Last Peds (new stuff)
The nurse is caring for a child with thalassemia who is receiving chelation therapy at home using a battery-operated pump. After teaching the parents about this treatment, which statement by the mother indicates a need for additional teaching?
A) "I can have the nurse administer the chelation therapy if I am uncomfortable."
The nurse is providing teaching to the parents of a newborn prior to a heelstick. The nurse is describing the procedure and recommending various methods for the parents to help comfort their baby. Which statement by the parents indicates a need for further teaching?
A) "It's better if we are not in the room for this."
For which child would nonopioid analgesics be recommended?
A) A child with juvenile arthritis
Prior to administering morphine to a 10-year-old child, the nurse reviews the adverse effects of the drug. Which system is primarily affected by the drug, causing most of the adverse effects?
A) Central nervous system
When evaluating the hemogram of an 8-month-old infant, the nurse would identify which type of hemoglobin as being the predominant type?
A) Hemoglobin A
The nurse is caring for a 13-year-old boy with acute myelogenous leukemia who is experiencing feelings of powerlessness due to the effects of chemotherapy. What intervention will best help the teen's sense of control?
A) Involving the boy in decisions whenever possible
The nurse is caring for a child who is recovering from an appendectomy. What is the appropriate term for the pain this child is experiencing?
A) Nociceptive pain
The nurse is conducting a physical examination of a toddler with suspected lead poisoning. Lab results indicate blood lead level 52 mcg/dL. Which action would the nurse expect to happen next?
A) Repeat testing within 2 days and prepare to begin chelation therapy as ordered.
The nurse is assessing the pain of a postoperative newborn. The nurse measures the infant's facial expression, body movement, sleep, verbal or vocal ability, consolability, and response to movements and touch. Which behavioral assessment tool is being used by the nurse?
A) Riley Infant Pain Scale
The nurse is teaching the parents of a child diagnosed with iron-deficiency anemia about ways to increase their child's intake of iron. The parents demonstrate understanding of the teaching when they identify which foods as good choices for the child? Select all that apply. A) Tuna B) Salmon C) Tofu D) Cow's milk E) Dried fruits
A, B, C, E
A nurse suspects that an adolescent may have community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA). What would the nurse expect to assess? Select all that apply. A. Participation in contact sport B. Recent cut on the lower leg C. History of a recent sore throat D. Raised fluctuant lesions E. Erythematous rash over the trunk and face
A, B, D
The parents of a 7-month-old child with an infection ask the nurse about how to treat their child's fever. After providing teaching, the parents voice understanding with which statements? Select all that apply. A. "If my child's fever is under 102°F , I don't need to make an appointment with the physician." B. "Having a temperature over 38°C puts my child at risk for the infection spreading to the bloodstream." C. "I can use acetaminophen to help with the symptoms of the infection but it won't get rid of the infection." D. "Even though people get frightened, fevers are not a bad thing during an infection unless it gets too high." E. "Any fever is dangerous and can cause serious damage to brain cells if it goes on too long."
A, C, D
2.The nurse is managing children who have chronic diseases in a neighborhood clinic. What are some examples of chronic conditions? Select all that apply. A) Diabetes mellitus B) Myocardial infarction C) Rheumatoid arthritis D) Compound fracture E) Acute asthma F) Bronchopneumonia
A, C, E
The nurse caring for infants in the neonatal intensive care unit (NICU) relies on the use of behavioral and physiologic indicators for determining pain. Which examples are behavioral indicators? Select all that apply. A) The infant grimaces. B) The infant's heart rate is elevated. C) The infant flails his arms and legs. D) The infant's respiratory rate is elevated. E) The infant is crying uncontrollably. F) The infant's oxygen saturation is low.
A, C, E
The nurse is counseling the parents of a 9-year-old boy who is receiving morphine for postoperative pain. Which statement from the nurse accurately reflects the pain experience in children?
D) "It is very rare that children become addicted to narcotics."
The nurse tells a joke to a 12-year-old to distract him from a painful procedure. What pain management technique is the nurse using?
B) Distraction
The nurse is caring for an 8-year-old girl who has been diagnosed with leukemia and will have a variety of tests, including a lumbar puncture, before beginning chemotherapy. What action would be the priority?
B) Educating the child and family about the testing procedures
The nurse is assessing a child with suspected thalassemia. What would the nurse expect to assess?
B) Frontal bossing
The nurse is caring for a 5-year-old boy undergoing radiation treatment for a neuroblastoma. Which nursing diagnosis would be most applicable for this child?
B) Impaired skin integrity related to desquamation from cellular destruction
The nurse is explaining the effects of heat application for pain relief. Which effect would the nurse be likely to include?
B) Increased pressure on nociceptive fibers
A nurse is providing care to a child with idiopathic thrombocytopenic purpura with a platelet count of 18,000/mm3. Which medication would the nurse most likely expect to be ordered?
B) Intravenous immune globulin
The nurse is preparing a presentation for a parent group about childhood cancers, focusing on brain tumors in children. What would the nurse describe as the most common type of brain tumor?
B) Medulloblastoma
A child is prescribed monthly injections of vitamin B12. When developing the teaching plan for the family, the nurse would focus on which type of anemia?
B) Pernicious anemia
What would be most appropriate to include in the plan of care for a child who has undergone surgery for removal of an astrocytoma?
B) Positioning the child on his unaffected side
The nurse is evaluating the laboratory test results of a 7-year-old child with a suspected hematologic disorder. Which finding would cause the nurse to be concerned?
B) RBC: 2.8 × 106/mm3
The nurse is caring for a child who reports chronic pain. What is the priority nursing assessment?
B) The pain's history, onset, intensity, duration, and location
The nurse is caring for a child who is experiencing pain related to chemotherapy treatment. What is a behavioral factor that might affect the child's pain experience?
C) Participation in normal routine activities
The nurse has applied EMLA cream as ordered. How does the nurse assess that the cream has achieved its purpose?
C) Lightly tap the area where the cream is.
The nurse is caring for a hospitalized, 1-week-old infant who appears very ill. Which assessment finding(s) will the nurse report to the health care provider? Select all that apply. A. Petchiae B. Heart rate100 beats/min C. Respiratory rate 60 breaths/min D. Axillary temperature 97.6°F (36.5°C) E. Characteristic of cry
A, B, C, D, E
When providing care to a child with aplastic anemia, which nursing diagnosis would be the priority?
A) Risk for injury
The mother of a 5-year-old girl brings the child to the clinic for an evaluation. The mother tells the nurse, "She seems to be so tired and irritable lately. And she looks so pale." Further assessment reveals pale conjunctiva and oral mucous membranes. The nurse suspects iron-deficiency anemia. Which additional finding would help provide additional evidence for this suspicion?
A) Spooned nails
The nurse is preparing to administer a topical anesthetic for a 10-year-old girl with a chin laceration. The nurse would expect to apply which medication as ordered in preparation for sutures?
A) TAC (tetracaine, epinephrine, cocaine)
A group of students is reviewing information about glucose-6-phosphate dehydrogenase (G6PD) deficiency. The students demonstrate understanding of the material what as the cause of the disorder?
A) X-linked recessive inheritance
The nurse is developing a plan of care for a child with thalassemia. What information would the nurse expect to include? Select all that apply. A) Packed RBC transfusions B) Deferoxamine therapy C) Heparin therapy D) Opioid analgesics E) Platelet transfusions F) Intravenous immunoglobulin
A, B
The nurse is researching behavioral-cognitive pain relief strategies to use on a 5-year-old child with unrelieved pain. Which methods might the nurse choose? Select all that apply. A) Relaxation B) Distraction C) Thought stopping D) Massage E) Sucking
A, B, C
The nurse is assessing a child with aplastic anemia. What would the nurse expect to assess? Select all that apply. A) Ecchymoses B) Tachycardia C) Guaiac-positive stool D) Epistaxis E) Severe pain F) Warm tender joints
A, B, C, D
The nurse is assessing a 8-month-old infant who has symptoms of poor feeding, a poor gag reflex, listlessness and a weak cry. What is the most important question the nurse should ask the parent about these symptoms?
A. "Have you given your infant any honey?"
The parents of a 5-year-old have just found out that their child has head lice. Which statement by the parents would support the nursing diagnosis of deficient knowledge?
A. "I can't believe it. We're not unclean, poor people."
A child is being treated for pertussis and is prescribed azithromycin by the health care provider. Which finding is most important for the nurse to report to the health care provider before administering this drug?
A. Child has had previous episodes of supraventricular tachycardia (SVT).
The nurse determines that it is necessary to implement airborne precautions for children with which infection?
A. Measles
After teaching a class on the role of white blood cells in infection, the instructor determines that the teaching was successful when the class identifies which type of white blood cells as important in combating bacterial infections?
A. Neutrophils
A mother brings her 8-year-old son for evaluation because of a rash on his lower leg. Which finding would support the suspicion that the child has Lyme disease?
A. Playing in the woods about a week ago
The nurse is performing a physical examination of an 8-year-old girl who was bitten by her kitten. Which assessment would lead the nurse to suspect cat-scratch disease?
A. Swollen lymph nodes
The nurse is caring for a 13-year-old girl with von Willebrand disease. After teaching the adolescent and her parents about this disorder and care, which response by the parents indicates a need for additional teaching?
C) "We should administer desmopressin as often as needed."
A 5-year-old girl is diagnosed with iron-deficiency anemia and is to receive iron supplements. The child has difficulty swallowing tablets, so a liquid formulation is prescribed. After teaching the parents about administering the iron supplement, which statement indicates the need for additional teaching?
C) "We will place the liquid in the front of her gums, just below her teeth."
A nurse is leading a discussion with a group of new mothers about newborn nutrition and its importance for growth and development. One of the mothers asks, "Doesn't the baby get iron from me before birth?" Which response by the nurse would be most appropriate?
B) "Because the baby grows rapidly during the first months, he uses up what you gave him."
The nurse is caring for a 12-year-old boy with idiopathic thrombocytopenia. The nurse is providing discharge instructions about home care and safety recommendations to the boy and his parents. Which response indicates a need for further teaching?
B) "He can resume participation in football in 2 weeks."
A child with suspected sickle cell disease is scheduled for a hemoglobin electrophoresis. When reviewing the child's history, what would the nurse identify as potentially interfering with the accuracy of the results?
B) Blood transfusion 1 month ago
The student nurse is learning about the effects of heat and cold when used in a pain management plan. What accurately describes one of these effects?
B) Cold alters capillary permeability.
A nurse is conducting a physical examination of a 5-year-old with suspected iron-deficiency anemia. How would the nurse evaluate for changes in neurologic functioning?
C) "Will you show me how you walk across the room?"
The nurse is assessing a 3-year-old boy whose parents brought him to the clinic when they noticed that the right side of his abdomen was swollen. What finding would suggest this child has a neuroblastoma?
B) The parents report that their son is vomiting and not eating well
A child is diagnosed with a helminthic infection. Which treatments would the nurse expect to be prescribed? Select all that apply. A. Erythromycin B. Albendazole C. Pyrantel pamoate D. Acyclovir E. Metronidazole F. Permethrin
B, C
RN is teaching the student nurse the physiology involved in pain transmission. Which statement describes a physiologic event in nervous system related to pain transmission? SATA A)Thermal stimulation may involve release of mediators (histamine/prostaglandins//bradykinin) B)Nociceptors are activated by noxious stimuli, stimuli are converted to electrical impulses that are relayed to the spinal cord & brain. C)Myelinated A-delta fibers are large fibers that conduct the impulse at very rapid rates; unmyelinated small C fibers transmit the impulse slowly. D)Once in dorsal horn of the spinal cord, nerve fibers divide and then cross to the opposite side & rise upward to thalamus. E)Point at which the person first feels the highest of the painful stimulus is =pain threshold. F)Peripheral sensitization allows nerve fibers to react to stimulus that is lower intensity than would be needed to cause pain.
B, C, D, F
A nurse is instituting neutropenic precautions for a child. What information would the nurse most likely include? Select all that apply. A) Placing the child in a semiprivate room B) Avoiding rectal exams, suppositories, and enemas C) Placing a mask on the child when outside the room D) Encouraging an intake of raw fruits and vegetables E) Discouraging fresh flowers in the child's room
B, C, E
After teaching a mother how to remove a tick from her 6-year-old boy's arm, the nurse determines that additional teaching is needed when the mother makes what statement?
B. "I'll grasp the tick and pull it away quickly."
A nursing instructor is teaching a group of students about the action of antipyretic agents in children. The instructor determines that the teaching has been successful when the students identify which action as the primary action?
B. Decrease the temperature set point
While hospitalized, a child develops scarlet fever. Isolation has been prescribed by the health care provider. The nurse would place this child in what type of isolation?
B. Droplet
A group of nursing students are reviewing the six links in the chain of infection and the nursing implications for each. The students demonstrate understanding of the information when they identify which precaution as helping to break the chain of infection to the susceptible host?
B. Maintaining skin integrity
A nurse is conducting a health history for a 1-month-old with an infectious disorder. Which segment of the maternal health history would be most helpful for the nurse when determining if the infant developed the infection from the mother?
B. Past medical history
A nurse is providing teaching to the mother of an adolescent girl about how to manage menstrual pain nonpharmacologically. Which statement by the mother indicates a need for further teaching?
C) "I need to follow these instructions exactly for them to work properly."
The nurse is teaching an 8-year-old child and his family how to manage cancer pain using nonpharmacologic methods. Which parent statement signifies successful child teaching?
C) "I will begin using the technique before he experiences pain."
The nurse is preparing a child for a lumbar puncture. How far ahead of the procedure should the nurse apply the EMLA cream?
C) 3 hours
The nurse is administering pain medication to a child with continuous pain from internal injuries. Which method would be ordered to dispense the medication?
C) Administer the medication around the clock at timed intervals.
The nurse is caring for a 5-year-old girl with a disseminated medulloblastoma. What intervention would be most appropriate for this situation?
C) Encouraging the family to cry and express feelings away from the child
The nurse is reviewing the white blood cell differential of a 4-year-old girl. Which value would lead the nurse to be concerned?
C) Eosinophils: 10%
The nurse is reviewing the laboratory test results of a child diagnosed with disseminated intravascular coagulation (DIC). What would the nurse interpret as indicative of this disorder?
C) Positive fibrin split products
A nurse is instructing a parent on how to obtain a stool culture for ova and parasites from a child with diarrhea. What would the nurse include in the teaching plan?
C. "Keep the specimen from coming into contact with any urine."
The nurse is providing education to the parents of a child diagnosed with pinworms. Which statement is most important for the nurse to include in the teaching?
C. "Make sure your child washes hands before eating."
The nurse is developing a teaching plan for the mother of a 4-year-old girl with cold and fever. What would the nurse include in this teaching plan?
C. Ensuring fluid intake to prevent dehydration
The nurse is caring for a neonate who is suspected of having sepsis. Which assessment findings would the nurse interpret as most indicative of sepsis?
C. Hypothermia
A child is diagnosed with scarlet fever. The nurse is reviewing the child's medical record, expecting which medication to be prescribed for this child?
C. Penicillin
The client has a heavily draining wound for which there is an order to change the dressing every 4 hours. The nurse becomes busy and does not change the dressing as ordered. Which link in the chain of infection has the nurse allowed to flourish?
C. Reservoir
The nurse is performing a physical examination on a 9-year-old boy who has experienced a tick bite on his lower leg and is suspected of having Lyme disease. Which assessment finding would the nurse expect to find?
C. Ring-like rash on lower leg
When reviewing infectious diseases in the pediatric population, nursing students identify which disease as a common childhood exanthema?
C. Rubella
A school-aged child with an infectious disease is placed on transmission-based precautions. If the child is not dehydrated or otherwise in distress, which nursing diagnosis would be the priority?
C. Social isolation related to infectivity and inability to go to the playroom
The mother of a 4-year-old boy has contacted the physician's office. She reports her son was exposed to someone with chickenpox. She has inquired about when her son may show if he has gotten the disease. What information should be provided?
C. The incubation period for the disease is between 10 and 21 days.
The nurse is caring for a child recently diagnosed with glucose-6-phosphate dehydrogenase (G6PD) deficiency. The nurse is teaching the parents about triggers that may result in oxidative stress. Which response indicates a need for further teaching? A) "I doubt he will ever eat fava beans, but they could trigger hemolysis." B) "He must avoid exposure to naphthalene, an agent found in mothballs." C) "He must never take methylene blue for a urinary tract infection."
D) "My son can never take penicillin for an infection."
The nurse is caring for a 2-year-old boy with hemophilia. His parents are upset by the possibility that he will become infected with hepatitis or HIV from the clotting factor replacement therapy. Which response by the nurse would be most appropriate?
D) "Since dry heat treatment of the factor began in 1986, there have been no reports of virus transmission."
. The nurse is providing instructions to a mother on how to use thought stopping to help her child deal with anxiety and fear associated with frequent painful injections. Which statement indicates the mother understands the technique?
D) "We'll repeat 'quick stick, feel better, go home soon' several times."
The nurse is conducting an assessment of a high school track athlete. The client tells the nurse he is experiencing pain along his outer thigh. He describes it as tight, achy, and tender, particularly after he runs. The nurse understands that he is most likely experiencing what kind of pain?
D) Deep somatic
Which test result would the nurse least likely expect to find in a child diagnosed with Wilms tumor?
D) Elevated homovanillic acid (HVA) with 24-hour urine collection
The nurse is caring for a child who has been admitted for a sickle cell crisis. What would the nurse do first to provide adequate pain management?
D) Initiate pain assessment with a standardized pain scale.
. Pentazocine is prescribed for a child with moderate pain. The nurse identifies this drug as an exterm-25ample of which type?
D) Mixed opioid agonist-antagonist
Which tool would be the least appropriate scale for the nurse to use when assessing a 4-year-old child's pain?
D) Numeric pain intensity scale
The nurse is conducting a pain assessment of a 10-year-old boy who has been taking acetaminophen for chronic knee pain. The assessment indicates that the recommended dose is no longer providing adequate relief. What is the appropriate nursing action?
D) Obtain an order for a different medication
The nurse is monitoring a child who has received epidural analgesia with morphine. The nurse is careful to monitor for which adverse effect of the medication?
D) Respiratory depression
The nurse is caring for a 16-year-old boy with acute myelogenous leukemia who is having chemotherapy and who has incomplete records for varicella zoster immunization. Which is the priority nursing diagnosis?
D) Risk for infection related to neutropenia and immunosuppression
.The nurse is using the acronym QUESTT to assess the pain of a child. Which is an accurate descriptor of this process?
D) Take the cause of pain into account when intervening.
The nurse uses the FLACC behavioral scale to assess a 6-year-old's level of postoperative pain and obtains a score of 9. The nurse interprets this to indicate that the child is experiencing:
D) severe pain.
The nurse is assessing the tympanic temperature of several children. The nurse documents that the child with which temperature reading has a fever?
D. 100.8° F (38.2° C)
After teaching the parents of a child with chickenpox (varicella zoster), the nurse determines that the parents have understood the teaching when they state that their child can return to school at which time?
D. After the lesions have crusted
The nurse is preparing a plan of care for a 5-year-old boy with chickenpox. Which nursing intervention should be questioned?
D. Provide alcohol baths as needed
The nurse is preparing to obtain a blood specimen via capillary heel puncture. Which action would be most appropriate for the nurse to do?
D. Wipe away the first drop of blood with dry gauze.
