Peds E1

The nurse is providing care for a hospitalized child who is scheduled to receive morning medications. Place the statements in order that the nurse will state them, beginning with what the nurse will say first during the medication administration. Use all options. 1. "Would you like your medicine before or after your mom helps you take a bath?" 2. "Hello, I am going to be your nurse for today." 3. "You are doing great today. Would you like to play a game now?" 4. "It is time for you to take your morning medications."

2, 4, 1, 3 Nursing care for a hospitalized child typically occurs in four phases: introduction, building a trusting relationship, decision-making phase, and providing comfort and reassurance. After introductions, the nurse should let the child know it is time to take his or her medication, and then can offer the child a choice to take medications before or after the bath (or other appropriate choice). Lastly, the nurse should provide comfort and reassurance by offering to play a game with the child.

The nurse is calculating the urinary output for the infant. The infant's diaper weighed 40 g prior to placing the diaper on the infant. After removal of the wet diaper, the diaper weighed 75 g. How many milliliters of urine can the nurse document as urinary output? Record your answer using a whole number.

35 mL

A 6-year-old with leukemia is placed on reverse isolation. What nursing actions could prevent depression and loneliness in this client? Select all that apply. A. Read a story while in the room. B. Quickly exit the room when possible. C. Do all nursing tasks at one time. D. Play a game while in the room. E. Spend extra time to talk while in the room.

A, B, D A child on isolation is subject to loneliness, which can be prevented by arranging to spend extra time in the room during treatments. Also, while in the room the nurse might read a story, play a game, or just talk to the child. Quickly exiting the room and providing cluster care will increase social isolation and may make the child feel punished.

The parents of a preschool-aged child ask the nurse what can be done to prevent ear infections. What response(s) by the nurse is correct? Select all that apply. A. "Avoid exposure to cigarette smoke in the car or home." B. "Use diluted rubbing alcohol to dry the ear after swimming." C. "Encourage the child to use earplugs when swimming." D. "Clean the ear with a cotton-tipped applicator after bathing." E. "Discourage the use of earphones being inserted into the ear."

A, B, D, E The nurse would recommend the child not be exposed to passive smoke nor use items such as ear buds. The child should use ear plugs when swimming, and the parent should help the ear dry by using a diluted rubbing alcohol solution after swimming. The nurse would advise the parents to avoid using a cotton-tipped applicator to clean or dry the child's ears because it can rupture the ear drum and push ear wax further into the ear canal.

The nurse is assessing the pain level of a school-aged child who is cognitively impaired using the r-FLACC pain tool. The nurse determines the child scores 10 points on the assessment. Which symptom(s) did the nurse assess to achieve this score? Select all that apply. A. shallow, sprinting respirations B. occasional tremors C. head banging and breath holding D. distressed looking face E. refusing any comfort measures

A, D, E The r-FLACC pain assessment tool is used to evaluate pain in cognitively impaired children. It has been revised to have additional descriptors of behaviors most commonly found with cognitive impairments. The tool measures Face, Legs, Activity, Cry, and Consolability. Each area is scored from 0 to 2. The child with a score of 10 would be in severe pain. This score is obtained when a child is assessed to have five areas that are scored 2: a distressed-looking face, increased spasticity or constant tremors, head banging or breath holding, repeated outbursts or constant grunting, and pushing away the caregiver or unable to be consoled. Occasional tremors (rather than increased spasticity or constant tremors) and shallow, sprinting respirations (rather than head banging or breath holding) would each be scored 1, giving the child a score of 8.

A child is hospitalized with complications related to hemophilia. The health care provider has discussed the child's plan of care with the parents, but they continue to ask questions. What action will the nurse take? A. Answer the parents' questions as completely as possible. B. Reassure the parents that they have been fully briefed on their child's treatment. C. Notify the health care provider that the parents still have questions. D. Encourage the parents to focus their attention on their child.

A. Answer the parents' questions as completely as possible. Because the health care provider has discussed the child's care, the nurse should answer the parents' questions as completely as possible. Telling the parents that they have been fully briefed negates their concerns and is inappropriate. Encouraging the parents to focus on their child also negates their concerns. Unless the parents ask specifically for the health care provider, the nurse can answer the parents' questions.

The nurse is teaching a group of parents about eyes and eye concerns. The nurse tells these caregivers about a condition that occurs when unequal curvatures in the cornea bend the light rays in different directions and this causes images to be blurred. The condition the nurse is referring to is: A. Astigmatism B. Hyperopia C. Refraction D. Myopia

A. Astigmatism Astigmatism is caused by unequal curvatures in the cornea that bend the light rays in different directions and produce a blurred image. Refraction is the way light rays bend as they pass through the lens to the retina. Myopia is nearsightedness; hyperopia is farsightedness.

The nurse is caring for a 14-year-old girl with atrial fibrillation. Which medication would the nurse expect to be prescribed? A. Digoxin B. Indomethacin C. Furosemide D. Alprostadil

A. Digoxin Digoxin is indicated for atrial fibrillation. It increases the contractility of the heart muscle by decreasing conduction and increasing force. Alprostadil is indicated for temporary maintenance of ductus arteriosus patency in infants with ductal-dependent congenital heart defects. Furosemide is used for the management of edema associated with heart failure. Indomethacin is used to close a patent ductus arteriosus.

What will the nurse view as best maintaining normalcy in the life of a 10-year-old boy who is experiencing a lengthy hospitalization? A. Keeping up with his schoolwork B. writing down his oral intake on the day and evening shifts C. Watching daytime television D. playing board games with the CLS E. Choosing the time of his bath or shower

A. Keeping up with his schoolwork A school-ager is exactly that—someone whose life is centered around school. Doing school and homework assignments is part of his usual day when not hospitalized. Watching daytime TV is not. Choosing the time hygiene activities occur provides him some control, while tracking his oral intake is an opportunity to participate in his care. Playing board games with the child life specialist is an age-appropriate activity that provides distraction. These support him developmentally but do not normalize his day, as does keeping up with school assignments. It will be easier for him to return to the classroom and feel more in step with his peers by doing this.

A worried mother calls the nurse and tells her that her son has developed a horrible croup cough and is having trouble breathing. What would be the best intervention for the nurse to recommend to the mother? A. Run a hot shower to fill the bathroom with steam and have the boy stay there. B. Administer cough syrup to the boy. C. Administer an analgesic to the boy. D. Have the boy drink a full glass of water to clear out the mucus.

A. Run a hot shower to fill the bathroom with steam and have the boy stay there. One emergency method of relieving croup symptoms is for a parent to run the shower or hot water tap in a bathroom until the room fills with steam, then keep the child in this warm, moist environment as this relaxes the airway tissues and widens the bronchi lumens. If this does not relieve symptoms, parents should bring the child to an emergency department for further evaluation and care. Caution parents not to give cough syrup routinely to children as many produce little effect and the risk of overdose, incorrect dosing, and adverse events is greater than the benefit of the syrup. An analgesic might help alleviate pain due to inflammation and irritation of the throat from coughing, but it is not the priority intervention in this case. Drinking would likely be painful for this child and would not provide lasting benefit.

The nurse sees a 3-year-old child in the ambulatory setting for localized wheezing on auscultation. Which statement by the parent would be most important to report to the health care provider? A. The child was eating peanuts yesterday. B. The child has two cousins who have many allergies. C. The child received the pneumococcal vaccine series within his or her first year. D. The parent has supervised the child in the same room for the past 24 hours.

A. The child was eating peanuts yesterday. Aspiration can cause airway mucosal inflammation. When aspiration from a small object occurs, the child may cough and gasp for a few seconds to a few minutes. Following that, the child may not be symptomatic for a day or longer. The aspiration of a foreign body may mimic an asthma attack, but an asthma attack would have generalized wheezing. Localized wheezing suggests only a small portion of a lung is involved, such as occurs following aspiration. Allergic situations cause early symptoms such as rash development and are generally not genetic or inherited in nature. The US Centers for Disease Control and Prevention recommends children receive pneumococcal vaccine series before 2 years of age, usually at 2, 4, and 6 months.

When examining a child with congenital heart disease, an organ in the upper right quadrant of the abdomen can be palpated at 4 cm below the rib cage. What would most likely explain this assessment finding? A. The liver size increases in right-sided heart failure. B. The spleen size increases due to increased destruction of red blood cells. C. The liver size increases due to cardiac medications. D. The spleen size increases due to frequent infection.

A. The liver size increases in right-sided heart failure. The liver increases in size due to right-sided heart failure. This is one of the cardinal signs of congestive heart failure. The spleen is in the upper left quadrant of the abdomen and would increase in size under certain circumstances, but this is asking for the upper right quadrant information. There are certain medications that can affect the liver, but this would not be the most likely reason for hepatomegaly.

The nurse is working with a child-life specialist to assist a young preadolescent who is preparing for treatment for cancer. Which technique will the nurse and specialist prioritize to assist this child in better understanding what will be happening in the treatment of the cancer? A. Therapeutic play B. Onlooker play C. Play therapy D. Cooperative play

A. Therapeutic play Therapeutic play is a play technique used to help the child better understand what will be happening to him or her in a specific situation. For instance, the child who will be having an IV started before surgery might be given the materials and encouraged to "start" an IV on a stuffed animal or doll. By observing the child, you can often note concerns, fears, and anxieties the child might express. Therapeutic play helps the child express feelings, fears, and concerns. The other types of play will not accomplish this goal.

The nurse is collecting data on a child admitted with a respiratory concern. The nurse notes that the child is anxious and sitting forward with the neck extended to breathe. The signs the nurse noted indicate the child likely has: A. epiglottitis. B. cystic fibrosis. C. tuberculosis (TB). D. asthma.

A. epiglottitis. The child with epiglottitis is very anxious and prefers to breathe by sitting forward with the neck extended. Immediate emergency attention is necessary. The child with asthma would have wheezing and distress trying to breathe. The child with cystic fibrosis would not have respiratory distress unless ill with respiratory infection. The drooling, leaning forward, and appearing distressed are not manifestations of TB.

When preparing to administer medication to an infant, the nurse should utilize which device? A. oral syringe without a needle B. measured medication spoon C. infant formula and bottle D. medicine cup

A. oral syringe without a needle When administering medication to an infant, an oral syringe without a needle or a dropper may be used. Medication should not be mixed with the infant's formula. Toddlers and older children may use a measured medication spoon or cup.

What is a complication of cystic fibrosis? A. pneumothorax B. Crohn disease C. kidney disease D. urinary tract infection

A. pneumothorax Cystic fibrosis (CF) is a genetic disorder causing thickened tenacious secretions of the sweat glands, gastrointestinal tract, pancreas, respiratory tract and exocrine tissues. The treatment is aimed at minimizing pulmonary complications, maximizing lung function, preventing infection, and facilitating growth. A pneumothorax is a complication of CF. A rupture of the subpleural blebs through the visceral pleura takes place. There is also a high reoccurrence rate and incidence increases with age. Crohn disease is a gastrointestinal disorder that is not associated with cystic fibrosis. Urinary tract infection and kidney disease are also not associated with CF. Most of the problems and complications associated with CF relate to the respiratory system, the gastrointestinal system, and infectious disorders.

The nurse is caring for a client receiving opioid medication for the treatment of postoperative pain. What are common side effects that the nurse should observe for? A. respiratory depression, constipation, and pruritis B. respiratory depression, diarrhea, and hypotension C. hypotension, nausea and vomiting, and diarrhea D. constipation, hypertension, and disorientation

A. respiratory depression, constipation, and pruritis Nausea and vomiting, pruritis, sedation, respiratory sedation, constipation, and urinary retention are common side effects of opioid medications. Hypotension, hypertension, diarrhea, and disorientation are not common side effects of opioid medication.

The nurse is caring for a client who has been diagnosed with a tumor in the small intestine that is pressing on the liver. Which type of pain does the nurse anticipate the client will report? A. visceral B. deep somatic C. neuropathic D. chronic pain

A. visceral Visceral pain is often produced by disease. It usually is diffuse and poorly localized and is described as a deep ache or sharp stabbing sensation that may be referred to other areas. Deep somatic pain typically involves the muscles, tendons, joints, fasciae, and bones and causes dull, aching, or cramping pain. Neuropathic pain usually results in burning, tingling, shooting, squeezing, or spasm-like pain. Chronic pain is defined as pain that continues past the expected point of healing for injured tissue.

The nurse has administered oral penicillin as ordered for prophylaxis of endocarditis. The nurse instructs the parents to immediately report which reaction? A. wheezing B. nausea with diarrhea C. abdominal distress D. stomach upset

A. wheezing The nurse must report any hypersensitivity reactions such as wheezing and pruritus, as these could be a sign of anaphylaxis. Stomach upset, nausea, and abdominal distress are common with oral antibiotics and do not need to be reported immediately.

A 5-month-old infant has had a head-to-toe assessment by the nurse, been examined by a teaching team of physicians, and now experienced a blood draw. What behaviors might this infant manifest? A. yawning, turning away, and making little eye contact B. turning toward new sounds and bright toys and making throaty verbalizations C. opening eyes widely, kicking, and looking intently at a black-and-white mobile D. assuming a tonic neck reflex posture while looking toward the opposite wall

A. yawning, turning away, and making little eye contact This infant is likely overstimulated, and yawning, turning away, avoiding eye contact, and irritability are signs of this. The infant is attempting to disengage. The tonic neck reflex should have disappeared by 5 months of age. The other behaviors are those of an infant interested in his environment and ready for interaction.

The nurse is preparing to educate the child about a procedure scheduled for the following morning. Which techniques should the nurse use when communicating with this child? Select all that apply. A. Using terms that the child will likely understand. B. Requesting that the parents leave the room during the education. C. Being patient with the child. D. Looking for nonverbal cues. E. Standing at the foot of the child's bed while teaching the child.

B, C, E The nurse should position himself or herself at the child's level. The nurse should ensure that the child's parents are present during education. It is appropriate to use words that the child will understand. It is appropriate to show patience during the interaction and to look for nonverbal cues that indicate understanding or confusion.

A child diagnosed with acute otitis media has been given a prescription for benzocaine. The nurse is correct when she makes which statement? A. "Benzocaine is an antibiotic for your ear infection." B. "Benzocaine drops should be placed in your ear to numb it and reduce pain." C. "Benzocaine drops should be placed in your eye to numb it and reduce pain." D. "Benzocaine is an antibiotic for your eye infection."

B. "Benzocaine drops should be placed in your ear to numb it and reduce pain." Benzocaine numbing eardrops can be prescribed for acute otitis media to help with severe pain. Benzocaine is not an antibiotic and when prescribed for otitis media should be placed in the ear.

Nursing students are learning about the importance of therapeutic communication in their pediatric course. The nursing instructor identifies a need for further teaching when a student makes which statement? A. "It is best to stoop to a child's level when listening." B. "It is best to stand when listening to a child to demonstrate knowledge." C. "It is good to lean forward when listening." D. "It is good to sit, not stand when listening."

B. "It is best to stand when listening to a child to demonstrate knowledge." Good listening is not passive but active. Posture reveals greatly whether one is listening. Sitting, not standing, means the nurse is actively listening and interested in what the child has to say. Leaning forward, not backward, displays interest in the child and conveys an openness. The nurse can convey good listening habits by pulling up a chair to the bedside or to a table when the child is sitting and engaging with the child at the same level.

A nurse is caring for a 6-year-old boy hospitalized due to an infection requiring intravenous antibiotic therapy. The child's motor activity is restricted and he is acting out, yelling, kicking, and screaming. How should the nurse respond to help promote positive coping? A. "Let me explain why you need to sit still." B. "Would you like to read or play video games?" C. "Your medicine is the only way you will get better." D. "Do I need to call your parents?"

B. "Would you like to read or play video games?" Distraction with books or games would be the best remedy to provide an outlet to distract the child from his restricted activity. The other responses would be unlikely to affect a change in the behavior of a 6-year-old.

The nurse is caring for a 5-year-old client and notes respiratory rate of 45 breaths per minute, blood pressure 100/70 mm Hg, heart rate 115, temperature 101°F (38.3°C), and oxygen saturation 86%. Which diagnostic test is priority for the nurse to complete? A. Complete blood count (CBC) B. Arterial blood gas (ABG) C. Electroencephalogram (EEG) D. Pulmonary function test

B. Arterial blood gas (ABG) The most useful diagnostic test in respiratory distress is an ABG. Knowing normal blood gas values for children is very important for evaluation and proper treatment. A CBC is a blood test used to test for disorders including anemia, infection, and leukemia. An EEG is a test used to find problems related to electrical activity of the brain. A pulmonary function test is performed to evaluate the respiratory system. Based on the findings, the child is experiencing respiratory distress and has an elevated temperature. Airway and breathing are priority over an elevated temperature. The child's blood pressure is within normal range for this age.

Pancreatic enzymes are part of the treatment in cystic fibrosis. When should the nurse administer the enzymes? A. Once a day B. Before meals and snacks with milk C. Three times a day with water D. At night after dinner

B. Before meals and snacks with milk Enzymes should be administered before all meals and snacks to help in normal absorption of nutrients from the food. The other choices do not promote absorption of foods or are not taken with food.

What will the nurse view as best maintaining normalcy in the life of a 10-year-old boy who is experiencing a lengthy hospitalization? A. Have the parents encourage the child to cough and deep breathe every 2 hours B. Blow a pinwheel and bubbles with the child C. Arrange for RT to do coughing and deep breathing exercises with the child D. Teach the child to use an incentive spirometer

B. Blow a pinwheel and bubbles with the child The nurse will have the child blow bubbles and a pinwheel to accomplish the prescription as these actions are most like play. These actions will encourage and engage the child and are likely to be accepted and even enjoyed. All of the measures have potential to get the child to cough and deep breathe to some extent, but blowing bubbles and a pinwheel is best for the client's age.

In children with otitis media, a procedure known as a myringotomy may be performed. Which statement is most accurate regarding this procedure? A. This procedure is performed as soon as otitis media is diagnosed. B. During this procedure, small tubes are inserted into the tympanic membrane. C. The purpose of this procedure is to decrease or stop the drainage. D. A small incision is made in the earlobe during this procedure.

B. During this procedure, small tubes are inserted into the tympanic membrane. Myringotomy (incision of the eardrum) may be performed to establish drainage and to insert tiny tubes into the tympanic membrane to facilitate drainage. The procedure is done for children with chronic otitis media, not as soon as the child is diagnosed.

A nurse is admitting a 7-year-old child to the pediatric unit of the hospital. While the nurse is showing the child and parents the room and explaining where things are, the child becomes upset and frightened. What is the best action by the nurse? A. Keep on showing and explaining to the parents and do not include the child. B. Go slowly with the acquaintance process. C. Ask the parents to leave the room while explaining procedures to the child. D. Tell the child that there is nothing to be afraid of and that nobody will hurt the child during hospitalization.

B. Go slowly with the acquaintance process. The child who reacts with fear to well-meaning advances and who clings to the caregiver is telling the nurse to go slowly with the acquaintance process. The child who knows that the caregiver may stay is more quickly put at ease. To provide security for the child and to provide family-centered care, it is the responsibility of the nurse to form good partnerships with families. Asking the family to leave the room in this situation would only frighten the child more. The nurse should never provide false reassurance. Telling the child there is nothing to be afraid of or nothing will hurt him or her are promises the nurse cannot make to the child.

A nurse is reviewing blood work for a child with a cyanotic heart defect. What result would most likely be seen in a client experiencing polycythemia? A. Decreased WBC B. Increased RBC C. Increased WBC D. Decreased RBC

B. Increased RBC Polycythemia can occur in clients with a cyanotic heart defect. The body tries to compensate for having low oxygen levels and produces more red blood cells (RBCs). This would cause an increased result on the lab tests. This problem does not affect the white blood cells (WBCs).

Parents asks the nurse why their premature infant is receiving a feeding through the mouth rather than the nose. What is the best explanation by the nurse? A. It is equally acceptable to use either insertion site. B. Newborns are obligate nose breathers so nasogastric may obstruct their breathing. D. Orogastric tube insertion can cause inflammation and obstruction of the nares. E. Nasogastric tubes decrease the possibility of striking the vagal nerve.

B. Newborns are obligate nose breathers so nasogastric may obstruct their breathing. Whether enteral catheters should be passed through the nares or the mouth is controversial. Because newborns are obligate nasal breathers, passing a catheter through the nose may obstruct their breathing space, and repeated insertion of a nasogastric tube can cause inflammation and obstruction of the nose; thus most tubes are inserted orally in small infants. Orogastric insertion can also decrease the possibility of striking the vagal nerve in the back of the throat and causing bradycardia, whereas nasogastric tubes increase the possibility of striking the vagal nerve.

A nurse suspects a child is experiencing cardiac tamponade after heart surgery. What would be the priority nursing intervention? A. Administer epinephrine. B. Notify the doctor immediately. C. Observe vitals every two hours. D. Elevate the head of the bed.

B. Notify the doctor immediately. The nurse would notify the doctor immediately. Cardiac tamponade is a medical emergency and should be addressed. The child can die if intervention is postponed. It would not be appropriate to perform any interventions until confirming that this is the actual diagnosis.

A home care nurse is teaching a parent how to administer a clotting factor infusion to their child. How can the nurse best evaluate the effectiveness of the teaching? A. Give cues as needed while the parent sets up the infusion. B. Observe the parent set up and administer the infusion. C. Ask the parent to repeat the instructions step-by-step. D. Make time for questions at the end of the teaching session.

B. Observe the parent set up and administer the infusion. Observing the parent set up and administer the infusion is the best way to evaluate the nurse's teaching. Asking the parent to repeat the instructions, providing an opportunity for asking questions, or providing cues as the parent sets up the infusion does not evaluate the effectiveness of the teaching.

Included in the nursing care plan for the child receiving total parenteral nutrition (TPN) will be which intervention? A. A daily stool softener B. Regularly monitoring the child's blood glucose C. Flushing the peripheral catheter delivering the TPN solution regularly with saline D. Keeping the child nothing by mouth (NPO)

B. Regularly monitoring the child's blood glucose Monitoring the blood glucose is important with TPN since the glucose content of the solution is high and can cause hyperglycemia. The need for a stool softener would be determined on an individual basis. Children receiving TPN may or may not be taking food and fluids orally. The catheter delivering the TPN solutions will be centrally placed to accommodate the concentrated TPN solution (larger vessel with more rapid blood flow).

The nurse is caring for a child admitted to the hospital. The child's mother had to go home to take care of her other children. The child has become quiet, is not crying and is refusing to eat. The nurse would document the child is in which stage of separation anxiety? A. Third stage B. Second stage C. First stage D. Fourth stage

B. Second Stage In the second phase of separation anxiety, the child displays hopelessness by withdrawing from others, becoming quiet without crying, and exhibiting apathy, depression, lack of interest in play and food, and overall feelings of sadness. In the first phase, the child reacts aggressively to this separation and exhibits great distress by crying, expressing agitation, and rejecting others who attempt to offer comfort. In the third phase of separation anxiety, the child forms coping mechanisms to protect against further emotional pain. There is no fourth stage of separation anxiety.

The nurse is educating the parents of a 4-year-old boy with strabismus. Teaching for the parents would include the: A. need for ultraviolet-protective glasses postoperatively. B. importance of patching as prescribed. C. importance of completing the full course of oral antibiotics. D. possibility that multiple operations may be necessary.

B. importance of patching as prescribed. Teaching the parents the importance of patching the child's eye as prescribed is most important for the treatment of strabismus. The need for UV-protective glasses postoperatively is a subject for the treatment of cataracts. The possibility of multiple operations is a teaching subject for infantile glaucoma. Teaching the importance of completing the full course of oral antibiotics is appropriate to periorbital cellulitis.

Which type of medication lacks a ceiling effect, and therefore is prescribed in initial doses that must be titrated to achieve pain relief while managing side effects? A. aspirin B. morphine C. acetaminophen D. ibuprofen

B. morphine A ceiling effect is when a dosage of a pain medication is frequently increased but smaller and smaller gains are made to reduce the pain. The severity of the side effects also increases as the dosage is increased. Mixed-agonist-antagonists have a ceiling effect. Pure opioid agonists (morphine, hydromorphone, fentanyl) do not have a ceiling effect. They can be given in initial dosages and as needed without having to increase the dose to gain pain relief. Acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, and aspirin have ceiling effects. Each has recommended dosages not to be exceeded every 24 hours.

What are some negative effects that chronic pain can have on the pediatric population? A. weight loss, increased blood pressure, and increased heart rate B. sleep disturbances, exhaustion, irritability, mood disturbances, and depression C. increased blood pressure, increased heart rate, and sleep disturbances D. increased appetite, sleep disturbances, and irritability

B. sleep disturbances, exhaustion, irritability, mood disturbances, and depression Chronic pain is defined as pain that continues past the expected point of healing for the injured tissue. This pain has many effects as the child continues in pain. These effects may include sleep disturbances, exhaustion, irritability, mood disturbances, and depression. Heart rate, respiratory rate, and blood pressure increases are seen more with acute pain. Children in any type of pain have a decreased (not increased) appetite.

A nursing instructor is teaching about eye disorders in childhood. Which statement made by a student indicates a need for further instruction? A. "A cataract is a marked opacity of the lens." B. "Cataracts can be present at birth." C. "Cataracts are only present in adults." D. "Glaucoma is caused by increased intraocular pressure."

C. "Cataracts are only present in adults." A cataract is a marked opacity of the lens and may be present at birth. It can cause blindness if not treated early. The cataract can be removed as early as 2 weeks of age and the best results are achieved if removed by 3 months of age. Glaucoma is increased intraocular pressure causing damage to the optic nerve.

A child who is receiving TPN has developed the need to have insulin injections. The child's mother questions this and states that her child does not have diabetes. What is the appropriate response by the nurse? A. "Illness can sometimes result in the need for insulin." B. "There is a chance these feedings your child is receiving are causing her to have diabetes." C. "The feedings are high in sugar and insulin is needed to manage this." D. "There is no need to worry. This is temporary."

C. "The feedings are high in sugar and insulin is needed to manage this." Glucose levels may be elevated when TPN is administered. While illness can impact serum glucose levels, this is not an appropriate response. Telling the parent there is no need to worry minimizes concerns and is not a correct response. The child does not have diabetes but warrants insulin coverage.

The nurse is caring for a preschooler who is hospitalized with a suspected blood disorder and receives an order to draw a blood sample. Which approach is best? A. "I need to take some blood." B. "I need to remove a little blood." C. "Why don't you sit on your mom's lap?" D. "We need to put a little hole in your arm."

C. "Why don't you sit on your mom's lap?" It is best to include the families whenever possible so they can assist the child in coping with their fears. Preschoolers fear mutilation and are afraid of intrusive procedures. Their magical thinking limits their ability to understand everything, requiring communication and intervention to be on their level. Telling the child that we need to put a little hole in their arm might scare the child.

A 7-year-old boy tells the nurse that his head sometimes hurts after he eats ice cream. The nurse recognizes that this type of pain is: A. Chronic cutaneous pain B. Chronic somatic pain C. Acute referred pain D. Acute visceral pain

C. Acute referred pain Acute pain means sharp pain, as is the case in this scenario. It generally occurs abruptly after an injury. The pain of a pin prink is an example. Chronic pain is pain that lasts for a prolonged period or beyond the time span anticipated for healing. Referred pain is pain that is perceived at a site distant from its point of origin. In this case, the typical ice cream "brain freeze" is a headache that results from the contact of the cold ice cream with the digestive tract.

The nurse notes a 3-year-old child is restless, has a respiratory rate of 55 breaths/minute, and has an oxygen saturation of 90%. Which action will the nurse take first? A. Notify the primary health care provider. B. Consult respiratory therapy. C. Apply oxygen via a facemask. D. Request a breathing treatment.

C. Apply oxygen via a facemask. Oxygen is the most indicated treatment and is needed to increase low partial pressure of oxygen (PaO2) levels in the blood. The child is showing signs of hypoxemia and needs oxygen. The nurse will notify the health care provider after administering oxygen. Respiratory therapy and breathing treatments may be needed based on the child's response to oxygen.

The nurse is caring for a 12-year-old in sickle cell crisis. The nurse determines that the child is very tense and might benefit from relaxation techniques. Which is the best approach for the nurse to take when implementing this pain reduction technique? A. Ask parents and visitors to leave the room during this intervention. B. Begin the intervention by having the child breathe in and out quickly 10 times. C. Close the door to the client's room, dim the lights, and close the curtains before beginning. D. Allow the television to remain on during this intervention to provide distraction for the client.

C. Close the door to the client's room, dim the lights, and close the curtains before beginning. Dimming the lights and closing the door to sounds, bright light, and distractions in the hall are good ways to begin a relaxation exercise. The television should be off during this technique so it will not be a distraction. Parents do not need to leave the room as this may cause increased anxiety for the child. Deep and slow breathing are relaxation techniques, not quick breathing.

An adolescent remarks rather sarcastically that she feels like a "lab rat." What is the priority nursing action? Share with the adolescent that everyone on the unit enjoys working with teenagers. A. Arrange for additional bedside activities of the adolescent's choice. B. Enable the teen to stay in contact with peers electronically. C. Ensure information is shared and decisions about care are made with the teen and not for the teen. D. Provide more physical privacy for this teenager.

C. Ensure information is shared and decisions about care are made with the teen and not for the teen. Sharing information openly and honestly plus including the adolescent in all decision making is the priority action. Parents or staff should not be seen as completely in charge. More privacy, connection with peers, and additional diversional activity all support the teen developmentally and need to be part of her care. Telling the adolescent the staff enjoys teens is hollow unless the girl experiences this behavior.

The nurse performs a cardiac assessment and notes a loud heart murmur with a precordial thrill. This murmur would be classified as a: A. Grade II. B. Grade I. C. Grade IV. D. Grade III.

C. Grade IV. A heart murmur characterized as loud with a precordial thrill is classified as Grade IV. Grade II is soft and easily heard. Grade I is soft and hard to hear. Grade III is loud without thrill.

The nurse is preparing to give a diphtheria, pertussis, and tetanus (DPT) immunization to a child in an acute care setting before discharge. The label on the DPT bottle indicates the immunization expired yesterday. What is the correct nursing action to take? A. Give the injection since it is only one day expired. B. Inform the prescribing practitioner. C. Return the bottle to the pharmacy and request a replacement. D. Discard the bottle.

C. Return the bottle to the pharmacy and request a replacement. The expired immunization bottle should be returned to the pharmacy and a replacement should be requested. Never give expired medications. Simply discarding the bottle does not solve the problem. It is not necessary to inform the prescribing practitioner.

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? A. There are no teaching methods that need to be considered. B. Hands-on learning should account for 90% of the teaching method. C. Student placement in the room is important but all other teaching methods may remain the same. D. Teaching sessions will need to be shortened due to eye strain.

C. Student placement in the room is important but all other teaching methods may remain the same. Amblyopia is when the vision in one of the eyes is reduced because the eye and the brain are not working together properly. The eye itself looks normal, but it is not being used normally because the brain is favoring the other eye. This condition is also sometimes called "lazy eye." The student can still see and, in some cases, has limited impairment due to brain compensation. It is associated with other conditions such as poor refraction, ptosis, cataracts, or strabismus. The child should be placed where he or she can be in direct view of the teacher or blackboard but the other teaching methods may remain the same. The methods do not need to be shortened nor does the child require a large percentage of the learning to be hands-on.

The nurse hears wheezing when auscultating a 4-year-old. Which condition would the nurse most likely rule out based on the assessment findings? A. Asthma B. Bronchiolitis C. Upper respiratory infection D. Cystic fibrosis

C. Upper respiratory infection Wheezing typically is not associated with upper respiratory infection. Wheezing is caused by an obstruction of the bronchioles that may be caused by bronchiolitis, asthma, cystic fibrosis, or chronic lung disease.

The nurse is preparing to administer an IV antibiotic to a child. After calculating the recommended dose with the child's weight, the nurse discovers the prescribed dose exceeds the safe dose range in a pediatric drug book. The medication has been given to the child at this dose for 3 days. A. What action should the nurse take next? B. Ask the child's parents if this dose has been given all week. C. Verify the dose with the prescribing health care provider. D. Call the pharmacy. E. Give the prescribed dose since the child has been receiving that dose for 3 days.

C. Verify the dose with the prescribing health care provider. Medication calculations should always be checked before giving the dose. When a medication dose is found to be outside of the safe dose range, the dose should be verified with the prescribing health care provider. Doses that exceed the recommended range should always be verified, even if they have been given before. The parents did not prescribe this medication. Even if the medication has been given for 3 days, it does not make the dose correct. Calling the pharmacy can only verify if the dose is out of the safe range. The pharmacy did not prescribe the medication nor does it know the child's medical background.

The nurse is teaching an in-service program to a group of nurses on the topic of children diagnosed with rheumatic fever. The nurses in the group make the following statements. Which statement is most accurate regarding the diagnosis of rheumatic fever? A. "Being up-to-date on immunizations is the best way to prevent this disorder." B. "This disorder is caused by genetic factors." C. "The onset and progression of this disorder is rapid." D. "Children who have this diagnosis may have had strep throat."

D. "Children who have this diagnosis may have had strep throat." Rheumatic fever is precipitated by a streptococcal infection, such as strep throat, tonsillitis, scarlet fever, or pharyngitis, which may be undiagnosed or untreated. Rheumatic fever is a chronic disease of childhood, affecting the connective tissue of the heart, joints, lungs, and brain. There is no immunization to prevent rheumatic fever. The onset of rheumatic fever is often slow and subtle.

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? A. "I will use a warm compress to help loosen crust that accumulated on his eyelid overnight." B. "I will wash my hands immediately after caring for him." C. "I will encourage my son to not touch his eyes." D. "I will use Visine drops in his infected eye to help reduce redness."

D. "I will use Visine drops in his infected eye to help reduce redness." Using a warm compress to remove crust from eyelids, washing hands frequently, and refraining from touching infected eyes are all ways to help manage bacterial conjunctivitis and prevent spreading the infection. Visine should not be used as it does not treat the cause of the infection and can cause rebound redness.

The primary health care provider prescribed ketoconazole for a child with ringworm. Which statement by the parents indicates the nurse needs to provide additional teaching on the prescription? A. "If this medication gets in my child's eyes, I will rinse with water immediately." B. "My child needs to take the full prescribed dosage." C. "I will wash my hands before and after I apply this medication." D. "I will wrap the skin tightly after applying the medication."

D. "I will wrap the skin tightly after applying the medication." Ketoconazole is an antifungal used to treat tinea infections. The nurse would teach to avoid covering treated skin areas with tightly. The area needs to allow for air to circulate to the skin in order to limit side effects. All other statements indicate correct understanding.

The parents of a 2-year-old toddler newly diagnosed with tricuspid atresia ask the nurse, "I do not understand why our toddler's fingertips are spread out and rounder than normal fingertips?" Which response by the nurse is best? A. "Increased cardiac workload from your toddler's heart defect affects various parts of the body, including the fingers." B. "This is a common complication of tricuspid atresia. Unfortunately, there is nothing we can do to treat it." C. "The number of red blood cells has significantly increased from the heart defect, resulting in the cells pooling in the fingertips." D. "The low blood oxygen levels from the heart defect causes the lack of oxygen to the fingers, causing these changes."

D. "The low blood oxygen levels from the heart defect causes the lack of oxygen to the fingers, causing these changes." Clubbing (which is what the parents are describing) of fingertips or toes can occur from the chronic hypoxia that occurs with disorders with decreased pulmonary blood flow, such as tricuspid atresia. Using the term "low oxygen levels in the blood" rather than "chronic hypoxia" is a better way to explain to the parents what is happening with their child. Clubbing is not the result of increased cardiac workload. Red blood cell pooling is not the cause of clubbing. Although clubbing is a possible result of tricuspid atresia, telling the parents this is a "common complication" does not address the parent's concerns.

The nurse is providing family education for the administration of ibuprofen. Which response indicates a need for further teaching? A. "This medication is taken by mouth." B. "I should monitor for signs of easy bruising or bleeding gums." C. "This should be given with food to avoid upsetting his stomach." D. "This can be taken with other medications we have at home that didn't require a prescription."

D. "This can be taken with other medications we have at home that didn't require a prescription." The nurse must emphasize that the parents should carefully read labels of over-the-counter medications they already have or will purchase. Some may contain ibuprofen or other nonsteroidal anti-inflammatory drugs, and if given in conjunction with ibuprofen may lead to overdose. The other statements are correct.

The nurse is caring for a 13-year-old who is hospitalized for management of his recently diagnosed diabetes. The child has been withdrawn, and when asked she reports she is "just tired of being sick". What action by the nurse will be of the greatest benefit to helping the child with this concern? A. Provide books and magazines of interest to her. B. Encourage the child to call her friends on the phone. C. Ask one of the parents to stay with her at all times. D. Encourage the child to participate in planning her daily care.

D. Encourage the child to participate in planning her daily care. When teens face illness they are also faced with a loss of control and independence. Activities that foster her involvement and encourage her to participate in care will work to reduce these feelings related to loss of control. Interacting with friends by phone will be helpful but will not establish feelings of control. Parents are encouraged to spend the night but this will not promote a sense of control. Providing books and magazines will offer diversion but will not promote feelings of control.

The nurse is providing postsurgical care for a 4-year-old boy following hernia repair. Before surgery, the nurse taught the child to use the poker chip tool to rate his pain. When assessing the child's postsurgical pain, the boy refuses to A. Touch the chips and clings to his mother. How should the nurse respond? B. Select the visual analog scale as the best one to use. C. Show the child once more how to use the chips. D. Give the mother the FACES pain rating scale to use with her son. E. Substitute the word-graphic rating scale for the poker chips.

D. Give the mother the FACES pain rating scale to use with her son. Different pain rating scales are appropriate for different developmental levels. Children often regress when in pain, so a simpler tool such as the FACES scale may be needed. It is also helpful to enlist the assistance of the parent. Expecting the child to select a chip is developmentally inappropriate when the child shows signs of regression. The child wouldn't understand the phrase "word-graphic scale," and this scale or the visual analog scale is more complex than this 4-year-old can handle.

A 9-year-old child with rheumatoid arthritis has difficulty moving the hands as well as other joints due to pain. The child refuses to participate in the prescribed physical therapy. What would be the best way for the nurse to make sure the child continues to exercise the joints? A. Give the client a coloring book about arthritis. B. Give the client a pamphlet about the importance of exercise. C. Show a video about exercising. D. Play a game like "Simon Says" to introduce exercises.

D. Play a game like "Simon Says" to introduce exercises. School-aged children love to play games. By playing "Simon Says" and introducing different exercises to help with movement, the nurse may help stimulate the client to want to be active. Reading about exercises and seeing them demonstrated by a person or in a video will not increase the child's desire, especially since the child is in pain. Exercise for this child should be a pleasant experience and playing a game will help accomplish that goal.

When planning to teach a toddler about coughing and deep breathing, which would be most effective? A. Discussing the importance of coughing B. Showing an audio-visual C. Demonstrating the technique D. Playing a game with coughing and breathing

D. Playing a game with coughing and breathing Toddlers have vivid imaginations so teaching should be done where the child can take an active role and understand the reality instead of the imaginary. Toddlers respond best to teaching techniques that include games so they feel as if they are playing instead of learning. When the child is active in the learning process it fosters self-confidence and provides them with a sense of control over the situation. The toddler age group does best learning when they can use all their senses in the learning process. Demonstrating, instructing, or showing a video does not provide this opportunity.

When reviewing the record of a child with tetralogy of Fallot, what would the nurse expect to discover? A. Anemia B. Leukopenia C. Increased platelet level D. Polycythemia

D. Polycythemia Tetralogy of Fallot is a congenital heart defect causing decreased pulmonary blood flow. This causes mild to severe oxygen desaturation. To compensate for the low blood oxygenation the kidneys produce erythropoietin to stimulate the bone marrow to make more red blood cells (RBCs). The increased amount of RBCs is known as polycythemia. This increased blood volume causes more workload on the heart. It also does not increase the amount of blood reaching the lungs so the child remains desaturated. Leukopenia, increased platelets, and anemia are not associated with tetralogy of Fallot.

A nurse is providing teaching on the medication regimen for beta-thalassemia to an adolescent. What is the best way for the nurse to determine if the teaching was successful? A. Ask the adolescent if the teaching was understood. B. Provide an opportunity for the adolescent to ask questions. C. Provide written materials to reinforce teaching. D. Request that the adolescent teach the information to the nurse.

D. Request that the adolescent teach the information to the nurse. The best way for the nurse to determine if teaching has been successful is to ask the client to "teach back" the information taught. Using this method, the nurse can correct any misconceptions. Providing written materials to reinforce teaching, having the client verbalize understanding the instructions, and providing an opportunity to ask questions are all appropriate client education strategies, but they do not evaluate the effectiveness of the teaching.

A child with heart disease is receiving digoxin and a diuretic. Which laboratory test result would be most important for the nurse to monitor? A. Serum sodium level B. Erythrocyte sedimentation rate C. Oxygen saturation level D. Serum potassium level

D. Serum potassium level Children receiving diuretics should have serum potassium levels obtained because diuretics tend to deplete the body of potassium. This is even more important if the child is also receiving digoxin because low serum potassium levels potentiate or increase the effect of the drug. Serum sodium levels may be obtained in children with heart failure to ensure that an increased sodium level is not causing edema. The erythrocyte sedimentation rate identifies inflammation and is unrelated to the use of diuretics and digoxin. Oxygen saturation levels may be done to evaluate for hypoxemia, but these results would be unrelated to the use of digoxin and diuretics.

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)? A. Symptoms of upper respiratory infection are present. B. The ear canal is devoid of cerumen. C. The tympanic membrane reacts to a puff of air. D. The child cries out when the ear is grasped.

D. The child cries out when the ear is grasped. External otitis (acute otitis externa or swimmer's ear) is an infection and inflammation of the skin of the external ear canal. The classic sign of external otitis is pain on movement of the pinna or pain on pressure over the tragus. Upon examination, the ear canal is red and swollen. Many times the tympanic membrane cannot be visualized because the swelling does not allow the insertion of an otoscope. Symptoms of upper respiratory infection many times accompany otitis media but are not seen in external otitis. The tympanic membrane reacting to a puff of air is a sign that there is no fluid buildup in the middle ear. The absence of cerumen in the ear canal is not related to external otitis.

The nurse is taking a respiratory history of a newly admitted child. While documenting the symptoms the child has, what other item is important to document when taking a history on an altered respiratory status? A. The child's weight B. The child's hospital history C. The child's diet D. The triggers in the environment

D. The triggers in the environment When assessing a respiratory history, it is very important for the nurse to find out what in the environment worsens the child's symptoms. These are called "triggers." The other choices would be part of a general health history.

The nursing student identifies which technique as the correct one to use when giving oral medications to an infant? A. Use a dropper and let it rest on the infant's tongue when squirting the medicine. B. Allow the child to lay flat while giving the liquid medication to relax the child. C. Use a dropper and squirt the liquid quickly into the back of the infant's mouth. D. Use a dropper and slowly inject the liquid into the side of the infant's mouth.

D. Use a dropper and slowly inject the liquid into the side of the infant's mouth. When giving liquid medication to an infant or child, the nurse should never administer it while the child is flat. Doing so could cause a child to aspirate. The nurse uses the dropper by placing it so the fluid flows slowly into the side of the child's mouth. The nurse should make sure the end of the syringe rests at the side of the infant's mouth to help prevent aspiration as well.

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? A. washing the child's hands and face when returning from outdoors B. making sure the child showers and shampoos before bedtime C. rinsing the child's eyelids with a clean washcloth and cool water D. encouraging the child to keep his hands away from his eyes

D. encouraging the child to keep his hands away from his eyes Keeping a 6-year-old child's hands away from his face is a difficult task, particularly when he is playing by himself or is at school. Washing the child's hands and face when returning from outdoors, rinsing the child's eyelids, and showering and shampooing before bedtime are all things the parents can supervise and ensure occurs, and thus would be less difficult to implement.

A 10-year-old child is scheduled for open reduction and internal fixation of the tibia following a skateboard accident. The nurse anticipates which pain medication and administration method will best provide postsurgical pain relief for this child immediately after surgery? A. acetylsalicylic acid (aspirin) given orally B. fentanyl given as an intramuscular injection C. nonsteroidal anti-inflammatory drugs (NSAIDs) given orally D. morphine given as an intravenous injection

D. morphine given as an intravenous injection For managing severe or acute pain, such as postoperative pain, opioids like morphine or fentanyl are preferred. Immediately after surgery, the intravenous route is preferable to the oral route because the child may not be able to tolerate oral medications at that time and intravenous medications begin to work much faster than oral medications. NSAIDs, such as ibuprofen or naproxen, are excellent for reducing pain because they reduce inflammation and pain; however, the child most likely will not be able to take an oral medication immediately following surgery. NSAIDs could be given intravenously as prescribed during the immediate postoperative period. Intramuscular injections should be avoided in children because the number of suitable injection sites in children is limited, injections are associated with pain on administration, and many children are afraid of injections. As a rule, other routes for administration of pain medication are used whenever possible.

A hospitalized toddler being treated for pneumonia requires supplemental oxygen. The respiratory rate is 44 breaths/min and the oxygen saturation is 90% on room air. Which oxygen delivery device would be best for this toddler? A. partial rebreather B. nonrebreather C. simple face mask D. nasal cannula

D. nasal cannula The best form of oxygen delivery for this toddler is a nasal cannula. The nasal cannula is the most comfortable and the most likely to stay in place. The nasal cannula provides up to 44% more oxygen delivery than room air. Oxygen can be delivered up to 4 liters via nasal cannula. The child can eat or talk with the nasal cannula in place. The oxygen should be humidified. The simple face mask can provide 35% to 60% of oxygen via a flow rate of 6 to 10 liters. It is used when there is increasing respiratory difficulty. Children have difficulty keeping it in place. A nonrebreather (face) mask is used for serious respiratory problems. It can deliver 95% oxygen via 10 to 12 liters flow. A partial rebreather mask is also needed when an increased amount of oxygen delivery is needed. This mask can provide 50% to 60% oxygen set at 10 to 12 liters flow.

An urgent care nurse is cleaning a forehead laceration on a 7-year-old. The mother is present. The child is crying and screaming. The nurse should: A. review safety measures that could have prevented the injury. B. have the mother speak firmly to the child to correct the crying and screaming. C. ask the child to be less noisy because he is "scaring and bothering other children." D. tell the child, "It's OK to cry, but I need you to hold still." E. Close the door tightly and reassure the child, "I am being gentle and am almost done."

D. tell the child, "It's OK to cry, but I need you to hold still." Children should be able to express their feelings openly when they are hurt or frightened. Acknowledging the crying/screaming is developmentally sound. Stating the need to hold still is accurate and respects the child's ability to help. Closing the door is a good idea but "gentle" and "almost done" show little understanding of the child's experience. Expecting the mother to discipline the child or for the child to be able to consider others is unrealistic. Discussing injury prevention at this point is inappropriate, is likely to promote guilt, and appears to place blame. This would interfere with relationship-building between nurse, child, and family.

The nurse is preparing to administer a vaccine to a 6-month-old child. The medication is to be given intramuscularly. The nurse is correct in choosing which administration site? A. ventrogluteal site B. deltoid muscle C. dorsogluteal site D. vastus lateralis site

D. vastus lateralis site The preferred injection site for infants less than 7 months old is the vastus lateralis muscle. In infants and children older than 7 months old the ventrogluteal site should be considered. The dorsogluteal site, often used in adults, is not recommended in children younger than 5 years of age. The deltoid muscle may be used in a child older than 3 years of age.