pediatric hesi part 1

Preoperative nursing care for a child w/ Wilm's tumor should include which intervention?

put a sign on the bed reading, "DO NOT PALPATE ABDOMEN"

Following the administration of immunizations to a 6-month-old girl, the nurse provides the family with home care instructions. Which statement by the mother indicates that further teaching is needed?

"I will give her a baby aspirin every 4 hours as needed for fever." Rationale: Although fever may occur, non-aspirin-containing medications should be used because of the risk of Reye's syndrome

The nurse is taking the family history of a 2-year-old child with atopic dermatitis (eczema). Which statement by the mother is most important in formulating a plan of care for this child?

"My husband and our daughter are both lactose-intolerant." Rationale: Environmental exposure to allergens (milk) and a positive family history for milk allergies are important data in planning care of the child with atopic dermatitis because milk allergies can contribute to the child's outbreaks.

A 7-month-old male infant diagnosed with spastic cerebral palsy is seen by the nurse in the clinic. Which statement by the parent warrants immediate intervention by the nurse?

"My son often chokes while I am feeding him." Rationale: Airway obstruction is always a priority when caring for any client

The nurse is assessing a male adolescent client's knowledge of contraception. The teen states, "I have all the info I need." What is the best response by the nurse?

"Tell me what you know about birth control." Rationale: Teens often obtain information from peers, which may not be accurate. Knowing the source of the information may assist the nurse in evaluating the information that the teenager has regarding contraception

A woman whose first child died at 6 weeks of age because of sudden infant death syndrome (SIDS) is being discharged following the birth of her second child. The mother tells the nurse that she is fearful that this infant will also develop SIDS. Which response is best for the nurse to provide this woman?

"The fear of losing another child to SIDS is very realistic. Have you thought about what support you may need?" Rationale: The most effective way to provide emotional support is to acknowledge what clients may be feeling, be a sounding board for them so they can listen to themselves, and allow them to discover their own solutions

Ampicillin, 75 mg/kg, is prescribed for a 22-lb child. It is available in a solution that contains 250 mg/5 mL. How many milliliters should the nurse administer in one dose?

15 Rationale: Take 22lbs / 2.2 = 10kg 10kg X 75mg/kg = 750mg 750/250 mg = 3mg X 5mL = 15

The mother of a 6-month-old asks the nurse when her baby will get the first measles, mumps, and rubella (MMR) vaccine. Based on the recommended childhood immunization schedule published by the Centers for Disease Control, which response is accurate?

12 to 15 months

A 6 month old returns fr. surgery w/ elbow restraints in place. What nursing care should be included when caring for any restrained child?

remove restraitnts one at a time and provide range of motion exercises

A nurse who is working in the Poison Control Center receives several telephone calls from parents whose children have ingested possible poisons. The nurse should recommend inducing vomiting for which child?

16-month old who drank 2 ounces of acetaminophen (Tylenol) elixir.

The nurse is preparing a teaching plan for the mother of a child who has been diagnosed with celiac disease. Choosing which lunch will be within the therapeutic management of a child with celiac disease?

Baked chicken, coleslaw, soda, and frozen fruit dessert Rationale: A child with celiac disease is managed on a gluten-free diet, which eliminates food products containing oats, wheat, rye, or barley

The nurse observes a 4-year-old boy in a day care setting. Which behavior should the nurse expect this child to exhibit?

Boasts aggressively when telling a story Rationale: Four-year-old children are aggressive in their behavior and enjoy telling tales

The mother of a preschool-aged child asks the nurse if it is all right to administer Pepto Bismol to her son when he "has a tummy ache." After reminding the mother to check the label of all over-the-counter drugs for the presence of aspirin, which instruction should the nurse include when replying to this mother's question?

Do not give if the child has chickenpox, the flu, or any other viral illness.

Which action by the nurse is most helpful in communicating w/ a preschool aged child?

use a doll to play and communicate

Which assessment finding(s) should the nurse expect when caring for a child with cystic fibrosis? (Select all that apply.)

Steatorrhea Foul-smelling stools Delayed growth Pulmonary congestion

A child with cystic fibrosis is having stools that float and are foul smelling. Which descriptive term should the nurse use to document the finding?

Steatorrhea.

As part of the physical assessment of children, the nurse observes and palpates the fontanels. Which child's fontanel finding should be reported to the healthcare provider?

A 6-month-old with failure to thrive that has a closed anterior fontanel.

Surgery is being delayed for an infant with undescended testes. In collaboration with the healthcare provider and the family, which prescription should the nurse anticipate

A trial of human chorionic gonadotrophic hormone

A child is admitted to the hospital for confirmation of a diagnosis of acute lymphoblastic leukemia. During the initial nursing assessment, which symptoms will this child most likely exhibit?

Bone pain, pallor Rationale: Leukemic cells invade the bone marrow, gradually causing a weakening of the bone and a tendency toward pathologic fractures. As leukemic cells invade the periosteum, increasing pressure causes severe pain and anemia results from decreased erythrocytes, causing pallor.

A 3-week-old infant is referred to an orthopedic clinic because the pediatrician heard a click when flexing the child's right hip during a routine physical examination. The orthopedic physician suspects that the child might have developmental dysplasia of the hip (DDH). The parents ask the nurse to identify risk factors commonly associated with DDH. Which response is accurate?

Breech presentation

In making the initial assessment of a 2-hour-old infant, which finding should lead the nurse to suspect a congenital heart defect?

Diminished femoral pulses Rationale: Diminished femoral pulses (D) could indicate coarctation of the aorta.

The nurse expects a 2-year-old child to exhibit which behavior?

Display possessiveness with toys. Rationale: Two-year-old children are egocentric and unable to share with other children.

During administration of a blood transfusion, a child complains of chills, headache, and nausea. Which action should the nurse implement?

Stop the infusion immediately and notify the healthcare provider

During administration of a blood transfusion, a child complains of chills, headache, and nausea. Which action should the nurse implement?

Stop the infusion immediately and notify the healthcare provider.

The nurse is planning the care of a 2 year old w/ severe eczema on the face, next, and scalp fr. scratching the affected areas. Which nursing intervention is most effective in preventing further excoriation due to the purities?

place elbow restraints on the child's arms.

At 8 a.m. the unlicensed assistive personnel (UAP) informs the charge nurse that a female adolescent client with acute glomerulonephritis has a blood pressure of 210/110. The 4 a.m. blood pressure reading was 170/88. The client reports to the UAP that she is upset because her boyfriend did not visit last night. What action should the nurse take first?

Administer PRN prescription of nifedipine (Procardia) sublingually.

To assess the effectiveness of an analgesic administered to a 4-yr old, what intervention is best for the nurse to implement?

use a happy-face/sad face pain scale.

The nurse is teaching the parents of a 5-year-old with cystic fibrosis about respiratory treatments. Which statement indicates to the nurse that the parents understand?

Administer aerosol therapy followed by postural drainage before meals.

Which intervention(s) should the nurse include in the teaching plan for the mother of a 6-year-old who is experiencing encopresis secondary to a fecal impaction? (Select all that apply.)

Administer mineral oil daily. Eliminate dairy products. Initiate consistent toileting routine. Rationale: Encopresis is fecal incontinence, usually as the result of recurring fecal impaction and an enlarged rectum caused by chronic constipation. Encopresis is managed through bowel retraining with mineral oil, eliminating dairy products, and initiating a regular toileting routine. A high-fiber diet and increased daily fluids are components of care for a child with encopresis.

A 16-year-old is brought to the Emergency Center with a crushed leg after falling off a horse. The adolescent's last tetanus toxoid booster was received eight years ago. What action should the nurse take?

Administer tetanus toxoid booster.

The nurse should teach the parents of a child with a cyanotic heart defect to perform which action when a hypercyanotic spell occurs?

Allow the child to assume a knee-chest position, with the head and chest slightly elevated. Rationale: Assuming a knee-chest position with the head and chest slightly elevated will help restore hemodynamic equilibrium.

Which nursing intervention(s) is (are) therapeutic when caring for a hospitalized toddler? (Select all that apply.)

Allow the toddler to choose a colored Band-Aid after an injection & Give brief but simple explanations to the child before procedures. Rationale: Giving the toddler a choice may increase autonomy in the hospitalized setting. Brief but simple explanations are beneficial with the toddler. Separation from the parent can cause emotional distress. Regression is expected, and bedwetting is not an indication for a urinary catheter. The nurse should encourage age-appropriate toys to be brought in from home.

Which nursing diagnosis has the highest priority when planning care for an infant with eczema?

Altered comfort (pruritus) related to vesicular skin eruptions Rationale: Altered comfort (pruritus) has the highest priority because itching will cause the infant to scratch, creating complications such as scarring or infection.

A 6-month-old infant w/ congestive heart failure (CHF) is receiving digoxin elixir. Which observation by the nurse warrants immediate intervention?

Apical heart rate of 60

A 2-year-old child recently diagnosed with hemophilia A is discharged home. What information should the nurse include in a teaching plan about home care?

Apply pressure and ice for bleeding while elevating and resting the extremity.

During routine screening at a school clinic, an otoscope examination of a child's ear reveals a tympanic membrane that is pearly gray, slightly bulging, and not movable. Based on these findings, what action should the nurse take?

Ask if the child has had a cold, runny nose, or any ear pain lately. Rationale: The tympanic membrane is normally pearly gray, not bulging, and moves when a client blows against resistance or when a small puff of air is blown into the ear canal. Because these findings are not completely normal, further assessment of history and related signs and symptoms are needed to interpret the findings accurately.

The nurse is conducting an initial admission assessment of a 12-month-old child in celiac crisis. Which intervention is most important for the nurse to implement?

Assess the child's mucous membranes and skin turgor Rationale: An infant having a celiac crisis has severe diarrhea and is at high risk for fluid volume deficit. The nurse should first assess for indications of fluid volume deficit

A child is rescued from a burning house and brought to the emergency room with partial-thickness burns on the face and chest. Which action should the nurse implemented first?

Assess the child's respiratory status

In developing a teaching plan for a 5 year old child w/ diabetes, which component of diabetic management should the nurse plan for the child to manage first?

process of glucose testing

A mother calls the clinic because her 6-year-old son, who has been taking prescribed antibiotics for 7 of the previous 10 days, continues to have a cough that she reports is worsening. Further questioning by the nurse reveals that the cough is nonproductive. What advice should the nurse provide to this mother?

Bring the child to the clinic today for an examination related to the cough. Rationale: The child should be evaluated as soon as possible for pneumonia. Antibiotics usually improve symptoms during the first few days of treatment but should be continued for the full prescribed course. A continued cough after 7 days of antibiotic treatment may indicate an infectious process in the lower lungs, which could cause a nonproductive cough. Children with pneumonia can deteriorate unexpectedly and rapidly and can become seriously ill, with no sputum production

A 4-year-old boy was admitted to the emergency room with a fractured right ulna and a short arm cast is applied. When preparing the parents to take the child home, which discharge instruction has the highest priority?

Call the healthcare provider immediately if his nail beds appear blue.

When taking the health history of a child, the nurse knows that which finding is an early indication of hypothyroidism in children?

Cessation of growth in a child that had been normal.

A 4-year-old girl continues to interrupt her mother during a routine clinic visit. The mother appears irritated with the child and asks the nurse, "Is this normal behavior for a child this age?" The nurse's response should be based on which information?

Children need to retain a sense of initiative without impinging on the rights and privileges of others.

A full term infant is admitted to the newborn nursery. After careful assessment, the nurse suspects that the infant may have an esophageal atresia. Which symptoms are this newborn likely to exhibit?

Choking, coughing, and cyanosis.

A 2-year-old child with Down syndrome is brought to the clinic for his regular physical examination. The nurse knows which problem is frequently associated with Down syndrome?

Congenital heart disease.

A 3-year-old boy is brought to the emergency room because he swallowed an entire bottle of children's vitamin pills. Which intervention should the nurse implement first?

Determine the child's pulse and respirations.

Which restraint should be used for a toddler after a cleft palate repair?

Elbow

The mother of a 4-year-old child asks the nurse what she can do to help her other children cope with their sibling's hospitalizations. Which is the best response that the nurse should offer?

Encourage the mother to have the children visit the hospitalized sibling.

The nurse is having difficulty communicating with a hospitalized 6-year-old child. Which approach by the nurse is most helpful in establishing communication?

Engage the child through drawing pictures.

The nurse is teaching the parents of a 2-year-old child with a congenital heart defect about signs and symptoms of congestive heart failure. Which information about the child is most important for the parents to report to the health care provider?

Exhibits a sudden and unexplained weight gain Rationale: Sudden and unexplained weight gain (B) can indicate fluid retention and is a sign of congestive heart failure.

A 6-year-old is admitted to the pediatric unit after falling off a bicycle. Which intervention should the nurse implement to assist the child's adjustment to hospitalization?

Explain hospital schedules to the child, such as mealtimes.

A 15-year-old girl tells the school nurse that all of her friends have started their periods and she feels abnormal because she has not. Which response is best for the nurse provide?

Explain that menarche varies and occurs between the ages of 12 and 18 years

The nurse admits a child to the intensive care unit with a diagnosis of acquired aplastic anemia. What is the most common cause of this type of anemia?

Exposure to certain drugs Rationale: Aplastic anemia often follows exposure to certain drugs such as chloramphenicol, sulfonamides, and phenylbutazone (Butazolidin), insecticides such as DDT, and chemicals, especially, benzene.

During discharge teaching of a child with juvenile rheumatoid arthritis, the nurse should stress to the parents the importance of obtaining which diagnostic testing?

Eye exams.

The nurse is developing a plan of care for a 3-year-old who is scheduled for a cardiac catheterization. To assist in decreasing anxiety for the child on the day of the procedure, which intervention is best for the nurse to implement?

Give the child a ride on a gurney to visit the cardiac catheterization lab and meet a nurse who works there.

A 12-month-old boy is admitted with a respiratory infection and possible pneumonia. He is placed in a mist tent with oxygen. Which nursing intervention has the greatest priority for this infant?

Have a bulb syringe readily available to remove secretions

A burned child is brought to the emergency department, and the nurse uses a modified rule of nines to estimate the percentage of the body burned. When calculating the percentage of burn, which parts of the child's body is proportionally larger than an adult's?

Head and neck Rationale: The standard rule of nines is inaccurate for determining burned body surface areas with children because a child's head and neck are proportionately larger than an adult's. Specially designed charts are commonly used to measure the percentage of burn in children.

The nurse is giving preoperative instruction to a 14-year-old female client who is scheduled for surgery to correct a spinal curvature. Which statement by the client best demonstrates that learning has taken place?

I understand that I will be in a body cast and I will show you how you taught me to turn

A 7-month-old infant with a rotavirus causing severe diarrhea is admitted for treatment. Which intervention should the nurse implement first?

Insert an intravenous (IV) line and begin IV fluids. Rationale: An infant with severe diarrhea is at high risk for dehydration, so the nurse's priority is to initiate IV fluids

The nurse is examining a male child experiencing an exacerbation of juvenile rheumatoid arthritis (JRA) and notes that his mobility is greatly reduced. What is the most likely cause of the child's impaired mobility?

Joint inflammation Rationale: Joint inflammation and pain are the typical manifestations of an exacerbation of JRA

When caring for a child with congenital heart disease and polycythemia, which nursing intervention has the highest priority?

Maintaining adequate hydration Rationale: The key word in this question is polycythemia. Hydration decreases blood viscosity and the risk for thrombus formation, the most common complication of polycythemia.

When inserting a nasogastric tube into the stomach of a 3-month-old infant, which nursing intervention is most important to implement?

Monitor the infant's heart rate

A 3-month-old infant develops oral thrush. Which pharmacologic agent should the nurse plan to administer for treatment of this disorder?

Nystatin (Mycostatin).

Which preoperative nursing intervention should be included in the plan of care for an infant with pyloric stenosis?

Observe for projectile vomiting. Rationale: Projectile vomiting (D), the classic sign of pyloric stenosis, contributes to metabolic alkalosis.

An infant is receiving digoxin (Lanoxin) for congestive heart failure. The apical heart rate is assessed at 80 beats/min. What intervention should the nurse implement?

Obtain a therapeutic drug level. Rationale: Sinus bradycardia (heart rate < 90 to 110 beats/min in an infant) is an indication of digoxin toxicity, so assessment of the client's digoxin level has the highest priority.

The nurse is assessing the neurovascular status of a child in Russell's traction. Which finding should the nurse report to the healthcare provider?

Pale bluish coloration of the toes

When discussing discipline with the mother of a 4-year-old child, the nurse should include which guideline?

Parental control should be consistent.

A newborn female whose mother is HIV-positive is scheduled for the first follow-up assessment with the nurse. If the child is HIV-positive, which initial symptom is she most likely to exhibit?

Persistent cold Rationale: Respiratory tract infections commonly occur in the pediatric population, but the child with AIDS has a decreased ability to defend the body against these common infections. Thus, the most typical presenting symptom of a child who contracted AIDS through vertical transmission (i.e., from the mother during delivery) is a persistent cold or respiratory infection

A child with a permanent tracheostomy is confined to a wheelchair and is going to school for the first time tomorrow. During the school day, which intervention should be implemented for this child?

Place suctioning supplies on the back of the wheelchair when transporting. Rationale: Suctioning supplies should always be readily available for use with any client who has a tracheostomy.

A child breaks out with varicella infection (chickenpox) while hospitalized for a minor surgical procedure. Which intervention should the nurse implement first?

Place the child in strict isolation to prevent an outbreak on the unit. Rationale: The period of communicability of varicella is 2 days before the rash appears until all lesions are crusted; varicella is spread by direct or indirect contact of saliva or vesicles. Strict isolation is indicated to prevent further exposure to staff and others. Staff who have had varicella or the vaccine are not susceptible to contracting or spreading the virus and should be the only personnel assigned to care for this client

A nurse provides the parents with information on health maintenance for their child with sickle cell disease. Which information reflected by the parents indicates understanding of the child's care?

Plenty of fluids should be consumed daily.

An infant is born with a ventricular septal defect (VSD) and surgery is planned to correct the defect. The nurse recognizes that surgical correction is designed to achieve which outcome?

Prevent the return of oxygenated blood to the lungs.

When evaluating the effectiveness of interventions to improve the nutritional status of an infant with gastro-esophageal reflux, which intervention is most important for the nurse to implement?

Record weight daily.

The nurse is preparing a child with an intussusception for a prescribed barium enema. What is the main purpose of conducting this procedure prior to surgical intervention?

Reduce the invaginated bowel segment. Rationale: Intussusception, an invagination or telescoping of one portion of the intestine into another, causes intestinal obstruction in children (usually occurs between 3 months and 5 years of age). Nonsurgical treatment is attempted with hydrostatic pressure created by barium instillation, which often reduces the area of bowel intussusception, thereby negating the need for surgical intervention.

A 6-month-old male infant is admitted to the postanesthesia care unit with elbow restraints in place. He has an endotracheal tube and is ventilator-dependent but will be extubated soon following recovery from anesthesia. Which nursing intervention should be included in this child's plan of care?

Remove restraints one at a time and provide range-of-motion exercises. Rationale: Removing restraints one at a time is safer than simultaneously. The infant should have the restrained extremities assessed frequently for signs of neurologic or vascular impairment, and range-of-motion exercises should be performed with these assessments. Under no circumstances should restraints be applied to the client continuously. Documentation of assessment findings regarding the restrained extremities must occur much more frequently than every 72 hours; however, the reason for using restraints must be justified and should be stated in the medical record.

The nurse is teaching an adolescent girl with scoliosis about a Milwaukee brace that her health care provider has prescribed. Which instruction should the nurse provide to this client?

Remove the brace 1 hour each day for bathing only. Rationale: The Milwaukee brace is designed to slow the progression in spinal curvature while the adolescent is growing. The brace should be worn 23 hours a day and removed a total of 1 hour a day for hygiene. There are no specific exercises for increasing the range of motion in the back that should be performed. A T shirt should be worn next to the body and the brace put on over the T shirt to protect the skin. The brace will not cure the spinal curvature but should slow the progression of the scoliosis.

To take the vital signs of a 4-month-old child, which order provides the most accurate results?

Respiratory rate, heart rate, then rectal temperature

An 18-month-old is admitted to the hospital with possible Hirschsprung's disease. When obtaining a nursing history, the nurse asks about bowel habits. What description of the disease?

Ribbon-like and brown.

The nurse reviews the latest laboratory results for a child who received chemotherapy last week and identifies a reduced neutrophil count. Which nursing diagnosis has the highest priority for this child?

Risk for infection

A child comes to the school nurse complaining of itching. Further assessment reveals that the child has impetigo. What action should the nurse take?

Send the child home with the parents to see the health care provider before returning to school. Rationale: Impetigo is a staphylococcal infection and is transmitted by person-to-person contact. The child should be sent home with a note to the parents explaining the condition

A 5-month-old is admitted to the hospital with vomiting and diarrhea. The pediatrician prescribes dextrose 5% and 0.25% normal saline with 2 mEq KCl/100 ml to be infused at 25 ml/hour. Prior to initiating the infusion, the nurse should obtain which assessment finding?

Serum BUN and creatinine levels

An 18-month-old child returns to the unit following a cardiac catheterization with a cannulated femoral artery site. Which intervention should the nurse implement?

Show the parents how to hold the child with the extremity extended. Rationale: The extremity should be extended to prevent trauma to the femoral catheterization site

The nurse notes that a 16-year-old male client is refusing visits from his classmates. Further assessment reveals that he is concerned about his edematous facial features. Based on these assessment findings, the nurse should plan interventions related to which nursing diagnosis?

Social isolation Rationale: Peer acceptance and body image are significant issues in the growth and development of adolescents. The answer addresses the problem of a lack of contact with peers stemming from his desire to protect his ego.

The nurse is preparing a health teaching program for parents of toddlers and preschoolers and plans to include information about the prevention of accidental poisonings. It is most important for the nurse to include which instruction?

Store all toxic agents and medicines in locked cabinets. Rationale: The only reliable way to prevent poisonings in young children is to make the items inaccessible

A father of a 5-year-old boy calls the nurse to report that his son, who has had an upper respiratory infection, is complaining of a headache, and his temperature has increased to 103° F, taken rectally. Which intervention has the highest priority?

Tell the parent to take the child to the emergency department. Rationale: The child is exhibiting symptoms that may indicate possible meningitis, and the parents should be encouraged to get immediate evaluation

Which class of antiinfective drugs is contraindicated for use in children under 8 years of age?

Tetracyclines.

A premature newborn girl, born 24 hours ago, is diagnosed with a patent ductus arteriosus (PDA) and placed under an oxygen hood at 35%. The parents visit the nursery and ask to hold her. Which response should the nurse provide to the parents?

The oxygen hood is holding the baby's oxygen level just at the point which is needed. You may stroke and talk to her.

The clinic nurse is taking the hx for a new 6-month-old client. The mother reports that she took a great deal of aspirin while pregnant. Which assessment should the nurse obtain?

Type of reaction to loud noises

A female teenager is taking oral tetracycline HCL (Achromycin V) for acne vulgaris. What is the most important instruction for the nurse to include in this client's teaching plan?

Use sunscreen when lying by the pool.

The mother of a 2-year-old boy consults the nurse about her son's increased temper tantrums. The mother states, "yesterday he threw a fit in the grocery store, and I did not know what to do. I was so embarrassed. What can I do if this occurs again?" Which recommendation is best for the nurse to provide this mother?

Walk away from him and ignore the behavior

A 14-year-old female client tells the nurse that she is concerned about the acne she has recently developed. Which recommendation should the nurse provide?

Wash the hair and skin frequently with soap and hot water.

A child falls on the playground and is brought to the school nurse with a small laceration on the forearm. Which action should the nurse implement first?

Wash the wound gently with mild soap and water.

The nurse is assigning care for a 4-year-old child with otitis media and is concerned about the child's increasing temperature over the past 24 hours. When planning care for this child, it is important for the nurse to consider that

a tympanic measurement of temperature will provide the most accurate reading

The nurse received a lab report stating a child w/ asthma has theophyline level of 15 mcg/dl. What action will the nurse take?

a. Hold the next dose of theophylline Therapeutic levels of theophylline is 10-20 mcg/dl, so the child's level is w/in the therapeutic rage.

Which menu selection by a child w/ celiac disease indicates to the nurse that the child understands necessary dietary considerations?

a. Oven baked potato chips & cola Celiac disease causes an intolerance to the protein gluten found in oats, rye, wheat, and barley. The child should avoid any produces containing these indredients to avoid symptoms such as diarrhea.

The nurse is assessing a 13 yr old girl w/ susptected hyperthyroidism. Which question is most important for the nurse to ask her during the admission interview?

are you experiencing any type of nervousness?

The nurse is caring for a 12 year-old w/ Syndrome of Inappropriate Antidiuretic Hormone (SIADH). This child should be carefully assessed for which complication?

changes in LOC

The nurse is assessing an 8 month old child who has a medical diagnosis of tetrology of Fallot. Which symptom is the client most likely to exhibit?

clubbed fingers

A 2-year-old child with gastro-esophageal reflux has developed a fear of eating. What instruction should the nurse include in the parents' teaching plan?

consistently follow a set mealtime routine.

a 6- year old admitted to the pediatric unit after falling of a bicycle. Which intervention should the nurse implement to assist the child's adjustments to hospitalization?

establishing an individual schedule familiarizes the child to the hospital environment and decreases anxiety.