Passpoint: exam #2

Parents bring their infant to the clinic, seeking treatment for vomiting and diarrhea that has lasted for 2 days. On assessment, the nurse detects dry mucous membranes and lethargy. What other finding suggests a fluid volume deficit? sunken fontanel decreased pulse rate low urine specific gravity increased blood pressure

sunken fontanel

An infant weighing 10 kg is receiving IV fluid replacement. The nurse should suspect that the infant is receiving too little IV fluid replacement when the child exhibits which clinical manifestation? increasing irritability an increase in blood pressure over the past 3 hours urine output of 26 mL for the past hour urine specific gravity of 1.033

urine specific gravity of 1.033 Normal specific gravity for a child should range from 1.002 to 1.030. Thus, a urine specific gravity of 1.033 is increased, suggesting too little fluid replacement.

An initial bolus of crystalloid fluid replacement for a child in shock is 20 ml/kg. The nurse is preparing to administer how many milliliters of fluid for a child weighing 30 kg? 300 mL 900 mL 700 mL 600 mL

600 mL

A nurse is helping a pregnant caregiver devise a plan to help her 2-year-old child adjust to the birth of her second child. Which statement by the client indicates more instruction is needed? "I'll give my child a doll so the child can imitate us when we care for the new baby." "I'll discuss with my child what routines will be the same and what will be different after the baby arrives." "I'll tell my child that the new baby can be a playmate when the baby arrives." "I'll enroll my child in a sibling class.``

"I'll tell my child that the new baby can be a playmate when the baby arrives."

When teaching a caregiver of a 17-month-old about toilet training, which instruction would initially be most appropriate? Place the toddler on the potty chair every 2 hours for 10 minutes. Offer a reward every time the toddler has a bowel movement in the potty chair. Remove the diaper and use training pants to begin the process. Be sure the toddler is ready before starting to toilet train.

Be sure the toddler is ready before starting to toilet train.

An adolescent presents with a large round ring with a swollen border on the left arm. The adolescent often plays ball games in a field behind the school. What condition does the nurse suspect? Lyme disease impetigo actinic keratosis cellulitis

Lyme disease

A 6-month-old infant is brought to the clinic. The mother reports the infant has been lethargic and not eating well. The infant's anterior fontanel is sunken. Which additional information is a priority for the nurse to assess? Number of hours infant has slept in the last 24 hours Number of wet diapers the in the last 24 hours Skin color and cap refill Number of feeds in the last 24 hours

Number of wet diapers the in the last 24 hours

What should be a priority for a 6-year-old child admitted with third-degree burns? Start an IV line. Administer prescribed antibiotics orally. Obtain baseline laboratory studies. Insert an indwelling urinary (Foley) catheter.

Start an IV line. The child will need fluid replacement therapy as soon as possible, primarily due to the shift of plasma from intravascular to interstitial spaces at burn sites. Blisters and edema resulting from this process lead to fluid and electrolyte loss

A nurse discussing injury prevention with a group of workers at a daycare center is focusing on toddlers. When discussing this age-group, the nurse should stress that toddlers will always chase a ball that rolls into the street. accidents are the leading cause of death among toddlers. toddlers can distinguish right from wrong. the risk for homicide is highest among toddlers.

accidents are the leading cause of death among toddlers.

A nurse is caring for a client who has just been immunized. When teaching the client's caregivers about potential adverse effects, the nurse should instruct the caregivers to immediately report pain at the injection site. local swelling at the injection site. mild temperature elevation. generalized urticaria.

generalized urticaria.

A parent asks the nurse if the lesions around her child's mouth could be impetigo. What manifestations would verify the parent's suspicion? macular erythema with a sandpaper-like texture of the skin honey-colored crusts, vesicles, and reddish maculae on the skin increased warmth, intense redness, swelling, and firmness of the skin erythema and formation of pus around hair follicles

honey-colored crusts, vesicles, and reddish maculae on the skin Rational: Impetigo presents as reddish macules that turn to vesicles, which then erupt and form honey-colored crusts. The lesions can be in any stage.Redness and formation of pus around follicles describes folliculitis.Cellulitis is described as being warm, intensely red, edematous, and firm.Macular eruption with a sandpaper-like texture describes staphylococcal scalded skin syndrome.

Which urine output indicates that a 5-month-old weighing 15 lb (6.8 kg) and being treated for dehydration has a normal urine output? 10 to 12 mL/kg per hour 6 to 8 mL/kg per hour 1 to 2 mL/kg per hour 3 to 5 mL/kg per hour

1 to 2 mL/kg per hour

A child underwent a tonsillectomy 4 hours ago. Which assessment finding should make the nurse suspect postoperative hemorrhage? frequent swallowing decreased heart rate vomiting of dark brown emesis refusal to drink clear fluids

frequent swallowing

A 2 1/2-year-old child and his 2-month-old sibling are brought to the clinic by their father, who explains that the older child says "no" whenever asked to do something. The nurse should explain that the negativism demonstrated by toddlers is frequently an expression of which characteristic? separation anxiety pursuit of autonomy need to expend excess energy sibling rivalry

pursuit of autonomy

A toddler is brought to the emergency department after ingesting an undetermined amount of drain cleaner. The nurse should expect to assist with which intervention first? inserting an indwelling urinary catheter administering an emetic securing the airway performing gastric lavage

securing the airway

The mother of a toddler asks the nurse what she should do with her toddler when he has a temper tantrum. Which suggestion would be most appropriate? Leave the toddler alone during the tantrum as long as he is safe. Punish the toddler for having a temper tantrum. Try to talk the toddler out of the tantrum. Move the toddler to a time-out chair.

Leave the toddler alone during the tantrum as long as he is safe Rational: Toddlers have temper tantrums in their attempt to develop autonomy. Toddlers should be left alone as long as they are safe during a tantrum. Moving the child to a time-out chair or punishing the child reinforces the behavior and is to be avoided. Attempting to talk to the toddler also reinforces the behavior. Additionally, at this cognitive level, toddlers do not understand as well as older children do.

The triage nurse in the emergency department must prioritize the care of children waiting to be seen. Which child is in the greatest need of emergency medical treatment? a 6-year-old with a fever of 104° F (40° C), a muffled voice, no spontaneous cough, and drooling a 13-year-old with a fever of 104° F (40° C), chills, and a cough with thick yellow secretions a 4-year-old with a fever of 101° F (38.3° C), a hoarse cough, inspiratory stridor, and restlessness a 3-year-old with a fever of 100° F (37.8° C), a barky cough, and mild intercostal retractions

a 6-year-old with a fever of 104° F (40° C), a muffled voice, no spontaneous cough, and drooling

When teaching the mother of a toddler diagnosed with lead poisoning, what should the nurse include as the most serious complication if the condition goes untreated? neurologic deficits cirrhosis of the liver stunted growth rate heart failure

neurologic deficits

When caring for a toddler with epiglottitis, the nurse should first: administer I.V. fluids. examine the client's throat. place a tracheotomy tray at the bedside. administer antibiotics.

place a tracheotomy tray at the bedside.

An emergency department nurse is caring for a child diagnosed with moderately severe croup. The nebulizer treatment of choice for a child with moderate to severe croup is: epinephrine. ipratropium bromide. budesonide. albuterol.

epinephrine Rational: Nebulized epinephrine is an adrenergic that reduces inflammation and edema of the tissue surrounding the trachea in a client with croup. Albuterol, metaproterenol, and other beta2-adrenergic drugs are used to treat asthma. Ipratropium is an anticholinergic used to treat severe asthma. Budesonide is a corticosteroid inhaler that is recommended for children with mild to moderate croup. However, in moderate to severe croup, it is preferred that the corticosteroid is given orally.

When assessing a family suspected of abusing its 4-year-old child, which behavior is the most important criterion that would suggest abuse? attempts by the child to defend or verify what the parent states incompatibility between the history (mechanism) and the injury responsibility taken by the child for the act a complaint other than the one associated with the signs of abuse

incompatibility between the history (mechanism) and the injury

The nurse advises a mother with a 2-year-old child to avoid encouraging excessive milk consumption by the toddler because excess milk consumption can lead to which problem? folate deficiency vitamin C deficiency iron deficiency biotin deficiency

iron deficiency

A client in the emergency department is diagnosed with a communicable disease. When complications of the disease are discovered, the client is admitted to the hospital and placed in respiratory isolation. Which infection warrants airborne isolation? mumps cholera impetigo measles

measles

A toddler is admitted to the facility for treatment of a severe respiratory infection. The child's recent history includes fatty stools and failure to gain weight steadily. The physician diagnoses cystic fibrosis. By the time of the child's discharge, the child's parents must be able to perform which task independently? allergy-proofing the home maintaining the child in an oxygen tent maintaining the child on a fat-free diet performing postural drainage

performing postural drainage Rational: The child with cystic fibrosis is at risk for frequent respiratory infections secondary to increased viscosity of mucus gland secretions. To help prevent respiratory infections, caregivers must perform postural drainage several times daily to loosen and drain secretions. Because exocrine gland dysfunction, not an allergic response, causes bronchial obstruction in cystic fibrosis, allergy-proofing the home isn't necessary. Oxygen therapy may be indicated, but only during acute disease episodes. Also, such therapy must be supervised closely; home oxygen therapy is inappropriate because chronic hypoxemia poses the risk of oxygen toxicity. If steatorrhea can't be controlled, the child should reduce, but not eliminate, dietary fat intake.