peds ch 38 and 39
A preschool-age child has just been admitted to the pediatric unit with a diagnosis of bacterial meningitis. The nurse would include which recommendation in the nursing plan?
decreased environmental stimuli
The nurse and an adolescent are reviewing the adolescent's record of her headaches and activities surrounding them. What activity would the nurse identify as a possible trigger?
drinking three cans of diet cola
The nurse is educating the parents of a 4-year-old boy with strabismus. Teaching for the parents would include the:
importance of patching as prescribed.
The nurse is assessing a 5-month-old infant. What would cause the nurse to be concerned about a possible visual impairment?
The infant does not imitate facial expressions.
The nurse is performing a physical assessment for an 8-year-old child with an earache. Which sign or symptom indicates external otitis (acute otitis externa or swimmer's ear)?
The child cries out when the ear is grasped.
The nurse is interviewing the caregivers of a child brought to the emergency unit. The caregiver states, "She has a history of seizures but this time it lasted more than 30 minutes and she just keeps having them." The most accurate description of this child's condition would be:
The child is in status epilepticus.
A child with poor eye alignment cannot establish single binocular vision but has double vision. Which nursing action is most appropriate for this client?
Refer the child to a pediatric ophthalmologist
The school nurse is instructing the classroom teacher regarding a student newly diagnosed with amblyopia. To prepare for classroom instruction, which concept is most important for the nurse to convey to the teacher?
student placement in the room is important but all other teaching methods may remain the same.
A child has recently been diagnosed with cataracts. The treatment for cataracts is:
surgery
The nurse cares for a 7-year-old child with new-onset seizure disorder. Which prescription will the nurse anticipate for this client?
use of anticonvulsant medications
The nurse is educating the parents of a 5-year-old girl with infectious conjunctivitis about the disorder. Which information is most important to provide to prevent the spread of the disorder?
washing hands frequently
A 9-year-old client who suffered a head injury has strabismus. The nurse assesses the client for intracranial pressure (ICP). Which additional intervention is most important for the nurse to perform?
Assess the level of consciousness (LOC).
While in a pediatric client's room, the nurse notes that the client is beginning to have a tonic-clonic seizure. Which nursing action is priority?
Protect the child from hitting the arms against the bed.
The nurse is using the pediatric Glasgow Coma Scale to assess a child's level of consciousness. What would the nurse assess? Select all that apply.
eye opening verbal response motor response
The nurse knows that the heads of infants and toddlers are large in proportion to their bodies, placing them at risk for what problem?
head trauma
A nursing instructor is teaching about eye disorders in childhood. Which statement made by a student indicates a need for further instruction?
"Cataracts are only present in adults."
The nurse has finished teaching the parents of a 10-month-old male ways to prevent another acute otitis media (AOM) infection. Which statement by the mother indicates she has the correct understanding of the information provided?
"I should continue to breastfeed my son because it lowers the incidence of acute otitis media."
The parents of a 4-year-old boy tell the nurse, "We're really worried that our child doesn't have 20/20 vision. It seems that he doesn't always see clearly at a distance." What is the best response by the nurse?
"20/20 vision isn't usually achieved until the age of 6 or 7 years but I will let the physician know your concerns."
Absence seizures are marked by what clinical manifestation?
Loss of motor activity accompanied by a blank stare
Dexamethasone is often prescribed for the child who has sustained a severe head injury. Dexamethasone is a(n):
steroid
The nurse caring for an infant with craniosynostosis, specifically positional plagiocephaly, should prioritize which activity?
moving the infant's head every 2 hours
The nurse recognizes that if the infant is following normal development, the infant will be able to focus and follow an object with the eyes by what age?
2 months of age
A child diagnosed with acute otitis media has been given a prescription for benzocaine. The nurse is correct when she makes which statement?
"Benzocaine drops should be placed in your ear to numb it and reduce pain."
A child returns to the clinic after an episode of external otitis (acute otitis externa or swimmer's ear) that has resolved. What would the nurse emphasize as the priority for preventing future episodes?
keeping ear canals dry
The parents of a child with infantile glaucoma are talking with the nurse about the disorder and the treatment options. Which statements by the parents require clarification by the nurse? Select all that apply.
"I am thankful that we will be able to manage this disorder with medications." "Thankfully this isn't a serious disorder. We were afraid vision loss would be a possibility.
The parents of a 17-year-old adolescent diagnosed with bacterial meningitis tell the nurse, "We just do not understand how this could have happened. Our adolescent has always been healthy and just received a booster vaccine last year." How should the nurse respond?
"I understand your frustration. Unfortunately, immunizations are not 100% effective in preventing the infection."
The nurse in the emergency department is caring for a child who has a simple contusion of the right eye following a motor vehicle accident. Upon discharge to home, which response by the parents requires further clarification?
"I will need to apply heat to the eye four times a day."
The nurse has finished teaching the mother of a 5-year-old male diagnosed with bacterial conjunctivitis how to manage her son's infection at home. Which statement by the mother would indicate a need for further education?
"I will use Visine drops in his infected eye to help reduce redness."
The nurse is obtaining the history from the parents of an infant who is suspected of having infantile glaucoma. Which statement by the parents would help to confirm this suspicion?
"It seems like bright lights really bother him."
The nurse is educating a 13-year-old paintball enthusiast about sports-related injuries. Which comment is most likely to be accepted by the child?
"Play tough, but wear protective gear."
The nurse is caring for an infant who is at risk for increased intracranial pressure. What statement by the parent would alert the nurse to further assess the child's neurological status?
"She has been irritable for the last hour....seems like she is just upset for some reason."
The parent of a 12-year-old child with Reye syndrome approaches the nurse wanting to know how this happened to the child, saying, "I never give my children aspirin!" What could the nurse say to begin educating the parent?
"Sometimes it is hard to tell what products may contain aspirin."
The nurse is educating parents of a male infant with Chiari type II malformation. Which statement about their child's condition is most accurate?
"Take your time feeding your baby."
A toddler has been diagnosed with otitis media with effusion. The parents tell the nurse, "We really don't understand what that diagnosis means." How should the nurse respond?
"The diagnosis means unwanted fluid is within the middle ear space, and there may or may not be an infection present."
A 1-year-old infant has just undergone surgery to correct craniosynostosis. Which comment is the best psychosocial intervention for the parents?
"The surgery was successful. Do you have any questions?"
A child having tympanostomy tubes placed asks, "How and when will the tubes be removed?" What is the nurse's best response?
"The tubes remain in place for 6 to 12 months until they come out by themselves."
The nurse provides education to the parent of an infant being treated for hydrocephalus with a ventriculoperitoneal (VP) shunt. Which statement by the parent indicates the need for further instruction?
"This shunt is the only surgery my baby will need."
The nurse is educating the family of a 7-year-old with epilepsy about care and safety for this child. What comment will be most valuable in helping the parent and the child cope?
"Use this information to teach family and friends."
The nurse is educating the parents of a 7-year-old boy who has hearing loss due to otitis media with effusion. Which statement by the parents indicates that further education is needed?
"We need to raise the volume of our voices significantly so he can hear us."
The emergency room nurse is taking a history of a 1-year-old child whose parent said that she had a "fit" at home. Which inquiry would be best to start with?
"What happened just before the seizures?"
A child is home with the caregivers following a treatment for a head injury. The caregiver should contact the care provider if the child makes which statement?
"You look funny. Well, both of you do. I see two of you."
The parents of a newborn state, "We are so excited that our baby was born with blue eyes! We were hoping the baby would take after our other child." How should the nurse respond?
"You probably won't know for sure the color of your baby's eyes until your baby is 6 to 12 months old."
A toddler requires the placement of pressure-equalizing (PE) tubes due to recurrent ear infections. Which information should the nurse include in teaching the parent about the PE tubes and surgical insertion? Select all that apply.
"Your child will have the procedure as an outpatient." "One purpose of the PE tubes is to help speech development." "The tubes will fall out on their own." "The tubes allow infected fluid to drain."
The nurse is discussing communication options with the parents of a 2-year-old girl with congenital hearing loss. The nurse integrates knowledge of what form of communication as having no verbal component?
American Sign Language
What information is most correct regarding the nervous system of the child?
As the child grows, the gross and fine motor skills increase.
The nurse is preparing a nursing care plan for a 2-year-old child with hearing impairment. Which intervention will be part of the plan?
Assess the child's ability to convey information.
The nurse is teaching parents of a 6-year-old child about otitis media (OM). What predisposes the child to OM infections?
Bacteria entering through the eustachian tube
The nurse is taking a health history for a 9-year-old child with conjunctivitis. Which finding would suggest that this is allergic conjunctivitis?
Recently helped clean the basement
During the physical assessment of a 2½-month-old infant, the nurse suspects the child may have hydrocephalus. Which sign or symptom was observed?
Dramatic increase in head circumference
In children with otitis media, a procedure known as a myringotomy may be performed. Which statement is most accurate regarding this procedure?
During this procedure, small tubes are inserted into the tympanic membrane.
The nurse is preparing a room for a child being admitted with meningitis. What is the appropriate action by the nurse?
Gather appropriate equipment and signage for respiratory isolation precautions.
A nurse is assessing a child's vision. Which test should the nurse use to test for accommodation?
Moving a penlight toward the client's nose and observing whethe eyes can follow it
Which nursing assessment data should be given the highest priority for a child with clinical findings related to meningitis?
Signs of increased intracranial pressure (ICP)
The nurse is performing the intake assessment of a 6-month-old in the pediatrician's office. The nurse alerts the physician that the child is showing signs of hearing loss based on what assessment findings? Select all that apply.
The child is not making any babbling sounds and the parent reports the child never does. The nurse dropped a metal tray in the room and the infant did not react. The parent reports that the infant does not wake up when the siblings are being loud during nap time. The infant does not turn the head when the nurse stands next to the infant and calls their name.
The nurse is preparing discharge education for the caregivers of a child with a seizure disorder. Which goal of treatment is priority for this client?
The child will remain free from injury during a seizure.
An adolescent is brought to the ambulatory care clinic after being hit in the eye during a sporting event. There is no serious damage but the adolescent has a "simple contusion" and scleral hemorrhage. What information should be provided?
The facial bruising should clear up in about 3 weeks.
A parent of a newborn asks the nurse if there is any way to prevent acute otitis media. What would the nurse state to the parent?
The frequency of otitis media is reduced in breastfed infants.
The nurse is educating the parents of a 7-year-old girl with epilepsy about managing treatment of the disorder at home. Which intervention is most effective for eliminating breakthrough seizures?
Understanding the side effects of medications
A 16-year-old child has experienced a small corneal abrasion. What will be included in the plan of treatment?
Use analgesics as prescribed.
The nurse is caring for a child with a suspected head injury. The nurse observes for what response to the child's eye reflex examination that would indicate potential increased intracranial pressure (ICP)?
While assessing the child's pupils, there is no change in diameter in response to a light.
The nurse is caring for a 20-month-old girl with equivocal bacterial otitis media, a severe earache, and a temperature of 39°C (102.2°F). Which intervention would the nurse expect to implement
administering antibiotics as soon as they're available
The nurse is caring for a 20-month-old girl with equivocal bacterial otitis media, a severe earache, and a temperature of 39°C (102.2°F). Which intervention would the nurse expect to implement?
administering antibiotics as soon as they're available
After conducting vision screening and examination of a preschooler, the nurse suspects amblyopia based on:
asymmetric corneal light reflex.
A child has been diagnosed with a basilar skull fracture. The nurse identifies ecchymosis behind the child's ear. This would be documented as:
battle sign
A 4-year-old child is brought to the emergency department after being in a motor vehicle accident. The child experienced head trauma in the accident. When assessing the child, which will be the first change noted in the presence of increasing intercranial pressure?
change in level of consciousness
The nurse is teaching the family of a 6-year-old boy with allergic conjunctivitis how to minimize his exposure to allergens. What action would the nurse anticipate as being most difficult for the family to implement?
encouraging the child to keep his hands away from his eyes
Preterm infants have more fragile capillaries in the periventricular area than term infants. This put these infants at risk for which problem?
intracranial hemorrhaging
The nurse is assessing a child following a head injury sustained in a bicycle accident. The child falls asleep frequently unless the parents are talking to the child or the nurse is asking the child questions. How should the nurse document the child's level of consciousness?
obtunded
A child with a seizure disorder is being admitted to the inpatient unit. When preparing the room for the child, what should be included? Select all that apply.
oxygen gauge and tubing suction at bedside padding for side rails
The nurse is educating the parents of a 6-year-old child about preventing hearing loss. Which topic will be included in the discussion?
prevention and treatment of otitis media
A child who has been having seizures is admitted to the hospital for diagnostic testing. The child has had laboratory testing and an EEG, and is scheduled for a lumbar puncture. The parents voice concern to the nurse stating, "I don't understand why our child had to have a lumbar puncture since the EEG was negative." What is the best response by the nurse?
"The lumbar puncture can help rule out any infection in fluid surrounding the brain and spinal cord as the cause of the seizures."
The parent of a child having tympanoplasty tubes placed asks, "Will my child lose hearing while the tubes are in place?" What is the nurse's best answer?
"The tubes are inserted into a section of eardrum in which the hearing is not affected."
The nurse is reinforcing teaching with the caregivers of a child being discharged from the urgent care setting following a mild head injury that occurred in a roller skating accident. What should the caregivers be instructed to do? Select all that apply.
Observe and report any vomiting that occurs within 6 hours. Observe for and report to provider any double or blurred vision. Wake the child every 1 to 2 hours to check level of consciousness.
A nurse is caring for a newborn with anencephaly. Which intervention will the nurse use?
Place a cap or similar covering on the newborn's head.
After performing eye tests, the school nurse notes a child has symptoms of myopia. Which recommendation will the nurse make to the child's teacher?
Place the child close to the blackboard.
A nurse is assessing a 3-year-old child for possible bacterial meningitis. Which sign would indicate irritation of the meninges?
Positive Kernig sign
A mother has just given birth to an infant born with anencephaly. The mother states, "With all of the technological advances in medicine, I am hopeful of a good prognosis for my baby." How should the nurse respond?
"It must be very difficult to deal with this diagnosis. Tell me what you know about the prognosis."
The mother of a toddler tells the nurse during a routine well-child appointment that she is concerned because, "It seems like my son is falling and hitting his head all of the time." What is the best response by the nurse?
"Due to the size of their heads and immature neck muscles falling is common, but I will let the physician know your concerns."
A pregnant client asks if there is any danger to the development of her fetus in the first few weeks of her pregnancy. How should the nurse respond?
"During the first 3 to 4 weeks of pregnancy, brain and spinal cord development occur and are affected by nutrition, drugs, infection, or trauma."
A child is brought to the emergency center after sustaining a seizure at home. When taking the child's history, which question(s) would the nurse ask the parents? Select all that apply.
"What time did the seizure occur?" "Can you describe to me the movements your child experienced?" "How long did the seizure last?" "Did your child lose bladder or bowel control?" "Did your child stop breathing during the seizure?"
The parents of an 8-year-old child report that the child's teachers noted the child is having problems seeing the board in school but state they do not understand this since the child is able to read from the computer with no difficulty. Which response from the nurse is most appropriate?
"What you are describing may be what is called myopia."
An 8-year-old boy comes to the emergency room with an eye injury after having a glass bottle shatter near his face. Which intervention should the nurse do first while assisting this client?
Instill a few drops of a topical anesthetic into the affected eye
A 5-year-old child is diagnosed with acute otitis media. Which nursing intervention would be priority?
Relieving the child's pain
The nurse is talking with the mother of a 4-year-old boy who will soon be going to a pre-kindergarten program. The child has had the Snellen vision test done at home, and he was unable to distinguish the pictures at the distance that would indicate his vision is normal. The child's mother asks the nurse if he will need glasses. Which statement made by the nurse would be most appropriate regarding the child's vision?
"A child's vision is not completely developed by this age. Your child might outgrow this nearsightedness."
During the newborn examination, the nurse notes that an infant who is appropriate for gestational age by birth weight has a head circumference below the 10th percentile and the fontanels (fontanelles) are not palpable. What action would the nurse take?
Report the findings to the pediatric health care provider.
The nurse is collecting data from a child who may have a seizure disorder. Which nursing observations suggest an absence seizure?
Minimal or no alteration in muscle tone, with a brief loss of responsiveness or attention
The nurse is caring for a toddler who is scheduled to have myringotomy tubes placed. Which statement by the child's parents indicates a lack of understanding?
"Hearing loss after the tubes are placed may be permanent."
The parents of a toddler have just learned that their child has profound hearing loss. The parents are very upset and state to the nurse, "It just isn't fair. We did everything right during our pregnancy all the way to this point." How should the nurse respond?
"I can't imagine how difficult this must be. When you're ready I would be happy to arrange a meeting with a support group of other parents with children who have hearing loss."
