N203-3
To avoid anaphylactic reactions in children, which question would be most important to ask a parent before administering penicillin to her infant? A) "What do you give her to alleviate itching?" B) "Has she ever had penicillin before?" C) "Do you have a telephone to call us immediately if she develops trouble breathing?" D) "Is there any family history of allergy to penicillin?"
"Has she ever had penicillin before? "Penicillin is a drug frequently involved in allergic reactions. The reaction occurs after the child has first been sensitized to the drug
The parent of a school-age child comments to the nurse, "Every time my child eats enchiladas at our local Mexican restaurant he gets a rash. It just doesn't make sense to me." How should the nurse respond?
"Has your child ever been tested for a peanut allergy?" Explanation: Enchilada sauce is an unexpected food that may contain a form of peanuts (such as peanut oil) that may be causing an allergic reaction in the child.
A nurse is providing dietary interventions for a 12-year-old with a shellfish allergy. Which response indicates a need for further teaching?
"He will likely outgrow this." Older children and adolescents with allergic reactions to fish, shellfish, and nuts usually continue to have that concern as a life-long problem
The nurse is providing a class for a group of childcare providers. When discussing allergic reactions, which statement by a participant indicates the need for further instruction? A) "Most allergic reactions will happen within a few minutes of eating a problematic food." B) "If a child has previously eaten a food and not had a reaction they are not 'truly' allergic to it. C) "Allergic reactions can happen hours after eating something." D) "In addition to hives some children may also have vomiting and diarrhea when having an allergic reaction to a food."
"If a child has previously eaten a food and not had a reaction they are not 'truly' allergic to it." Previous exposure with no incident does not mean an individual cannot develop a hypersensitivity to a food or other substance. An allergy may develop at any time. The remaining statements are correct.
The mother of a 5-year-old child with allergies to a variety of foods including eggs, milk, peanuts and shellfish, asks if her child will "always have these problems". What response by the nurse is most accurate? A) "Sadly, allergies to foods will persist." B) "Most children with allergies will outgrow them." C) "We cannot be sure at this point but most children who are allergic to peanuts will not have this allergy in adulthood." D) "In most cases allergies to peanuts and shellfish persist into adulthood but the others may diminish and disappear."
"In most cases allergies to peanuts and shellfish persist into adulthood but the others may diminish and disappear." Foods such as peanuts, milk, soy, shellfish, tree nuts are common allergens. By adulthood many allergies will diminish or disappear. Allergies to shellfish, peanuts and tree nuts often persist into adulthood.
The mother of a child with a possible food allergy asks the nurse for information about how to test for it. Which response by the nurse would be most appropriate?
"The best way is to eliminate the food from the diet and then look for improvement." Food allergies are best identified by eliminating a suspected food from the diet and observing whether symptoms improve. After a time of improvement, the food is reintroduced and if the child is allergic to the food, the symptoms will return. Skin testing with either a patch or intracutaneous injection is ineffective for determining food allergies. Serum antibody levels can be measured but are not specific in helping to determine food allergies.
The nurse is monitoring the CD4 count of an infant who has contracted HIV from the mother in utero. The nurse is concerned that treatment with antiretroviral therapy is not effective when noting which CD4 level? a. 1300/ mm3. b. 1500 /mm3 c. 2000/mm3 d. 1600/mm3
1300/mm3 The number of CD4 T lymphocytes in the blood helps to determine the effectiveness of antiretroviral therapy. Normal is 1500/mm3 in the infant, so anything below that number may indicate that the therapy is not effective.
An infant is diagnosed with a congenital cataract. What would the nurse expect to assess? A) Absent red reflex B) Rapid irregular eye movement C) Misalignment of the eyes D) Enlarged eye appearance
A Feedback: Assessment findings associated with congenital cataract include a history of lack of visual awareness; clouding of the cornea, which may or may not be visible; and no red reflex. Rapid irregular eye movement would suggest nystagmus. Misalignment of the eyes would suggest strabismus. Enlarged appearance of the eye is associated with infantile glaucoma.
A 6-year-old child has been diagnosed with growth hormone deficiency. The child's mother requests more information about this condition. Which statements should be included in the nurse's response? Select all that apply. A) "The majority of children who have this condition are born of normal weight and length." B) "There are several potential causes of this condition." C) "This condition is most likely related to dwarfism in past generations of your family." D) "Most children with this condition are nutritionally deprived." E) "Your child most likely does not eat adequate amounts of protein."
A) "The majority of children who have this condition are born of normal weight and length." B) "There are several potential causes of this condition." Feedback: Growth hormone deficiency can result from a variety of causes. These causes may include genetic mutations, tumors, infection and birth trauma. Some cases have not identifiable causes. Most children diagnosed with this condition are of normal length and weight at birth but in childhood fall behind in growth. A small proportion of children may have nutritional concerns.
A child with diabetes insipidus is being treated with vasopressin. The nurse would assess the child closely for signs and symptoms of which condition? A) Syndrome of inappropriate antidiuretic hormone (SIADH) B) Thyroid storm C) Cushing syndrome D) Vitamin D toxicity
A) Syndrome of inappropriate antidiuretic hormone (SIADH) Feedback: SIADH, although rare in children, is a potential complication of excessive administration of vasopressin. Thyroid storm may result from over administration of levothyroxine (thyroid hormone replacement). Cushing syndrome is associated with corticosteroid use. Vitamin D toxicity may result from the use of vitamin D as treatment of hypoparathyroidism.
A nurse is developing a plan of care for a child who is admitted to the hospital forsurgery. The child is visually impaired. What would be most appropriate for the nurse to include in the child's plan of care? Select all that apply. A) Explaining instructions using simple and specific terms the child understands B) Allowing the child to explore the postoperative equipment with his hands C) Touching the child on his shoulder before letting the child know someone is there D) Using the child's body parts to refer to the area where he may have postoperative pain E) Speaking to the child in a voice that is slightly louder than the usual tone of voice
A, B, D Feedback: When interacting with a visually impaired child, the nurse would make directions and instructions simple and specific, encourage exploration of objects such as postoperative equipment through touch, and use the parts of the child's body as reference points for the location of items or for this child, his postoperative pain. The nurse should identify him- or herself first before touching the child and speak in a tone of voice that is appropriate to the situation
The nurse is caring for a 3-month-old with nasolacrimal duct obstruction. Which intervention would be most appropriate for the nurse to implement? A) Being careful to prevent spread of infection B) Teaching the parents how to gently massage the duct C) Applying hot, moist compresses to the affected eye D) Referring the child to an ophthalmologist
ANS: B Feedback: Massaging the nasolacrimal duct can cause it to open and drain. Teaching the parents how to do this would be part of the nurse's plan of care. Nasolacrimal duct obstruction is not infectious. Applying hot, moist compresses to the eye is an intervention for conjunctivitis. Nasolacrimal duct obstruction is often self-resolving, so there would be no need for a specialist's care.
A school-aged child has a bee-sting allergy. When the child is stung by a bee during a school recess, assuming that all of the following interventions are covered by school protocol, which initial intervention by the school nurse would be most appropriate? a) Immediately transport the child to the local hospital. b) Administer epinephrine immediately. c) Apply a warm compress to the site of the bee sting. d) Notify the child's mother.
Administer epinephrine immediately. Epinephrine counteracts histamine release to decrease bronchospasm and difficulty breathing.
The nurse is discussing food allergies with parents of a young child. She explains that a very effective way to determine which foods a child may be allergic to is to implement: A) a food diary. B) Allergy skin testing. C) An elimination diet. D) A raw food diet.
An Elimination diet The food diary may identify foods the child does not tolerate well, but it lacks the objectivity of the elimination diet. Skin testing usually involves whole proteins and will not test for reactions to food breakdown products. A raw food diet does not apply to allergy identification.
The nurse is caring for a 10-year-old with allergic conjunctivitis. The nurse would be alert to the child's increased risk for what issue? A) Atopic dermatitis B) Insect bite sensitivity C) Acute otitis media D) Frequent sore throats
Ans: A Feedback: Atopic dermatitis is a risk factor specifically for allergic conjunctivitis because of repeated exposure to the particular allergens. Acute otitis media, insect bite sensitivity, and frequent sore throats can occur but are not related to the allergic conjunctivitis.
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 B)Strawberry tongue C)Infected tonsils D)Swollen neck
Ans: A Lymph nodes, especially under the arms, can become painful and swollen due to cat-scratch disease. Strawberry tongue is typical of scarlet fever. Infected tonsils and an edematous neck are symptoms of diphtheria.
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) "Unless my child develops a fever over 102.2°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."
Ans: A, C, D In infants older than 3 months of age, fever less than 39°C (102.2°F) usually does not require treatment by a physician. Antipyretics, such as acetaminophen, provide symptomatic relief but do not change the course of the infection. A fever can actually enhance various components of the immune response. Infants younger than 3 months of age with a rectal temperature greater than 38°C should be seen by a physician or nurse practitioner because of increased risk of sepsis.
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? A)Keeping linens dry and clean B)Maintaining skin integrity C)Washing hands frequently D)Coughing into a handkerchief
Ans: B Maintaining the integrity of the child's skin and mucous membranes is a precaution that will break the chain of infection at the susceptible host. Keeping linens dry and clean is a precaution to take at the reservoir link. Washing hands frequently breaks the chain at the mode of transmission. Coughing into a handkerchief is a precaution for the portal of exit.
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
Ans: B, C Drugs used to treat helminthic infections include albendazole and pyrantel pamoate. Erythromycin is used to treat bacterial infections. Acyclovir is used to treat viral infections. Metronidazole is used to treat trichomoniasis. Permethrin is used to treat pediculosis.
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? A)Rash on face B)Edematous neck C)Hypothermia D)Coughing
Ans: C Hypothermia is a sign of sepsis in neonates. A rash on the face is a symptom of scarlet fever. An edematous neck is a sign of diphtheria. Paroxysmal coughing is a symptom of pertussis.
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? A) Susceptible host B) Portal of exit C) Reservoir D) Mode of transmission
Ans: C The reservoir is the area where a pathogen grows and reproduces. Leaving the dressing unchanged allows for a dark, warm, nutrient rich, and moist environment where many organisms will thrive. A susceptible host is a person who cannot fight off an infection. The portal of exit is the way a pathogen exits the host. The mode of transmission is the way the pathogen travels.
The nurse is caring for a 6-year-old visually impaired boy and is about to begin thephysical examination. Which intervention would be most appropriate to promote effective communication with the child? A) Show him the stethoscope. B) Describe the examination room. C) Use his name before touching him. D) Allow him to explore the exam room.
Ans: C Feedback: When interacting with a visually impaired child, it is a good communication technique to use his name to gain his attention before touching him. Letting him listen to his heart with the stethoscope, describing the examination room, and promoting exploration by touch are sound ways to interact, but are not specific to communicating with the child at the beginning of the assessment.
While reviewing various studies about the use of antipyretics possibly prolonging illness, the nurse notes that there are benefits to their use for the child with fever. What would the nurse identify as the best explanation related to the benefit of antipyretics? A)They slow the growth of bacteria. B)They increase neutrophil production. C)They encourage T-cell proliferation. D)They help decrease fluid requirements.
Ans: D Antipyretics provide symptomatic relief by increasing comfort in the child and decreasing fluid requirements, which helps to prevent dehydration. Fever has been shown to slow the growth of bacteria, increase neutrophil production, and encourage T-cell proliferation.
The nurse is preparing a plan of care for a 5-year-old boy with chickenpox. Which nursing intervention should be questioned? A)Administer antipyretics as ordered. B)Keep the child's fingernails short. C)Monitor fluid intake and output. D)Provide alcohol baths as needed.
Ans: D Treatments such as sponging the child with alcohol or cold water are not appropriate interventions for fever management. Rather, the nurse would use tepid sponge baths and cool compresses. Administering antipyretics, keeping the child's fingernails short, and monitoring intake and output are appropriate.
What is an appropriate nursing intervention to provide comfort for a child itching from chickenpox? A. Encourage frequent warm baths. B. Give acetaminophen (Tylenol). C. Give diphenhydramine (Benadryl). D. Apply a thick coat of Caladryl lotion over open lesions.
Answer: C A. Cool baths are recommended for relief of itching.B. Acetaminophen (Tylenol) has no anti-itching effects.C. Antipruritic medicines such as diphenhydramine (Benadryl) are useful for severe itching, which interferes with sleep and may contribute to secondary infection.D. Caladryl lotion (contains Benadryl) should be applied sparingly over open lesions to minimize absorption.
The nurse is caring for a newborn and knows that his vision, unlike his hearing, is not fully developed. Which aspect of the child's vision would the nurse expect to be similar to his father's vision? A) Adequate color detection B) Visual acuity of 20/100 C) Nearsightedness D) Monocular vision
B Feedback: If the child's father has lost visual acuity, he and his new son could possibly have the same 20/100 vision. Poor color detection, nearsightedness, and monocular vision are characteristic of newborns and are the result of their lack of development.
The nurse is examining a 3-year-old boy with acute otitis media who has a mild earache and a temperature of 38.5C. Which action will be taken? A) Obtain a culture of middle ear fluid B) Instruct the parents to watch for worsening symptoms C) Administer antibiotics D) Administer antivirals
B Feedback: In this case, the child will be continually observed. If the symptoms persist or become worse, antibiotics will be prescribed. This clinical practice guideline was developed by the American Academy of Pediatrics and the American Academy of Family Physicians in order to avoid overusing antibiotics or obtaining a middle ear fluid culture with every occurrence of acute otitis media. Administering antiviral agents would not be appropriate for this child.
Assessment of a child leads the nurse to suspect viral conjunctivitis based on whatfinding? A) Mild pain B) Photophobia C) Itching D) Watery discharge
B Feedback: Viral conjunctivitis is characterized by lymphadenopathy, photophobia, and tearing. Mild pain is associated with bacterial conjunctivitis. Itching and watery discharge are associated with allergic conjunctivitis.
A 5-year-old child with type 1 diabetes is brought to the clinic by his mother for a follow-up visit after having his hemoglobin A1C level drawn. Which result would indicate to the nurse that the child is achieving long-term glucose control? A) 9.0% B) 8.2% C) 7.3% D) 6.9%
B) 8.2% Feedback: For a child 6 years of age and younger, the target HbA1C level should be less than 8.5% but greater than 7.5%. For children between the ages of 6 to 12 years, the target HbA1C level is less than 8%. For children and adolescents between 13 to 19 years of age, the target HbA1C level would be less than 7.5%.
The nurse is caring for an 8-year-old girl with an endocrine disorder involving the posterior pituitary gland. What care would the nurse expect to implement? A) Instructing the parents to report adverse reactions to the growth hormone treatment B) Teaching the parents how to administer the desmopressin acetate C) Informing the parents that treatment stops when puberty begins D) Educating the parents to report signs of acute adrenal crisis
B) Teaching the parents how to administer the desmopressin acetate Feedback: The nurse would teach the parents how to administer desmopressin acetate, which treats diabetes insipidus, a disorder related to the posterior pituitary gland. Instructing parents to report adverse reactions to growth hormone is an intervention for growth hormone deficiency. Informing the parents that treatment stops at the normal time of puberty is a teaching intervention for precocious puberty. Educating the parents to report signs of an acute adrenal crisis is an intervention for congenital adrenal hyperplasia. All three of these other disorders are related to the anterior pituitary.
A mother brings her child to the health care clinic because she thinks that the child hasconjunctivitis. Which assessment findings would lead the nurse to suspect bacterial conjunctivitis? Select all that apply. A) Itching of the eyes B) Inflamed conjunctiva C) Stringy discharge D) Photophobia E) Mild pain F) Tearing
B, E Feedback: Bacterial conjunctivitis is manifested by inflamed conjunctiva, a purulent or mucoid discharge, mild pain, and occasional eyelid edema. Itching and a stringy discharge suggest allergic conjunctivitis. Photophobia and tearing suggest viral conjunctivitis.
The nurse is examining a 7-year-old boy with blepharitis. What would the nurse least likely expect to assess? A) Redness B) Scaling C) Pain D) Edema
C Feedback: Blepharitis has symptoms of redness, scaling, and edema, but not pain. Pain is typically associated with hordeolum.
A child with persistent otitis media with effusion is to undergo insertion of pressure-equalizing tubes via a myringotomy. The child is to be discharged later that day. After teaching the parents about caring for their child after discharge, which statement indicates that the teaching was successful? A) "The tubes will stay in place for about a month and then fall out on their own." B) "His chances for ear infections now have dramatically decreased." C) "He should wear earplugs when swimming in a pool or a lake." D) "We should keep the ears protected with cotton balls for the first 24 hours."
C Feedback: When pressure-equalizing tubes are inserted, the surgeon may recommend avoiding water entry into the ears. Therefore, earplugs are suggested when the child is in the bathtub or swimming. When swimming in a lake, earplugs are especially important because lake water is contaminated with bacteria and entry of that water into the middle ear must be avoided. Typically, the tubes remain in place for at least several months and generally fall out on their own. Placement of pressure-equalizing tubes does not prevent middle ear infection. Other than earplugs for bathing and swimming, nothing else is placed in the child's ear
A child has been prescribed growth hormone. When collecting data from this patient, which report is of the greatest concern? A) "I sometimes have headaches." B) "I feel tired." C) "My hips often hurt." D) "I take this medication with food."
C) "My hips often hurt. "Feedback: Limping or complaints of hip pain are of concern. This may signal issues with the epiphysis and warrants further evaluation. Headaches and fatigue are not associated with medication. Taking this medication with food is not contraindicated.
The nurse is administering 10 units of NPH insulin to a child at 8 a.m. The nurse would expect this insulin to begin acting at which time? A) By 8:15 a.m. B) Between 8:30 and 9 a.m. C) Between 9 and 11 a.m. D) Around 12 noon
C) Between 9 and 11 a.m. Feedback: NPH insulin has an onset of action of 1 to 3 hours, so the drug would begin to act between 9 and 11 a.m. A rapid-acting insulin would begin to act by 8:15 a.m.; regular insulin would begin to act between 8:30 and 9 a.m. No type of insulin would begin acting around 12 noon.
The nurse suspects that a 4-year-old with type 1 diabetes is experiencing hypoglycemia based on what findings? Select all that apply. A) Blurred vision B) Dry, flushed skin C) Diaphoresis D) Slurred speech E) Fruity breath odor F) Tachycardia
C) Diaphoresis D) Slurred speech F) Tachycardia Feedback: Manifestations of hypoglycemia include behavioral changes, confusion, slurred speech, belligerence, diaphoresis, tremors, palpitation, and tachycardia. Blurred vision; dry, flushed skin; and fruity breath odor suggest hyperglycemia.
A child with growth hormone deficiency is receiving growth hormone. What result would the nurse interpret as indicating effectiveness of this therapy? A) Rapid weight gain B) Complaints of headaches C) Height increase of 4 inches D) Growth plate closure
C) Height increase of 4 inches Feedback: Effectiveness of growth hormone therapy is indicated by at least a 3- to 5-inch increase in linear growth in the first year of treatment. Rapid weight gain and headaches are adverse reactions of this therapy. The drug is stopped when the epiphyseal growth plates close.
The nurse is assessing a child who has had an open wound for the last 2 weeks with no signs of healing. The parents report they have been using over-the-counter antibiotic ointment with no signs of improvement. The child is active in football in the fall and the swim team in the winter. What disorder does the nurse suspect? A. impetigo B. staphylococcal scalded skin syndrome C. community acquired MRSA D. folliculitis
C. community acquired MRSA Risk factors for community-acquired MRSA (CA-MRSA) are turf burns, towel sharing, participation in team sports, or attendance at day care or outdoor camps. The condition usually presents with a moderate to severe skin infection or with an infection that is not responding as expected to therapy. Impetigo is a readily recognizable skin rash infection. Staphylococcal scalded skin syndrome results from infection with S. aureus that produces a toxin, which then causes exfoliation, and it has abrupt onset. Folliculitis is an infection of a hair follicle.
A nurse is examining a child who has sustained blunt trauma to the eye area. The nurse suspects a simple contusion based on what finding? A) Pain in the eye B) Impaired visual acuity C) Blurred vision D) Intact extraocular movements
D Feedback: A simple contusion of the eye area is manifested by bruising and edema of the lids or surrounding eye area, intact extraocular eye movement, intact visual acuity, absence of diplopia or blurred vision, pain surrounding the eye but not within the eye, and pupils that are equal, are round, and react to light and accommodation.
The nurse is instructing the parents of a school-age child with an eye disorder how tocare for her eye. Which condition would the nurse explain as resolving by itself without the use of antibiotics? A) Blepharitis B) Hordeolum C) Corneal abrasion D) Chalazion
D Feedback: Chalazion usually resolves spontaneously but may require surgical drainage. Therapeutic management of blepharitis, hordeolum, and corneal abrasion may require antibiotic ointment
A nurse develops a plan of care for a child that includes patching the eye. This plan ofcare would be most appropriate for which condition? A) Astigmatism B) Hyperopia C) Myopia D) Amblyopia
D Feedback: Eye patching is used for amblyopia or any condition that results in one eye being weaker than the other. Corrective lenses would be appropriate for astigmatism, hyperopia, and myopia.
The nurse is caring for a 3-year-old boy with amblyopia. Which intervention would be most appropriate to include in the child's plan of care? A) Rinsing the eye with cool water B) Educating the family about the disease C) Encouraging frequent hand washing D) Promoting eye safety
D Feedback: Promoting eye safety is extremely important for the child with amblyopia; if the better eye suffers a serious injury, both eyes may become blind. Rinsing the eye with cool water, educating the family about the disorder, and encouraging frequent hand washing are interventions for infectious conjunctivitis.
The mother of a child with a possible food allergy asks the nurse for information about how to test for it. Which response by the nurse would be most appropriate? A) "Skin testing using a patch is probably the easiest method." B) "We can inject an extract of the food under the skin and see if there is a reaction." C) "We can check the level of antibodies in the blood to confirm the allergy." D) "The best way is to eliminate the food from the diet and then look for improvement."
D) "The best way is to eliminate the food from the diet and then look for improvement." Food allergies are best identified by eliminating a suspected food from the diet and observing whether symptoms improve. After a time of improvement, the food is reintroduced and if the child is allergic to the food, the symptoms will return. Skin testing with either a patch or intracutaneous injection is ineffective for determining food allergies. Serum antibody levels can be measured but are not specific in helping to determine food allergies.
The nurse is caring for a 13-year-old girl with delayed puberty. Based on the nurse's knowledge of this condition, the nurse would include which nursing diagnosis in the child's plan of care? A) Disabled family coping related to the child's disorder B) Imbalanced nutrition, less than body requirements related to the child's short stature C) Noncompliance related to the need for lifelong hormone therapy D) Deficient knowledge related to the administration of estradiol
D) Deficient knowledge related to the administration of estradiol Feedback: Deficient knowledge related to the administration of estradiol is an appropriate nursing diagnosis for this child. There are oral, transdermal, topical, injectable, and vaginal preparations available. Disabled family coping due to the child's disorder and noncompliance due to long-term therapy are not likely diagnoses because of the simplicity and brevity of the treatment for this disorder. Imbalanced nutrition evidenced by short stature would be appropriate for a child with growth hormone deficiency
A group of students are reviewing information about the various types of insulin used to treat type 1 diabetes. The students demonstrate understanding of the information when they identify which of these insulins as having the longest duration? A) Lispro B) Regular C) NPH D) Glargine
D) Glargine Feedback: Of the insulins listed, glargine (Lantus) has the longest duration of action, that is, 12 to 24 hours. Lispro lasts approximately 3 to 5 hours; regular lasts 5 to 8 hours; and NPH lasts approximately 10 to 16 hours.
The nurse is obtaining a health history from parents whose 4-month-old boy has congenital hypothyroidism. What would the nurse most likely assess? A) The child has above-normal growth for his age. B) The child is active and playful. C) The skin is pink and healthy looking. D) It is difficult to keep the child awake.
D) It is difficult to keep the child awake. Feedback: The parents may state, during the health history, that it is difficult to keep the child awake. Physical examination would reveal that the child is below weight and height, that his skin is pale and mottled, and that he is lethargic and irritable.
The nurse is preparing to administer IVIG to a child who has not received the medication before. What medication should the nurse expect to administer prior to the infusion? A) Solu-Medrol B) Ibuprofen C) Diphenhydramine D) Ketorolac
Diphenhydramine Premedication with diphenhydramine or acetaminophen may be indicated in children who have never received IVIG, have not had an infusion in more than 8 weeks, have had a recent bacterial infection, have a history of serious infusion-related adverse reactions, or are diagnosed with agammaglobulinemia or hypogammaglobulinemia. Solu-Medrol, ibuprofen and Ketorolac would not routinely be administered prior to IVIG
The nurse on a pediatric unit finds a child having extreme shortness of breath, a swollen tongue, and urticaria on her face and neck. The nurse notices her lunch tray to have a half-eaten peanut butter and jelly sandwich. The client is allergic to peanuts. What is the first medication the nurse should be prepared to administer?
Epinephrine The child is demonstrating an anaphylactic reaction. While all of the medications may be necessary, the first medication to be administer is epinephrine to counteract the analphylaxis.
The nurse is administering intravenous immune globulin (IVIG). The nurse assesses vital signs and for adverse reactions every 15 minutes for the first hour of administration. After the first hour, the nurse most likely would continue to assess the child at which frequency? A) Every 30 minutes B) Every 45 minutes C) Every 60 minutes D) Every 2 hours
Every 30 minutes The nurse needs to continue assessments according to institutional protocol. Every 15 minutes for the first hour and every 30 minutes through the remainder of the infusion is the standard assessment.
The nurse is caring for a child who has undergone stem cell transplantation for severe combined immune deficiency. What finding would the nurse interpret as indicative of graft-versus-host disease? A) Presence of wheezing B) Splenomegaly C) Maculopapular rash D) Chronic or recurrent diarrhea
Maculopapular rash The nurse should monitor the stem cell transplant child closely for a maculopapular rash that usually starts on the palms and soles for indication that graft-versus-host disease is developing. Wheezing and recurrent diarrhea are not typical clinical manifestations of graft-versus-host disease. Splenomegaly is associated with hypogammaglobulinemia.
A nurse is assessing a child who may have a latex allergy. The nurse asks the child about allergic reactions to certain foods. Which foods if identified by the child as experiencing an allergic reaction would help support the suspected latex allergy? Select all answers that apply. A) Peaches B) Plums C) Carrots D) Tomatoes E) Apples F) Lettuce
Peaches Plums Carrots Tomatoes Foods with a known cross-sensitivity to latex include pear, peach, passion fruit, plum, pineapple, kiwi, fig, grape, cherry, melon, nectarine, papaya, apple, apricot, banana, chestnut, carrot, celery, avocado, tomato, or potato. Apples and lettuce are not associated with a cross-sensitivity.
What would best identify foods to which a child is allergic? A) Hyposensitivity testing in the arm B) Thoughtful elimination of diet choices C) Corticosteroid challenge testing D) Complete dietary protein restriction
Thoughtful elimination of diet choices Elimination diets involve adding foods slowly to a child's diet so foods to which the child is allergic can be identified. Hypersensitivity, not hyposensitivity, testing is used to assess reactions to certain potential allergens. No need to restrict protein. Corticosteroid challenge testing is used to assess adrenal functioning.
A child with primary immune deficiency is about to receive an infusion of IVIG. What is the most appropriate premedication to minimize the reaction? a. Diphenhydramine b. Nonsteroidals c. Steroids
a. Diphenhydramine Diphenhydramine and acetaminophen are the most commonly used medications for this purpose. Nonsteroidals and steroids typically are not used for this indication.
The nurse is preparing to administer the child's dose of intravenous immune globulin (IVIG). Which actions should the nurse take? Select all that apply. a. Take baseline vital signs and monitor the vital signs during the infusion b. Prepare to give acetaminophen to the child c. Prepare to give diphenhydramine to the child d. Prepare to give IVIG intramuscularly
a. Take baseline vital signs and monitor the vital signs during the infusion b. Prepare to give acetaminophen to the child c. Prepare to give diphenhydramine to the child IVIG should be given only intravenously and should not be given as an intramuscular injection. IVIG cannot be mixed with other medications. The nurse should closely monitor the child's vital signs during the infusion of the IVIG. The child may require an antipyretic and/or an antihistamine during infusion to help with fever and chills.
The parents of an adolescent tell the nurse, "Our child seems to have allergy symptoms every time we visit our favorite cafe. I don't understand since the only allergy indicated in the testing was to eggs?" How should the nurse respond? a. "Maybe the allergy testing didn't evaluate everything your child is allergic to." b. "Does your child get a whipped cream or foam topping on their favorite drink?" c. "That doesn't really make any sense if your child is only allergic to eggs." d. "Maybe coffee drinks just don't agree with your child's system."
b. "Does your child get a whipped cream or foam topping on their favorite drink?" Albumin, globulin, ovalbumin should be avoided if allergic to eggs. Some foam toppings for drinks contain these substances and would cause an allergic reaction to the person allergic to eggs. This would be important information to ascertain from the family as they would likely not be aware of this.
The nurse is caring for a child presenting with eye inflammation, knee pain, poor appetite and poor weight gain. The nurse is aware that this is which type of juvenile idiopathic arthritis? a. polyarticular b. pauciarticular c. systemic d. rheumatic
b. Pauciarticular (oligoarticular) Pauciarticular or (oligoarticular) arthritis symptoms include involvement of four or fewer joints; quite often the knee is involved, eye inflammation, malaise, poor appetite, poor weight gain. Polyarticular involves five or more joints; frequently involves small joints and often affects the body symmetrically. Systemic includes joint involvement, fever and rash may be present at diagnosis. Rheumatic arthritis typically involves small joints.
The nurse is preparing to administer IVIG to a child who has not received the medication before. What medication should the nurse expect to administer prior to the infusion? a. Aspirin b. ibuprofen c. prednisone d. diphenhydramine
d. Diphenhydramine Premedication with diphenhydramine or acetaminophen may be indicated in children who have never received IVIG, have not had an infusion in more than 8 weeks, have had a recent bacterial infection, have a history of serious infusion-related adverse reactions, or are diagnosed with agammaglobulinemia or hypogammaglobulinemia. Aspirin, ibuprofen and prednisone would not routinely be administered prior to IVIG.
The nurse is planning to administer IVIG to a child for the first time. What actions related to this therapy are indicated?
• After mixing, roll the vial of medication. • Store the vial in the refrigerator until use. • Promote hydration prior to administration. • Medicate with acetaminophen prior to administration. IVIG must be reconstituted. After the diluent is added to the powder, gently roll the vial between your hands to mix. Shaking will damage the medication. Reconstituted IVIG may be refrigerated overnight but should be brought to room temperature prior to infusion. Premedication with acetaminophen may be indicated in children who have never received IVIG. The child should be well hydrated prior to the administration. Adverse reactions should be monitored for within 15 minutes of the initiation of the infusion
