Pediatrics: Pediatric: Preschool -age ?s

What is preschool age?

2 ½ to 4 ½ years old; children in a pre-kindergarten class are generally 4 or 5 years old.

90-90 traction.

Skeletal traction applied to a lower extremity

What is the most common intra-abdominal tumor in children?

Wilms tumor

A nurse is preparing a 4-year-old child for surgery. Which is the best nursing intervention? A. Allowing the child to wear underwear if desired. B. Sharing the plan for pain control with the child. C. Ensuring that the child has only favorite foods for 24 hours. D. Explaining the surgery in detail.

Correct response: A. Allowing the child to wear underwear if desired. Explanation: Allowing the preschool-age child to make choices during the preoperative period helps to relieve fear and anxiety, so allowing a child to wear underwear during the preoperative period is most appropriate. Preschool-age children have short attention spans and active imaginations; sharing detailed explanations about the pain management plan or procedure may increase anxiety. Promising only favorite foods is unrealistic.

A nurse is caring for a preschool-age client with a neuroblastoma who has been receiving chemotherapy for the last 4 weeks. His laboratory test results indicate a Hgb of 12.5 g/dL (125 g/L), HCT of 36.8% (0.37), WBC of 2000 mm3 (2 X 109/L), and platelet count of 150,000/μL (150 X 109/L). Based on the child's values, what is the highest priority nursing intervention? A. Encourage meticulous handwashing by the client and visitors. B. Prepare to give the child a transfusion of platelets. C. Encourage mouth care with a soft toothbrush. D. Prepare to give the child a transfusion of packed red blood cells.

Correct response: A. Encourage meticulous handwashing by the client and visitors. Explanation: A WBC of 2000 mm3 (2 X 109/L) is low and increases the child's risk for infection. Meticulous handwashing is a standard/routine precaution and the first line of defense in combating infection. A platelet count of 150,000 ?L (150 X 109/L) is within normal range, so there is no need to transfuse the child with platelets. Mouth care will help decrease the risk of infection. However, handwashing is the priority because it will have the greatest effects on diminishing the risk of infection. A Hgb of 12.5 g/dL (125 g/L) and a HCT of 36.8% (0.37) are within normal range so there is no need to transfuse packed red blood cells.

A child is being discharged after being diagnosed with an asthma attack. What information regarding the rescue inhaler is most important for the nurse to include in discharge teaching? A. Monitor heart rate. B. Report nausea and vomiting. C. Watch for hyperactivity. D. Record changes in taste.

Correct response: A. Monitor heart rate. Explanation: Albuterol (salbutamol) is a beta-adrenergic blocker bronchodilator used to relieve bronchospasms associated with acute or chronic asthma or other obstructive airway diseases as a rescue inhaler. Signs and symptoms of albuterol toxicity that the nurse should instruct the parents to watch for include tachycardia, restlessness, nausea, vomiting, dizziness, and a bad taste in the mouth. While all of these are potential side effects, tachycardia and heart palpitations are the most serious, so monitoring the heart rate is most important to include in discharge teaching.

The nurse is observing the parents of a 4-year-old child who has been admitted to the hospital. Which of the following actions indicate that the parents understand how to best minimize anxiety during their child's hospitalization? Select all that apply. A. The parents bring the child's favorite toy to the hospital. B. The parents explain all procedures to the child in great detail. C. The parents remain at the child's side during the hospitalization. D. The parents bring the child's siblings for a brief visit. E. The parents leave the room when the child undergoes a painful procedure. F. The parents punish the child if the child is not cooperative.

Correct response: A. The parents bring the child's favorite toy to the hospital. C. The parents remain at the child's side during the hospitalization. D. The parents bring the child's siblings for a brief visit. Explanation: The most effective means of minimizing the child's anxiety during hospitalization is to have the parents stay. Having a familiar toy helps the child to deal with the anxiety of unfamiliar surroundings. Sibling visitation can also help to ease the child's anxiety. Explaining a procedure to a young child in great detail only maximizes fear. Parents can be effective in calming and comforting a child during painful procedures, so they should remain in the room. Rewards, not punishment, should be offered to a preschooler.

The mother asks the nurse why peanuts are one of the worst things a child can aspirate. What should the nurse include in the explanation as the main reason for the problem associated with aspirating peanuts? A. They swell when wet. B. They contain a fixed oil. C. They decompose when wet. D. They contain sodium.

Correct response: A. They swell when wet. Explanation: Peanuts swell and become soft when moistened with bronchial secretions, making them difficult to remove. Although peanuts contain a fixed oil that can cause lipoid pneumonia, begin to decompose when wet, and contain sodium, these factors do not make them particularly dangerous when aspirated.

A child is being seen in the emergency department for reports of severe sore throat, trouble swallowing, and fever. The child has swollen cervical lymph nodes and a fiery red pharynx on examination. Which assessment findings below should be reported immediately to the healthcare provider? A. drooling and not swallowing B. coughing and sneezing C. loud snoring and noisy respirations D. sudden onset of ear pain

Correct response: A. drooling and not swallowing Explanation: Drooling and refusal to open mouth indicate a potentially life-threatening situation as the child may be unable to swallow and have a severely narrowed throat. Coughing or sneezing does not indicate a priority problem. Noisy respirations could be indicative of a pending problem; however, the drooling is a higher priority. Sudden onset of ear pain is not as high a priority problem as the drooling and the inability to swallow.

A parent of a child with hemophilia states that she worries whenever the child has a bump or cut. The nurse should explain that after the area is cleansed, the wound should be treated by applying which measure? A. gentle pressure B. warm, moist compresses l C. a tourniquet above the injured area D. a wet-to-dry dressing

Correct response: A. gentle pressure Explanation: In children with hemophilia (an inherited bleeding disorder), a bump or cut can cause serious bleeding. After the injured area is cleansed, gentle pressure should be applied to allow clot formation, which will help stop the bleeding. In addition, the area should be immobilized and elevated. Cold applications, instead of warm moist compresses, are commonly used to promote vasoconstriction and help control the bleeding. A tourniquet should not be used because of the high risk of tissue hypoxia and resulting necrosis. Wet-to-dry dressings should be avoided because they could be irritating to the area.

A child experiences nausea and vomiting after receiving cancer chemotherapy drugs. What is most important for the nurse to include in the plan of care? A. Encourage the child to eat a bland diet after chemotherapy treatment. B. Administer an antiemetic upon completion of chemotherapy treatment. C. Eliminate perfumes and other odors during the chemotherapy session. D. Administer an antiemetic 30 to 60 minutes before the next chemotherapy session.

Correct response: B. Administer an antiemetic 30 to 60 minutes before the next chemotherapy session. Explanation: The nurse should administer an antiemetic 30 to 60 minutes before the chemotherapy session because antiemetics counteract nausea most effectively when given before administration of an agent that causes nausea. Antiemetics also work better when given continuously rather than as needed. A bland diet, eliminating odors, and an antiemetic after chemotherapy may all help to decrease nausea and vomiting, but the most important intervention is preventing the nausea and vomiting by administering an antiemetic before the chemotherapy session.

The parent of a 4-year-old expresses concern that the child may be hyperactive. The parent describes the child as always in motion, constantly dropping and spilling things. Which action would be appropriate at this time? A. Determine whether there have been any changes at home. B. Explain that this is not unusual behavior. C. Explore the possibility that the child is being abused. D. Suggest that the child be seen by a pediatric neurologist.

Correct response: B. Explain that this is not unusual behavior. Explanation: Preschool-age children have been described as powerhouses of gross motor activity who seem to have endless energy. A limitation of their motor ability is that in moving as quickly as they do, they are not always able to judge distances, nor are they able to estimate the amount of strength and balance needed for activities. As a result, they have frequent mishaps. This level of activity typically is not associated with changes at home. However, if the behavior intensifies, a referral to a pediatric neurologist would be appropriate. Children who have been abused usually demonstrate withdrawn behaviors, not endless energy.

x A mother tells the nurse that she wants her 4-year-old to stop sucking her thumb. When developing the teaching plan, the nurse should suggest which intervention? A. Apply a special medicine that tastes terrible on the thumb. B. Get the child to agree to stop the thumb sucking. C. Remind the child every time the mother sees the thumb in her mouth. D. Put the child in time-out every time the mother observes thumb sucking.

Correct response: B. Get the child to agree to stop the thumb sucking. Explanation: A 4-year-old is old enough to be able to cooperate and stop the behavior. Therefore, the first step is to obtain the child's cooperation. When this has occurred, then the mother makes sure it is okay to remind the child when the behavior is viewed. Using a substance that does not taste good is not effective as the child may suck it off, and it does not promote health behavior. The mother also should be encouraged to praise the child when she sees her not engaging in the behavior; "time-out" is considered a punishment and does not promote the desired behavior.

The nurse is caring for a 5-year-old child with a femur fracture. The parent explains that the fracture occurred from a fall. The child's recollection of the event conflicts with the parent's explanation. What is the nurse's immediate responsibility? A. Question the parent about the discrepancy in stories. B. Keep the child safe, and assess for abuse. C. Call the police department to report abuse. D. Restrict parental visitation until abuse is ruled out.

Correct response: B. Keep the child safe, and assess for abuse. Explanation: The assessment for risk is the priority nursing action. This would include verbalizing concerns to the most immediate supervisor and involving hospital social workers and the medical team. These initial steps need to be implemented, and then the appropriate authorities must be alerted. Questioning the parent about the discrepancy is not helpful, and there is no basis for restricting parental visitation at this time.

Parents of a 5-year-old child call the clinic to tell the nurse that they think their child has been abused by the daycare provider. What should the nurse advise them to do first? A. Make an appointment to speak with the daycare provider. B. Schedule an immediate appointment with their healthcare provider. C. Call Child Protective Services to file a complaint. D. Talk to their attorney to file charges against the accused.

Correct response: B. Schedule an immediate appointment with their healthcare provider. Explanation: Because more information needs to be obtained from the child and family, making an immediate appointment is most appropriate. A healthcare provider can also document chief complaints, document recollections, gather physical evidence, and take photographs. It's unclear what type of abuse the parents are concerned about. Calling Child Protective Services is appropriate but isn't the first action to take; the appointment with a healthcare provider should be scheduled before CPS is contacted. Talking to an attorney or the daycare provider are not the first priorities.

A 4-year-old child who has been ill for 4 hours is admitted to the hospital with difficulty swallowing, a sore throat, and severe substernal retractions. The child's temperature is 104° F (40° C), and the apical pulse is 140 bpm. The white blood cell count is 16,000/mm3 (16,000 X 109/L). What is priority for nursing intervention? A. infection B. airway obstruction C. difficulty breathing D. potential for aspiration

Correct response: B. airway obstruction Explanation: The child's signs and symptoms in conjunction with the acute onset suggest possible croup or epiglottitis. The priority diagnosis at this time is airway obstruction. The airway may become completely occluded by the epiglottis at any time. Although the child has an infection, and the client has respiratory distress, the immediate priority is to establish and maintain a patent airway. No evidence is provided to support the potential for aspiration.

During the acute stage of meningitis, a 3-year-old child is restless and irritable. Which intervention would be most appropriate to institute? A. Limiting conversation with the child B. keeping extraneous noise to a minimum C. allowing the child to play in the bathtub D. performing treatments quickly

Correct response: B. keeping extraneous noise to a minimum Explanation: A child in the acute stage of meningitis is irritable and hypersensitive to loud noise and light. Therefore, extraneous noise should be minimized and bright lights avoided as much as possible. There is no need to limit conversations with the child. However, the nurse should speak in a calm, gentle, reassuring voice. The child needs gentle and calm bathing. Because of the acuteness of the infection, sponge baths would be more appropriate than tub baths. Although treatments need to be completed as quickly as possible to prevent overstressing the child, they should be performed carefully and at a pace that avoids sudden movements to prevent startling the child and subsequently increasing intracranial pressure.

After having a blood sample drawn, a 5-year-old child insists that the site be covered with a bandage. When the parent tries to remove the bandage before leaving the office, the child screams that all the blood will come out. The nurse encourages the parent to leave the bandage in place and tells the parent that the child's reaction is based on which factor? A. fearing another procedure B. lacking understanding of body integrity C. expressing severe pain D. attempting to regain control

Correct response: B. lacking understanding of body integrity Explanation: The preschool-age child does not have an accurate concept of skin integrity and can view medical and surgical treatments as hostile invasions that can destroy or damage the body. The child does not understand that exsanguinations will not occur from the injection site. Here, the child is verbalizing a fear consistent with the developmental age. The child would most likely verbalize concerns of not wanting another procedure or exhibit other symptoms associated with pain if those were the underlying issues. If control was the main issue, the child would try to control more than just the bandage removal.

Which toy is most appropriate for a 3-year-old child? A. bicycle B. puzzle with large pieces C. push/pull toy D. computer game

Correct response: B. puzzle with large pieces Explanation: A puzzle is the most appropriate toy because, at age 3, children are expanding their repertoire of motor skills and like to color, draw, and put together puzzles. A bicycle is appropriate for a 5- or 6-year-old child. While a 3-year-old might enjoy playing with a push/pull toy, this is more appropriate for a crawling infant or younger toddler as they further develop gross motor skills and begin to play make-believe. The computer game would be appropriate for a school-age child; the American Academy of Pediatrics recommends no more than 1 hour of high-quality educational screen time for children ages 2 to 5, accompanied by a parent.

The nurse instructs a group of parents about emergency treatment for accidental poisoning and injury. The nurse would need to do further teaching if a participant makes which statement? A. "I should flush my child's eye with room temperature tap water for 15 to 20 minutes if a caustic material gets into it." B. "I should save the emesis if my child vomits." C. "I should call the poison control center if there are any symptoms." D. "I shouldn't induce vomiting unless the poison control center instructs me to."

Correct response: C. "I should call the poison control center if there are any symptoms." Explanation: Many poisons require immediate attention but do not cause immediate symptoms. Therefore, parents who believe that a child has ingested or otherwise been exposed to a poisonous substance should immediately call the Poison Control Center. Eyes should be flushed for 15 to 20 minutes with saline or room temperature tap water. Emesis should be saved for analysis, especially if the type or amount of poison ingested is not clear. Vomiting caustic substances may lead to esophageal or airway damage; therefore, vomiting should only be induced if directed by the Poison Control Center.

The nurse discovers that a young client has been given a dose of morphine four times the dose prescribed. What is the priority action of the nurse? A. Monitor the client's respiratory rate for 5 minutes. B. Follow the facility policy for reporting of the error. C. Obtain naloxone and assess the need for administration. D. Bring emergency resuscitation equipment to the child's room.

Correct response: C. Obtain naloxone and assess the need for administration. Explanation: Naloxone is an opioid antagonist that is given as an antidote for morphine. An antidote is an agent that neutralizes a poison or counteracts its effects. This would be an immediate priority for the nurse. Respiratory depression is a common side effect of opioids, and with a dosage error of this magnitude, it would be the priority to have naloxone ready to administer. Documentation of the error would happen after the client is treated and deemed stable. Emergency resuscitation equipment should be obtained after treating the client if indicated.

For a 3-year-old child with tracheobronchitis, the nurse formulates a nursing diagnosis of ineffective airway clearance related to stasis of secretions. After implementing interventions, what does the nurse indicate as the most desired outcome? A. The child exhibits a respiratory rate of 36 breaths per minute. B. The child exhibits an arterial oxygen saturation of 92%. C. The child exhibits clear breath sounds. D. The child exhibits decreased anxiety.

Correct response: C. The child exhibits clear breath sounds. Explanation: The nurse should expect clear breath sounds because this outcome indicates an improved respiratory status and airway clearance. A respiratory rate of 36 breaths per minute supports a nursing diagnosis of ineffective breathing pattern. An arterial oxygen saturation of 92% supports a nursing diagnosis of impaired gas exchange, and a decrease in anxiety supports the nursing diagnosis of anxiety.

A nurse realizes she is 1 hour and 30 minutes late in administering a dose of medication for a 4-year-old child. She gives the medication immediately, and assesses the child. The child isn't harmed by the delay. Which action should the nurse take next? A. No further action is necessary. B. The nurse should notify the physician of the error. C. The nurse should follow facility procedures for reporting an error. D. The nurse should document a medication error in the client's chart.

Correct response: C. The nurse should follow facility procedures for reporting an error. Explanation: Although no harm came to the child, this scenario is an example of a medication error. The nurse should follow the facility's procedure for reporting the error because it allows the facility to adequately assess the causes of medication errors, and isn't meant to place blame on any one person. The nurse in this instance doesn't need to notify the physician because there was no harm to the child. Also, the nurse shouldn't document that an error took place in the child's chart; doing so may place the nurse at risk in the event of a lawsuit.

The nurse is providing teaching to the parents of a young child with a urinary tract infection. The nurse's goal is to help the parents understand their role in the treatment of the infection. Which statement by the parents lets the nurse know that the teaching has been successful? A. We can treat the infection by increasing oral fluid intake." B. We need to encourage cranberry juice to treat the infection." C. We need to administer the oral antibiotics as prescribed." D. We need to come to the emergency department for IV fluids."

Correct response: C. We need to administer the oral antibiotics as prescribed." Explanation: Oral administration of antibiotics specific to the pathogen is the best course of treatment for a child with a urinary tract infection. Increasing oral fluid or giving cranberry juice may be preventative measures to protect against getting a urinary infection, but they would not treat the infection. Going to the emergency department for IV fluids is not a recommended course of action.

A client with suspected rheumatic fever is admitted to the pediatric unit. When obtaining the client's history, the nurse considers which information to be most important? A. fever that started 3 days ago B. lack of interest in food C. recent episode of pharyngitis D. vomiting for 2 days

Correct response: C. a recent episode of pharyngitis Explanation: Rheumatic fever- A disease that can result from inadequately treated strep throat or scarlet fever. A recent episode of pharyngitis is the most important factor in establishing the diagnosis of rheumatic fever. Although the client may have a history of fever or vomiting or lack interest in food, these findings are not specific to rheumatic fever.

When administering gentamicin to a client, plasma levels should be monitored. In determining the effectiveness of the medication, the nurse assesses A. a serum trough level every morning. B. a serum peak level after the second dose. C. a serum trough and peak level around the third dose. D. serial serum trough levels after three doses (24 hours).

Correct response: C. a serum trough and peak level around the third dose. Explanation: Aminoglycosides such as gentamicin have a narrow range between therapeutic and toxic serum levels. A serum peak and trough level, taken 30 minutes before the dose and 30 minutes after the third dose has been administered, is the most accurate way to determine the correct serum values because the third dose provides enough medication buildup in the bloodstream to be measured. A trough level every morning, a serum peak level after the second dose, and serial serum trough levels will not provide sufficient data about the effectiveness of the antibiotic.

A preschool-aged child with suspected epiglottitis is emitting no sounds during inhalation attempts and begins drooling. What is the nurse's priority action? A. administering oxygen by face mask B. administering parenteral antibiotics C. assisting with tracheotomy D. monitoring the electrocardiogram for arrhythmias

Correct response: C. assisting with tracheotomy Explanation: The child is showing signs of total airway obstruction, so the nurse should immediately prepare to assist with emergency tracheotomy. Supplemental oxygen is required with epiglottitis, but administration by mask or other external device will not be successful once obstruction progresses to this point. The child does need parenteral antibiotics; however, the priority is airway management. The most common rhythm in this client is sinus tachycardia related to compensation. However, monitoring for arrhythmias isn't a priority over airway management.

When teaching a preschool-age child how to perform coughing and deep-breathing exercises before corrective surgery for tetralogy of Fallot, which teaching and learning principle should the nurse address first? A. organizing information to be taught in a logical sequence B. arranging to use actual equipment for demonstrations C. building the teaching on the child's current level of knowledge D. presenting the information in order from simplest to most complex

Correct response: C. building the teaching on the child's current level of knowledge Explanation: Before developing any teaching program for a child, the nurse's first step is to assess the child to determine what is already known. Most older preschool children have some understanding of a condition present since birth. However, the child's interest will soon be lost if familiar material is repeated too often. The nurse can then organize the information in a sequence because there are several steps to be demonstrated. These exercises do not require the use of equipment. The nurse should judge the amount and complexity of the information to be provided, based on the child's current knowledge and response to teaching.

A nurse is finishing a shift on the pediatric unit. Because the shift is ending, which intervention takes priority? A. checking client pain levels for report to the next shift nurse B. checking to see that client orders have been transcribed C. documenting the care provided during the shift D. completing input and output recording for the shift

Correct response: C. documenting the care provided during the shift Explanation: Documentation should take top priority as this is the only way the nurse can legally claim that client interventions were performed. Checking client pain levels should be done throughout the shift and clients should be medicated so that they are not in need during busy change of shift times. Waiting until the end of the shift to review that client orders have been transcribed may lead to a delay in treatment and should be completed in a timely manner throughout the shift. Completing input and output recording can be assigned to a nurse assistant and should be delegated.

A nurse is deciding whether to report a suspected case of child abuse. Which criterion is the most important for the nurse to consider? A. inappropriate parental concern for the degree of injury B. absence of parents to question about the injury C. inappropriate response of the child to the injury D. incompatibility between the child's history and the injury

Correct response: C. incompatibility between the child's history and the injury Explanation: Incompatibility between the history and the injury is the most important criterion on which to base the decision to report suspected child abuse. For example, the child may have a skull fracture but the parents state that the child fell off of the sofa. The other criteria also may suggest child abuse but are less reliable indicators.

A child with lead poisoning is admitted to the facility for chelation therapy. The nurse must stay alert for which adverse effect of chelation therapy? A. anaphylaxis B. chills C. seizures D. heart failure

Correct response: C. seizures Explanation: Chelation therapy removes lead by combining it with another substance to form a soluble compound that the kidneys can excrete. The nurse should stay alert for seizures because as lead is mobilized from bone and other tissues, the serum lead level rises rapidly, increasing the client's risk of seizures. Chelation therapy doesn't cause anaphylaxis, chills, or heart failure.

The nurse teaches a pediatric client about an upcoming procedure. Which approach indicates that the nurse has selected the correct technique for the client's developmental level? A. using dolls and stories to prepare school-age children B. preparing an adolescent a few days in advance of the procedure C. using puppets and storytelling to prepare a preschooler D. preparing a toddler a few hours prior to the procedure

Correct response: C. using puppets and storytelling to prepare a preschooler Explanation: Preschool-age children are best prepared for procedures using play techniques such as puppets and storytelling. School-age children have a grasp of logic and respond well to diagrams, illustrations, videos, and books. Adolescents need to feel that they have had input into their care. They also need more time to build self-confidence. It is best to prepare adolescents a week in advance of a procedure. Toddlers should be prepared just before a procedure will occur.

The mother of a 4-year-old child asks about dental care for her child. "I help brush her teeth every day, and her teeth look healthy," the mother states. "When should I take her to see a dentist?" Which response would be most appropriate? A. "Because you help brush her teeth, there is no need to see a dentist right now." B. Ideally she should have seen a dentist already, but it's still not too late." C. "Your child doesn't need to see the dentist until she starts school." D. "A dental checkup is a good idea even if no problems are noticeable."

Correct response: D. "A dental checkup is a good idea even if no problems are noticeable." Explanation: Routine dental examinations should begin when a child is young, with newer recommendations suggesting visits begin before a child's first birthday, especially in at-risk children. Even though the mother helps the child brush her teeth every day, this does not replace the need for preventative dental visits, which can help reduce dental disease. The statement that the child should have been taken to a dentist already is likely to be interpreted as a reprimand. This tone is not therapeutic and may alienate the mother. There is nothing that can be done about decisions already in the past. Waiting until the child starts school may be too late because dental caries can occur before the age of 2 years.

Parents of a 4-year-old child with sickle cell anemia express a desire to have a second child and question the probability of another child being affected by the disorder. What is the best response by the nurse? A. "Because you have a child with sickle cell anemia, you should speak with a genetic counselor before having another child." B. "Because you have a child with sickle cell anemia, there is a 50% chance of having another child affected." C. "Because you both are carriers of the sickle cell trait, the chances of your next child being affected increase by 50%." D. "Because you both are carriers of the sickle cell trait, there is a 25% chance that your next child will be affected."

Correct response: D. "Because you both are carriers of the sickle cell trait, there is a 25% chance that your next child will be affected." Explanation: Sickle cell anemia is an autosomal recessive disorder, which means that parents who have the recessive gene (trait) have a 1 in 4 (or 25%) chance of having a child affected by the disorder. This probability does not increase in subsequent pregnancies. This couple may be referred to a genetic counselor, but the nurse is able to provide the information requested regarding probability and should answer appropriately.

A 3-year-old child of Vietnamese descent with a fever, decreased urine output, wheezing, and coughing is brought to the emergency department. On examination, the nurse discovers red, round, welt-like lesions on the child's upper back and chest. Which question should the nurse ask next? A. "Has your child been exposed to shingles?" B. "Are you aware of any child abuse?" C. "Does your child have any allergies?" D. "Can you tell me about any cultural practices in your family?"

Correct response: D. "Can you tell me about any cultural practices in your family?" Explanation: The nurse should consider that the lesions may be caused by cultural practice. Many Vietnamese people perform coining, a cultural practice in which a coin is repeatedly rubbed lengthwise on the oiled skin to rid the body of a disease. Coining can produce welt-like lesions on the child's back or chest, and children subjected to the practice are commonly thought to have been abused. Interviewing the family and assessing its cultural background can help distinguish between abuse and culture practice. Shingles, a form of herpes zoster, is a communicable disease usually affecting immunocompromised individuals and older adults. The disease produces small crusty pustules on the lower back and trunk. The description of the lesions doesn't fit those produced by an allergic reaction.

A girl has a urinary tract infection (UTI). Which statement by the parent demonstrates understanding of preventing future UTIs? A. I should help my child learn to wipe her bottom from back to front." B. When she starts urinating frequently, I should call the provider to request antibiotics." C. I will let her take a warm bath for 15 minutes each day." D. I shouldn't let my daughter take bubble baths."

Correct response: D. "I shouldn't let my daughter take bubble baths." Explanation: Saying that the child should not take bubble baths demonstrates effective teaching because oils in the bubble bath preparation may irritate the urethra, contributing to UTIs. Girls and women should wipe the perineum from front to back, not back to front, to avoid contaminating the urinary tract with fecal bacteria. Although antibiotics are used to treat UTIs, they are not given prophylactically. No evidence suggests that warm baths help prevent UTIs.

A 5-year-old child asks the nurse if it will hurt to have his tonsils and adenoids taken out. Which response by the nurse would be best? A. "It won't hurt because we put you to sleep." B. "It won't hurt because you are such a big boy." C. "It will hurt because of the incisions made in the throat." D. "It will hurt, but we have medicine to help you feel better."

Correct response: D. "It will hurt, but we have medicine to help you feel better." Explanation: Preschool-aged children are fearful of physical injury. Truthful but simple explanations will minimize distorted fears and reduce anxiety. Telling the child that it will not hurt is inappropriate, not truthful, and can possibly lead to mistrust. Additionally, stating that the child is a "big boy" may deter the child from reporting pain for fear of being labeled a "baby." A detailed explanation may be beyond the child's understanding and add to his fears. Using the term incision is inappropriate because the child probably will not understand what this term means.

A nurse is preparing a child, age 4, for cardiac catheterization. Which explanation of the procedure is most appropriate? A. "Your mom will be able to be in the room with you." B. "The test usually takes an hour to complete." C. "You must sleep the whole time that the test is being done." D. "The special medicine will feel warm when it's put in the tubing."

Correct response: D. "The special medicine will feel warm when it's put in the tubing." Explanation: To prepare a 4-year-old child without increasing anxiety, the nurse should provide concrete information in small amounts about nonthreatening aspects of the procedure. Therefore, saying the special medicine will feel warm is most appropriate. Allowing parents to be in the room during a procedure depends on facility policy, therefore may not be true. This also does not provide information about the procedure. Explaining the time needed for the procedure wouldn't provide sufficient information. Stating that the child will need to sleep isn't true and could provoke anxiety.

A child who tests positive for the human immunodeficiency virus (HIV) is placed in foster care. The foster parents ask the nurse how to prevent HIV transmission to other family members. How should the nurse respond? A. "Make sure the child uses disposable plates and utensils." B. "Use isopropyl alcohol to clean surfaces contaminated with the child's blood or body fluids." C. "Don't let the child share toys with other children." D. "Wear gloves when you're likely to come into contact with the child's blood or body fluids."

Correct response: D. "Wear gloves when you're likely to come into contact with the child's blood or body fluids." Explanation: HIV is transmitted by blood and body fluids. Therefore, the nurse should respond by telling family members to wear gloves when anticipating contact with the child's blood or body fluids. Standard household methods for cleaning dishes and utensils are adequate, so the child needn't use disposable plates and utensils. To disinfect HIV-contaminated surfaces, the nurse should instruct the foster parents to use a solution of 1 part bleach to 10 parts water. The child may share toys; any toys that become soiled with the child's blood or body fluids should be disinfected with the bleach solution.

Which nursing action would be most successful in gaining a preschooler's cooperation in preparing for surgery? A. Have the child remove their own underwear. B. Encourage the child to use the hospital blanket as a transition object to make the child feel more secure. C. Let the child choose which parent can accompany the child to the preoperative waiting area. D. Let the child choose whether to ride to the preoperative area on a stretcher or in a wagon.

Correct response: D. Let the child choose whether to ride to the preoperative area on a stretcher or in a wagon. Explanation: Giving the child a choice would promote cooperation, and children commonly prefer a nonthreatening method of travel such as a wagon. Having the child take off their own underwear isn't appropriate, because preschoolers commonly have a fear of genital mutilation; the child would likely resist removing underwear. Children usually won't transfer feelings of security from personal objects to another object such as a hospital blanket. Both parents are encouraged to accompany the child to the preoperative area, so having the child choose one parent isn't appropriate.

What recommendation should the nurse give a family about appropriate beverages for children? A. Give children whole milk until 5 years of age. B. It is better to give your child bottled water rather than tap water. C. Offering sports drinks is the ideal way to provide hydration during physical activity. D. Sugary drinks, including juice, should be avoided.

Correct response: D. Sugary drinks, including juice, should be avoided. Explanation: Baby's should avoid cows milk until 12 months old. They should stop drinking whole milk after the age of 2. Sugary drinks contain empty calories and considered to be a major factor in the childhood obesity epidemic. Juice should be limited to no more than 120 to 180 mL per day. Water from community sources is more likely to contain fluoride that promotes dental health than bottled water. Sports drinks are considered sugary drinks. Unless a child has had excessive fluid loss, water is all that is needed to stay hydrated during physical activity.

A young child is returning to the pediatric unit after having surgery to form a colostomy. When assessing the stoma, the nurse becomes most concerned when what is observed? A. slight bleeding of the stoma B. stomal tissue that is moist C. a stoma that is edematous D. a dark maroon stoma

Correct response: D. a dark maroon stoma Explanation: Ischemia may occur within 24 hours of the ostomy surgery and result in a dark, necrotic stoma that appears maroon to black. Causes of stomal necrosis include constricting sutures, mesenteric tension, disproportionate clipping of the mesentery, emboli, pressure associated with barrier wafer constriction, and abdominal edema or distension. A healthy stoma is dark pink and moist. Following surgery, a stoma may be edematous, and there may be bleeding when the stoma is touched.

A child is in the emergency department with suspected epiglottitis and has been ordered an X-ray to confirm the diagnosis. The nurse would prepare the child for X-ray by which methods? A. in radiology, transported by wheelchair, accompanied by a nurse B. in radiology, transported by stretcher, accompanied by a nurse C. in surgery, by portable X-ray D. in the emergency department, by portable X-ray

Correct response: D. in the emergency department, by portable X-ray Explanation: The child is at risk for obstruction related to the swollen epiglottis. The nurse should not move the child, keep a careful watch, and get a portable X-ray in the emergency department.

A preschool-age child refuses to take ordered medication. Which nursing strategy is most appropriate? A. mixing the medication in milk so the child isn't aware that it's there B. explaining the medication's effects in detail to ensure cooperation C. making the child feel ashamed for not cooperating D. showing trust in the child's ability to cooperate even with an unpleasant procedure

Correct response: D. showing trust in the child's ability to cooperate even with an unpleasant procedure Explanation: To gain a preschooler's cooperation, the most appropriate strategy is for the nurse to show trust and express faith in the child's ability to cooperate even with an unpleasant procedure. Hiding the medication in milk may foster mistrust. The nurse should provide simple, not detailed, explanations and should use terms the child can understand. Shaming the child is inappropriate and may lead to feelings of guilt.

The nurse observes a parent of a child with cystic fibrosis performing chest percussion. The nurse determines that the skill is being done correctly when the parent uses which technique? A. firmly but gently striking the chest wall to make a popping sound B. gently striking the chest wall to make a slapping sound C. percussing over an area from the umbilicus to the clavicle D. placing a blanket between the parent's hand and the child's chest

Correct response: firmly but gently striking the chest wall to make a popping sound Explanation: The parent should firmly yet gently strike the chest wall with the hand cupped to make a hollow popping sound. A slapping sound indicates that an incorrect technique is being used. The area over the rib cage is percussed to loosen mucus from the underlying lung passages. The child should wear a thin piece of clothing (T-shirt) over the chest area to protect the skin without diminishing the effect of the percussion.

Bryant's traction.

Skin traction applied bilaterally to the lower extremities is

What age does Wilm's tumor usually affect & location?

affects children ages 6 months to 4 years and favors the left kidney.

Russell traction

s skin traction applied to a lower extremity, with the extremity suspended above the bed and a sling placed under the knee.

What is preschool age?

3-5 years old

While assessing a child experiencing respiratory distress, the nurse notes subcostal retractions. Which graphic highlights the area where subcostal retractions are seen?

Explanation: Subcostal retractions are retractions seen below the lower costal margin of the rib cage. Option B highlights the area where subcostal retractions are seen. Option A shows the areas where intercostal retractions would be seen. Option C shows the area for suprasternal retraction. Option D shows the areas for clavicular retractions.

A 4-year-old child is admitted to the hospital for surgery. The nurse applies interventions to address what major stressor for a child of this age? A. separation from family B. fear of bodily injury C. loss of control D. fear of pain

Correct response: A. separation from family Explanation: For infants through preschoolers, separation from the family is the major stressor posed by hospitalization. To minimize the effects of separation, the nurse may suggest that a family member stay with the child as much as possible. Reducing this stressor may help a young child withstand other possible stressors of hospitalization, such as fear of bodily injury, loss of control, and fear of pain.

A child is receiving peritoneal dialysis to treat renal failure. To detect early signs of peritonitis, the nurse should stay alert for A. redness at the catheter site. B. abdominal tenderness. C. abdominal fullness. D. headache.

Correct response: B. abdominal tenderness. Explanation: The nurse should stay alert for abdominal tenderness because it's an early sign of peritonitis. Redness at the catheter site indicates a skin infection. Abdominal fullness is expected during dialysate infusion. Headache isn't associated with peritonitis.

A nurse is performing a respiratory assessment on a 5-year-old child diagnosed with pneumonia. Which assessment finding should be reported to the health care provider immediately? mouth breathing foul odor from the mouth moderate intercostal retractions irregular respirations while awake

Correct response: moderate intercostal retractions Explanation: Normally, children and men use the abdominal muscles to breathe, whereas women use the thoracic muscles. Use of the accessory or intercostal muscles would indicate a respiratory problem and should be immediately reported to the physician. Mouth breathing and a foul odor from the mouth aren't cause for concern. Irregular respirations while awake are not an unusual finding in a young child.

A nurse is assessing a 4-year-old child's peripheral IV line, observing that it is not infusing. What is the first action the nurse should take to correct this situation? A. Change the IV bag. B. Check the power source of the pump. C. Reposition the child's extremity. D. Adjust the height of the IV bag.

Correct response: C. Reposition the child's extremity. Explanation: The most likely reason for difficulty running an IV in this age group is a positional issue of the child or extremity because of the child's activity level.

To decrease the likelihood of bradyarrhythmias in children during endotracheal intubation, succinylcholine is used with which agent? A. epinephrine B. isoproterenol C. atropine D. lidocaine

Correct response: atropine Explanation: Succinylcholine It can relax the muscles during surgery or other medical procedures. Atropin can treat heart rhythm problems, stomach or bowel problems, and certain types of poisoning when injected. It can also decrease saliva before surgery and dilate the pupils before an eye exam. Succinylcholine is an ultra-short-acting depolarizing agent used for rapid-sequence intubation. Bradycardia can occur, especially in children. Atropine is the drug of choice in treating or preventing succinylcholine-induced bradycardia. Lidocaine is used in adults only. Epinephrine bolus and isoproterenol aren't used in rapid-sequence intubation because of their profound cardiac effects.

A client is admitted with a tentative diagnosis of congenital heart disease. When assessment reveals a bounding radial pulse coupled with a weak femoral pulse, the nurse suspects that the client has A. patent ductus arteriosus. B. coarctation of the aorta. C. a ventricular septal defect. D. truncus arteriosus.

Correct response: coarctation of the aorta. Explanation: Narrowing of the aorta. Depending where the narrowing occurs, the area before the narrowing experiences a high BP while the area after narrowing experience low BP (registered nurse RN.) The nurse should suspect coarctation of the aorta because it causes signs of peripheral hypoperfusion, such as a weak femoral pulse and a bounding radial pulse. These signs are rare in patent ductus arteriosus, ventricular septal defect, and truncus arteriosus.

When developing a care plan for a hospitalized client, the nurse knows that children in which age-group are most likely to view illness as a punishment for misdeeds? A. infancy B. preschool age C. school age D. adolescence

Correct response: B. preschool age Explanation: Preschool-age children are most likely to view illness as a punishment for misdeeds. Separation anxiety, although seen in all age-groups, is most common in older infants. Fear of death is typical of older school-age children and adolescents. Adolescents also fear mutilation.

A community nurse is assessing a young child who has had a colostomy stoma for several years. The nurse notices that the stoma is dark pink and moist. What is the best response to the child's parents about the appearance of the stoma? A. "The stoma looks infected; you need an antibiotic cream." B. "The stoma looks healthy; continue your present care." C. "The stoma is irritated; change the appliance more frequently." D. "The stoma is too moist; we must try to prevent skin breakdown."

Correct response: "The stoma looks healthy; continue your present care." Explanation: A normal, healthy stoma should be dark pink and moist. This child's parents should continue the present care. There is no indication of infection or irritation. There is no data that support the stoma being "too moist" or that there is skin breakdown.

A 3-year-old client is admitted to the pediatric unit with pneumonia. The child has a productive cough and appears to have difficulty breathing. The parents tell the nurse that the child has not been eating or drinking much and has been very inactive. Which interventions to improve airway clearance should the nurse include in the care plan? Select all that apply. A. Limit fluid intake. B. Perform chest physiotherapy as ordered. C. Encourage coughing and deep breathing. D. Keep the head of the bed flat. Perform postural drainage. E. Maintain humidification with a cool mist humidifier.

Correct response: Perform chest physiotherapy as ordered. Encourage coughing and deep breathing. Perform postural drainage. Maintain humidification with a cool mist humidifier. Explanation: Chest physiotherapy and postural drainage work together to break up congestion and then drain secretions. Coughing and deep breathing are also effective to remove congestion. A cool mist humidifier helps loosen thick mucous and relax airway passages. Fluids should be encouraged, not limited. The child should be placed in semi-Fowler's to high Fowler's position to facilitate breathing and promote optimal lung expansion.

A child is admitted to the pediatric unit with a fracture of the hip. The physician orders Russell traction. This type of traction is skin traction applied to a lower extremity, with the extremity suspended above the bed. skeletal traction applied to a lower extremity. skin traction applied to an extended lower extremity. skin traction applied bilaterally to the lower extremities.

Correct response: skin traction applied to a lower extremity, with the extremity suspended above the bed. Explanation: Russell traction is skin traction applied to a lower extremity, with the extremity suspended above the bed and a sling placed under the knee. Skeletal traction applied to a lower extremity is called 90-90 traction. Skin traction applied to an extended lower extremity is called Buck's extension traction. Skin traction applied bilaterally to the lower extremities is called Bryant's traction.

A child with hemophilia is hospitalized after falling. Now the child complains of severe pain in the left wrist. What should the nurse do first? A. Perform passive range-of-motion (ROM) exercises on the wrist. B. Massage the wrist and apply a warm compress. C. Elevate the affected arm and apply ice to the injury site. D. Notify the health care provider.

Correct response: C. Elevate the affected arm and apply ice to the injury site. Explanation: Severe joint pain in a child with hemophilia indicates bleeding; therefore, the nurse should first elevate the affected extremity and apply ice to the injury site to promote vasoconstriction. ROM exercises may worsen discomfort and bleeding. Massage and warm compresses also may increase bleeding. The nurse should notify the health care provider only after taking measures to stop the bleeding.

A preschooler goes into cardiac arrest. When performing cardiopulmonary resuscitation (CPR) on a child, how should the nurse deliver chest compressions? A. with the fingers of one hand B. with two fingertips C. with the palm of one hand D. with the heel of one hand

Correct response: D. with the heel of one hand Explanation: When performing CPR on a child between ages 1 and 8, the nurse should use the heel of one hand to compress the chest one-third to one-half the depth of the chest. Using only the fingers of one hand isn't appropriate for CPR. The use of two fingertips is appropriate for infant CPR but this method can't compress the chest sufficiently on an older child. The palm is never used for chest compressions in CPR.

The nurse assesses a child after heart surgery to correct tetralogy of Fallot. Which finding would the nurse report to the health care provider as an indication that the client has low cardiac output? A. bounding pulses and mottled skin B. altered level of consciousness and thready pulse C. capillary refill of 2 seconds and blood pressure of 96/67 mm Hg D. extremities warm to the touch and pale skin

Correct response: B. altered level of consciousness and thready pulse Explanation: With a low cardiac output and subsequent poor tissue perfusion, signs and symptoms would include pale, cool extremities; cyanosis; weak, thready pulses; delayed capillary refill; and decrease in level of consciousness.

Parents of a preschool-age child ask the nurse about nutrition. Which statement about a preschooler's nutritional requirements is accurate? A. Caloric requirements per kilogram of body weight increase slightly during the preschool-age period. B. The preschooler's nutritional requirements differ greatly from those of a toddler. C. The quality of food that a preschooler consumes is more important than the quantity. D. Protein should account for 25% of the preschooler's total caloric intake.

Correct response: The quality of food that a preschooler consumes is more important than the quantity. Explanation: Stating that food quality is more important than quantity is most accurate because a high caloric intake may include many empty calories. The preschooler's caloric requirement is slightly lower than the toddler's. Overall, however, the preschooler's nutritional requirements are similar to a toddler's. The preschooler requires 1.5 g/kg of protein daily, satisfied by two meat servings, three milk servings, four bread servings, and four fruit and vegetable servings.

The nurse is admitting a 4-year old with a possible meningococcal infection. Which type of isolation is indicated? A. airborne precautions B. contact precautions C. droplet precautions D. standard precautions

Correct response: droplet precautions Explanation: Causes meningitis... Meningococcal infections are spread through close mucous membrane or respiratory contact with large respiratory droplets. Meningococcal infections are not spread by small airborne organisms or contact with a person's skin or contaminated items. Standard precautions, used when touching body fluids, are not sufficient to prevent the spread of meningitis.

A child is diagnosed with Wilms' tumor. During assessment, the nurse expects to detect A. gross hematuria. B. dysuria. (Painful ruination) C. nausea and vomiting D. an abdominal mass.

Correct response: D. an abdominal mass. Explanation: The most common sign of Wilms' tumor is a painless, palpable abdominal mass, sometimes accompanied by an increase in abdominal girth. Gross hematuria is uncommon, although microscopic hematuria may be present. Dysuria isn't associated with Wilms' tumor. Nausea and vomiting are rare in children with Wilms' tumor.

x A hospitalized 5-year-old is pulseless, and after verifying the child is not breathing, the nurse begins chest compressions. Where should the nurse apply pressure? A. on the lower sternum with the heel of one hand B. midway on the sternum with the tips of two fingers C. over the apex of the heart with the heel of one hand D. on the upper sternum with the heels of both hands

Correct response: D. on the lower sternum with the heel of one hand Explanation: The chest is compressed with the heel of one hand positioned on the lower sternum, two fingerbreadths above the sternal notch (at the nipple line). Fingertips are used to compress the sternum in infants, and the heels of both hands are used in adult cardiopulmonary resuscitation.

A nurse is providing cardiopulmonary resuscitation (CPR) to a child, age 4. The nurse should A. compress the sternum with both hands at a depth of 1½″ to 2″ (4 to 5 cm). B. deliver 12 breaths/minute. C. perform only two-person CPR. D. use the heel of one hand for sternal compressions.

Correct response: D. use the heel of one hand for sternal compressions. Explanation: The nurse should use the heel of one hand and compress one-third to one-half the depth of the chest. The nurse should use the heels of both hands clasped together and compress the sternum 1½″ to 2″ (at least 5 cm) for an adult. For a small child, two-person rescue may be inappropriate. For a child, the nurse should deliver 20 breaths/minute instead of 12 breaths/minute.

The nurse must administer a unit of packed red blood cells to a 4-year-old child. The child's blood type is Type B Rh factor positive. When the unit of blood arrives, it is labeled as Type O Rh factor negative. What is the appropriate action for the nurse to take? A. Begin the administration of the blood as ordered. B. Return the blood and order a new unit of Type B. C. Document the error with an incident report. D. Have the child's blood retested for blood type.

Correct response: A. Begin the administration of the blood as ordered. Explanation: Type O Rh negative blood is the universal donor and can be administered to a child who is Type B. As long as the crossmatch report confirms "OK to transfuse," there would be no need to return this unit to the blood bank. This should not be considered an error and would not be documented as such. There is no indication for retesting the child's blood type.

Which finding is expected when the nurse is assessing a child who has sustained full-thickness burns? A. blanching to the touch B. excessive bleeding C. minimal pain D. blistering and a moist appearance

Correct response: C. minimal pain Explanation: Full-thickness burns are serious injuries in which all the skin layers are destroyed. Lack of pain is characteristic of full-thickness burns. With full-thickness burns, blanching and bleeding are absent because blood supply is destroyed. Blisters and a moist appearance characterize partial-thickness burns.

After teaching the parents about the cause of ringworm of the scalp (tinea capitis), which statement by a parent indicates successful teaching? A. It results from overexposure to the sun." B. It's caused by infestation with a mite." C. It's a fungal infection of the scalp." D. It's an allergic reaction."

Correct response: C. "It's a fungal infection of the scalp." Explanation: Ringworm of the scalp is caused by a fungus of the dermatophyte group of the species. Overexposure to the sun would result in sunburn. Mites, such as chiggers or ticks, produce bites on the skin, resulting in inflammation. An allergic reaction commonly is manifested by hives, rash, or anaphylaxis.

A 4-year-old child has recently been diagnosed with acute lymphocytic leukemia (ALL). Which statement, made by the parents, indicates the effectiveness of teaching? Select all that apply. A. "I read that ALL is a rare form of childhood leukemia." B. "I understand that ALL affects all blood-forming organs and systems throughout the body." C. "Because of the increased risk of bleeding, I will eliminate evening teeth brushing." D. "I realize that the adverse effects of chemotherapy includes sleepiness, loss of hair, and sores in the mouth." E. I am glad that there's a 95% chance of obtaining a first remission with treatment." F. I will not discipline my child during this difficult time."

E. I am glad that there's a 95% chance of obtaining a first remission with treatment." B. I understand that ALL affects all blood-forming organs and systems throughout the body." D. I realize that the adverse effects of chemotherapy includes sleepiness, loss of hair, and sores in the mouth." Explanation: Acute lymphocytic leukemia (ALL) is the most common form of leukemia. In ALL, immature white blood cells (WBCs) crowd out healthy WBCs, red blood cells, and platelets in the bone marrow. These abnormal WBCs affect all blood-forming organs and systems. Common adverse effects of chemotherapy and radiation include nausea, vomiting, diarrhea, sleepiness, alopecia (loss of hair), anemia, stomatitis (sores in the mouth), pain, and increased susceptibility to infection. A first remission occurs in about 95% of cases. Brushing teeth does not result in increased or abnormal bleeding. A child with leukemia still needs appropriate discipline and limits because a lack of consistent parenting may lead to negative behaviors and fear.

Buck's extension traction

Skin traction applied to an extended lower extremity

While interviewing a preschool-age girl who has been sexually abused about the event, which approach would be most effective? A. Describe what happened during the abusive act. B. Draw a picture and explain what it means. C. "Play out" the event using anatomically correct dolls. D. Name the perpetrator.

Correct response: "Play out" the event using anatomically correct dolls. Explanation: A 3-year-old child has limited verbal skills and should not be asked to describe an event, explain a picture, or respond verbally or nonverbally to questions. More appropriately, the child can act out an event using dolls. The child is likely to be too fearful to name the perpetrator or will not be able to do so.

x A preschool child is admitted to the pediatric unit with acute nephritis. Which electrolyte replacement agent is used as an adjunct to treatment for this condition? A. magnesium sulfate B. calcium glubionate C. potassium chloride D. sodium lactate

Correct response: A. . magnesium sulfate Explanation: Magnesium sulfate is an electrolyte that's used as an adjunct to treat acute nephritis. It also is used to treat seizures and severe toxemia. Calcium glubionate, potassium chloride, and sodium lactate are not therapeutic in acute nephritis and, in fact, may worsen the condition.

A child, age 5, is brought to the pediatrician's office for a routine visit. When inspecting the child's mouth, the nurse expects to find how many teeth? A. Up to 10 B. Up to 15 C. Up to 20 D. Up to 32

Correct response: C. Up to 20 Explanation: A child may have up to 20 deciduous teeth by age 5. The first tooth usually erupts by age 6 months; the last, by age 30 months (2.5). Deciduous teeth usually are shed between ages 6 and 13. Deciduous teeth is the official term for baby teeth, milk teeth, or primary teeth.

Before performing an otoscopic examination on a child, where should the nurse palpate for tenderness? A. tragus, mastoid process, and helix B. helix, umbo, and tragus C. tragus, cochlea, and lobule D. mastoid process, incus, and malleus

Correct response: C. tragus, mastoid process, and helix Explanation: Before inserting the otoscope, the nurse should palpate the child's external ear, especially the tragus and mastoid process, and should pull the helix backward to determine the presence of pain or tenderness. The umbo, incus, and malleus (parts of the middle ear) and the cochlea (part of the inner ear) are not palpable.

A mother who is visibly upset tells the nurse she wants to take her child home because the child is dying. What would be the nurse's best response? A. "I know how you feel, but the medication will make your child feel better." B. "I can't let you do this without calling your health care provider (HCP) first." C. "Can you tell me why you want to take your child home now?" D. "I can imagine how hard this is for you, but it's not what is best for the child."

Correct response: "Can you tell me why you want to take your child home now?" Explanation: With a parent who is visibly upset, it is best to try to determine the cause. Therefore, asking the mother about why she wants to take the child home can provide insight into the problem. The nurse cannot stop the mother from taking her child home. However, the HCP should be notified about the mother's decision and efforts are needed to explain the ramifications of taking the child home. It is inappropriate for the nurse to say "I know how you feel" or "I can imagine how hard this is" unless the nurse has had the same experience.

A 4-year-old postoperative child is found unresponsive. Place the following actions in the correct sequence to perform CPR after the child has been assessed for responsiveness and help has been called. All options must be used. Click an option, hold and drag it to the desired position, or click an option to highlight it and move it up or down in the order using the arrows to the left. 1. Perform 30 compressions. 2. Check for breathing. 3. Feel for the carotid pulse. 4. Provide 2 rescue breaths. 5. Open the airway.

Correct response: Feel for the carotid pulse. Perform 30 compressions. Open the airway. Check for breathing. Provide 2 rescue breaths. Explanation: Following the 2015 American Heart Association guidelines for CPR, the rescuer would activate the emergency response system and get an automatic external defibrillator (AED) or appoint another person to do this. The next step is to check the pulse for no more than 10 seconds. If no pulse is detected, the rescuer gives 30 chest compressions. Next, the rescuer opens the airway with the head tilt-chin lift or jaw thrust maneuver and checks for breathing. If breathing is not detected, the rescuer gives 2 rescue breaths and immediately resumes chest compressions at a cycle of 30 compressions to 2 breaths. The rescuer would use the AED as soon as it arrives.

The nurse is caring for a lethargic but arousable preschooler who is a victim of a near-drowning accident. What should the nurse do first? A. Administer oxygen. B. Institute rewarming. C. Prepare for intubation. D. Start an IV infusion.

Correct response: A. Administer oxygen. Explanation: Near-drowning victims typically suffer hypoxia and mixed acidosis. The priority is to restore oxygenation and prevent further hypoxia. Here, the client has blunted sensorium, but is not unconscious; therefore, delivery of supplemental oxygen with a mask is appropriate. Warming protocols and fluid resuscitation will most likely be needed to help correct acidosis, but these interventions are secondary to oxygen administration. Intubation is required if the child is comatose, shows signs of airway compromise, or does not respond adequately to more conservative therapies.

The parent of a preschool-age child tells the nurse that the child is hyperactive and something needs to be done. Which response by the nurse would be most appropriate initially? A. "What makes you think your child is hyperactive?" B. "What do you think needs to be done?" C. "How does your child behave normally?" D. "Does the preschool teacher think your child is hyperactive?"

Correct response: "A. What makes you think your child is hyperactive?" Explanation: The best approach by the nurse is to determine why the parent thinks the child is hyperactive. Some children are very active but do not have the necessary defining characteristics of hyperactivity. Asking what the parent thinks needs to be done, how the child behaves normally, and if the preschool teacher thinks the child is hyperactive would be an appropriate follow-up question once more information is gathered from the parent to determine whether the child indeed is hyperactive.

After the nurse teaches the mother of a child with atopic dermatitis how to bathe her child, which statement by the mother indicates effective teaching? A. "I let my child play in the tub for 30 minutes every night." B. "My child loves the bubble bath I put in the tub." C. "When my child gets out of the tub I just pat the skin dry." D. "I make sure my child has a bath every night."

Correct response: "When my child gets out of the tub I just pat the skin dry." Explanation: Atopic dermatitis is a chronic pruritic dermatitis that usually begins in infancy. Many of the children diagnosed with it have a family history of eczema, allergies, or asthma. Atopic dermatitis is best treated with hydrating the skin, controlling the pruritus, and preventing secondary infection. Patting the skin dry removes less natural skin moisturizer and thus maintains skin hydration. Water has a drying effect on the skin. Playing in the tub for 30 minutes each night would deplete the skin of its natural moisturizers, thereby leading to increased pruritus and dry skin. Bubble baths are to be avoided in children with atopic dermatitis because they may act as an irritant, possibly exacerbating the condition. Also, bubble baths deplete the skin of its natural moisturizers. The issue is not whether the child bathes every night. Rather, the goal is to decrease dryness and itching.

A preschool-age child scheduled for surgery in the morning is admitted to the facility for the first time. Which nursing action would ease the child's anxiety? A. beginning preoperative teaching as soon as possible B. explaining that the child will be "put to sleep" during the operation and will feel nothing C. having the child act out the surgical experience using dolls and medical equipment D. explaining preoperative and postoperative procedures step by step

Correct response: having the child act out the surgical experience using dolls and medical equipment Explanation: Having the child act out the surgical experience using dolls and medical equipment would ease anxiety and give the nurse an opportunity to clarify the child's misconceptions. Preschoolers have a limited concept of time, so the nurse should provide preoperative teaching just before surgery rather than starting it as soon as possible; also, a delay between teaching and surgery may heighten anxiety by giving the child a chance to worry or fantasize. The nurse should avoid using such phrases as "put to sleep" because these may have a dual or negative meaning to a young child. Long explanations are inappropriate for the preschooler's developmental level and may increase anxiety.

The nurse teaches appropriate care measures to the parents of a 5-year-old child who has been given trimethoprim/sulfamethoxazole for a urinary tract infection. What directives should be included in the teaching plan? Select all that apply. Use a sunscreen. Report any rash. Administer medication with milk or food. Keep medication out of the sunlight. Keep the child well hydrated.

Keep medication out of the sunlight. Use a sunscreen. Keep the child well hydrated. Report any rash. Explanation: The child receiving trimethoprim/sulfamethoxazole should wear sunscreen daily while on the medication, and the medication must be kept out of direct sunlight. (It comes in a dark bottle.) Children with a urinary tract infection should drink lots of fluids to help flush the organisms from the bladder. The medication does need to be taken with milk or food. Trimethoprim/sulfamethoxazole has been associated with Steven-Johnson syndrome, so any rash requires prompt attention.