Pediatric Final Exam

Which of the following behaviors serves as an example of the nurse directly upholding the ANA Code of Ethics for Nurses?

The nursing union develops a safe patient-to-nurse ratio.

The nurse is conducting a health assessment on a 10-year-old boy from an Asian culture who has bruises on his arms and back. The bruises appear similar in size and shape. The nurse is familiar with Asian culture but should evaluate the patient by asking which questions? Select all that apply.

"Have you fallen or injured yourself recently?" "What does your family do to heal illness?" "Has anyone hit you or otherwise hurt you?"

The nurse is assessing a pediatric patient in the emergency room for injuries sustained from a fall. The nurse asks the parents how the child was injured. Which response by the parent uses the most productive communication pattern?

"I forgot to check the baby gate when I came home"

The nurse is assessing an adolescent patient in the emergency department after she was attacked at a party. The patient refuses to give her parent's contact information and states, "They will kill me when they find out that I went to the party." What is the nurse's best response?

"I need to contact the social worker, as we have a duty to report this attack to your family and the authorities""

The nurse is attempting to collect information from the parents of a critically ill child brought to the emergency department. The parents are from a different country, and English is their second language. The child's father suddenly shouts, "I cannot talk with you, care for my child now!" Which response by the nurse is correct?

"I will get an interpreter to help us understand each other."

The nurse is assessing an adolescent patient in the emergency department with a suspected intentional overdose. After given treatment, the patient refuses to give her parent's contact information and states, "It is none of their business." What is the nurse's best response?

"I'm sorry, but I'm obligated to tell them. Let me help you develop a plan for their possible responses."

The nurse at a family clinic is providing care to an adolescent patient diagnosed with diabetes. The patient has verbalized discomfort with the feelings of isolation when unable to drink alcohol with their friends. Which of the following would be the most appropriate response to this statement?

"It is understandable that you want to be included, but perhaps we can work out a plan on how to avoid those situations"

The emergency department nurse is providing care to a 3-year-old child who has suffered a major accident. The parents ask the nurse, "Is our child going to be okay?" What is the most effective communication response at this time?

"Your child has suffered a major injury; let me give you some privacy. May I call the chaplain just to be with you?"

The nurse is presenting information to pregnant couples about the "safe to sleep" campaign to prevent SIDS. One attendee states, "Babies sleep best on their bellies. What difference does position make?" Which answer by the nurse is best?

"Positioning on the back opens the airway fully"

A nurse is providing care to an adolescent patient. Which statement by the nurse is most likely to enhance communication with the patient?

"What concerns do you have about your health?"

The nurse in a pediatric clinic is concerned about health-care disparities among the patient population. Which patient or family comment indicates the presence of health disparities related to culture? Select all that apply.

1. "I didn't bring my child sooner because I have a limited income." 2. "I tried all the remedies my mother used, but he just got sicker." 5. "We took a bus and transferred twice to get our sick child here."

The pediatric nurse is providing care for a terminally ill patient who is 17 years of age. The patient has been resistant to aggressive chemotherapy because of undesirable side effects. The patient states, "I have finally convinced my parents to sign a DNR order. It is my life, and I should be able to decide how I want to live." Which legal consideration causes the nurse greatest concern?

A DNR order can be reversed at any time by the legal guardians

The nurse is providing care to two children on a pediatric unit. One child is diagnosed with iron- deficiency anemia, and the other has sickle cell disease. Which manifestation does the nurse recognize as being different between the two children?

A child with sickle cell disease experiences varying amounts of joint pain

The nurse is providing information to the parents of a toddler who is scheduled for surgery for the replacement of the pulmonic valve. The parents have many questions about the function of the valve. Which information from the nurse is correct?

A defect in the valve causes less blood to get to the lungs for oxygenation

The nurse learns that a 16-year-old patient has not received the human papilloma virus vaccine (HPV-Gardasil). Which should the nurse explain to the patient at this time about the vaccination?

A dose should be given today with follow-up doses in 1 to 2 months, and the last in 6 months. Rationale: Because the patient is over age 15, a first dose should be given now, with follow-up doses in 1 to 2 months, and the final dose in 6 months.

A 6-year-old patient is brought to the pediatrician's office with symptoms of feeling ill, periorbital edema, weight gain, and anorexia. The nurse suspects nephrotic syndrome. Which laboratory value confirms the nurse's suspicion?

A high level of protein in the urine

An adult female arrives in the emergency department following a spontaneous birth at home. The female indicates that no prenatal care has been received. Which assessment finding about the female causes the nurse greatest concern for the newborn?

A laboratory result reveals a positive Hep B e Antigen (HBeAg)

The nurse in the newborn unit of a pediatric hospital is providing care for a neonate born at 34 weeks' gestation. The nurse is aware that the immediate risk to the neonate is which condition?

A lack of phospholipids in the alveoli

The nurse is admitting an infant who is 3 months of age. The parents sought medical attention when the infant began passing pale-colored stools that are nearly white. The infant had been diagnosed with biliary atresia at birth and underwent corrective surgery. For which treatment will the nurse prepare the parents?

A liver transplant

The nurse in the emergency department of a pediatric hospital is providing care for a toddler with a sudden high fever. The parent states, "She has been grumpy all day and I thought she just needed a nap." Which finding does the nurse recognize as an indication of an immediate medical emergency?

A rash of scattered red bumps is found on the skin

The nurse is providing care for an infant who is 2 months old. Which assessment finding will cause the nurse to suspect an upper respiratory infection?

A stuffy nose and reddened eardrums

A 16-year-old adolescent is diagnosed with osteosarcoma and has evidence of metastasis. The nurse calculates the absolute neutrophil count (ANC) daily. The patient asks the nurse to explain the ANC. Which information does the nurse provide?

ANC measures of three types of white blood cells. A lower ANC indicates vulnerability to infection

The nurse is assessing a 7-year-old child at a pediatric clinic. The nurse notices that several developmental milestones have been missed or are late during previous visits. The parent states, "I know she is a little slow, but she will catch up quickly." Which action by the nurse is warranted?

Ask the parent detailed questions about the pregnancy, birth, and early childhood

The nurse is admitting an adolescent who is 19 years of age with a diagnosis of acute renal infection. While obtaining medical and health history information, which finding does the nurse identify as supporting the diagnosis?

Acknowledgement of being sexually active since 14 years of age

A 15-year-old female asks the pediatric nurse how tall she may be as an adult. The adolescent's father is 6 feet 0 inches tall; her mother is 5 feet 4 inches tall. Which calculation will the nurse use to provide a probable answer?

Add the parents' height in inches together; divide by 2; subtract 2.5 inches

A 15-month-old toddler has a strange rash on his nose and mouth. It contains papules and vesicles and has a honey-like, glazed look. The toddler has a history of eczema, but the nurse differentiates the features of the presenting rash and explains that he has developed a secondary infection. What is the treatment of choice for this type of dermatological disease?

Administer topical antibiotics as ordered until the skin is clear. Rationale: A topical antibiotic is the treatment of choice for impetigo. In severe cases, an oral antibiotic will be given in addition to the ointment. Staphylococcus aureus or group A beta-hemolytic streptococcus are causative factors for impetigo.

The nurse in a pediatric emergency department is providing care for a 1-year-old patient with a history of congenital adrenal hyperplasia (CAH). The patient is exhibiting the manifestations of a febrile illness. Which medical intervention does the nurse expect to be prescribed?

Administration of corticosteroids by injection

The nurse is providing care to a hospitalized pediatric patient, and the patient is refusing all pain medication despite signs of obvious distress. The patient tells the nurse, "All you nurses lied, and the shots hurt." What is the most appropriate nursing measure at this time?

Admit to the patient that the shots hurt but explain they help

The nurse is presenting a class to high school females about decreasing the developmental risks related to pregnancy. Which information does the nurse consider to be most important?

All females of child-bearing age should take 0.4mg of folic acid daily

Which statement best describes the common core concepts of the different models of pediatric nursing?

All models focus on importance of family relationship to the child

The nurse is planning a teaching session for a 10-year-old patient and the patient's parents. The patient is newly diagnosed with type 1 diabetes mellitus. Which is the most important topic for the nurse to cover?

All procedures involved in insulin production

A 12-year-old patient is experiencing pain in the abdomen after receiving chemotherapy. When developing a care plan, for which interventions will the nurse plan for pain management?

Alternative therapy such as aromatherapy

The nurse is performing a developmental assessment on a toddler at age 3 years. The nurse notices a variety of mixed developmental milestones that have been missed during the visit. Which delay does the nurse expect to be of greatest concern to the parent?

An inability to express needs with language

A 6-month-old infant presents to the clinic with a diaper rash. The nurse observes a well- demarcated rash and satellite lesions on buttocks and legs. Based on the assessment, which treatment will the nurse recommend?

An ointment containing nystatin (Mycostatin). Rationale: Mycostatin is the treatment of choice for a Candida infection. Infection with Candida albicans, a yeastlike fungus, results in candidiasis of the diaper area.

The nurse is providing care for a 7-year-old child whose admitting diagnosis is poststreptococcal glomerulonephritis. The nurse expects which care to be prescribed for the child?

Antibiotic therapy

A 2-year-old has recently been diagnosed with a terminal type of cancer but is not experiencing any severe symptoms of the illness at this time. The mother of the patient is depressed and feels guilt over the illness. She admits to mentally planning the funeral and expecting to be devastated. The nurse identifies the mother as experiencing which stage of grief?

Anticipatory

A third-grade teacher discusses behavioral problems with a student. The teacher states, "He walks around class making horrible sucking noises. He does not respond to me." Which information does the nurse seek from the student's parents?

Ask if the student has been tested by a physician for seizure disorder

A nurse is caring for an infant from a different culture than her own. The mother allows the infant to continue to cry without assessing for a cause of the distress. The nurse is disturbed about this parenting. Which is the best action for the nurse to take initially?

Ask the mother to share what she believes about infant crying

The home care nurse is assessing the home environment for the pediatric patient. The nurse notes that the family is unable to perform some of the physical therapy exercises safely. What is the most appropriate initial nursing action?

Assess the family's understanding of a safe way to perform the physical therapy exercises

A pediatric patient has acute myelocytic leukemia, and patient and family are considering treatment options aimed at long-term success. Which contemplated treatment involves using the patient's stem cells collected before radiation of cancerous bone marrow? Select all that apply.

Autologous Peripheral Blood Stem Cells (PBSC)

The parents of a 4-year-old toddler bring the child to the pediatrician because a lump is found in the toddler's waist area. Diagnostic testing verifies the toddler has a Wilms' tumor on the right kidney. The toddler is to be sent home until scheduled surgery. Which teaching is essential for the parents regarding preoperative care?

Avoid palpating the tumor and pushing or lifting the area

The nurse is reviewing the laboratory results of an adolescent who has chronic glomerulonephritis. Which of the following findings should the nurse expect?

BUN 50 mg/dL

An older patient with weeping lesions caused by herpes zoster asks if a trip to visit small grandchildren can still occur this upcoming weekend. Which should the nurse say to the patient in response?

Be sure to keep the lesions covered until they crust over. Rationale: The lesions of shingles must be covered until they crust over to prevent the transmission of chickenpox to the grandchildren.

The nurse in a pediatric clinic is obtaining a health history on a child who is 9 years of age. The nurse learns the child exhibits a chronic cough, midsternal discomfort, and frequent sore throats without infection. Physical assessment indicates the child is on the 50th percentile on the height chart and on the 85th percentile for weight. Which recommendation does the nurse make?

Begin an age-appropriate weight loss program

A patient who is 17 years old comes to his health-care provider for a sports physical. The nurse's visual assessment places the patient in high percentiles for both weight and height. Which additional assessments does the nurse expect to be conducted for a complete health evaluation? Select all that apply.

Body mass index Lipid profile TSH level

An adolescent who is 15 years of age is brought to the pediatric clinic because of bloody urine. Which additional finding during assessment will cause the nurse to consider acute kidney injury (AKI)?

Bruising in the flank area

A parent brings a 2-year-old child with a fever and a rash to the pediatric clinic. The health-care provider suggests the child may have one of several conditions that present with similar symptoms, but wants to rule out Kawasaki disease. Which tests does the nurse expect to be performed? Select all that apply.

CBC; specifically WBC CRP ESR echocardiogram or EKG

The nurse is collecting assessment information on a pediatric patient who is 13 years of age. The patient is at the clinic for recurrent gastrointestinal distress. Which questions are appropriate for the nurse to ask the patient? Select all that apply.

Can you describe the pain you are having Do you ever have cramping or bloating Are there any changes at home or school

The nurse is providing teaching for the parents of a child diagnosed with hemolytic uremic syndrome (HUS) 10 months ago. Which statement by a parent indicates the teaching is understood?

Careful skin inspection and care is given because of swelling and poor circulation

The nurse is providing care for a school-age patient who received a head injury while playing sports. Which initial assessment finding causes the nurse greatest concern?

Changes in breathing and heart rates

A 4-year-old who had a broken arm is preparing to have the cast removed after 4 weeks. The child's parent states, "I had a cast on my arm a lot longer than that for it to heal. Are you sure the cast has been on long enough?" Which is the best response to the parent?

Children's bones heal faster than adults, so they don't need to wear a cast as long as an adult. Rationale: A child's bones tend to heal faster than adults. The immobilization times are shorter.

A 13-year-old male patient is diagnosed with hypopituitarism and is prescribed to begin growth hormone replacement therapy. Which patient teaching information will best optimize the replacement therapy outcomes for the patient?

Clear communication about side effects of therapy and how they are managed

A nurse is providing relationship-based care to a pediatric patient. Which of the following is a challenge the nurse is likely to encounter while using this model of care?

Communicating with the blended family on a regular basis

A 19-year-old college student is being treated for non-metastatic Hodgkin's lymphoma with chemotherapy. Which recommendation by the nurse was made prior to beginning chemotherapy in order to promote a level of health?

Consider sperm banking because of expected sterilization

During an outside gym class, a high school student was stung on the lip by a bee. After determining that the student was not allergic to bee stings, which treatment should the school nurse recommend to soothe the sting? Select all that apply.

Create a paste of baking soda and water and apply to the lips. Rationale: A baking soda paste made by mixing baking soda with cold water may be soothing to a sting site. This is considered a complementary and alternative therapy. Wash the lips with cool water and apply ice to the sting. Rationale: The immediate care of a sting is to wash the site of the sting. To reduce pain and swelling, the patient can apply ice to the sting. Take an over-the-counter antihistamine. Rationale: The child can be given an OTC oral antihistamine such as Benadryl.

An adolescent is brought to the health-care provider's office for evaluation of an arm lesion that is swollen, red, and warm. There is also a fluid weeping from the wound. The nurse should anticipate which test will most likely be ordered?

Culture and sensitivity of the fluid. Rationale: Diagnostic testing of a skin lesion includes culture and sensitivity tests on any drainage present, which would identify the organism causing the symptoms of the cellulitis.

A nurse is caring for a school-age child who has mild persistent asthma. Which of the following is an expected finding?

Daytime sx occur more than two times a week; minor limitations to normal activity; PEF greater than or equal to 80%

A 16-year-old patient is approaching the terminal stage of a brain tumor. The nurse notices the patient is calling friends and making plans for a social gathering several months away. When friends are present the patient assures them of a full recovery because of a new doctor. The nurse recognizes the patient is experiencing which stage of grief?

Denial

As the director of nursing (DON), who is responsible for planning the needs of a pediatric unit for the next several years, the DON focuses on the changing demographics for the pediatric population. Based on Federal statistics, which needs does the DON prioritize for culturally sensitive care? Select all that apply.

Determine whether local changes reflect national demographic changes. Identify the probable increase in Hispanic children requiring care. Obtain literature that is presented in both English and Spanish.

The nurse is collecting information about a school-age patient brought to a pediatric clinic by a parent. The parent reports several incidences of syncope. Which assessment question helps the nurse to identify a possible diagnosis of vasovagal syncope?

Did your child feel strange and faint after standing up?

The nurse is providing discharge instructions to the family of a 14-year-old patient who was treated for an exacerbation of a chronic illness. The nurse recognizes that this will add stress to the family unit and has developed a plan of care based on the family-centered care model. Which intervention best addresses the crisis experienced by the family unit at this time?

Discuss treatment options and alternatives with the family

A 14-year-old student reports to the school nurse that he has a persistent pain and soreness in his legs. The student is part of the football team. There is no evidence of injury to the student. Which information should the nurse provide to the student? Select all that apply.

Do stretching exercises before playing or being active. Rationale: Stretching exercises can prevent injury for athletes. Ensure shoes and equipment fit properly and are stable. Rationale: Shoes and equipment must fit properly and be stable to assist in preventing injury. Learn proper body mechanics for the activities. Rationale: Proper body mechanics assist in preventing injury in athletic activities.

The nurse is caring for a 15-year-old patient who has been diagnosed with mononucleosis. The patient asks how the infection was obtained. Which information should the nurse include when responding to the patient?

Drinking from the cup of a person with the infection. Rationale: The virus that causes mono is transmitted through person-to-person contact, sharing personal objects such as cups or toothbrushes, and through saliva.

The nurse is providing care to a 5-year-old child who is recovering from a tonsillectomy in the hospital. The nurse notes that the 9-year-old sibling is tending to the psychosocial needs of the patient, while the parents discuss their marital conflicts in front of the children. Which nursing diagnosis is appropriate for this family?

Dysfunctional Family Processes

The nurse is preparing a teaching plan for a patient and family. The patient is diagnosed with hyperpituitarism. Which teaching information will optimize therapy outcomes for the patient? Select all that apply.

Education about home administration of medications Education about the disorder and treatment options Explanations of long-term complications for noncompliance

A parent arrives at the family clinic seeking medical attention for his 14-year-old child. The child has a fever, malaise, nausea, and abdominal pain. Which finding should indicate to the nurse that the patient is experiencing hepatitis A?

Elevated serum bilirubin. Rationale: Abnormal laboratory values that indicate the presence of Hep A include an elevated serum bilirubin level.

An adolescent is diagnosed with mononucleosis. Which teaching should the nurse provide to the parents when providing care at home? Select all that apply.

Encourage ample fluids. Rationale: The patient with mono needs to ingest ample fluids to prevent development of dehydration. Avoid all contact sports for 6 to 8 weeks. Rationale: To prevent injury to the spleen, contact sports are not permitted for 6 to 8 weeks if the spleen is enlarged. Even though the patient's status of the spleen is not identified, the patient should avoid these types of sports until approved by the HCP. Examples include: basketball, football, soccer, rugby, baseball, boxing, ice hockey, rodeo, wrestling, martial arts, lacrosse, and water polo. Encourage rest with quiet activities and play. Rationale: The patient with mono is easily fatigued and should engage in quiet activities and play Provide ibuprofen or acetaminophen for elevated temperature. Rationale: The patient should be provided with acetaminophen or ibuprofen for fever control.

An adolescent develops a fever, cough, and a maculopapular rash. Which question should the nurse ask when completing the health history with this patient?

Have you been around anyone with a cold over the last 3 weeks. Rationale: Foodborne viruses manifest with gastrointestinal distress. Chickenpox is a respiratory-borne viral disease with an incubation period of about 21 days.

The nurse is providing care for a pediatric patient whose family culture is Hispanic. Which action is best when the nurse notices the patient is eating poorly at meals and rejecting snacks?

Encourage the family to prepare and bring favorite foods to the patient

The nurse is providing care to a preschool-aged child who has been placed in a hip Spica cast for treatment of a femur fracture. The child is given narcotic pain medication for the first 48 hours before being sent home. When providing discharge instructions to the child's parents, which is the most important?

Ensure the cast is not too tight around the abdomen. Rationale: Preventing injury from the cast due to reducing circulation or placing pressure on the abdominal area is the priority.

The nurse is providing care for an adolescent patient admitted with a diagnosis of nephrolithiasis. The patient's symptoms include flank pain, hematuria, and vomiting. The nurse notices an hourly output of 20 mL/hour. Patient's medical history includes UTIs, type 1 diabetes mellitus, and one kidney at birth. Which medical prescription does the nurse expect immediately from the physician?

Establish NPO status and prepare the patient for surgery

The nurse is providing end-of-life education to parents of a child diagnosed with a terminal illness. Which topics of education are important for the nurse to provide? Select all that apply.

Explain how the progression of the disease will affect their child. Describe the physical changes that will occur during the dying process. Describe what to expect after death including how the child will look.

A 9-year-old child is being treated for a brain tumor. The patient asks the nurse why there is pain in his head. Which reply by the nurse includes pathophysiology and age-appropriate communication?

Explain the growing brain tumor presses on some nerves in the head

The nurse is aware that pediatric patients and their families have cultural needs and influences during periods of hospitalization. Which cultural elements does the nurse specifically provide for the hospitalized patient? Select all that apply.

Follow the schedules for meals and sleep times observed at home Encourage visitations and play times with the patient's siblings

A 2-year-old child is being evaluated for a musculoskeletal disorder. The child's laboratory results indicate hypophosphatemia, a normal erythrocyte sedimentation rate, and negative rheumatoid factor. Which disorder is the child likely experiencing?

Genu Varum (bowlegs). Rationale: Genu Varum (bowlegs) can be associated with hypophosphatemia

A teenager is being cared for in the emergency department after being trapped in a garage fire at her home. Partial-thickness burns are present on the side of the face, as well as on both arms. Which nursing action is the highest priority?

Give 100% humidified oxygen. Rationale: The priority action is establishing ABCs. The nurse should give 100% O2 if the individual has been burned severely or if the fire was in a confined space. POX is used to monitor O2 sats.

A 16-year-old adolescent has Addison's disease. The adolescent's current medication involves corticosteroid and mineralocorticoid replacement therapy. During sports practice, the adolescent collapses and loses consciousness with sudden, penetrating pain in the lower back and legs. Which action is taken by the school nurse?

Give IM Solu-Cortef and call the paramedics for emergency IV infusion

The pediatric nurse is preparing a community education program for parents and children who have endocrine disorders. With which normal regulatory functions does the nurse begin the presentation before covering endocrine disorders? Select all that apply.

Growth and development Sexual development Energy use and storage An individual's response to stress Levels of glucose, fluid, and sodium in the blood

A toddler who is 2 years old is playing in the playroom at the hospital and suddenly begins to choke and cough. The nurse attending the toddler places the child in which position to dislodge a possibly inhaled object?

Head down and on the right side

The nurse in a pediatrician's office is assessing a 9-year-old male patient who is being monitored for the possible diagnosis of hypopituitarism. Which assessment finding does the nurse recognize specifically as an indication of growth hormone deficiency?

Height increase of 1.75 inches in 12 months

A parent brings a 2-month-old baby in for a routine wellness examination. Which vaccination should the nurse prepare to administer to this patient?

Hepatitis B. Rationale: The Hep B vaccine is provided to all newborns. 3 doses of Hep B are given before age 2 years; at birth, at 1 to 2 months of age, and at 9 to 12 months of age

The nurse is providing care for a child who is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). Which laboratory result does the nurse expect with this condition?

High urine and low serum osmolarity

The school nurse is teaching a middle-school class about the hormones that regulate body functions. Which information provided by the nurse is accurate?

Hormones are chemicals secreted by endocrine glands

The nurse is developing a health fair for children aged 5 and 6 years. Which of the following would be appropriate topics for this population based on current trends? Select all that apply.

How to deal with bullying on the internet How to prevent the flu with hand washing How to choose and eat healthy foods Ways to stay active and stay healthy

An 86-month-old child is brought to the well-baby clinic for her immunizations. The nurse observes that the child's extremities are bright red, with a few blisters. The nurse questions the mother about the extent of sun exposure and determines that the child has a second-degree sunburn. After administering the immunization, the nurse provides education about sunburn prevention to the infant's mother. Which statement by the mother indicates that she needs more teaching?

I apply sunscreen right after we get to the pool. Rationale: Sunscreen should be applied 30 minutes before going out in the sun. This statement demonstrates that the mother needs more teaching.

The nurse is providing care for an infant with an inner ear infection. The nurse is aware that the condition has occurred multiple times in a 3-month period. Which comment by the parent indicates to the nurse that specific teaching is needed regarding the incidences of infection?

I now put her to bed with a bottle

The nurse is providing care for a neonate diagnosed with tetralogy of Fallot. Prostaglandin E1 therapy is prescribed to keep the foramen ovale and the ductus arteriosus open. Which is the most important intervention for the nurse to include in the neonate's plan of care?

Maintain a separate IV access for continuous administration of the medication

A toddler who is 2 years of age is cared for by a grandmother because of the death of the toddler's mother from AIDS. A critical nursing intervention is for the nurse to provide home-care instructions. Which points should the nurse emphasize? Select all that apply.

Importance of keeping up to date with all childhood immunizations Proper nutrition for a toddler diagnosed with the disease Monitoring playmates in order to avoid childhood viruses

A parent brings an adolescent who is 16 years of age to the pediatric clinic, because the patient is experiencing unusual sensations in the feet. The nurse learns the patient was diagnosed with type 1 diabetes mellitus as a toddler; glucose levels have always been erratic and difficult to control. Which assessment findings does the nurse expect based on the health history? Select all that apply.

Inability to identify a sharp or blunt sensation on the sole of the foot Problems with balance when standing without support Signs of weakness during neuromuscular checks to the lower legs

The nurse is providing care to a 10-year-old patient hospitalized for multiple injuries from a motor vehicle crash. Which nursing intervention is appropriate for communication with this child?

Include the child in some decisions regarding care, such as choosing food from the hospital menu.

The nurse is providing family teaching for a child diagnosed with hypoparathyroidism. Which additional teaching will the nurse include related to alternative dietary management? Select all that apply.

Including dietary supplements such as magnesium and boron Giving calcium and vitamin D with acidic substances

The nurse is caring for a school-age patient diagnosed with hepatitis A. For which reason should the nurse begin implementing contact precautions for this patient?

Incontinent of feces. Rationale: A patient with Hep A should be placed in contact precautions in the event of fecal incontinence.

A teenager suffered second-degree burns of the face and hands while at a campfire that burned out of control. Emergency treatment is provided, and the patient is then admitted to a burn treatment center. Which nursing action should the nurse perform first?

Maintain adequate airway and oxygen supply. Rationale: The nurse should assess for signs of respiratory distress: dyspnea, wheezing, stridor, tachypnea, decreased breath sounds, retractions. A POX is used to monitor O2 sats. The nurse should administer O2 or assist with endotracheal intubation PRN and keep the head of the bead elevated.

The pediatric nurse is providing care to a 5-year-old patient for speech impediments that were caused by repeated incidences of otitis media. Which of the following is an example of current issues regarding this type of medical problem? Select all that apply.

Increased admissions based on environmental risk factors, such as smoking Increased admissions based on knowledge deficits due to language barriers Deficient knowledge that has negatively impacted the adherence to the antibiotic regimen

The pediatric nurse is preparing a teaching plan for new mothers with small infants. Which is a key point for the nurse to include in the teaching plan?

Infant airways get blocked more easily than those in older children

The mother of a 3-month-old returns for a visit with the physician who is caring for the infant's hip dysplasia. However, the nurse notes that upon arrival, the infant is not wearing the prescribed Pavlick harness. The mother indicates she thought the infant was uncomfortable so she removed it. Which is the best response by the nurse?

Inform the mother how to check for capillary refill in the toes. Rationale: This is done when the child is wearing the harness.

The nurse is admitting a 6-month-old infant for testing because of a second UTI and suprapubic pain with palpation. Diagnostic tests reveal a grade II vesicoureteral reflux (VUR). Which information does the nurse provide to the family?

Information about medication therapy

A parent brings an 18-month-old toddler to the pediatric emergency department for abdominal pain and stool mixed with blood and mucus. The pain is recurring three to four times an hour. Which intervention will the nurse initiate first?

Initiate intravenous access

A 17-year-old pediatric patient is admitted for a fractured femur. The patient exhibits signs of being withdrawn and emotional throughout the day. During reassessment by the nurse, which approaches will reveal spiritual distress? Select all that apply.

Inquiring about the meaning of the fracture and hospitalization to the patient Performing an assessment of the patient's behaviors using the FICA scale

Parents bring a toddler who is 2-1/2 years old to the hospital because of observed difficulty with breathing. In addition, they share that at bedtime the toddler has a barky cough. The toddler is diagnosed with laryngotracheobronchitis, commonly referred to as croup. Which assessment finding does the nurse expect related to the diagnosis?

Inspiratory stridor heard in the upper airway

The school nurse is providing care to the student population in the urban elementary school. The nurse notes that the children do not feel safe playing outside during recess due to the recent violent incidents in the surrounding area. What are some disease processes that the nurse may notice due to this inactivity? Select all that apply.

The general population is at higher risk for obesity The students are at higher risk for diabetes mellitus

The nurse in a pediatric clinic is gathering information from the parent of a toddler who has anorexia, generalized edema, and joint pain following a bout with strep throat. Which question(s) will most likely give the nurse information for a specific condition?

Is the child urinating, and what color is the urine

The parents are preparing to take their newborn, who was diagnosed with tetralogy of Fallot with pulmonary atresia, home. The nurse is developing a teaching sheet regarding care of the newborn for the parents. Which information does the nurse need to include in the teaching plan?

It is important to maintain calorie intake

A 15-year-old male is very distressed about the skin problems on his face, neck, and back. He has whiteheads on his face and some blackheads. The nurse educates him about acne and designs a plan of care to use to treat and prevent skin eruptions. Which statement should the nurse include when teaching about skin care?

Keep hair clean and off the face. Rationale: Hair should be kept clean and off the face.

The nurse is caring for a 13-year-old patient diagnosed with adolescent idiopathic scoliosis. The curve in her back was treated by spinal fusion with rod insertion. Which is the priority nursing intervention in the postoperative period?

Keep oxygen saturation within normal limits. Rationale: Oxygen saturation is the priority in this list. It is the ability to maintain an open airway and breath effectively (ABCs) that makes this the priority.

The nurse is preparing an 8-year-old patient for a cardiac catheterization. Which intervention will the nurse initiate immediately postprocedure?

Keep the involved extremity straight for 4 to 6 hours

A 7-year-old with a myelomeningocele is paralyzed from the waist to her feet. She is either in bed or in a chair day and night. A physical evaluation is performed regularly to check skin integrity. While conducting a skin assessment, the nurse finds a partial-thickness skin loss with exposed dermis on the sacrum. How does the nurse classify this pressure ulcer on the assessment form?

Second-degree pressure ulcer. Rationale: stage 2 is manifested by partial-thickness skin loss with exposed dermis

Parents of a toddler with eczema are concerned about alleviating discomfort from itching and preventing infection, since constant scratching has been an issue. They ask the nurse what measures they can take to care for their child. The nurse creates a teaching sheet to provide information regarding the care of a patient with eczema. Which concept should the nurse include on the teaching?

Maintain hydration of the skin. Rationale: the key to successful treatment is hydration of the skin

The pediatric nurse is examining the skin of a young child and notices eight café-au-lait spots between 1.5 and 3 inches in diameter on the body, along with axillary freckling. Which recommendation does the nurse make to the parent?

Make an appointment with a physician for testing and evaluation

A teenaged patient arrives in the emergency department where the physician diagnoses a dislocated shoulder. It is the patient's first dislocation. Which should the nurse prepare for treatment of the dislocation?

Make sedative medication available. Rationale: A dislocation is treated by relocation of the joint using a sedative medication

The pediatric nurse in an acute care facility is providing care for a patient who is 12 years of age with a history of sickle cell anemia. During this hospitalization, it is determined that the patient has experienced a stroke. Which teaching is most important for the nurse to provide to the patient and parents?

Manifestations of increased intracranial pressure

The nurse must obtain data for a routine assessment of the 8-month-old patient. Which of the following are part of that assessment? Select all that apply.

Measure the head circumference and record results. Enter height and weight in the growth chart. List most recent immunizations in the chart.

The school is preparing a teaching plan for a 13 year old female student about anatomy, puberty, and reproduction. Does the beginning of menstruation indicate the ability to become pregnant?

Menstruation indicates an ability to become pregnant

The nurse is providing care for a 2-month-old infant admitted to the hospital for testing because of a persistent low-grade fever. Laboratory tests and ultrasound of the abdomen confirm the presence of gallstones. Which procedure does the nurse expect to be prescribed for this infant?

Monitoring without surgical interventions

The nurse is preparing to complete assessments on children in a homeless shelter. Which assessment will assist the nurse to identify possible musculoskeletal conditions each child?

Motor Development Patterns. Rationale: Motor Development delays can be related to musculoskeletal conditions due to the potential impact on movement.

The nurse is providing care for a 9-year-old patient who was recently diagnosed with cardiomyopathy after a viral infection. Which teaching does the nurse provide to the patient's parents about the diagnosed condition? Select all that apply.

Need for intensive care of the patient Preparation for anticipatory grieving Allowing patient to discuss feelings Reasons for frequent medical visits

The nurse in a pediatric clinic is performing a physical examination of a patient who is 8 years of age. The patient's weight is over the 95th percentile on the growth chart. The patient also expresses the presence of knee and abdominal pain. The patient's parent states, "He will outgrow it; all my boys start off like this." Which information does the nurse present to the parent? Select all that apply.

Obesity is related to the development of diabetes mellitus There is a high risk for cardiac disease Obesity adversely affects joint health and function

The nurse is assisting with high school sports physicals. The nurse performs a physical assessment on a male student who is tall and thin, with disproportionately long arms. Which additional finding will prompt the nurse to recommend a cardiac evaluation?

Notable laxity of joints

The pediatric nurse receives a medical prescription to obtain a urine sample for culture from an infant 6 months of age diagnosed with a UTI. By which method will the nurse collect the sample?

Performing urinary catheterization

A 3-month-old infant is diagnosed with pulmonary stenosis. Which parent teaching does the nurse provide?

Options for treatment include a repair of the artery or the valve

The nurse in a pediatric clinic is working with a preschool patient and a parent about managing the child's functional constipation. Which is the most important information for the nurse to share?

Parental action is required for the onset of vomiting or severe abdominal pain

The nurse is providing care for a 12-year-old patient who is hospitalized with generalized weakness and muscle wasting, which began in the hips, pelvic area, thighs, and shoulders. The physician suspects Duchenne muscular dystrophy. Which action by the physician does the nurse expect?

Perform an echocardiogram to evaluate cardiac functioning

The child is visiting the clinic for a pre-sports-participation physical. Which should be included as part of the patient education to prevent musculoskeletal injury during participation?

Perform stretching exercises before play. Rationale: Performing stretching will assist the child in preventing musculoskeletal injury.

A child is being treated with a hip Spica cast and preparing to be discharged home. Which statement by the parents demonstrates effective education and readiness to care for the child?

Placing the absorbent part of the diaper toward the skin is the best. Rationale: Placing the absorbent part of the diaper against the skin of the child in a Spica cast assists in protecting the patient's skin from urine and feces collecting around the cast.

A high school freshman visits the school nurse to ask how she can get rid of the warts on her hands. She is embarrassed what her friends will think if they notice them, and she fears spreading them to others. Which of the following should the nurse include in the plan of care? Select all that apply.

Plantar or palmar warts are caused by human papilloma virus (HPV). Rationale: Plantar warts on the soles of the feet or the palms of the hands are due to HPV-1 Hand hygiene should be performed after touching the warts. Rationale: Warts may be mildly contagious. Hand hygiene is critical. A patch with salicylic acid (Duofilm) is helpful to dissolve warts. Rationale: salicylic acid in the form of liquid, gel, or a patch, may be effective in removing warts.

The nurse is providing care for an adolescent diagnosed with Crohn's disease. The nurse provides patient teaching regarding which manifestation of the condition?

Possibility of oral aphthous ulcers

The nurse recognizes the needs of professional development to provide safe and effective care to the pediatric population by attending which of the following courses?

Procedure with rationale to administer HPV vaccines to the middle school population

The nurse is providing patient teaching for a school-age patient and parents. Chemotherapy is prescribed for cancer treatment. Before the first dose is administered on an outpatient basis, which teaching is most important for the nurse to provide?

Prompt recognition of adverse effects after the therapy

The nurse is caring for a child in the emergency department. The child's arm is abnormally positioned, and the child is holding the arm near that area and is crying with pain. The child's parents explain that the child fell off the bicycle when riding on the streets of this subdivision. Which is the priority care to provide to the child?

Protect the child from more injury. Rationale: Protecting the patient from further injury is the priority care during emergent care of musculoskeletal injuries.

The school nurse is present at a school assembly when a student falls to the floor with a seizure. Which intervention does the nurse initiate when providing care to the student during the seizure?

Protect the student from injury related to seizure movement

A 12-year-old patient has a diagnosis of hyperthyroidism and is hospitalized for the manifestations of a thyroid storm. Which home-care concept will the nurse include in the care of the patient during hospitalization?

Provide a low-stress, low-pressure environment

The nurse is providing teaching to the parent of a toddler 2 years of age diagnosed with otitis media. The toddler presented with a fever of 100.9°F (38.3°C) and does not indicate symptoms related to pain. Which information does the nurse give the parent when the physician orders 48 to 72 hours of supportive care? Select all that apply.

Provide age-appropriate analgesics as needed Support hydration with fluid increases Monitor temperature and report increases

A school-age child is diagnosed with hand, foot, and mouth disease. Which should the nurse instruct the parent to do when caring for the patient at home? Select all that apply.

Provide bland foods and fluids. Rationale: the patient with hand, foot, and mouth disease has oral lesions. The patient should consume bland foods and fluids to reduce pain when eating and drinking. Offer generous amounts of oral fluids. Rationale: The patient with hand, foot, and mouth disease should have ample fluids to ensure adequate hydration. Use acetaminophen or ibuprofen for pain control. Rationale: the patient with hand, foot, and mouth disease should be provided with mild over-the-counter analgesics such as acetaminophen or ibuprofen.

A parent brings her school-age child to the physician's office for evaluation of a sore throat, fever, headache, and fine red rough rash over both arms and abdomen. For which health problem should the nurse plan care for this patient?

Scarlet fever with strep throat. Rationale: Strep throat and a fine red rough rash are main symptoms of scarlet fever.

A nurse is caring for a school-age child who has inflammation of the right eye. Which finding, if present, would indicate to the nurse that the child has bacterial conjunctivitis rather than viral conjunctivitis?

Purulent drainage. Rationale: Purulent drainage is a symptom of bacterial conjunctivitis.

The nurse is preparing a 13-year-old patient for a full physical examination by the primary care provider (PCP). The patient asks that her mother leave the room because of the sensitive nature of the examination. What is the best course of action to be taken by the nurse to protect the interested parties?

Reassure the mother that the nurse will remain as a chaperone while she leaves the room.

The nurse is providing care to a school-age child admitted because of the presence of colicky abdominal pain, palpable purpura on the lower extremities, edema of the face and lips, and anorexia. The suspected diagnosis is Henoch-Schönlein purpura. Which diagnostic test result does the nurse expect to validate the diagnosis?

Renal biopsy shows IgA deposition

The nurse is providing care for a 14-year-old patient who is within the first 24 hours postoperative for scoliosis treatment. Which intervention, if performed, would demonstrate appropriate care measures?

Repositioning the patient every 2 to 4 hours while in bed during recovery period. Rationale: Repositioning the patient every 2 to 4 hours postoperatively prevents tissue damage to pressure areas.

The nurse is preparing teaching materials for an adolescent patient recently diagnosed with nonalcoholic fatty liver disease (NAFLD). The adolescent initially presented with right upper quadrant pain, obesity, and hepatomegaly. Which teaching will the nurse initially present?

Review lifestyle changes and diet modifications with the adolescent

A high school male adolescent arrives at the emergency department following a fall sustained while rock climbing. The physician prescribes diagnostic tests to rule out acute kidney injury (AKI). Which diagnostic finding does the nurse report immediately to the health-care provider?

Serum potassium of 5.7 mEq/L

The nurse in a pediatric clinic is obtaining information about a 7-month-old infant with GI symptoms. The parent informs the nurse that bloating, flatulence, and foul-smelling stools occurred with the introduction of wheat cereal. Which additional information will cause the nurse to initiate emergency care?

Severe vomiting and diarrhea

A junior high school student is cooking in the home economics room when some oil splashes on her fingers and hand. She immediately rinses her hand with cool tap water. The skin is not broken, but soon, a blister begins to form. The teacher sends the student to the school nurse for evaluation and treatment. Which nursing intervention is most appropriate?

Soak the burn in cool water and apply aloe vera cream. Rationale: soaking in cool water and applying aloe vera cream is the appropriate first aid for superficial burns. Do not use butter, oils, or ice on the burn. These may cause additional injury.

A parent with a school-age child with mumps asks for information about the illness and treatment. Which information should the nurse provide? Select all that apply.

Sometimes the complications of mumps involve the testicles. Rationale: Boys may have painful swelling of the testicles (orchitis) from the mumps virus. Mumps are seen by observation of swelling around the ears and jaw. Rationale: Mumps is manifested by swelling of parotid salivary glands in from of the ear, below the ear, and/or under the jaw. Provide food and drink that is nonirritating to the mouth and surrounding glands. Rationale: The patient with mumps should be provided with bland, soft foods and bland liquids. Citrus juices should be avoided. The patient should be kept well hydrated.

A school-age child is brought to the clinic to be evaluated for a headache and stomachache. For which reason should the nurse prepare the patient to have a rapid strep test?

Strawberry tongue. Rationale: A rapid strep test would be done if a strawberry tongue is assessed, an indication of strep throat or scarlet fever.

The parents of a toddler, diagnosed to be in the second stage of a terminal illness, are concerned about how to manage pain without sedation effects of pain medications. Which suggestion by the nurse is likely to meet the needs of both the parents are the patient?

Suggest a parent hold the patient and perform gentle massage. Rationale: The parents have expressed a desire for pain management without sedation effects of pain medication. The unspoken need of the parents is to have the ability to interact with their child and still achieve pain management. When the nurse suggests that a parent hold the patient and perform a gentle massage, the needs of both the patient and parents are being met. The suggested actions will promote relaxation and potentially decrease pain

The nurse is caring for a child who reports he has pain in his ankle after "twisting" it during play. Which would be the most appropriate follow-up assessment to this report?

Swelling and deformity of the ankle joint. Rationale: Swelling and deformity will inform about injury to the joint.

The nurse is performing a physical assessment on a 7-year-old child as a requirement for playing a sport at school. The nurse reports which assessment finding as abnormal and requests a follow-up from a primary care physician?

Systolic blood pressure is 90mmHg and diastolic is 20mmHg

The nurse is providing care for a 12-month-old patient who is experiencing poor weight gain. Physical assessment reveals an open anterior fontanel and open cranial sutures. To differentiate between a decrease in growth hormone and a congenital thyroid problem, which laboratory test does the nurse expect to be ordered?

TSH

The nurse is writing teaching material about caring for a child with influenza. Which information should the nurse include? Select all that apply.

Tamiflu can be given to children older than one on weight-based dosing. Rationale: Oseltamivir (Tamiflu) may be given to children older than 1 year and should be given on weight-based dosing. Manifestations of the flu include fever, chills, headache, and myalgia (aching). Rationale: Symptoms of influenza include fever, chills, headache, sneezing, coughing, malaise, conjunctivitis, and myalgia (aching). Medications for influenza must be given within 48 hours of the onset of symptoms. Rationale: Medications for influenza must be given within 48 hours of the onset of symptoms.

A 3-year-old, well-known to the nursing staff, is admitted to the hospital frequently for fracture treatment secondary to osteogenesis imperfecta. It is known by staff and parents that the child is fragile. The nurse develops a long-term care plan to review with the parents. Which is the priority intervention for this child's plan of care?

Teach methods to prevent falls and injury. Rationale: Preventing falls and injury is the priority, as it keeps the patient safe and may reduce growth deformities.

The nurse is providing postoperative teaching to the parents of a preschool child after a tonsillectomy. For which events does the nurse prompt the parents to contact the physician? Select all that apply.

The child is frequently swallowing without food or fluids Bright red blood is noticed in the child's mouth The child refuses pain pills because it hurts to swallow

An 11-year-old child who had been treated for a broken leg is having his cast removed. After removal, the child asks the nurse about playing basketball for his local league. Which should be included in the response to the child?

The child should avoid playing basketball for up to 4 weeks but can then resume playing. Rationale: Children need to avoid contact activities for 2 to 4 weeks once out of the cast.

The nurse is providing care to a 7-year-old child who has been diagnosed with avascular necrosis. The patient's guardians ask the nurse what to expect due to this diagnosis. Which would be appropriate information to provide to the parents?

The child will be hospitalized and place in traction. Rationale: The child may be treated by being placed in traction (buck's or Bryant's) while hospitalized.

The nurse is informing a new mother of the concern about her newborn who is 36 hours old and has not passed any meconium. The nurse shares a suspicion of Hirschsprung's disease. The mother asks the nurse multiple questions about the condition. Which information will the nurse provide?

The condition is congenital and causes blockage of the intestines

Shortly after the birth of a male neonate, the parents are informed about the diagnosis of hypospadias. The physician explains that the neonate's urethral opening is located midpenile, and surgery will occur between the ages of 6 and 12 months. Which additional explanation does the nurse provide to the parents?

The diagnosis is usually an isolated anomaly

The nurses on a unit that cares for terminal pediatric patients wish to implement a change in facility policy to allow parents/guardians to remain during a patient code. Which is the most powerful reason that nurses can present to administration?

The family knows everything possible was done to save the patient

The nurse is completing the admission process for a pediatric patient by obtaining information related to the patient's culture. Which area of assessment is most important if the patient is an infant?

The family's perception of the current health status

A grandmother brings a toddler to a pediatric clinic and states, "I am worried that my grandchild is not getting adequate care." The nurse is able to verify the child is underweight for height and age. Which findings will cause the nurse to initiate additional assessment? Select all that apply.

The grandmother cannot provide an adequate feeding history The toddler repeatedly asks if the nurse will get some food The toddler's evaluation at birth indicates prematurity The mother is a single parent and lives alone with the toddler

The nurse in a pediatric clinic is assessing an infant who is 3 months old during a well-baby visit. Which assessment finding will be of greatest concern to the nurse?

The infant exhibits 15-second periods of apnea

The nurse in an acute care pediatric facility is preparing to assume care of multiple patients at the change of shift. Which patient will the nurse plan to assess first?

The infant who prefers a tripod position instead of lying down

The nurse on a pediatric acute care unit is providing care for an infant who is 11 months of age. The infant is diagnosed with a lower respiratory infection that produces large amounts of thick secretions the infant cannot cough up. When planning to suction the infant, which factor is important to remember?

The infant will respond negatively to a temporary loss of breath

The nurse is assessing the family of a pediatric patient in the home-care setting. Which of the following family APGAR findings best correlates with the nursing diagnosis of caregiver role strain?

The mother provides primary care of the ill child and household while the father works two jobs to provide financial support

The pediatric nurse in a clinic is mentoring a newly hired nurse who has no experience in pediatrics. The new nurse is performing a physical assessment on an infant who is 1 month of age. Which observation will prompt the nurse to discuss assessment skills with the new nurse?

The new nurse states, "how can I hear bowel sounds when he cries?"

The nurse is gathering health information on a child who is 8 years of age. The parent reports the child is extremely difficult to wake in the morning. Which other information will prompt the nurse to recommend screening for a sleep disorder?

The nurse validates the child is obese

The nurse in a pediatric office is aware that certain factors may be indicators of heart disease in children. Which children does the nurse recognize with manifestations related to heart disease? Select all that apply.

The newborn with dysmorphic facial features Identification of scoliosis in a new adolescent patient An infant who is unable to meet developmental milestone A toddler with clubbing and erythema of the fingers and toes

The nurse is providing discharge teaching to the family of a hospitalized 9-year-old patient, recently diagnosed with asthma. The family states that they feel overwhelmed with the treatment plans and cannot perform the necessary nebulizer treatments. Which nursing intervention best reflects the professional performance aspect of pediatric nursing standards?

The nurse arranges for a home care respiratory therapy consultation to teach the family proper techniques in the home setting

Which of the following are examples of a nurse adhering to the pediatric standards of practice? Select all that apply.

The nurse educates the parents on how to administer insulin to their 9-year-old child. The nurse asks the 3-year-old child to describe their level of pain with a Faces or Oucher scale. The nurse refuses to divulge medical information to the parents of a pregnant adolescent. The nurse uses evidence-based practice to maintain competency of new practices.

The emergency department nurse is providing care to a 5-year-old child with a repeated exacerbation of otitis media. When it becomes apparent that the parents smoke and refuse to prevent the child's exposure to secondhand smoke, the nurse voices frustration to the family that they are causing the child's otitis media. Which of the provisions of the ANA Code of Ethics for Nurses has the nurse failed to follow?

The nurse practices with compassion and respect for dignity, unrestricted by the nature of health problems

The nurse is attempting to provide education to the family of a newborn in the home-care setting. Which nursing intervention will assess comprehension of the communication with the family?

The nurse provides both written and verbal instructions at an age-appropriate level and asks for a return demonstration

Which of the following tasks is associated with the pediatric medical home care model of pediatric nursing?

The nurse refers the family to a childhood cancer support group prior to discharge from the hospital

Which of the following examples accurately represent the unique role of the pediatric nurse? Select all that apply.

The nurse shared information on the progress and interventions with the family The nurse engaged in one-to-one conversations with the family members as well as the patient The nurse developed interventions based on the knowledge of development

The nurse at a pediatric clinic is assessing a 12-year-old female. The patient ask the nurse, "I am scared about what's happening to my body. How does it happen?" Which information from the nurse is most appropriate?

The ovaries play a role in the regulation of puberty and fertility

The nurse is assessing preschool twins during a well-child visit in the family clinic. Which of the following statements by the parents would indicate a healthy transition for the family per Duvall's family development theory?

The parents state that they have maintained scheduled play dates to help the children socialize

A 19-year-old patient has a history of hyperthyroidism that is managed with medication. The patient recently moved into an apartment and is living independently. Which behavior indicates to the nurse the patient is continuing appropriate health management? Select all that apply.

The patient called for refills of antithyroid medications and beta-blocking agents The patient went to an urgent care facility over the weekend for a sore throat and fever

With endorsement from the family, the physician initiates hospice care for an adolescent patient who is terminally ill. For which family expectation about hospice care will the nurse provide additional information?

The patient will die in the hospital

A 10-year-old patient is diagnosed with type 2 diabetes mellitus. Which medical history finding will help the nurse identify alternative interventions for managing the patient's condition?

The patient's BMI is greater than 85th percentile for age and weight

The nurse is admitting a 15-year-old girl of Asian descent for abdominal pain lasting 3 days. The accompanying parent reports that the patient is exhibiting intense pain, vomiting, and diarrhea. The nurse notes that the patient places her pain level at 3 on a scale of 0 to 10. Which conclusion does the nurse draw regarding the discrepancy in the level of pain?

The patient's response may be related to cultural expectations

During the treatment of a preschool child for anemia, laboratory tests reveal the child is also positive for lead poisoning. The child is currently living in an older home being renovated by the parents. Which teaching does the nurse provide to the parents? Select all that apply.

The possibility of removing the child from the environment Methods to remove paint chips or dust from the environment The need for a child development specialist to evaluate the child

The nurse assesses a toddler with an apparent ear infection in the emergency department. During the assessment, the nurse finds that the child is not up to date on immunizations or well-baby checkups. Upon further investigation, the nurse discovers that the family is uninsured and undocumented immigrants. What are the most likely barriers to effective communication at this time?

The possible language issue may affect the family's comprehension of instructions

The nurse is providing care for a pediatric patient who received a concussion while playing football. The patient had brief loss of consciousness and now reports a headache with a pain level of 6 on a 0 to 10 scale. The patient states, "My team plays again in five days and I should be better." Which information is vital for the patient and parents to understand?

The risk for acquiring second impact syndrome

A 17-year-old patient with influenza tells the nurse, "I can't believe I got sick. I've been taking vitamin C, vitamin D, echinacea, and some other herbal remedies to boost my immune system." Which should the nurse say in response to this patient? Select all that apply.

The safe use of supplements and herbs has not been determined. Rationale: The safety of supplements and herbs have not been determined and need additional study. The effectiveness of supplements and herbs against influenza has not been determined. Rationale: The effectiveness of supplements and herbs for a specific health problem has not been determined and needs additional study.

The nurse is teaching a pediatric electrocardiogram (EKG) class to nurses in a pediatric cardiac unit. Which anatomical structure does the nurse use to describe the initiation of cardiac electrical conduction?

The sinoatrial node in the right atrium

The nurse in a pediatric clinic is collecting information for the reason a parent has brought a toddler to the clinic. The parent states the toddler cries with urination and is sometimes incontinent. The nurse obtains an axillary temperature of 101.2°F (38.4°C). For which additional reason does the nurse suspect a urinary tract infection (UTI)?

The toddler is 3 years of age

The nurse is providing care to a child in the home care setting. The nurse often provides the mother with advice that varies from how to perform the child's medical care to marital advice. The nurse has stated that this is her favorite patient and has made this child's home the last stop of her shift to use her free time for visits. What is the relationship status between the nurse and family?

This is not a therapeutic relationship, as the nurse has become enmeshed within the family

The nurse assesses the pain level of a school-age patient who is receiving end-of-life care and determines a need for pain medication. The physician has prescribed morphine sulfate to be administered either orally or rectally. For which reason will the nurse decide to administer the medication orally?

To prevent the patient from being embarrassed by rectal administration

A school-aged child is refusing to use her right hand to write or type in the classroom. The child states that her wrist hurts. There is no apparent deformity, but the wrist is swollen. The child reports crashing her bike and landing on her hand 2 days prior. If fractured, which type of fracture does the child likely suffer from?

Torus Fracture. Rationale: The torus fracture occurs when the bone buckles but does not break. It is often diagnosed days after the injury and is often in the radius or ulna.

A parent brings a 12-month-old toddler to the pediatrician because the toddler cries a lot and then stops on her own. The parent has noticed a little blood in the diaper every time it is wet. Assessment reveals a temperature of 101.3°F (38.5°C). Which condition does the nurse anticipate after a urinalysis?

Urinary Tract Infection

The nurse is providing care for a pediatric patient who is 11 years of age. The patient is diagnosed with an aggressive form of cancer and is scheduled to begin chemotherapy. The patient tells the nurse, "I think I am going to die, but I also think I will get much sicker first." Which communication by the nurse is most appropriate for this patient?

Use basic terms to explain the disease progression and side effects of treatment T

The nurse in a pediatric oncology unit understands that painful tests and treatments are common for children with cancer. Which interventions does the nurse decide to use to help manage pain for a 6-year-old patient scheduled for diagnostic testing?

Use language that is age appropriate for the child

The nurse is providing care for a 4-year-old child diagnosed with non-Hodgkin's lymphoma. The nurse is aware that multiple blood samples are ordered, and the child is scheduled for a lumbar puncture with bone marrow aspiration. Which intervention will the nurse plan to prepare the patient for the testing?

Use simple terms and provide needless syringe for treatment on a stuffed animal

A school nurse is examining a third-grade student complaining of a small lump on her head. After parting the hair, it is evident that a tick has embedded into the scalp. Which nursing intervention should the school nurse take?

Use tweezers or forceps to remove the tick, pulling up with steady pressure. Rationale: The tick should be removed with tweezers. A steady pressure should be applied while pulling upward.

A parent brings his school-age child to the clinic for a rash that developed over the face, trunk, and extremities. Which question should the nurse ask the parent when assessing the patient?

Was the child exposed to anyone with a respiratory infection. Rationale: These symptoms are indicative of fifth disease, which is transmitted through respiratory secretions. Assessing whether the patient was exposed to anyone with a respiratory infection would be appropriate.

An eighth-grade student appears in the school infirmary with a skin manifestation that itches. He states that it began on the way to school after he took a shortcut through a field. The nurse performs a skin assessment and finds areas of erythema with streaks and patches on both legs. She determines that he is exhibiting signs of contact dermatitis. What is the first action that the nurse should take?

Wash the area thoroughly with soap and water. Rationale: Washing the exposed area with soap and water should be done immediately to remove the resin oils that are causing the irritation.

A 5-year-old child is brought to the urgent care center for treatment of a bite. The nurse asks what happened, and the parent explains that the child disturbed their pet cat while it was sleeping. The cat was started and bit the child. Which intervention should the nurse perform first?

Wash the wound with large amounts of sterile saline under pressure. Rationale: The nurse should give immediate wound care. Wounds may be irrigated under pressure with large amounts of sterile saline.

The nurse on a pediatric unit is providing care for a preschool child with syndrome of inappropriate antidiuretic hormone (SIADH). The parents brought the child to the hospital to receive IV therapy. Which statements by the parents indicate to the nurse that the child is receiving appropriate care? Select all that apply.

We recognized the symptoms of sodium depletion The confusion, headache, and irritability are unusual She loves her new little bracelet and shows it to everyone

The nurse is assessing a 4-month-old infant during a routine well-baby visit. During the neurological assessment, which finding is a reason for concern?

When the cheek is brushed, the head is turned toward the stimuli

A 9-year-old male patient arrives at the emergency department with suprapubic tenderness, nausea, vomiting, and painful urination. Which laboratory result does the nurse expect from a urinalysis?

White blood cells: 15,000 cells/microL

The mother of a 6-week-old patient calls the physician's office and reports her infant is irritable, running a fever, holds his hip in an "unusual" position, and was recently given antibiotics for an ear infection. Which response by the nurse is most appropriate?

You need to take him to the walk-in clinic or emergency room for evaluation. Rationale: The infant is demonstrating symptoms of possible septic arthritis of the hip and needs immediate evaluation for the possible condition.

A nurse is completing preoperative care teaching with an adolescent client who is scheduled to receive spinal instrumentation for scoliosis. Which of the following information should the nurse include in the teaching?

You will need to receive blood. Rationale: Clients who have spinal instrumentation for scoliosis have a lengthy surgery with blood loss and require blood replacements.