometimes, it seems like it just bursts out of his mouth." A diagnosis of hypertrophic pyloric stenosis is suspected. When performing the physical examination, what would the nurse most likely find?

Hard, moveable, olive-shaped mass in the right upper quadrant Explanation: With hypertrophic pyloric stenosis, a hard, moveable, olive-shaped mass would be palpated in the right upper quadrant. A sausage-shaped mass in the upper midabdomen would suggest intussusception. Tenderness over the McBurney point would be associated with appendicitis. Epigastric or umbilical pain would be associated with peptic ulcer disease.

Through which mechanism is Duchenne muscular dystrophy acquired?

Heredity Muscular dystrophy is hereditary and acquired through a recessive sex-linked trait. Therefore, it isn't caused by viral, autoimmune, or environmental factors.

The student nurse is developing a care plan for a child who suffered a fractured tibia and will have a cast on his lower leg for approximately 6 weeks. Which nursing diagnosis would be the priority for this client?

Impaired physical mobility related to a cast on the leg Impaired physical mobility would be the priority need for this client. Basic comfort, food, fluid, and other basic needs are considered a higher priority than diversional activities and self-esteem. Pain would be the normally be the highest priority in this list, but this client would have acute inflammation rather than chronic inflammation.

The nurse is caring for a child with a diagnosis of pyloric stenosis during the preop phase of the child's treatment. What goal has the highest priority at this time?

Improving hydration

The nurse is caring for a child with a diagnosis of pyloric stenosis during the preoperative phase of the child's treatment. What is the highest priority at this time?

Improving hydration Explanation: Preoperatively, the highest priority for the child with pyloric stenosis is to improve nutrition and hydration. Maintaining mouth and skin integrity, and relieving family anxiety are important, but these are not the priority. The child will not likely have intense pain. Preparing the family for home care would be a postoperative goal.

The nurse is caring for a 5-year-old child with a temperature of 102 °F (39 °C). The nurse is aware that fever in a 5-year-old child is most commonly associated with what?

Increased caloric needs Fever increases metabolic rate requiring a higher calorie intake. For each degree Celsius, caloric requirements increase by 12%. Febrile seizures occur most commonly in children between 6 months and 5 years of age. However, it is the fever that triggers the seizure, not the seizure triggering the fever.

Which condition would alert the nurse that a child may be suffering from muscular dystrophy?

Increased lumbar lordosis An increased lumbar lordosis would be seen in a child suffering from muscular dystrophy secondary to paralysis of lower lumbar postural muscles. Increased lower extremity support may also be seen. Hypertonia isn't seen in this disease. Upper extremity spasticity isn't seen because this disease isn't caused by upper motor neuron lesions. Hyperactive reflexes aren't indications of muscular dystrophy.

The young child has been diagnosed with bacterial meningitis. Which nursing interventions are appropriate? Select all that apply.

Initiate droplet isolation Identify close contacts of the child who will require post-exposure prophylactic medication Administer antibiotics as ordered Initiate seizure precautions

The nurse is assessing the neurologic status of an 11-month-old girl. Which finding would be cause for concern?

Inspection shows a sluggish pupillary reaction.

A nurse has rushed to the site of an accident where members of a family have suffered carbon monoxide poisoning. What is the highest priority action that must take place during carbon monoxide poisoning?

Remove the individual from the room. The first step in handling accidental carbon monoxide poisoning is to remove the individual from the site. If moving the person out of doors is impossible, rescuers should open windows and doors to reduce the level of toxic gas and promote the client's ventilation of air. Once emergency personnel arrive, they administer oxygen. CPR may or may not be necessary. In the case of extremely high blood levels of carbon monoxide, the victim may be treated with hyperbaric oxygen at a hospital.

A 9-month-old girl is brought to the emergency room with what appears to be bouts of intense abdominal pain 15 minutes apart in which she draws up her legs and cries, often accompanied by vomiting. In between the bouts, the child recovers and appears to be without symptoms. Blood is found in the stool. What condition should the nurse suspect in this case?

Intussusception Explanation: Intussusception, the invagination of one portion of the intestine into another, usually occurs in the second half of the first year of life. Children with this disorder suddenly draw up their legs and cry as if they are in severe pain; they may vomit. After the peristaltic wave that caused the discomfort passes, they are symptom-free and play happily. In approximately 15 minutes, however, the same phenomenon of intense abdominal pain strikes again. After approximately 12 hours, blood appears in the stool and possibly in vomitus, described as a "currant jelly" appearance. Volvulus with malrotation and necrotizing entercolitis typically occur in the first 6 months of life and do not match the symptoms described above. Short-bowel/short-gut syndrome typically occurs when a large portion of the intestine has been removed due to a previous disease or trauma.

A 10-year-old girl with an intestinal virus has been vomiting and has become dehydrated. She says she is mildly thirsty, her skin turgor is poor, and her skin is dry and cool. Her serum sodium level is normal. The nurse recognizes that she has which type of dehydration?

Isotonic Explanation: Signs and symptoms of isotonic dehydration include the following: mild thirst; poor skin turgor; dry, cool skin; decreased urine output; irritability; and a normal sodium level. Signs and symptoms of hypotonic dehydration include the following: moderate thirst; very poor skin turgor; clammy, cool skin; decreased urine output; lethargy; and a reduced sodium level. Signs and symptoms of hypertonic dehydration include the following: extreme thirst; moderate skin turgor; warm skin; decreased urine output; extreme lethargy; and an increased sodium level. Acidotic is not a type of dehydration.

An adolescent girl with scoliosis is refusing to wear the prescribed body brace. Which instruction is best to progress her to the treatment goals?

It is important to wear the brace now to improve your spinal alignment, decreasing your symptoms . It is important to have the adolescent understand the treatment and how the treatment will benefit them currently. Body bracing helps to hold the spine in alignment and prevent further curvature decreasing symptoms. The brace will not correct the problem. Herniation and torticollis are not associated with scoliosis.

A nurse is caring for a toddler in stable condition after being diagnosed with accidental poisoning due to the ingestion of cleaning solution. What teaching point is essential prior to discharge?

Keep cleaning solutions in a locked area.

The nurse is preparing the plan of care for a child experiencing respiratory distress. What action would be the top priority?

Maintaining a patent airway

What is the antidote for acetaminophen toxicity?

Mucomyst

The nurse is caring for an adolescent brought to the emergency department with an acetaminophen overdose. The nursing care begins with an assessment and intravenous catheter (IV) placement and includes the anticipated administration of which agent?

N-acetylcysteine

The nurse is assessing a preadolescent client reporting pain and swelling just below the knee. The client states it hurts worse after running. What treatment would the nurse expect to be prescribed for this client?

NSAIDs, ice, and limiting exercise The child's symptoms suggest Osgood-Schlatter disease, which is a thickening and enlargement of the tibial tuberosity probably from overuse. Treatment includes administration of NSAIDS, ice, and limiting strenuous activity. Ankle and knee strengthening exercises, applications of ice, and use of acetaminophen is not indicated for this disorder.

The nurse is caring for a 4-year-old client with head trauma. Which intervention should the nurse anticipate first?

Neck stabilization with brace

The nurse is caring for a child who had a cast on his lower leg placed two hours ago. When assessing the child's foot, the nurse notes that the toes are cool and the child reports extreme pain. What is the best action by the nurse?

Notify the health care provider of the findings immediately. Cool fingers or toes, extreme pain, and impaired movement are symptoms of compartment syndrome. Compartment syndrome can severely decrease blood flow to the area causing damage and necrosis to the surrounding area. If compartment syndrome occurs, the cast needs to be released immediately; therefore, the health care provider must be notified of these assessment findings immediately. Administration of pain medication, positioning, and ice are interventions that may be prescribed after a cast is placed, but they are not the first treatment for compartment syndrome.

A mother calls the doctor's office and tells the nurse that she is concerned because her 4-month-old keeps "spitting up" with every feeding. What would indicate that the child is regurgitating as opposed to vomiting?

Only occurs with feeding Explanation: Regurgitation typically occurs only with feeding, runs out of the mouth with little force, smells barely sour and is only slightly curdled, appears to cause no pain or distress, occurs only once per feeding, and amounts to only about 1 to 2 tsp. Vomiting may occur at times other than feeding, is forceful and is typically projected 1 ft or more away from infant, is extremely sour smelling and curdled, is typically accompanied by crying, continues until the stomach is empty, and amounts to the full stomach contents.

A nurse is assessing a 3-year-old child for possible bacterial meningitis. Which sign would indicate irritation of the meninges?

Positive Kernig Sign

In caring for an infant diagnosed with pyloric stenosis, the nurse would anticipate doing what?

Preparing the infant for surgery

A child admitted with extensive burns is now being allowed to eat. When assisting with the child's nutrition, the nurse would encourage intake of which nutrient?

Protein

The nurse is caring for a comatose school-age child receiving gastrostomy tube feedings. The nurse aspirates 15 ml of stomach contents prior to administering a feeding. What is the appropriate action by the nurse?

Replace the stomach contents and continue with the feedings as prescribed.

In caring for the child with meningitis, the nurse recognizes that which nursing diagnosis would be most important to include in this child's plan of care?

Risk for injury related to seizure activity

A 10 year old comes to the emergency department as a victim of child abuse. The child's mother reports that he was hit in the head and other body areas with a baseball bat. Upon further examination, the child's blood pressure is 84/40. What physiological action does the nurse anticipate?

Shock from bleeding points other than the head injury Shock with hypotension is rare during an isolated head injury. If a child is in shock, investigate for bleeding points other than the head.

The emergency department nurse is attending a 3-year-old child with a bite wound. The parents tell the nurse that the child was in the backyard playing and came into the home crying and holding his hand. They saw two puncture marks on the heel of the left hand. The father searched the yard and found no sign of any animal or reptile. The nurse notes the child is starting to have difficulty breathing, and the bite area is severely edematous. What nursing intervention is most appropriate?

Show the child pictures of animals and reptiles to identify what bit him; administer oxygen and perform a skin test to prevent a possible anaphylactic reaction to horse venom. The child or parent should attempt to describe the biting animal. Skin testing and specific antivenom should be given. Antivenom is used in the the treatment of venomous bites, the venom is diluted and injected into a horse. The horse undergoes an immun response producing antibodies against the venom's active molecule, which is used to treat the client

Which nursing assessment data should be given the highest priority for a child with clinical findings related to meningitis?

Signs of increased intracranial pressure (ICP)

The nurse is discussing types of treatment used when working with children who have orthopedic disorders. Which form of treatment covers the lower part of the body, usually from the waist down, and either one or both legs while leaving the feet open?

Spica cast The hip spica cast covers the lower part of the body, usually from the waist down, and either one or both legs while leaving the feet open. The cast maintains the legs in a frog-like position. Usually, there is a bar placed between the legs to help support the cast.

A 3-year-old child has sustained injuries from a fall. Once the airway is secured, what interventions would be next?

Stabilize the cervical spine.

Based on knowledge of the progression of muscular dystrophy, which activity would a nurse anticipate the client having difficulty with first?

Standing Muscular dystrophy usually affects postural muscles of the hip and shoulder first. Swallowing and breathing are usually affected last. Sitting may be affected, but a client would have difficulty standing before having difficulty sitting.

A child with a severe head injury arrives at the emergency department very groggy. She is subsequently difficult to arouse for several hours. The nurse would document this condition as what?

Stupor

An infant arrives at the emergency department with vomiting, seizures, and irritability for the last 8 hours. A radiograph confirms bleeding into the space between the dura and arachnoid membrane. What diagnosis would the nurse expect the physician to make for this patient?

Subdural hematoma Subdural hematoma is venous bleeding into the space between the dura and arachnoid membrane. Signs and symptoms include seizures, increased intracranial pressure, vomiting, hyperirritability, and enlargement of the head.

The nurse is caring for an infant immediately after a pyloromyotomy surgery has been performed to treat pyloric stenosis. The infant's parents are understandably anxious about their child. Given the situation, what is the most appropriate way for the nurse to position the infant during the anesthesia recovery period?

Support him and place him on his side. Explanation: Postoperatively the child should be placed on his side to prevent aspiration of mucus or vomitus, especially during the anesthesia recovery period. After fully waking from the surgery, he can be held by a family caregiver in a position that does not interfere with IV infusions and is comforting to both caregiver and child.

The nurse is caring for a 6-month-old infant who was admitted to the emergency room 24 hours ago with signs of severe diarrhea. The infant's rectal temperature is 104°F (40°C), with weak and rapid pulse and respirations. The skin is pale and cool. The child is on IV rehydration therapy, but the diarrhea is persisting. The infant has not voided since being admitted. Which is the priority nursing intervention?

Take a stool culture Explanation: Treatment of severe diarrhea focuses on regulating electrolyte and fluid balance by initiating a temporary rest for the GI tract, oral or IV rehydration therapy, and discovering the organism responsible for the diarrhea. All children with severe diarrhea or diarrhea that persists longer than 24 hours should have a stool culture taken to determine if bacteria are causing the diarrhea, and if so, a definite antibiotic therapy can be prescribed. Because a side effect of many antibiotics is diarrhea, antibiotics should not routinely be used to treat diarrhea without an identifiable bacterial cause. Before the initial IV fluid is changed to a potassium solution, be certain the infant or child has voided—proof that the kidneys are functioning; in this case, the child is not voiding yet. The child should not be fed a cracker, as the GI tract should be rested until the diarrhea stops.

A 13-year-old girl suffered a serious fall while hiking with friends and injured her head. She is now being evaluated by a nurse in the emergency room. The nurse notices clear fluid flowing from the girl's nose. The girl's friend said that she had been suffering from pollen allergy recently. Which of the following interventions should the nurse implement to determine whether the fluid is cerebrospinal fluid (CSF) or rhinitis from an allergy?

Test the fluid with a glucose reagent strip CSF will test positive for glucose, whereas the clear, watery drainage from an upper respiratory tract infection or allergy will not.

While assessing a child with a suspected skull fracture, the nurse notes clear fluid draining from the child's nose. What is the priority action by the nurse?

Test the fluid with a glucose reagent strip.

A 13-year-old client suffered a serious fall while hiking with friends and suffered a head injury. Upon arrival to the emergency department, the nurse notices clear fluid from the nose. A friend said that the client had been sneezing a lot from a pollen allergy. Which intervention will the nurse implement to determine whether the fluid is cerebrospinal fluid (CSF) or mucus from allergic rhinitis (hay fever)?

Test the secretions with a glucose reagent strip.

A child with severe diarrhea cannot drink and requires intravenous rehydration. After beginning the therapy, the nurse determines that potassium can be added to the intravenous fluid because which of the following has occurred?

The child has voided. Explanation: Potassium cannot be given until it is established that the child is not in renal failure. Giving potassium IV when the body has no outlet for excessive potassium can lead to excessively high potassium levels and heart block. Before initial IV fluid is changed to a potassium solution, the nurse must be certain that the infant or child has voided—proof that the kidneys are functioning.

The nurse is preparing discharge education for the caregivers of a child with a seizure disorder. Which goal of treatment is priority for this client?

The child will remain free from injury during a seizure.

When creating a care plan for a child with a head injury, the nurse uses the nursing diagnosis of Risk for excess fluid volume related to administration of hypertonic solution. Which is an appropriated outcome evaluation for this diagnosis?

The child's lungs remain clear to auscultation.

Idiopathic scoliosis is the most common form that occurs.

True Idiopathic scoliosis, with the majority of cases occurring during adolescence, is the most common scoliosis.

The nurse is caring for a child who has had an open reduction with cast placement on the forearm. While assessing the cast, the nurse notes serosanguineous fluid on the cast. What action by the nurse is appropriate?

Using a ballpoint pen, outline the fluid stain. Mark the time it is outlined. Although oozing of serosanguineous fluid after an open reduction is a common, it does need to be noted and documented. The nurse should outline the stain with a ballpoint pen or crayon rather than a marker, mark the time so it can be determined how rapidly the spot is increasing. If the stain is small, notification of the health care provider and replacement of the cast is not necessary.

A client with muscular dystrophy has lost complete control of his lower extremities. He has some strength bilaterally in the upper extremities, but poor trunk control. Which mechanism would be the most important to have on the wheelchair?

Wheelchair belt This client has poor trunk control; a belt will prevent him from falling out of the wheelchair. Antitip devices, head rest supports, and extended breaks are all important options but aren't the most important options in this situation.

The nurse is caring for a child who has suffered a first-degree partial thickness burn to their forearm. What education should the nurse provide to the parents?

When a minor burn occurs, apply cool water, not ice, to the burn to cool the skin. Infection is a concern so application of an antibiotic ointment and a gauze dressing is indicated. A follow up appointment in about 2 days is indicated to change the dressing and assess for any infection. The dressing should be kept dry, no swimming or getting wet while bathing, until the burn is healed.

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. Rationale: To perform the child's eye reflex examination, the nurse will shine a penlight into the eyes and observe if the pupils constrict, which is a normal response. Lack of pupillary light reflex can indicate increased intracranial pressure (ICP). To perform the "doll's eye" reflex examination, the nurse will place the child in a supine position and move the head gently but rapidly to one side. During this movement, it is normal for the child's eye to move to the opposite side. If the child has increased ICP, this response will be absent. While the other options are potential signs of increased ICP, they do not demonstrate the child's eye reflex examination

The nurse is assessing a child who has suffered a head injury. Which assessment finding would indicate loss of midbrain functioning?

arms adducted and extended with pronation of wrists with fingers flexed

A child is diagnosed with aseptic meningitis. The child's mother states, "I don't know where she would have picked this up." The nurse prepares to respond to the mother based on the understanding that this disorder is most likely caused by:

enterovirus.

The nurse is caring for an 11-year-old presenting with tenderness in the shoulder. He is the pitcher for his baseball team and reports shoulder pain with active internal rotation but is able to continue past the pain with full range of motion. Based on these reported symptoms, the nurse is aware that the disorder is most likely to be:

epiphysiolysis of the proximal humerus. Epiphysiolysis of the proximal humerus is an overuse disorder that occurs with rigorous upper extremity activity such as pitching and causes tenderness in the shoulder. Osgood-Schlatter disease causes knee pain and painful swelling or prominence of the anterior portion of the tibial tubercle. Sever disease causes pain over the posterior aspect of the calcaneus. Epiphysiolysis of the distal radius is an overuse disorder that causes wrist pain. It is common in gymnasts.

The nurse knows that the heads of infants and toddlers are large in proportion to their bodies, placing them at risk for what problem?

head trauma

A 14-year-old girl is diagnosed as having scoliosis. When doing scoliosis screening with her, an important observation would be to note:

her posterior spine when she bends forward. A lateral curvature of the spine (scoliosis) is best revealed when the child bends forward. Bending to the side would not provide an accurate assessment of the spine nor would assessing the iliac crest or the chest.

The nurse is assessing a child and notes S-shaped curvature of the spine. What terminology would the nurse use when documenting this assessment finding?

idiopathic scoliosis Idiopathic scoliosis is an S-shaped curvature of the spine. Kyphosis is an outward curvature of the cervical spine. Lordosis is an inward curving of the lumbar spine. Sway back is another term used for lordosis.

Pyloric stenosis has been diagnosed in a 3-week-old male infant who has frequent vomiting after feedings. An important preoperative nursing intervention is:

maintaining NPO status while restoring hydration and electrolyte balance. Explanation: NPO is needed to avoid vomiting and aspiration during surgery. Hydration and electrolyte replacement is often needed because of the history of vomiting, which causes loss of both fluid and electrolytes. Feeding when surgery is pending would not be safe. Hourly abdominal assessment would not yield needed information and would further disturb the infant. Pain is not the source of crying. The infant is hungry.

A 7-year-old boy has experienced severe diarrhea resulting from an intestinal virus. The nurse is concerned that the child will develop an acid-base imbalance. Which of the following blood test results would indicate that the boy is experiencing metabolic acidosis?

pH of 7.25, HCO3 of 20 mEq/L Explanation: The pH of blood is normally slightly alkaline, ranging from 7.35 to 7.45. The level of bicarbonate (HCO3) in arterial blood is normally 22 to 26 mEq/L. Metabolic acidosis results from diarrhea as a great deal of sodium is lost with stool. With metabolic acidosis, arterial blood gas analysis will reveal a decreased pH (under 7.35) and a low HCO3 value (near or below 22 mEq/L). With metabolic alkalosis, pH will be elevated (near or above 7.45), and HCO3 level will be near or above 28 mEq/L.

A nurse is caring for an infant who has just undergone a ventricular tap. In what position should the nurse place the infant immediately after the procedure?

semi-Fowler position with a parent at the bedside

The nurse is caring for a child diagnosed with Duchenne muscular dystrophy and notes the presence of a Gower sign on the assessment form. What action by the child would support this assessment?

when on the floor, rising to the knees and pressing the hands against the ankles, knees, and thighs to stand A Gower sign is when children "walk up their front." When on the floor, the only way they can stand is to roll on their stomach and push themselves up to their knees. They then press their hands against their ankles, knees, and thighs. The presence of a waddling gait, difficulty climbing stairs, and a short heel cord are all present in Duchenne muscular dystrophy, but they are not the Gower sign. Meeting milestones late is also a symptom of this disorder, but it is not the Gower sign.