Pediatric Ch. 4

On World Hygiene Day the nurse is conducting a health screening in a school. The nurse finds that a student is untidy and has dirt under the nails. What instruction does the nurse give to the child?

"A person can lead a healthier life by maintaining good hygiene."

The nurse is assessing a school-aged child who complains of pain in the stomach. Which question helps the nurse to identify the severity of the pain?

"Does the pain prevent you from sleeping?"

The nurse is interviewing the mother of a 9-year-old boy. Which question is the most appropriate as the nurse begins to assess the child's school performance?

"How is he doing in school?"

During a class excursion, one of the students with a history of lactose intolerance develops manifestations of an allergic reaction after drinking a milkshake. The teacher calls a nurse on a telephone and tells about the student's condition. What is the nurse's priority instruction for the teacher?

"I will notify the child's primary health care provider."

While assessing a child the nurse finds that the child has glossy and pink conjunctiva. What does the nurse report about the patient's condition to the primary health care provider?

"The child has adequate nutrition."

The nurse is interacting with a mother of a neonate while assessing the health of the neonate. The neonate's mother looks tired and does not effectively interact with the Which response does the nurse make for effective interaction?

"You are handling the baby very well."

What is the most common method of assessing dietary intake in children?

24-hour recall

What intervention can the nurse implement to help involve a younger child in the physical examination process?

Allow the child to handle or hold the equipment.

What explains the importance of detecting strabismus in young children?

Amblyopia, a type of blindness, may result.

How can the nurse avoid stimulating the cremasteric reflex when palpating a 2-year-old boy for the presence of testes?

Asking the boy to sit in the tailor position

What are some atraumatic ways in which nurses can encourage deep breathing in children? Select all that apply.

Asking the child to "blow out" the light on an otoscope or pocket flashlight Placing a small tissue on the top of a pencil and asking the child to blow off the tissue Placing a cotton ball in the child's palm, asking the child to blow the ball into the air, and having the parent catch it

What is the most appropriate method for a nurse to use to view the tonsils and oropharynx of a 6-year-old child?

Asking the child to open the mouth wide and say "Ah"

At what age should the nurse expect the anterior fontanel to fuse?

Between 12 and 18 months

What is an important part of establishing therapeutic communication with adolescents?

Building a foundation for a trusting relationship

The nurse is providing teaching to the family of a young child. What are some signs of information overload? Select all that apply.

Constant fidgeting Long periods of silence Attempting to change the topic of discussion

The nurse is performing a physical assessment of a l-year-old infant. What is the recommended method for assessing this infant's heart rate?

Counting the apical impulse for a full minute

A 5-year-old boy is having a checkup before starting kindergarten. What test does the nurse use to assess his cerebellar function?

Finger-to-nose test

What are some signs of information overload in a patient or family member?

Frequently looking at the clock

When a measuring device for assessing a young child's height is not available, how should the nurse accurately measure the length of an 18-month-old child?

Have the child lie on a paper-covered surface, mark the paper at the points for the top of the head and the heels, then measure between these points.

While working a night shift, the nurse learns that no translator is available in the hospital. What can the nurse do to ensure correct translations when using children as translators?

Interrupting the parent and asking the child to translate every few sentences

The nurse needs to take the blood pressure of a small child. One of the available cuffs is too large, and the other is too small. What is the best nursing action?

Locate the proper size of cuff before taking the blood pressure.

What would the nurse expect when assessing a preschooler's chest?

Movement of the chest wall to be symmetric bilaterally and coordinated with breathing

A nurse notes during physical assessment that the infant's chest anteroposterior diameter equals the transverse diameter. How should this finding be interpreted by the nurse?

Normal

After performing a clinical assessment of a patient's nutritional status, the nurse concludes that the patient has adequate nutritional intake. Which findings support the nurse's conclusion? Select all that apply.

Presence of tongue with rough texture Presence of uniform, smooth, intact teeth Presence of cylindric and prominent abdomen

How should the nurse position the pinna to visualize the eardrum of a 4-year-old child?

Pull pinna up and back.

While performing an assessment of children in an orphanage, the nurse diagnoses that a child has manifestations of excessive niacin. Which finding does the nurse identify in the child?

Seborrheic dermatitis

A nurse is obtaining a health history of an adolescent patient. What are the components of the health history? Select all that apply.

Sexual history Review of systems Family medical history

What creative communication technique involves using the language of children to probe areas of their thinking while bypassing conscious inhibitions or fears?

Storytėlling

While assessing a child, the nurse finds that the child's hair is stringy, dry, and depigmented. What does the nurse conclude from this finding?

The child has poor nutrition.

The nurse is assessing skin turgor in a child. The nurse grasps the skin of the abdomen between the thumb and index finger, pulls it taut, and quickly releases it. The tissue remains suspended, or tented, for a few seconds and then slowly falls back on the abdomen. The nurse, drawing on knowledge of the assessment of skin turgor, interprets this finding to indicate what?

The child has poor skin turgor.

The nurse is assessing a 3-year-old African American child who is being seen in the clinic for the first time. The child's height and weight are in the 20th percentile on the commonly used growth chart from the National Center for Health Statistics. When interpreting the data, what does the nurse recognize?

The child's growth is within normal limits.

What is the most appropriate way for the nurse to ensure correct measurement of the brachial artery blood pressure?

The cuff bladder width should be 40% of the circumference of the upper arm.

The nurse manager observes that a nurse is teaching a child's parents about the dietary requirements for managing protein energy malnutrition (PEM). After the teaching the nurse manager says to the nurse, "It looked to me like the child's parents were feeling overwhelmed with your teaching." Which signs did the nurse manager observe in the child's parents to support this onclusion? Select all that apply.

They were silent for a long period of time. They looked at the clock frequently. Their facial expressions were fixed.

What tests are used to assess visual acuity in children ages 3 to 5 years? Select all that apply.

Tumbling E Snellen letters Snellen numbers

Parents of a school-age child with rheumatoid arthritis inform the nurse, "My child has stopped interacting with others, refrains from eating, and is unable to sleep because of the pain." What would be the best nursing intervention to determine the severity of the child's pain?

Use the FACES pain scale.

During assessment of a 2-year-old child with breathing problems, the nurse asks for the birth history of the child. The parent asks, "How will pregnancy and birth affect the child's present condition?" What is the best response by the nurse?

"Prenatal influences have effects on the child's development."

Which statement is true concerning the increased use of telephone triage by nurses?

Access to high-quality health care services has increased with telephone triage.

What factors have encouraged the increased use of telephone triage by nurses? Select all that apply.

Access to high-quality health care services has increased. Empowered parents are participating in their children's medical care.

The nurse is ready to begin the physical examination of an 8-month-old infant. The child is sitting contentedly on the mother's lap, chewing on a toy. What should the nurse do first?

Auscultate the heart and lungs.

What nursing care guidelines should the nurse implement when communicating with children? Select all that apply.

Avoid extended eye contact and other threatening gestures. Communicate through transitional objects such dolls and puppets.

What is the term used to describe the reason for the child's visit to the clinic or hospital?

Chief complaint

What is the appropriate direction in which to pull the pinna of an infant during an otoscopic examination?

Down and back

What is included in guidelines for a nurse using an interpreter in developing a care plan for an 8-year-old child admitted to rule out epilepsy?

Explaining to the interpreter what information must be obtained from the patient and family

The nurse intern is performing an assessment of a child with attention deficit hyperactivity disorder (ADHD). The nurse intern reports to a nurse practitioner that the child is not effectively participating and is moving all around the room during the assessment. What suggestion does the nurse practitioner give to the nurse intern? Select all that apply.

Gently restrain the child for a few minutes. Complete the assessment as quickly as possible. Conduct the assessment in the presence of the child's parents.

Superficial palpation of the abdomen is often perceived by the child as tickling. Which measure by the nurse is most likely to minimize this sensation and promote relaxation?

Having the child "help" with palpation by placing his or her hand over the palpating hand

When taking a child's blood pressure the nurse should understand that the most important factor in accurately measuring blood pressure is which of the following?

How choosing the appropriate cuff size most accurately reflects radial arterial pressure

The nurse is taking a health history of child. At the beginning of the interview one of the parents says, "She was born 6 weeks premature." In what section of the health history should this information be recorded?

Past history

The nurse is performing a clinical assessment of nutritional status for a group of patients and documents the assessment findings. Which patient's findings indicate excess manganese levels in the blood?

Patient 4

The nurse manager instructs the staff to arrange the assessment room in a new pediatric ward. Which appropriate instruction does the nurse manager give to the staff?

Place toys and dolls in the room.

During a physical assessment the nurse notes that the child's height and weight are below the 5th percentile and that the child has pale skin; stringy, dull, dry, thin hair; and a flat abdomen. The child also exhibits generalized muscle wasting. The parent reports not having enough money to buy groceries several times a month. In light of these clinical findings, of what does the nurse suspect the child has a deficiency?

Protein

The nurse is assessing the cornea and the pupils of a child. Which findings indicate that the pupils are normal? Select all that apply.

Pupils constrict when light approaches. Pupils appear to be round, clear, and equal. Pupils constrict if a bright object moves near the face.

Which statement correctly explains why it can be difficult to assess a child's dietary intake?

Recall of children's food consumption is frequently unreliable.

What should nurses recognize as appropriate actions when they are communicating with families through an interpreter? Select all that apply.

Refraining from interrupting family members and the interpreter while they are conversing Being aware that cultural differences may exist with regard to views on sex, marriage, and pregnancy Explaining to the interpreter the reason for the interview and listing the types of questions that will be asked

What is the most common test of visual acuity in children beyond infancy?

Snellen letter chart

The nurse is teaching about techniques for maintaining good oral hygiene to children at a primary health care center. The nurse asks the children to describe a picture in which a child eats lot of chocolates and develops cavities. Which technique does this indicate?

Storytelling

A nurse needs to assess a young child's blood pressure. What is a the developmentally appropriate way for the nurse to prepare child for the procedure?

Telling the child, "Squeezing the bulb pushes air into the cuff and makes the silver in the tube go up."

While performing a mental health assessment of a child, the nurse asks the child to draw their family picture on a piece of paper. The nurse notices that the child has drawn a small picture of the parents with large limbs at one corner of the page with broken wavering lines. What does the nurse infer from the child's drawing? Select all that apply.

The child is aggressive. The child has feelings of insecurity.

The primary health care provider instructed the nurse to give anticipatory guidance to an infant's parents. What anticipatory guidance does the nurse provide to the parents to prevent anxiety while taking care of the infant? Select all that apply.

The nurse advises the infant's parents about the identified needs. The nurse informs the infant's parents about support groups. The nurse motivates the parents to provide competent and effective care.

While visiting the home of a patient, a nurse interacts with the child's parents to assess the physical and mental health of the child. Which interviewing strategy does the nurse implement during the assessment?

The nurse asks the name of each family member and interacts with them.

The nurse is performing an assessment of a neonate. Which body site does the nurse choose to safely and accurately obtain a neonate's temperature?

The nurse places the tip of the thermometer in the axilla.

The nurse is performing an assessment of the mental and physical health of a child at a community health center. The nurse finds that the child is very shy and avoids interacting with the nurse. Which action does the nurse follow for effective interaction with the child during the assessment?

The nurse prefers to use short sentences while,interacting with the child.

The nurse is caring for an adolescent patient with measles. Which action does the nurse follow for effective communication while interacting with the patient?

The nùrse remains silent and just listens to the patient.

The nurse is interviewing the parent of a 6-year-old child who has a behavior problem. The parent says, "Of course there is nothing to worry about. It is just once in a while that I see that the child's bed is wet in the morning. It will wear off with age." What can be concluded from the parent's communication?

The parent is actually anxious about the child.

The nurse is caring for a preschooler, and the mother asks the nurse how many calories the child should consume each day. What is the best response to this mother's question?

The quality of food consumed by the child is more important than the quantity.

What questions could the nurse ask to assess the quality of a child's current dietary intake? Select all that apply.

What are your child's favorite snacking foods? Does your child eat breakfast, lunch, and dinner daily?