PEDS Practice: Chapter 1 Introduction to Child Health and Pediatric Nursing, PEDS Practice: Chapter 2 Factors Influencing Child Health, PEDS: Chapter 3 Growth and Development of the Newborn and Infant, Peds - Chapter 04: G&D of the Toddler, Pediatric...

The nurse is collecting data on a 9-year-old child being admitted to the pediatric unit. What is the most appropriate way to gather information from the child's caregiver?

Ask the caregiver questions and write the answers down. The family caregiver provides most of the information needed in caring for the child, especially the infant or toddler. Rather than simply asking the caregiver to fill out a form, it may be helpful to ask the questions and write down the answers. page 273

A parent asks if the reason her infant has a congenital heart defect is because of something she did while she was pregnant. What is the best response by the nurse?

There are several reasons a baby can have a heart defect, let's talk about those causes. Focus on the therapeutic communication in this situation, while still obtaining more information. This will help the nurse explore various options for the cause of the defect with the parent.

The nurse is examining a 3-year-old girl during a regular visit. Which finding would disclose a developmental delay in this child? a) The child demonstrates separation anxiety. b) The child follows directions when made one at a time. c) The child copies a circle on a piece of paper. d) The child imitates the nurse in use of a stethoscope.

The child demonstrates separation anxiety.

The nurse is examining a 2-year-old girl for speech and language development. Which finding would suggest a delay in speech development? a) The child puts together sentences of two words. b) The child does not use the names of familiar objects. c) The child repeats what the parents say out of context and at random moments. d) The child does not speak clearly but shows understanding of what is said.

The child does not use the names of familiar objects.

The nurse is discussing food allergies with parents of a young child. She explains that a very effective way to determine which foods a child may be allergic to is to implement:

an elimination diet. The food diary may identify foods the child does not tolerate well, but it lacks the objectivity of the elimination diet. Skin testing usually involves whole proteins and will not test for reactions to food breakdown products. A raw food diet does not apply to allergy identification.

The mother of an infant asks you when to begin brushing her son's teeth. Your best response would be:

as soon as the first tooth erupts. Toothbrushing should begin with the eruption of the first tooth.

According to Erikson, the adolescent develops his or her own sense of being an independent person with individual thoughts and goals. This stage is referred to as:

identity vs. role confusion.

During the assessment of a 15-year-old female the nurse notes a new body piercing in the navel. Which statements by the nurse would be appropriate in regard to this new piercing?

• "I notice you have a new piercing. Be sure to clean it twice a day so you don't get an infection." • "Did they tell you when you got your piercing how important cleaning it is? Infections can take up to a year to heal in a naval piercing."

What anticipatory guidance can the nurse provide the girl who has noted the development of breast buds?

Menarche should follow in about 2 years.

A 3-month-old still has a Moro reflex. Which statement is most true of this reflex?

Most 3-month-olds still have a Moro reflex. Typically, Moro (startle) reflexes last until 5 to 6 months and then fade.

The nurse is reviewing a job description of a school nurse. Which activity would the nurse question?

Provide immunizations to students.

To give eardrops to a 4-year-old, what would be the best technique to use?

Pull the pinna of the ear up and back. Pulling the pinna up and back straightens the ear canal in the child over 3 years of age. pg 381

A parent brings an infant in for poor feeding. Which assessment data would most likely indicate a coarctation of the aorta?

Pulses weaker in lower extremities compared to upper extremities An infant with coarctation of the aorta has decreased systemic circulation, causing this problem. The cyanosis would be associated with tetralogy of Fallot.

The mother of a 15-month-old is concerned about a speech delay. She describes her toddler as being able to understand what she says, sometimes following commands, but using only one or two words with any consistency. What is the nurse's best response to this information? 1. The toddler should have a developmental evaluation as soon as possible. 2. If the mother would read to the child, then speech would develop faster. 3. Receptive language normally develops earlier than expressive language. 4. The mother should ask her child's physician for a speech therapy evaluation.

Receptive language normally develops earlier than expressive language.

What behavioral responses to pain would a nurse observe from an infant younger than age 1?

Reflex withdrawal to stimulus and facial grimacing Infants younger than age 1 become irritable and exhibit reflex withdrawal to the painful stimulus. Facial grimacing also occurs. Localized withdrawal is experienced by toddlers ages 1 to 3 in response to pain. The nurse would observe passive resistance in school-age children. Preschoolers show a low frustration level and strike out physically

The nurse is observing the behavior of a preschool-aged child and becomes concerned. Which observation suggests that the child's thinking is inconsistent with normal preschooler growth and development?

Refusing to play with "real" children

Parents are concerned because their 18-month-old will eat only when they feed him. They report he was independent with feeding at home but is unwilling in the hospital. The nurse considers this behavior:

Regression

Parents who just moved into their "dream home" are concerned because their toddler boy, who had achieved daytime bowel and bladder control, has begun wetting and defecating in his underwear. The nurse explains this is called: a) Egocentrism b) Ritualism c) Autonomy d) Regression

Regression

A child is administered oxybutynin (Ditropan) following surgical repair of a hypospadias. The purpose of this drug is to:

Relieve bladder spasms. The presence of a urethral catheter can cause painful bladder spasms. A drug such as ocybutynin reduces the possibility of this.

The mother of a 9-month-old child reports her child's eyes are often crossed. The nurse confirms this during the examination. What action is indicated?

Report the findings to the physician. Persistent strabismus is normal in newborns. If noted after the age of 6 months it should be evaluated by a pediatric ophthalmologist. This will need to be reported to the physician so that the referral can be made. Page 294

Which gross motor developmental milestone is least likely for a 2 year old? a) Rides a tricycle b) Jumps in place c) Climbs d) Stands on one foot with help

Rides a tricycle Explanation: A gross motor developmental milestone for a 2- to 3-year-old includes jumping in place. Riding a tricycle occurs at 3 to 4 years of age. Climbing occurs at occurs at 18 months to 2 years. At 12 to 18 months, the child can stand on one foot with help.

When providing education to a mother regarding pain management for a toddler with otitis media, which statement by the mother indicates further teaching needs for this parent?

";I should give my toddler one baby aspirin." Children should not use acetylsalicylic acid for routine pain management because of the increased risk of Reye syndrome. The use of the other options is appropriate and all indicate an understanding of pain management for this child.

The parents of an 8-month-old boy voice concern to the nurse that their child is not developing motor skills as he should. What question would be appropriate for the nurse to ask in determining if their fears are warranted?

"Does he move a toy back and forth from one hand to the other when you give it to him?" Transferring an object from one hand to the other is expected at 7 months of age, so this would be expected of an 8-month-old. The other options are not expected until later months, so questioning the parents about these skills would not help in determining if he was at the motor skill developmental level that should be expected.

An adolescent boy of African American descent has been diagnosed with hypertension. Which statement made by the boy indicates to the nurse that additional teaching is needed?

"Drinking sodas is not related to my blood pressure."

Which nurse response to the parent indicates the nurse recognizes the importance of the child's increasing responsibility for their personal heath choice?

"I recommend you talk with your adolescent child and discuss their preference for which dentist to visit." The child's participation in their health choices increases as the child grows and develops. By asking the adolescent for input, the nurse is encouraging the parent to include the child in responsible decision making. The other choices are ideal suggestions for younger children, but these children are dependent on their parents providing supervision of their health choices. pg 237

The mother and father of a 5-year-old boy are discussing bicycle safety with the nurse. What comment indicates further teaching is needed?

"We just got him a new bike he can grow into."

A dental home (like a medical home) establishes a continuing comprehensive relationship of care with the child and family. The American Academy of Pediatric Dentistry (AAPD) recommends this dental home be established by the time the child is age:

1 year The recommendation is by the child's first birthday. This is the time the first dental exam should occur. pg 263

Parents are proud of their toddler's fast-developing fine motor skills. Which skill they describe should the nurse point out as a safety risk? a) Turn book pages b) Hold crayon to write c) Ability to turn knobs d) Put shapes into matching openings

Ability to turn knobs

The nurse is interviewing an adolescent. What should the nurse recognize as an important aspect of interviewing the adolescent?

Adolescents will share more about themselves in a private conversation. Adolescents can provide information about themselves. Interviewing them in private often encourages them to share information that they might not contribute in front of their caregivers. Page 273

The nurse is caring for a burn client with orders for oral ibuprofen and morphine PRN to control pain. Which nursing interaction is the most beneficial for the nurse to implement for pain management?

Alternate these medications around the clock to diminish peaks and valleys in pain control. Pain is best managed by a proactive, preemptive approach. Anticipating and treating pain is much more effective and humane than trying to manage pain once it is present. PRN administration of pain medication tends to propagate a pain cycle with peaks (side effects like sedation) and troughs (pain) of drug action. If pain is present or anticipated for most of the day, medications must be scheduled and administered around the clock (ATC), with additional doses of analgesics available for prompt relief of breakthrough pain. pg 430

The nurse is communicating with a family about their child's illness. Which communication technique would be considered a block to effective communication with the family? a. using silence b. using clichés c. defining the problem d. clarifying

B A cliché is the first level of communication. It is pleasant chatting and not intended for a relationship to extend beyond a superficial level. Introducing one's self and role allows the communication to progress to a more therapeutic level. The use of silence will allow the parents to sort out their thoughts. The nurse needs to clarify in the communication to illicit the information needed. The parents both will need to collaborate to define the problem so that a plan of care may be developed.

The nurse is reviewing the health history of an infant who is demonstrating developmental delays. Which finding would be considered a possible risk factor?

Being raised by a single teenaged mom Parental factors can be associated with developmental delays in the child. Being raised by a single parent or a parent having less than a high school education are associated with delays in the child. Birth weight less than 1500 grams is associated with delays. Children born at 33 weeks' gestation or less are at an increased risk for developmental delays. pg 239

How can the nurse most simply describe for distressed parents a rhabdomyosarcoma that has been found in their 5-year-old?

Call it a tumor of muscle tissue A rhabdomyosarcoma is a tumor of striated muscle that most commonly develops in the head, neck, arms, and legs, as well as in the genitourinary tract, of children. The other descriptors are incorrect

A nurse realizes that a child's hospitalization is stressful for the family for which reasons? Select all that apply.

Cause of the illness The illness's treatment Guilt about the illness Past experiences of illness and hospitalizations Disruption in family life

The nurse is caring for a 7-year-old boy and his family, who are immigrants. Which intervention will most significantly affect the success of the care provided?

Communicating with sensitivity using understandable terms Being understood is essential to the provision of all nursing care. An interpreter may be needed. Speaking slowly and using simple terms is also useful. Inquiring about common health problems in their home country, asking about transportation, and helping them access aid programs are all secondary to and dependent upon effective communication.

What is the best awake state for infant interaction?

Eyes wide and bright The best time for a family to interact with an infant is when the infant is in the quiet or active alert stage. Examples of this are minimal body activity, regular respirations, face with shiny look, eyes wide and bright, and paying attention to stimuli.

The nurse is caring for a preschool-aged child who needs a CT scan. Which action would the nurse use to best prepare the child for this diagnostic test?

Help the child to pretend that the CT scan machine is a camera.

According to Erikson, the adolescent develops their own sense of being independent people with their own thoughts and goals. This stage is referred to as:

Identity vs. role confusion They must develop their own personal identity—a sense of being independent people with unique ideals and goals

What information should be included in an 8-year-old's pediatric history?

Immunizations Immunizations should be included in a pediatric history so it's clear if the child is up to date. The other choices are not critical factors. Page 275

The father of a 5-year-old child reports that he uses a series of local urgent care centers for routine care. What is the greatest concern about this practice?

It is difficult to have continuity of care with these practices.

The father of a 5-year-old child reports that he uses a series of local urgent care centers for routine care. What is the greatest concern about this practice?

It is difficult to have continuity of care with these practices. The American Academy of Pediatrics discourages children and families from using urgent care centers or the emergency department for routine care, since it is difficult to provide coordinated, comprehensive family-centered care consistent with a "medical home" concept. page 337

A client who just learned she is pregnant says, "I can no longer eat strawberries, even though they are my favorite." What best explains this statement?

It is related to culture. People from different cultures tend to eat different types of food. Some women may omit various foods during pregnancy because they believe a particular food will mark the baby (e.g., strawberries cause birthmarks, raisins cause brown spots). Food preferences, selections, and seasons do not explain her sudden omission of strawberries in her diet.

An infant girl is prescribed digoxin. The nurse would teach her parents that the action of this drug is to:

Slow and strengthen her heartbeat. Digoxin is a cardiac glycoside that slows and strengthens the heartbeat.

A father and his 12-month-old son are in for an office visit. The son is now walking regularly, and the father asks the nurse for recommendations on shoes. Which of the following should the nurse suggest? a) Flip-flops b) Ankle-high shoes c) Sneakers d) Shoes with much arch support

Sneakers

The nurse is caring for an 8-month-old infant with a suspected congenital heart defect. The nurse examines the child and documents which expected finding?

Softening of the nail beds Softening of nail beds is the first sign of clubbing due to chronic hypoxia. Rounding of the fingernails is followed by shininess and thickness of nail ends.

If an adolescent has hepatitis B, what would be an important nursing action?

Strict enforcement of standard precautions Hepatitis B is spread through contaminated blood. Standard precautions help prevent contact with this.

The nurse is preparing to participate in a community discussion on the needs of the adolescents in the local school. The nurse should point out which goal is the primary concern for these young individuals as the committee makes plans?

Teens are busy developing their own personal identity.

Computer use at home and at school has increased adolescents' comfort in gaining access to and using the Internet. This has expanded their exposure to risks. What potential risks are there for an adolescent to be exposed to?

Teens can be exposed to inappropriate materials, harassment, threats, and potential for molestation.

The 18-month-old has most likely attained which of the following gross motor skills? a) The ability to walk independently. b) The ability to walk up stairs alone. c) The ability to pedal a tricycle. d) The ability to balance on one foot.

The ability to walk independently.

The nursing instructor is leading a class discussion on the various aspects of adolescents. The instructors determines the class is successful after the students correctly choose which milestone as the beginning of adolescence?

The beginning of puberty

Which activity would be most beneficial in educating children regarding hospitals and hospitalization?

The caregivers take all of the children in the family to an open house at the hospital.

A nurse is providing education to a family about cardiac catheterization. What information would be included in the education?

The catheter will be placed in the femoral artery. The femoral artery is the correct placement of the cardiac catheter. The child will need to lie still for several hours after the procedure. The procedure is usually postponed if the child has a fever.

During the weekly team meetings, the physician and case manager discuss the client's planned assent. What activity should the nurse most anticipate?

The client will have a conference with the physician about the planned course of care and treatment. Assent means agreeing to something. In pediatric health care, the term assent refers to the child's participation in the decision-making process about health care. As a child gets older assent or dissent should be given more serious consideration. The pediatric client needs to be empowered by physicians to the extent of his or her capabilities, and as the child matures and develops over time the client should become the primary decision maker regarding his or her health care.

A 5-month-old infant being assessed was born at 32 weeks. The nurse doing the well-child check-up should compare the baby to what norms?

The development of a 3-month-old The infant was born 8 weeks early. Two months are subtracted from the present age of 5 months. Both growth and development should be assessed using 3-month norms.

Where is the point of maximal impulse (PMI) found in a 5-year-old girl?

The fourth intercostal space. The area of most intense cardiac pulsation, or point of maximal impulse (PMI), varies with age. In children younger than 7 it occurs at the fourth intercostal space. page 301

The nurse is administering a PRN pain medication to a child. What is the highest priority for the nurse in this situation?

The nurse checks the last time the medication was given. When giving a PRN medication, always check the last time it was given and clarify how much has been given during the past 24 hours. The other choices are important but checking when and how much the child has had are the priorities.

In understanding the gastrointestinal system, the nurse recognizes that this system includes the stomach and intestines as well as:

The pharynx and esophagus The main organs of the gastrointestinal (GI) or digestive system are the mouth, pharynx (throat), esophagus, stomach, small intestine, large intestine, rectum, and anal canal. The brain, spinal column, and nerves are part of the nervous system, and there is a protective coating surrounding the nerves.

The nurse has just taken the blood pressure of a 13-year-old, and the percentile rank is 88%. Why would the nurse categorize the child as prehypertensive?

The teenager's blood pressure was 122/83. A blood pressure greater than 120/80 is categorized as prehypertensive regardless of the percentile. Preterm birth is a risk factor for hypertension and does not indicate prehypertension itself. A high-fat diet and lack of exercise are risks for cardiovascular disease. Both require the nurse's attention to promote health but are not factors in categorizing the adolescent as prehypertensive. pg 248

A nurse is caring for an 18-month-old girl undergoing traction therapy in a rehabilitation unit. The nurse understands that the girl is in the second phase of separation anxiety when she observes what behavior?

The toddler is quiet, looks sad, and is disinterested in playing.

Suicide is so common in adolescents it ranks third as a cause of death in the 10- to 24-year-old age group.

True

The best way for a parent to handle a temper tantrum by a toddler is to calmly express disapproval and then ignore it. a) False b) True

True

The nurse at a family health clinic is teaching a group of parents about normal infant development. What patterns of communication should the nurse tell parents to expect from an infant at age 1?

Understands "no" and other simple commands At age 1, most babies understand the word "no" and other simple commands. Children at this age also learn one or two other words. Babies squeal, make pleasure sounds, and use multisyllabic babbling at age 6 months. Using speech-like rhythm when talking with an adult usually occurs between ages 9 to 12 months.

A 5-year-old girl catches the flu from a friend at day care after the friend sneezed and wiped mucus on a toy that the girl played then with. In this case, what is the portal of exit in the chain of infection?

Upper respiratory excretion The portal of exit is the route by which an organism leaves an infected child's body to be spread to others. Organism can be carried out of the body by upper respiratory excretions, feces, vomitus, saliva, urine, vaginal secretions, blood, or lesion secretions. The friend would be the reservoir, which is the container or place in which an organism grows and reproduces. The toy would be the means of transmission. The 5-year-old girl would be the susceptible host.

The nurse is caring for a 10-year-old boy with diphtheria. What would the nurse institute as a tier 2 precaution?

Use of a protective mask Use of a protective mask if within 3 feet of the child is a tier 2 precaution with diphtheria, which is transmitted through contact with droplets. Use of a protective gown is a tier 2 precaution for contact transmission. Negative air pressure ventilation is a tier 2 precaution for airborne transmission. Face shields are part of tier 1 precautions against contaminated splashes

The nurse is examining an 8-month-old girl for appropriate development during a regular check-up. Which observation points to a developmental risk?

Uses only the left hand to grasp Favoring one hand over the other may be a warning sign that proper motor development is not occurring in the other arm or hand. Grasping small objects with the entire hand is common at 8 months and precedes the pincer grasp, which is used about 2 months later. Crawling with stomach down and being unable to pull to standing are abilities that may not occur for another 4 to 8 weeks

Parents and their 35-month-old child have returned to the clinic for a follow-up appointment. Which of the findings may signal a speech delay? a) Asks "why" often b) Talks about a past event c) Uses two-word sentences or phrases d) Half of speech understood by outsider

Uses two-word sentences or phrases

The nurse is caring for a 2-year-old postoperative PET client. Which consideration is the most appropriate for this child's developmental stage?

Uses words for pain such as owie, boo-boo, or hurt The toddler uses simple terms to describe pain, such as owie, boo-boo, or hurt. School-aged and preschool-aged children fear bodily mutilation. Preschool-aged children delay or put off treatment, and school-aged children understand time. pg 413

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?

Vastus lateralis site The preferred injection site for infants less than 7 months old is the vastus lateralis muscle. In infants and children greater 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. pg 382

After teaching nursing students about childhood exanthems, the instructor determines that the teaching was successful when the students identify what as the primary cause?

Viruses Most childhood exanthems are caused by viruses.

The nurse is working with a group of caregivers of children in a community setting. The topic of hospitalization and the effects of hospitalization on the child are being discussed. Which statement made by the caregivers supports the most effective way for children to be educated about hospitals?

We are going to take our child to an open house at the hospital so she can see the pediatric unit." Families are encouraged to help children at an early age develop a positive attitude about hospitals. The family should avoid negative attitudes about hospitals. Some hospitals have regular open house programs for healthy children. Children may attend with parents or caregivers or in an organized community or school group. page 320

The nurse is caring for a 2-year-old girl with suspected vulvovaginitis. The nurse suspects the cause as Candida albicans based on which finding?

White cottage cheese-like discharge White cottage cheese-like discharge indicates C. albicans. Thin gray discharge with a fishy odor points to Bordetella or Gardnerella. Foul yellow-gray discharge indicates Trichomonas vaginalis. Irritation of the labia and vaginal opening is commonly found with poor hygiene

The nurse is promoting nutrition to a teen who is going through a growth spurt. Which food should the nurse recommended for its high iron content?

Whole grain bread

The mother of a 2-year-old boy has asked for some ideas for snack foods that would be less likely to cause dental caries. Which of the following items would the nurse most likely suggest? a) A handful of unsalted peanuts b) A handful of organic raisins c) Fruit strips cut into pieces d) Whole grain chips broken into pieces

Whole grain chips broken into pieces

The way you would advise a toddler's mother to handle temper tantrums would be to a) promise him a special activity if he will stop. b) distract him with a toy when he begins breath holding. c) appear to ignore them. d) mimic his behavior by also holding her breath.

appear to ignore them.

Parents usually ask when their child can return to school after having chickenpox. The correct answer would be:

as soon as all lesions are crusted. Chickenpox lesions are infectious until they crust.

A toddler's mother tells you that no matter what she asks of her child, he says, "No." A suggestion you might make to help her handle this problem is for her to a) give him secondary, not primary, choices. b) ask no further questions of him. c) pretend she does not hear him. d) tell him never to say, "No" again.

give him secondary, not primary, choices

Pediatric nurses are developing more home care and community-based services for children with chronic illnesses because:

increasing numbers of children live with chronic disabilities due to advances in health care that allow children with formerly fatal diseases to survive. Advances in health care have led to more children living with chronic illness or disability. The statements about genetic disease and older women may contain some truth but have only added a few people to the chronic illness total. Acute care pediatric nursing positions are decreasing in community hospitals but are more available in medical centers. Uninsured families may or may not be able to access nonhospital care. pg 6

The nurse is caring for a 10-year-old boy who had an appendectomy 2 days ago. Prior to surgery he had expressed that he was worried that after the procedure he would hurt and have lots of pain. The nurse asks the child what his pain level is on a scale of 0 to 10, with 10 being the worst pain. He tells the nurse he has no pain. The most appropriate action by the nurse would be to:

observe him for physical signs which might indicate pain.

A young child is hospitalized with pneumonia. Upon admission he informs the nurse that he is not having pain but just a bad cough. A few hours later, the child he begins to complain of pain in his right lower back. This first report of feeling pain refers to:

pain threshold. Pain threshold refers to the point at which the child first feels the pain.

The best way for an infant's father to help his child complete the developmental task of the first year is to:

respond to her consistently. A sense of trust is difficult to learn if things are constantly changing. Consistently responding to an infant's needs helps to build a sense of trust.

The nurse is explaining patterns of incidence and transmission of HIV to a group of adolescent girls. She explains that the risks for this population are much higher because of the possibility of both vertical and horizontal transmission. Horizontal transmission refers to transmission of the disease during:

sexual contact. Horizontal transmission refers to person-to-person transfer of the virus. Transmission by feeding with breast milk, birthing, and pregnancy are all examples of vertical transmission.

The nurse is talking with the parents of a hospitalized child who has three siblings at home being cared for by the grandparents. The main idea the nurse wants the parents to understand is that siblings may experience:

stress equal to that of the affected child.

The activity that would best foster the developmental task of an adolescent who is physically challenged would be:

talking to another adolescent who has a similar disorder

At a physical examination, a nurse asks the father of a 4-year-old how the boy is developing socially. The father sighs deeply and explains that his son has become increasingly argumentative when playing with his regular group of three friends. The nurse recognizes that this phenomenon is most likely due to:

testing and identification of group role

The nurse is caring for a child with heart failure related to a congenital heart defect. One of the nursing diagnoses identified includes "Excess fluid volume." During a family care planning conference. the parents ask why this diagnosis applies to their child. What is the best response by the nurse?

• "Cardiac problems cause the heart to not pump effectively, which causes swelling in the body and fluid in the lungs." This response best explains the meaning of the nursing diagnosis and it's cause. Although there are standardized care plans as a guide, each care plan must be individualized to the client. Stating, "The heart is a pump and it isn't pumping effectively" does not explain the nursing diagnosis. Telling the parents not to worry does not help in educating them.

A chronically ill adolescent is readmitted to the hospital with an infected wound requiring long-term dressing changes. What is the best way the nurse can encourage independence for this client?

Allow the adolescent to choose the time for the dressing change.

The nurse is completing a CRIES Scale for an child who had surgery a few hours ago. Which elements will be included in the assessment? Select all that apply.

Facial expression Vital signs Sleeping activities The CRIES scale assesses neonatal discomfort related behaviors in the postoperative period. The elements assessed include crying, oxygen required to maintain saturation above 95%, increased vital signs, expression, and sleeplessness. Activity and positions are reflected in the FLACC scale. pg 420

All infants should have their head circumference measured at health-assessment visits. This measurement is made from

just above the eyebrows through the prominent part of the occiput. Measuring heads consistently from above the eyebrows to the occiput allows measurements at different visits to be compared. Page 287

A staff nurse is talking about Piaget's theory with a nursing student. Infants are in the sensorimotor stage of cognitive development during which object permanence is mastered. An example of an infant displaying this ability is:

looking for a toy in her crib at the last place she saw it. Looking for the toy where it was last seen indicates object permanence. The infant knows the object still exists even though she cannot see it. All the rest of the infant's behaviors show use of her senses and motor activity but do not illustrate object permanence.

At what age would it be okay to introduce carrots to an infant's diet?

Solid food can be introduced at 4 to 6 months of age. Solid food may be introduced at 4 to 6 months of age. The infant must be ready to handle spoon-feeding. The first food should be rice cereal. Rice cereal is bland and usually does not cause an allergic reaction.

Nurses should provide anticipatory guidance to males to prepare them for what particular pubertal change in late adolescence?

Nocturnal emissions This involuntary ejaculation during the night can be disturbing to the adolescent male who has little or no understanding of what is happening in his body.

A 6-month-old is admitted to the hospital because of a fever. When you obtain a health history, what data would you obtain first?

Details about the fever Health interviews typically begin with a history of the chief complaint, because this is what people want to talk about first and represents a primary health problem. Page 275

A nurse is teaching the parents about the kidney transplant their child is going to receive. What would be included in the teaching?

Immunosuppression is common after a kidney transplant. A child is placed on medications for immunosuppression after the transplant to prevent the body from rejecting the allograft.

Put the following stages of infectious disease in correct order:

Incubation period Prodromal period Illness Convalescent period Infectious diseases follow certain stages during which the communicability (ability to be spread to others) or severity of the illness can be predicted: 1) incubation period, 2) prodromal period, 3) illness, and 4) convalescent period.

A child with ALL is beginning treatment with methotrexate in an attempt to eradicate the leukemic cells. The stage of therapy represents the:

Induction stage An induction stage is the first attempt at eradicating the leukemic cells to induce or achieve a complete remission.

The nurse is caring for a hospitalized 30-month-old who is resistant to care, is angry, and yells "no" all the time. The nurse identifies this toddler's behavior as 1. Problematic, as it interferes with needed nursing care. 2. Normal for this stage of growth and development. 3. Normal because the child is hospitalized and out of his routine.

Normal for this stage of growth and development.

The nurse is conducting a physical examination of a healthy 6-year-old. Which action should the nurse do first?

Observe the skin for its overall color and characteristics The physical examination of children, just as for adults always begins with a systematic inspection, followed by palpation or percussion, then by auscultation. Page 281

What advice would be most appropriate for the child with a stinging-insect allergy?

Obtain a medical alert ID bracelet so the presence of the allergy can be identified easily. Stinging-insect allergy can lead to anaphylactic shock. Alerting health care personnel to the possibility of an insect sting is important.

The nurse is caring for a 6-year-old child with burns on both hands. Which pain assessment technique is the most accurate for this client?

Obtain a self-report A proposed hierarchy of assessment techniques can guide nurses in determining the presence and intensity of clients' pain. Ranked in order by their importance and reliability for assessing pain are self-report, presence of pathology or a condition associated with pain, behavior, proxy ratings, and finally, physiological indicators of pain. pg 416

The nurse is observing a play group of children of all ages. The toddlers in the group would most likely be doing which of the following activities? a) Playing with the plastic vaccum cleaner pushing it around the room b) Painting pictures in the art corner of the room c) Watching a movie with other children their age d) Pretending to be mommies and daddies in the play house

Playing with the plastic vaccum cleaner pushing it around the room

A mother reports her 2-year-old daughter has gradually eaten more and more poorly since her 1-year-old well-child visit. The nurse assesses the child's growth and development as normal. What concept explains the mother's concern? a) Improper snacking b) Poor role modeling c) Physiologic anorexia d) Iron-deficiency anemia

Physiologic anorexia

A 6-year-old will be hospitalized for a surgical procedure. How can the nurse best ease the stress of hospitalization for this child?

Prepare the child for hospitalization by explaining what to expect and showing him or her around the hospital. The best way to ease the stress of hospitalization is to ensure that the child has been well prepared for the hospital experience. page 313

In caring for an infant diagnosed with pyloric stenosis, the nurse would anticipate that she would:

Prepare the infant for surgery. A surgical procedure called a pyloromyotomy (also known as a Fredet-Ramstedt operation) is the treatment of choice for pyloric stenosis.

A parent tells a nurse that the child has recently established some friendships for the first time. In which age group do you expect this child to be?

Preschool

The nurse is caring for a 16-year-old child with a diagnosis of acquired immunodeficiency syndrome (AIDS). What treatment goal has the highest priority for this child?

Preventing spread of infection Major goals for the child include maintaining the highest level of wellness possible by preventing infection and the spread of the infection. Because the adolescent has the belief that nothing can hurt him or her, and because of the increasing rate of sexual activity in this age group which often involves multiple partners, the highest priority is teaching and preventing the spread of the infection. Othe goals include maintaining skin integrity, minimizing pain, improving nutrition, alleviating social isolation, and diminishing a feeling of hopelessness. The primary goal for the family is improving coping skills and helping the teen cope with the illness.

The nurse is examining the hands of a child with suspected iron deficiency anemia. Which finding should the nurse expect?

Spooning of nails A convex shape of the fingernails termed 'spooning' can occur with iron deficiency anemia. Capillary refill in less than 2 seconds, pink palms and nail beds, and absence of bruising are normal findings.

A nurse is providing care to an infant who develops roseola during hospitalization. The nurse would institute which infection control precaution?

Standard If an infant develops roseola infantum in the hospital, the nurse would follow standard precautions. There is no need for airborne, droplet, or contact precautions.

When obtaining a child's health history the child's biological data is assessed. What is the next thing to assess in the child's history?

The chief complaint of the child The next step in the health assessment is the reason for seeking treatment. Remember to include the child's reason because it may be different from that of the parent or caretaker. Page274

The nurse knows this is a description of peritoneal dialysis when compared to hemodialysis:

The child can live a more normal lifestyle. The child can live a more normal lifestyle with peritoneal dialysis. This is a 7-day-a-week procedure, but there are less diet restrictions and more freedom with this type of procedure. Peritoneal dialysis can be performed at home

A 15-month-old boy has been brought to the clinic because he is pale and listless. Which of the following findings and observations would lead the nurse to suspect iron deficiency anemia as the cause of the clinical manifestations? a) The nurse hears a grade 2 heart murmur. b) The child eats a vegetarian diet. c) The child drinks four cups of milk per day. d) The child drinks very little fruit juice.

The child drinks four cups of milk per day

A 12-month-old seen at a walk-in clinic weighed 8 pounds 4 ounces (3.75 kg) at birth. Weight now is 20 pounds 8 ounces (9.3 kg). The nurse determines:

The child weighs less than expected for age. Birth weight should triple by 12 months. The child should weigh near 24 pounds 12 ounces (11.25 kg). The child is underweight for age.

The nurse is admitting a 15-year-old to the pediatric unit. What does the nurse recognize as a priority for this child?

The child's need for privacy should be respected. Adolescents must be given privacy, individualized attention, confidentiality, and the right to participate in decisions about their health care.

The nurse is caring for a 2-year-old child who has been hospitalized after being injured in an automobile accident. During the assessment the child is quiet and watchful of all the nurse's actions. When considering the level of pain being experienced by the child what inference can be made?

The child's nonverbal behaviors may indicate the presence of discomfort. Responses to pain can vary in children. A child of this age may present with vocal behaviors indicating pain. The child may be tearful or crying loudly. Being quiet can also signal pain. pg 413

The nurse is caring for a 12-year-old postoperative spinal rod placement client with scoliosis. Which factors might intensify the child's postoperative pain experience?

The client had a painful experience with an appendectomy at age 10. Negative painful past experiences can intensify a child's response to pain. Temperament has not been shown to influence the actual intensity of the pain experience, but it does seem to influence children's expression of pain behaviors. Age does not intensify the pain experience. Discussion of pain control methods can alleviate stress and therefore decrease the pain experience. pg 415

A 4-year-old girl with a urinary tract infection is scheduled to have a voiding cystourethrogram. When preparing her for this procedure, the nurse would want to prepare her to:

Void during the procedure. A voiding cystourethrogram requires the child to void during the procedure so that bladder emptying and urethra flow can be assessed.

A young client arrives at the clinic with a rash on the trunk and flexor surfaces of the extremities. The mother informs the nurse that the rash started a day before on the exterior surfaces of the extremities; 2 days before, the child had a really bad rash on the face. The physician diagnoses the child with erythema infectiosum. The nurse tells the mother that this is also known as:

fifth disease. Erythema infectiosum is also known as "fifth disease." It starts with a fever, headache, and malaise. One week later, a rash appears on the face. A day later, the rash appears on the extensor surfaces of the extremities. One more day later, the rash appears on the trunk and flexor surfaces of the extremities.

It is naptime and the caregiver of a 2-year-old says to her child, "I will help you put all of your stuffed animals in a row next to your bed just like we do every day." This statement is an example of: a) discipline. b) ritualism. c) dawdling. d) negativism.

ritualism

The nurse is providing teaching for the parents of an 8-year-old girl who has undergone surgery. The nurse emphasizes the importance of maintaining adequate hydration. Which response by the mother would indicate a need for further teaching?

"I will remind her that she will need an IV if she does not drink." The child is likely to view an IV both as frightening and as punishment. Intravenous fluids should be seen as therapy. Threats such as this should not be used to achieve compliance with eating or drinking. The other statements show understanding.

The nurse is providing discharge teaching to the client with myasthenia gravis. Which statements by the parents of the client demonstrate knowledge of proper care? Select all that apply.

"If my child shows signs of an upper respiratory infection I will contact our physician right away." "We love to take family vacations to Florida, but we will have to find a new vacation spot." "I picked up our child's medical alert bracelet today." Anticholinergic drugs should be given 30 to 45 minutes before meals, on time and exactly as ordered. Difficulty swallowing may occur from a myasthenic crisis. Infections can exacerbate the disease so the physician should be notified immediately if signs of infection are present. Heat can also exacerbate symptoms so avoidance of high temperatures is important. A medical alert bracelet is helpful for when the family is not present.

The nurse is teaching an inservice program to a group of nurses on the topic of children diagnosed with sickle cell anemia. The nurses in the group make the following statements. Which statement is most accurate regarding sickle cell anemia?

"If the trait is inherited from both parents the child will have the disease." When the trait is inherited from both parents (homozygous state), the child has sickle cell disease, and anemia develops. The trait does not skip generations. The trait occurs most commonly in African Americans. Either sex can have the trait and disease.

The nurse is providing emotional support for the mother of a 12-year-old child hospitalized for complications of cancer. The child's mother tearfully reports her younger child is acting out and always seems angry with her and her husband. What response by the nurse would be most beneficial?

"Is there any way you and your husband could spend the evening at home with your younger child while another family member visits with your child?"

Debbie asks her nurse what she thinks about giving her baby a pacifier. Debbie is struggling with this issue and is very teary-eyed about making a decision. How should the nurse respond to Debbie?

"It is a personal decision, let me give you a pamphlet from the AAP." The nurse would not give a biased opinion and would offer Debbie literature on which to base her own decision making. The other choices offer personal views or are not supportive in educating Debbie.

The nurse is educating the parents of a 7-year-old boy, scheduled for surgery, to help prepare the child for hospitalization. Which statement by the parents indicates a need for further teaching?

"It is best to wait and let him bring up the surgery or any questions he has" It is important to be honest and encourage the child to ask questions rather than wait for the child to speak up. The other statements are correct. pg 331

In working with the toddler, which of the following statements would be most appropriate to say to the toddler to decrease the behavior known as negativism? a) "You love having the same food every day, do you want apples again with lunch?" b) "It is time for lunch, I am going to put your bib on." c) "Do you want help getting into your chair so we can have lunch?" d) "Are you getting hungry and ready for lunch?"

"It is time for lunch, I am going to put your bib on."

Parents ask why their child is receiving prednisone to treat leukemia, because it is not a chemotherapy drug. How should the nurse answer?

"Prednisone decreases edema cause by tumor necrosis." Prednisone is not a chemotherapeutic agent, but a hormone and it is given in conjunction with chemotherapy to decrease edema caused by tumor necrosis or the tumor. Reducing inflammation, stimulating appetite, and promoting weight gain are some actions and possible side effects of prednisone but do not provide the reason why the medication is used to treat leukemia.

An adolescent's mother states that she does not know what to do with him: He is taking two or three showers a day when not that long ago she could barely get him to take a bath at all. What should the nurse's reply be to the mother?

"Reinforce the family rules but also allow him to develop his own routine."

Evan, a 14-year-old, and his mother are in the office for an annual visit and his mother jokes openly in front of you about the changes in Evan's voice and the hair under his armpits. What is an appropriate response from the nurse when she is talking with the mother?

"Remember that he can become modest and self-conscious and teasing may cause embarrassment."

A few days after discharge, the parent of an 8-year-old calls the pediatric clinic, concerned about the child's behavior now that she is home. The parent expresses that the child is treating her siblings badly and using language she knows she is not allowed to use. The parent asks the nurse for suggestions regarding how to handle this behavior. Which statement would be most appropriate for the nurse to make to this parent?

"Respond to her behavior in a firm, loving, consistent way." The return home may be a difficult period of adjustment for the entire family. The older child may demonstrate anger or jealousy of siblings. The family may be advised to encourage positive behavior and to avoid making the child the center of attention because of the illness. Discipline should be firm, loving, and consistent. The child may express feelings verbally or in play activities. The family may be reassured that this is not unusual.

The mother of a 6-month-old child reports she has been hearing so much about autism. She questions if this is something that can be tested for. What response by the nurse is appropriate?

"Screening is recommended between 18 and 24 months or when concerns are identified." The American Academy of Pediatrics recommends performing a screening test for autism with a standardized developmental tool at 18 and 24 months or at any point that concerns about autism spectrum disorder are raised. Although the child is younger than the normal period of screening it could be performed in the event there are identified concerns. pg 239

The nurse comes into an infant's room on the pediatric floor. The nurse wants to try to feed the infant for the first time since her surgery. How does the nurse know what infant state the child is in by what the mother says and that it is okay to try and feed the infant?

"She has been a chatterbox and smiles just like her brother." The best time to feed an infant is when the child is in the active alert state. This infant is talking and smiling, which shows she is calm and actively awake. In the active alert state the infant has normal respirations, limited movement, and eyes that are bright and shiny and attentive. The other choices put the infant in a crying state, quiet alert or deep sleep, or drowsing. These stages are not optimal for interacting with the child.

The parents of a 4-year-old girl tell the nurse that their daughter is having frequent nightmares. Which statement indicates that the girl is having night terrors instead of nightmares?

"She screams and thrashes when we try to touch her."

A 15-year-old female adolescent tells the nurse she would like to get a tattoo. What response by the nurse is most appropriate?

"Tattoos are invasive and there is the potential for disease with their application."

A 12-year-old boy is admitted to the hospital for gastrointestinal illness. The child's parents tell the nurse that their son is normally very outgoing and happy but "as soon as we came to the hospital, our son acted so differently. I know he is sick but this was something different." What is the best response by the nurse?

"Tell me about your son's previous experience with hospitals, both with himself and loved ones."

The mother of an African-American adolescent voices concern to the nurse because her daughter, "has gotten her period before all of her friends." How should the nurse respond?

"That must be difficult, but on average African-American girls start their period earlier than other ethnicities." Menarche, the first menstrual period, usually begins between the ages of 9 and 15 years (average 12.8 years), but on average African-American girls reach menarche earlier than other ethnicities.

The nurse is providing anticipatory guidance to the parents of a 15-year-old who voice concerns with their teenager's sleep habits. They state, "Left to her own devices, I'm sure she'd stay up until 3:00 in the morning on the weekends and sleep until after lunchtime." Which should the nurse explain to the parents?

"That must be hard for you to manage. Perhaps we can explore some strategies with her to establish more predictable sleep patterns."

The nurse is speaking with a teenager who has requested HIV testing. Which is the best statement by the nurse regarding HIV testing?

"The ELISA method detects antibodies so a person may have a false negative test for up to six months after exposure. ELISA method detects only antibodies, so the test may remain negative for several weeks up to 6 months (false-negative) after exposure. A false-positive may result with autoimmune disease. The ELISA test requires serial testing. HIV test results are confidential.

The nurse is assessing a 6-month-old child. The mother asks when the soft area in her child's head will go away. What is the best response by the nurse?

"The area is called the anterior fontanel and typically closes anytime between 9 and 18 months of age." The anterior fontanel typically closes by the age of 9 to 18 months. Fontanels are soft areas on the skull that remain open in infancy to allow for rapid brain growth in the first months of life. This answer is a true statement but does not answer the mother's question. Page 293

The mother of a child with a possible food allergy asks the nurse for information about how to test for it. Which response by the nurse would be most appropriate?

"The best way is to eliminate the food from the diet and then look for improvement."

The father of a 6-year-old boy reports that his son is having difficulty adapting to the changes in the family structure since the father remarried a few months ago. The father asks the nurse for suggestions on what to do. What information can be provided by the nurse?

"The display of a united front between you, your wife, and your son's mother is important."

The nurse is caring for a 4-year-old who requires a venipuncture. To prepare the child for the procedure, which explanation is most appropriate?

"The doctor will look at your blood to see why you are sick." The nurse should provide a description of and reason for the procedure in age-appropriate language. The nurse should avoid the use of terms such as culture or strep throat as it is not age appropriate for a 4-year-old. The nurse should also avoid confusing terms like "take your blood" that might be interpreted literally. pg 390

The nurse is providing instructions to the parents of a child with a severe peanut allergy. Which statement by the parents indicates a need for further teaching about the use of an epinephrine auto-injector?

"The epinephrine auto-injector should be jabbed into the upper arm." An epinephrine auto-injector should be jabbed into the outer thigh, as this is a larger muscle, at a 90 degree angle, not into the upper arm. The other statements are correct.

A child who is receiving TPN has developed the need to have insulin injections. The child's mother questions thia and states that her child does not have diabetes. What is the appropriate response by the nurse?

"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 providing child and family education prior to discharge following a cardiac catheterization. The nurse is teaching about signs and symptoms of complications. Which statement by the mother indicates a need for further teaching?

"The feeling of the heart skipping a beat is common." Reports of heart "fluttering" or "skipping a beat" should be reported to the doctor as this can be a sign of a complication. This statement is appropriate because tub baths should be avoided for about 3 days. This statement is appropriate because strenuous activity is limited for about 3 days. Changes in skin color or difficulty breathing indicate potential complications that need to be reported.

The parents of a 4-month-old diagnosed with sepsis tell the nurse that the physician explained sepsis to them but they don't really understand it. The parents state, "Could you please explain it to us?" What is the best response by the nurse?

"The infection your child has causes the release of toxins into the system, which can lead to impaired function in the lungs, liver, and kidneys." Keeping the answer to what sepsis is will help the parents understand the pathophysiology. While all answers are correct, the response: "The infection your child has causes the release of toxins into the system, which can lead to impaired function in the lungs, liver, and kidneys" provides the most understandable explanation and addresses the parent's question.

The parents of a 3-year-old child report he was exposed to pertussis 2 days ago. They are concerned and ask the nurse how long it will take until he becomes ill if he indeed contracted the infection. What response by the nurse is indicated?

"The signs of disease will be noted in 1 to 3 weeks." Pertussis is an acute respiratory disorder characterized by paroxysmal cough (whooping cough) and copious secretions. The disease is caused by Bordetella pertussis. The incubation period is 6 to 21 days, usually 7 to 10 days.

The mother of a 11-month-old has come to the clinic with concerns. She reports to the nurse that her baby's "soft spot in the front" is now gone. The nurse assesses the infant and notes the fontanel has closed. What response by the nurse is most appropriate?

"The soft spot or fontanel has closed." The anterior fontanel traditionally closes between 12 and 18 months. In some infants this may close sooner. This does not indicate there is any abnormality in the development of the infant.

The nurse is discussing measles, mumps, and rubella vaccination with a mother who is concerned about using the combined vaccine for her 12-month-old. Which statements by the nurse will be most helpful to the mother in accepting the vaccine?

"The vaccine is shown to be effective and safe and will reduce the number of injections your child will need." The mother may not understand that combining the vaccines creates no safety or effectiveness problems and reduces the number of injections her child must endure. The other statements are true and offer some reassurance as to safety and efficacy but are not as helpful to the parent in understanding how she can protect her child from unnecessary discomfort. pg 262

A nurse is caring for a 10-year-old boy with nocturnal enuresis with no physiologic cause. He says he is embarrassed and wishes he could stop immediately. How should the nurse respond?

"There are several things we can do to help you achieve this goal." The child wants to stop this problem immediately, so the nurse's most therapeutic response is to assure the child that enuresis is indeed solvable. For some children, learning about the high prevalence of the problem may provide consolation. However, this may not alleviate the child's embarrassment and it does not address his desire for solutions. Telling the child that he will "grow out of this" downplays his embarrassment and does not address his desire to solve the problem. Pull-ups conceal the consequences of enuresis but do not provide a solution

A 15-year-old female is being seen for an annual physical examination. The teen asks the nurse if what they talk about will be kept private. What is the appropriate response by the nurse?

"There are some things I may need to share with your parents or physician." Teens value privacy. The determination of what may and may not be kept confidential is based on individual state laws. The nurse may need to divulge certain things. It is best to be honest with a teen concerning the privacy of the interview, assessment and care. pg 273

The nurse is providing family education for the administration of ibuprofen. Which response indicates a need for further teaching?

"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 read closely labels of over-the-counter medications they already have or 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. pg 428

A 15-year-old client's mother comments on the fact that her daughter seems to always choose the opposite of what everyone else wants and that her mood swings are a common occurrence. What statement shows the nurse that the client's mom understands these changes?

"This is common for this age group and it will get better with time."

Jenny is a 15-year-old who is being seen today in the clinic, and her mom comments on the fact that Jenny seems to always choose the opposite of what everyone else wants and that her mood swings are a common occurrence. What statement below shows the nurse that Jenny's mom understands these changes?

"This is common for this age group and it will get better with time." During the middle adolescence the teenager spends more time ignoring adult authority and becomes more reliant on peer relationships. Adolescents might choose a stance directly opposite that of their parents and use peer support to back their ideas. Mood swings are a common occurrence during the adolescent period and they tend to smooth out and the teen will become more introspective. By late adolescence emotions become more consistent

During a well-child visit for a 2-month-old infant, the nurse explains the need to perform a hearing screening on the child within the next few months. The child's mother reports she has not noticed any deficits and does not see the need for this being done. Which response by the nurse is indicated?

"Unfortunately hearing losses in infants are common and it is best to check hearing before your child is 6 months old to rule out problems." Hearing screening should be performed by the age of 6 months. This will help to ensure early intervention if needed. pg 243

The nurse is educating the parents of a 5-month-old on how to administer an oral antibiotic. Which response indicates a need for further teaching?

"We can mix the antibiotics into his formula or food." Never mix a medication with formula or food. The child may associate the bitter taste with the food and later refuse to eat it. pg 387

A nurse is teaching the parents of a child diagnosed with rheumatic fever about prescribed drug therapy. Which statement would indicate to the nurse that additional teaching is needed?

"We can stop the penicillin when her symptoms disappear." For a child with rheumatic fever, drug therapy must be given for the full 10 to 14 days to ensure complete eradication of the infection. The drug must not be stopped when the signs and symptoms disappear. To prevent recurrent attacks, prophylactic antibiotic therapy is prescribed for at least 5 years or until the child is 18 years old. Additional prophylactic therapy should be instituted when dental or tonsillar surgery is planned

The nurse is providing teaching to the parents of a child with varicella. Which statement indicates that the parents have understood the instructions?

"We need to make sure that he washes his hands frequently." The child with varicella needs to wash his hands frequently with antibacterial soap to reduce bacterial colonization. A cool bath with soothing colloidal oatmeal may help the skin discomfort. Alcohol would be too drying to the skin. Acetaminophen, not aspirin, should be used to reduce fever. The lesions should eventually crust over. Soft crusts with drainage may suggest an infection.

The nurse is caring for a 9-year-old boy with episodes of chronic pain. The nurse is educating the parents how to help the child manage pain nonpharmacologically. Which statement indicates a need for further teaching?

"We should start the method after he feels pain." The parents must understand that they should begin the technique or method chosen before the child experiences pain or when he first indicates he is anxious about or beginning to experience pain. The other statements are accurate. page 426

When obtaining information from a teen concerning the reason for seeking health care, which question would be most important?

"What health concerns are you having?" When obtaining data from a client, using the appropriate questions is important. Questions should be open-ended to yield the most information. Making questions direct will further refine the information made available. It is important that when interviewing the teen the nurse not promote a condition. Assuming the teen is ill is not appropriate. page 275

Which question by the nurse is the best one to elicit complete information about a young boy's immunization status?

"When and where did your child receive his last immunization?" The when/where questions gather relevant information and are good starting points for further investigation of the immunization status as well as an opening for discussion of any concerns. The parent is likely to be able to answer these questions. Asking which immunization the child needs and questions regarding immunizations at various ages may cause the parent to be unable to answer and create discomfort. The up-to-date question will likely result in a "yes-no" response and yield little information and not further discussion. pg 250

A mother tells the nurse that she is newly pregnant and asks about her 15-month-old's need for the chicken pox immunization because her two older children did "fine" when they had the disease. What is the nurse's best response?

"When your child avoids chicken pox, it protects other children from being exposed to the disease. Some cannot be immunized because of their health conditions." The best response explains the impact that chicken pox can have on vulnerable individuals. High immunization levels mean low levels of disease. This reduces exposure for those who are unimmunized and susceptible. The live-virus vaccine given to the toddler does not present risk to the pregnant mother or fetus. Varicella vaccine is not inexpensive. Avenues for providing immunizations to families who cannot afford them are available. The "why not" response is somewhat dismissive and does not address the mother's question. pg 260

The nurse is caring for an infant with Down syndrome who has been diagnosed with atrioventricular canal defect. The parents ask the nurse, "Why do you not put oxygen on our baby more often when his lips and fingernails are blue?" What is the best response by the the nurse?

"While it seems that oxygen would help, it actually worsens this condition. Treating the cause of the disease will help." For children with congenital defects with increased pulmonary blood flow, oxygen supplementation is not helpful. Oxygen acts as a pulmonary vasodilator. If pulmonary dilation occurs, pulmonary blood flow is even greater, causing tachypnea, increasing lung fluid retention, and eventually causing a much greater problem with oxygenation; therefore, preventing the development of pulmonary disease via early surgical correction is essential. Although oxygen must be ordered by the physician and it isn't the best treatment, the nurse stating, "While it seems that oxygen would help, it actually makes the condition worse. Treating the cause of the disease will help" best answers the question while also showing empathy.

The nurse is mentoring a newly licensed nurse in the health clinic, talking with the single mother of an infant. The mother was 10 minutes late to the appointment and is concerned the clinic will not allow the health visit to be conducted today. Which statement by the newly licensed nurse would alert the nurse to provide additional teaching to the newly licensed nurse?

"Why don't you plan to have your retired neighbor bring the baby next time since having the parent with the baby isn't necessary?" The nurse should not indicate to the mother that she is not necessary at the child's health promotion visits. The nurse would instead validate the role of the mother and her influence on the child's concept of wellness. The other choices support the mother in taking an active role in her child's health and decrease the barriers to clinic access.

An adolescent who is depressed states, "Nothing ever seems to be right in my life." Which would be the most appropriate response by the nurse?

"You are feeling sad right now. It's a hard time.

Stacy is going to visit her son in the intensive care unit. She has been pumping breast milk and storing it in the fridge. Stacy is making her son's bottle for his feeding and goes to warm the breast milk. What option should the nurse give the mom to prepare the bottle?

"You can use the hot water tap to get warm water to warm the bottle." The nurse should recommend using warm water or a warm-water tap to place the bottle in before feeding. A microwave should never be used; it could create hot spots and burn the infant. The other choices are not recommended and can cause stomach discomfort. Page 85

A first-time father calls the pediatric nurse stating he is concerned that his 4-year-old daughter still wets the bed almost every night. Remembering his own experience of being punished for wetting the bed at 4 years old, he is not sure punishment is the best approach to address this. Which nursing instruction is the most appropriate?

"Bedwetting is not uncommon in young children. Try to calmly change the bed without showing your frustration."

The nurse is collecting data from a 15-year-old boy who is being seen at the ambulatory care clinic for immunizations. During the initial assessment, he voices concerns about being shorter than his peers. What response by the nurse is indicated?

"Boys your age will often continue growing for a few more years." Teenage boys can experience growth in height until age 17.5. The nurse should reassure the teen that this may happen for him. Telling the client not to be ashamed, or assuring him it is not as short as his peers fails to provide information or support. Determining the height of the other men in the family may be indicated at a later time but is not the most appropriate initial comment

The nurse is discussing Varicella immunization with a mother of a 13-month-old. The mother is reluctant to vaccinate because she feels it is "not necessary." Which comment by the nurse will be most persuasive for immunization?

"Children not immunized are at risk if exposed to the disease." The most compelling argument for vaccinating for Varicella is that children not immunized are at risk if exposed to the disease. The mother needs to know about the chance of her child contracting the illness if not immunized. The contagious nature of the disease, low risk of the vaccine, or the low incidence of reactions is not appropriate explanations for why the child should have the vaccine.

The father of a 13-year-old boy reports his family has a strong history of depression. He questions screening for his son. What information should be provided by the nurse?

"Children should be screened for depression every year beginning at age 11." Academy of Pediatrics recommended screening tool [CRAFFT) and a depression screening is recommended annually beginning at age 11. It is clear that the parent is voicing concerns for his son's risk factors. The question asked does not provide the information being requested. pg 241

The nurse is teaching an inservice 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?

"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

A high-school athlete comes to the emergency department with hypertension, aggressiveness, and psychosis. What question would be important for the nurse to ask the client?

"Do you take anabolic steroids?"

The nurse is employed at a clinic that provides services to a large population of clients from a culture with a present-based orientation. When providing education about proper nutrition to a family from this culture, which would be the best response by the nurse?

"Eating a healthy breakfast will give your child the energy to stay awake and focused during school each day." Significant numbers of children belong to cultures with a present-based orientation. These cultures are more concerned about what is going on now. For these children, health promotion activities need shorter-term goals and outcomes to be useful. pg 237

The nurse is doing a presentation for a group of nursing students about the topic of menstrual disorders. After discussing the disorder secondary amenorrhea, the students make the following statements. Which statement made by the nursing students is the most accurate regarding the cause of secondary amenorrhea?

"Emotional stress can be a cause of this disorder." Secondary amenorrhea can be the result of discontinuing contraceptives, a sign of pregnancy, the result of physical or emotional stress, or a symptom of an underlying medical condition. A complete physical examination, including gynecologic screening, is necessary to help determine the cause. Primary amenorrhea occurs when a girl has had no previous menstruation. A spontaneous abortion does not cause secondary amenorrhea.

A nurse is conducting a physical examination of a 12-year-old girl with suspected systemic lupus erythematosus (SLE). How would the nurse best interview the girl?

"Have you noticed any hair loss or redness on your face?" Alopecia and the characteristic malar rash (butterfly rash) on the face are common clinical manifestations of SLE. Rhinorrhea, wheezing, and an enlarged spleen are not hallmark manifestations of SLE. Petechiae and purpura are more commonly associated with hematological disorders, not SLE.

The nurse is counseling an overweight, sedentary 15-year-old girl. The nurse is assisting her to make appropriate menu choices. Which statement indicates the adolescent understands how to make appropriate dietary selections?

"I need to have 4 servings of fruit each day."

The nurse is caring for a child who weighs 31 kg. A medication is ordered for this child with a dosage range of 20 to 40 mg per kg of body weight per dose. Which dosage would be appropriate for the nurse to administer to this child in one dose?

1,000 mg per dose If a dosage range of 20 to 40 mg per kg of body weight is a safe dosage range and a child weighs 31 kg, the low dose of this medication would be 31 X 20 = 620. The high dose of this medication would be 31 X 40 = 1240. Therefore, a dose of 1,000 mg per dose would be appropriate.

The nurse is monitoring the CD4 count of an infant who has contracted HIV from the mother in utero. The nurse is concerned that treatment with antiretroviral therapy is not effective when noting which CD4 level?

1300/mm3 The number of CD4 T lymphocytes in the blood helps to determine the effectiveness of antiretroviral therapy. Normal is 1500/mm3 in the infant, so anything below that number may indicate that the therapy is not effective.

A 13-year-old girl has grown rapidly in height over the past 2 years and is taller than most of the boys in her class. She wonders when she will stop growing. What should the nurse tell her as a general guideline for the ages at which most girls stop growing?

16 to 17 years old

An infant has been brought to the clinic for a well-child check. The infant is 12 months of age. The child's birth weight was 6 pounds, 7 ounces. What is the anticipated weight for the child at this visit?

19 pounds, 5 ounces Most infants double their birth weight by 4 months of age and triple their birth weight by the time they are 1 year old. Page 64

The toddler grows about how many inches in height per year? a) 5 inches b) 1 inch c) 7 inches d) 3 inches

3 inches

The registered nurse (RN) and licensed practical nurse (LPN) are caring for a hospitalized child. Which action by the LPN will cause the RN to intervene? a. The LPN holds down the child while another nurse starts an IV b. The LPN requests minimal laboratory blood draws c. The LPN attempts to follow the child's home schedule as best as possible d. The LPN lets the child keep their security blanket during a lumbar puncture

A The RN would intervene if the LPN held down the child or used traditional restraints unnecessarily. Using alternative positioning such as "therapeutic hugging" is recommended and should be attempted first if at all possible. Minimal sticks should be advocated for with all clients. Following the child's home schedule will help with maintain a sense of control and help with the child's behavior. The child should be allowed to keep security items when appropriate.

What is the main benefit of effective therapeutic communication for the nurse-client relationship? a. helps develop trust between nurse and the child b. will cause the child to do what the health care provider requires c. improves the child's ability to cope d. helps the child understand the reason for hospitalization

A Therapeutic communication involves open-ended questions, therapeutic play, acknowledgment of the client's emotions, and active listening, which all help to enhance the nurse-client relationship by building trust between the client and the nurse. Therapeutic play, not therapeutic communication, improves the child's ability to cope. Therapeutic communication is not intended to cause the child to do what the health care provider requires. Education helps the child and family understand the reason for hospitalization.

The nurse is assessing children in an ambulatory clinic. Which child would be most likely to have iron-deficiency anemia?

A 15-year-old girl who has heavy menstrual periods Adolescents with heavy menstrual flows lose enough blood each month to cause iron-deficiency anemia

The nurse realizes that the 5-year-old's growth chart and BMI indicate the child is at risk for obesity. What other findings reinforce this risk? Select all that apply.

A father who is overweight Food used as reward or punishment Television on during meals Expectations to eat everything on plate

The nurse is caring for a child with appendicitis. The nurse understands that this child is experiencing what type(s) of pain? Select all that apply.

Acute pain Visceral pain Visceral pain is pain that develops within organs such as the heart, lungs, gastrointestinal tract, pancreas, liver, gallbladder, kidneys, or bladder. Acute pain is pain usually associated with rapid onset, trauma, or surgery. It lasts a few days. Deep somatic pain usually involves the muscles, tendons, joints, fascia, and bones. Neuropathic pain is due to malfunctioning of the peripheral or central nervous system. pg 410

Prior to administering an intermittent tube feeding, which action should be performed?

Assess tube placement. Checking for tube placement is a priority before administering any intermittent tube feeding and periodically during continuous tube feedings, regardless of the type of tube being used. pg 398

The nurse is providing preoperative care for a 7-year-old boy with a brain tumor and his parents. Which intervention is priority?

Assessing the child's level of consciousness The priority intervention is to monitor for increases in intracranial pressure because brain tumors may block cerebral fluid flow or cause edema in the brain. A change in the level of consciousness is just one of several subtle changes that can occur indicating a change in intracranial pressure. Lower priority interventions include providing a tour of the ICU to prepare the child and parents for after the surgery, and educating the child and parents about shunts.

Conscious sedation is a pain-management technique that is used with children. During conscious sedation for a preschooler, which action would be most important?

Assessing vital signs frequently, because they can become depressed Conscious sedation is the use of a drug such as pentobarbital sodium to induce a conscious but sleepy state. Vital signs must be monitored closely to be certain the child's vital centers do not become depressed.

The nurse is providing care to a 6-year-old child following surgery. The nurse asks the child to rate the pain using the Faces of Pain scale. Which phase of the nursing process is the nurse demonstrating?

Assessment

When preforming neurological reflexes on the infant, which primitive reflex will be present longest?

Babinski Primitive reflexes are subcortical and involve a whole-body response. Selected primitive reflexes present at birth include Moro, root, suck, asymmetric tonic neck, plantar and palmar grasp, step, and Babinski. Except for the Babinski, which disappears around 1 year of age, these primitive reflexes diminish over the first few months of life, giving way to protective reflexes.

A 6-year-old reports pain in the stomach upon eating. The nurse replies, "Let me see if I have this right. Every time you eat anything, you get a pain in your tummy?" The nurse is using which technique of therapeutic communication? a. Open-ended questions b. Reflecting c. Clarifying d. Perception checking

C Clarifying consists of repeating statements others have made so both people can be certain that the message is understood. This is an example of clarifying. Reflecting is restating the last word or phrase. Open-ended questions invite a variety of responses and allow the client to give all the pertinent information needed to answer the question. Perception checking documents a feeling or emotion that is reported. It is a way of understanding others accurately instead of jumping to conclusions.

The nurse is preparing a 4-year-old to go visit his older sibling in the pediatric intensive care unit (PICU). What teaching method would best help in this child's preparation? a. pictures b. video c. dolls d. story

C Preschool-age children tend to be frightened of intrusive procedures. Explaining to preschool-age children what the sibling may look like or what the environment may look like is difficult for them to comprehend. Explaining to children why the tubes are necessary, why the sibling cannot talk, and what the sibling will look like is best taught with dolls or puppets. Using dolls or puppets help children visualize details. Pointing to a place on a doll's body is not as intrusive as pointing to the child's own body. Visualizing the tubes coming out of the doll helps the child visualize details. Explaining to children why the tubes and the machines are necessary calls for clear understanding and praise for learning. Pictures, videos, and stories do not allow the child to actively participate in the learning process.

Place in correct order the steps in the anaphylactic response.

Exposure to allergen Rapid immune response Vasodilation Bronchoconstriction Circulatory collapse Anaphylaxis typically is a very rapid response to exposure to an allergen. Vasodilation leads to potential circulatory collapse. Bronchospasm occurs simultaneously with other system reactions, also contributing to the life-threatening possibility.

What is the leading cause of neonatal sepsis and death?

Group B streptococcus Group B streptococcus is the leading cause of neonatal sepsis and death.

What is a current trend in child health care?

Health promotion rather than health restoration is stressed. It is recognized that keeping individuals well is more cost effective for a system than helping ill individuals return to wellness.

The nurse has completed an examination of a 32-month-old girl with normal gross and fine motor skills. Which of the following observations would suggest the child is experiencing a problem with language development? a) She asks many questions. b) She uses complete 3-to-4 word sentences. c) Her vocabulary is between 10 and 15 words. d) She talks incessantly.

Her vocabulary is between 10 and 15 words.

The nurse is caring for a child with a diagnosis of pyloric stenosis during the preoperative phase of the child's treatment. What is the highest priority at this time?

Improving hydration Preoperatively the highest priority for the child with pyloric stenosis is to improve nutrition and hydration. Maintaining mouth and skin integrity, and relieving family anxiety are important, but these are not the priority. The child will not likely have intense pain. Preparing the family for home care would be a postoperative goal.

A nurse is assessing the skin of a 12-year-old with suspected right ventricular heart failure. Where should the nurse expect to note edema in this child?

Lower extremities Edema of the lower extremities is characteristic of right ventricular heart failure in older children. In infants, peripheral edema occurs first in the face, then the presacral region, and the extremities

A teen is suspected of having anovulatory menstrual cycles. This would be the result of which hormone?

Lutenizing hormone Lutenizing hormone is responsible for ovulation. Estrogen and progesterone impact the menstrual cycle but do not control ovulation. Prolactin is responsible for preparing the breasts for nursing

The parents of a 16-year-old are fearful that their child may be using illegal drugs. They report to the nurse that they have noticed recently that their child seems much more focused when doing homework or chores, is losing weight, displays a high level of energy, and becomes agitated easily. The nurse is aware that the teen is displaying symptoms of which type of drug use?

Methamphetamine Euphoria, increased energy and alertness, agitation, weight loss, insomnia, tachycardia, and hypertension are symptoms of methamphetamine use.

A 5-year-old boy is receiving an analgesic intravenously while in the hospital. What should the nurse do to determine whether the drug is being properly excreted from this child?

Monitor the child's fluid intake and output. Monitoring intake and output is important in children receiving drugs to be certain urine excretion or an outlet for drug metabolites is adequate. The other interventions listed are not typically used to determine whether drug excretion is occurring. pg 31

The nursing instructor is illustrating the various types of play. The instructor determines the class is successful when the students correctly choose which example as best representing onlooker play?

Observing without participating

A 15-year-old girl is in the hospital for surgery and is confined to bed. The nurse can tell that the client is nervous about being in the hospital. She tells the nurse that she feels "gross" and "on display" in her hospital gown. What should the nurse do to encourage a sense of autonomy and dignity related to the girl's body image?

Offer to assist the girl in washing her hair and let her pick the shampoo.

The nurse is reviewing a job description of a school nurse. Which activity would the nurse question?

Provide immunizations to students. School nurses typically don't administer vaccines to children. They act as a liaison between the child and various health care provider and other community agencies. Training staff and students on topics such as first aid, CPR, and health promotion activities, and providing emergency first aid are examples of activities of the school nurse.

Parents of a toddler describe how they handled their child's temper tantrum in a shopping mall. What action of the parents indicates need for additional teaching? a) Tried to refocus the child's attention as tantrum behavioral cues appeared b) Reasoned with the child to stop the behavior c) Made sure the child was rested and not hungry before going to the mall d) Remained relatively calm even though embarrassed

Reasoned with the child to stop the behavior

The nurse works at a health clinic located in a suburb of a large city. Which action by the health clinic will further enhance the bond between child, family and community?

Setting up screenings in a public library downtown By bringing services into the city to a community resource already established (library) the clinical nurse will be increasing access via public transportation and location. The other choices inhibit community access by closing at a time when most parents are still at work, by assuming parents can afford taxi fares, and by limiting evening hours and walk-ins for those parents who may be unable to schedule transportation but instead rely on neighbors or family for rides. pg 238

A school-age client is in the clinic for a sprained ankle and is ordered to take NSAIDs for pain control. What should the nurse inform the mother may be associated with long-term administration of any NSAID?

Severe gastric irritation Long-term administration of NSAIDs can lead to severe gastric irritation and may be associated with heart attacks. pg 428

The nurse is caring for a 10-year-old boy with end-stage renal disease (ESRD) with metabolic acidosis. What would the nurse expect to administer if ordered?

Sodium bicarbonate tablets Bicitra or sodium bicarbonate tablets are used for the correction of acidosis. Ferrous sulfate is used for the treatment of anemia. Vitamin D and calcium are used for the correction of hypocalcemia and hyperphosphatemia. Erythropoietin stimulates red blood cell growth

The nurse is preparing to administer the child's dose of intravenous immune globulin (IVIG). Which actions should the nurse take? Select all that apply.

Take baseline vital signs and monitor the vital signs during the infusion Prepare to give acetaminophen to the child Prepare to give diphenhydramine to the child IVIG should be given only intravenously and should not be given as an intramuscular injection. IVIG cannot be mixed with other medications. The nurse should closely monitor the child's vital signs during the infusion of the IVIG. The child may require an antipyretic and/or an antihistamine during infusion to help with fever and chills.

To obtain an accurate heart rate in an infant, what would be most important for the nurse to do?

Take the apical pulse. Taking the apical pulse with a pediatric stethoscope and counting the rate for a full minute is the most accurate way to obtain the heart rate on an infant. The radial pulse should only be used in older children over the age of 10 as it is difficult to palpate accurately in children younger than 2 years of age because the blood vessels lie close to the skin surface and are easily obliterated. Page 283

The nurse is anticipating that health supervision for a 5-year-old child will be challenging. Which indicator supports this concern?

The home is in a high-crime neighborhood. Neighborhoods with high crime, high poverty, and lack of resources may contribute to poor health care and illness. If the aged grandparents have healthy lifestyles, they would be positive partners. Developmentally appropriate chores and responsibilities could be positive signs of parental guidance. The doting mother could make a strong health supervision partner. pg 238

The nurse is preparing to discharge a 5-year-old child from the hospital who will require dressing changes to a wound at home. The parents have been taught the appropriate wound care measures during the stay in the hospital. Which action by the parents assures the nurse that learning occurred?

The parents have performed the wound care and dressing change with the nurse's supervision the last 2 days prior to discharge Demonstration of wound care is the best way to evaluate if the parents are knowledgeable of the procedure. Voicing understanding and listing the steps don't assure the nurse that learning occurred. Helping the nurse with the wound care is beneficial when initially learning the procedure, but does not ensure the ability to perform the procedure independently. page334

A 2-year-old is having a temper tantrum. What advice should the nurse give the mother? 1. For safety reasons, the toddler should be restrained during the tantrum. 2. Punishment should be initiated, as tantrums should be controlled. 3. The mother should promise the toddler a reward if the tantrum stops. 4. The tantrum should be ignored as long as the toddler is safe.

The tantrum should be ignored as long as the toddler is safe.

The nurse working on the pediatric unit is talking with the child-life specialist. The nurse asks the specialist what the technique is called in which activities are used to help the child have a better understanding of what will be happening to him or her in a specific situation. What best describes what the nurse is discussing?

Therapeutic play

The nurse is working with a pregnant client with HIV who is receiving oral zidovudine. What is the primary rationale for this intervention?

To help prevent transmission of the disease to the fetus A goal of therapy during pregnancy is to maintain the CD4 cell count at greater than 500 cells/mm3 by administering oral zidovudine which helps halt maternal/fetal transmission dramatically along with one or more protease inhibitors, such as ritonavir (Norvir) or indinavir (Crixivan), in conjunction with an NRTI. If P. carinii pneumonia develops, a woman is treated with trimethoprim with sulfamethoxazole. Kaposi's sarcoma is normally treated with chemotherapy. Women may need a platelet transfusion close to birth to restore coagulation ability.

The nurse is observing a 36-month-old boy during a well visit. Which motor skill has he most recently acquired? a) Kick a ball b) Undress himself c) Push a toy lawnmower d) Pull a toy while walking

Undress himself

A nurse is assessing a 2 year old's language development. Which of the following would the nurse expect to assess? a) Verbalization of 4 to 6 words b) Knowledge of full name c) Ability to name one color d) Use of a two-word noun-verb sentence

Use of a two-word noun-verb sentence

When teaching an infant's mother about bathing her, it would be important to instruct her that:

bath time provides an opportunity for play. Infants do not need a daily bath as long as the diaper area is washed with diaper changes. Soap is actually drying to an infant's skin. Washing the hair with soap can help remove excess oil.

The adolescent comes to the clinic seeking information about sexuality concerns. The clinic nurse assures the adolescent that confidentiality and privacy will be maintained unless a life-threatening situation occurs. Maintaining confidentiality demonstrates which nursing goal? Select all that apply.

development of a trusting relationship compliance with existing laws an environment where adolescents can be truthful

The nurse is assessing the risk potential for infection for children on a pediatric unit, based on their developmental level. Which group does the nurse determine is at the highest risk for respiratory infections?

infants The physiologic immaturity of an infant's body systems increases the risk for infection. Ingestion of toxic substances and risk of poisoning are major health concerns for toddlers as they become more mobile and inquisitive. Because preschool- and school-age children are, generally, very active, they are more prone to injury and accidents.

When assessing symptoms such as rashes, pain, or lesions, what would be included in the location factor of the symptom?

localized or generalized When assessing symptoms such as pain, rashes, or lesions, the location must be assessed for local or generalized. Pain should also be assessed for deep, superficial, or radiating. The other choices describe the quality and quantity of the symptom. Page 292

A mother, who is HIV positive, is distraught when she learns that her 6-month-old baby is also human immunodeficiency virus (HIV) positive. The child had undergone open heart surgery as a newborn and had received numerous blood transfusions. The nurse recognizes that the most likely means of transmission of the disease to this child was:

placental spread during pregnancy Although it is decreasing in incidence, transmission of HIV from mother to child by placental spread is still the most common reason for childhood HIV infection in the United States. Children with hemophilia no longer have a high incidence of the disease because blood products are now screened for the virus. HIV is not transmitted by animals or through usual casual contact, such as shaking hands or kissing, or in households, day care centers, or schools. Infection via breast milk is possible but less likely that via placental spread.

A young child who has been reporting fatigue and running a low-grade fever for 4 days begins to have pustules over the entire body. The physician diagnoses chickenpox. The period before the pustules developed is referred to as the:

prodromal period The prodromal period is between the beginning of nonspecific symptoms and disease-specific ones.

A 4-year-old child is admitted to the hospital for surgery. Before you administer medicine, the best way to identify the child would be to

read the child's armband. Children may answer to the wrong name to please an adult. For this reason, checking the armband is the best method to identify a child. pg 375

The most common complication of varicella is:

secondary bacterial infections. The most common complication of varicella is secondary bacterial infection caused by the child scratching the lesions. Other complications include pneumonia, scarring, and encephalitis.

A 2-year-old holds his breath until he passes out when he wants something his mother does not want him to have. You would base your evaluation of whether these temper tantrums are a form of seizure on the basis that a) seizures are not provoked; temper tantrums are. b) seizures typically occur with fever; temper tantrums do not. c) seizures rarely occur in toddlers. d) with seizures, cyanosis rarely develops.

seizures are not provoked; temper tantrums are.

The nurse conducting a 6-month well-baby check-up assesses for the presence/absence of the asymmetric tonic neck reflex. At this age the reflex:

should have disappeared This primitive (not protective) reflex should be present at birth and disappear around age 4 months.

A mother of a 2-year-old asks the nurse, "What would be a good between-meal snack?" Which of the following would be appropriate for the nurse to suggest? Select all that apply. a) Cookies b) Orange slices c) Yogurt d) Cheese e) Pieces of apples

• Orange slices • Yogurt • Cheese • Pieces of apples

The rash in roseola is pruritic. Which measure would you teach the father to provide comfort?

Apply cool compresses to the skin to stop local itching. Cool compresses can minimize pruritus. Aspirin should not be given with increased temperature (flu-like symptoms).

What would be most effective in helping promote initiative and nutritional health for a preschooler?

Allowing the child to spread soft cheese on crackers

The nurse is caring for an 18-month-old boy hospitalized with a gastrointestinal disorder. The nurse knows that the child is at risk for separation anxiety. The nurse watches for behaviors that indicate the first phase of separation anxiety. For which behavior should the nurse watch?

Crying and acting out

The nurse is preparing a 4-year-old girl for a lumbar puncture. The child is extremely fearful and crying. The nurse needs to quickly gain the child's cooperation so the procedure can move forward as ordered. Which approach by the nurse should be used?

Engage the mother in therapeutic hugging. Often therapeutic hugging will calm a child and keep the youngster still for a procedure. Asking the child to calm down or telling her everyone is trying to help will not assist the child adequately for her to be able to cooperate. Alternate measures should be tried before using a restraint, and the least restrictive type of restraint should be used. A mummy restraint is quite restrictive. page 327

A toddler's "no" can best be eliminated by asking a question instead of making a statement. a) True b) False

False

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 touch the chips and clings to his mother. How should the nurse respond?

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. pg 416

Which milestone would you expect an infant to accomplish by 8 months of age?

Sitting without support Most babies sit steadily at 8 months, creep at 9 months, and pull to standing at 10 months.

A nurse is describing growth and development during the preschool period. What would the nurse identify as a predominant and heightened characteristic for this age group?

Imagination

The charge nurse is reviewing room assignments for a 5-year-old child who is very tearful. Which room assignment would be best?

In a room with a child near the same age

The nurse has prepared an IM injection to give a 13-year-old. After some searching, the nurse locates the 13-year-old in the playroom in front of a video game. Which action is the best one for the nurse to take?

Inform the child that it is time for an injection. Explain why the injection is needed and have him move to the procedure room. Explaining the reason for a medication is appropriate for a 13-year-old. The medication should not be given in the playroom. The playroom is a safe area for clients. Painful procedures should be done in a procedure room. Asking the child to take a break from the game sounds like the nurse is asking permission to give the medication: A child should not be given the opportunity to refuse a medicine. pg 377

An infant with poor feeding is suspected of having a congenital heart defect. The parents are asking why a chest x-ray is necessary in their infant. What is the best response from the nurse?

It will determine if the heart is enlarged. Chest x-rays are performed to see if the heart is enlarged. This will determine if the heart muscle is increasing in size. Disturbances in heart conduction are detected by an EKG. Visualizing where blood is being shunted is through the echocardiogram. The image used to clarify the structures of the heart is the MRI

The nurse is assessing a newborn. The child's mother asks about small pink area on the bridge of the child's nose. What would be the appropriate response by the nurse?

It's called a salmon nevi or a stork bite. They typically fade over time but may never go away totally." Light pink macule typically found on the eyelids, nasal bridge, or back of neck are called salmon nevi (or, more commonly, "stork bites"). They usually fade over time, but may never go away completely. A strawberry nevus is a raised reddish papule made of blood vessels (hemangiomas). They recede over time, usually by age 9 years. A nevus flammeus is a dark purple-red flat patch and grows with the child. It is more commonly known as a port-wine stain. Ecchymosis is a purplish discoloration that is more commonly known as a bruise.

The school nurse is preparing health promotion presentations regarding unintentional injuries for a high school health fair. On which topic should the nurse place as the priority when preparing the presentation?

Motor vehicle safety

Which nursing diagnosis would be the priority when caring for a child in renal failure following a kidney transplant?

Risk for infection related to immunocompromised state Children are administered anti-immune therapies to lower immune system response and help prevent rejection following a transplant; this leaves them susceptible to infection.

The nurse is providing home care for an 8-year-old girl who is dependent on a ventilator, and for her family. What is a part of case management for the child and family?

Scheduling respite care of the child with a child care provider

The nurse is collecting information from a 14-year-old female who was brought to the clinic for a well-child visit by her mother. Which techniques would be most beneficial in this process?

Speak directly to the teen when making inquiries. Sit down facing the teen during the data collection period. When caring for teens it is important to establish a rapport. Questions should be directed to the teen. Sitting when obtaining the health history information is beneficial. It helps to promote comfort between the nurse and client. Parents and teens should be allowed to choose who is present during the physical examination. Page 273

A school nurse finds a 10-year-old's blood pressure is over the 95th percentile. The nurse advises the parent to seek medical attention for the child. What outcome would the nurse expect?

The child will need the blood pressure checked two more times. The child will need the blood pressure checked two more times. It is routine to check the blood pressure on three separate occasions to get the most accurate analysis of the blood pressure. The child usually does not need surgery or need to go to the emergency room. This is not a normal result in a blood pressure finding.

A father asks you what symptoms he can expect with normal teething in his infant. What would you tell him?

The child's gumline will be tender. Normal teething creates tender gumlines but does not include an elevated temperature or constipation.

The nurse is performing an assessment on a 8-month-old infant. The infant's medical history notes that he was born at 32 weeks' gestation. The infant is progressing normally. At what adjusted age should the nurse expect the infant's developmental accomplishments?

The infant will most likely present with developmental skills consistent with a 6-month-old infant. When assessing the growth and development of a premature infant, the nurse will use the infant's adjusted age to determine expected outcomes. To determine adjusted age, the nurse subtracts the number of weeks that the infant was premature from the infant's chronological age. The infant who was born at 32 weeks' gestation was 8 weeks or 2 months premature. To determine the adjusted age, the nurse subtracts 2 months from the chronological age of 8 months: 6 months.

The nurse is caring for an adolescent diagnosed with genital herpes. The drug of choice for treating genital herpes is:

Valcyclovir The drug valcyclovir is useful in relieving or suppressing the symptoms of genital herpes.

The nurse is caring for a pediatric client diagnosed with tetralogy of Fallot. After speaking with the physician, the parents state to the nurse, "The doctor said something about our child having too many red blood cells. We don't understand how that could happen?" What is the best response by the nurse?

Your child's body is trying to compensate for the low blood oxygen levels from the heart defect by making more red blood cells, but this makes the heart actually work harder." To compensate for low blood oxygen levels, the kidneys produce the hormone erythropoietin to stimulate the bone marrow to produce more red blood cells (RBCs). This increase in RBCs is called polycythemia. Polycythemia can lead to an increase in blood volume and possibly blood viscosity, further taxing the workload of the heart. The correct response is the clearest and easiest description for the parents to understand. Telling the parents the doctor was discussing polycythemia with them doesn't answer their question.

The best way for parents to aid a toddler in achieving his developmental task would be to a) allow him to make simple decisions. b) help him learn to count. c) urge him to dress himself completely alone. d) give him small household chores to do.

allow him to make simple decisions.

Anticipatory guidance for an infant for the 4th month should include the fact that she probably will:

be able to turn over onto the back. Infants typically turn over front to back at 4 months, enlarging the area of the house that needs to be childproofed.

The student nurse is discussing the plan of care for a child admitted to the hospital for treatment of an infection. Which action should be taken first?

Obtain blood cultures When treating a child suspected of having an infection, the blood cultures must be obtained first. The administration of antibiotics may impact the culture's results. A urine specimen may be obtained but is not the priority action. Intravenous fluids will likely be included in the plan of care but are not the priority action.

A 10-year-old boy has an unknown infection and will need to provide a urine specimen for culture and sensitivity. To assure that the sensitivity results are accurate, which step is most important?

Obtain specimen before antibiotics are given In order to ensure a successful culture, the nurse must determine if the child is taking antibiotics. Throat cultures require specimens taken from the pharyngeal or tonsilar area. Stool cultures may require three specimens, each on a different day. The nurse would use aseptic technique when getting a blood specimen as well as the urine, but antibiotics cannot be received by the child prior to the test being done.

A nurse is preparing to start an intravenous (IV) line on a 5-year-old. Where does the nurse understand the procedure should be performed so that the child's "safe place" will not be disrupted?

The treatment room

A 5-year-old girl is to receive long-term antibiotics. The mother is concerned about what type of administration method will be used. Which medication administration route may be the most easily accepted?

A peripherally inserted central catheter (PICC) line in an antecubital space Since PICC lines are typically inserted in the arm, parents and children may view this as more of a regular intravenous line and be more accepting of this. An intraosseous line is not a route for long-term administration.

The nurse is caring for a child who receives dialysis via an AV fistula. Which finding indicates an immediate need to notify the physician?

Absence of a thrill The nurse should always auscultate the site for presence of a bruit and palpate for presence of a thrill. The nurse should immediately notify the physician if there is an absence of a thrill. Dialysate without fibrin or cloudiness is normal and is used with peritoneal dialysis, not hemodialysis

A family the nurse is working with administers cycled total parenteral nutrition (TPN) over a 12-hour period at night to free their teenage son for activities during the day. In teaching this family, what areas would the nurse stress? Select all that apply.

Administering the solution at half-rate during the first and last hour of the infusion Inspecting the insertion site of the catheter regularly Infusing cycled TPN at half-rate during the first and last hour of the infusion prevents hyper- and hypoglycemia. Risk for infection is always present, and the insertion site needs regular care and inspection. TPN should be stored in the refrigerator and infused by pump (not gravity) for precise rate control. Weighing the teen twice daily is not necessary. Monitoring weight weekly is sufficient for most.

Which assessment would you expect to introduce for the first time in the physical examination of a 3-year-old child?

Blood-pressure recording Assessing blood pressure is generally introduced at preschool age. The preschool E-chart is used for vision screening at this age. Page 284

The charge nurse is reviewing room assignments for a 5-year-old child who is very tearful. Which room assignment would be best?

In a room with a child near the same age Placing the child in a room with a child near the same age would be beneficial. This would promote sharing and bonding over similar circumstances. Rooming alone may promote feelings of isolation and despair. Placement with an older or younger child would not be of mutual benefit.

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?

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).

A nurse is caring for a child with Kawasaki disease. Which assessment finding would the nurse expect to see?

Peeling hands and feet and fever One of the signs of Kawasaki disease is the peeling hands and feet. The other symptoms are not necessarily characteristic of Kawasaki disease.

A nursing instructor is teaching students about the chain of infection. What does the instructor tell students is responsible for allowing the pathogen to enter?

Portal of entry The portal of entry, or the opening through which a pathogen can enter a child's body, can be inhalation, ingestion, or breaks in the skin.

The nurse is assessing a child brought to the emergency department with a badly abscessed ingrown toenail that could have been avoided with early treatment. When assessing for potential barriers to health care, the nurse should address which possible factors? Select all that apply.

The family's current health care insurance status The family's cultural beliefs about health and illness The family's spirituality and religion The child's previous experiences in the health care system There are numerous potential barriers to health care in varied domains, including spirituality, finances, culture, and previous experience. Genetics have a major effect on health and illness but are not considered to be an independent barrier to health care.

The nurse is performing an admission assessment on a 12-year-old who suffered a head injury in a motor vehicle accident. Which finding will alert the nurse that the client is demonstrating complications from the accident?

The nurse brings an ink pen toward and away from each eye and notes the pupil dilating as the object moves closer The eyes demonstrate accommodation, or focusing at different distances, if the pupil constricts as the object moves closer; dilating would indicate a possible neurological issue. Normal vital signs for a school-age child include a pulse of 60 to 100 bpm and a respiratory rate of 14 to 22 breaths per minute. Being able to rate pain shows intact neurological status. Cerumen lubricates and protects the external ear canal and is normally orangish-brown in color.

When assessing a wound for proper anesthetic effect, which finding would indicate the wound would be ready for suturing?

The nurse can visualize a blanching effect in the wound bed When assessing readiness of an anesthetic agent, look for blanching of the wound bed to assess effectiveness. Redness, a blue tone, and fresh bleeding would not indicate a wound is properly anesthetized.

A nurse is preparing to administer an intravenous (IV) medication to a child but the child is in the playroom in the pediatric unit. What is the best action by the nurse?

The nurse should request that the child come with the nurse to the treatment room to have the medication administered.

A 12-year-old girl needs a lumbar puncture to collect cerebral spinal fluid for laboratory exam plus injection of medication into the central nervous system. She expresses great fear of the procedure because of anticipated pain and the inability to hold still. The nurse contacts the physician to make which suggestion?

The use of conscious sedation for the lumbar puncture. The nurse recognizes the child's fear and is acting as her advocate suggesting the use of conscious sedation. It will be the most effective way to relieve the child's anxiety, pain, and concern about cooperation. A medication given for anxiety prior to the procedure may ameliorate some stress and make lying still a bit easier but will not relieve pain. Support from parents and a child life specialist is helpful and can be part of the conscious sedation plan. Alone it would not be adequate to assist the child. Delaying the procedure to do additional teaching could be helpful in some situations but not the best choice here.

The nurse is caring for a child who is undergoing peritoneal dialysis. Immediately after draining the dialysate, which action should the nurse should take immediately?

Weigh the old dialysate The nurse should weigh the old dialysate to determine the amount of fluid removed from the child. The fluid must be weighed prior to emptying it. The nurse should weigh the new fluid prior to starting the next fill phase. Typically, the exchanges are 3 to 6 hours apart so the nurse would not immediately start the next fill phase.

The nurse is reinforcing teaching with the caregiver of 5-year-old twins regarding urinary tract infections (UTIs). The caregiver is puzzled about why her daughter has had three urinary tract infections but her son has had none. She reports that their diets and fluid intake is similar. Which statement would be accurate for the nurse to tell this mother?

"A girl's urethra is much shorter and straighter than a boy's, so it can be contaminated fairly easily." Many different bacteria may infect the urinary tract, and intestinal bacteria, particularly Escherichia coli, account for about 80% of acute episodes. The female urethra is shorter and straighter than the male urethra, so it is more easily contaminated with feces.

The nurse is assigned to care for a 14-year-old child who is hospitalized in traction for serious leg fractures after an automobile accident. The parents ask the nurse to avoid administering analgesics to their child to help prevent him from becoming addicted. Which response by the nurse is indicated?

"Administering medications to manage reports of pain is not going to cause addiction." Responsible nursing care requires the nurse administer pain medication as needed. The nurse has the authority to discuss the child's pain control needs with the parents. There is no need to discuss the reduction of medications with the physician. Family history of drug abuse is not a factor in the care of this child. Young children can become addicted to analgesics. There is, however, no indication that addiction is a valid concern with this child. pg 414

A 15-year-old female tells the nurse that she is worried that something is wrong with her because her left breast is bigger than her right breast. What is the best response by the nurse?

"As your breasts continue to develop it is not unusual for females to have one breast larger than the other." Female breast development may begin as early as age 8, but starts by age 13 in most girls. Breast development then continues in a characteristic, but usually asymmetric, pattern, with one breast larger than the other throughout the lifespan. Page 300

A 16-year-old girl has arrived for her sports physical with a new piercing in her navel. Which response by the nurse is best?

"Be sure to clean the navel several times a day."

A 16-year-old girl has arrived for her sports physical with a new piercing in her navel. Which response by the nurse is best?

"Be sure to clean the navel several times a day." The best response is to describe the proper care using frequent cleansing with antibacterial soap. It is too late for warnings about the dangers of piercing such as skin- or blood-borne infections, or disease from unclean needles.

A newborn who is suspected of having leukemia is being prepared for bone marrow aspiration. The newborn's mother asks whether any type of sedation or anesthesia will be used. What statement should the nurse make in response?

"Because this is a painful procedure, your child will receive conscious sedation to alleviate pain." In the past, it was believed infants do not feel pain because of incomplete myelination of peripheral nerves. Evidence-based practice has shown this not to be true as myelination is not necessary for pain perception. A second argument in the past against needing to provide pain relief for infants was that they have no memory. It can be shown, however, physiologic changes occur with pain even in preterm infants, so even with a lack of memory, it is clear pain is experienced. Sedation does not typically involve risk high enough to forgo it before a painful procedure. pg 412

A teen mom asks the discharge nurse if it is okay to sleep in bed with her baby. She says her mom always did it with her siblings and it seemed okay. How should the nurse respond?

"Bed sharing has positive effects on babies, let me get you information." The nurse should enforce that bed sharing is sometimes a positive experience if the parents are safe and responsible. When done properly, the effect can be positive on infant nutrition and physiology. The other responses do not promote safety or educate the teen.

The nurse is discussing the topics of sex and sexuality and how to discuss these issues with a group of caregivers of adolescents. Which statement made by the nurse is most appropriate to tell this group of caregivers?

"Being honest and straightforward with teenagers will encourage them to ask their parents about subjects like sexuality

The nurse is assessing a newborn child. The mother asks why the newborns feet are blue. What is the best response by the nurse?

"Blueness of hands and feet is a common finding in newborns. It is a result of their circulatory system switching from being in the womb to life outside the mom's body." Blueness of the hands and feet, known as acrocyanosis, is normal in babies up to several days of age and results from an immature circulatory system completing the switch from fetal to extrauterine life. Although blueness in hands and feet may indicate a lack of oxygen and may be called peripheral cyanosis, acrocyanosis is a normal finding in a newborn. Pallor is defined as paleness, not blueness of skin. Page 290

The caregiver of an infant tells the nurse that her dentist told her not to let the child go to bed with a bottle of milk. The caregiver states she doesn't understand the reason for this since her baby seems to enjoy the bottle. The most appropriate response to this caregiver would be:

"Bottles given at bedtime can cause erosion of the enamel on the teeth." The sugar from formula or sweetened juice coats the infant's teeth for long periods and causes erosion of the enamel on the deciduous teeth. While giving water in a bottle at bedtime is acceptable and a pacifier will satisfy the sucking need, the most appropriate response is to warn of possible enamel erosion. Giving a bottle at bedtime is not a factor that leads to obesity

The nurse is counseling a pregnant adolescent about the health benefits associated with breastfeeding. Which statement by the client indicates understanding?

"Breastfeeding my baby will pass on passive immunity." Passive immunity results when immunoglobulins are passed from one person to another. This immunity is temporary. This is the type of immunity that takes place when a mother breastfeeds her child. Active immunity results when an individual's own immunity generates an immune response. page 249

An HIV positive woman has asked about breastfeeding her son. What response by the nurse is appropriate?

"Breastfeeding will increase your child's risk of contracting HIV." HIV can be transmitted by breastfeeding. A newborn who received the recommended plan of drug treatment has a reduced risk for contracting the infection. Contracting HIV is not an absolute for this infant. The client should be discouraged from breastfeeding. Breastfeeding does provide immunity when the mother is free of infection but not in this scenario. Telling the mother that this is not a good idea is not the best response as it does not take advantage of the opportunity to provide education and improve client outcomes.

The nurse has just finished administering the DTaP vaccine to a 2-month-old and is educating the parent about immunization. Which statement is accurate?

"Bring her back for the second dose when she is 4 months old." DTaP is given as a series of five injections—at 2, 4, and 6 months; between 15 and 18 months, and between 4 and 6 years. A TdaP booster is needed by 11 to 12 years. There are common side effects such as fever and redness and swelling at the injection site as well as other less common reactions such as seizures. The "T" in the vaccine stands for tetanus.

The student nurse asks the nursing instructor why nurses must be adept at understanding normal growth and development in children when providing care. What should the nursing instructor respond?

"By knowing normal growth and development, the nurse is able to identify problems in growth and development." The nurse must understand normal growth and development in order to identify children who are not meeting milestones. A child meeting milestones does not need further intervention. Understanding normal growth and development is important in applying the assessment findings when measuring height and weight of children, but will not assure the procedure is completed properly. Administering the correct dose of medication is vital and involves accurate knowledge of the medication and dosage. pg 239

The nurse is obtaining a functional history during an admission assessment of a 12-year-old child. Which questions would be appropriate for the nurse to ask during this part of the assessment? Select all that apply.

"Can you tell me if you play any sports or participate in any physical activities?" "Do you wear a seat belt any time you are a passenger in a car?" "Do you use a computer or a smart phone?" The functional history should contain information about the child's daily routine. Questions such as the amount of physical activity, car safety, and use of computers and smart phones (including the amount of time on these devices) are included in this assessment. Asking about heart problems is included in the family history assessment, and asking about parents is included in the family composition assessment. pg 276q

The mother of a 7-year-old child reports to his assigned nurse that she will need to leave for the night to care for her other children at home. She says she is worried about how her son will do, so she plans to slip off when he falls asleep. What response by the nurse is appropriate?

"Children do best with honesty, so I would recommend you tell him you will need to leave."

The mother of a 7-year-old child reports to his assigned nurse that she will need to leave for the night to care for her other children at home. She says she is worried about how her son will do, so she plans to slip off when he falls asleep. What response by the nurse is appropriate?

"Children do best with honesty, so I would recommend you tell him you will need to leave." When children are ill and hospitalized it is important to establish and maintain trust. Honesty within the confines of what they are developmentally able to understand is important. The mother should be encouraged to tell her child the truth. Not telling him may result in him becoming very upset if he awakens and his mother is not there. While children are resilient this is not promoting trust and honesty. pg 344

The parents of a child, recently adopted internationally, asks the nurse why it is recommended that their child be screened for intestinal parasites. What would be the best response by the nurse?

"Children with intestinal parasites often exhibit no signs or symptoms, so a screening is recommended." Children with intestinal parasites are often asymptomatic so screening is recommended. It is not true that all children from other countries have intestinal parasites. The public school system does not screen or treat for parasites. The screening is done for the health of the child and is not related to the cost of treatment. Treatment would not be completed unless the child had intestinal parasites.

A 9-month-old has been brought to the clinic for a well-child visit. The mother reports her son was born 6 weeks prematurely. During the data collection, the child's mother reports her son seems to be a few months "behind" what she recalls from her older children. What is the best response by the nurse?

"Delays are normal when a child is premature." When infants are born prematurely delays may be noted. When assessing the growth and development of a premature infant, use the infant's adjusted age to determine expected outcomes. To determine adjusted age, subtract the number of weeks that the infant was premature from the infant's chronological age. Plot growth parameters and assess developmental milestones based on adjusted age. Delays will not necessarily be resolved by the age of 6 months. While the mother should talk with the physician about concerns, this is not the best initial response by the nurse

The parents of an adolescent tell the nurse, "Our child seems to have allergy symptoms every time we visit our favorite cafe. I don't understand since the only allergy indicated in the testing was to eggs?" How should the nurse respond?

"Does your child get a whipped cream or foam topping on their favorite drink?" Albumin, globulin, ovalbumin should be avoided if allergic to eggs. Some foam toppings for drinks contain these substances and would cause an allergic reaction to the person allergic to eggs. This would be important information to ascertain from the family as they would likely not be aware of this.

The nurse is discussing fever with the parents of a child who is in the emergency department with a temperature of 101 degrees Fahrenheit. Which statement by a parent indicates an understanding about fevers and their management in the ill child?

"Fevers can be beneficial because they can slow down the growth of the bacteria or virus that may be causing the infection." Fevers can be protective and can help the body fight the infection. Fevers slow down bacterial or viral growth. Mismanaging fevers include inappropriate dosing of antipyretics, awakening a child at night to administer antipyretics, and using cold water or sponging the child with alcohol to reduce the temperature

The nurse is providing a nutrition workshop for the parents of infants. The nurse understands that further instruction is required when hearing which comments from the parents? Select all that apply.

"Food is so expensive. I can't afford for my child to leave any food on the plate." "I have tried at least 10 times with every green vegetable and I can't get my son to like them." "I let my child eat whatever he wants right now so that we don't argue about food. Hopefully he will like healthy foods when he grows up." Page 86

The parents of an 8 year-old state, "I am happy that our child is healthy," when the nurse says that the child falls into the 95th percentile for BMI. How should the nurse respond?

"For a child a BMI between the 85th and 95th percentile alerts us to the risk for being overweight. Let's talk about your child's diet and activity level." BMI between the 85th and 95th percentiles for children between the ages of 2 and 20 indicates risk for overweight. BMI greater than the 95th percentile indicates the child is overweight. Informing of the parents of these findings and discussing diet and activity effectively address the issue in a therapeutic way. Page 289

The nurse is caring for an 11-year-old girl. The girl's mother reports that the girl does not want to play team sports like soccer or volleyball anymore. Her daughter insists she does not enjoy them. The mother is concerned that her daughter will not get enough physical activity and asks the nurse for guidance. How should the nurse respond?

"Give her some options; it's important to find something she enjoys."

The parents of an overweight 2-year-old boy admit that their child is a bit "chubby," but argue that he is a picky eater who will eat only junk food. Which response by the nurse is best to facilitate a healthier diet? a) "Calorie requirements for toddlers are less than infants." b) "You may have to serve a new food 10 or more times." c) "Give him more healthy choices with less junk food available." d) "Serve only healthy foods. He'll eat when he's hungry."

"Give him more healthy choices with less junk food available."

A mother voices concern to the nurse that her child should not be using alcohol-based hand gels to help prevent the spread of infection. How should the nurse respond?

"Hand gels are actually very effective in preventing the spread of infection." Hand hygiene includes both hand washing with soap and water and the use of alcohol-based products (gels, rinses, foams) that do not require water. If there is no visible soiling of the hands, approved alcohol-based products are preferred because of their superior microbicidal activity, reduced drying of the skin, and convenience.

To avoid anaphylactic reactions in children, which question would be most important to ask a parent before administering penicillin to her infant?

"Has she ever had penicillin before?" Penicillin is a drug frequently involved in allergic reactions. The reaction occurs after the child has first been sensitized to the drug.

The parent of a school-age child comments to the nurse, "Every time my child eats enchiladas at our local Mexican restaurant he gets a rash. It just doesn't make sense to me." How should the nurse respond?

"Has your child ever been tested for a peanut allergy?" Enchilada sauce is an unexpected food that may contain a form of peanuts (such as peanut oil) that may be causing an allergic reaction in the child.

When questioning a 15-year-old about his health history, what would be an appropriate way for the nurse to ask about the child's drug history?

"Have you heard that some teens like to smoke? Have you tried this? When obtaining a health history from teens, the nurse should approach questions about sensitive subjects in a nonthreatening manner. This method may encourage the teen to not be afraid to ask questions and be more open. The other choices are all direct questions that may make the teen apprehensive or discourage them from being truthful when answering. Page 274

The father of a child mentions to the nurse that he is very worried about his 14-year-old son because he is associating with a group of kids that get into trouble frequently. What responses by the nurse would be appropriate? (Select all that apply.)

"Have you thought about encouraging your son to become involved in a sport? This could occupy his time in a constructive way." "Are there any activities that your son likes? There are often clubs offered at schools for a variety of interests." A child's friends can have a major influence, positive or negative, on his or her growth and development. Encouraging sports or clubs can help the father guide the son to friends that will likely have a more positive influence. Telling the father to prevent him from associating with a certain group often ends up pushing the child to that peer group. Instilling good values is not a guarantee to good choices at this age. Stating it's hard to be a parent offers no support or guidance.

A male nurse is meeting with a group of 12-year-old boys to discuss expected bodily changes. After one of the boy's says, "My older brother told me my bed might be wet and that means I had a wet dream. Is that true?" What is the best response from the nurse?

"Having wet dreams indicates that your body is going through a process of maturing."

The nurse is discussing sensory development with the mother of a 2-year-old boy. Which parental comment suggests the child may have a sensory problem? a) "I dropped a pan behind him and he cried." b) "He doesn't respond if I wave to him." c) "He was licking the dishwashing soap." d) "He wasn't bothered by the paint smell."

"He doesn't respond if I wave to him."

The nurse is taking a health history of a toddler with a suspected congenital heart defect. Which response by the mother could indicate that the child is experiencing hypercyanotic spells?

"He likes to stop and squat wherever he walks." The walking toddler may squat periodically to relieve a hypercyanotic spell. This position serves to improve pulmonary blood flow by increasing systemic vascular resistance. Constant movement and quick walking are normal for a toddler. Activity level with a daily nap is typical of a toddler. Difficulty breathing would suggest a problem.

A nurse is educating the parents how to administer daily oral medication to their 5-year-old boy. Which response indicates a need for further teaching?

"He needs to take his medicine or he will lose a privilege." The nurse should emphasize that the parents should never threaten the child in order to make him take his medication. It is more appropriate to develop a cooperative approach that will elicit the child's cooperation since he needs ongoing, daily medication. The other statements are correct. pg 387

A nurse is caring for a very shy 4-year-old girl. During the course of a well child assessment, the nurse must take the girl's blood pressure. Which approach is best?

"Help me take your doll's blood pressure" It is best to approach a shy 4-year-old by introducing the equipment slowly and demonstrating the process on the girl's doll first. Toddlers are egocentric; referring to how another child performed probably will not be helpful in gaining the child's cooperation. The other questions would most likely elicit a "no" response. Page 280

A nurse is caring for a very shy 4-year-old girl. During the course of a well child assessment, the nurse must take the girl's blood pressure. Which approach is best?

"Help me take your doll's blood pressure" It is best to approach a shy 4-year-old by introducing the equipment slowly and demonstrating the process on the girl's doll first. Toddlers are egocentric; referring to how another child performed probably will not be helpful in gaining the child's cooperation. The other questions would most likely elicit a "no" response. Page 280

The nurse is preparing to administer the hepatitis A vaccine to a child. Which statement by the child's parent would indicate a need for further education?

"Hepatitis A can result in a serious infection that affects the liver." Hepatitis B virus can result in a serious infection that affects the liver. Hepatitis A vaccine is recommended to be given to all children at age 12 months, followed by a repeat dose in 6 to 12 months. Hepatitis A is spread through close physical contact and by eating or drinking contaminated food or water. pg 260

The nurse is caring for a 13-year-old girl. The child has been identified as overweight with no underlying psychological or secondary causes. The nurse is reviewing the child's weight-loss progress and nutrition at a follow-up visit. What finding indicates a need for further discussion and teaching?

"Her goal is to be a size smaller by our vacation in two weeks."

The nurse is caring for a 13-year-old girl. The child has been identified as overweight with no underlying psychological or secondary causes. The nurse is reviewing the child's weight-loss progress and nutrition at a follow-up visit. What finding indicates a need for further discussion and teaching?

"Her goal is to be a size smaller by our vacation in two weeks." The mother must be reminded that a successful weight loss program emphasizes long-term permanent changes, not rapid weight loss or short-term diets to meet a short-term goal.

The nursing instructor has completed a presentation on normal immune function. Which statement by a student would suggest a need for further education?

"Humoral immunity is generally functional at birth." Normal immune function is a complex process involving phagocytosis (process by which phagocytes swallow up and break down microorganisms), humoral immunity (immunity mediated by antibodies secreted by B cells), cellular immunity (cell-mediated immunity controlled by T cells), and activation of the complement system. Cellular immunity is generally functional at birth, and as the infant is exposed to various substances over time, humoral immunity develops.

The nurse is caring for a 3-year-old child who is hospitalized for pneumonia. When considering his developmental age and need for security, which statement by the nurse after an invasive procedure would be most helpful?

"I am proud of how you were such a good boy." Toddlers and preschoolers may attribute illness and hospitalization a punishment for wrong deeds or misbehavior. Communicating to them that they are "good" and well behaved is beneficial. Calling them a "big boy" while flattering will not have the same impact as alleviating fears of misbehavior for this age group. While they are likely relieved the procedure is over, saying it is not helpful. Telling them you explained they would be "ok" is not of benefit. pg 315

The nurse is caring for a 2-year-old boy with an umbilical hernia and is teaching the mother about this condition. Which response from the mother indicates a need for further teaching?

"I can tape a quarter over the hernia to reduce it." The use of home remedies to reduce an umbilical hernia should be discouraged because of the risk of bowel strangulation. The mother needs to be aware that strangulation can occur, but it is rare with an umbilical hernia. Pain, tenderness, or redness indicates incarceration, which although rare with umbilical hernias, can occur. She needs to understand the signs of strangulation and understand that some children have self-esteem issues related to the large protrusion of the unrepaired umbilical hernia. Physical needs of the child have priority over any types of potential psychosocial issues. Self-esteem issues may arise due to a large protrusion of an unrepaired umbilical hernia.

The nurse is providing teaching about food substitutions when cooking for the child with an allergy to eggs. Which response indicates a need for further teaching?

"I can use the egg white when baking, but not the yolk." The parents must understand that their child cannot consume any part of an egg in any form. The other statements are accurate.

The nurse is caring for a child who was involved in an automobile accident in which extensive damage to the small intestine occurred. A surgical resection of the small intestine resulted in massive small intestine loss, causing short bowel syndrome. The parents voice concern to the nurse that their child will "never be the same." What is the best response by the nurse?

"I can't imagine what you're going through. We will be here to support and educate you on your child's condition and treatments throughout their care." Being empathetic and reassuring the parents that the staff will be there to support them and educate them will provide some relief of anxiety since this is a chronic condition. Telling them their is nothing they could have done to prevent this from happening does not help the current situation. Giving hope is good, but giving possible false hope sets the family up for disappointment. Telling the family to be strong does not provide support.

The nurse is conducting a follow-up visit for a 13-year-old girl who has been treated for pelvic inflammatory disease. Which remark indicates a need for further teaching?

"I cannot have unprotected sex again until my partner is treated." The girl's partner should be treated, but she must strongly encourage the girl to require her partner to wear a condom every time they have sex, even after he undergoes antibiotic therapy.

The nurse manager is orienting a new nurse. Which statement by the new nurse would indicate that the nurse manager should intervene?

"I do not need to document the vaccine manufacturer's name in the child's permanent record." pg 251 Documentation in the child's permanent record includes the following: date the vaccine was administered, name of vaccine (commonly used abbreviation is acceptable), lot number and expiration date of vaccine, manufacturer's name, site and route by which vaccine was administered (e.g., left deltoid, intramuscularly), edition date of VIS given to the parents, name and address of the facility administering the vaccine (where the permanent record will be kept), name of the person administering the immunization. Only significant adverse effects need to be reported to the Vaccine Adverse Event Reporting System.

The nurse is assessing for violence in the home. Which statement by a parent would warrant further investigation?

"I don't think my children have seen my husband hit me." The statement "I don't think my children have seen my husband hit me" indicates that there is violence in the house. This would warrant further investigation. Arguing, having a gun in the house, and police at the neighbor's house do not indicate violence in the house.

A teacher refers a student to the school nurse because the student is frequently falling asleep during class. After talking with the student, the nurse is most concerned by which statement by the student?

"I get 7 hours of sleep every night so I don't know why I am so tired."

What statement by the mother of a 20-month-old indicates a need for further teaching about nutrition? a) "She drinks three 6-ounce cups of whole milk each day." b) "I give my daughter juice at breakfast and when she is thirsty during the day." c) "When she doesn't eat well at meals we give her nutritious snacks." d) "New foods are offered along with ones she likes."

"I give my daughter juice at breakfast and when she is thirsty during the day."

The nurse has performed client teaching to a 15-year-old boy with Crohn disease, and his parents regarding the cobblestone lesions in his small intestine. Which comment by the family indicates learning occurred?

"I have to be careful because I am prone to not absorbing nutrients." Crohn disease typically effects the small intestine more than the large intestine and it's onset is between the ages of 10 to 20 years. The cobblestone lesions in the small intestine prevents absorption of nutrients that normally occurs. The diarrhea is not directly related to the cobblestone lesions, and ulcerative colitis is characterized by the disease effecting the intestine(s) in a continuous pattern.

A nurse is caring for a boy preparing to undergo a dressing change. Which statement by the father lets the nurse know that the child's pain experience is at risk of being intensified?

"I hope that you will be a brave boy and not cry." Parents can increase or decrease the child's ability to handle a situation. Showing disapproval about crying and expecting the boy to be brave may intensify the pain experience and be beyond the child's coping capabilities. Reacting to the child's pain in an accepting manner and offering comfort measures helps the child cope.

The nurse is counseling an overweight, sedentary 15-year-old girl. The nurse is assisting her to make appropriate menu choices. Which statement indicates the adolescent understands how to make appropriate dietary selections?

"I need to have 4 servings of fruit each day." The sedentary teen needs to consume approximately 1,600 calories each day. The recommended number of daily servings of fruit is four. A balanced diet includes a small amount of fat. To avoid all fat could place the child's health at risk. Protein intake is important for the development of tissue. The teen will need about 5 ounces of protein daily.

A child is being discharged from the hospital and the nurse has completed discharge teaching regarding prescribed liquid medications. Which comments by the parent demonstrates understanding of discharge instructions for safe medication administration? Select all that apply.

"I need to make sure to use the medicine dropper the pharmacy gives me instead of the syringe I use for my B12 injections." "I shouldn't use a liquid dropper from my kitchen because it may be a different measurement than one from the pharmacy." "I will be sure to not give too much of the liquid medication at one time." Only droppers given by the pharmacy for the specific medication should be used. Different syringes may have different measurements than pediatric oral syringes. Mixing medication syringes is avoided if a dropper is packaged with a certain medication since the drop size may vary from one dropper to another. Giving small amounts of liquid avoids aspiration. Pinching the child's nose increases the risk for aspiration and interferes with the development of a trusting relationship.

The health care provider has prescribed oral tetracycline for an adolescent girl to help clear acne. What statement about the medication made by the girl would require additional teaching from the nurse?

"I need to take the medication with food every day"

During the assessment of a 15-year-old female the nurse notes a new body piercing in the navel. Which statements by the nurse would be appropriate in regard to this new piercing?

"I notice you have a new piercing. Be sure to clean it twice a day so you don't get an infection." "Did they tell you when you got your piercing how important cleaning it is? Infections can take up to a year to heal in a naval piercing."

A nurse with no pediatric experience has been transferred to a pediatric unit to work for the day. Which comments by the nurse indicate knowledge of developmental considerations when providing hygiene needs to a 3-month-old infant?

"I plan on using a sponge bath to bathe the infant."

A nurse with no pediatric experience has been transferred to a pediatric unit to work for the day. Which comments by the nurse indicate knowledge of developmental considerations when providing hygiene needs to a 3-month-old infant?

"I plan on using a sponge bath to bathe the infant." A 3-month-old would require a sponge bath or tub bath to bathe because they cannot sit unaided. Talcum powder is not suggested for infants. A bathtub can be used for toddlers or older. No child should ever be left alone during bathing for any length of time. page 329

A nurse caring for Paulo, an infant born with a cleft palate, notices that the parents rarely interact with their child. The nurse overhears the mother telling her husband that she "feels like crying" every time she looks at their son. What would be the best response from the nurse?

"I sense you could use more information on caring for a cleft palate. Would you be interested in meeting with other parents who have dealt with this?" The nurse should support the family's adjustment to a child's condition by demonstrating an accepting, caring attitude toward the child and family and providing the parents with opportunities and support for normal infant-parent interactions.

The nursing students are learning how to perform a health assessment on a pediatric patient. The nursing instructor identifies a need for further teaching when a student states:

"I should take blood pressure on a child beginning at age 2 years." When performing assessments, the nurse does not usually take blood pressure on children younger than 3 years. The nurse should always establish good rapport with the child's parents. The nurse would use an electronic thermometer to take a temperature on a child who is 3 years. Page 284

The nurse is caring for a client who has sickle cell anemia and is in a sickle cell crisis. The child is hospitalized for treatment of symptoms and pain management during the crisis. The parents tell the nurse that they don't think their child needs any pain medication because he is sleeping a lot. How should the nurse respond?

"I understand why you think your child isn't in pain; sleep is often a way for children to cope with pain." Sleep or play may be a coping strategy for the child in pain, and sleep may reflect exhaustion of the child who is coping with pain; therefore, the nurse and parents should not assume the child is pain free. Stating, "I think your child can determine if they are feeling pain better than you can determine it" is not therapeutic communication and may anger the parents. Telling the parents that the medication must be given as ordered does not address the parent's concern. pg 414

The mother of a 9-year-old female voices concern to the nurse about her daughter developing breasts "at such a young age." How should the nurse respond?

"I understand your concern, but girls typically enter puberty around the age of 9 or 10."

The mother of a 9-year-old female voices concern to the nurse about her daughter developing breasts "at such a young age." How should the nurse respond?

"I understand your concern, but girls typically enter puberty around the age of 9 or 10." Voicing empathy regarding the mother's concern conveys support, and letting her know that this is normal growth and development helps ease her concerns. The other responses don't address her concerns or show genuine empathy.

The nurse is caring for an infant recently diagnoses with thrush and was prescribed nystatin. Which statement by the infant's mother would suggest a need for further education?

"I will add the nystatin to her bottle four times per day." Administer nystatin suspension four times per day following feeding, not mixed in the bottle, to allow the medication to remain in contact with the lesions. In the younger infant, apply nystatin to the lesions with a cotton-tipped applicator. Infants and young children often mouth their toys, so it is important to clean them appropriately. Explain to parents of infants with thrush the importance of reporting diaper rash because fungal infections in the diaper area often occur concomitantly with thrush and also need to be treated.

The nurse is speaking to a hospitalized child's parent about ways to encourage good nutrition while the child is hospitalized and after discharge. Which statement by the parent would indicate the need for further education?

"I will make the menu choices for my child so I make sure he is getting a balanced diet." Offering the child choices and allowing the child to choose what he or she wants from the menu helps to promote nutrition. Having family present for meals, using familiar objects such as sippy cups and offering ice chips as fluid intake are all additional ways to promote nutrition in hospitalized children.

The nurse is speaking to a hospitalized child's parent about ways to encourage good nutrition while the child is hospitalized and after discharge. Which statement by the parent would indicate the need for further education?

"I will make the menu choices for my child so I make sure he is getting a balanced diet." Offering the child choices and allowing the child to choose what he or she wants from the menu helps to promote nutrition. Having family present for meals, using familiar objects such as sippy cups and offering ice chips as fluid intake are all additional ways to promote nutrition in hospitalized children. page 331

The father of a 4½-year-old boy has contacted the nurse because he is concerned that his son is frequently touching his genitals. The nurse explains that this is normal during the preschool years. Which statement by the father would indicate a need for further teaching?

"I will need to find an appropriate punishment for him if this continues."

A nurse has just given otic medication instructions to the parents of a 12-year-old. Which statement would indicate that the parents need further education concerning the medication?

"I will pull the outer ear down and back before administering the medication." The proper technique to instill ear drops involves pulling the outer ear up and back. Do not administer otic medication if it is cold. Cold medication may cause discomfort and produce vomiting or vertigo in the child. If an otic medication must be refrigerated, it should be warmed to room temperature in the palms of the hands. Proper otic administration technique involves holding the dropper one-half inch above the ear canal and being careful not to touch the dropper to the ear to prevent contamination of the dropper with microorganisms. For children under 3, pull the pinna up and back. pg 381

The student nurse is assisting the more experienced pediatric nurse. Which statements by the student indicate further education is required? Select all that apply.

"I'm going to redress the child's IV site while she is in the playroom." "I took our new teenaged child down to show him the playroom." "It would be easy to perform a straight catheterization while the baby is in his crib."

The nurse has finished completing a client education program for parents on proper medication administration to children. Which statement by a parent would indicate a need for further education?

"If my toddler won't swallow her medication, I will hold her nose until she has to swallow." Proper medication administration includes placing a pill in applesauce or ice cream to help a child learn how to swallow it. When giving medications to an infant or small child, always have them in an upright position to avoid aspiration. Allowing a toddler or preschooler to squirt medication into their own mouth. You should never force medication into a child's mouth or pinch their nose. This increases the risk for aspiration and interferes with developing a trusting relationship. pg 386

The nurse is talking with the parents of a 6-month-old girl hospitalized with a respiratory infection. The parents state, "Since our child is so young it will be easier for her to cope with us being at work all day." How should the nurse respond?

"Is there a familiar person in your child's life that might be able to spend time with her while you're at work?" By 5 to 6 months of age, infants have developed an awareness of self as separate from mother. As a result, infants of this age are acutely aware of the absence of their primary caregiver and become fearful of unfamiliar persons. If the parents must both be at work, a familiar person to be with the child would be beneficial. Telling the parents the child will be fine may be instilling false hope. "Just be prepared for her to show signs of separation anxiety..." is not supportive and may cause the parents to feel guilty. "...I will be happy to give her extra attention when you both are at work" may be making promises that the nurse can't keep, and the nurse is still a stranger to the child. page 315

The nurse is evaluating if nutrition counseling for new mothers has been effective. Which comments by the mothers indicate the need for more instruction? Select all that apply.

"It is much healthier if I puree my own baby food and add a very small amount of salt to make it taste better." "No-spill sippy cups are a good way to limit the amount of juice that comes into contact with the baby's teeth." Either home-made pureed or pre-packaged baby food is acceptable, but neither should have any spices added to it. No-spill sippy cups actually allow juice to be in constant contact with the teeth because they are much like bottles in that the child must suck on them to get a drink.

A mother is concerned because her 14-month-old son, who had a big appetite when breastfeeding a few months ago, seems uninterested in eating solid food. She still breastfeeds him daily, but is thinking of weaning him soon. How should the nurse respond to this mother? a) "It is not normal for toddlers to lose their appetites; have him tested for a gastrointestinal condition." b) "It is normal for toddlers to lose their appetites; try weaning him all at once so that he will be more interested in the solid food." c) "It is not normal for toddlers to lose their appetites; spoon feed him yourself to make sure he gets proper nutrition." d) "It is normal for toddlers to lose their appetites; try starting him with just a tablespoonful of food on his plate."

"It is normal for toddlers to lose their appetites; try starting him with just a tablespoonful of food on his plate."

A nursing instructor is discussing ways to promote safe Internet use in children with a group of nursing students. Which statement by a student would indicate a need for further education?

"It is okay for a parent to place a computer in a child's room if it is used for homework." Computers in a child's room should be avoided. They should be placed where a parent can monitor use. Time limits, not opening emails from people they don't know, and not sharing passwords with anyone are all correct statements regarding safe Internet use.

After teaching the mother of a 13-month boy old about suggestions for bathing and hygiene, the nurse determines that the teaching was successful when the mother states which of the following? a) "I'll drain the tub while he's still in it so he won't fall." b) "I'll wash his hair everyday with just plain soap." c) "It might be best to give him a bath in the evening." d) "I can use bubble baths to lure him into the tub."

"It might be best to give him a bath in the evening."

A father tells the nurse that his son has been asking questions about his genitals. The father states that he is unsure how to answer the questions of a 4-year-old. How should the nurse respond?

"It's best to answer his questions using accurate anatomical names and keep your answers

The parents of a 5-year-old child with a cardiovascular disorder tell the nurse they don't understand why their child isn't gaining weight, "We make sure our child has 3 very nutritious meals every day." How should the nurse respond?

"It's great you are providing nutritious meals, but smaller frequent meals will tire your child less and promote weight gain." Small, frequent feedings will reduce the amount of energy required to feed or eat and prevents overtiring the child. Questioning if the parents are making nutritious foods or foods the child likes does not address the issue of energy expenditure when eating 3 larger meals per day. Just stating that it is "hard to get your child to eat enough" also does not address the situation

The parents of a newborn are deciding if they want their baby circumcised. The parents ask the nurse if their newborn can feel any pain during the procedure. How should the nurse respond?

"It's hard to know for sure, but research shows that it is possible for newborns to experience pain." Research has demonstrated that the nervous system structures needed for pain impulse transmission and perception are present before birth (American Medical Association, 2013). Therefore, children of any age, including preterm newborns, are capable of experiencing pain. pg 411

The mother of a young child, who has been treated for a bacterial urinary tract infection, tells the nurse her daughter has a white thick covering over her tongue. The mother states that she "has tried everything to get it off my child's tongue." How should the nurse respond?

"It's not unusual for a fungal infection to occur while taking an antibiotic for an infection. I will let your primary care provider know so we can get it treated." Thrush is a fungal infection that can occur on the tongue while on an antibiotic for an unrelated bacterial infection. The antibiotic destroys normal flora, which allows the fungal infection to occur. Thrush requires an antifungal agent, such as nystatin liquid, to destroy the infection. Additional antibiotics will not help since it is a fungal infection

The mother of a child tells the school nurse that her son has been acting out at home ever since she got remarried. "My new husband is a wonderful man and is great to my son. I don't understand why he is acting this way." What is the best response by the nurse?

"It's not unusual for children in a new step role to act out. He's feeling lots of different emotions. Be sure to keep communication open with him." Offering support to the mother and offering suggestions for open communication are effective techniques in dealing with this situation. Children may feel jealous of the stepparent or feel disloyal toward the previous biological parent. There may be competition or rivalry among the stepchildren. The child may fear that the stepparent is interfering with the child's relationship with the parent or taking away his or her source of love, affection, and attention. The other responses do not offer support or suggestions on how to deal with the son's behavior.

A nurse is discussing safety measures with the parents of a toddler. Which of the following would the nurse emphasize to address the most frequent type of accident in toddlers? a) "Keep all cleaning products and drugs out of the reach of your child." b) "Turn the handles of your pots away from the edge of the stove when cooking." c) "Make sure to have your child securely fastened in a car seat." d) "Have your child wear a helmet when beginning to ride a tricycle."

"Keep all cleaning products and drugs out of the reach of your child."

What is the best response by the nurse to the parents of a child with leukemia who express guilt because they did not take immediate action when their child seemed to develop one respiratory infection after another?

"Keep in mind that the signs of leukemia are often subtle and difficult to recognize." Pointing out that the signs and symptoms of leukemia are often difficult to recognize indicates to the parents that they were not neglectful, while also providing information about the disease. The other responses minimize the parents' feelings or tell them how they should feel and are not therapeutic.

The nurse is preparing to assess the internal ear structures of a 3-year-old. The child is resistant to the otoscope. How should the nurse respond?

"Let's see if I can find some puppies or kittens." The nurse should try to gain the youngster's cooperation by playing a funny pretend game using the "puppies or kittens" to engage the child. It is more likely the preschooler would prefer to sit on a parent's lap even though a red chair was offered. Politely asking the child to sit still is respectful but not likely to gain cooperation. Asking permission to look into the child's ear is an invitation for the young preschooler to answer "no." Page 296

The nurse is caring for a preschooler who requires postsurgical breathing exercises. Which approach will best elicit the child's cooperation?

"Let's see who can blow these cotton balls off the table first." Any intervention should be developmentally appropriate, and play can often serve as a vehicle for care. Turning breathing exercises into a game is likely to engage the preschooler. Telling the child he needs to do breathing exercises or he will develop another illness or not feel better is not likely to impress the young child. Connecting the two events in a meaningful way is beyond his cognitive ability. Asking if the child "wants" to play a breathing game is an open invitation for a "No" answer. page 323

The nurse is collecting data from a teen being seen for a well-child check-up. During the interview, the teen reports he sleeps about 6 hours per night during the week but is able to sleep 8 to 9 hours per night on the weekend. What response by the nurse is most appropriate?

"Let's talk about ways to increase the amount of rest you get during the week." It is recommended that teens get 8 to 9.5 hours of sleep per night. Teens who do not get adequate rest during the week often sleep more hours on the weekend. The best practice would be to determine ways to improve daily rest patterns.

A nurse is caring for a child who requires intravenous maintenance fluid. The child weighs 30 kg. Which is the child's daily maintenance fluid requirement?

1,700 mL The child's daily intravenous fluid maintenance is 1,700 mL. The child requires 100 mL/kg for the first 10 kg, plus 50 mL/kg for the next 10 kg, plus 20 mL/kg for each kg more than 20 kg. This equals the number of kg required for 24 hours. (10 x 100) + (10 x 50) + (10 x 20) = 1,700. pg 391-392

A pregnant client tells her nurse that a friend of hers recently gave birth to an infant who was found to have congenital heart disease. She asks the nurse whether there is anything she can to reduce the risk of this type of condition occurring in her baby. What information should the nurse mention to this client?.

"Make sure you are fully immunized." The cause of congenital heart disease often cannot be documented, although it is associated with familial patterns of inheritance and possibly triggers such as rubella (German measles) and varicella (chickenpox) infection during pregnancy. Women need to enter pregnancy fully immunized to help prevent infection during pregnancy. Encouraging the child to eat a low-sodium diet and exercise as he grows up will help prevent acquired heart disease, not congenital heart disease

A new home healthcare nurse asks her preceptor for some hints to help establish a good relationship with her pediatric clients and their families. What is the best response by the preceptor?

"Make sure you find out things that the child is interested in. This will give you things to talk about."

The nurse is providing a class to a group of parents about child rearing. One of the participants reports that she regularly uses spanking as a form of discipline for her 5-year-old son. What is the best response by the nurse?

"Many studies show that spanking can lead to aggression in children." Spanking is a controversial issue. Some argue that it provides children with a model of aggressive behavior as a solution for conflict, that it has been associated with increased aggression in children, and that it can lead to an altered parent-child relationship. Various studies have linked spanking in childhood with physical aggression and violence in childhood and persistent anger in adulthood. Spanking is not largely considered to be a useful form of discipline. Spanking is not considered beneficial in children older than age 5. Telling the mother that spanking is wrong is argumentative and does little to provide the needed education.

The student nurse is reviewing the records of a pediatric client. Which statement about the client's progress indicates the need for further instruction?

"Maturation refers to the child's increases in body size." Growth refers to an increase in physical size. Development is the sequential process by which infants and children gain various skills and functions. Heredity influences growth and development by determining the child's potential, while environment contributes to the degree of achievement. Maturation refers to an increase in functionality of various body systems or developmental skills. Page 64

In discussing the causes of iron deficiency anemia in children with a group of nurses, the following statements are made. Which of these statements is a misconception related to iron deficiency anemia?

"Milk is a perfect food, and babies should be able to have all the milk they want." Babies with an inordinate fondness for milk can take in an astonishing amount and, with their appetites satisfied, may show little interest in solid foods. These babies are prime candidates for iron deficiency anemia. Many children with iron deficiency anemia, however, are undernourished because of the family's economic problems. A caregiver knowledge deficit about nutrition is often present. Because only 10 percent of dietary iron is absorbed, a diet containing 8 to 10 mg of iron is needed for good health. During the first years of life, obtaining this quantity of iron from food is often difficult for a child. If the diet is inadequate, anemia quickly results.

The father of a child with mononucleosis is concerned with his child's fever and cough. The father asks when antibiotic therapy will begin. What is the best response by the nurse?

"Mononucleosis is a viral infection so an antibiotic isn't used. We address the symptoms with appropriate therapy." Antibiotics are only used for bacterial infections, not viral infections unless a secondary bacterial infection develops from the virus. Treatment for viral infections is aimed at treating the client's symptoms.

The school nurse has completed an educational program about vaccines to a group of parents. Which statement by a parent would indicate the need for further education?

"My 7-year-old will need to get a Hib booster at his next checkup." Hib vaccine is not routinely given to children 5 years of age or older. Haemophilus influenzae type B is a bacterium that causes several life-threatening illnesses in children younger than 5 years of age. These infections include meningitis, epiglottitis, and septic arthritis. A booster vaccine is needed at 12 to 15 months. pg 260

The mother of a 1-month-old baby is scheduling the next well-child visit for her baby. Which statement by the mother indicates an understanding of the recommended appointment schedule?

"My baby will need to again be seen when he is 2 months old." Health supervision visits for children without health problems and appropriate growth and development are recommended at birth, within the first week of life, by 1 month, then at 2 months, 4 months, 6 months, 9 months, 12 months, 15 months, 18 months, 24 months, 30 months, and then yearly until age 21. pg 239

A child will be undergoing a Holter monitor test. Which statement by the mother indicates the need for further instruction?

"My child cannot have any thing to eat or drink after midnight the day of the test." Ambulatory electrocardiographic monitoring (Holter) testing is an exam that spans approximately 24 hours. The test is done to review the activity of the heart. The individual is encouraged to follow their normal activities during the test. There is no need for the child to be NPO prior to or during the test.

During the toddler years, the child attempts to become autonomous. If the following statements were made by caregivers of 3-year-old children, which observation reflects that the child is developing autonomy? a) "Every night my child follows the same routine at bedtime." b) "When my child falls down, he always wants me to pick him up." c) "My child uses the potty chair and is dry all day long." d) "My child has temper tantrums when we go to the store."

"My child uses the potty chair and is dry all day long."

The nurse is caring for families at a health clinic. Which statement by a client would indicate to the nurse the health clinic could be more effective at providing health supervision to this communiuty?

"My husband takes off work to go to the clinic with our child so he can relay the visit details to me in our language." To be effective, the child's medical home must be easy to access, focused on the family, be culturally congruent and be community focuses. The clinic not having interpreters and printed information in the parents' native language demonstrates a lack of cultural congruency. Additional barriers are encountered when a parent must take time off from work in order to be at the appointment. Easy access is demonstrated by a location near the bus stop and the waiting room is child friendly. Offering a list of resources within the community and via city transportation further enhances the effectiveness of the clinic.

The father of a toddler tells the nurse that his child had a fever the previous night. During the assessment, which statement by the father indicates further discussion is necessary regarding temperature measurement?

"My mother said she always used a glass thermometer when I was a kid and it was very accurate. Maybe that would be better." The nurse should address the comment about use of a glass thermometer. These thermometers should be avoided since they contain mercury, which is toxic if the thermometer would break. Tympanic temperature measurement is dependent on several factors, so accuracy is sometimes questionable. Oral electronic thermometers are generally very accurate. Rectal temperatures are usually not necessary due to being invasive. Pag 281

The mother of a 13-year-old boy confides to the pediatric nurse practitioner that her son has recently had a nocturnal seminal emission. The mother is concerned, and the nurse explains "wet dreams" and the other male traits of puberty to the mother. Which response indicates a need for further discussion?

"My son must be sexually active or having overly sexual thoughts to have a nocturnal emission." Spontaneous erections and nocturnal seminal emissions do not mean that the child is sexually active or having overactive sexual thoughts. Parents need to be instructed that these occurrences are spontaneous and that the child is not doing anything to cause them.

A neonate is brought to the emergency department by her mother because she "just doesn't look right." The neonate is suspected of having sepsis. Which statement by the mother would help to confirm this suspicion?

"My water broke quite a while before I actually delivered her." Prolonged or premature rupture of membranes increases a neonate's risk for sepsis. A weak cry or lack of smile or facial expression may be present with sepsis. A significant increase in breathing rate (tachypnea) or increased work of breathing evidenced by nasal flaring, grunting, and a retraction is noted with sepsis. Neonates with sepsis do not have a fever. In fact, they may have below-normal temperature.

The nurse is teaching a first-time mother with a 14-month-old boy about child safety. Which is the most effective overall safety information to provide guidance for the mother? a) "Put chemicals in a locked cabinet." b) "Place a gate at the top of each stairway." c) "Never let him out of your sight when outdoors." d) "Don't smoke in the house or car."

"Never let him out of your sight when outdoors."

The nurse is working with the 5-day-old baby boy of a young Jewish couple. What comment is not culturally sensitive?

"Oh, I see you have chosen not to have your baby circumcised." Ritual circumcision for Jewish babies takes place on the eighth day of life. All the other comments are acceptable.

During a physical assessment of a 6-year-old child, the nurse observes the child has lost a tooth. The nurse uses the opportunity to promote oral health care with the child and parents. Which comment should the nurse include in this discussion?

"Oral health can affect general health." The nurse will advise the parents that poor oral health can have significant negative effects on systemic health. Discussing fluoridation and community health may have little interest to the mother. Placing the hands in the mouth exposes the child to pathogens and is appropriate for personal hygiene promotion. Soft drink consumption is better covered during healthy diet promotion. pg 263

A 14-year-old boy has come to his primary-care physician's office for a routine well-child visit. In reading the child's history, the nurse notes the child's father suffers from alcoholism. If the child's mother makes the following statements, which statement would be important for the nurse to gather further data regarding?

"Our next door neighbor is older than my son, and he drinks when they hang out together." Some diseases and conditions are seen across families and this is important in prevention as well as detection for the child. The caregiver can usually provide information regarding family health history. The nurse should use this information to do preventive teaching with the child and family. Early adolescence is a time when experimental use of substances, especially alcohol and tobacco, might be seen. It would be important to assess the use of substances and follow up regarding the behaviors of the adolescent. Page 276

The nurse is caring for the parents of a newborn who has an undescended testicle. Which comment by the parents indicates understanding of the condition?

"Our son's condition may resolve on its own." Normally both testes will descend prior to birth. In the event this does not happen the child will be observed for the first 6 months of life. If the testicle descends without intervention further treatment will not be needed. Surgical intervention is not needed until after 6 months if the testicle has not descended

A pregnant woman reports she is interested in breastfeeding to promote improved health for her child. Which statement by the nurse is most appropriate?

"Passive immunity can be transmitted to your child providing him with some temporary immunity against illness." Children may obtain some temporary immunity from breastfeeding. This is referred to as passive immunity. Active immunity is achieved when the immune system is exposed to pathogens and antigens are developed. pg 249

The nurse is preparing a 6-year-old for a venipuncture. The boy appears anxious and is crying. How can the nurse foster feelings of control to help minimize his anxiety about the procedure?

"Pick your favorite Band-Aid and show me which arm to use." Allowing the child options related to the style of the Band-Aid and the extremity to use gives the child some control over the happenings. Offering a pinwheel is a distraction technique. Encouraging the parent to hold the child during the procedure promotes feelings of security. Encouraging the child or parents to ask questions facilitates communication. pg 437

The mother of a child who just had abdominal surgery holds his hand and smoothes his hair. When the nurse appears to administer a scheduled analgesic, the mother says she believes the child has been in pain the last hour or more. The nurse's best response is:

"Please tell me and all of the nurses when you believe he is in pain." Having the mother share her assessments is very helpful. She knows the child the best. The statements about the medication and checking every 4 hours may be true but do not acknowledge the mother and the importance of her input. Looking comfortable (stillness) and even sleeping can be a coping strategy used by the child. Stable vital signs can be misleading. (Continually elevated signs can be interpreted as stable.) Many events can raise vital signs, including anxiety or happy excitement. Physiologic signs should be interpreted with care and combined with behavioral signs of pain. pg 415

The nurse is discussing taking a temperature on a child with a group of nursing students in a post-conference setting. Which statement made by the nursing students is most accurate related to taking a temperature?

"Rectal temperatures should not be taken on a child with diarrhea." A rectal temperature should not be taken in the newborn because of the danger of irritation to the rectal mucosa or in children who have had rectal surgery or who have diarrhea. page 283

A nurse is interviewing the mother of a sleeping 10-year-old girl to assess the level of the child's postoperative pain. Which comment should trigger additional questions and necessitate further teaching?

"She is asleep, so she must not be in pain." Just because the girl is sleeping does not mean she is not in pain. Sleep may be a coping strategy or reflect excessive exhaustion due to coping with pain. An easygoing temperament and the ability to articulate how she feels will be helpful for the nurse to establish a baseline assessment. If the girl had never had surgery before, she is less likely to have previous memories or episodes of prolonged or severe pain pg 414

The nurse is reinforcing dietary teaching with the caregiver of a child diagnosed with celiac syndrome. The caregivers make the following statements. Which statement indicates a need for further teaching regarding the dietary restrictions for the child with celiac syndrome?

"She loves hotdogs, and we always cut hers up into small pieces." Commercially canned creamed soups, cold cuts, frankfurters, and pudding mixes generally contain wheat products and should not be included in the diet of the child with celiac syndrome. This caregiver needs further teaching regarding giving her child hotdogs, even if they are cut into small pieces. The other choices show an understanding of the dietary restrictions.

An adolescent confides in the nurse that he is currently in a homosexual relationship with a classmate. He states, "I am not sure if I am really gay?" What is the best response by the nurse?

"Some teenagers experiment with homosexuality at this age. It may take some time before you determine if you are gay." Adolescents may experiment with homosexual behavior, though homosexual behavior as a teen does not necessarily indicate that the adolescent will maintain a homosexual orientation

The nurse is working with the caregivers and families of children who are hospitalized. Members of the group make the following statements. Which statement gives an indication of an issue that would likely be a major factor influencing the family's response to the child's illness?

"Sometimes I wonder if the reason she is sick is because I have so many responsibilities at work and at home." The child's family suffers stress for a number of reasons. In this situation the caregiver felt guilt about the illness. The cause of the illness, its treatment, guilt about the illness, past experiences of illness and hospitalization, disruption in family life, the threat to the child's long-term health, cultural or religious influences, coping methods within the family, and financial impact of the hospitalization all may affect how the family responds to the child's illness. Although some of these are concerns of the family and not specifically the child, they nevertheless influence how the child feels. page 333

The nurse is collecting data on a 2 ½-year-old child admitted with a diagnosis of gastroenteritis. When interviewing the caregivers, which question is most important for the nurse to ask?

"Tell me about the types of stools you child has been having." For the child with gastroenteritis, the interview with the family caregiver must include specific information about the history of bowel patterns and the onset of diarrheal stools, with details on number and type of stools per day. Recent eating patterns, if the child is toilet trained, and how many times a day the child urinates are important questions, but the highest priority is gathering data regarding the stools and stool pattern

The nurse is caring for a 10-year-old girl and is trying to obtain clues about the child's state of physical, emotional, and moral development. Which question is most likely to elicit the desired information?

"Tell me about your favorite activity at school?" A good health history includes open-ended questions that allow the child to narrate their experience. The other questions would most likely elicit a yes or no response. Page 274

During an assessment, a preschool-aged child tells the nurse about having 12 siblings. The nurse is aware that the child has two older brothers. What would be the nurse's best response?

"That is a good pretend answer but tell me the names of the brothers you really have."

The nurse is admitting a 12-month-old to the medical unit. During the admission process the parents tell the nurse that their child is very advanced because he says "ball" when he picks up a football. How should the nurse respond?

"That is great that he is recognizing objects and is able to name them. He is right on target for language skills." Recognizing the parents' excitement about their child's language skills while still letting them know that this is what the expected level is for language is a polite and accurate way to respond. The other responses do not give notice to the parents' pride and would likely make the parents feel defensive about their child's skill.

The mother of an African-American adolescent voices concern to the nurse because her daughter, "has gotten her period before all of her friends." How should the nurse respond?

"That must be difficult, but on average African-American girls start their period earlier than other ethnicities."

A frustrated mother comes to a 9-month well-baby check-up because her son is refusing all of the solid food she gives him. When talking with this mother, the nurse discovers that she has struggled all her life with a weight problem. She attributes this problem to being forced to eat all of the food she was served as a child, even when she was full. Because she doesn't want to cause the same problem in her child, she tells the nurse that each time her son pushes food away with his tongue she believes that he doesn't want it. Which statement would be most appropriate for the nurse to say to this mother?

"The baby needs to learn how to move the food to the back of the mouth for swallowing, so catch the food and offer it again until the baby learns this." The infant knows only one way to take food: namely to thrust the tongue forward as if to suck. This is called the extrusion (protrusion) reflex and has the effect of pushing solid food out of the infant's mouth. The process of transferring food from the front of the mouth to the throat for swallowing is a complicated skill that must be learned. If the food is pushed out, the caregiver must catch it and offer it again. The baby soon learns to manipulate the tongue and comes to enjoy this novel way of eating.

The nurse has been caring for a 12-year-old boy during his five-day hospitalization. The child's IV has infiltrated, and the care provider is getting ready to change the intravenous line site. Which statement made by the nurse would be appropriate in supporting the child?

"The client is left-handed and likes to draw; an IV site in his right arm would be best." The staff nurse may serve as the child's advocate when the care provider comes to start an infusion. The staff nurse who has cared for the child has the child's confidence and knows the child's preferences. pg 391

The caregiver of a 1-year-old son calls the nurse, upset that his wife has just told him that their son is being given a hormone. His wife says that the pediatrician called it human chorionic gonadotropic hormone but that is all she understood. The nurse most accurately clarifies the caregiver's question by making which statement regarding the son's treatment?

"The doctor is hoping that the hormone will cause your son's undropped testes to move into their proper place." Shortly before or soon after birth, the male gonads (testes) descend from the abdominal cavity into their normal position in the scrotum. Occasionally one or both of the testes do not descend, which is a condition called cryptorchidism. The testes are usually normal in size; the cause for failure to descend is not clearly understood. A surgical procedure called orchiopexy is used to bring the testes down into the scrotum and anchor them there. Some physicians prefer to try medical treatment such as injections of human chorionic gonadotropic hormone before doing surgery. If this is unsuccessful in bringing down the testes, orchiopexy is performed. If both testes remain undescended, the male will be sterile. If the processus does not close, fluid from the peritoneal cavity passes through, causing hydrocele. If the hydrocele remains by the end of the first year, corrective surgery is performed

The nurse is preparing to remove an IV device from the arm of a 6-year-old girl. Which approach is best for minimizing fear and anxiety?

"The first step is for you to help me remove this dressing from your IV." The nurse should explain what is to occur and enlist the child's help in the removal of the tape or dressing. This provides the child with a sense of control over the situation and also encourages his or her cooperation. The nurse should avoid using scissors to remove the tape or dressing and the comment regarding cutting may be perceived as threatening and/or frightening. Telling the child to be a big girl is inappropriate and does not teach. Telling the child the procedure will not hurt and using the terms tug and pinch could increase the child's fear and lead to misunderstanding. pg 393

The nurse is obtaining a health history on a 10-year-old child and asks the parents about their health history, the health history of their other children, and of their parents' health history. The parents ask the nurse why this information is necessary. What is the best response by the nurse?

"The information can alert us to any disease process that might run in families." Obtaining a three-generation health history can help in determining the risk of potential disease processes that have familial tendencies, such as diabetes, heart disease, etc. While the family health history is part of the standard assessment that must be completed, this response does not address the parent's question. Page 275

The nurse is documenting the relationship between a postpartum mother and her infant. Which observation would demonstrate attachment?

"The mom is talking to the infant while breast-feeding the infant." The nurse would document attachment when she observes eye-to-eye contact between infant and mother, and the mother holding the infant close and talking softly with the infant. The attachment relationship occurs with eye-to eye contact, communication, and physical contact. The other choices display none of these characteristics between infant and mother.

A father believes his 2-year-old son is frightened by seeing an intramuscular (IM) medication injected into his thigh and requests that the child's "butt" be used. What will be the nurse's response?

"The muscle in his butt is not well enough developed to receive this injection until he has walked for 1 year." Muscle development follows use, and 1 year of walking allows for full development of the gluteus and less likelihood of injury to the sciatic nerve. Since most children do little walking at 12 months, it is not likely the child has been walking for a year. The other explanations do not address muscle development or are inaccurate statements. pg 382

The father of a child with periorbital cellulitis comes to the nurses' station and asks to speak with the nurse. He demands to have more medication for his child because, "Whatever you gave him 20 minutes ago just isn't working!" What is the nurse's best response?

"The oral pain medication we gave 20 minutes ago typically takes about 45 minutes to take effect and peaks in about 1 to 2 hours. I will be back in 20 minutes to check the pain level again." Oral pain medicine takes about 45 minutes to digest and take effect; then it peaks in 1 to 2 hours. Before dosing again, give the medicine some more time to work and then reassess the pain. Stating there is nothing you can do is unhelpful. Telling a parent to be patient will not diffuse the parent's anger. Putting the parent off will only intensify the situation. pg 430

The nurse is caring for a 9-year-old one-day post-op appendectomy client. She is due to receive a dose of IV morphine. Her mother is at the bedside and asks why her daughter needs another dose of morphine when she received one just 4 hours ago. Which statement shows the nurse's understanding of pain management?

"The physician has ordered morphine to be given around the clock in order to keep on top of your daughter's postoperative pain." It is important to provide pain medication around the clock to manage pain more effectively and avoid peaks and cycles of pain. The response "I am just following the doctor's orders" does not answer the question. The mother never expressed concern about her daughter becoming an addict. Asking if the mother wants her daughter to be in pain is judgmental and inappropriate. pg 430

The nurse is conducting a health screening for a 3-year-old boy as required by his new preschool. Which statement by the parents warrants further discussion and intervention?

"The school is quite structured and advocates corporal punishment."

A physician recommends a gastrostomy for a 4-year-old client with an obstruction. The parents ask the certified wound, ostomy, and continence nurse (CWOCN) what the surgery entails. What is the nurse's best response?

"The surgery creates an opening between the stomach and abdominal wall." Ostomies can be created at various sites in the GI tract, depending on the child's clinical condition. A gastrostomy provides an opening between the stomach and the abdominal wall, and an esophagostomy communicates between the esophagus and an external site on the neck. Ostomies may be created at various sites in the small intestine (e.g., jejunostomy, ileostomy) or in the large intestine (e.g., colostomy).

The nurse is discussing the treatment of congenital aganglionic megacolon with the caregivers of a child diagnosed with this disorder. Which statement is the best explanation of the treatment for this diagnosis?

"The treatment for the disorder will be a surgical procedure." Treatment of congenital aganglionic megacolon involves surgery with the ultimate resection of the aganglionic portion of the bowel. Chronic anemia may be present, but iron will not correct the disorder. Enemas may be given to initially achieve bowel elimination, but they will not treat the disorder. Differentiation must be made between this condition and psychogenic megacolon because of coercive toileting or other emotional problems. The child with aganglionic megacolon does not withhold stools or defecate in inappropriate places, and no soiling occurs.

A single male caregiver of a 14-year-old girl accompanies his daughter to her pre-high school physical. In the course of discussion about how his daughter is developing, he remarks, "She's terrific most of the time. Of course when she gets her period, she's miserable and mean, but I tell her that's just what it's like to be a woman." What would be the most appropriate response by the nurse?

"There are nutritional and medical things she can do to lessen the symptoms; I'll give both of you information about some strategies and we'll track her for a few months." Women of all ages are subject to the discomfort of premenstrual syndrome (PMS), but the symptoms may be alarming to the adolescent. Symptoms include edema (resulting in weight gain), headache, increased anxiety, mild depression, and mood swings. Generally the discomforts of PMS are minor and can be relieved by reducing salt intake during the week before menstruation, taking mild analgesics, and applying local heat. When symptoms are more severe, the physician may prescribe a mild diuretic to be taken the week before menstruation to relieve edema; occasionally oral contraceptive pills are prescribed to prevent ovulation.

A newly hired nurse is receiving education about the role of the facility's ethics committee during the orientation period. Which statements indicate an understanding of the role of this group? Select all that apply.

"This group will review each case presented and formulate a decision for the facility." "Education concerning ethics is a role of the committee." "The role of the ethics committee has increased over the years." Ethics committees are formulated to assist a facility in making ethical decisions. These committees not only provide case-by-case review and resolution of ethical dilemmas but also review existing institutional policies and provide education to staff, physicians, children, and families on ethical issues. As technology has advanced, ethical dilemmas have increased and made the role of the committees more important over time.

The nurse brings a 2-day-old infant into the mother's room in the postpartum unit. The mother voices concern that her newborn's hands and feet "look a little blue." How should the nurse respond?

"This is common for newborns up to several days of age. It happens because of the immature circulatory system trying to get used to being outside the uterus." Blueness of the hands and feet, known as acrocyanosis, is normal in babies up to several days of age and results from an immature circulatory system completing the switch from fetal to extrauterine life. This response is the best description because it lets the mother know this is not unusual and explains why it is occurring without using medical terminology. Page 291

The nurse is caring for a 17-year-old child who was sprained her ankle. The physician has prescribed ibuprofen to manage the pain. What statement by the teen indicates the need for further instruction?

"This medication should be taken on an empty stomach." Ibuprofen belongs to a group of medications referred to as non steroidal anti-inflammatory drugs. Side effects of this medication may include nausea, vomiting, bleeding gums and bruising. Taking this medication with foods may help to lessen gastrointestinal upset. pg 428

The nurse is preparing to administer an intramuscular immunization to a 5-year-old child. What statement to the child is appropriate for inclusion in the preadministration period?

"This will help prevent you from getting sick." When providing teaching to a child it is important to be open, honest and provide developmentally appropriate information. Explaining that this will prevent later illness is something a child can understand. Saying that pain may result if movement occurs is a scare tactic and counterproductive. Yes, this is an immunization but this is terminology that is too complex for a child. Using the word "shot" is scary for the child and should not avoided if possible. pg 376

The parent of a 4-year-old child tells the nurse about being frustrated because all the parent seems to do lately is fight with the child over what the child wants to eat and wear. The parent notes sometimes wanting to spank the child for always disagreeing. What would be the best suggestion for the nurse to make to this parent?

"Use the time-out technique for discipline."

The nurse is showing the student nurse how to flush a pediatric client's peripherally inserted central catheter (PICC) line. The nurse prepares a 3-mL normal saline flush using a 5-mL syringe. The student asks the nurse why the flush was prepared this way. What is the most accurate response by the nurse?

"Using a larger-volume syringe exerts less pressure on the PICC line." Using a larger-volume syringe (i.e., 5 mL or larger) exerts less pressure on the PICC, thereby reducing the risk of rupture. pg 393

A mother who is returning to work outside the home has found a daycare center close to her office and is eager to have her 15-month-old son placed there so he can be close by. The center will only take children who are potty-trained. The mother asks the nurse for advice about how to persuade her son to use the potty. Which of the following would be the most appropriate response for the nurse to make to this mother? a) "Each time you change his diaper, tell your son how important and fun it is to use the potty chair." b) "Get your son a potty chair and have him sit on it for a few minutes each day." c) "Encourage your son to watch his older siblings use the toilet." d) "Wait a few more months until your son has more muscle control and shows signs that he's ready to be potty trained."

"Wait a few more months until your son has more muscle control and shows signs that he's ready to be potty trained."

The nurse is working with a group of caregivers of children in a community setting. The topic of hospitalization and the effects of hospitalization on the child are being discussed. Which statement made by the caregivers supports the most effective way for children to be educated about hospitals?

"We are going to take our child to an open house at the hospital so she can see the pediatric unit."

The nurse in a community clinic is speaking with the parents of a child. The parents are planning to get a divorce and discuss with the nurse how they plan on handling talking with their child. Which statements by the parents demonstrate an effective approach to speaking with their child? Select all that apply.

"We plan on reminding our child that the divorce is not their fault in any way." "We both plan on communicating with our child every day, no matter whose house our child is staying at the time." "We plan on seeking the advice of a counselor during this difficult transition." There are several ways a divorce can be made less stressful for a child. The child should be informed well in advance of anyone moving out of the house (except when abuse is present or there are concerns for immediate safety), so waiting until the child is at school is not advisable. Reasons for the divorce and that the divorce is occurring should be done with both parents present.

A mother in the outpatient setting is explaining how she plans to prepare her 5-year-old for hospital admission. What remark indicates the parent requires additional teaching?

"We told him to use his manners and behave like a big, brave boy."

A mother in the outpatient setting is explaining how she plans to prepare her 5-year-old for hospital admission. What remark indicates the parent requires additional teaching?

"We told him to use his manners and behave like a big, brave boy." Expecting manners and brave "big-boy" behavior is unrealistic. The child's coping skills are not yet well developed. Expressing true feelings should be allowed. The other preparations are helpful and promote understanding of the experience. page 317

Which statements by a parent would indicate to the nurse that the family has a future-based orientation?

"We will fill our son's prescription for asthma prevention medication today in case he has another asthma attack." "We will get our son vaccinated for varicella. We don't want him to get chickenpox." "We limit the amount of TV our children watch and are sure they get enough physical activity." Obtaining prescriptions to have on hand for an asthma attack demonstrates planning ahead for an event. Having the child vaccinated now in order to avoid the disease in the future demonstrates a future-based orientation in which the child/family believe they have control in their own health. Ensuring physical activity helps in preventing obesity in children. The other choices indicate a present-based orientation in which there is little control over health concerns and the family/child feel their own input or prevention strategies are not going to make a difference. pg 237

The nurse is teaching parents how to avoid a power struggle with their 2-year-old girl. Which comment indicates that more teaching is needed? a) "Childproofing our home will make it less necessary to say 'No!'" b) "We will make sure she shares her toys with cousins her age." c) "Both of us, as parents, will agree on and consistently enforce the limits we set." d) "We will give her a choice whenever possible."

"We will make sure she shares her toys with cousins her age."

The nurse is preparing to see a 14-month-old child and needs to establish the chief purpose of the visit. Which approach with the parents would be best?

"What can I help you with today?" Asking "What can I help you with?" is very welcoming and allows for a variety of responses that may include functional problems, developmental concerns, or disease. Asking about the chief complaint may not be clear to all parents. Asking if the child feels sick will most likely elicit a yes or no answer and no other helpful details. Asking whether the child has been exposed to infectious agents is unclear and would not open a dialogue. Page 275

The nurse is gathering data from the caregiver of a 3-year-old boy. While in the waiting room, the nurse heard the caregiver say the boy feels nauseated. In interviewing the child's caregiver, what would be the most appropriate initial question for the nurse to ask?

"What caused you to decide to bring your son to the clinic today?" To best care for the child, it is important to get the most complete explanation of what brought the child to the health care setting. Repeating the caregiver's statement regarding the child's chief complaint would be helpful in clarifying that the nurse has correctly heard what the caregiver has said. page 275

The father of a 6-week-old infant voices concerns about his son's stooling. He further shares that his son grunts and cries when having a bowel movement. What response by the nurse is most appropriate?

"What does his stool look like?" Grunting, crying and straining during bowel movements by infants and newborns is normal. This is due to the immaturity of the gastrointestinal system. The most important thing to do initially is to determine the appearance of the stool. The grunts and cries are not of concern unless the stool is dry and hard, so asking about the characteristics is the initial response. Simply indicating this is normal without having additional information is not the appropriate response. There is no need for a stool specimen based upon the infomation provided.

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?

"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. page 323

A 12-year-old girl who has not yet reached menarche comes to the pediatrician's office for her annual well-child check. As the nurse is weighing and measuring her, the child says emphatically that she does not want to get her period. Which response would be most appropriate for the nurse to make to this child?

"What have you heard about it that makes you worried?" The beginning of menstruation, called menarche, normally occurs between the ages of 12 and 13 years. For many girls this is a joyous affirmation of their womanhood, but others may have negative feelings about the event depending on how they have been prepared for menarche and for their roles as women. The nurse would need to explore the child's understanding of the implications of menarch

A 10-year-old girl with long hair is brought to the emergency room because she began acting irritable, reported a headache, and was very sleepy. Which question is most appropriate for the nurse to ask the parents?

"What were you doing prior to her beginning to feel sick?" If the family had been camping or in a wooded area, the girl could have been bitten by a tick which would not be easy to discover because of her long hair. Ticks like dark, hair-covered areas and the signs and symptoms presented are neurological, with a rapid onset, which can be characteristic of a tick bite. The other questions are important but are not focusing on the causative agent.

A group of caregivers of toddlers are discussing the form of discipline in which the child is placed in a "time-out" chair. Which of the following statements made by these caregivers is most appropriate related to this form of discipline? a) "Our 'time-out' chair is in the master bedroom so she can't see anyone else in the family." b) "She is two years old now and I put her in 'time out' for five to 10 minutes when she misbehaves." c) "We use the 'time-out' chair when our son gets tired but doesn't want to take a nap." d) "When my son starts getting frustrated and aggressive, I remind him that if he throws a fit he will have to go to 'time out.'"

"When my son starts getting frustrated and aggressive, I remind him that if he throws a fit he will have to go to 'time out.'"

The father of a 2-year-old girl tells the nurse that he and his wife would like to begin toilet training their daughter soon. He asks when the right time is to begin this process. Which of the following should the nurse say in response? a) "It is best to wait a little longer, until she is 3; only then will she be socially developed enough to understand what you are asking her to do." b) "She's well past the age to begin toilet training; most children are ready by age 1, when they have developed the needed nervous control." c) "When she starts tugging on a wet or dirty diaper, she is letting you know she's ready." d) "The best time to start toilet training is as soon as the child begins walking."

"When she starts tugging on a wet or dirty diaper, she is letting you know she's ready."

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?

"Would you like to read or play video games?"

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?

"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. page 317

A mother calls the doctor's office to let them know that her son has had a fever and a runny nose. The mother wants to know if she should still bring him for his 15-month immunizations. What is the appropriate response from the nurse?

"Yes, bring him in, he can still have his shots." Low-grade fevers and minor respiratory infections are not contraindications for vaccinations. The only true contraindications are a history of reactions to vaccines or encephalopathy within 7 days after the DTaP vaccine. If the mother does not bring her son in, or if he is seen in the office but no immunizations are given, he will be behind on his vaccination schedule.

The nurse goes in to check on a new mother to see how breast-feeding is going with her new son. The nurse observes the infant is on the mother's lap with the blanket unwrapped, and the mother is washing his face, and gently stroking the baby. The mother has had trouble breastfeeding the last few times. What is the appropriate response from the nurse?

"You are doing a wonderful job attempting to waken the baby." The nurse should be emotionally supportive to the new mom. The mom's techniques are commonly used in breastfed infants who are sleeping. The encouragement from the nurse will support the mom through this learning period. The other responses do not emotionally support the mom or contribute to a positive learning environment.

The nurse is caring for a 15-year-old involved in a motor vehicle accident (MVA). The client is receiving patient-controlled analgesia (PCA) via an epidural for pain in the extremities due to bilateral compound leg fractures. Which statement is correct when teaching this adolescent how to manage pain in this manner?

"You might experience decreased sensation and ability to move your legs while using this route of medication. Epidural analgesia can cause decreased sensation and ability to move the lower extremities. PCA medication should only be administered by the client unless otherwise indicated. A cardiac monitor along with frequent physical assessment is a good way to monitor for respiratory depression. Removing the monitor after a few hours would be contraindicated. The client should be taught to press the button before severe levels of pain are reached to decrease peaks and valleys in pain control. pg 430

The nurse is talking with the parents of a newborn who is being discharged following an uneventful delivery. The parents express their excitement about going home but have concerns about what they need to do to help their 2-year-old adjust to the new baby. Which of the following suggestions would be most appropriate for the nurse to offer these parents? a) "You should plan some time for the primary caregiver to focus on the toddler while the secondary caregiver focuses on the infant." b) "It would be good to have a grandparent or another special adult in the child's life take the toddler on an errand or a special visit." c) "You should plan some time for the secondary caregiver to focus on the toddler while the primary caregiver focuses on the infant." d) "It would be helpful to move the toddler to a new bedroom with a "grown-up" bed."

"You should plan some time for the primary caregiver to focus on the toddler while the secondary caregiver focuses on the infant."

When explaining the procedure of bone marrow aspiration to a child with leukemia, what would be the best explanation?

"You will feel pressure on your hip from the needle." Bone marrow aspiration requires hard pressure to allow the needle to puncture the bone. It is usually done under local anesthesia or conscious sedation.

A mother of a toddler asks the nurse, "How will I know that my daughter is ready for toilet training?" Which response by the nurse would be most appropriate? a) "You'll probably notice that your daughter is uncomfortable in wet diapers." b) "Most children are ready for toilet training by the time they are 18 months old." c) "Your daughter can understand holding urine and stool by about 1 year of age." d) "Don't worry, your daughter will probably give you very definite signals."

"You'll probably notice that your daughter is uncomfortable in wet diapers."

The mother of a newborn reports she does not think her baby likes his formula since he spits up after only taking a small amount. Which response by the nurse is most appropriate?

"Your baby's stomach is small and can only hold about 1/2 to 1 ounce at birth." At the time of birth an infant's stomach can only hold 1/2 to 1 ounce. This will gradually increase. While it is true that the infant does not eat much this does not meet the educational needs of the mother and is not the best response. Burping is a part of normal newborn feeding practices but is not the best response. There is no indication there is a milk intolerance from the information reported.

Children in what age range are screened by nurses using the Denver II Screening Test?

0 to 6 years The Denver II Developmental Screening Test is the most widely used tool to assess childhood development during the years leading up to school. It is regularly administered by nurses, requires special training but is simple to learn to administer. pg 242

The father of a 4-year-old is concerned his child is not telling the truth and blaming others for things that have happened. Which response should the nurse prioritize after the father shares that the child is blaming someone named "Andrew" for a broken tool, and they have no idea who this is?

"Your son may have a friend named Andrew, but it could be an imaginary friend."

The nurse caring for a 28-week pre-term infant prepares to obtain a capillary blood specimen for a routine bilirubin test via heel stick. The parents are at the bedside and ask the nurse if their infant will feel pain when he is stuck. Which is the best response for the nurse to make?

"Your son will experience pain for a brief moment when his heel is stuck." Neuroanatomical and neuroendocrine components of the pain pathway are sufficiently developed in the neonate to allow the transmission and perception of pain. Ample evidence indicates that both term and pre-term neonates have the capacity to experience and remember pain much like older children and adults do. Telling a parent not to be concerned about a routine procedure diminishes their feelings and is not appropriate. pg 412

The nurse is assessing the blood pressure of an adolescent. In which range should the nurse expect the blood pressure measurement for a healthy 13-year-old boy?

100 to 120/70 to 80 mm Hg The normal adolescent's blood pressure averages 100 to 120/70 to 80 mm Hg. The average infant's blood pressure is about 80/55 mm Hg. The toddler or preschooler's blood pressure averages 90 to 110/55 to 75 mm Hg. The normal school-ager's blood pressure averages 100 to 120/60 to 75 mm Hg

The infant weighs 6 lbs., 8 oz. (2.95 kg) at birth. If the infant is following a normal pattern of growth, what would be an expected weight for this child at the age of four months?

13 lbs. (5.9 kg) Most infants double their birthweight by 4 months of age and triple their birth weight by the time they are 1 year old.

The nurse will use the Denver Articulation Screening for children in what age range?

2 1/2 to 7 years The Denver Articulation Screening is designed for children 2 ½ to 7 years to identify difficulty in producing word sounds (articulation). It is standardized, easy to administer in a brief time and meant only for English-speakers. Those who score below their age group norms should be retested within two weeks and referred for complete language testing if the repeat exam is abnormal. pg 242

The nurse is conducting a well-child examination of a 4-year-old and is assessing the child's height. By how much should the nurse expect the child's height to have increased since last year's examination?

2.5 to 3 inches (6.35 to 7.62 cm)

The infant measures 21 ½ inches (54.6 cm) at birth. If the infant is following a normal pattern of growth, what would be an expected height for this child at the age of six months?

27 ½ inches (69.9 cm) Most infants double their birth weight by 4 months of age and triple their birth weight by the time they are 1 year old. By 12 months of age, the infant's length has increased by 50 percent

The infant weighs 7 lbs. 4 oz. (3.3 kg) at birth. If the infant is following a normal pattern of growth, what would be the expected weight for this child at the age of 12 months?

21 lbs. 12 oz. (9.9 kg) By one year of age, the infant has tripled his or her birth weight and has grown 10 to 12 inches.

The child weighs 47 pounds. How many kilograms does the child weigh? Record your answer using one decimal place.

21.4 There are 2.2 lb per kg. 47 lb x 1 kg/2.2 pounds = 21.363636 kg. When rounded to the tenths place, the answer is 21.4 kg. pg 376

The student nurse is caring for a child who weighs 48 pounds and is 38 inches tall. Which is the child's body mass index (BMI)?

23 The formula used to calculate the English version: ______Weight in pounds________ X 703 height in inches X height in pounds . The correct calculation equals 23.

A nurse realizes the importance of nutritional assessment during the health history. When doing so, the nurse must assess the quality as well as quantity of food eaten. The best way to assess food intake is to do:

24-hour recall. Food intake is best obtained by asking a parent to describe a typical day (24-hour recall), listing what the child ate for each meal and between meals as well. Page 276

The nurse is caring for a child who weighs 42 lbs. The medication ordered for the child has a therapeutic dosage range of 33 mg/kg per day to 48 mg/kg per day. The medication ordered is to be given three times a day. Which dosage would be appropriate for the nurse to administer to this child in one dose?

250 mg per dose One kilogram equals 2.2 lbs.; therefore, a child weighing 42 lbs. weighs 19 kg. The low dose of this medication would be 19 X 33 = 627 divided by three times a day equals 209 mg per dose. The high dose of this medication would be 19 X 48 = 912 divided by three times a day equals 304 mg per dose. Therefore, a dose of 250 mg per dose would be appropriate.

The child has been diagnosed with severe dehydration. The physician has ordered the nurse to administer a bolus of 20 mL/kg of normal saline over a 2-hour period. The child weighs 63.5 lb (28.8 kg). At which mL/hour should the nurse set the child's intravenous administration pump? Record your answer using a whole number.

289 The child weighs 63.5 pounds. 63.5 pounds x 1 kg/2.2 pounds = 577.2727 mL 577.2727 mL of normal saline/2 hours = 288.6364 mL Rounded to the nearest whole number = 289 mL/hour

By which age should the child know his/her own gender? a) 1 b) 3 c) 4 d) 2

3

The nurse is preparing to administer an oral dose of Reglan to a 5-year-old child who weighs 40 pounds. The order reads Metoclopramide (Reglan) 0.8 mg/kg/day to be given in 4 oral doses. How many milligrams of Reglan would you give per dose?

3.65 mg per dose The patient's weight in pounds must be converted to kilograms first: 40 divided by 2.2 equals 18.2 kilograms. Then multiply 0.8 mg by 18.2 kg, which equals 14.6 mg per day for the patient's weight. Divide 14.6 mg by 4, the number of doses each day, to arrive at 3.65 mg per dose. pg 377

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

35 The diaper must be weighed before being placed on the infant and after removal to determine urinary output. For each 1 gram of increased weight, this is the equivalent of 1 milliliter of fluid. 75 grams - 40 grams = 35 grams = 35 mL pg 392

The nurse is caring for a child who weighs 75 lb. The medication ordered for the child has a therapeutic dosage range of 33 mg/kg per day to 48 mg/kg per day. The medication ordered is to be given four times a day. Which dosages would be appropriate for the nurse to administer to this child in one dose?

375 mg per dose One kilogram equals 2.2 lb.; therefore, a child weighing 75 lb. weighs 34 kg. The low dose of this medication would be 34 X 33 = 1122 divided by four times a day equals 280.5 mg per dose. The high dose of this medication would be 34 X 48 = 1632 divided by four times a day equals 408 mg per dose. Therefore, a dose of 375 mg per dose would be appropriate. pg 377

The nurse is performing an Apgar test on a newborn. The newborn is at high risk for a hearing deficit because the infant's 1-minute Apgar score fell below what number?

4 The newborn with an Apgar score of 4 or less at 1 minute or of 6 or less at 5 minutes is at high risk for a hearing deficit. Careful, continuing follow-up is important. pg 245

The nurse is assessing deep tendon reflexes on a child admitted for severe dehydration. The assessment reveals hyperactive reflexes. How should the nurse document this finding?

4+ Deep tendon reflexes are graded by the strength of the response using the standard scale from 0 to 4+: 0, no response; 1+, diminished or sluggish; 2+, average; 3+, brisker than average; 4+, very brisk, may involve clonus. Page 307

The adolescent weighs 113 lb (51.36 kg). The nurse closely monitors the child's urine output. How many milliliters of urine is the least amount that the adolescent should make during an 8-hour shift? Record your answer using a whole number

411 The child weighs 113 lb (51.36 kg). 51.36 kg x 1 mL/1 kg = 51.36 mL/hour. 51.36 x 8 hours = 410.90. Rounded to the nearest whole number = 411 mL

The school nurse is calculating the morbidity rate of an elementary school's absenteeism related to a highly communicable infection that has been present in the school over the last two weeks. Today the school has 127 of its 300 students absent. What is the morbidity rate that the nurse will report?

42.3

A parent is disciplining the 5-year-old daughter by putting her in time-out. How long should the child be in time-out?

5 minutes The amount of time that a child spends in time-out is typically 1 minute per year of age; for example, a 3-year-old would spend 3 minutes in time-out.

The nurse is caring for a 12-year-old post-appendectomy client who weighs 86 pounds. The child has a temperature of 38.5 ºC (101.3 ºF). The nurse prepares to give the client a dose of oral Tylenol. The order reads "Tylenol 15mg/kg/dose every 4 to 6 hours PO PRN for fever or pain." How many milligrams of Tylenol should the nurse give the client?

587 milligrams The child's weight must first be converted to kilograms by dividing 86 by 2.2. The result is 39.1 kilograms. Next, the 39.1 kilograms must be multiplied by 15 milligrams. This answer is 587 milligrams. pg 377

The physician has ordered ibuprofen 150 mg every 6 hours as needed for a 3-year-old child for a fever greater than 38 Celsius. The label of the ibuprofen bottle reads "ibuprofen oral suspension 100 mg/5 mL." How much ibuprofen liquid will the nurse administer if the child's temperature goes above 38 C? Record your answer using one decimal place.

7.5 ml The dose ordered (150 mg) is divided by the available dosage (100 mg) then multiplied by 5 mL

The nurse is assessing the heart rate of a healthy 6-month-old. In which range should the nurse expect the infant's heart rate?

90 to 160 bpm The normal infant heart rate averages 90 to 160 beats per minute (bpm); the toddler's or preschooler's is 80 to 115, the school-age child's is 60 to 100 bpm.

The nurse is preparing to administer medication to a 10-year-old who weighs 70 lb (32 kg). The prescribed single dose is 3 to 4 mg/kg per day. Which dose range is appropriate for this child?

96 to 128 mg The nurse should use the child's weight in kilograms. The nurse would then multiply the child's weight in kilograms by 3 mg (32 kg x 3 mg = 96 mg) for the low end and then by 4 mg for the high end (32 pounds x 4 mg = 128 mg). pg 377

A nurse is caring for a small child with leukemia who will be hospitalized frequently for chemotherapy. What type of referral can the nurse make that will help the child and family through this time? a. Child life specialist b. Occupational therapist c. Child psychologist d. Play therapist

A A child life specialist (CLS) is a specially trained individual who provides programs that prepare children for hospitalization, surgery, and other procedures that could be painful. The CLS is a member of the multidisciplinary team and works in conjunction with health care providers and parents to foster an atmosphere that promotes the child's well being. The CLS provides therapeutic play, nonmedical preparation for surgeries and procedures, support for siblings, advocacy for the child and family and grief and bereavement support. An occupational therapist would be needed if there were injuries to the upper extremities or hands. A child psychologist would only be warranted if the child was exhibiting psychological distress.

The school-age child with a new colostomy will require teaching by the nurse to learn to care for the ostomy. In order for the nurse to teach the child effectively, what is most important for the nurse to know about the child? a. learning style b. reason for the colostomy c. manual dexterity ability d. presence of parent

A An assessment of the child's learning style needs to be completed prior to conducting the teaching session. Assessing individual learning styles helps to meet each child's best way of learning. The reason for the colostomy is not necessary; care of the colostomy is the focus of the teaching. Manual dexterity may be important for the child to be able to handle equipment safely, but it is not the most important fact to know. The procedure can be adjusted to take into consideration manual dexterity. The parent may or may not be present for the teaching session if the goal is to teach the child self-care skills. Reference:

A parent wants to wait outside the room while a procedure is completed on his young child, saying, "I don't think I can stand to see you do this!" The nurse's best response is: a. "Certainly. I will stay with your child during the procedure." b. "Stay. It will be less scary for your child." c. "This will only take a few minutes. You should be with your child." d. "Good. That is what the team doing the procedure would prefer." e. "Come, stand by his head. You won't see much up there"

A Excusing the parent from the procedure is the best response. The parent's needs and abilities need to be respected and supported. Children usually receive the most support from parents. However, others can provide effective support including nurses and child life personnel. Consider, also, that an anxious parent usually means an anxious child. Assist the parent to comfort the child after the procedure.

The nurse suspects poor literacy skills in a child's family member when which statement is made? a. "I forgot my glasses, so I'll read this when I get home and let you know if I have questions." b. "I need you to review once more the best way to be sure he swallowed all his medicine." c. "He gets a suppository every 3 days to prevent constipation." d. "We communicate with the special education teachers and school daily with a notebook."

A Identifying poor literacy or health literacy skills can be difficult. Many will work to hide this lack. "Forgetting" one's glasses could provide an excuse for not reading or questioning and should raise concerns about literacy. If other indicators such as a history of medication errors, English as a second language, an elderly caretaker (grandparent), or numerous missed appointments are present, the index of suspicion is higher. Needing a review, knowing how the suppository was used, and notebook communication with the school would ordinarily not raise a literacy or health literacy concern, although they do not rule it out.

The nurse is assessing the teaching needs of the parents of an 8-year-old boy with leukemia. Which assessment should the nurse explore as a potential issue with the parent's health literacy? a. The parents missed the last scheduled appointment. b. The entire family is fluently bilingual. c. The parents are taking notes on answers to their questions. d. The mother seems to ask most of the questions regarding care.

A Missing appointments is one of the red flags to health literacy problems as the parents may not have understood the importance of the appointment or may not have been able to read or understand appointment reminders. Being bilingual does not indicate health literacy issues. Taking notes or one parent being the primary spokesperson for the child's health care are not unusual practices.

A 15-year-old is seen at a health care facility for facial acne. When counseling him, you would teach him that the basic cause of his acne is:

Activation of androgen hormones. As androgen rises with puberty, sebaceous glands are activated to increase production of sebum, which leads to plugging of ducts (comedones).

The nurse is caring for a hospitalized preschool child and needs to hang IV fluids by the infusion pump. The nurse introduces the infusion pump to the child based on what developmental principle? a. The child may think the equipment causes the pain. b. The child is too young to for an explanation of the equipment. c. Explaining the equipment will only increase the child's fear. d. One explanation will be enough to reduce the child's fear.

A Preschool-age children tend to be frightened of intrusive procedures. Teaching about intrusive procedures or medical equipment or explaining to children why it is necessary calls for clear explanations and praise for learning. Preschool-age children are interested in learning because developing a sense of initiative is the main developmental task. The nurse should keep explanations short and words simple. A preschooler's attention span rarely exceeds 5 minutes. Because preschool children notice only one characteristic of an object, the nurse may need to repeat the instructions or explanations later. Children need to have explanations for the needed aspects of care they are to receive.

Following a principle of learning, the nurse can anticipate that school-age children will best learn a skill such as bandaging if they: a. are allowed to practice it. b. have it demonstrated to them by a teacher. c. are shown a photo of someone important doing it. d. are criticized for not learning it well.

A School-age children are in a concrete cognitive stage. They learn best if they can actually practice procedures and demonstrate them on their own. Nurses should explain procedures and the reasons for them in a simple logical way. This age group is not yet where they can think abstractly. They learn best with role playing, games, and show and tell. They need activities that create enthusiasm. Watching someone else do the procedure or seeing it in a book does not allow the child to learn the material and master the procedure. Children should not be criticized for not learning well. The technique of teaching should be changed to meet the child's learning needs.

The nurse is reviewing a group of medical records for compliance with recommended well-child care visits. Which finding would warrant further investigation?

A 13-year-old child who was last seen 2 years ago. Health supervision visits for children without health problems and appropriate growth and development are recommended at birth, within the first week of life, by 1 month, then at 2 months, 4 months, 6 months, 9 months, 12 months, 15 months, 18 months, 24 months, 30 months, and then yearly until age 21.

The nurse is caring for a variety of pediatric clients in the community health clinic. Which client is the nurse most concerned with being at risk for iron-deficiency anemia?

A 16-year-old, pregnant for the first time and lives with her parents The adolescent is at risk for iron-deficiency anemia due to the growth spurt, and the pregnant adolescent is at higher risk due to the needs of the developing baby. The other choices indicate low-risk situations for iron-deficiency anemia. pg 247

The nurse is visualizing the ear canal and tympanic membrane of a 14-month-old boy. Which finding would warrant further investigation?

A bubble behind the tympanic membrane A bubble behind the tympanic membrane is not a normal finding and indicates a need for further investigation. The other findings are within normal limits.

What is a true statement regarding varicella zoster virus infection?

A complication of this infection includes secondary bacterial infections of the skin. Varicella zoster virus infection carries with it the complication of a secondary bacterial infection of the skin. The incubation period is 10 to 21 days. It is transmitted by direct contact with the vesicles and by airborne route. It tends to be more severe in adolescents and adults.

A group of nursing students is discussing terminology related to the genitourinary system during a post-conference setting. One of the students asks what mittelschmerz is or what it means. A classmate of this student correctly answers that mittelschmerz is:

A dull, aching abdominal pain at ovulation Mittelschmerz is a dull, aching abdominal pain at the time of ovulation (hence the name, which means "midcycle"). The beginning of menstruation is called menarche. Symptoms include edema (resulting in weight gain), headache, increased anxiety, mild depression, and mood swings. Nonsteroidal, anti-inflammatory drugs (NSAIDs), such as ibuprofen (advil, motrin) inhibit prostaglandins and are the treatment of choice for primary dysmenorrhea, which is painful menstruation. (less)

The nurse is providing parental anticipatory guidance to promote healthy emotional development in a 12-month-old boy. Which statement best accomplishes this? a) A sense of control can be provided through offering limited choices. b) Emotions of a 12-month-old are labile. He can move from calm to a temper tantrum rapidly. c) Aggressive behaviors such as hitting and biting are common in toddlers. d) A regular routine and rituals will provide stability and security.

A regular routine and rituals will provide stability and security.

The nurse is conducting a physical examination of an 18-month-old with suspected intussusception. Which finding would the nurse identify as the hallmark of this condition?

A sausage-shaped mass in the upper midabdomen A sausage-shaped mass in the upper midabdomen is the hallmark of intussusception. Perianal skin tags are highly suspicious of Crohn disease. Abdominal pain and guarding are also common with intussusception but are seen with many other conditions. Tenting would indicate dehydration

A 17-year-old female is meeting with the nurse for an annual well-visit and is asking the nurse questions about how to know when one is in love. The nurse should point out which factor to help decide if both individuals have reached a mutual agreement and are ready for an intimate relationship?

A sense of trust and identity

In discussing the psychosocial development of the adolescent, it is important to understand that in order for adolescents to be in intimate relationships in which feelings are mutually shared, both persons must have:

A sense of trust and identity In order to be intimate or to share one's deepest feelings with another person, is impossible unless both persons have established a sense of trust and a sense of identity.

The parents of a 30-month-old girl have brought her into the emergency department because she had a seizure. During the health history, the nurse suspects the child had a breath-holding spell. Which of the following parental reports suggests breath-holding? a) The child was lethargic afterward. b) The child became unconscious. c) The event took place during a nap. d) A tantrum preceded the event.

A tantrum preceded the event

A nurse is examining the skin of a 15-year-old girl. Which finding would most warrant concern on the part of the nurse?

A very dark mole with an uneven border At least a few acne lesions on the face or back are usually present in an adolescent. Lesions or rashes caused by allergies to cosmetics also may be seen. If a child has a tattoo or body piercing, assess the site for inflammation to be certain an infection is not present. Look carefully for moles that are very dark, have uneven borders, or have recently changed shape as these are signs of melanoma or skin cancer. Page 277

The nurse is helping the mother of a 5-month-old boy understand the importance of developmentally appropriate play. Which one of the toys best meets the needs of this child?

A yellow rubber duck for the bath The rubber duck is most appropriate. It is safe, visually stimulating while bobbing on the water, and adds pleasure to bath time. A push-pull toy promotes skill for a walking infant. Pots and pans from the kitchen cupboard are played with successfully after sitting is mastered. A 5-month-old does not have the fine motor coordination to use stacking toys. Page 73

The nurse is teaching a 7-year-old girl about her upcoming tonsillectomy. Which techniques would be appropriate for this child? Select all that apply. a. Explaining that anesthesia is a lot like falling asleep b. Allowing the child to do as much self care as possible c. Explaining the procedure that will happen later in the day d. Using plays or puppets to help explain the procedure e. Offering choices of drinks and gelatin after the procedure

A, B, E School age children better understand about and participate in their own care than preschoolers and toddlers. They need time to prepare themselves mentally for the procedure and should be given 3 to 7 days. Plays and puppets are more appropriate for preschoolers. Active involvement in self care will help them adjust and learn. Giving them choices to make allows them control and involvement in the process.

The parents of a child admitted for a new diagnosis tell the nurse they have researched the disease on the Internet so they do not have any questions regarding their child's care. Which response(s) by the nurse is therapeutic? Select all that apply. a. "It is great that you have researched the diagnosis, but please be aware that each case can differ somewhat based on the individual." b. "I am surprised you do not have any questions. There are always variances that can make each case a little different." c. "Educating yourself is always good as long as you are using reliable resources. What sources have you used?" d. "I will let the health care provider know that you feel confident in the information you have researched about the diagnosis." e. "Please feel free to call me if you have any questions."

A, C, E It is important for the nurse to recognize that the parents educating themselves is a positive action while pointing out that each case may still have differences than what they researched. Also, determining if the parents used reliable resources is important in determining if the parents have accurate information about the diagnosis. Providing the parents the opportunity to contact the nurse later if needed will serve to keep communication open. Telling the parents that the nurse will inform the health care provider does not encourage furhter communication. Telling the parents that the nurse is "surprised" they do not have questions may cause the parents to be defensive.

Which nursing diagnosis would best apply to a child with rheumatic fever?

Activity intolerance related to inability of heart to sustain extra workload Children with rheumatic fever need to reduce activity to relieve stress during the course of the illness

Which statement is most appropriate when initiating a nursing action with a preschooler? a. "These sticky snaps are for your chest." b. "It is time to take your temperature." c. "Is it OK if I listen to your heart?" d. "Can I put this little clip on your finger?" (oxygen saturation monitor)

A. Many healthcare words can be confusing or scary for children. Avoiding those that are not understood or have double meanings reduces stress. "Sticky snaps" is nonthreatening and understood; "electrode patches" would not be. "Take" implies removing something, which can raise anxiety. "Can I?" and "Is it OK?" are an invitation for the preschooler to refuse.

A nurse is assessing a child with a tick-borne disease. What finding would indicate to the nurse that the child has developed ehrlichiosis and not Rocky Mountain spotted fever?

Absence of rash Both Rocky Mountain spotted fever and ehrlichiosis are manifested by fever, headache, and malaise. However, there is rarely a rash with ehrlichiosis, which helps to differentiate it from Rocky Mountain spotted fever.

When discussing the growth and development of an adolescent, the nurse refers to various theories and phases of development. A nurse is discussing Erikson's theory of psychological development with an adolescent client. Based on Erikson's theory of psychosocial development, which should the nurse identify as the major challenge faced by adolescents?

Achieving their own identity According to Erikson's theory of psychosocial development, the major challenge of adolescence is the achievement of identity. Achieving independence from parental domination is another task of adolescence, but not the ultimate one.

An 8-year-old boy and his father visit the pediatrician's office with reports of a sudden onset of abdominal pain and reddish-brown urine. A urinalysis shows 4+ protein. On taking the boy's health history, the nurse learns that he had strep throat a little over a week ago. Which condition should the nurse suspect?

Acute glomerulonephritis Glomerulonephritis, inflammation of the glomeruli of the kidney, is most common in children between the ages of 5 and 10 years. The child typically has a history of a recent streptococcal respiratory infection (within 7 to 14 days). Symptoms are as described above. Kidney agenesis (absence of kidneys) and polycystic kidneys (formation of large, fluid-filled cysts in the place of normal kidney tissue) are serious congenital conditions that would likely be discovered either in utero or shortly after birth, not conditions that would appear acutely in an 8-year-old. Nephrosis is altered glomerular permeability apparently due to an autoimmune process or a T-lymphocyte dysfunction that results in fusion of the glomeruli membrane surfaces, which, in turn, leading to abnormal loss of protein in urine. The highest incidence is at 3 years of age, and it occurs more often in boys than in girls. In addition to proteinuria, a major symptom of nephrosis is edema, which is absent in this case.

The caregiver of a child with a history of ear infections calls the nurse and reports that her son has just told her his urine "looks funny." He also has a headache, and his mother reports that his eyes are puffy. Although he had a fever 2 days ago, his temperature is now down to 100 degrees Fahrenheit. The nurse encourages the mother to have the child seen by the care provider because the nurse suspects the child may have:

Acute glomerulonephritis. Acute glomerulonephritis is a condition that appears to be an allergic reaction to specific infections, most often group A beta-hemolytic streptococcal infections such as rheumatic fever. Presenting symptoms appear one to three weeks after the onset of a streptococcal infection such as strep throat, otitis media, tonsillitis, or impetigo. Usually the presenting symptom is grossly bloody urine. Periorbital edema may accompany or precede hematuria. Fever may be 103 to 104 degrees Fahrenheit at the onset but decreases in a few days to about 100 degrees Fahrenheit. Slight headache and malaise are usual, and vomiting may occur.

The nurse is reviewing the medical history of a 4-year-old child. What would the nurse identify as potentially indicative of a primary immunodeficiency? Select all that apply.

Acute otitis media, one episode every 3 to 4 weeks over the past year. Recurrent deep abscess of the thigh Oral thrush, persistent over the past 6 to 7 months Warning signs associated with primary immunodeficiency include four or more new episodes of acute otitis media in 1 year, recurrent deep skin or organ abscesses, persistent oral thrush or skin candidiasis after 1 year of age. A history of infections requiring IV antibiotics to heal and two or more episodes of pneumonia in 1 year are also warning signs.

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:

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. pg 410

An infant is to receive a hepatitis B vaccine within a few hours after birth. What is the best approach for the nurse to take when giving this medication?

Administer the medication in the infant's vastus lateralis with a 25-gauge needle. The vastus lateralis site is a safe choice for IM injections in an infant. A 25-gauge needle is recommended for infants. The dorsogluteal site should not be used until the child has been walking for one year. The deltoid muscle is not a recommended IM site for infants. pg 384

The nurse is caring for a child who is receiving naproxen for treatment of juvenile idiopathic arthritis. What interventions should the nurse include in this client's care plan?

Administer the medication with food Monitor lab results for an increase in liver enzymes Monitor renal labs for a decrease in renal function Naproxen is a nonsteroidal anti-inflammatory drugs (NSAID) that acts by inhibiting prostaglandin synthesis. Side effects include GI upset or bleeding (administering with food helps prevent GI side effects); decreased liver and renal function. Extended release preparations cannot be crushed as this disrupts the extended release action. Muscle strength is not typically affected by naproxen.

The nurse is preparing discharge instructions for a 7-year-old child and the parents. Which instructions by the nurse will likely require further clarification?

Administer the prescribed antibiotic t.i.d. in order to establish a therapeutic dose. Monitor for the most common side effects from the medications prescribed.

What scenario demonstrates the nurse's knowledge when using guided imagery to relieve pain in pediatric clients?

After achieving a relaxed state, beginning a guided imagery of walking down a sandy beach and collecting seashells, a favorite activity of the 13-year-old female Imagery begins with achieving a relaxed state. Guide the child to choose a favorite place. When using guided imagery, do not lead the child; let the child become immersed in their personal image and take command of the experience. Guided imagery is not appropriate for preschoolers and toddlers. pg 424

A nurse is explaining cognitive development in children to a client, with the help of Piaget's theory of cognitive development. What would be the best explanation by the nurse about the formal operations level of cognitive development?

After age 12 children can think in the abstract including complex problem solving. There are four levels of cognitive development in Piaget's theory. The sensorimotor level is up to age 2 where children learn by touching, tasting, and feeling. They learn to control body movement. Preoperational level is children from ages 2 to 7 years who investigate and explore the environment and look at things from their own point of view. At the concrete operations level from ages 7 to 11 years, children internalize actions and can perform them in the mind. At the formal operations after the age 12 children can think in the abstract. Complex problem solving is included in this category.

A nurse is caring for a child having an arm laceration sutured. What intervention can the nurse provide that will help the child not consider the procedure as a totally negative experience?

Allow the child to choose a treat from the drawer. Children given a treat or a small toy after an uncomfortable procedure tend to remember the experience as not totally bad. pg 402

A 5-year-old child is being seen at the ambulatory care clinic for a well-child visit. The child is hiding behind his mother. What initial action by the nurse is indicated?

Allow the child to remain "hidden" during the initial part of the interview. Children may be shy when at the physician's office. To allow the child the opportunity to initially be "invisible" may be beneficial to help the child become acclimated to the surroundings. Telling the child to act like a big boy is not indicated and may "shame" the child and hinder the development of rapport between the nurse and the child. Eventually the child's mother may need to place him on the examination table but this should not be the initial action by the nurse. Promise of a small token may not work and should not be used at this time. Page 273

The school nurse is assessing a 16-year-old girl who was removed from class because of disruptive behavior. She arrives in the nurse's office with dilated pupils and is talking rapidly. Which drug might she be using?

Amphetamines

The school nurse is assessing a 16-year-old girl who was removed from class because of disruptive behavior. She arrives in the nurse's office with dilated pupils and is talking rapidly. Which drug might she be using?

Amphetamines Amphetamine use manifests as euphoria with rapid talking and dilated pupils. Signs of opiate use are drowsiness and constricted pupils. Barbiturates typically cause a sense of euphoria followed by depression. Marijuana users are typically relaxed and uninhibited

What is the correct amount of wet diapers a mature infant should have each day?

An infant should have 6 to 8 wet diapers/day. Urination occurs in the first 24 hours of life. A normal amount of urine is 200 to 300 mL/day as the infant matures. This amount is equal to 6 to 8 wet diapers/day.

When preparing to perform an IV insertion, what is the most important nursing intervention?

Apply EMLA cream to two possible insertion sites and wait at least 10 minutes before attempting. EMLA cream reduces the pain of IV catheter insertion and reduces the child's distress. Cover two potential sites, in case the first stick is unsuccessful. An explanation of the IV insertion will vary based on the developmental level of the child. It is more important to prevent pain. Informed consent is not necessary for IV insertion pg 431

The nurse is to obtain a stool specimen from a 4-year-old child who has very liquid stool. The child is ambulatory but weak. Which collection method would be most effective for the nurse to use?

Apply a urine bag to the anal area. With very liquid stool, applying a urine bag to the anal area is most effective in collecting the specimen. Using a tongue blade to scrape a specimen from a diaper would be appropriate if the stool is formed. However, putting a diaper on a 4-year-old would be demeaning. Defecating into a collection container that sits at the back of the toilet would be more appropriate for an older child who is ambulatory. A bedpan would be appropriate if the child was bedridden.

The nurse plans to apply EMLA cream to decrease the pain of an injection. What would be the best technique?

Apply it at least 1 hour before the procedure. EMLA, a topical anesthetic cream, must be applied at least 1 hour prior to a procedure to be effective. It should be covered after application to prevent the child from tasting it (which could anesthetize the gag reflex) and for maximum absorption. pg 431

Traditionally, hot and cold are viewed as potential causes of disease by which group?

Arab Americans Arab American beliefs often hold that hot and cold are potential causes for illness

Curious parents ask what type of immunity is provided to their child through immunization with various vaccines. What will be the nurse's answer?

Artificially acquired active immunity Artificially acquired active immunity develops through vaccine administration of an antigen that stimulates the child's body to produce antibodies against that antigen (pathogen) and to remember the antigen should it reappear. Natural immunity is produced through natural invasion of an antigen (pathogen). Natural and artificial passive immunity involves providing antibodies to fight a pathogen rather than expecting the child's body to produce them. This type of immunity has a short life. pg 249

The nurse enters the room to give a subcutaneous injection of insulin to a 6-year-old female who is diabetic. What is the best method of medication administration?

Ask her where she would like to have the nurse give the injection. Asking the client to choose where to receive the injection gives a degree of control. Announcing that it is time for the medication does not give any sense of control to the child. Asking permission to give a medication to a child is not appropriate: A child should not be given the opportunity to decline a medication. It is not appropriate to tell a child not to cry during a painful procedure: The child should be given permission to yell out or cry if they feel the need to. pg 377

The nurse is obtaining the health history for a 9-year-old child who has been brought to the ambulatory care clinic with complaints of a backache. Which initial action by the nurse is most appropriate?

Ask the child when the pain started. When beginning the interview it is best to ask the child about the health complaints. If additional information is needed the parent should then be consulted. Palpating the back and asking the child to demonstrate movements takes place during the examination portion of the appointment and not the health history portion. Page 273

The nurse is performing an assessment of the genitalia of a 15-year-old male. The nurse notes that the pigment of the skin of the scrotum is much lighter than the rest of the client's skin color. What is the nurse's best action?

Ask the client if the scrotal skin has always been lighter in pigment than the rest of the patient's skin While assessment findings do need to be documented, the nurse should ask the client if this finding has always been present because the scrotum is normally darker in color than the rest of the body's skin. The client is old enough to ask him rather than initially speaking with the parents. pg 304

The nurse is caring for a 13-year-old boy with cystic fibrosis. The nurse prepares and verifies several medications and brings them and the medication administration record to the client's room. The nurse observes that the client is not wearing an identification band. Which action is the correct one for the nurse to take?

Ask the client to recall their name and date of birth. If the child does not have an identification band in place, the nurse must first identify the child before administering any medication. A parent should identify a baby or a younger child. Ask an older child his or her name and date of birth or other identifier. There is no need to notify the prescribing physician. Admitting may be called at a later time to obtain a new identification band. Locating another RN to identify the client is not necessary.

The parents of a 5-year-old tell the nurse that it "seems like our child is afraid of everything from fireworks to butterflies." What actions should the nurse take? Select all that apply.

Ask the parents if they can identify anything that may be causing their child be be fearful. Suggest to the parents to talk with their child about his fears. Work with the parents and child to devise strategies to help deal with the fears.

The nurse is performing an admission assessment of an adolescent with the teen and the parents. During the assessment the nurse suspects that the teen may be pregnant. What is the best way for the nurse to address this situation?

Ask the parents to wait in the family lounge while finishing the assessment, then ask the teen during the assessment

A 14-year-old female has been brought to the pediatric ambulatory care clinic for a "sports physical" by her mother. The teen tells the nurse she does not want to have her mother present during the examination. What action by the nurse is most appropriate?

Ask the teen's mother to wait in a separate area nearby until the physical examination has been completed. Teens may be modest and uncomfortable having a physical examination in front of their parents. When possible requests by teens for privacy should be granted. Page 278

The nurse is promoting the benefits of achieving a healthy weight to an overweight 12-year-old child and her parents. Which approach is best?

Ask what activities she enjoys such as dance or sports Asking what activities the child enjoys in order to promote exercise is best for several reasons. It provides assessment of the child's activity preferences and whether the child is health-centered (positive) or weight-centered (negative). It also offers variety. If one sport doesn't work, others might. Emphasizing appropriate weight or dietary shortcomings can lead to eating disorders or body hatred. Suggesting only softball limits the success of the healthy weight promotion. pg 264

A 6-year-old boy is suspected of having late-stage Lyme disease. Which assessment should the nurse use to produce findings supporting this concern?

Asking the child if his knees hurt Recurrent arthritis in large joints such as the knees is an indication of late-stage Lyme disease. The appearance of erythema migraines would suggest early-localized stage of the disease. Facial palsy or conjunctivitis would suggest the child is in the early disseminated stage of the disease.

A 10-year-old girl is living with her grandparents. Which nursing intervention is most important with this family structure?

Assessing the child for emotional problems Children living with their grandparents may experience emotional stress if the biological parents are in and out of the child's life. Teaching basic child care skills is appropriate for the adolescent family. Determining the decision maker is important with an extended family, and financial aid is important for single parents.

The nurse notes that a 5-year-old boy is approaching obesity. Which is the priority intervention?

Assessing the diet of the child and family The greatest influence on the child's behaviors is the family. Therefore, habits of the family are likely to be those of the child. Evaluating the family diet is most important. Determining the activity level of the child ranks next in importance. Sedentary behaviors lead to weight gain. Asking about culturally related eating habits can produce some helpful but limited nutrition information. Screening the child for metabolic disorders would not be done unless there was other evidence that points to this possibility.

The nurse is preparing a subcutaneous insulin injection for a preschooler. How and where should the nurse administer the insulin?

At a 45- to 90-degree angle into the elevated tissue of the upper arm Subcutaneous administration distributes medication into the fatty layers of the body. It is used for insulin administration. Preferred subcutaneous sites include anterior thigh, buttocks, upper arms, and abdomen. The rest of the sites are intramuscular ones and not appropriate for insulin administration. pg 384

The mother of a 5 month-old tells the nurse that she thinks her baby has difficulty hearing. The nurse anticipates assisting with which hearing tests to assess this 5 month-old child's hearing? Select all that apply.

Auditory brain stem response Otoacoustic emissions (EOAE) Auditory brain stem response and otoacoustic emissions (EOAE) testing are the methods used for infants 6 months of age and younger. Tympanometry is used for children 7 months and older. Conditioned play audiometry (CPA) is for children 2 to 4 years of age, and pure-tone audiometry is for children 4 years and older. pg 243

During the health history of a 2-week-old neonate, the nurse discovers the child has not yet had a hearing screening. What test should the nurse schedule?

Auditory brain stem response test Auditory brain stem response (ABR) test and the evoked otoacoustic emissions (EOAE) test are indicated for newborns. A child not screened for hearing at birth should be screened before 1 month of age. The Rinne and Weber tests are used with children 6 years and older. Tympanometry is appropriate for children beyond 7 months of age. pg 244

The nurse will expect that which hearing test will be performed before the newborn is discharged home?

Auditory brainstem response The auditory brainstem response (ABR) or the brainstem auditory-evoked response (BAER) is used for newborns. It measures the infant's electroencephalographic response to sound. All of the other hearing tests listed are used with older infants and children and are not appropriate for evaluating newborns. p 245

A 5-year-old is being prepared for diagnostic cardiac catheterization, in which the catheter will be inserted in the right femoral vein. What intervention should the nurse take to prevent infection?

Avoid drawing a blood specimen from the right femoral vein before the procedure Because the vessel site chosen for catheterization must not be infected at the time of catheterization (or obscured by a hematoma), never draw blood specimens from the projected catheterization entry site before the procedure (generally a femoral vein). The other interventions listed are performed for reasons other than prevention of infection. Children scheduled for the procedure are usually kept NPO for 2 to 4 hours beforehand to reduce the danger of vomiting and aspiration during the procedure. Be certain to record pedal pulses for a baseline assessment. The site for catheter insertion is locally anesthetized with EMLA cream or intradermal lidocaine.

A nurse is performing a physical examination on a newborn. Which assessment should she include?

Axillary temperature, femoral pulse, head circumference When examining newborns, take axillary or temporal temperatures to prevent rupture of rectal mucosa. Be certain to take femoral pulses in newborns to rule out coarctation of the aorta. Include newborn reflexes, head circumference, and an assessment of gestational age as routine parts of the examination. Taking blood pressure is not necessary because this value is unreliable in newborns. page 279

A 7-year-old child with sickle cell anemia who comes to the hospital frequently appears withdrawn and depressed. The client refuses to talk to anyone or even admit to feeling sad. What would be the bestthing for the nurse to do that might help the child deal with his or her feelings? a. Tell the client a joke. b. Get the client to draw a picture. c. Play a happy song for the client. d. Leave the client alone.

B A useful nonverbal technique to assess how children feel about a frightening experience is to ask them to draw a picture. Children cannot always verbally express what they are feeling. Being able to convey feelings on paper can open the door for the nurse or child life specialist to help the child deal with the problem. Humor will not fill the void. It is not effective with depression because it is not interpreted as humor. Usually children are looking for a firm support person to be with them, not an amusing one. Using music can be helpful, but the child should pick the type of music that will then convey the mood. The nurse should not leave the child alone. Doing so will only add to further isolation.

A mother rooming-in with her 10-month-old infant appears upset following the visit of a consultant physician. The mother has questions but states, "The doctor is always so busy." The nurse will: a. ask the mother for her questions so that the nurse can relay them to the medical team. b. assist the mother in preparing a list of questions for the physician's next visit. c. encourage the mother to remain at the infant's bedside so as not to miss any future consultant visits. d. explain to the mother the limits on the consultant's time.

B Empowering parents so that they can be active partners in their child's care is part of family-centered care. Helping the mother state and write her questions will provide information to which the nurse can respond plus help the mother interact more effectively with the consultant and other health team members. Relaying the mother's questions may be helpful on limited occasions but places the nurse between the parent and provider relaying information in a "third party" manner. Keeping the mother at the bedside watching and waiting causes unnecessary watchfulness and stress. Supporting the "busyness" of the consultant burdens the mother further.

An 8-year-old child is scheduled to have a tonsillectomy and adenoidectomy in 2 weeks. What intervention can the nurse provide to help the child and family adjust to the hospitalization? a. Tell the child about being able to eat popsicles and ice cream after surgery. b. Take the child on a tour of the facility and surgical suite and explain what to expect preoperatively and postoperatively. c. After interviewing the child, give the child a prize for answering the questions. d. Tell the child that the parents will not be able to see him or her until after the child returns to the hospital room.

B Nurses can help children cope with the experience by using age-appropriate and child-specific interventions. Preparation can help children and their families to adjust to illness and hospitalization. Preparing the child reduces stress and fear. As much as possible, the nurse or child life specialist can show the child the areas where the child will have surgery, play with age-appropriate dolls to learn such things as IV insertion, and answer all the child's questions. Telling the child the parents will not be able to see him or her increases fear and anxiety. Being able to have a popsicle after surgery is the truth, but it is not the entire truth nor does it prepare the child for unknown places. The purpose of prehospital preparation is not to interview the child but to prepare the child.

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. Make time for questions at the end of the teaching session. b. Observe the parent set up and administer the infusion. c. Ask the parent to repeat the instructions step-by-step. d. Give cues as needed while the parent sets up the infusion.

B 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.

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

B 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 in complete 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.

A nurse is preparing to start an intravenous (IV) line in a child with severe pneumonia. The nervous child asks the nurse to wait until later to do the procedure. How should the nurse proceed? a. Inform the child that the procedure will have to happen immediately. b. Explain to the child why the IV is needed and find creative games to utilize while inserting the IV. c. Call the health care provider to see if the medication can be given in liquid form by mouth. d. Ask the parent to hold the child down so that the procedure can be completed.

B When a procedure is necessary the nurse should use a firm, positive, and confident approach that provides the child with a sense of security. The child should be allowed to express feelings of anger, anxiety, fear or frustration but also know the procedure is necessary. In atraumatic care, the nurse should use a topical anesthetic at the IV site prior to the IV insertion to minimize pain. The parents should not be used as a restraint. This causes severe anxiety for the parent and the child. If an IV is prescribed to be placed, then most likely IV medications will be needed. Just because the child does not want the IV, the child should not be allowed to dictate care.

The teaching session using pictures for a preschool-age child did not have an intended outcome. In which ways could the nurse modify the teaching session to best fit the child's developmental level? Select all that apply. a. Involve the parents in the teaching session. b. Offer rewards as each step is learned. c. Active participation by the preschooler. d. Teach all information in a short session. e. Teach in a formal session.

B, C When planning a teaching session, the nurse needs to incorporate the principles of teaching. Two principles that apply to this situation include (1) children learn best by actively participating in the learning and (2) learning occurs best if rewards, not penalties, are offered. Teaching all the information in one session or teaching the information in a formal setting will not provide positive results. Developmentally, preschoolers can focus only for short periods of time and can only absorb information in that short window. If the information is presented in such a format, the child can actively participate and learning will occur. Offering rewards such as praise increases the child's self-esteem.

A nurse is caring for a 7-year-old child on the pediatric surgical unit. The family moved to the country 1 year ago. What are the bestmethods for the nurse to establish a therapeutic relationship with the child and family? Select all that apply. a. The nurse obtains the assistance of a language interpreter b. The nurse asks the family and child about preferences regarding care c. The nurse observes the interaction between the child and the family d. The nurse asks the family what is the primary language spoken in the home e. The nurse asks the child and family about cultural practices

B, C, D, E Asking questions of the family and child, observing interactions of the family, and asking what the primary language spoken is will most help the nurse in establishing a therapeutic relationship. A language translator may not be necessary.

The nurse is educating a 4-year-old child about what to expect during an upcoming procedure. Which statement(s) is appropriate for the nurse to use? Select all that apply. a. "You will end up in 'ICU' where you will wake up with some electrodes on your chest." b. "They are going to give you some special medicine to help the doctor see what is happening inside your belly." c. "This little tube will go in your nose and down into your belly." d. "I am going to give you this shot and it will put you to sleep." e. "When they come to get you, you will get on a special rolling bed."

B, C, E It is appropriate to use the word "tube" and not a "catheter." It is appropriate to call a "gurney" a "rolling bed." It is better to call dye "special medicine." Terms used in the other options may be misunderstood by a 4-year-old child.

Which assessment is the most important for determining an accurate dose of a pediatric medication?

Body surface area Body surface area (BSA) is the most accurate measure for dosing medications for children. In pediatrics, there are no standard amounts of a drug given per age; rather, dosage is based on weight using an established amount of the drug per body weight. Body mass index is not considered when determining pediatric medication dosing. pg 377

A nurse is assessing a neonate with sepsis. The nurse understands that most commonly the cause involves:

Bacteria Neonatal sepsis can be caused by viruses such as herpes simplex or enteroviruses and by protozoa (e.g., Toxoplasma gondii). However, bacteria are typically the culprits.

The nurse is doing dietary teaching with the caregivers of a child diagnosed with idiopathic celiac disease. Of the following foods, which would most likely be appropriate in the child's diet?

Bananas The young child should be started on a starch-free, low-fat diet. Bananas contain invert sugar and are usually well tolerated. Products that contain wheat, rye, or oats should be excluded.

A child is diagnosed with intussusception. The nurse anticipates that what action would be attempted first to reduce this condition?

Barium enema A barium enema is successful in reducing a large percentage of intussusception cases. Other cases are reduced surgically. Upper endoscopy is used to visualize the upper gastrointestinal tract from the mouth to the upper jejunum. Endoscopic retrograde cholangiopancreatography is used to view the hepatobiliary system.

A nurse is instructing the parents of a toddler on the use of an anesthetic cream in advance of an upcoming procedure the child will have. What information should the nurse mention to them?

Be careful not to let your son remove the dressing, as the cream can cause damage to his eyes if he rubs them. To reduce the pain of procedures such as venipuncture, lumbar puncture, and bone marrow aspiration, a local anesthetic cream that contains 4% lidocaine can be used. The cream is applied to the skin, and the site is then covered with an occlusive dressing or plastic wrap to keep young children from wiping away or tasting the cream. The time needed for effect between different brands varies from 30 minutes to 1 hour so must be applied within that time frame before an expected procedure. Caution them not to allow their child to remove the dressing as the cream could anesthetize the gag reflex if eaten or cause eye damage if rubbed into the eyes.

The nurse is obtaining a child's health history. Place the information listed in the order in which the nurse would complete the history.

Biographic data Chief complaint History of present illness Past medical history Family medical history Social and environmental history When conducting a comprehensive pediatric history, the nurse would obtain the information in the following order: biographic data, chief complaint, history of present illness, past medical history, family medical history and social and environmental history. Page 275

The parent reports the 13-month-old infant was using auditory expressive language. The vocalizations have been diminished over the last month and the child no longer says words. Select the best rationale for the infant's language behavior. a) This behavior is common in children when autism is developing. b) Biological factors such as otitis media could be causing hearing loss. c) The environment has changed since the grandparents moved in with the family. d) The parent has decreased the usual sensory stimulation for the child.

Biological factors such as otitis media could be causing hearing loss

When developing the plan of care for a 5-year-old boy with Rocky Mountain spotted fever, the nurse knows the cause of the illness is:

Bite of a tick Rocky Mountain spotted fever is a tick-borne infection. Rabies is due to the bite of an animal. Community-acquired methicillin-resistant Staphylococcus aureus is transmitted through direct person-to-person contact, respiratory droplets, blood, or sharing of personal items and touching surfaces or items contaminated with methicillin-resistant S. aureus. Scarlet fever is an infection resulting from group A streptococcus.

The nurse is collecting data on a 6-year-old child admitted with acute glomerulonephritis. Which vital sign would the nurse anticipate with this child's diagnosis?

Blood pressure 136/84 Hypertension appears in 60% to 70% of clients during the first 4 or 5 days with a diagnosis of acute glomerulonephritis. The pulse of 112 would be a little high for this age child, but not a concern with this diagnosis. The other vital signs are within normal limits for this age child

In addition to the child's history, symptoms, and blood studies, what information helps to confirm the diagnosis of leukemia?

Bone marrow aspiration In addition to the history, symptoms, and laboratory blood studies, a bone marrow aspiration must be done to confirm the diagnosis of leukemia. Genetic studies are done for hereditary diseases such as sickle cell anemia and hemophilia. The modified Jones criteria are used as a guide to note the manifestations of rheumatic fever, and chest x-rays help in diagnosing congestive heart failure.

The nurse is preparing a presentation for a local health fair depicting the differences in maturity between preadolescents. Which differing factor should the nurse prioritize in the presentation?

Boys grow at a slower, steadier rate than do girls.

Which suggestion by the nurse meant to promote good dental health in the 15-month-old is inappropriate? a) Wean the child from the bottle. b) Avoid grazing (continual snacking) throughout the day. c) Arrange for your child's first dental visit as soon as possible. d) Brush your child's teeth with a pea-sized amount of fluoride-containing toothpaste.

Brush your child's teeth with a pea-sized amount of fluoride-containing toothpaste. Using fluoride toothpaste prior to age 2 years promotes development of fluorosis.

A 15-year-old client with type 1 diabetes has been noncompliant with the dietary regimen. When educating the adolescent, what is the most important thing the nurse can do to allow the adolescent to be in control and involved in the decision-making process? a. Provide information and allow the adolescent to process and ask questions. b. Offer choices whenever possible. c. Speak directly to the adolescent and consider the client's input in the decisions about care and education. d. Praise the adolescent often.

C A teaching tip for adolescents that will allow them control and involvement in the decision-making process is to speak directly to them and consider their input in all decisions about their care and education. Adolescents are particularly sensitive about maintaining body image and the feelings of control and autonomy. Reasons as to why things are important should be conveyed to them. The nurse should collaborate with the teen to develop an acceptable solution to being compliant. The nurse should also expect some noncompliance from adolescents. Even with noncompliance in some areas, there some things the adolescent does well—and the adolescent should be praised for these accomplishments. Choices can be offered whenever possible but for a client with diabetes these choices are often limited.

The nurse is having trouble communicating with a hospitalized child. Which communication technique would be the most beneficial for the nurse to offer the child? a. having the child keep a diary b. attending a group discussion c. drawing pictures d. playing video games

C A useful nonverbal technique to learn how children feel about a frightening experience is to ask them to draw a picture of what happened or a picture of themselves. A child's use of color may be a clue as to their mood (happy children will use bright colors; depressed children will use black or dark colors). The child's age would matter if the child were to keep a diary. This would have to be an older school age child or adolescent. If the child is not communicative, attending a group discussion might tend to increase the anxiety because more pressure would be exerted to participate in the group. Playing video games is a single activity and requires the child to focus on the game and not the problem.

The nurse is caring for an adolescent with a newly diagnosed disease process. The adolescent refuses to learn about the disease. Which technique should the nurse use to encourage the adolescent to be actively involved in education about this disease? a. Help the adolescent to realize that he or she is different from peers and needs teaching while they do not. b. Encourage the adolescent to be educated about the disease to know what to expect concerning treatments. c. Help the adolescent understand how new information about the disease will improve health status now. d. Urge the adolescent to listen attentively to what information the nurse wants to teach.

C Adolescents are present-oriented, so they generally respond best to information that has direct application. Adolescents do not focus on the future. Urging adolescents to listen and understand that they are different from peers will not encourage learning about the disease process. Adolescents want to be like their peers. Thus, the nurse should provide reasoning why something is important and how it affects the adolescent's current life.

When teaching an adolescent about home care after hospitalization, what is most important for the nurse to do? a. Focus the discussion on skill techniques. b. Use the same type of language as the adolescent. c. Allow opportunity for the adolescent to express feelings. d. Provide assurance the nurse will maintain confidentiality.

C Adolescents, struggling for identity, can be responsible for their own self-care if they understand how the new action they are being taught will affect them. Affective learning is important for the adolescent to express his/her feelings about what has happened and their illness. Adolescents have a strong need to be exactly like their friends. This means they will rarely continue with any action that makes them conspicuous in front of their peers. The nurse should not use the same language as the adolescent because there may be pertinent information that would not be shared if the nurse is not translating the adolescent's language correctly. Maintaining confidentiality is always important, and assurance should be given to the adolescent that the nurse will not share information with the adolescent's friends, but that is not the most important task for the nurse at this time.

The expected outcome of teaching a school-age child about bike safety is that the child will wear a helmet 100% of the time when riding a bike. How best can the nurse assure that this outcome is achieved? a. Teach the class outside. b. Limit the time for each teaching session. c. Involve the family in the planning. d. Refer the family to safety websites.

C After formulating a nursing diagnosis, an individualized plan for communication or teaching should be constructed. The plan should detail not only what is to be communicated or learned but also the methods to accomplish this and how it can be evaluated. The most effective way to ensure the expected outcomes are achieved is to ask the child or family to join in the planning. The nurse should make sure the outcomes are concrete and measurable. Teaching the class outside or with the helmet would be appropriate only if this was written in the teaching plan. The family may be referred to safety websites to help them understand bike safety, but it is not a measurable effect of the child wearing the helmet 100% of the time when on the bike.

The nurse is educating an 8-year-old client newly diagnosed with diabetes mellitus on how to administer insulin. Which finding indicates the nurse's education was successful? a. The parents of the child demonstrate good technique in administering insulin to their child. b. The child lists five foods to ingest when determining that blood glucose levels are too low. c. The child demonstrates good technique in self-injection of insulin. d. The child is able to draw the correct amount of insulin up in the syringe.

C As a final step of communication or teaching, what was communicated or learned must be evaluated. A new plan may need to be developed and teaching continued if communication or learning was less than optimal. An example of an outcome criterion is the child demonstrates good technique in self-injection of insulin. Having the child draw up the correct amount of insulin is needed, but does not indicate the client is able to self-administer insulin. The purpose of the education is to have the child, not the parents, develop skills to provide self-care. Learning about foods for hypoglycemia is a seperate topic than self-administration of insulin.

After teaching a class of nursing students about acquired immunodeficiency, the instructor determines that the teaching was effective when the students identify what as a contributing factor? Select all that apply.

Cancer Immunosuppressive drugs Malnutrition Factors contributing to secondary (acquired) immunodeficiency include severe systemic infection, cancer, renal disease, radiation therapy, severe stress, malnutrition, immunosuppressive therapy, and aging.

The nurse is educating the family of a 2-year-old boy with bronchiolitis about the disorder and its treatment. The family parents speak only Chinese. Which action, involving an interpreter, can jeopardize the family's trust? a. Using an older sibling to communicate with the parents b. Using a person who is not a professional interpreter c. Asking the interpreter questions not meant for the family d. Allowing too little appointment time for the translation

C Asking questions or having private conversations with the interpreter may make the family uncomfortable and destroy the child/nurse relationship. Translation takes longer than a same-language appointment, and must be considered so that the family is not rushed. Using a nonprofessional runs the risk that they won't be able to adequately translate medical terminology. Using an older sibling can upset the family relationships or cause legal problems.

A 7-year-old child who has recently immigrated with his family is brought to the school nurse because he refuses to eat lunch. Which response should the nurse prioritize? a. Eat lunch with the child. b. Discuss the situation with the child. c. Investigate for potential cultural issues. d. Refer the family to a nutritionist.

C Culture influences the family's health beliefs. A newly immigrated family may have attitudes toward food that are culturally founded. The nurse should seek to clarify the cultural food influences of the family and the needs of this child. Discussing the issue with the parents may be an option if the nurse is unable to detect a possible cultural connection by talking with the child. Referring the family to a nutritionist would be inappropriate.

A nurse is working with a 13-year-old girl who continually demands cups of water or juice, specific foods, and constant changes to her bed position. How should the nurse respond to this client? a. Scolding her for her demanding attitude b. Informing the girl's mother of her demanding attitude c. Graciously meeting all of her requests, within reason d. Withdrawing from the room to evade the constant demands

C Demanding behavior generally stems from insecurity or fear. Give more of yourself, not less, to counteract this response. When you have proven you are dependably there for them, children do not feel so insecure, and the need to be demanding usually fades. Withdrawing from them has the opposite effect if it increases the child's insecurity and the demanding behavior. Ask, "Is there anything else I can do for you?" not, "Haven't I already done enough?" Scolding the girl or informing her mother will not address the girl's underlying insecurity.

The nurse is assessing the learning needs of the parents of 5-year-old girl who is scheduled for surgery. Which nonverbal cue should the nurse use to show interest in what the family members are saying? a. Sit straight with feet flat on the floor b. Look at child when the father is talking c. Nod head while the mother speaks d. Stand several steps away from parents

C Nodding the head while the other person speaks indicates interest in what they are saying. When children and parents feel they are being heard, it builds trust. Sitting straight with feet flat on the floor, looking away from the speaker, and keeping distance from the family may send a message of disinterest.

A preschool child fell off a tricycle and broke an arm that will require surgical repair. The nurse wants to prepare the child for surgery. Which is the best technique the nurse could use to teach the child about what to expect? a. coloring b. games c. dolls d. demonstration

C Teaching preschool children about what to expect from a hospital experience is often taught using a series of puppets or dolls to represent different hospital personnel such as the surgeon, a nurse, and a nurse's assistant. Preschool children are particularly receptive to puppets and dolls because, with their imagination at its peak, they believe the puppet or doll is actually talking to them. Children can practice giving the doll "shots" or submitting it to procedures they will experience. Coloring, games, and demonstration can be helpful in many situations, but dolls allow the child to have a hands-on learning experience.

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. Provide written materials to reinforce teaching. b. Ask the adolescent if the teaching was understood. c. Request that the adolescent teach the information to the nurse. d. Provide an opportunity for the adolescent to ask questions.

C 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 nurse is preparing to teach an 8-year-old child recently diagnosed with diabetes how to give an insulin injection. Which is the best technique for the nurse to use? a. video b. role modeling c. demonstration d. coloring book about diabetes

C The purpose of demonstration is to show how the procedure actually is done. Having to imagine steps is little different than reading about them. School-aged children, because of their stage of cognitive development (concrete operations), learn best by demonstration. Watching a video is a good teaching strategy to show the process but it does not have the "real" syringe and vial the child can see and touch. Once the demonstration is complete the child should be allowed to return the demonstration and/or have time to practice with the nurse's assistance.

Which is most likely to encourage parents to talk about their feelings related to the poor prognosis their child has been given? a. being sympathetic b. using direct questions c. using open-ended questions d. avoiding periods of silence

C Therapeutic communication is an interaction between two people that is planned, deliberate, has structure, and is helpful and constructive. Using open-ended questions is an example of a therapeutic communication technique. Nurses should demonstrate empathy to clients, not sympathy. Empathy is the ability to put yourself in another person's place and understand and be sensitive to the feelings of another. Direct questioning is a nontherapeutic form of communication and requires only yes or no answers. In instances where there is no cure for the child, if the nurse practices therapeutic communication the nurse still has the ability offer support by the words used or nonverbal communication such as touch. In perspective, these are the most valued, most appreciated, and most helpful aspects of care.

The nurse is providing anticipatory guidance to the parents of an 18-month-old girl. Which recommendation should be the most helpful to the parents? a) Giving the child time out for 1 ½ minute b) Ignoring bad behavior and praising good behavior c) Describing proper behavior when she misbehaves d) Slapping her hand using one or two fingers

Describing proper behavior when she misbehaves

The father of a child hospitalized after a fire questions the use of therapeutic play. He reports he does not understand the purpose. What information can be provided to him? a. Playing provides the child with a way to expend some energy during the hospitalization. b. All children like to play. c. This type of play gives the child an outlet to deal with stress. d. Therapeutic play lets the nursing staff observe the child's developmental level.

C Therapeutic play (type of play that provides an emotional outlet or improves the child's ability to cope with the stress of illness and hospitalization), and education to help the child and family understand the reason for the hospitalization and the necessary tests and procedures.

A nurse is preparing to administer medication to a preschooler. What can the nurse do to ensure communication with the child is effective? a. Show the child a video about medication administration. b. Allow the child to determine if he or she wants to take the medication at that time. c. Allow the child to choose between juice, water, or soda to take the medication. d. Use medical terminology when discussing the medication with the child.

C When a child is ill and medication is needed to be administered the child should not have a choice in the timing or even if the child wants to or does not want to take the medication. The medication is administeresed for the benefit of the child. The preschooler does, however, have choices in the matter. The preschooler can choose how he or she wants to take the medicine, that is, in a medicine cup or through a syringe, if the child wants to squirt the medicine by oneself with nursing support or what type of liquid the child would like the medication mixed with. Showing a preschooler a video does not accomplish the education, because a preschooler sees the person on the screen separate from oneself. The nurse should always speak to the child in words the child can understand.

The nurse has applied a restraint to the child's right wrist to prevent the child from pulling out an intravenous line. Which assessment findings ensure that there is proper circulation to the child's right arm? Select all that apply.

Capillary refill is less than 2 seconds in upper extremities bilaterally Fingers are pink and warm bilaterally Radial pulses are easily palpable bilaterally It is important to assess the child's peripheral vascular circulation especially when the child has a restraint placed on an extremity. Capillary refill, color, temperature, and pulses are appropriate to assess to ensure that the child's peripheral vascular circulation has not been compromised. pg 326

The nurse is listing physiologic indicators of pain in children while teaching a pain management class for peers. Which of the indicators will be included? Select all that apply.

Change in blood pressure Oxygen saturation level Palmar sweating A change is blood pressure, oxygen saturations, and palmar sweating are physiologic indicators. Facial expression and body movements are behavioral indicators. However, all are important signs to consider in assessing children's pain. pg 412

The nurse is caring for a child with an ileostomy. What nursing intervention will be included in this child's plan of care?

Check for leakage around the stoma. An ileostomy is made by bringing a part of the small intestine through the abdominal wall to create an outlet for fecal material. The drainage from the ileostomy contains digestive enzymes, so the stoma must be fitted with a collection device to prevent skin irritation and breakdown. A colostomy is a similar opening in the colon that allows fecal material to be eliminated. A new colostomy may be left open to the air; alternatively a bag, pouch, or other appliance may be used to collect the stool. A urostomy may be created to help in the elimination of urine. Ostomy bags should be checked for leakage, emptied frequently, and changed when needed. pg 399

Choose the options that will assist nurses in overcoming some of the barriers to having children fully immunized. Select all that apply.

Checking the immunization status of siblings who accompany the child who has the healthcare appointment Using every health contact with the child (hospital, urgent care, emergency, and well-child visits) to check status/administer vaccines Using combination vaccines to reduce the number of injections children receive Checking the status of siblings and using all contacts to immunize children plus employing combination vaccines all assist in improving the immunization status of children. Using separate vaccines to improve understanding and parental record keeping is not substantiated. Postponing immunizations may result in immunizations not given or being improperly spaced. Some experts say, however, that a partially immunized child is safer than one unimmunized, so getting some vaccines and not others may be a realistic compromise with certain parents. pg 262

The school nurse is providing nutritional guidance to a 9th-grade health class. Which foods should the nurse recommend as good sources for calcium?

Cheese, yogurt, and white beans

A teenage girl asks why chemotherapy causes hair loss. Which response by the nurse is accurate?

Chemotherapy affects cancer cells and normal cells that multiply rapidly. Chemotherapy is cytotoxic to rapidly proliferating cells---malignant or normal. Normal cells that turn over rapidly include those of bone marrow, hair, and mucous membranes. The other responses are not accurate.

The nurse is reviewing the laboratory test results of several children who have come to the clinic for evaluation. Which child would the nurse identify as having the least risk for hyperlipidemia?

Child A with a total cholesterol of 150 mg/dL and low-density lipoprotein (LDL) of 80 mg/dL. Total cholesterol levels below 170 mg/dL and LDL levels less than 100 mg/dL are considered within the acceptable range. Total cholesterol levels between 170 and 199 mg/dL and LDL levels between 100 and 129 mg/dL are considered borderline. Total cholesterol levels between 170 and 199 mg/dL and LDL levels between 100 and 129 mg/dL are considered borderline. Total cholesterol levels greater than or equal to 200 mg/dL and LDL levels greater than or equal to 130 mg/dL are considered elevated and place this child at greatest risk

When a child is scheduled for a cardiac catheterization, an important health teaching point for parents is that the:

Child will return with a bulky pressure dressing over the catheter insertion area. Cardiac catheterization is typically performed with the child awake but using conscious sedation. A dressing will be placed on the catheter insertion site

The nurse is presenting an inservice training to a group of pediatric nurses on the topic of play. After discussing various types of play, the following examples are given. Which is the best example of parallel play? a) Children are playing in an organized group with each other b) Children are playing apart from others without being part of a group c) Children are playing together in an activity without organization d) Children are playing independently and are side by side

Children are playing independently and are side by side

The nurse is talking to the parents of an 2-month-old infant who has been admitted to the hospital with sepsis. The parents report being confused since their older children also had the flu but they recovered without incident. What information can the nurse provide to the parents?

Children this young do not have mature immune systems to fight infection. Sepsis can affect any age group but infants less than 3 months of age have a higher risk. Neonates and young infants have a higher susceptibility due to their immature immune system, inability to localize infections, and lack of immunoglobulin M (IgM), which is necessary to protect against bacterial infections.

A nursing student compares and contrasts childhood and adult cancers. Which statement does so accurately?

Children's cancers, unlike those of adults, often are detected accidentally, not through screening. Children's cancers are often found during a routine checkup, following an injury, or when symptoms appear---not through screening procedures or other specific detection practices. A very small percentage of children may be followed closely because they are known to be at high risk genetically. Most children's cancers are highly responsive to therapy. Few prevention strategies are available for children, although many are known to be effective for adults. Several lifestyle and environmental influences regarding children's cancers are suspect, but few have been scientifically documented. The reverse is true in the adult population.

A nurse is working to provide health promotion services throughout the community. What institutions or organizations best serve as important avenues for disseminating health promotion information? Select all that apply.

Churches, synagogues, and mosques Schools (public and private) Day care centers Religious groups value health and often have a health committee or parish nurse who can participate in a community-wide health promotion effort. Schools teach health in their classrooms and have health promotion activities for students and employees through things such as nutrition and exercise programs. Day care centers work to promote health through the programs developed for their enrollees and parents. Many families can be reached through these venues. Political organizations and environmental groups may well have health-promoting functions, but these are likely to be narrower in focus and directed toward a particular constituent base. pg 263

The nurse is preparing to administer a PO medication to a 6-year-old in the hospital for an exacerbation of asthma. The nurse notes that the child is due for an oral dose of Prevacid in one hour. What is the most important action for the nurse to take before administering this medication to the client?

Clarify the order, since there is no apparent link between the client's diagnosis and the medication. There is no clear link between this client's diagnosis and the Prevacid administration. The nurse should clarify a medication order that does not have a clear link to the client's diagnosis before giving the medication. Asking the mother how she usually gives the medication is a good idea; however, it is not the priority nursing action in this scenario. Parental permission is not required to administer this medication. Consent to treat is signed upon admission to the hospital.

The nurse is caring for a 7-year-old with a low-profile gastrostomy tube placed 6 months ago. Which is the priority intervention to prevent irritation of the skin at the insertion site?

Cleaning the surrounding skin with soap and water daily plus keeping the area dry Daily cleansing with soap and water and keeping the area dry are essential. Moisture can create irritation and encourage the growth of organisms in the warm, moist climate created. Alcohol can sting if used on the area plus remove protective skin oils, promoting excess drying, which can lead to skin breakdown. Cleaning under the bumper or disc with hydrogen peroxide is not recommended because it is irritating and damaging to skin cells. Rotating the gastrostomy tube or button daily is important to prevent adherence in the tract, but keeping the skin clean and dry is the priority. pg 399

The nurse is reviewing the care plan and records of a 14-year-old on the oncology unit who is receiving narcotic pain medication. The client normally has a bowel movement on a daily basis. For the nursing diagnosis "Risk for constipation related to potential adverse effects of narcotic analgesic agents," what would be the best goal?

Client will have a soft, formed bowel movement daily Since the client's normal bowel pattern is daily, the most measurable goal describes the characteristics of normal stools on a daily basis. The other options are not measurable, making it impossible to measure during the evaluation phase of the nursing process.

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?

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. page 424

Parents bring a toddler age 19 months to the clinic for a regular checkup. When palpating the toddler's fontanels, what should the nurse expect to find?

Closed anterior and posterior fontanels By age 18 months, the anterior and posterior fontanels should be closed. The diamond-shaped anterior fontanel normally closes between ages 9 and 18 months. The triangular posterior fontanel normally closes between ages 2 and 3 months. Page 293

An injured child has been hospitalized. The physician orders an application to help constrict capillaries and therefore reduce capillary permeability and edema. Which does the nurse apply to the child?

Cold pack Cold reduces pain by constricting the capillaries and therefore reducing vessel permeability, edema, and pressure at an injured site.

The nurse is caring for a family and their internationally adopted child. The parents indicate the child was adopted and brought to the United States 7 days ago. What recommendation would the nurse give the family?

Complete a comprehensive health screening within the next week When a child is adopted internationally, it is recommended the child have a health screening within the first few weeks of coming to the United States. The child should be screened for Hepatitis after arrival to the US due to unreliable testing methods in their home country. The child's medical record should be undated with each visit. Vaccines are not postponed for mild respiratory illnesses or low grade fevers

A child is diagnosed with an enterovirus infection. Which type of infection control precaution would be most important for the nurse to use?

Contact For the child with an enterovirus infection, contact precautions are used during the illness. Standard precautions are followed at all times and are appropriate for any child. Droplet precautions would be used for a child infected with pertussis. Airborne precautions would be indicated for the child with varicella.

A nursing instructor is teaching the students about the standard and transmission-based precautions. What type of precautions require placing a client in an isolated room with limited access, wearing gloves during contact with the client and all body fluids or contaminated items, wearing two layers of protective clothing, and avoiding sharing equipment between clients?

Contact precautions Contact precautions means placing the client in an isolation room with limited access, wearing gloves during contact with the client and all body fluids, wearing two layers of protective clothing, limiting movement of the client from the room, and avoiding sharing equipment between clients.

The nurse is caring for a 7-year-old post-op child who is reporting an 8 out of 10 on a pain intensity scale. The child's mother is requesting pain medication. The child received ibuprofen three hours ago. What is the correct nursing action?

Contact the physician and request an opioid pain medication. The nurse must advocate for the child. Advocacy may involve convincing a parent that opioids are appropriate for the situation or consulting with the prescriber regarding an ineffective medication regimen. Explaining to the mother that the child cannot receive any more pain medication is ineffective and does not advocate for the child in pain. Turning on the television is not a bad idea; however, it is not the priority. It is not appropriate to apologize. The nurse can do something. Contacting the physician to request more medication is in the nurse's power. pg 434

The nurse is caring for a child with an intravenous device in his hand. Which sign would alert the nurse that infiltration is occurring?

Cool, puffy skin Signs of infiltration included cool, puffy, or blanched skin. Warmth, redness, induration, and tender skin are signs of inflammation. pg 393

A child needs a peripheral IV start as well as a venous blood sample for a laboratory test. The nurse will take what action?

Coordinate placing the peripheral IV and the lab blood draw. Coordinate the IV placement and lab blood draw to minimize the number of venipunctures for the child. Gaining venous access for each purpose separately does not do this and is not necessary. Having a well-hydrated child makes venous access easier, but oral hydration will take some time, thus delaying needed treatment. pg 390

The nurse is assessing a child with a complex medical history that includes fatigue, Raynaud phenomenon, anemia and photosensitivity. The nurse should anticipate that this child may require which treatment?

Corticosteroid therapy This child's symptoms are consistent with systemic lupus erythematosus (SLE), which is usually treated with corticosteroids. Antiretrovirals, IVIG and phototherapy are of no benefit in the treatment of SLE.

The nurse is preparing to assess the respiratory rate of a crying 15-month-old boy. To get the most accurate assessment, what approach should the nurse take?

Count after the child stops crying and is comfortable. Respirations should be assessed when the child is resting or sitting quietly because respiratory rate changes significantly when children cry, eat, or become more active. They also breathe more rapidly when anxious or frightened. Counting respirations for a full minute assures accuracy. Infants' respirations are primarily diaphragmatic; therefore, counting abdominal movements promotes accuracy. Placing a stethoscope to count respirations tends to be seen as invasive by a toddler and will result in movement away or an increase in respirations. page 283

A 10-year-old in renal failure is on continuous ambulatory peritoneal dialysis (CAPD). What would it be important to teach his parents?

Cramping should not occur with an infusion. Continuous ambulatory peritoneal dialysis should not cause discomfort. The return flow should be clear; cloudy return flow suggests infection.

The nurse is performing an assessment on a teen's clavicle strength. The teen is asked to shrug and raise their shoulders while the nurse applies gentle pressure to them. When documenting the findings, this should be identified as an assessment of which cranial nerve?

Cranial nerve XI Test shoulder strength and the function of cranial nerve XI in the older child by requesting that the child shrug the shoulders while you apply downward pressure. Cranial nerve VII is responsible for the tongue and facial movements. Cranial nerve IX is responsible for swallowing and salivation. Cranial nerve X is responsible for speech and swallowing. Page 306

A child is being evaluated for renal and urinary tract disease. What would the nurse expect to be ordered to evaluate the child's glomerular filtration rate?

Creatinine clearance rate The glomerular filtration rate is measured by creatinine clearance rate, or the amount of creatinine excreted in 24 hours as determined by a 24-hour urine sample along with a venous blood sample and compared with the urine findings. Urinalysis provides general information about kidney function. A kidneys, ureters, and bladder x-ray provides information about the size and contour of the kidneys. A computed tomography reveals the size and density of kidney structures and adequacy of urine flow.

The nurse is caring for an 18-month-old boy hospitalized with a gastrointestinal disorder. The nurse knows that the child is at risk for separation anxiety. The nurse watches for behaviors that indicate the first phase of separation anxiety. For which behavior should the nurse watch?

Crying and acting out Children in the first phase, protest, react aggressively to this separation, and reject others who attempt to comfort the child. The other behaviors are indicators of the second phase, despair.

The nurse is performing double diapering for a male infant with hypospadias who has undergone a surgical repair. The nurse performs the following steps. Place the steps in the order in which the nurse performs them.

Cuts a hole in the front of the smaller diaper Unfolds both diapers, placing smaller diaper inside larger diaper Places both diapers under the infant Brings the penis and catheter/stent through the hole in the smaller diaper Closes the smaller diaper Closes the larger diaper When performing double diapering, the nurse cuts a hole or a cross-shaped slit in the front of the smaller diaper and then unfolds both diapers, placing the smaller diaper (with the hole) inside the larger one. Next, the nurse places both diapers under the child and carefully brings the penis (if applicable) and catheter/stent through the hole in the smaller diaper, closing the diaper. Finally, the nurse closes the larger diaper, making sure the tip of the catheter/stent is inside the larger diaper.

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. Reassure the parents that they have been fully briefed on their child's treatment. b. Notify the health care provider that the parents still have questions. c. Encourage the parents to focus their attention on their child. d. Answer the parents' questions as completely as possible.

D 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.

A nurse manager on a pediatric unit is making assignments for the day. The nurse's goals are atraumatic care for pediatric clients and minimizing parent-child separation. What method of care delivery should the nurse implement? a. Assign an unlicensed assistive personnel to care for the child to give the parents a break. b. Assign a team of nurses and unlicense assitive personnel. c. Assign a medication nurse and a primary nurse. d. Assign a core primary nurse.

D Family-centered care is the gold standard for pediatric nursing. It decreases anxiety for both the parent and the child, recovery times are shortened and pain management is enhanced. When a primary nurse is assigned to the child and family, they have an identifiable source to help meet their needs. Oftentimes when more than one person is providing care, effective communication is lost. The family is the primary source for the child and they should not be separated. Having a medication nurse and a primary nurses tends to fragment care. The unlicensed assistive personnel can provide basic care for the child, but the parents to be offered to communicate how much involvement they wish in their child's care.

The nurse is preparing a hospitalized child for a lumbar puncture. The health care provider states the procedure will be performed in the child's hospital room. To advocate for the child, what should the nurse inform the health care provider? a. "We will have to have the parents hold the child down because there is not enough assistance on the floor." b. "The parents want to be present during the procedure, and I informed them that this is not the policy of our facility." c. "I will prepare the hospital room for the child, because that room is where the child will feel most comfortable." d. "I will have the procedure prepared in the treatment room, so that the child may view the hospital room as safe and secure."

D In the hospital, all invasive procedures should be performed in the treatment room or a room other than the child's room. The child's room should remain a safe and secure area. The lumbar puncture requires special positioning and holding. This should be done by the nurse and not the parents. The decision to have the parents watch the procedure is up to the health care provider and/or hospital policy. If the parents observe the procedure, they need education prior to the procedure about what to expect.

A nurse is assigned to care for a 6-month-old infant hospitalized with diarrhea and dehydration. Because the infant does not have developed speech, what can the nurse do to communicate with the infant? a. Use a stuffed animal to tell a story. b. Write on a whiteboard. c. Use puppets to communicate with the infant. d. Sing to the infant.

D Infants primarily communicate through touch, sight, and hearing. Communication can occur through cuddling, holding, rocking, and singing to the infant. The child cannot read, so writing on the whiteboard would be beneficial only for the parents. A 6-month-old infant uses toys as developmental tools, not communication tools. The infant may want to snuggle with the stuffed animal while the nurse tells the story or sings.

The registered nurse (RN) and licensed practical nurse (LPN) are caring for a adolescent clients. The RN will intervene if the LPN is seen in which situation while caring for a client? a. Actively listening to the client while maintaining a relaxed, open body posture b. Speaking to the client while the caregivers listen and observe c. Asking open-ended questions when talking to the client d. Using medical terminology to answer the client's questions

D The RN will intervene when the LPN uses medical terminology to answer the client's questions. Terminology should be used that the client can easily understand. It is appropriate for the LPN to actively listen, speak to the client, and ask open ended questions.

A parent calls the pediatric clinic and tells the nurse "I think my child is having a sickle cell crisis. Should I bring the child to the office?" What is the nurse's best response? a. "Take your child to the emergency department now." b. "Call 911 and give the child some water while you wait." c. "What makes you think your child is in crisis?" d. "Tell me about the symptoms your child is experiencing"

D The best response is for the nurse to ask about the symptoms the child has, which will help confirm that the child is in crisis. Once the nurse is sure that the child is in crisis, the parent can be advised to take the child to the emergency department or to call 911. Giving the child water may not be appropriate depending on the child's level of consciousness. Asking the parent what makes him or her think the child is in crisis may not elicit the needed information right away. Asking specifically about the child's symptoms is more to the point.

The nurse is teaching the parents of a newborn with a metabolic problem about the disorder and its treatment. What is the leasteffective teaching technique? a.Explain the disorder in common terms b.Discuss how to handle a possible emergency situation c. Use the USDAs "MyPlate" diagram to teach necessary nutrition alterations d. Provide literature for the parent to read and then have them ask questions

D The parents may not understand the literature based on their reading level or ability, their understanding of terms, or their own overall literacy. They may not ask questions for all of the former reasons or to avoid appearing "dumb." The other techniques should provide support by using "lay" words, exchanging ideas (discussion) regarding managing an emergency, and using a common visual symbol (USDAs "MyPlate") to teach about nutrition.

The nurse is caring for a child who appears fearful and is reluctant to talk. The nurse uses therapeutic communication skills to interact with the child. What initial goal does the nurse accomplish when using these skills to communicate with the child? a. Inform the child of priority problems. b. Assist the child to control emotions. c. Provide a plan of action. d. Assess the perception of the problem.

D Therapeutic communication is an interaction between two people that is planned (e.g., the nurse deliberately intends to determine how a child truly feels), has structure (e.g., the nurse uses specific wording techniques that will encourage a truthful response) and is helpful and constructive (e.g., at the end of the exchange the nurse will know more about the child than in the beginning and ideally the child will know more about a particular problem or concern). The initial goal in working with this child is to determine the child's perception of the problem. Once that is accomplished, the nurse can develop a plan of care to identify priority problems and help the child deal with the fear.

The nurse is preparing to administer a diphtheria, tetanus and pertussis vaccine to a 3-year-old child. Which version of the formulation of the vaccine should be administered?

DTaP The vaccine currently used for children younger than age 7 is diphtheria, tetanus, acellular pertussis (DTaP). The older version of this vaccine was DPT. Diphtheria and tetanus (DT) vaccine is used for children younger than age 7 who have contraindications to pertussis immunization. The TdaP is used clients over the age of 7. pg 251

A nurse is assessing the pain level of an infant. Which finding is not a typical physiologic indicator of pain?

Decreased heart rate Decreased heart rate is not a physiologic response to pain. Instead, infants demonstrate an increased heart rate, usually averaging approximately 10 beats per minute with possible bradycardia in preterm newborns. Decreased oxygen saturation and palmar and plantar sweating are common physiologic responses to pain in the infant.

While awaiting an appointment at the doctor's office for his 20-month-old daughter, a young father is astonished to see his daughter assume a proper stance and swing a toy golf club in the play area of the waiting room. A nurse also observes the behavior, and the father recalls that his daughter saw him practicing his golf swing in their back yard a few days ago. The nurse explains that this is an instance of which of the following? a) Autonomy b) Parallel play c) Deferred imitation d) Assimilation

Deferred imitation

The mother of a 2-year-old tells you she is constantly scolding him for having wet pants. She says her son was trained at 12 months, but since he started to walk, he wets all the time. Which nursing diagnosis would be most applicable? a) Total urinary incontinence related to delayed toilet training b) Excess fluid volume related to inability to control urination c) Deficient parental knowledge related to inappropriate method for toilet training d) Ineffective coping related to lack of self-control of 2-year old

Deficient parental knowledge related to inappropriate method for toilet training

A nurse is developing a plan of care for a 4-year-old client with cystic fibrosis who has frequent hospitalizations related to his illness. Which would be the most appropriate nursing diagnosis for this client?

Delayed growth and development related to frequent illness

A parent is asking how she can help her son deal with the peer ridicule at school in regards to enuresis. What is the best response by the nurse?

Demonstrate love and acceptance at home. Demonstrating love and acceptance at home will help counteract the ridicule the child is getting at school.

Parents report that their 4-year-old is difficult to understand. Which screening tool will the nurse use?

Denver Articulation Screening The nurse would administer the Denver Articulation Screening. It is given to children 2½ to 7 years of age to detect differences in speech sounds beyond those considered normal. It is standardized, is easy to administer in a brief time, and is meant for English speakers only. Those who score below their age group norms should be retested within 2 weeks and referred for complete language testing if the repeat examination is abnormal. The Denver II includes a language category but is not an articulation screening test. Goodenough-Harris and Bayley are tests of intelligence that do not evaluate speech sounds. page 242

When working in a very busy pediatric office or clinic, nurses could substitute which screening test for the Denver II Developmental Screening Test to detect delays that otherwise could be missed?

Denver Prescreening Developmental Questionnaire (R-PDQ) The Denver Prescreening Developmental Questionnaire serves as a parental report of items on the Denver II. It is designed to identify children for whom follow-up with a complete Denver II Developmental Screening Test is needed. It is useful for practices with little time to conduct the full Denver II for all infants and young children. The Bayley Scale and the Goodenough-Harris Test focus mainly on intelligence testing and require special training to administer and score. The Denver Articulation Screening is designed to assess early speech development. pg 242

A child is scheduled for a urea breath test. The nurse understands that this test is being performed for which reason?

Detect Helicobacter pylori Urea breath test is used to detect the presence of H. pylori in the exhaled breath. This test does not evaluate gastric pH. Serum amylase and lipase levels are used to confirm pancreatitis. Esophageal manometry is used to evaluate esophageal contractile activity and effectiveness

The nurse is caring for a preoperative pediatric client. What would it be best for the nurse to do with this client?

Determine how much the child knows and is capable of understanding.

The nurse is caring for a preoperative pediatric client. What would it be best for the nurse to do with this client?

Determine how much the child knows and is capable of understanding. The nurse must determine how much the child knows and is capable of learning in order to best prepare the child for surgery. Keeping terminology at the child's and caregivers' level of understanding is important when doing teaching. page 323

The nurse is caring for a 2-year-old boy who needs a lumbar puncture. His mother is present. What would prevent informed consent from being obtained?

Determining the mother cannot read the form It would not be legal for this mother to give consent. A mother younger than 18 years of age or never married may not be a problem in most states because she would be considered autonomous. The physician or nurse could read the consent form to a mother who cannot read plus carefully explain the medical information in terms she understood.

Infant development is best described by which statement?

Development proceeds cephalocaudally. Growth and development both proceed from head to toe, or in a cephalocaudal sequence.

The nurse working in pediatrics is aware of the special needs of children related to pain assessment. What is the highest priority for the nurse to consider when completing a pain assessment?

Developmental age of child While all of the options are important for assessing pain in children, the highest priority to provide an appropriate pain assessment is knowing the developmental age of the child. The chronological and developmental ages may differ and care needs to be based on both, but the type of pain assessment tool used will be based on the developmental age. pg 412

A child with primary immune deficiency is about to receive an infusion of IVIG. What is the most appropriate premedication to minimize the reaction?

Diphenhydramine Diphenhydramine and acetaminophen are the most commonly used medications for this purpose. Nonsteroidals and steroids typically are not used for this indication.

The nurse is preparing to administer IVIG to a child who has not received the medication before. What medication should the nurse expect to administer prior to the infusion?

Diphenhydramine Premedication with diphenhydramine or acetaminophen may be indicated in children who have never received IVIG, have not had an infusion in more than 8 weeks, have had a recent bacterial infection, have a history of serious infusion-related adverse reactions, or are diagnosed with agammaglobulinemia or hypogammaglobulinemia. Aspirin, ibuprofen and prednisone would not routinely be administered prior to IVIG.

The nurse is caring for a child who is receiving an intravenous immunoglobulin treatment. The client calls the nurse and reports she vomited. What action should be completed first?

Discontinue the infusion. Clients receiving intravenous immunoglobulin are at risk for anaphylaxis. Vomiting can signal an allergic response. The first action would be to stop the infusion. The remaining activities are appropriate for inclusion in the plan of care but are not of the highest priority.

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?

Encourage the child to participate in planning her daily care.

A toddler requires 1.5 mL (.05 oz) of an antibiotic given intramuscularly (IM). How will the nurse administer this medication?

Divide the dose. Administer 0.75 mL (0.25 oz) IM in each vastus lateralis. The recommended amount of solution a toddler should receive in one IM injection should not exceed 1 mL (0.33 oz). Dividing the dose is necessary even though two injections will cause additional stress. These could be given simultaneously by two nurses. Seeking an oral route could be explored, but may not be feasible. The manufacturer's directions regarding the amount of diluent should be followed to ensure safety. pg 384

The 4-year-old due for the DTaP, IVP, MMR, and varicella vaccines has a runny nose, slight cough, and temperature of 99° F (37.2° C). What should be the response of the nurse?

Do the well-child exam and give the immunizations due. The well-child exam can proceed and all the immunizations can be given. The child is not at risk for adverse reactions because she has an upper respiratory infection and very slightly elevated temperature. The child is also not at risk for not developing the proper immune response. Slight fever and minor respiratory illness should not postpone immunizations. Those postponed are at risk for not being received. There is no reason to give some of the immunizations and not others (MMR). pg 251

The nurse is examining the back and spinal area of a 14-year-old female. A small dimple is noted. What action is most appropriate?

Document the finding as normal. A normal pilonidal dimple is sometimes seen at the base of the spine. This finding should be documented. There is no additional study or evaluation of this area indicated at this time. Muscle weakness and asymmetry are not associated with the presence of the dimple, which is benign. Page 306

During a routine physical examination of a 13-year-old female, the nurse notes the presence of a tender nodule just below the nipple on her right breast. Which action by the nurse is indicated?

Document the finding as normal. Adolescent females may have a tender nodule beneath the nipple. This signals the onset of puberty. page 300

During a routine physical examination of a 13 year old female the nurse notes the presence of a tender nodule just below the nipple on her right breast. Which action by the nurse is indicated?

Document the finding as normal. Adolescent females may have a tender nodule beneath the nipple. This signals the onset of puberty. Page 300

The nurse is assessing the 10-month-old infant. The nurse notes the anterior fontanel has closed. What initial action by the nurse is indicated?

Document the findings as normal. The anterior fontanel most often closes between 12 and 18 months of age. It may normally close as early as 9 months of age. The closure of the fontanel at 10 months of age, while somewhat early, does not signal any health issues for the infant.

The nurse is caring for a child admitted with gastroesophageal reflux (GER). Which clinical manifestation would likely be seen in this child?

Effortless vomiting just after the child has eaten : Almost immediately after feeding, the child with gastroesophageal reflux vomits the contents of the stomach. The vomiting is effortless, not projectile in nature.

Food allergies have become more and more common in the last few decades. What are some common food allergies of childhood? Select all that apply.

Eggs Peanuts Milk

A nurse is preparing a presentation for a group of new parents and is planning to discuss nutrition during the first year. As part of the presentation, the nurse is planning to address foods that should be avoided to reduce the risk of possible food allergies. Which foods would the nurse most likely include? Select all that apply.

Eggs Shrimp Peanuts Foods that should be avoided in children younger than 1 year of age include cow's milk, eggs, peanuts, tree nuts, sesame seeds, and fish and shellfish (i.e., shrimp). Carrots, potatoes, and bananas are not considered problematic.

The nurse is assessing a child who is experiencing renal complications as a result of lupus. Which finding is of the greatest concern?

Elevated blood pressure Renal complications may result from lupus. This may be accompanied by hypertension making monitoring of blood pressure of the highest importance.

What would best identify foods to which a child is allergic?

Elimination diet Elimination diets involve adding foods slowly to a child's diet so foods to which the child is allergic can be identified.

The nurse is providing health-promotion teaching to a group of parents of preschoolers at a local daycare. What information would the nurse include in this education session? Select all that apply.

Encourage children to select their own clothing to wear each day. Parents will need to supervise tooth-brushing and be responsible for flossing. Treat any toileting accidents in a matter-of-fact manner and assist the child in getting dry

What is the best advice about nutrition for the toddler? 1. Encourage cup drinking and give water between meals and snacks. 2. Encourage unlimited milk intake, because toddlers need the protein for growth. 3. Avoid sugar-sweetened fruit drinks and allow as much natural fruit juice as desired. 4. Allow the toddler unlimited access to the sippy cup to ensure adequate hydration.

Encourage cup drinking and give water between meals and snacks.

The mother of a 10-year-old child diagnosed with rubella asks what can be done to help her child feel better during her illness. What information can be provided?

Encourage rest and relaxation. Rubella infection is usually mild and self-limited. The care given is normally supportive. Rest is encouraged. Medications administered are normally limited to anti-pyretics and analgesics. Antibiotic and antiviral therapies are not normally included in the plan of treatment. Range of motion is not needed as mobility of the client is not limited.

The grandmother of a 1-year-old cancer patient comes to visit the child in the PICU. She sits in a chair near the child's bed but doesn't touch him. Which action by the nurse would be most appropriate?

Encourage the grandmother to rock the child in a rocking chair.

The nurse is caring for a 16-month-old child on the pediatric unit. The child's mother is a single mother who has two other young children at home. She must leave her 16-month-old daughter overnight in the hospital. Which of the following actions by the nurse will be most appropriate in helping the child feel secure and in reassuring this mother? a) Distract the child with a special blanket, stuffed animal, or other "lovey" from home while the mother quietly slips out b) Tell both the mother and child that the child will be carefully guarded and won't be in as much danger as she might be if she were home exploring her environment c) Remind the child and mother that by staying in the hospital now the child will get well and be home again soon, and that the other children also need their mother d) Encourage the mother to give her daughter a personal item of the mother's to hold on to until she returns and to tell the child a specific time she will return such as "when breakfast comes in the morning."

Encourage the mother to give her daughter a personal item of the mother's to hold on to until she returns and to tell the child a specific time she will return such as "when breakfast comes in the morning."

A nursing instructor is reviewing a care plan written by a student on a hospitalized child. Which nursing intervention for the diagnosis of self-care deficit related to regression would the nursing instructor question?

Encourage the parents to do as much self-care for the child as possible.

A nursing instructor is reviewing a care plan written by a student on a hospitalized child. Which nursing intervention for the diagnosis of self-care deficit related to regression would the nursing instructor question?

Encourage the parents to do as much self-care for the child as possible. Appropriate nursing interventions for the diagnosis of self-care deficit related to regression include encouraging the child and family, not just the child, to perform as much self-care as possible. Assessing usual home routines, providing appropriately sized equipment, and encouraging rest periods are all appropriate nursing interventions for this diagnosis.

A nurse is developing a teaching plan for the parents of an 8-year-old experiencing nocturnal enuresis. The nurse determines that additional teaching is needed when the parents identify what as an appropriate measure?

Encouraging fluid intake after dinner In many children, limiting fluids after dinner can be helpful for nocturnal enuresis. Bladder-stretching exercises also can be helpful. If these measures are ineffective, desmopressin may be prescribed. Stress factors may be contributing to the child's problem. Therefore, measures to address stress and promote coping would be appropriate

The nurse is assisting with the administration of the child's initial dose of parenteral opioids. Which action should the nurse take first?

Ensure naloxone is readily available Explanation: When administering parenteral or epidural opioids, the nurse should always have naloxone readily available in order to reverse the opioids effects, should respiratory distress occur. Premedication with acetaminophen is not required with opioids. After administration, the nurse should continually assess for adverse reaction. The nurse should assess bowel sounds for decreased peristalsis after administration. pg 429

The nurse is preparing to administer acetaminophen to a 4-year-old girl to provide comfort to the child. Which precaution is specific to antipyretics?

Ensure proper dose and interval It is very important to ensure that the proper dose is given at the proper interval because an overdose can be toxic to the child. Concerns with allergies and taking the entire, prescribed dose are precautions when administering antibiotics and all medications. Drowsiness is not a side effect of antipyretics.

Morbidity rates among children are most highly associated with which cause?

Environmental factors The factors most commonly associated with child morbidity are environmental and socioeconomic problems. The more difficult the societal issues and the more marked the environmental poverty, the higher the illness rates and childhood morbidity. Firearms, violence in schools, homicide, and suicide are all factors in morbidity, but they are not strictly related to children.

A nurse is caring for an infant whose mother is human immunodeficiency (HIV) positive. The nurse knows that which diagnostic test result will be positive even if the child is not infected with the virus?

Enzyme-linked immunosorbant assay (ELISA) The ELISA test will be positive in infants of HIV-infected mothers because of trans-placentally received antibodies. These antibodies may persist and remain detectable up to 24 months of age, making the ELISA test less accurate in detecting true HIV infection in infants and toddlers than the polymerase chain reaction (PCR). The PCR test is positive in infected infants over the age of 1 month. The erythrocyte sedimentation rate would be ordered for an immune disorder initial workup or ongoing monitoring of autoimmune disease. Immunoglobulin electrophoresis would be ordered to test for immune deficiency and autoimmune disorders.

A group of nursing students are reviewing the functions of white blood cells. The students demonstrate an understanding of the information when they identify which white blood cell as responsible for combating allergic disorders?

Eosinophils Eosinophils function to combat allergic disorders and parasitic infestations. Neutrophils function to combat bacterial infections. Lymphocytes function to combat viral infections. Monocytes function to combat severe infections.

Which diagnostic tool is used to identify children who may have an infection or inflammatory process?

Erythrocyte sedimentation rate (ESR) The ESR is a screening procedure to identify children who may have an infectious or inflammatory process. A blood culture is utilized to confirm sepsis. Gastric lavage is used to identify TB in a child when bronchoscopy cannot be performed.

The nurse is monitoring the labs of a child admitted for an exacerbation of juvenile pauciarticular arthritis. Which lab result does the nurse expect to be elevated?

Erythrocyte sedimentation rate (ESR) The erythrocyte sedimentation rate (ESR) is an indicator of inflammation; it would likely be elevated during an exacerbation of arthritis. Immunoglobulin electrophoresis determines the level of individual immunoglobulins; it would not be elevated in an autoimmune disease. Lymphocyte immunophenotyping T-cell quantification measures T-cells; this would be used to monitor immunosuppressive disorders. The radioallergosorbent test measures minute quantities of IgE in the blood; it is used for asthma and food allergy testing.

The labor and delivery nurse is caring for a mother who has demonstrated polyhydramnios upon delivery. The newborn displays copious, frothy bubbles of mucus in the mouth and nose, as well as drooling. The nurse is concerned that the infant has what disorder?

Esophageal atresia Esophageal atresia refers to a congenitally interrupted esophagus where the proximal and distal ends do not communicate; the upper esophageal segment ends in a blind pouch and the lower segment ends a variable distance above the diaphragm. Polyhydramnios is often the first sign of esophageal atresia because the fetus cannot swallow and absorb amniotic fluid in utero, leading to accumulation. Omphalocele and gastroschisis are congenital anomalies of the anterior abdominal wall. Hiatal hernia involves a weakened diaphragm.

A nurse taking a health history of a newborn notes that there is a maternal history of polyhydramnios. What GI condition might this history precipitate?

Esophageal atresia (EA) A maternal history of polyhydramnios is usually present in one-third of cases of EA and in some cases of tracheoesophageal fistula (TEF).

The nurse is working with a teenage patient. He has relatively straight teeth, but his lower front teeth are slightly crossed over. The nurse suggests to the child's caregiver that an orthodontist see him. What is the reason the nurse might make this suggestion?

Even slight malocclusions make chewing and jaw function less efficient. Dental malocclusion (improper alignment of the teeth) is a common condition that affects the way the teeth and jaws function. Correction of the malocclusion with dental braces improves chewing ability and appearance. Crooked teeth do not lead to more cavities, nor do they lead to infection and tooth loss.

The nurse is performing a physical exam on a 3-year-old boy. What method would the nurse use to perform the exam?

Examine the child's head and work down to the child toes. A preschool or toddler child should be examined starting from their head and working down all the way to their toes for a thorough exam. In infants, the examination starts with the chest, and then proceeds from head to toes. page 280

The nurse administers an antipyretic rectal suppository. The child has a bowel movement 15 minutes later. What is the appropriate nursing action?

Examine the stool for the presence of the suppository. The stool should be examined for the suppository that may have been expelled with the bowel movement. If it is found, the physician or nurse practitioner can be notified to determine if the suppository should be repeated. The nurse should not administer another dose without examining the stool or contacting the physician or nurse practitioner. Rechecking the child's temperature would provide little useful information since only a very limited time has elapsed since the temperature was last checked.

The nurse is performing a health surveillance visit with a 12-year-old boy. Which characteristic suggests the boy has entered adolescence?

Experiences frequent mood changes If the boy has just entered adolescence, he is likely to exhibit frequent mood changes. A growing interest in attracting girls' attention and understanding that actions have consequences are typical of the middle stage of adolescence. Feeling secure with his body image does not occur until late adolescence

The nurse is caring for an infant who was injured in a severe automobile accident. The child experienced several fractures and is in significant pain. The child's mother questions if this will impact her child later in life. What information should be provided by the nurse?

Experiences with pain even in infancy can influence an individual's response to pain later. Repeated exposure to painful procedures and events can have long-term consequences. Memories of pain may be stored in the child's nervous system, influencing later reactions to painful stimuli. pg 414

A client was admitted to the medical unit for exacerbation (flare-up) of symptoms of systemic lupus erythematosis (SLE). When reviewing the client's chart the nurse notices that the he has a "butterfly rash." The nurse will assess for this rash on what area of the client's body?

Face A malar rash (a butterfly-shaped rash over the cheeks) is a common occurrence with SLE

When educating a parent how to support their child while experiencing a painful procedure, what is the best information for the nurse to convey to the parents?

Explain in detail the role of the parent as a coach and emphasize the coping plan. Break down complex procedures into specific steps and reinforce coping strategies for each distinct task. Model, or demonstrate, coping behaviors. Detail parents' coaching role and reinforce the need to emphasize the coping plan, rather than apologizing for the pain. Although parents want to help their children and some are able to act as coaches, the response of the child to pain and stress and to their parents' distraction interventions is highly variable. Some children appear to be soothed by their parents' distraction actions; others appear to become distressed. The parents should be focused on the coping plan, not on the time remaining. pg 426

A 16-year-old girl visits her gynecologist with a complaint of metrorrhagia, or bleeding between menstrual periods, since her last visit 3 months ago. On consulting the client's chart, the nurse learns that she was prescribed an oral contraceptive at her last visit. Which intervention should the nurse implement in this situation?

Explain that breakthrough bleeding is normal during the first 3 or 4 months of oral contraceptive use but that it should go away after that. Metrorrhagia is bleeding between menstrual periods. This may occur in teenagers taking oral contraceptives (breakthrough bleeding) during the first 3 or 4 months of use. If metrorrhagia occurs for more than one menstrual cycle in a teenager who is not taking oral contraceptives (which is not the case here), she be referred to her primary care provider for examination, because abnormal vaginal bleeding is an early sign of uterine or cervical carcinoma or an ovarian cyst. Endometrium ablation, used with premenopausal women to halt metrorrhagia, is not recommended for adolescents. There is no need at this point for the client to change prescriptions, as the bleeding will likely go away in the next month or so as the client's body adapts to the current contraceptive.

The nurse is talking to the mother of a 19-month-old girl about setting limits and supervising activities. In which of the following situations will the nurse recommend letting the child do as she pleases? a) Exploring her body b) Choosing her own foods c) Deciding her bedtime schedule d) Playing on the picnic table

Exploring her body

A nurse is giving a talk to high school students about preventing the spread of human immunodeficiency virus (HIV). What does the nurse identify as ways in which HIV is spread? Select all that apply.

Exposure to blood and body fluids through sexual contact Sharing contaminated needles Transfusion of contaminated blood Perinatally from mother to fetus Through breastfeeding HIV is spread by exposure to blood and other body fluids through sexual contact, sharing of contaminated needles for injection, transfusion of contaminated blood, perinatally from mother to fetus, and through breastfeeding.

The nurse is preparing to assess the pain of a developmentally and cognitively delayed 8-year-old. Which pain rating scales should the nurse choose?

FACES pain rating scale The nurse should select the pain assessment tool that is appropriate for the child's cognitive abilities. The FACES pain rating scale is designed for use with children ages 3 and up. A child with limited reading skills or vocabulary may have difficulty with some of the words listed to describe pain on the word graphic scale. Some of the concepts might be too difficult on the visual analog and numerical scales for a developmentally disabled child. The base age for the Adolescent pediatric pain tool is 8 years, but its use would likely be inappropriate for an 8-year-old with cognitive delays. pg 416

The nurse is caring for a 12-year-old with cerebral palsy who is unable to communicate verbally. Which pain assessment tool is the most appropriate for the nurse to use when assessing pain in this patient?

Face, leg, activity, cry, and consolability (FLACC) descriptor pg 420

A child's pain tolerance refers to the point at which the child first senses pain.

False A child's pain threshold refers to the point at which the child first senses pain. This varies greatly from person to person and is probably most influenced by heredity. All people also have a point above which they are not willing to bear any additional pain. This is a person's pain tolerance. pg 409

Marijuana use has no long-term side effects.

False Long-term side effects of marijuana can include pulmonary disorders such as sinusitis, bronchitis, emphysema, and perhaps lung cancer (which can develop after only 1 year of continual use compared with 20 years of cigarette use), as well as lack of sperm formation or subfertility in males

After assessing a child, the nurse suspects coarctation of the aorta based on a finding of:

Femoral pulse weaker than brachial pulse. A femoral pulse that is weak or absent in comparison to the brachial pulse is associated with coarctation of the aorta. Bounding pulse is characteristic of patent ductus arteriosus or aortic regurgitation. A narrow or thread pulse is associated with heart failure or severe aortic stenosis. Hepatomegaly is a sign of right-sided heart failure.

Place in proper order the vision screening procedures used by the nurse to assess children from neonate to school age.

Fixate on an object at 10 to 12 inches Follow object to midline Follow object past midline Respond to E chart Use Snellen test for visual acuity Neonates should be able to fixate on an object 10 to 12 inches from the face. After fixation, infants should follow to midline. By 2 months, infants follow to 180°. The preschool E chart, sometimes called the "tumbling E," works well for this age group. School-age children who know the alphabet should be given the Snellen test. p 243

A 17-year-old boy chats excitedly with the nurse about his plans for college and a career. He says he has checked out every college in the region and determined which one is the best fit for him and would give him the best career options. The nurse recognizes which developmental aspect in this young man?

Formal operational thought

The parents of a 2-year-old girl are concerned with her behavior. For which behavior would the nurse share their concern? a) Likes to change toys frequently b) Plays by herself even when other children are present c) Frequently babbles to herself when playing d) Refuses to share toys with her sister

Frequently babbles to herself when playing

Noah is an 18-month-old who is brought to the ER with flu-like symptoms. He is diagnosed with pneumonia secondary to aspiration of stomach contents. The nurse explains to the parents that pneumonia is a condition that often occurs secondary to:

Gastroesophageal reflux disease. The child with gastroesophageal reflux disease may present with the physical findings of pneumonia secondary to aspiration of refluxed stomach contents.

Which nursing intervention demonstrates proper use of cutaneous stimulation to relieve pain with pediatric clients?

Gently massaging a preterm infant's leg for two minutes prior to obtaining a blood sample from a heel stick Gentle massage of the leg for two minutes prior to heel stick may decrease pain response in preterm infants. Use of heat or cold therapy is contraindicated in infants, who are more prone to thermal injuries. Ice packs should not be used for longer than 15 minutes at a time. Heat is most effective in relieving pain from inflammation and spasm.

The nurse finds the diet of a 30-month-old girl to be low in calcium. What suggestion can significantly increase this toddler's calcium intake? a) Offer chocolate milk to increase milk intake. b) Include dark greens and spinach in her meals. c) Use unsweetened applesauce as a dessert. d) Give her slices of cheddar cheese as a snack.

Give her slices of cheddar cheese as a snack

The nurse is caring for a 4-year-old boy following surgical removal of a stage I neuroblastoma. Which intervention is most appropriate for this child?

Giving medications as ordered via least invasive route Giving medications as ordered using the least invasive route is a postsurgery intervention focused on providing atraumatic care and is appropriate for this child. Since the child has a stage I tumor, it can be treated by surgical removal, and does not require chemotherapy or radiation therapy. Applying aloe vera lotion is good skin care following radiation therapy. Administering antiemetics and maintaining isolation are interventions used to treat side effects of chemotherapy.

The pediatric nurse recognizes that what statement is true regarding medications administered via the intravenous route?

Giving medications through the intravenous route is less traumatic than other routes. Delivering medications intravenously is actually less traumatic than administering multiple intramuscular injections. pg 385

The nurse is teaching the mother of a 2-year-old boy about age-appropriate toys. Which would be of most interest plus stimulating to the growth and development of this child? a) Providing a brightly colored plastic bucket and shovel b) Offering the child a variety of large stuffed toys c) Giving the child bowls, pot, pans, and large spoons d) Giving the child a toy vacuum cleaner

Giving the child bowls, pot, pans, and large spoons

What is one of the most commonly reported communicable diseases in the United States?

Gonorrhea Gonorrhea is one of the most commonly reported communicable diseases in the United States.

A 4-year-old girl reports having ear pain. To examine the child's ear, how should the nurse proceed?

Grasp the pinna and pull up and back. The ear is examined in a child younger than 3 years of age by pulling the pinna down and back. In a child over 3 years old, the ear is examined by pulling the pinna up and back. These maneuvers straighten the ear canal so that the tympanic membrane can be visualized. page 296

Infants born to mothers who are HbsAg-positive need to receive the hepatitis B immunoglobulin (HBIG) within how many hours?

HBIG needs to be given in 12 hours. The infant needs to receive the vaccine within 12 hours and complete all doses. Otherwise, the infant is at 90% risk of contracting hepatitis B or liver cancer in his or her 30s and 40s.

The nurse is assessing a child who is receiving TPN. The nurse determines the TPN bag was hung 24 hours ago. What initial action by the nurse is indicated?

Hang a new bag of TPN. TPN bags should not hang over 24 hours. The nurse should discontinue the current bag and hang a new one. There is no need to notify the physician. The rate of the TPN should never be changed without a physician's order. pg 401

The nurse is conducting a physical examination of an infant with suspected pyloric stenosis. Which finding indicates pyloric stenosis?

Hard, moveable "olive-like mass" in the upper right quadrant A hard, moveable "olive-like mass" in the right upper quadrant is the hypertrophied pylorus. A sausage-shaped mass in the upper mid abdomen is the hallmark of intussusception. Perianal fissures and skin tags are typical with Crohn disease. Abdominal pain and irritability is common with pyloric stenosis but are seen with many other conditions

The nurse is observing a 3-year-old boy in a daycare center. Which behavior might suggest an emotional problem? a) Has persistent separation anxiety b) Sucks his thumb periodically c) Goes from calm to tantrum suddenly d) Is unable to share toys with others

Has persistent separation anxiety

A nurse working with a 7-year-old who has had a hernia repair realizes that discharge planning starts at what point?

Immediately upon admission

A preschooler who received chemotherapy in the pediatric oncology outpatient department 1 week ago now has a temperature of 101.5°F (38.6°C). Which is the most appropriate response by the nurse?

Have the parent bring the child to the pediatric oncology clinic as soon as possible. The preschooler is considered immune suppressed following recent chemotherapy. A fever can mean sepsis, which would require immediate investigation of blood and other body fluids to identify the organism, plus prompt treatment with an IV antibiotic. This can be accomplished only by seeing the pediatric oncologist and is likely to result in hospitalization.

The nurse identifies the nursing diagnosis of risk for infection related to chemotherapy-induced immunosuppression. What would the nurse include in the teaching plan for the child and parents about reducing the child's risk? Select all that apply.

Having the child sleep in a single bed and room Encouraging frequent, thorough handwashing To reduce the risk of infection, the nurse should teach the child and parents about minimizing the child's exposure to potentially infectious situations. The nurse should encourage the parents to arrange for the child to sleep in a single bed and room and, if possible, avoid close contact with other family members who may be developing upper respiratory tract infections. Thorough and frequent handwashing, especially after using the bathroom and before eating, is essential. A high-calorie, high-protein diet helps to rebuild white blood cells and should be encouraged. If possible, the child's exposure to large crowds and visitors should be limited because of the increased risk of infection from these individuals. Fresh flowers and plants should be avoided because they could harbor mold spores.

A 16-year-old's caregivers are worried about changes in his behavior. He has always been industrious in his schoolwork and very focused on sports. Now he has a girlfriend and seems to spend almost all of his time with or on the phone with her and little or no time on his schoolwork. What information might the nurse offer these caregivers about this behavior?

He has developed his own identity by now; being able to establish close relationships with girls is important preparation for all of his adult relationships. They should honor his need to be with or talk to his girlfriend as long as he has completed his schoolwork for the day. When identity has been established, generally between the ages of 16 and 18 years, adolescents seek intimate relationships, usually with members of the opposite sex. Intimacy, which is mutual sharing of one's deepest feelings with another person, is impossible unless both persons have established a sense of trust and a sense of identity. Intimate relationships are a preparation for long-term relationships, and people who fail to achieve intimacy may develop feelings of isolation and experience chronic difficulty in communicating with others.

The parents of a 16-year-old male are worried about recent changes in his behavior, ignoring his schoolwork and sports, and spending almost all of his free time interacting with his girlfriend. Which suggestion should the nurse point out would best address this situation?

He has developed his own identity by now; being able to establish close relationships with girls is important preparation for all of his adult relationships. They should honor his need to be with, or talk to, his girlfriend as long as he has completed his schoolwork for the day.

A 6-month-old girl is seen with retinoblastoma. When taking a health history from her father, which symptom would you expect him to report he has noticed?

He has noticed one pupil appears white. As the tumor grows against the retina of the eye, the red reflex is no longer visible; the pupil appears white.

A 2-month-old boy has inconsolable crying, is gassy, and constantly draws his legs up. It has been determined that the boy has colic. What is the best intervention to treat colic?

He needs to try a different formula to assess for sensitivity. Colic peaks between 3 weeks and 6 months of age. Treatment is a restful, soothing environment. Changing an infant's formula or having a breastfeeding mom decrease her intake of gassy foods may alleviate the symptoms.

When assessing a toddler's language development, what is the standard against which you measure language in a 2-year-old? a) He should be able to count out loud to 20. b) He should say two words plus "ma-ma" and "da-da." c) He should say 20 nouns and 4 pronouns. d) He should speak in two-word sentences ("Me go").

He should speak in two-word sentences ("Me go").

An adolescent boy is diagnosed with hepatitis A. Which problem should be considered when planning care?

He will become fatigued easily. Most children with hepatitis are exhausted. Urine is not infectious.

The nurse is teaching a group of parents about head lice. Which statement is essential to include during the presentation?

Head lice are becoming very resistant to treatment. The accurate advice is that head lice are becoming resistant to treatment. Children with head lice do not need to stay home, but parents should follow school policies regarding whether children are allowed in school until they are nit-free. Children should be allowed to participate in sleepovers, preferably bringing their own pillows. Head lice do not survive long once they have fallen off. Most children can be treated effectively without treating their bedding and clothing.

A nurse asking questions during an infant's health surveillance visit has the mother tell her: "My baby was premature and weighed 3 pounds at birth." The medical record provides an Apgar score of 5 at 5 minutes and indicates the child received gentamicin in the neonatal intensive care unit (NICU). What should the nurse consider as the greatest risk for this child?

Hearing deficit The greatest risk is for a hearing deficit. All factors point in that direction: low birth weight, Apgar less than 6 at 5 minutes, and having received an ototoxic medication. This child should have had a hearing evaluation prior to discharge from the NICU and now should be screened periodically at well-child visits. This premature infant is also at risk for anemia, hypertension, feeding problems, visual defects, and gross motor problems that would not be of the same concern in the full-term child. pg 245

Parents report that their neonate received intravenous antibiotics while in the newborn nursery. The nurse recognizes this as a potential risk factor for which health problem?

Hearing impairment The child's hearing is at risk. Determining which antibiotics were administered will be helpful in evaluating the risk. Certain antibiotics are ototoxic. These require regular follow-up to check the child's hearing ability. Having received antibiotics should not increase the risk for the other health problems. pg 243

The nurse is reviewing the medical record of an infant who is being seen for the 12-month well-child visit. Which findings are normal for this infant? Select all that apply.

Heart rate 101 beats per minute Blood pressure 100/50 Respiratory rate 28/minute Temperature 99 degrees Farenheit The respiratory rate slows from an average of 30 to 60 breaths in the newborn to about 20 to 30 in the 12-month-old. As the cardiovascular system matures, the average pulse rate decreases from 120 to 140 in the newborn to about 100 in the 1-year-old. Blood pressure steadily increases over the first 12 months of life, from an average of 60/40 in the newborn to 100/50 in the 12-month-old. Page 65

The nurse is reviewing vital signs taken by the unlicensed assistive personnel on a group of toddlers. Which warrants follow up by the nurse.

Heart rate 60, respiratory rate 31 In the toddler the heart rate may range from 70 to 120 beats per minute. The respiratory rate may range from 20 to 30 per minute. Page 283

The nurse is taking vital signs on a group of assigned preschool children. Which assessment finding would indicate the need for further action?

Heart rate of 120 beats per minute The normal range for heart rate for a preschooler is between 65 and 110 beats per minute. The normal range for respiratory rate for a preschooler is between 20 and 25 breaths per minute. A heart rate of 120 would be abnormal. Page 283

Which intervention would probably be most effective in preventing an adolescent from attempting suicide with an overdose again?

Helping him learn better problem solving

A toddler insists on brushing his own teeth and being left alone in the bathtub. What advice would you give his parents regarding this? a) It is unusual for 2-year-olds to have such strong opinions. b) Helping with his own tooth brushing allows him to experience autonomy. c) His mother should continue to give full care in all aspects. d) Leaving him alone in the bathtub is a good way to encourage autonomy.

Helping with his own tooth brushing allows him to experience autonomy.

A neonatal nurse teaches students how to recognize gastrointestinal disorders in infants. The nurse tells the students that failure of the newborn to pass meconium in the first 24 hours after birth may indicate what disease?

Hirschsprung disease The nurse should suspect Hirschsprung disease when the newborn does not pass meconium in the first 24 hours after birth, and has bilious vomiting or abdominal distention and feeding intolerance with bilious aspirates and vomiting. Typical signs and symptoms of gastroenteritis include diarrhea, nausea, vomiting, and abdominal pain. The characteristic GI manifestation of UC is bloody diarrhea accompanied by crampy, typically left-sided lower abdominal pain. Clinical manifestations of untreated SBS include profuse watery diarrhea, malabsorption, and failure to thrive

To assess the sociocultural aspects of the family of an adolescent in an ambulatory clinic, what would you try to find out more about?

His family structure Family structure is a characteristic strongly influenced by culture and ethnicity

A 9-month-old boy with iron-deficiency anemia is given ferrous sulfate therapy. Which assessment would best help you determine that he is actually taking it daily?

His stools will appear black. A side effect of ferrous sulfate therapy is to color stools black

A nurse who has worked in a variety of settings over the past several years is trying to determine what setting she would most like to work in now. The nurse is very organized, works well in an autonomous environment, and prefers one-on-one care. Which setting would best fit this nurse's needs?

Home Health Home health would provide the most autonomy (which requires being organized), and takes place in the client's home, giving one-on-one care. All areas of nursing require organization in order to provide efficient care. A physician's office would likely provide the least amount of autonomy since the physician is always present, as well as other office staff. The health department nurse and the school nurse would favor an autonomous person, but there is still more direct supervision than with home health nursing. pg 341

A nurse who has worked in a variety of settings over the past several years is trying to determine what setting she would most like to work in now. The nurse is very organized, works well in an autonomous environment, and prefers one-on-one care. Which setting would best fit this nurse's needs?

Home health

The nurse is caring for a child diagnosed with hydronephrosis. Which manifestation is consistent with complications of the disorder?

Hypertension Complications of hydronephrosis include renal insufficiency, hypertension, and eventually renal failure. Hypotension, hypothermia, and tachycardia are not associated with hydronephrosis.

When describing anaphylaxis to a group of parents whose children have experienced anaphylaxis from insect stings, the nurse integrates knowledge that this response is related to which immunoglobulin?

IgE Anaphylaxis is an acute IgE-mediated response to an allergen that involves many organ systems and may be life-threatening.

The nurse is working with a 5-year-old boy who must receive repeated intravenous injections as part of his treatment. He hates the injections, however, and is frightened whenever he sees the syringe and needle. In an attempt to overcome this fear, the nurse holds the syringe up for him to see and tells him, "This looks kind of like a space rocket, don't you think? Here comes the space rocket—it needs to refuel." Which pain management technique is the nurse using here?

Imagery Imagery involves the use of the imagination to create a mental image. This mental image usually is a positive, pleasurable image, but it need not be real. As an example, a child could imagine a venipuncture needle as a silver rocket ship probing the moon or a submarine diving under the water to escape a torpedo just in time. Thought stopping is a technique in which children learn to stop anxious thoughts by substituting a positive or relaxing thought in its place. Hypnosis involves the child entering a trance-like state to effectively avoid sensing pain. Biofeedback is based on the theory people can regulate internal events such as heart rate and pain response in response to a stimulus. A biofeedback apparatus is used to measure muscle tone or the child's ability to relax. pg 424

The nurse is caring for a 6-year-old sickle-cell client in an acute care setting. A high priority for this client's plan of care is pain relief. The nurse understands that untreated acute pain can lead to which physiological effects?

Impaired mobility, anorexia, anxiety, sleep disturbances, and developmental regression Unrelieved acute pain can lead to impaired mobility; anorexia, causing poor nutritional intake; delayed wound healing; anxiety and irritability; somatic symptoms; sleep disturbances; avoidance; developmental regression; and increased parental distress. Constipation, nausea, vomiting, nocturnal enuresis, and migraine headaches are not effects of acute pain. pg 410

The nurse is teaching an in-service program to a group of nurses on the topic of gastrointestinal disorders. The nurses in the group make the following statements. Which statement is most accurate related to the diagnosis of gastroesophageal reflux?

In this disorder the sphincter that leads into the stomach is relaxed. Gastroesophageal reflux (GER) occurs when the sphincter in the lower portion of the esophagus, which leads into the stomach, is relaxed and allows gastric contents to be regurgitated back into the esophagus. Congenital aganglionic megacolon is characterized by persistent constipation resulting from partial or complete intestinal obstruction of mechanical origin. Colic consists of recurrent paroxysmal bouts of abdominal pain. Pyloric stenosis is characterized by hypertrophy of the circular muscle fibers of the pylorus which leads to an obstruction at the distal end of the stomach.

Which of the following is appropriate with reference to enhancing a child's self-esteem? a) Utilize belittling techniques as opposed to time-outs. b) Avoid applauding for unsuccessful attempts. c) Include the child in activities that interest the adult. d) Utilize negative criticism as well as positive reinforcement.

Include the child in activities that interest the adult.

A 6-year-old child is being treated for a parasitic infection. When reviewing results from the child's white blood cell count, which finding would be anticipated?

Increased eosinophils levels Eosinophils are the first line of defense against parasitic infections and allergic reactions and will be elevated. Monocytes are a second line of defense and will be elevated in response to leukemias, lymphomas, and chronic inflammation. Basophils respond to allergic disorders and hypersensitivity reactions. Neutrophils are the first line of defense upon invasion of bacteria, fungus, cell debris, and other foreign substances.

A nursing instructor has presented a class on the stages of an infectious disease to a group of students and asks the students to place the stages in their proper sequence from beginning to end. Place the stages in their proper sequence.

Incubation Prodrome Illness Convalescence An infectious disease begins with incubation, then progresses to the prodrome stage, then to illness, and finally to convalescence.

Nursing students are learning about the infectious process. They correctly identify the first stage of an infectious disease to be the:

Incubation period The incubation period is the first stage of the infectious disease. It is the time between the invasion of an organism and the onset of symptoms of infection.

A 6-year-old girl is diagnosed with pulmonary stenosis. The mother asks the nurse what the likely treatment for this condition will involve. What should the nurse tell the mother?

Insertion of a catheter with an uninflated balloon tip into the affected valve, followed by inflation of the balloon to break up adhesions Balloon angioplasty by way of cardiac catheterization is the procedure of choice for pulmonary stenosis. With this procedure, a catheter with an uninflated balloon at its tip is inserted and passed through the heart into the stenosed valve. As the balloon is inflated, it breaks valve adhesions and relieves the stenosis. The other answers refer to interventions related to patent ductus arteriosus, not pulmonary stenosis.

The mother of a child with myasthenia gravis has called the clinic and reports her child appears very anxious and the child's heart is beating very fast. What action by the nurse is indicated?

Instruct the child be brought to the emergency department promptly. Myasthenia gravis is an autoimmune disorder that is characterized by weakness and fatigue. There is no cure. The disease may be aggravated by stress, exposure to extreme temperatures, and infections, resulting in a myasthenic crisis. Myasthenic crisis is a medical emergency with symptoms including sudden respiratory distress, dysphagia, dysarthria, ptosis, diplopia, tachycardia, anxiety, and rapidly increasing weakness. The symptoms reported are consistent with a crisis and prompt care is indicated. Waiting 24 hours to have the child seen by the physician is not appropriate. Questions about changes in routine and medication compliance may be asked but the first priority is to have the child seen

Most urinary tract infections seen in children are caused by:

Intestinal bacteria Although many different bacteria may infect the urinary tract, intestinal bacteria, particularly Escherichia coli, account for about 80% of acute episodes. Hereditary and dietary concerns are not causes of urinary tract infections

By which route is the diphtheria, tetanus, and pertussis (TDaP) vaccine administered to infants?

Intramuscularly All diphtheria, tetanus, and pertussis vaccines (TDaP, TD, Tdap) are administered intramuscularly to children of all ages. A needle of appropriate length must be used to reach the muscle and avoid depositing the vaccine in subcutaneous tissue. pg 250

The nurse is administering an oral liquid medication to a 5-year-old child. What would be the most appropriate for the nurse to do when administering this medication?

Let the child hold the medication cup. Medication cups and spoons can be used to administer liquid medications to the older child. The child can hold the medication cup and drink the liquid medication. pg 378

A parent who is feeding his child formula prepared at home using evaporated milk is concerned about whether the child is receiving all necessary nutrients. What would it be important for this parent to add to his child's diet to supplement the formula?

Iron Infants who are fed home-prepared formulas (based on evaporated milk) need supplemental vitamin C and iron. Evaporated milk has adequate amounts of vitamin D, which is unaffected by heat used in the preparation of formula. Calcium and vitamin E would not be concerns in this infant's formula.

Parents tell the nurse their 3½-year-old refuses to eat meat but are pleased she drinks "lots of milk." What risk does the nurse identify?

Iron deficiency

The nurse is performing a vision screening for 6-year-old child. Which screening chart is best for the nurse use to determine the child's ability to discriminate color?

Ishihara The Ishihara chart is best for the 6-year-old because the child will know numbers. CVTME charts are designed to assess color vision discrimination for preschoolers. The Allen figures chart and the Snellen charts are for assessing visual acuity. pg 246

A nurse reads the medical history of a client who is scheduled for a hernia repair that is termed "reducible." What best describes this type of hernia?

Its contents can be easily manipulated back into the peritoneal cavity. A hernia in the abdominal region is considered reducible when its contents are easily manipulated back into the peritoneal cavity. An incarcerated hernia occurs when the abdominal contents become trapped and difficult to reduce. A strangulated hernia occurs when the herniated intestines become twisted and edematous compromising blood flow. Intestinal obstruction and ischemia may occur

What will the nurse view as best maintaining normalcy in the life of a 10-year-old boy who is experiencing a lengthy hospitalization?

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. pg 324

To gain cooperation from a toddler, what is the best approach by the nurse? 1. Immediately pick the toddler up from the mother's lap. 2. Kneel in front of the toddler while he or she is on the mother's lap. 3. Do the nursing tasks quickly so the toddler can play. 4. Ask the toddler if it is okay if you begin the needed task.

Kneel in front of the toddler while he or she is on the mother's lap.

A child is brought to the clinic with fever, cough, and coryza. The nurse inspects the child's mouth and observes what look like tiny grains of white sand with red rings. How would the nurse document these findings?

Koplik spots Koplik spots are bright red spots with blue-white centers appearing primarily on the buccal mucosa and indicate rubeola (measles). They are often described as tiny grains of white sand surrounded by red rings. Lymphadenopathy is used to document enlargement of the lymph nodes. Slapped cheek appearance refers to the erythematous flushing associated with fifth disease. Nits refer to the adult eggs of pediculosis.

The appearance of which hallmark clinical manifestation occurs in measles?

Koplik spots The hallmark of measles is the appearance of Koplik spots. Other typical symptoms include fever, conjunctivitis, and a cough.

According to Eric Erikson, the developmental task of the toddler is developing autonomy. Which of the following describes Erikson's psychosocial development task for the toddler? a) Learning to trust b) Learning to speak c) Learning to understand and respond to discipline d) Learning to act on one's own

Learning to act on one's own

The nurse has been assigned to care for a child who is on transmission-based precautions. This nurse has not cared for this child before. Which action would be the best way to help the child feel comfortable with the nurse?

Let the child see his or her face before the mask is put on. If masks or gloves are part of the necessary precautions, the child may experience even greater feelings of isolation. Before putting on the mask, the nurse should allow the child to see his or her face; this process will help the child easily identify the nurse. Being introduced by the previous nurse, reading to the child, or explaining that the caregiver will visit soon are appropriate but are not the best ways to help the child feel less isolated and more comfortable with the nurse in the isolation setting.. page 322

The nurse is meeting with a group of caregivers of adolescents. Which example should the nurse point out is most effective for the caregiver to support the adolescent?

Let them choose their hairstyle, even though it may not look the best for them

The nurse is discussing healthy eating habits with a school-age child and her parents. Which recommendation would the nurse make for the family?

Light snacks should be offered so the child doesn't overeat at meals Children who do not manage their hunger with snacks will likely overeat at a meal. Protein is a better choice at breakfast for energy and to avoid being sleepy during the day. Bedtime snacks are recommended if the child is hungry but should not be routine. Avoid battles over food during a meal. Offer the child healthy foods they do like and they will eventually explore new or previous disliked foods. pg 264-265

A group of students is reviewing material about ways parents can help to foster a child's self-esteem. The students demonstrate a need for additional studying when they identify which method? a) Limiting the choices and decisions that the child makes b) Using positive reinforcement while limiting criticism c) Showing respect and support to the child d) Acting as a coach rather than a cheerleader

Limiting the choices and decisions that the child makes

A father brings his 10-year-old daughter in to the physician's office with jaundice, headache, fever, and anorexia, symptoms she has had for the past few days. The nurse should suspect infection of which organ in this client?

Liver No matter which virus is involved, hepatitis is a generalized body infection with specific intense liver effects. Type A occurs in children of all ages and accounts for approximately 30% of instances. With hepatitis A, children notice headache, fever, and anorexia. Jaundice occurs as liver function slows

The nurse will record what information about each vaccine after immunizing a child? Select all that apply.

Lot number and expiration date of vaccine Site and route of vaccine administration Manufacturer of vaccine Lot number, expiration date, site and route of administration, and the name of the vaccine manufacturer should be recorded. The name and address of the facility and the person administering the vaccine are also documented. In this way, details that can be used to track any untoward events related to the vaccine are available. Proper vaccine storage is important for the efficacy of the vaccine but presently is not recorded at the time of administration. The viral or bacterial nature of the vaccine is already known. pg 251

A group of camp nurses is discussing various types of tick bites. One of the nurses states that deer ticks are carried by white-footed mice and white-tailed deer, and can carry the organism that causes which disease?

Lyme disease Deer ticks, carried by white-footed mice and white-tailed deer, can carry the organism that causes Lyme disease.

A nurse is preparing a presentation for parents about common childhood infectious diseases. What conditions would the nurse include as being caused by a tick bite? Select all that apply.

Lyme disease Rocky Mountain spotted fever Infectious diseases caused by tick bites include Lyme disease and Rocky Mountain spotted fever. Psittacosis is transmitted to children by birds. Ascariasis is a roundworm infection. Scabies is a parasitic infection caused by a female mite.

The nurse is caring for a child with HIV. The doctor will most likely order which test to monitor the child's progress?

Lymphocyte immunophenotyping T-cell quantification Lymphocyte immunophenotyping T-cell quantification is for ongoing monitoring of progressive depletion of CD4 T lymphocytes in HIV disease. The nurse would expect the physician to order a complement assay (C3 and C4) for ongoing monitoring of systemic lupus erythematosus. IgG subclasses measures the levels of the four subclasses of IgG and is used to determine immunodeficiencies. Immunoglobulin electrophoresis is ordered for immunodeficiency and autoimmune disorders, not to monitor systemic lupus erythematosus.

The nurse is evaluating the complete blood count of a 7-year-old child with a suspected hematological disorder. Which finding is associated with an elevated mean corpuscular volume (MCV)?

Macrocytic red blood cells (RBCs) When the MCV is elevated, the RBCs are larger and referred to as macrocytic. The WBC count does not affect the MCV. The platelet count and Hgb are within normal ranges for a 7-year-old child.

The family reports to the nurse that their adolescent always wants to argue, will not participate in family functions, and has poor school grades. What recommendation should the nurse make for an adolescent client who presents with these symptoms?

Make an appointment with the health care provider.

A 16-year-old is seen in the emergency department with symptoms including a high fever, chills, headache, nausea and vomiting, and painful joints. During the nursing history the teenager reports recently returning from a trip to a rain forest in South America. What infectious disease does the nurse suspect the client has contracted?

Malaria Malaria comes from a bite of Anopheles species of mosquito and is mostly found in Africa, Asia and South America. Anaplasmosis comes from a tick and occurs mostly in the upper Midwest and northeast United States. West Nile disease comes from a mosquito and is found throughout United States, with higher rates found in Great Plains and mountain regions. Rabies is a viral infection that comes from close contact with the saliva of a rabid animal.

When caring for a child with Kawasaki disease, the nurse would know that:

Management includes administration of aspirin and IVIG. Kawasaki disease is managed with IVIG and aspirin to prevent cardiac complications. Joint pain is not necessarily a permanent problem associated with Kawasaki disease. Antibiotics and steroid creams are not used for this disorder.

As the nurse prepares to administer a medication to a preschooler, she realizes that the child is extremely underweight for her age. What action would the nurse take?

Measure her height and weight, and check whether the dose is correct for her. Before any medicine is administered, it should be confirmed that the dose is correct for the child's weight and height because of the great variability in these areas. pg 376

A 16-year-old is being cared for at home following months of therapy for injuries sustained in an automobile accident. The child is paralyzed from the neck down, is ventilator supported, and uses a specialized wheelchair for mobility. The nurse case manager acts as an advocate for the family by assisting with obtaining what kind of benefits to supplement health care costs?

Medicaid waver

The nurse is assessing a 9-year-old boy with pneumonia. Which finding is a factor for this child's morbidity?

Medical records reveal a history of asthma Asthma is a morbidity factor for additional childhood illness, particularly respiratory illness. The child's height and weight are appropriate and not associated with increased risk. The normal WBC count may help to determine if the pneumonia is bacterial or viral. Being in a Boy Scout troop may increase the risk of exposure, but would not be as closely associated with morbidity as is asthma.

What anticipatory guidance can the nurse provide the girl who has noted the development of breast buds?

Menarche should follow in about 2 years. Menarche usually follows within 2 years of the first signs of breast development. Peak height velocity (PVH) in girls occurs 6 to 12 months following menarche. It does not follow immediately. Breast development progresses through several stages and will not be complete until late puberty. Adult height is not reached at the time of menarche but about 6 to 12 months following menarche.

The parents of a 6-month-old have brought their child to the emergency department with vomiting and diarrhea for the past 3 days. The report the child as being very lethargic today. During the assessment the nurse notes decreased skin turgor, delayed capillary refill, and pale, slightly dry skin. Based on the objective and subjective data, what does the nurse determine the child to be?

Moderately dehydrated In addition to these signs and symptoms, signs and symptoms of moderate dehydration also include sunken fontanels, mildly sunken orbits, and urine output

The adolescent receiving morphine IV for pain control needs which included in his nursing care plan (NCP)? Select all that apply.

Monitoring for itching Stand-by assistance when using the bathroom Naloxone readily available Naloxone should be readily available to reverse possible respiratory depression, a side effect of morphine. Dizziness and sedation are likely to accompany this pain control. Therefore, safety measures such as assistance when getting up to go to the bathroom or ambulating plus use of side rails are important inclusions in the NCP. Itching, particularly of the face and hands, is a relatively common side effect of morphine sulfate. It can be treated with cool compresses or an antihistamine and included in the plan of care. A high-fat diet and assessing for a suppressed cough reflex are interventions not needed for the portion of this adolescent's NCP that addresses pain control through use of IV morphine.

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?

Morphine Recommended doses of analgesics and co-analgesics that have a ceiling of effect generally reflect the dose required to achieve therapeutic analgesic blood levels; whereas recommended doses of opioids and co-analgesics that lack a ceiling of effect are considered initial dosages. These recommended doses are based on empiric evidence and clinical experience and must be titrated to achieve optimal analgesia while minimizing analgesic-related side effects. Ibuprofen, Tylenol, and aspirin are not opioids and therefore do not have a ceiling. pg 429

When obtaining the history of a child diagnosed with West Nile virus, the nurse would expect to find exposure to what cause of this illness?

Mosquito bite West Nile virus is transmitted to humans primarily through the bite of infected mosquitoes. Deer ticks are associated with the transmission of Lyme disease. Exposure to cat feces can increase the risk for toxoplasmosis. Poor sanitation can lead to several infections such as roundworm infestation.

The mother of a 3-month-old is concerned because her daughter does not yet sit by herself. Which statement best reflects average sitting ability?

Most babies do not sit steadily until 8 months; she is normal. Many infants sit steadily by 8 months of age.

The nurse is reviewing the medical record of a child with a cleft lip and palate. When reviewing the child's history, what would the nurse identify as a risk factor for this condition?

Mother age 42 with pregnancy Advanced maternal age is a risk factor for cleft lip and palate. Drugs such as anticonvulsants, steroids, and other medications during early pregnancy are considered risk factors. Acetaminophen is not associated with an increased risk for cleft lip and palate. Preterm birth is not a risk factor for the development of cleft lip and palate. Hypoxia or anoxia is a risk factor for the development of necrotizing enterocolitis.

Based on the most frequent cause of death in adolescents, what preventive measure would the nurse most want to teach an adolescent?

Motor-vehicle safety Motor-vehicle accidents are the number one cause of death in adolescents.

The nurse is performing a vision screening for a 2-month-old. Which technique should the nurse use?

Move a card with a black-and-white checkerboard pattern in a 180-degree arc past the infant. By 2 months of age, the infant should be able to fixate and follow objects 180 degrees. The black-and-white checkerboard pattern has distinct contrasts for which the young infant's vision is attuned. A colorful toy is less visually appealing. The clown photo held at 10 to 12 inches from the infant will invite fixation but not check the visual range. The black-and-white panda has good contrast, but the 2-month-old should follow to 180 degrees, not to just midline. pg 243

Once temper tantrums have started, which of the following interventions are appropriate? a) Engage the child's behavior. b) Speak to the child during the tantrum. c) Move objects out of the way or move the child to prevent injury. d) Have a long talk with the child regarding the tantrum.

Move objects out of the way or move the child to prevent injury.

The caregivers of 2 ½-year-old Frances tell the nurse that they are working hard to teach her to share and communicate with other children. The nurse recognizes and acknowledges their devotion, but explains to them that a child this age is probably not at a developmental level to play and share with other children. Of the following activities, which activity would the nurse recommend as the most appropriate activity for a 2 ½-year-old? a) Throwing a baseball sized ball b) Looking at large print magazines c) Mowing the lawn with a toy lawnmower d) Sharing finger paints and painting with the caregiver

Mowing the lawn with a toy lawnmower

A 15-year-old boy visits his primary care physician's office with fever, headache, and malaise, along with complaints of pain on chewing and pain in the jawline just in front of the ear lobe. The boy asks his mother to leave the exam room for a minute and then tells the nurse that he is also experiencing testicular pain and swelling. The nurse recognizes that this client most likely has which condition?

Mumps Initial symptoms of mumps include fever, headache, anorexia, and malaise. Within 24 hours, pain on chewing and an "earache" occurs. When the child points to the site of the earache, however, he points to the jawline just in front of the ear lobe, the site of the parotid gland. By the next day, the gland appears swollen and feels tender; the ear becomes displaced upward and backward. Boys may also develop testicular pain and swelling (orchitis). None of the other conditions listed matches the symptoms indicated.

A 7-year-old with an earache comes to the clinic. The child's mother reports that 1 day ago her child had a fever and headache and did not want to play. When the nurse asks where it hurts, the child points to the jawline in front of the earlobe. What does the nurse expect the diagnosis to be for this child?

Mumps Mumps begin with a fever, headache, anorexia, and malaise. Within 24 hours an earache occurs. When pointing to the site of pain, however, the child points to the jawline just in front of the earlobe.

A child in the clinic has a fever and reports a sore neck. Upon assessment the nurse finds a swollen parotid gland. The nurse suspects which infectious disease?

Mumps Mumps is an infectious disease with a primary symptom of a swollen parotid gland

The nursing instructor is describing the events of anaphylaxis. Place the assessment findings in the order that they would occur from first to last.

Nausea, vomiting, diarrhea Urticaria, angioedema Bronchospasm Hypoxia Seizures Initially, a child may be nauseous, with vomiting and diarrhea, because of the sudden increase in gastrointestinal secretions produced by the stimulation of histamine. This is followed by urticaria and angioedema. Bronchospasm can become so severe the child becomes dyspneic and hypoxemic. Continued bronchospasm leads to hypoxia. As blood vessels dilate, the blood pressure and pulse rate fall. Seizures and death may follow as soon as 10 minutes after the allergen is introduced into the child's body.

The nurse is discussing proper discipline with the mother of a 15-month-old boy. Which statement is most important? a) Never spank the child for any reason. b) Use praise when the child is doing something right. c) Toddlers are unable to learn rules easily. d) Rules and limits should be simple and few.

Never spank the child for any reason.

The student nurse is caring for a 2 1/2-week-old in the newborn intensive care unit. Which term is most accurate when discussing this client?

Newborn A more accurate term for this child would be newborn rather than infant because the newborn or neonatal period of infancy is defined as the period from birth until 28 days of age. Infancy is the period of time up to 1 year old. Child and baby don't refer to the client's age accurately.

The nurse is assessing the oral cavity of a 4-month-old infant. Which finding is consistent with a child of this age?

No teeth Normally infants are not born with teeth. Occasionally there are one or more teeth at birth. These are termed natal teeth and are often associated with anomalies. The first primary teeth typically erupt between the ages of 6 and 8 months.

Nurses should provide anticipatory guidance to males to prepare them for what particular pubertal change in late adolescence?

Nocturnal emissions

A nurse suspects a child is experiencing cardiac tamponade after heart surgery. What would be the priority nursing intervention?

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 17-year-old has been diagnosed with HIV. When developing the plan of care, which initial action should be included?

Notify the local health department of the individual's HIV status. The legal notification the local health department is mandated for certain communicable diseases. HIV is included in this category. Listing the sexual contacts and notifying them is the responsibility of the health authorities, not the individual clinic or office. Contacting the CDC will rest with the local health department.

The nurse is caring for a 5-week-old infant who is spitting up "all the time." This is the mother's first child. What should be the priority nursing intervention?

Observe the mother while she feeds and burps her infant. Assessing the mother's feeding and burping technique is the first nursing action needed. The mother may be overfeeding or inadequately burping the child. Recommending smaller and more frequent feedings would be determined by the assessment. Assuring the mother that some spitting up is normal and describing the capacity of the infant's stomach is helpful information but not the priority.

The nurse is caring for a child who is scheduled to begin chemotherapy. When planning education for the parents what action by the nurse is most correct?

Obtain a small conference room and arrange the chairs in a circle for both the nurse and family members to sit. Teaching is an important function of the nurse. When providing the education, it is important to offer the information in an environment that is conducive to learning. A circular set of chairs will allow the nurse to face the parents during the exchange. A large class that has the nurse standing and the parents sitting does not provide the ability for a personal interaction needed for this session. Giving the parents information in writing should be done in conjunction with a face-to-face teaching session. Video information may be beneficial but does not replace the the face-to-face teaching session.

While working in the emergency room, the nurse receives a call that a 3-year-old child sustained extensive burns in a house fire. Assuming all of the following actions are included in the standing burn-care protocol, which action should be the nurse perform first?

Obtain a weight Obtaining a weight provides a base for calculating the fluid that will need to be replaced. NG placement and/or drinking milk are not actions to take at this point. Tetanus can be given later and is not critical to active management. pg 392

The first method of choice for obtaining a urine specimen from a 3-year-old child with a possible urinary tract infection is:

Obtaining a clean catch voided urine In the cooperative, toilet-trained child, a clean midstream urine may be used successfully to obtain a "clean catch" voided urine. If a culture is needed, the child may be catheterized, but this is usually avoided if possible. A suprapubic aspiration also may be done to obtain a sterile specimen. In the toilet-trained child, using a cotton ball to collect the urine would not be appropriate

The parents of a 2-year-old boy report to the nurse because their child is "such a picky eater." Which recommendation would be most helpful for developing healthy eating habits in this child? a) Encouraging the parents to eat a variety of wholesome foods themselves b) Offering a variety of foods along with the foods the child likes c) Advising the parents to minimize distractions at mealtime d) Assuring the parents that food jags are normal, and they can be honored safely

Offering a variety of foods along with the foods the child likes

The nurse is teaching a group of nursing students about acute glomerulonephritis genitourinary conditions. A student asks the about a condition that occurs when there is a decreased volume of urine output. The condition the student is referring to is:

Oliguria Oliguria is a subnormal volume of urine. Amenorrhea is the absence of menstruation. Pyelonephritis is an inflammation of the kidney and renal pelvis. Ascites is edema in the peritoneal cavity

A client questions how long it will take for the oral pain medication administered to begin to take effect. What information can be provided by the nurse?

One to two hours is needed for oral medications to begin to take effect. Oral administration provides relatively steady blood levels of the drug when administered as a scheduled dose. Effectiveness typically occurs 1 to 2 hours after administration. pg 430

A mother calls the doctor's office and tells the nurse that she is concerned because her 4-month-old keeps "spitting up" with every feeding. What would indicate that the child is regurgitating as opposed to vomiting?

Only occurs with feeding Regurgitation typically occurs only with feeding, runs out of the mouth with little force, smells barely sour and is only slightly curdled, appears to cause no pain or distress, occurs only once per feeding, and amounts to only about 1 to 2 tsp. Vomiting may occur at times other than feeding, is forceful and is typically projected 1 ft or more away from infant, is extremely sour smelling and curdled, is typically accompanied by crying, continues until the stomach is empty, and amounts to the full stomach contents.

The registered nurse is creating a care plan for a hospitalized child. She has identified anxiety related to hospitalization as a nursing diagnosis. Which interventions would be most appropriate to include? Select all that apply.

Orient the child and family to the unit and room. Assess for signs and symptoms of anxiety and fear. Explain all events, treatments and procedures to the child and family. Encourage the patents to inform the child when they are leaving and when they will be back.

The registered nurse is creating a care plan for a hospitalized child. She has identified anxiety related to hospitalization as a nursing diagnosis. Which interventions would be most appropriate to include? Select all that apply.

Orient the child and family to the unit and room. Assess for signs and symptoms of anxiety and fear. Explain all events, treatments and procedures to the child and family. Encourage the patents to inform the child when they are leaving and when they will be back. Place the child in a semi-private room with a child of similar age if possible rather than in a private room. Orienting the child and family to the room and unit, assessing for signs and symptoms of anxiety and fear, explaining all events to both the child and family and encouraging the parents to inform the child when they are leaving and when to expect them back are all appropriate interventions for this diagnosis. page 344

The most accurate screening test for the presence of HIV antigen in young children is

PCR PCR tests directly for the HIV antigen. ELISA and the Western blot test detect the presence of HIV antibodies. The CD4 count is used as a measure of disease status and progression.

The nurse is planning immediate postoperative care for an infant after a cleft-lip repair. What should the plan include?

Pain medication should be given on a routine basis. After any surgery on a child, the plan should include pain medication administration on a routine basis. The infant will not be able to request pain medication and will need to rest the surgical site. Providing pain medication will help the infant in the postoperative period. pg 430

The nurse caring for an 18-month-old infant with Meckel diverticulum knows that the most common clinical manifestation of this condition is:

Painless rectal bleeding With Meckel diverticulum, most symptomatic children present younger than age 2 years. Intermittent, painless rectal bleeding is the most common clinical manifestation of Meckel diverticulum. The blood is most often bright red or maroon and may be passed independent of stool due to ulceration at the junction of the ectopic tissue and the normal ileal mucosa.

A mother brings her 10-year-old son to the ER with complaints of abdominal pain. The nurse performing a physical assessment notes the following symptoms: upper right quadrant pain that radiates to the back; fever; nausea; and abdominal distention. Which disease would the nurse consider as a diagnosis?

Pancreatitis The child admitted with the suspicion of pancreatitis typically has a complaint of abdominal pain, either epigastric, upper left, or upper right quadrant pain that may radiate to the back. Nausea and vomiting, fever, tachycardia, hypotension, and jaundice may be present. Abdominal signs such as abdominal distention, decreased bowel sounds, rebound tenderness, and guarding also may be noted.

When observing a group of toddlers playing in a child care setting it is noted that the toddlers are all playing with buckets and shovels but are not playing with each other. This type of play is referred to as which of the following? a) Onlooker play b) Associative play c) Solitary play d) Parallel play

Parallel play

A nurse is caring for a child. Which individual would the nurse identify as being primarily responsible for initiating and coordinating health care?

Parents Parents and guardians have the primary responsibility for initiating and coordinating services rendered by health professionals. A social worker or case manager may be involved but are not primarily responsible for the child's care. The community provides programs to promote and support children's health. pg 17

While obtaining a health history on a 3-year-old child, the nurse finds what information a concern? Select all that apply.

Parents report the child as an infant had failure to thrive. Parents report the child has had recurrent bacterial infections. Parents report the child didn't start walking until 1 ½ years old. Parents report the child didn't sit up by herself until 9 months old. When collecting health history the nurse must be attuned to reports that may signal underlying conditions. A child who has experienced failure to thrive, repeated bacterial infections and developmental delays with regard to walking and sitting up presents the need for further investigation. These are consistent with an autoimmune disorder.

The nurse is caring for a child presenting with eye inflammation, knee pain, poor appetite and poor weight gain. The nurse is aware that this is which type of juvenile idiopathic arthritis?

Pauciarticular (oligoarticular) Pauciarticular or (oligoarticular) arthritis symptoms include involvement of four or fewer joints; quite often the knee is involved, eye inflammation, malaise, poor appetite, poor weight gain. Polyarticular involves five or more joints; frequently involves small joints and often affects the body symmetrically. Systemic includes joint involvement, fever and rash may be present at diagnosis. Rheumatic arthritis typically involves small joints.

The nurse is recommending food items for an 18-month-old girl. Which ones will benefit the child's neurologic system most? a) Vegetable soup, whole wheat bread, and blueberries b) Peanut butter on crackers, cheese, and whole milk c) Oatmeal pancakes with bananas d) Ground beef, broccoli, and apple slices

Peanut butter on crackers, cheese, and whole milk

The nurse is caring for an adolescent diagnosed with syphilis. The drug of choice for treating syphilis is:

Penicillin Syphilis responds to one intramuscular injection of penicillin G benzathine; if the child is sensitive to penicillin, oral doxycycline, tetracycline, or erythromycin can be administered as alternative treatment.

When the physician looks in a child's mouth during a sick-visit exam, the mother exclaims: "Her tongue is bright red! It was not like that yesterday." The physician would most likely order which medication based on the probable diagnosis of scarlet fever?

Penicillin to prevent acute glomerulonephritis A "strawberry tongue" is a classic sign of scarlet fever. Penicillin is prescribed to prevent the complications of acute glomerulonephritis and rheumatic fever associated with beta-hemolytic group A streptococcal infections.

What developmental categories will the nurse assess when screening with the Denver II Developmental Screening Test? Select all that apply.

Personal-social Fine motor--adaptive Language Gross motor skills The Denver II is not a test of intelligence; it is used to assess the child's level of development. This differentiation should be made clear to parents. A task not passed on the Denver II indicates a delay in that area. Further evaluation is needed to determine the reason for this delay. pg 239

After teaching a class to a group of nursing students about reporting infectious diseases to the Centers for Disease Control and Prevention, the instructor determines a need for additional discussion when the students identify which infection as being reportable:

Pinworm Pinworm infections are not required to be reported. Gonorrhea is a reportable infectious disease. Lyme disease is a reportable infectious disease. Pertussis is a reportable infectious disease.

The nurse is caring for a 6-year-old child with a congenital heart defect. To best relieve a hypercyanotic spell, what action would be the priority?

Place the child in a knee-to-chest position. The priority nursing action is to place the infant or child in a knee-to-chest position. Once the child has been placed in this position, the nurse should provide supplemental oxygen or administer medication as ordered. A calm, comforting approach should be used but is not the priority action. Once a child is placed in the knee-to-chest position, supplemental oxygen would be provided as ordered. Once a child is placed in the knee-to-chest position, medications would be given as ordered.

The nurse is preparing a postsurgical care plan for an infant girl located on a general hospital unit that only occasionally admits children. To ensure the infant's safety, what should the nurse include in the plan?

Place the infant in a room close to the nurses' station. The infant will need close monitoring, and having the child nearby will promote frequent checks and awareness of her status. Family cannot be required to stay at all times. That may be impossible for some. One client should never be responsible for another. The infant is the nurses' responsibility. Putting the infant in a carrier and bringing her to the nurses' station is not safe. page 324

An infant with tetralogy of Fallot becomes cyanotic. Which nursing intervention would be the first priority?

Place the infant in the knee-chest position. Placing the infant in the knee-chest position is the first priority when caring for an infant with tetralogy of Fallot. Starting IV fluids and preparing the child for surgery would not be necessary since it is known that the infant has a cyanotic birth defect. Raising the head of the bed would not be a priority since the infant needs to be placed in the knee-chest position.

The nurse is measuring the head circumference of a child. What technique is accurate related to this procedure?

Place the tape measure around the head just above the eyebrows. The head circumference is measured routinely in children to the age of 2 or 3 years or in any child with a neurologic concern. Place a paper or plastic tape measure around the largest part of the head just above the eyebrows and around the most prominent part of the back of the head. During childhood the chest exceeds the head circumference by 2 to 3 inches. Page 289

What feeding practice used by the parents of an 8-month-old should the nurse discourage?

Placing all liquids given the child in a "no spill" sippy cup. No-spill sippy cups promote sucking rather than teach cup drinking. Reserve these for times when avoiding spills is a must. The other feeding practices are age appropriate and safe. Soft table and finger foods promote accepting new textures and self-feeding. Reoffering rejected food allows the child to accept it when ready. Including the infant at the family table provides for modeling of eating behaviors and socialization. Page 86

A nurse is assessing an infant's reflexes. The nurse places his or her thumb to the ball of the infant's foot to elicit which reflex?

Plantar grasp Touching the thumb to the ball of the infant's foot would elicit the plantar grasp reflex. The other reflexes are not elicited by this method. Page 307

The nurse is assessing the growth of a premature infant. What would be the appropriate action by the nurse to complete this assessment?

Plot the infant's weight, height, and length on a growth chart. The assessment for growth for a premature infant entails plotting his or her weight, length, and height on a growth chart, which is then analyzed. If the infant is below the growth curve, they are not growing appropriately and interventions may be needed. The nurse weighing the diapers is checking the intake and output of the infant, as does asking mom if the infant eats enough. Taking vital signs does not relate to growth. pg 289

A nurse is attempting to assess the extent of an injury a 5-year-old boy sustained when he fell down a flight of stairs. The child is visibly upset but capable of communicating. Which pain scale would be most appropriate to use in this situation?

Poker chip tool The poker chip tool uses four red poker chips placed in a horizontal line in front of the child. Each chip represents a different level of pain. The technique can be used with children as young as 4 years of age, provided the child has some concept of "more or less." The Pain Experience Inventory is designed to elicit the terms a child uses to denote pain and what actions a child thinks will best alleviate pain. If possible, it should be used before the child has pain. The CRIES inventory is a 10-point scale named for five physiological and behavioral variables commonly associated with neonatal pain, and thus is not age-appropriate in this case. The FLACC pain assessment tool is a scale by which health care providers can rate a young child's pain when a child cannot give input, such as during circumcision. pg 416

A child with Down syndrome has had surgery and experiences periodic pain. The child is 13 years old but functions much like an 8-year-old. Which pain scales may be appropriate to use with this girl? Select all that apply.

Poker chip tool FACES pain rating scale The poker chip tool has been successfully used for those 4 years of age and older. The child stacks pieces of hurt. This is concrete and would be a potential choice for use with this girl. The FACES scale can be used in children as young as 3 years. The faces are generic line drawings indicating increasing degrees of distress. The child points to the one indicating how he or she feels. This could be effective with the girl who functions as an 8-year-old. The other scales are not likely to work as well for rating this child's pain. The Adolescent Pediatric Pain Tool is useful with children ages 8 years to age 17 years. The hurt is colored, a scale rates severity, and a word list is used to describe pain. This is most likely too complex for the child with Down syndrome. The same is true for the word-graphic scale. Children between 4 years and 17 years have used it. The child is asked to indicate the level of pain on the scale following an explanation of the descriptors. This activity may not hold the attention of the child with Down syndrome and may be too wordy for adequate comprehension. Often children regress to an earlier developmental level when stressed by illness, and a simpler scale is more effective. When possible, teaching the child to use the scale prior to a painful experience aids in getting reliable feedback. pg 416

An infant born to a mother who was HIV positive was tested at birth and found to be negative. The infant is scheduled for follow-up testing. Which test would the nurse expect to be performed?

Polymerase chain reaction (PCR) test The PCR is the preferred test to determine HIV infection in infants over 1 month of age. The ELISA is positive in infants of HIV-infected mothers because of transplacentally received antibodies. These antibodies may persist and remain detectable up to 24 months of age, making the ELISA test less accurate at detecting HIV infection in infants and toddlers than the PCR. The platelet count would provide no information about the infant's HIV status. CD4 counts would be used to monitor HIV infection but not to confirm whether the infant is positive or negative for the virus.

The nurse is preparing to give a 4-month-old an oral medication. Which technique demonstrates the nurse's accurate knowledge of the infant's developmental level?

Position the infant upright, offer the infant a bottle of formula, remove the bottle and squirt the medication on the side of the tongue towards the cheek, then offer the infant the bottle again. Proper medication administration for an infant includes the following: Position the infant upright, present a pleasant- or neutral-tasting substance to ensure that the child is awake and swallowing, give the medication slowly enough to allow the child to swallow and prevent any risk of aspirating, and give a pleasant-tasting "chaser." An infant should not be placed supine since this would increase the risk of aspiration. Medications should not be placed in a patient's staple food to avoid an aversion to the food in the future. pg 379

A mother of a 3-year-old asks the nurse about what kinds of toys would be appropriate. The nurse would suggest which of the following? a) 100-piece jigsaw puzzles b) Pounding bench c) Memory games d) Bicycle with training wheels

Pounding bench

A 12-year-old boy has just undergone a liver transplantation and is recovering. After performing a finger stick puncture and assessing the results, the nurse administers a 10% solution of dextrose IV. What is the correct rationale for this intervention?

Prevention of hypoglycemia Hypoglycemia is a major danger following liver transplantation because glucose levels are regulated by the liver, and the transplanted organ may not function efficiently at first. Assess serum glucose levels hourly by finger stick puncture. A 10% solution of dextrose IV may be necessary to prevent hypoglycemia. Careful tissue matching before the transplantation is needed to reduce the possibility of stimulating T-cell rejection. Sodium, potassium, chloride, and calcium levels are evaluated approximately every 6 to 8 hours to be certain electrolyte balance is maintained, but potassium is rarely added to IV solutions because of the risk that renal failure has occurred. IV therapy with hypotensive agents such as hydralazine (Apresoline) and nitroprusside may be needed to reduce hypertension

The nurse is taking a health history and examining a 3-year-old boy. Which action is most important for the parents to take?

Protect the child from all tobacco smoke First-, second-, and third-hand tobacco smoke has been shown to have many detrimental effects on children. This is the first lifestyle change the parents should make. All other actions are important, and if not changed, can have negative effects on the preschooler's growth and development. However, they are not known to be as harmful as tobacco smoke.

On the first postoperative day, a 4-year-old who was hospitalized for an emergency appendectomy has begun to cry relentlessly, will not let the nurse touch her, and keeps asking for her mother. The pediatric nurse is aware that this patient is in which stage of separation?

Protest

A client tells the nurse that she has noticed an increase in her weight and fat deposits during the last year. The nurse reviews the client's chart and recognizes that the client is most likely going through puberty. Which nursing action is most appropriate at this time?

Provide reassurance that these are normal changes.

A client tells the nurse that she has noticed an increase in her weight and fat deposits during the last year. The nurse reviews the client's chart and recognizes that the client is most likely going through puberty. Which nursing action is most appropriate at this time?

Provide reassurance that these are normal changes. Increased fat deposits and weight and height changes are normal as girls begin hormonal changes of puberty. During adolescence, girls are very sensitive about their appearance and constant need for reassurance. Puberty is a period when children are very self-conscious about their overall appearance. Reassurance needs to be provided that increased fat deposits and weight and height changes are normal

What shows the nurse's understanding of age-appropriate distraction interventions?

Providing action-oriented video games to a 15-year-old male client Action video games have demonstrated a unique ability to engross teenagers' attention. Therefore, they are likely to be applicable to other teenagers. Blow bubbles are an intervention more suitable to a preschool-aged child, not a teenage girl. A storybook is more suitable for a preschool- or school-aged child, not a 13-year-old. Puppets are more suitable for a preschool-aged child, not a 10-year-old girl.

The student nurse is working on a program to address barriers to immunizations. Which would be an example of an intervention that the student nurse should include?

Providing combination vaccines to reduce the number of shots the child is to receive. One of the top parental concerns regarding vaccine safety is that too many vaccines are given during a single office visit. Manufacturer-produced combination vaccines address this issue. Scheduling separate appointments for each child in a family actually increases the barriers to proper immunization. Modified vaccine schedules can put the child at risk for contracting a disease. Free immunizations can be administered at a variety of agencies, not just public health agencies. pg 262

The nurse at an outpatient facility is obtaining a blood specimen from a 9-year-old girl. Which technique would most likely be used?

Puncturing a vein on the dorsal side of the hand The usual sites for obtaining blood specimens are veins on the dorsal side of the hand or the antecubital fossa. Administration of sucrose prior to beginning helps control pain for young infants. Accessing an indwelling venous access device may be appropriate if the child is in an acute care setting. An automatic lancet device is used for capillary puncture of an infant's heel.

The nurse is performing an examination of the eyes of a 7-year-old girl. Which finding would indicate that the third cranial nerve is intact?

Pupil constriction in response to light If the pupil constricts (reduces in size) in response to the light, it is confirmation the third cranial nerve is intact; it should not dilate. The eyelid blinking in response to touching the cornea with a wisp of cotton is a test of the blink reflex, but should not be performed in children, as it can be painful and frightening to them. During a Hirschberg test, the light of an otoscope should reflect evenly off both pupils if they are in equal alignment. Page 295

The nursing staff at the clinic are discussing the best way to encourage cooperation from young pediatric clients during screenings. Which suggestion would be appropriate?

Purchase stickers or make coloring pages to be given to the children after the screening is completed. Young children respond well to a reward system. Allowing them to have a sticker or a coloring page after the screening is finished will encourage cooperation. They should not be permitted to play with equipment that is dangerous (syringes/medication) or should be sterile when used on them. Playing with medication is contraindicated also because it gives the illusion that medication is a toy. Allowing a child the choice of completing the reward before the screening will hinder cooperation...the child should only complete the reward after screening.

A child is having difficulty swallowing pills. What is the best action for the nurse to take at this time to help this child swallow medications?

Put the pills in some ice cream or applesauce. A useful technique when children cannot swallow pills is to put them into some ice cream or applesauce. Do not use candy for practice, because you do not want to suggest that medicine is the same as candy. Never crush medications if it is contraindicated. The nurse should always administer a prescribed medication, even if doing so may be difficult. pg 378

Parents comment that their son seemed more coordinated on the basketball floor at 12 years than he does now at 14. The nurse can include what information in the response?

Rapid and uneven growth of early adolescence (11 to 14 years) can interfere with coordination. Uneven growth of soft tissues and bones during growth spurts can cause decreased coordination for boys. The age of 14 years is usually the time of peak height velocity (PHV).

A child diagnosed with acute glomerulonephritis will most likely have a history of:

Recent illness such as strep throat Symptoms of acute glomerulonephritis often appear one to three weeks after the onset of a streptococcal infection such as strep throat.

The nurse is reviewing documentation on a client's chart. The physician has referred to parens patriae. When considering this notation, what should be included in the client's plan of care?

Recognize the child's care has been ordered by the state. Generally the parents of a minor child have the right to make care decisions. In the event the parents have decided on a course of nontreatment, the state may intervene and overrule the parents. In this case an order for treatment to continue can be made by the courts. This is referred to as parens patriae (the state has a right and a duty to protect children).

While examining a child, the nurse notes quiet, soft sounds each time the stethoscope is moved over the child's chest. The nurse knows that these are not breath sounds. What actions should the nurse take? Select all that apply.

Record the location and timing of the sounds. Auscultate with the child lying down. Auscultate with the child sitting up. Refer the child for further evaluation. The sounds described are characteristic of a grade 2 heart murmur. The child's heart should be auscultated with the child in two different positions—upright and reclining. Innocent murmurs often disappear when the child's position is changed. Recording the location and timing of the sounds is important to further evaluation and in determining the type and meaning of the murmur. A child with a heart murmur needs further evaluation by an experienced examiner. pg 301

What suggestions regarding the evaluation of a childcare center would the nurse share with a preschooler's mother?

Specific program goals to be accomplished should be available.

A nurse practitioner suspects that a child has scarlet fever based on which assessment finding?

Red, strawberry tongue. The characteristic assessment finding that distinguishes scarlet fever from other disorders is the appearance of the red, strawberry tongue. Sore throat, an enanthematous and exanthematous rash, and white exudate on the tonsils are also seen with scarlet fever, but it is the strawberry tongue that helps to confirm the diagnosis.

The nurse is assessing an adolescent for a rule-out appendicitis. The nurse is aware the appendix is located in the right lower quadrant. The teenager is complaining of pain in the left lower quadrant. What type of pain should the nurse document?

Referred pain Referred pain is pain that is perceived at a site distant from the point of origin. Appendicitis appears with referred pain during assessment. Chronic pain is ongoing, localized pain is with a superficial injury, and cutaneous pain is another name for localized pain. pg 411

Included in the nursing care plan for the child receiving total parenteral nutrition (TPN) will be which intervention?

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). page 401

The nurse is preparing to apply restraints to a child who has become combative. What actions will be included in the nurse's plan of care? Select all that apply.

Remove restraints and perform range of motion activity every 2 hours. Explain to both the child and parent the restraints are not a form of punishment. Document application of restraints in the child's medical record. Before applying a restraint, explain the reason for the restraint to the child and the parents. Emphasize that the rationale is to maintain the child's safety; the restraint is not punishment. Having the child and parents state the reason for the restraint demonstrates their understanding. After applying the restraints an initial assessment must be performed in 15 minutes and then every hour. At least every 2 hours the restraints should be removed and range of motion performed. The restraints are to be tied to the bed or crib frame and not the bed's side rails. pg 326

The nurse is administering the drug cyclophosphamide (Cytoxan) to a child who has severe systemic lupus erythematosis (SLE). What body system is the nurse most concerned with adverse effects immediately after administration of this drug?

Renal Cyclophosphamide (Cytoxan) is a cytotoxic drug that interferes with normal function of DNA by alkylation, and is given for treatment of severe SLE. The medication is very nephrotoxic; therefore, the nurse must provide adequate hydration and have child void frequently during and after infusion to decrease risk of hemorrhagic cystitis.

The nurse is working with the mother of a 6-year-old girl to think of an effective means of distracting the girl from a painful procedure that she will shortly undergo. To be effective, the distraction technique must have which characteristics?

Requires concentration of the child When helping parents choose a distraction technique such as blowing soap bubbles with their child, be certain they do not interpret "distraction" as just talking to the child or suggesting a video game to divert attention. Although these are distractions, a distraction activity must require concentration; simple distractions can allow pain to break through. The other answers listed are not necessary as a part of distraction techniques. pg424

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?

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 and it is not necessary to inform the prescribing practitioner. pg 388

The nurse is attempting to control the infectious process while caring for a client. The nurse changes the client's wound dressing when the dressing becomes soiled. Which link of the chain of infection is the nurse interrupting with this intervention?

Reservoir The reservoir is the place where a microorganism grows and reproduces. Dressings left unchanged leave a dark, warm, moist environment for microorganisms to thrive. Covering the mouth and using personal protective equipment are ways to control portals of exit. Modes of transmission can be controlled with hand washing and personal protective equipment. The susceptible host is the person who is susceptible to develop an infection. Promotion of natural defenses is a good way to prevent infection.

When doing a health assessment on a child, the nurse should include a physical assessment. What is the most important thing to assess first when performing the physical assessment?

Respirations The assessment of respirations should always be done first. Completing other parts of the physical assessment could influence the count of respirations.

The charge nurse is planning staffing on a pediatric unit. The charge nurse is aware that the majority of admissions for children under the age of 5 years are for diseases of which body system?

Respiratory According to Child Health USA 2010, diseases of the respiratory system, such as asthma and pneumonia, account for the majority of hospitalizations in children younger than 5 years of age, while diseases of the respiratory system, mental health problems, injuries, and gastrointestinal disorders lead to more hospitalizations in older children. page 313

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?

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. pg 428

The mother of a child who has been termed to have a "difficult" temperament voices frustration in managing his care. What would be the best initial course of action by the nurse for this parent?

Review strategies that are beneficial in the care of a child with a difficult temperament. Difficult temperament children have challenges with regard to behavior. These children may be frustrating to their caregivers and parents. The best course of action would be to provide coping strategies and suggestions for how to best manage the care of the child. Labeling the child should be avoided. The remaining options may be beneficial but are not of the highest priority

When providing care to a child with vesicoureteral reflux (VUR), which nursing diagnosis would be the priority?

Risk for infection When vesicoureteral reflux is present, the primary goal is to avoid urine infection so that infected urine cannot gain access to the kidneys. Fluid volume typically is not a problem associated with VUR. Nutritional problems are not associated with VUR. Activity intolerance is not associated with VUR

The mother of a 4-month-old refuses for her baby to be "stuck" when immunized. What immunization will the nurse administer under these restrictions?

Rotavirus Rotavirus is the only vaccine given orally. All the others are injected. Because of the ease of administration, oral polio vaccine containing a live virus continues to be used in underdeveloped countries. Vulnerable individuals are at risk for infection from live viruses excreted in the stool. This is the reason why only injected polio vaccine is used in the United States.

While enrolled in a geography course, a student nurse learns that diarrheal illness is deadly for large numbers of infants in Third World countries. What vaccine will this nursing student identify as part of the solution to this problem?

Rotavirus (RV) Rotavirus is a very common cause of gastroenteritis among young children that spreads readily via the fecal-oral route. The disease is most severe in children between 4 and 23 months, causing severe, watery diarrhea that results in dehydration. The other vaccines do not prevent diarrheal illness. pg 261

A nurse is assessing a child who was recently adopted from a foreign country and has not yet received any immunizations. The child has a high fever, rhinitis, and sore throat. The nurse also notes small, irregular, bright red spots on the buccal membrane. What would the nurse suspect?

Rubeola Small, irregular, bright red spots on the buccal membrane suggest Koplik spots and, together with the child's other assessment findings, suggest rubeola. Koplik spots distinguish the disease because none of the other exanthems has this finding. Rubella is characterized by a low-grade fever, mild cough, sore throat, and red maculopapular rash. Varicella is characterized by a low-grade fever, malaise, and rash that begins as a macule and progresses to a papule and then a vesicle. Variola is characterized by chills, fever, headache, vomiting, and the appearance of a rash and high fever after 3 to 4 days.

The nurse is conducting a skin assessment of a newborn. The examination reveals a light pink macule on the back of the neck. The nurse understands that this is a normal variation and is most likely which type of birthmark?

Salmon nevus A light pink macule on the back of the neck is a salmon nevus or "stork bite." A nevus flammeus (port wine stain) is dark purple-red. It is a flat patch that grows with the child. Petechiae are pinpoint reddish macules that do not blanch when pressed. Purpura are large purple macules created by bleeding under the skin.

A 6-year-old child is brought to the clinic by his parents. The parents state, "He had a sore throat for a couple of days and now his temperature is over 102° F (38.9° C). He has this rash on his face and chest that looks like sunburn but feels really rough." What would the nurse suspect?

Scarlet fever Scarlet fever typically is associated with a sore throat, fever greater than 101° F (38.9° C), and the characteristic rash on the face, trunk, and extremities that looks like sunburn but feels like sandpaper. CAMRSA is typically manifested by skin and tissue infections. Diphtheria is characterized by a sore throat and difficulty swallowing but fever is usually below 102°F . Airway obstruction is apparent. Pertussis is characterized by cough and cold symptoms that progress to paroxysmal coughing spells along with copious secretions

The nurse is preparing a female toddler for the repair of an eyebrow laceration. The girl is most likely to demonstrate which response in anticipation of the procedure?

Scream and cling tightly to her parent. A toddler is most likely to show regressive behaviors such as clinging and crying loudly. Preschoolers may say they need to go to the bathroom or get an item from another place to try to postpone the procedure. School-age children are more likely to withdraw into supposed inattention or silence and show muscular tension. Adolescents may look stoic in order to appear in control of themselves, or they may ask many questions (intellectualizing). pg 413

The nurse is instructing a group of women of childbearing age about human immunodeficiency virus (HIV) during pregnancy. What would be a priority recommendation in this setting?

Screening for HIV No screening mandate has been put forth for HIV, but all pregnant women should be encouraged to undergo this test. Prophylactic treatment would be initiated only once the woman has been screened. Screening for STIs and ensuring proper nutrition are also part of health promotion for women in this age group, but they are of lower priority than identifying HIV-positive individuals.

A child with heart disease is receiving digoxin and a diuretic. Which laboratory test result would be most important for the nurse to monitor?

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 teaching healthy eating habits to the parents of a 7-month-old girl. Which recommendation is the most valuable advice?

Serve new foods several times When introducing a new food to an infant, it may take multiple attempts before the child will accept it. Parents must demonstrate patience. Letting the child eat only the foods she prefers, forcing her to eat foods she does not want, or actively urging the child to eat new foods can negatively affect eating patterns.

A 16-year-old client has been hospitalized 100 miles from home for a week. She is recovering from surgery to repair a broken kneecap, an injury incurred while skateboarding. She was cheerful and chatty when she first arrived, but the nurse notes in recent days she has become increasingly quiet and seems lonely. Which nursing intervention would be most appropriate for this client?

Show her where the teen lounge in the hospital is so she can meet other teens, use a phone, and check her e-mail. Adolescents need access to their peers so they can keep up social contacts. Access to a phone, computer, and e-mail will help the teen stay connected. Recreation areas are important. In settings specifically designed for adolescents, recreation rooms can provide an area where teens can gather to do schoolwork, play games and cards, and socialize.

Before administering an immunization to their child, the nurse asks parents to take which priority action?

Sign a consent form Parents must sign a consent form before immunization of the child after receiving full information about the vaccines, their importance, and their administration. Reassuring the child and assisting in restraining are both important but are not the priority. Having the child's immunization record with them allows this record to be updated; otherwise, a full record should be given to the parent. pg 251

The nurse is preparing to perform an assessment on a child who has recently been diagnosed with a chronic disease. The previous shift nurse reports that the father of the child is not dealing well with the diagnosis and appears to be in the anger phase response to illness. What actions should the nurse take to ensure safety? Select all that apply.

Sit close to the doorway when talking with the child and father. Ask another nurse to assist with the assessment. Approach the child and father in a calm manner, showing empathy for the situation. Sitting close to the doorway allows the nurse the ability to leave the room for assistance in case the father becomes excessively angry or abusive. Taking another nurse into the room will free one of the nurses to exit the room for assistance, if necessary. Empathy shows concern and compassion for the situation, which encourages a therapeutic working relationship between the nurse and father. While security may be notified of the potential need for their assistance, standing outside the room is likely to fuel the anger of the father. The nurse should speak and make eye contact with both the child and father to show interest in both parties. Page 273

Which developmental milestone would the nurse expect an 11-month-old infant to have achieved?

Sitting independently Infants typically sit independently, without support, by age 8 months. Walking independently may be accomplished as late as age 15 months and still be within the normal range. Few infants walk independently by age 11 months. Building a tower of three or four blocks is a milestone of an 18-month-old. Turning a doorknob is a milestone of a 24-month-old.

What are some negative effects that chronic pain can have on the pediatric population?

Sleep disturbances, exhaustion, irritability, mood disturbances, and depression The effects of chronic pain on the child may include sleep disturbances, exhaustion, irritability, mood disturbances, and depression. Heart rate and blood pressure typically return to normal values with chronic pain. pg 410

A young boy is in the emergency department with swelling and pain in the right ankle. He states that he was playing soccer, somehow twisted the ankle, and could not walk off the field. The physician tells the client that it is only a sprain. Which type of pain is this client experiencing?

Somatic Somatic pain originates from deep body structures, such as muscles or blood vessels. The pain of a sprained ankle is somatic pain. pg 410

A 3-year-old is scheduled for a surgery to correct undescended testes. An important postoperative consideration the nurse would want to prepare the parents for is:

Some discomfort at the surgery site. After they are returned to the scrotum, testes may be sutured there to prevent them from returning to the abdominal cavity. This produces a "tugging" or painful sensation.

The nurse is assessing the development of a 15-month-old girl during a regular visit. Which of the following skills would the nurse expect to see? a) Stands alone b) Feeds herself with a spoon c) Runs to her mother d) Points to her nose and mouth

Stands alone

The caregiver of a child diagnosed with celiac disease tells the nurse that the child has large amounts of bulky stools and what looks like fat in his stools. The clinical manifestation this caregiver is describing is:

Steatorrhea. Steatorrhea (fatty stools) is a classic symptom of celiac disease. Currant jelly stools are a sign of intussusception. Projectile vomiting is a sign of pyloric stenosis.

Place these primitive protective reflexes of infancy in the order in which they will disappear as the child matures.

Step Root Moro Plantar Babinski Page 71

A 16-year-old tells you she has terrible dysmenorrhea. Which action prostaglandinwould be the best health teaching measure regarding this?

Take over-the-counter ibuprofen for its prostaglandin action. An anti-inflammatory medication is most helpful in reducing the discomfort of dysmenorrhea.

An adolescent girl and her caregiver present at the pediatrician's office. The adolescent reports severe abdominal pain. A diagnosis of pelvic inflammatory disease is made. The nurse notes in the child's chart that this is the third time she has been treated for PID. Which action by the nurse would be most appropriate?

Take the child to a private room and interview her regarding her sexual history and partners. Adolescents must be made aware of the seriousness of PID, a common result of a chlamydial infection. Pelvic inflammatory disease can cause sterility in the female, primarily by causing scarring in the fallopian tubes that prohibits the passage of the fertilized ovum into the uterus. A tubal pregnancy may be the consequence of a chlamydial infection. In the male, sterility may result from epididymitis caused by a chlamydial infection. All sexual partners must be treated.

An adolescent girl and her caregiver present at the pediatrician's office. The adolescent reports severe abdominal pain. A diagnosis of pelvic inflammatory disease (PID) is made. The nurse notes in the child's chart that this is the third time she has been treated for PID. The most appropriate action by the nurse would be to:

Take the child to a private room and interview her regarding her sexual history and partners. Pelvic inflammatory disease can cause sterility in the female primarily by causing scarring in the fallopian tubes that prohibits the passage of the fertilized ovum into the uterus. Adolescents must be made aware of the seriousness of PID, a common result of a chlamydial infection. Be certain to provide the adolescent with a private interview. The adolescent may be extremely reluctant to reveal either social or sexual history especially in the presence of a family member.

The caregiver of a child being treated at home for acute glomerulonephritis calls the nurse reporting that her daughter has just had a convulsion. The child is resting comfortably but the caregiver would like to know what to do. The nurse would instruct the caregiver to do which action?

Take the child's blood pressure and report the findings to the nurse while the nurse is still on the phone. Blood pressure should be monitored regularly using the same arm and a properly fitting cuff. If hypertension develops, a diuretic may help reduce the blood pressure to normal levels. An antihypertensive drug may be added if the diastolic pressure is 90 mm Hg or higher. The concern is immediate so reporting the findings in a few hours could delay needed treatment. The child should be weighed daily in the same clothes and using the same scale, but the blood pressure is the priority in this situation.

Urine that stands at room temperature for any length of time changes composition.

True For best results, specimens collected should be fresh because urine that stands at room temperature for any length of time changes composition.

Parents of 3-year-old son ask the nurse for suggestions on how to deal with their son's nightmares. Which suggestion would be least effective? a) Talk to him that night about the details of the dreams. b) Search the room to show him that there aren't any monsters. c) Try reassuring him that it was a dream and not real. d) Try having him sleep with a nightlight on in his room.

Talk to him that night about the details of the dreams.

The activity that would best foster the developmental task of an adolescent who is physically challenged would be:

Talking to another adolescent who has a similar disorder. A sense of identity is developed by "trying on" roles and discussing values and goals with others.

An 18-year-old reveals that she has a nipple ring and is looking to get a tattoo in the next few months. What is the most important thing that the nurse can teach her at this time?

Tattooing carries risks such as infection, disease, and nerve damage

Jamie, an 18-year-old, comes to the clinic. In the health history she reveals that she has a nipple ring and is looking to get a tattoo in the next few months. What is the most important thing that the nurse can teach her at this time?

Tattooing carries risks such as infection, disease, and nerve damage. The nurse needs to emphasize that tattoos and body piercing can be painful, and carry risks of complications such as infection, blood-borne diseases, keloids and granulomas, allergic reactions, excessive bleeding, nerve damage, or damage to the piercing site. Complications are more likely if they tattoo themselves or have the tattoos done by a friend. The nurse needs to encourage the adolescent to seek the expertise of a trained technician, doctor, or nurse to have the piercing, tattooing, or branding done

To decrease childhood mortality, pediatric nurses need to consistently engage in what activity throughout all age groups?

Teach injury prevention and proper safety practices. The leading cause of death throughout childhood is unintentional injury. pg 15

The home health nurse, who is visiting the home of a 4-year-old, prepares a nursing care plan with the nursing diagnosis of "At risk for injury related to the parents insufficient knowledge of safety practices for preschooler." Which nursing interventions should the nurse include in the plan of care? Select all that apply.

Teach the parents to use a forward-facing car seat with harness and top tether. Teach the parents that the preschooler should use an approved bicycle helmet when riding a bicycle at any time.

The nurse is caring for a 13-year-old girl. As part of a routine health assessment the nurse needs to address areas relating to sexuality and substance use. Which statement or question should the nurse say first to encourage communication?

Tell me about some of your current activities at school. The nurse should first begin with open-ended questions regarding work, hobbies, activities, and friendship in order to make the teen feel comfortable. Once a trusting rapport has been established, the nurse should move on to the more emotionally charged questions. While it is important to assure confidentiality, the nurse should first establish rapport. Page 273

The nurse at the pediatrician's office receives a call from the mother of a child who has just been bitten by the neighbor's dog. What action would be the priority?

Tell the mother to seek medical help immediately. The mother should seek medical help for her child immediately. Once the child has been seen by a physician, it can be determined whether immunoprophylaxis is necessary. Education about animals is important to prevent any recurrent bites, but this is appropriate only after the child has been seen and a plan has been determined. Flu-like symptoms such as fever occur early in rabies infection. However, the child must be seen first. Explaining how to care for the bite would be done only after the child is seen and an appropriate plan is determined.

A client's mother informs the nurse that she has a hard time getting her 6-year-old son to take medication at home. Which would be the best suggestion for the nurse to offer this mother to help correct this problem?

Tell the mother to state firmly, "It's time for you to drink your medicine." The best guideline for the mother to help in getting a child to take his medication is to state firmly, "It's time to take your medication." Asking or pleading with the child does not work. Firmness is required. Adults also should never refer to medicine as candy. If a child happens to like a medicine, he or she may help themselves to it, and consuming too much can be fatal. pg 377

The nurse is assessing a 10-day-old infant for dehydration. Which finding indicates severe dehydration?

Tenting of skin Tenting of skin is an indicator of severe dehydration. Soft and flat fontanels indicate mild dehydration. Pale and slightly dry mucosa indicates mild or moderate dehydration. Blood pressure of 80/42 mm Hg is a normal finding for an infant.

A single mother has brought her 9-month-old, recently adopted Chinese daughter for a health supervision visit. Although there are screening documents from China and the child seems healthy, the nurse plans to screen for infectious diseases. What explains the nurse's caution?

Testing by the child's home country is unreliable. Documents from many foreign countries have proven unreliable. Universal screening is recommended for internationally adopted children. Insidious symptoms are common to infants overall. Pediculosis is not an infectious disease (lice do not carry disease). Internationally adopted children generally come from areas with prevalence of infectious disease, so having come from a rural area is not a particular risk indicator. p 238

The nurse is caring for a 5-month-old boy with an undescended left testis. What would the nurse identify as indicative of true cryptorchidism?

Testis cannot be "milked" down inguinal canal With true cryptorchidism, the retractile testis cannot be "milked" down the inguinal canal. Fluid in the scrotal sac is a hydrocele. A venous varicosity along the spermatic cord is a varicocele. Testis that can be brought into the scrotum refers to a retractile testis.

A newborn has been diagnosed with a congenital heart disease. Which congenital heart disease is associated with cyanosis?

Tetralogy of Fallot Tetralogy of Fallot is associated with cyanosis. The defects include ventricular septal defect (VSD), right ventricular hypertrophy, right outflow obstruction, and overriding aorta. Coarctation of aorta, pulmonary stenosis, and aortic stenosis are acyanotic heart diseases and are not associated with cyanosis

The nurse is interacting with several families with children during their health visits. Which child would the nurse prioritize to receive a hearing screening?

The 3-week-old infant who was discharged without a hearing screening Healthy People 2020 details the objective to increase the proportion of newborns who are screened for hearing loss by the age of 1 month. The 3-week-old infant would need to be screened since a screening was not done previously. The other choices indicate the screening is not recommended due to it previously being completed and there are not indications of hearing loss. page 243

The nurse is assessing the psychosocial development of an an adolescent. The nurse determines that the client is in the middle post-conventional phase with which observation?

The adolescent tells the nurse, "I'm starting to think that some of my friends care a lot more about what other people think of them than what I do." According to Kohlberg, the middle post-conventional phase is characterized by the adolescent developing their own set of morals by evaluating individual morals in relation to peer, family, and societal morals. This is demonstrated when the adolescent stated. The early post-conventional phase is characterized by asking broad, usually unanswerable questions about life such as the question about God. During the late post-conventional phase the adolescent internalizes their own morals and values, and continue to compare own morals and values to those of society. During this phase the adolescent also evaluates morals of others.

In working with an infant, the nurse recognizes what as a characteristic of the infant?

The child grows and develops skills more rapidly than at any other time in their life. The infant grows and develops skills more rapidly than she ever will again. The toddler insists she can do things one minute and then becomes dependent the next minute. The preschool age child soaks in information and asks "why" and "how" over and over. The school-age child has a longer attention span and can become absorbed in a craft or activity for several hours. Page 64

During assessment of a pediatric client, what factor makes the nurse concerned that the pulse oximetry reading is inaccurate?

The child has a hemoglobin reading below normal The hemoglobin of the RBC carries oxygen, so low hemoglobin can cause inaccurate readings of oxygen saturation levels. Pneunomia may cause the oxygen saturation to be low because of poor gas exchange, but the diagnosis will not cause the pulse oximeter measurement to be inaccurate. The probe may be placed on the finger, toe, ear, foot, or forehead. Alarms on pulse oximeters are typically set to alarm when the saturation falls below 90%

A caregiver brings her 7-year-old son to the pediatrician's office, concerned about the child's bedwetting after being completely toilet trained even at night for over 2 years. The caregiver further reports that the child has wet the bed every night since returning home from a one-week fishing trip. The child refuses to talk about the bedwetting. The nurse notes the child is shy, skittish, and will not make eye contact. Further evaluation needs to be done to rule out what possible explanation for the bedwetting?

The child has been sexually abused, maybe on the fishing trip Enuresis may have a physiologic or psychological cause and may indicate a need for further exploration and treatment. Enuresis in the older child may be an expression of resentment toward family caregivers or of a desire to regress to an earlier level of development to receive more care and attention. Emotional stress can be a precipitating factor. The health care team also needs to consider the possibility that enuresis can be a symptom of sexual abuse. Bruising, bleeding, or lacerations on the external genitalia, especially in the child who is extremely shy and frightened, may be a sign of child abuse and should be further explored.

A 9-month-old child has been admitted to rule out sepsis. Which finding offers the most support to the presence of this disorder?

The child has had 8 ounces of formula in the past 24 hours. Sepsis is a systemic overresponse to infection resulting from bacteria and viruses, which are the most common fungi, viruses, rickettsia, or parasites. It can lead to septic shock, which results in hypotension, low blood flow, and multisystem organ failure. Signs of sepsis include a lack of appetite, letheragy, hypotonia, and temperature elevations.

During the health history of a 2-month-old infant, the nurse identified a risk factor for developmental delay and is preparing to screen the child's development. Which risk might the nurse have found?

The child has small eyes and chin. Congenital facial malformations are developmental warning signs. Neonatal conjunctivitis, when properly treated, has no long-term effects on development. Parents who are college students are not risk factors as would be high school dropouts. A 36-week birth is not a warning sign, but 33 weeks or less is.

In discussing with the nurse their 2-year-old's behavior, which of the parents' descriptors suggests the child may be ready for toilet teaching? a) The child often removes her shoes and socks. b) The child frequently repeats words parents just said. c) The toddler walks with a wide, swaying gait. d) The child hides behind her bedroom door when defecating.

The child hides behind her bedroom door when defecating.

What best describes Erikson's psychosocial development task for the adolescent child?

The child is developing her own personal identity. The adolescent is developing their own personality and identity. The developmental task for the school-age child is to develop a sense of industry and completing activities builds that feeling of confidence. Erikson's psychosocial developmental task for toddlers is to achieve autonomy (independence) and do things on their own. Learning to speak and to understand and respond to discipline are not developmental tasks according to Erikson

The nurse is reviewing the assessment data from a 4-year-old admitted to the hospital for management of early onset sepsis. Which finding supports the diagnosis?

The child is irritable Sepsis may be associated with lethargy, irritability, or changes in level of consciousness. The septic child will likely not be anxious to have a high activity level and would prefer to remain in bed. The temperature elevation of 98.8 °F (37.11°C) is not significant and does not confirm the presence of sepsis.

An 11-year-old boy is lying quietly in bed watching a DVD. This is his first postoperative day following open reduction of an ankle fracture. One nurse concludes the child does not need his PRN pain medication; another nurse disagrees. Which of the possibilities described is likely to be true? Select all that apply.

The child may be concerned about getting a "shot" and is avoiding the display of pain behaviors. The 11-year-old is using the DVD to withdraw from his discomfort and is lying still to avoid movement, which exacerbates his pain. The school-ager may be more concerned about the treatment for the pain (shot) than the pain itself. Also, he may feel he should be brave and "deal" with his pain without complaint. Watching the DVD as a way to withdraw and lying still to avoid pain related to movement are likely coping behaviors and not indicators of lack of pain. At 11 years old, the child does have the capability to recognize and describe his pain but may need to be encouraged to do so. pg 413

The nurse is advised in the change of shift report that a child on the unit is considered a "mature minor". What criteria must this child meet to be considered in this role?

The child must have the maturity to understand the information provided related to his condition and planned course of treatment. In some states, a mature minor may give consent to certain medical treatment. The physician must determine that the adolescent (usually older than 14 years of age) is sufficiently mature and intelligent to make the decision for treatment. The provider also considers the complexity of the treatment, its risks and benefits, and whether the treatment is necessary or elective before obtaining consent from a mature minor.

The nurse working in the emergency department is caring for an 8-year-old male who was hit by a car while running across the street and has suffered extensive abrasions, contusions, and broken bones. IV morphine analgesia has been given. The child is unable to follow simple directions to allow for procedures to be completed. What is the best action to take for this child?

The child should be sedated. If a child is unable to follow directions and allow a procedure to proceed safely with analgesia alone, the child should be sedated. Children are routinely restrained without sedation or analgesia for painful procedures, something that would be unthinkable with an adult. This would not be an appropriate intervention. The child is in too much pain to understand an explanation at this point.

The nurse is conducting a physical examination of a 5-year-old girl. The nurse asks the girl to stand still with her eyes closed and arms down by her side. The girl immediately begins to lean. What does this tell the nurse?

The child warrants further testing for cerebellar dysfunction. This indicates a positive Romberg test which warrants further testing for possible cerebellar dysfunction. Page 307

The nurse is reviewing the documentation from a previous shift concerning the client's scoring on the FLACC scale. The score concerning the assessment of the child's face reports a score of "2". What can be inferred by this?

The child was fretful and grimacing. The FLACC is a scale used to assess behaviors in an attempt to determine pain levels being experienced. A score of "2" indicates the child appears to be in distress. The lower the scores the less pain anticipated. A score of "0" would be documented if the child was resting and displaying no obvious signs of discomfort. A score of "1" would be given in the event the child appeared sad or withdrawn. pg 420

The nurse is examining the heart and peripheral perfusion of an 8-year-old. The nurse will assess the apical impulse at which location?

The fifth intercostal space lateral to the left midclavicular line The apical pulse can be found at the fifth intercostal space lateral to the left midclavicular line in children over 7 years of age. The apical pulse's point of maximal intensity is at the fourth intercostal space just medial to the child's left midclavicular line until age 4 years and at the fourth intercostal space at the left midclavicular line from ages 4 to 6 years. The fifth intercostal space medial to the left midclavicular line incorrectly locates the apical pulse medially rather than laterally for someone over 7 years. Page 301

A newborn is diagnosed with hypospadias and the parents want him to be circumcised. What would be the best response by the nurse?

The foreskin is needed for repair. A child's foreskin is not removed since it is needed to help repair a hypospadias. Once the hypospadias is repaired, a circumcision can be performed at the same time. Meatal stenosis has to do with the urethral opening diameter, not the placement

What is a true statement regarding measles?

The incubation period is 10 to 12 days. The typical incubation period is 10 to 12 days. Outbreaks peak in the winter and spring. It is highly contagious and is transmitted by airborne suspended droplets

What action shows an example of Erik Erikson's developmental task for the infant?

The infant cries and the caregiver picks the child up. Erikson's psychosocial developmental task for the infant is to develop a sense of trust. The development of trust occurs when the infant has a need and that need is met consistently.

The nurse is conducting a physical examination of a 5-month-old boy. Which observation may be cause for concern about the infant's neurologic development?

The infant displays an asymmetric tonic neck reflex (fencing reflex). The tonic neck reflex normally disappears by age 4 months, the palmar grasp reflex by age 6 months, and the Babinski reflex (fanning of toes when sole of foot stroked) by 12 months. Retaining these primitive reflexes may indicate a neurologic abnormality. The anterior fontanel, which remains open for brain growth, closes between 12 and 18 months of age.

The nurse is completing a developmental assessment on a 6-month-old infant. Which findings indicate the need for additional follow-up? Select all that apply.

The infant does not pay attention to noises behind him. The infant has frequent episodes of crossed eyes. The infant seems disinterested in the surrounding environment. Warning signs that may indicate problems with sensory development include the following: young infant does not respond to loud noises; child does not focus on a near object; infant does not start to make sounds or babble by 4 months of age; infant does not turn to locate sound at age 4 months; infant crosses eyes most of the time at age 6 months. Language development at this stage of development does not include stringing together 2-word sentences. Page 74

A nurse is talking to and making facial expressions at a 9-month-old baby girl during a routine office visit. What is the most advanced milestone of language development that the nurse should expect to see in this child?

The infant says "da-da" when looking at her father By 9 months, an infant usually speaks a first word: "da-da" or "ba-ba." The other answers refer to earlier milestones in language development. In response to a nodding, smiling face, or a friendly tone of voice, a 3-month-old infant will squeal with pleasure or laugh out loud. By 4 months, infants are very "talkative," cooing, babbling, and gurgling when spoken to. At 6 months, infants learn the art of imitating. They may imitate a parent's cough, for example, or say "Oh!" as a way of attracting attention.

The nurse is reviewing topics to be discussed with caregivers related to caring for infants. Which statement would be the most appropriate statement for the nurse to make to this group of caregivers?

The infant sleeps 10-12 hours at night and take 2-3 naps during the day Most infants sleep 10-12 hours at night and take 2-3 naps. By being put to bed while awake and allowed to fall asleep, the infant learns good sleeping habits. The infant should be dressed in the same amount of clothing the adult finds comfortable. Hard-soled shoes are not needed by infants and may hamper the development of the foot.

Using knowledge of normal growth and development, what would be expected when observing a 12-week-old infant?

The infant smiles at significant others By 12 weeks of age the infant smiles at his mother and significant others. The other choices are seen in the infant who is about 20 weeks of age. Page 77

During the health history of a 3-month-old, the nurse identified risk factors for developmental delay and is preparing to assess the child's development. Which risk factors did the nurse find? Select all that apply.

The infant's mother is a single parent. The mother did not complete high school. Being a single parent and not having a high school education are risk factors that could result in developmental problems for the child. Often poverty is the underlying associated difficulty. The other findings should not intrude negatively on the infant's development. pg 239

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?

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 observing the parents and child during a health supervision visit. Which observation would alert the nurse to inquire and observe further?

The mother says, "Wait until we are finished with this doctor's visit and then I will take you to the bathroom." The parent is not responding the child's need to go to the bathroom, which would alert the nurse to inquire and observe further. The other choices are ideal responses from the parent, indicating they have a healthy parent-child interaction and dynamic. pg 237

A nurse is interviewing a mother who is about to deliver her baby. Which response would alert the nurse for a higher potential for a heart defect in the infant?

The mother states she has lupus. Having lupus while pregnant could contribute to a congenital heart defect. Acetaminophen and sleeping do not have an effect on a child developing a heart defect. The seizure medication can have an impact on the child having a heart defect, but not necessarily a history of seizures in the mother.

What is typical of a grade II heart murmur?

The murmur is soft but easily heard. When assessing heart murmurs, a grading scale is used to describe the sound of the murmur. A grade II heart murmur is usually soft and it is easily auscultated. page 302

The student nurse is reviewing the chart of a newborn. The document indicates the newborn is in the quiet alert state. Which is the best description of this sleep phase?

The newborn's eyes are open and no body movements are noted. The normal newborn moves through 6 stages of consciousness. The quite alert state is when the infant's eyes are open but the body is calm. Open eyes accompanied by body movements is characteristic of the active alert state. Page 65

The nurse is caring for a term infant suffering from meconium aspiration in the nursery. The nurse reviews orders for a peripherally inserted central catheter (PICC) line placement and intubation. Which statement demonstrates the nurse's knowledge of painful procedures and the newborn?

The newborn's pain pathway components are developed enough at birth to experience pain. pg 414 Neuroanatomical and neuroendocrine components of the pain pathway are sufficiently developed in the neonate to allow the transmission and perception of pain. While infants may not remember painful experiences as distinct actual events, the functional structures for long-term memory, specifically, the integrity of the limbic system and diencephalons, are well developed in newborns. These early painful experiences may be stored as procedural memory, not accessible to conscious recall. Ample evidence indicates that both term and preterm neonates have the capacity to experience and remember pain much like older children and adults do. Newborns should receive analgesia for painful procedures.

The nurse is administering medications to a 10-year-old girl who takes medications at home for a chronic condition. The child's mother is at the bedside. What are some guidelines for medication administration? Select all that apply.

The nurse compares the child's ID band with the medication record. The nurse reads the label on the side of the medication bottle. The nurse documents the medication administration after giving the medication. Check the drug label to confirm that it is the correct drug. Do not use a drug that is not clearly labeled. Check the identification bracelet each time that a medication is given to confirm identification of the client. Always double-check the dose by calculating the dosage according to the child's weight. Have another qualified person double-check any time that a divided dosage is to be given or for insulin, digoxin, and other agents governed by the facility's policy. Recording the administration of the medication, especially PRN medications, is critical to avoiding potential errors in medication administration.

Due to casts on both arms, the nurse must measure an 11-year-old client's blood pressure in the thigh. After placing the blood pressure cuff on the thigh, which action by the nurse demonstrates understanding of the procedure?

The nurse places the stethoscope over the popliteal artery The stethoscope should be placed on the artery nearest, but below the blood pressure cuff. pg 284

The nurse is working in a pediatric facility whose mission statement strongly emphasizes providing family-centered care. What nursing intervention best exemplifies this facility's belief?

The nurse plans a meeting with the parents, child, and case worker to discuss care alternatives for the child Providing care with an emphasis on a family-centered approach leads to better client outcomes as well as satisfaction with the facility and staff in care provided. Family-centered care involves a mutually beneficial partnership between the child, the family, and health care professionals.

The nurse enters the hospital room of a toddler to perform an assessment. Which actions or statements by the nurse will impede the assessment process? Select all that apply.

The nurse removes the toddler's pajama shirt when assessing the blood pressure The nurse hugs the toddler to show care and nurturing when entering the room The nurse tells the parent that it is important for the child to lie on the bed rather than sit on their lap during the assessment Toddlers usually prefer to remove their clothing one item at a time as needed for the examination; only the arm should be removed from the pajama shirt for blood pressure measurement. The nurse should use little touch at the beginning of the encounter with the child and the caregiver; too much touch initially can scare the child. Toddlers will prefer to sit on the caregiver's lap during the assessment for security. pg 280

The nurse is caring for a 10-year-old female with the diagnosis of leukemia. The parents of the child are divorced, but are very attentive to their child. The nurse notices that the parents seldom talk to each other, and when they do, they are very rude to one another. The child has voiced to the nurse that she is sad that her parents "don't like each other anymore." What is the best nursing action?

The nurse should ask the child if she has told her parents how she feels, and offer to be with her when she talks to them.

The parents of a 10-year-old with HIV have never told their child that he has the virus. The child asks the nurse why he is "on so many medications." What action should the nurse take?

The nurse should encourage the child to talk with his parents about his medications Generally, children older than 6 years of age will eventually need to have their diagnosis disclosed to them in an age-appropriate manner. They begin to ask questions and often seem to sense that something is going on other than what they've been told so far. Encouraging discussion with the parents is the best first step.

The nurse is weighing an 18-month-old infant who is in the clinic for a well-child visit. Which action by the nurse would be most appropriate for weighing this child?

The nurse should have the child sit on the scale while keeping a hand close to but not touching the child. The toddler who is able to sit can be weighed while sitting. Keep a hand within 1 inch of the child at all times to be ready to protect the child from injury. Page 288

The nurse is administering a tube feeding to a child. The nurse aspirates the stomach contents as part of the process for checking placement of the tube. Which action is correct for the nurse to do with the aspirated stomach contents?

The nurse should measure and replace the residual stomach contents. Aspirate, measure, and replace the residual stomach contents at the beginning of the procedure. pg 398

The nurse is administering a gavage feeding through a nasogastric feeding tube. Which nursing intervention is the highest priority?

The nurse verifies the position of the feeding tube. Verify position of tube to ensure that the tube is in the stomach by aspirating stomach contents is the highest priority because of the danger of aspiration if the tube is not in the stomach but rather in the esophagus or the lung. pg 397

The nurse is caring for a child hospitalized with pertussis. Which nursing intervention would be the highest priority for this child?

The nurse will administer oxygen. The major complication of pertussis (whooping cough) is pneumonia and respiratory complications. Oxygen, bed rest, and monitoring for airway obstruction are nursing interventions. The highest priority is administering oxygen to maintain adequate oxygenation of cells

When administering medications to an infant, what information would be most important for the nurse to consider?

The oral medication should be directed toward the posterior side of the mouth when using a syringe or dropper. A syringe or dropper should be directed toward the posterior side of the mouth with the infant in the upright position when administering an oral medication. pg 379

Due to a certain warning sign, the nurse is anticipating that health supervision for a 7-year-old child will be challenging. Which indicator supports this concern?

The parents made several negative remarks about the child. Disparaging remarks about the child is a warning sign. Lack of respect for the child can undermine the nurse-parent-child partnership needed for successful health supervision. Older grandparents who follow a healthy lifestyle are a plus for the child. Developmentally appropriate home responsibilities suggest positive parenting practices. A garden providing fresh produce can support good eating habits. page 236

The nurse is caring for a 7-year-old child in droplet precautions due to the diagnosis of pertussis. While visiting the child, which actions by the parents require the nurse to intervene? Select all that apply.

The parents state, "We should postpone immunizing our 5-year-old since there has been contact with the infection." The parents state, "We have been limiting our child's fluids to help decrease the amount of coughing." All close contacts who are younger than 7 years of age and who are unimmunized or underimmunized should have pertussis immunization initiated or the series completed according to the recommended dosing schedule. Fluids should be increased in order to help thin secretions and prevent dehydration during the infection. The parents are correct in removing their PPE at the door and washing their hands when leaving the room, and wearing a mask. All antibiotics should be finished in order to treat the infection adequately and prevent immunity to antibiotics.

A child with a serious health condition has been hospitalized to undergo treatments. After a week of treatment the physicians have determined that the child has only weeks to live. What is the most likely initial course of action the nurse can anticipate?

The physician will confer with the parents to outline the severity of the child's condition. When a child is not expected to recover, steps will be taken to review the care being provided. The parents will be told of the expected outlook for the child followed by likely recommendations to discontinue treatment and focus on comfort measures. Although orders may be received to withhold resuscitation, a conference with the parents is indicated first. There is no need at this time to notify the facility's ethics committee

The mother of a 1-month-old infant voices concern about her baby's respirations. She states they are rapid and irregular. Which information should the nurse provide?

The respirations of a 1-month-old infant are normally irregular and periodically pause. The normal respiratory rate for a 1-month-old infant is 30 to 60 breaths per minute. By 1 year of age the rate will be 20 to 30 breaths per minute. The respiratory patterns of the 1-month-old infant are irregular. There may normally be periodic pauses in the rhythm.

An infant is to have a scalp-vein intravenous infusion begun. What is an advantage of this insertion site?

The scalp veins are easily visualized. The scalp veins are easily visualized, being covered only by a thin layer of subcutaneous tissue. These veins do not have valves, so the device may be inserted in either direction, although the preference would be in the direction of blood flow. pg 388

Which information obtained by the nurse from the parents at the initial health supervision visit would alert the nurse to conduct the newborn metabolic screening during this visit?

The screening was completed when the newborn was 24 hours old Newborn metabolic screenings should when the child is older than 48 hours. The other options indicate the screening was completed appropriately and should not be repeated.

The hospital charge nurse is evaluating the care given by one of the staff nurses to determine if the nurse is providing developmentally appropriate care to infants on the unit. Which actions by the staff nurse demonstrate knowledge of developmentally appropriate care for infants? Select all that apply.

The staff nurse uses the en face position when holding newborns The charge nurse notices the staff nurse provide comfort during and after procedures by holding and talking to infants The staff nurse uses gentle stroking and holding of the infants The charge nurse witnesses the staff nurse assisting the parents with care of their infant

The student nurse is assessing a 9-year-old's cardiovascular system. Which assessment technique should the nurse further discuss with the student?

The student auscultates the heart at the third to fourth intercostal space just medial of the child's left midclavicular line. The point of maximum impulse (PMI) is lateral to the left midclavicular line at the fifth intercostal space in children ages 7 years and older. The student nurse is demonstrating auscultation of the PMI for a child under the age of 4 years. Page 301

The student nurse is performing an assessment of an infant. Which action by the student nurse requires further instruction by the instructor?

The student nurse asks the parents to step out of the room while performing the assessment It is often helpful for the parents to hold the infant during the assessment. This provides the infant with a sense of security during the assessment; therefore, it is not necessary for the parents to be asked to step out of the room during the assessment. Auscultation of the heart while the infant is sleeping allows a better assessment since the infant is not moving or crying. Assessing the ears often evokes crying so this should be left until the end of the assessment. Undressing the infant is necessary to perform a thorough assessment. Page 279

The student nurse is preparing to care for a recently placed gastrostomy tube. Which action would prompt further instruction from the overseeing nurse?

The student obtains an antimicrobial soap to clean the area surrounding the tube. The skin around a gastrostomy tube requires cleaning at least once a day. Routine site care includes gentle cleansing with sterile water or saline for newly placed tubes, or for established tubes, soap and water followed by rinsing or cleaning with water alone. To clean under an external disc or bumper, a cotton-tipped applicator may be used.

The physician has made a notation in the medical record of a 17-year-old that the teen is not demonstrating successful completion of Erikson's stages of development. What behavior would be consistent with this assessment?

The teen is uncertain and frequently unable to make decisions.

A nurse is using a doll to explain what will be done when starting an intravenous (IV) line on a 4-year-old. What type of play is this?

Therapeutic play Therapeutic play is a technique to help children better understand what will be happening to them in a specific situation. For instance, the child who will have an IV line started before surgery might be given the materials and encouraged to "start" an IV on a stuffed animal or doll. page 332

The nurse is completing an assessment on a 2-year-old child. The nurse notes the presence of a raised reddish purple spot on the back of the child's neck. Which statement about this finding is correct?

These lesions will normally fade as the child ages. The lesions described are consistent with strawberry nevus. They are benign and normally fade as the child ages, usually by the age of 9 years. Nevus flammeus are associated with the development of Sturge-Weber syndrome.

A nurse is caring for a child that just had open-heart surgery and the parents are asking why there are wires coming out of the chest of the infant. What is the best response by the nurse?

These wires are connected to the heart and will detect if your child's heart gets out of rhythm. The wires may be connected to a pacemaker. Connection to the temporary pacemaker is usually until the child is out of danger for arrhythmia.

The nurse is assessing the sleeping practices of the parents of a 4-month-old girl who wakes repeatedly during the night. Which parent comment might reveal a cause for the night waking?

They put her to bed when she falls asleep. If the parents are keeping the child up until she falls asleep, they are not creating a bedtime routine for her. Infants need a transition to sleep at this age. If the parents are singing to her before she goes to bed, if she has a regular, scheduled bedtime, and if they check on her safety when she wakes at night, then lie her down and leave, they are using good sleep practices.

A nurse is caring for a young child who has been hospitalized in a facility that is located several hours from the child's home. The child has not seen his parents in three weeks. When they arrive to visit, the child ignores them. The nurse is aware that this is common in which stage of separation anxiety?

Third stage

A mother expresses surprise to the nurse that her toddler daughter has begun masturbating. The most important initial nursing response is: a) This is a normal and expected activity best treated matter-of-factly. b) Check for undue stress in your toddler's life. c) Toilet teaching places much focus on the genitals. d) Toddler girls as well as boys will masturbate.

This is a normal and expected activity best treated matter-of-factly.

A 14-year-old male is brought to the clinic by his father with concerns that he is developing an excessive amount of breast tissue. The examination confirms that he has slight enlargement of the breast tissue. What information should be relayed to the teen and his parent?

This is a normal and transient condition of adolescent males. Breast growth in adolescent males may occur in response to hormonal levels. This condition will self resolve as hormones become more balanced. Therapy and laboratory studies are not indicated at this time. Page 299

A child with a congenital heart defect is getting an echocardiogram. How would the nurse describe this test to the parent?

This is a test that will check how blood is flowing through the heart. Echocardiograms can determine the size of the heart and how the heart is pumping blood. An echocardiogram does not check the electrical impulses or the size of the heart. This is a non-invasive test.

A toddler's father is concerned because his son refuses to share. What is your best response concerning this? a) His son is probably reacting to some family crisis. b) This is normal toddler behavior; sharing is learned later. c) Behavior modification techniques can change the child's behavior. d) Play time with other children should be cut back until he learns to share.

This is normal toddler behavior; sharing is learned later.

Which statement is the goal of distraction techniques used to control pain?

To divert the child's attention away from the pain through controlled, purposeful behaviors The goal of distraction interventions is to divert the child's attention away from the pain through controlled, purposeful behaviors. Distraction interventions are used in conjunction with pain medications to reduce pain. Giving the client choices—not using distraction techniques—enables a greater sense of control. The goal of distraction interventions is not parent-focused and the purpose is entertainment for the child. pg 424

A family of five seeks care for their preschooler with an upper respiratory infection. The facility has no medical record for the family. Why does the nurse encourage this family to establish a medical home?

To establish a continuing relationship with a physician or nurse practitioner A medical home is a physician or nurse practitioner with a long-term, comprehensive relationship with the family. This results in better health supervision and overall improved care. Having a medical home does not give special treatment to its constituents in the way of priority or services, insurance coverage, or cost reduction, although, because of the high level of health supervision, some of these benefits could result due to illnesses being prevented or discovered and treated early. p 236

A father brings his 2-year-old son in for a well visit. The nurse assesses his growth since the last appointment. Which of the following findings should concern the nurse? a) Prominent abdomen b) Forward curve of the spine at the sacral area c) Total weight gain of 15 lb in the past year d) Increase in height of 5 inches in the past year

Total weight gain of 15 lb in the past year

Constipation may be initially caused by psychological problems.

True Some children begin holding stool for psychological reasons. Once the process begins, however, the hardened stool, the anal fissures, and the pain on defecation soon occur, and what began for an emotional reason becomes a physical ailment. This is important to understand, because with these children, therapy involves both counseling to correct the initial problem and treatment of the physical symptoms

Which developmental task, according to Erikson, should an infant accomplish during the infant year?

Trust The developmental task of the infant year, according to Erikson, is to gain a sense of trust or knowing how to love.

The nurse is caring for the family with a 2-month-old boy with colic. The mother reports feeling very stressed by the baby's constant crying. Which intervention would provide the most help in the short term?

Urging the baby's mother to take time for herself away from the child Urging the parents to get time away from the child would be most helpful in the short term, particularly if the parents are stressed. Educating the parents about when colic stops would help them see an end to the stress. Observing how the parents respond to the child helps to determine if the parent/ child relationship was altered. Assessing the parents' care and feeding skills may identify other causes for the crying.

Which nursing intervention is likely to be most effective in keeping the immunization status of children of all ages at its highest possible level?

Use every contact to potentially immunize Each health care contact with children should be seen as an occasion to give needed immunizations. Children cared for in outpatient departments for minor problems, those seen for injuries, children scheduled for surgery, those hospitalized, and all others should have their immunization records reviewed and immunizations due should be administered unless contraindicated. Assisting with media campaigns, providing a community-wide immunization event, and using measures to reduce pain all encourage immunization but will not have the impact that immunizing at each contact provides. page 262

The nurse is taking a health history for an 8-year-old boy who is hospitalized. Which is a risk factor for sepsis in a hospitalized child?

Use of immunosuppression drugs The use of immunosuppression drugs is a risk factor for the hospitalized child. Maternal infection or fever and resuscitation or invasive procedures are sepsis risk factors related to pregnancy and labor. Lack of juvenile immunizations is a risk factor affecting the overall health of the child but does not impact the chance of sepsis.

Parents of a 2-year-old girl are having a conversation with the nurse about tantrums. Which of the following techniques would the nurse most likely to suggest? a) Use short "time-outs" and remain calm. b) Vary the response based on the situation. c) Promise a reward if she behaves. d) Tell her she is bad and will be punished.

Use short "time-outs" and remain calm

A new mother reports that she is exhausted and that the little sleep she gets is determined by her baby's daytime naps and the few hours the baby sleeps during the night. The nurse discusses with this mother the importance of helping the infant establish healthy sleeping patterns. What would be most helpful for this mother to do to encourage healthy sleeping patterns?

Use the crib for sleeping only, not for play activities. A consistent bedtime routine is usually helpful in establishing healthy sleeping patterns and in preventing sleep problems. Using the crib for sleeping only helps the child associate the bed with sleep. Depriving the baby of sleep during the afternoon or evening will make the baby over-tired and less able to establish a healthy sleeping pattern. While letting a baby cry for a while is acceptable, this does not promote consistency in the baby's sleeping pattern.

Parents and their 35-month-old child have returned to the clinic for a follow-up appointment. Which of the findings may signal a speech delay? a) Asks "why" often b) Uses two-word sentences or phrases c) Half of speech understood by outsider d) Talks about a past event

Uses two-word sentences or phrases

The nurse is doing an assessment of a 10-year-old girl. She whispers the girl's name from behind the girl. Which cranial nerve is the nurse assessing for?

VIII Testing a child's hearing by observing a response to a whisper without a visual clue, assesses cranial nerve VIII, the acoustic nerve. Nerve V is the trigeminal, nerve IV is the trochlear, and nerve III is the oculomotor, none of which are involved in hearing. Page 295

A nurse is preparing to administer an ordered IM injection to an infant. The nurse knows that the most appropriate injection site for this child is which muscle?

Vastus lateralis The preferred injection site for infants is the vastus lateralis muscle. An alternative site is the rectus femoris muscle. The dorsogluteal is not a recommended site for the infant. The deltoid muscle, which is a small muscle mass, is used as an IM injection site in children after the age of 4 to 5 years of age due to the small muscle mass. pg 382

A nursing student is preparing to give an intramuscular (IM) injection to an infant. Which site does the nurse identify as mandatory for this administration?

Vastus lateralis muscle For IM injections in infants, the mandatory site for administration is the vastus lateralis muscle of the anterior thigh. Using the gluteal muscle is hazardous. The deltoid muscle is used for older children as well as for adults, or a ventrogluteal site should be used. pg382

The nurse is preparing to administer an IV antibiotic to a child. After calculating the recommended dose with the child's weight, she discovers the ordered dose exceeds the safe dose range in a pediatric drug book. The medication has been given to the child at this dose for three days. What should the nurse's next action be?

Verify the dose with the prescribing practitioner. 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 practitioner. 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 had been given for three 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 do they know the child's medical background. pg 375

A 5-year-old arrives at the emergency department and reports abdominal pain. After performing an assessment and laboratory work, the physician diagnoses appendicitis. The nurse knows that this child is experiencing which type of pain?

Visceral Visceral pain involves sensations that arise from internal organs, such as the intestines. The pain of appendicitis is visceral pain. pg 410

The nurse is assessing the abdomen of a 3-year-old. Which finding should be reported immediately?

Visible peristaltic waves Visible peristaltic waves are abnormal and require further evaluation. The other findings are considered normal for the child's age. Page 303

The client is a 1-year-old girl from a low-income family presenting with a vitamin D deficiency and anemia. What assistance program would you recommend to the child's young mother?

WIC The special supplemental nutrition program for women, infants, and children (WIC) provides services to supply nutritional food to low-income women and their children. SCHIP or CHIP provides health insurance to newborns and children in low-income families who do not otherwise qualify for Medicaid and are uninsured. The Early Childhood Intervention (ECI) program, sponsored by Easter Seals, is available for the child with disabilities or developmental delays. pg 8

Parents bring their 9-year-old child to the clinic for a well-child visit. They are concerned because several children in the neighborhood have developed Lyme disease and ask for suggestions on what to do to reduce their child's risk. What would be appropriate for the nurse to suggest? Select all that apply.

Wearing protective clothing when playing in wooded areas. Inspecting the skin closely for ticks after the child plays in wooded areas. Contacting the health care provider if there is any area of inflammation that might be a bite. The nurse should teach the parents to have the child wear protective clothing and dress the child in light clothing when playing in wooded areas or going outdoors. The parents should inspect the child's skin closely for ticks after being outside in wooded areas and if any ticks are found, remove them with a tweezer, not rub them with a credit card. The parents also should be instructed to contact their health care provider if they notice any area of inflammation that might be a tick bite

In caring for a child with nephrotic syndrome, which interrventions will be included in the child's plan of care?

Weighing on the same scale each day The child with nephrotic syndrome is weighed every day using the same scale to accurately monitor the child's fluid gain and loss.

Which nursing activity requires the pediatric nurse to implement the ethical principle of nonmaleficence?

Weighing the potential harm caused by a child's chemotherapy with its potential benefits Questions of risks versus benefits often require the care team to examine options in the light of nonmaleficence; that is, the responsibility to avoid undue harm. Encouraging an adolescent to take ownership of her health will likely involve the principle of autonomy. Mediating in a family dispute or providing empathic care is less likely to involve the principle of nonmaleficence. pg 16

The nurse has administered oral penicillin as ordered for prophylaxis of endocarditis. The nurse instructs the parents to immediately report which reaction?

Wheezing The nurse must report any hypersensitivity reactions such as wheezing and pruritus, as these could be a sign of anaphylaxis. Stomach upset is common with oral antibiotics and is not something that needs to be reported immediately. Nausea with diarrhea is common with oral antibiotics and does not need to be reported immediately. Abdominal distress is common with oral antibiotics and does not need to be reported immediately.

The nurse is providing postsurgical care for a 5-year-old. The nurse knows to avoid which question when assessing the child's pain level?

Would you say that the pain you are feeling is sharp or dull? A preschooler may have difficulty distinguishing between the types of pain such as if the pain is sharp or dull. It also limits the information being obtained by the nurse. They can, however, tell someone where it hurts and can use various tools such as the FACES scale (cartoon faces) or the OUCHER scale (photograph and corresponding numbers) to rate their pain. pg 413

The nurse is caring for a 7-year-old boy in a body cast. He is shy and seems fearful of the numerous personnel moving in and out of his room. How can the nurse help reduce his fear?

Write the name of his nurse on a board and identify all staff on each shift, every day. The best approach would be to write the name of his nurse on a small board and then identify all staff members working with the child (each shift and each day). Reminding the boy he will be going home soon or telling him not to worry does not address his concerns or provide solutions. Encouraging the boy's parents to stay with him at all times may be unrealistic and may place undue stress on the family. pg 319

A nurse is providing care to a child with HIV who is prescribed therapy with a nucleoside reverse transcriptase inhibitor. What would the nurse expect to administer?

Zidovudine Zidovudine is a nucleoside reverse transcriptase inhibitor. Nevirapine and efavirenz are classified as nonnucleoside reverse transcriptase inhibitors. Ritonavir is a protease inhibitor.

A chief danger of scarlet fever is that children may develop:

acute glomerulonephritis. Because this is a streptococci-based infection, there is a chance the child will develop rheumatic fever or glomerulonephritis following the illness.

A 5-year-old is hospitalized after an asthma attack at school. The child tells the nurse that the janitor was cleaning in the classroom prior to the attack and that a lot of dust was in the air. The dust that likely caused the attack is known as a (an):

allergen. Mediating substances that are released and cause tissue injury and allergic symptoms are called allergens. An antigen is any foreign substance capable of stimulating an immune response. An antigen that can be readily destroyed by an immune response is called an immunogen. Macrophages are mature white blood cells.

To gain a preschooler's cooperation to swallow an oral medication, your best approach would be to:

ask if he would like to take his medicine in a cup or through an oral syringe. Ask if he would like to take his medicine in a cup or through an oral syringe. Medicine never should be compared to candy. Children cannot be depended on to take medicine without supervision; bribing is also ineffective. pg 378

A toddler's parents want to begin toilet training him. As a rule, the best instruction you could give them is: a) toilet training is a 12-month process. b) children can remain dry during the night before they can do so during the day. c) all children should be toilet trained by age 2 years. d) bowel training is easier than urine training.

bowel training is easier than urine training.

Immediately following administering a medication by enteral tube, the nurse will:

flush the tube with water. It is important to flush the tube to ensure all of the medication reaches the child's digestive tract and to prevent occlusion of the tube. Right (not left) side-lying position will aid in stomach emptying, although it was not specified that the enteral tube was located in the stomach. Elevating the head of the bed is done prior to placing material in the gastrointestinal tract. Checking for signs of nausea and vomiting is always important but not the immediately following nursing action in this situation. pg 398

The site most often used when administering a medication using the intradermal route is the:

forearm. Intradermal injections are most often used for tuberculosis screening and allergy testing. The forearm is the site most often used. The anterior thigh, lateral upper arms, and abdomen are the preferred sites for subcutaneous administration. pg 384

The nurse is caring for a child with juvenile idiopathic arthritis (JIA). There is involvement of five or more small joints and it is affecting the body symmetrically. This tells the nurse that the child:

has polyarticular JIA. Polyarticular JIA is defined by the involvement of five or more joints, frequently the small joints, and affects the body symmetrically. Pauciarticular JIAs is defined by the involvement of four or fewer joints. Systemic JIA presents with fever and rash in addition to join involvement at the time of diagnosis. The child with JIA is not at greater risk for anaphylaxis.

A pediatric nurse will state that the priority reason to have a thorough grasp of the growth and development of children is to:

identify developmental risks or delays promptly. Finding risks for developmental delays early allows for prompt intervention likely to result in a more positive outcome. Having thorough knowledge of growth and development does enhance the joy of working with children, does assist with providing anticipatory guidance for parents, and does promote effective communication with the various ages. These are all important, but not the priority.

When planning how to respond to a 3-year-old child about telling stories ("tall tales"), the nurse would base the statement on the fact that:

imagination in a 3-year-old is at its peak.

The nurse is caring for a 10-year-old boy who had an appendectomy 2 days ago. Prior to surgery he had expressed that he was worried that after the procedure he would hurt and have lots of pain. The nurse asks the child what his pain level is on a scale of 0 to 10, with 10 being the worst pain. He tells the nurse he has no pain. The most appropriate action by the nurse would be to:

observe him for physical signs which might indicate pain. Nursing judgment is in order. Some children may try to hide pain because they fear an injection or because they are afraid that admitting to pain will increase the time they have to stay in the hospital. To use the color scale, a child younger than 7 is given crayons ranging from yellow to red or black. Yellow represents no pain; the darkest color (or red) represents the most pain. The child selects the color that represents the amount of pain he or she feels.

A nursing instructor is teaching students the importance of understanding how drugs are absorbed, distributed, metabolized, and excreted. This concept is referred to as the study of:

pharmacokinetics The study of a drug's absorption, distribution, metabolism, and excretion is known as pharmacokinetics. pg 375

A parent must administer a medication in syrup form to a 2-month-old infant. The nurse suggests:

placing the medicine in an empty nipple without an attached bottle The young infant should naturally and easily suck the medicine through an empty nipple, getting the entire dose. Formula and rice cereal are essential foods for the infant and the desirability of them should not be altered by the taste of the medication. In addition, a 2-month-old is not developmentally ready for spoon feeding of rice cereal or medication from a medicine spoon.

The nurse pulls the 5-month-old to sitting position from supine and notes head lag. The nurse's response is to:

refer the infant for developmental and/or neurologic evaluation. There should be no head lag by 4 months. Head lag in the 5-month-old may indicate motor or neurologic problems and needs immediate follow-up. All other nursing actions indicate failure to recognize the problem. Page 72

Parents who just moved into their "dream home" are concerned because their toddler boy, who had achieved daytime bowel and bladder control, has begun wetting and defecating in his underwear. The nurse explains this is called: a) regression. b) egocentrism. c) autonomy. d) ritualism.

regression

A child is diagnosed with group A streptococcal pharyngitis. The nurse would teach the parents to be alert for signs and symptoms of:

scarlet fever. Group A streptococcal pharyngitis can progress to scarlet fever with the rash appearing in about 12 hours after the onset of the disease. Group A streptococcal pharyngitis is not associated with pneumonia. Impetigo is a group A strep infection involving the skin. Osteomyelitis can occur with an infection by group B streptococcus.

You teach a child to use a FACES pain rating scale prior to surgery. At that time, she points to the smiling face. Following surgery when you suspect she has pain, she points again to the smiling face. You would interpret this as

she is using the scale to predict what she would like, not what she has. Preschoolers use "magical thinking," or believe that what they wish will come true. They may use pain scales, therefore, to "wish" for a smiling face, rather than for rating their pain. pg 413

The nurse is caring for a 4-year-old with sickle cell anemia. A physical finding you might expect to see in him is:

slightly yellow sclerae. Many children with sickle cell anemia develop mild scleral yellowing from excess bilirubin from breakdown of damaged cells.

A parent asks why spanking works so well to stop her toddler's behavior. The nurse explains it is the:

suddenness and shock value of the act. The surprise and shock interrupt the behavior quickly. With repeated use these effects diminish; then the intensity must increase. The American Academy of Pediatrics recommends against spanking due to its many negative effects and lack of effectiveness over other methods. When punishing, the parent should remain calm. Anger may result in injury. Anxiety is one of the negative effects of spanking. The attention is negative; however, a child without appropriate attention may settle for the negative.

The nurse is educating the mother of a newborn about feeding practices. The nurse correctly advises the mother that:

the newborn's stomach can hold between one-half and 1 ounce. The capacity of the normal newborn's stomach is between one-half and one ounce. The recommended feeding plan is to use a demand schedule. Newborns may eat as often as 1.5 to 3 hours. Demand scheduled feedings are not associated with problems sleeping at night.

The nurse is caring for a 10-year-old child admitted for a surgical procedure to be done the next day. The nurse takes the child to a special area in the playroom and lets the child "start" an IV on a stuffed bear. This is an example of:

therapeutic play.

Apply adhesive bandages generously after venipuncture or finger punctures as young children find bandages comforting.

true Apply pressure to the site with a dry gauze dressing and then cover with a small adhesive bandage. If possible, allow the child to choose the bandage. pg 394

The nursing student is discussing the effects on hormone production for an 11-year-old boy who has been admitted with a brain injury. Which statements by the nursing student are accurate?

• "Gonadotropin-releasing hormone (GnRH) is produced by the hypothalamus. Since this child has a brain injury, this could be a concern for normal production of other hormones." • "The production and secretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) could be effected by his brain injury." • "Sperm production could be impacted because follicle-stimulating hormone (FSH) and luteinizing hormone (LH) stimulate its production." • "Maturation of the testicles is directly impacted by luteinizing hormome (LH). Having a brain injury at this age could cause problems with this stage of puberty." Gonadotropin-releasing hormone (GnRH), produced by the hypothalamus, travels to the anterior pituitary gland to stimulate the production and secretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). The increased levels of FSH and LH stimulate the gonadal response. LH stimulates acts on testicular Leydig cells in boys, prompting maturation of the testicles and testosterone production. FSH with LH stimulates sperm production. Since production of these hormones are stimulated by the hypothalamus and the pituitary glands, a brain injury at this age could the onset or continuation of changes seen with puberty.

The nurse is working with the mother of a toddler experiencing constipation. What information regarding childhood constipation should the nurse share with the mother?

• "Have your son sit on the toilet twice a day, after breakfast and dinner, for 5 to 15 minutes." • "If your child has a fecal impaction, you can give him an enema." • "Reward your child for sitting on the toilet as asked, not just when they have a bowel movement." Proper education for constipation in children includes educating the families about the importance of compliance with medication use. Many children present to their physician or nurse practitioner with fecal impaction or partial impaction. Teach parents how to disimpact their children at home; this often requires an enema or stimulation therapy. To facilitate daily bowel evacuation, the child should sit on the toilet twice a day (after breakfast and dinner) for 5 to 15 minutes. Instruct the family to keep a "star" or reward chart to encourage compliance. Parents should award the star for compliance with time sitting on the toilet and should not reserve rewards for successful bowel movements only.

The nurse is reviewing nutritional recommendations with the parents of a teen diagnosed with hyperlipidemia. Which statements indicate an understanding of the recommended diet for this condition?

• "I should plan to have vegetables with each evening meal served." • "Adding fresh fruits to my child's lunch is a good idea." • "My child loves chicken and I can still serve it but I need to remove the skin." Hyperlipidemia refers to high levels of lipids (fats/cholesterol) in the blood. High lipid levels are a risk factor for the development of atherosclerosis, which can result in coronary artery disease, a serious cardiovascular disorder occurring in adults. Dietary management is the first step in the prevention and management of hyperlipidemia in children older than 2 years of age. The diet should consist primarily of fruits, vegetables, low-fat dairy products, whole grains, beans, lean meat, poultry, and fish. As in adults, fat should account for no more than 30% of daily caloric intake. Fat intake may vary over a period of days, as many young children are picky eaters. Limit saturated fats by choosing lean meats, removing skin from poultry before cooking, and avoiding palm, palm kernel, and coconut oils as well as hydrogenated fats

A 16-year-old adolescent is talking with the nurse at a local health clinic about skin care. Which comments by the teen does the nurse determine require additional conversation?

• "My favorite time of day to be outside is the middle of the day, around noon." • "I only tan before going on spring break to get a base tan so I won't burn." • "The more exposure and burns I get now will toughen my skin so I won't get skin cancer when I'm older." The nurse should further discuss comments that demonstrate incorrect information about sun exposure. Any exposure to tanning beds should be avoided to prevent skin cancer risks. Other risks for skin cancer include being in the sun between the times of 10:00 am and 4:00 pm, and sun exposure and burns during childhood and adolescence. A minimum SPF of 15 should be used, so SPF 30 is good practice, as is wearing sun-protective clothing when outside during the day.

During a well-child visit, the nurse observes the child saying "no" to her mother quite frequently. The mother asks the nurse, "How do I deal with her saying no all the time?" Which of the following would be appropriate for the nurse to suggest? Select all that apply. a) "Offer her two options from which to choose." b) "Offer her something she would like, such as ice cream, to distract her." c) "Use timeout every other time she tells you no." d) "Make a statement instead of asking a question." e) "Limit the number of questions you ask of her."

• "Offer her two options from which to choose." • "Make a statement instead of asking a question." • "Limit the number of questions you ask of her."

The nurse is caring for a 7-year-old who is being discharged following surgery with a Gore® Helex device to repair an atrial septal defect. The parents of the child demonstrate understanding of the procedure with which statements?

• "We know how important our child's medications are so we will write out a schedule to be sure medications are taken as prescribed." • "We will be sure to monitor our child for any signs of infection and notify the doctor if we notice any." • "We will be sure to not allow our child to ride a bicycle for at least 2 weeks." With the Gore® Helex device, strenuous activity should be avoided for 2 weeks after the procedure, so neither soccer or bicycle riding would be allowed. Children should be monitored for the possible presence of atrial arrhythmias (lifelong) after surgical closure for the defect. Infection is a complication that must be monitored for and reported to the physician, and medications must be given as prescribe

The pediatric nurse has digoxin ordered for each of five children. The nurse should withhold digoxin for which children?

• 5-year-old child who developed vomiting and diarrhea, and is difficult to arouse • 16-year-old child with a heart rate of 54 beats per minute • 2-year-old child whose digoxin level was 2.4 ng/mL from a blood draw this morning The nurse should not administer digoxin to children with the following issues: The adolescent with an apical pulse under 60 beats per minute, the child with a digoxin level above 2 ng/mL, and the child who exhibiting signs of digoxin toxicity.

The nurse is caring for a child diagnosed with rheumatic fever. The nurse would do all of the following nursing interventions. Which two interventions would be the priority for the nurse?

• Carefully handle the child's knees, ankles, elbows and wrists when moving the child. • Administer salicylates after meals or with milk Pain control and relief are the highest priorities for the child with rheumatic fever. Position the child to relieve joint pain. Large joints, including the knees, ankles, wrists, and elbows, are usually involved. Carefully handle the joints when moving the child to help minimize pain. Salicylates are administered in the form of aspirin to reduce fever and relieve joint inflammation and pain

The nurse is preparing to talk with an adolescent about contraception. During the interaction, which communication techniques will be beneficial?

• Face the teen during the interaction. • Use open-ended questions. • Let the teen know that you may not know all the answers for their questions. • Ask that the teen be open and patient when you are providing information.

A stay-at-home father wants to purchase commercial toddler meals because his 16-month-old girl recently choked on table food. Which food items will the nurse suggest not be given to this child? Select all that apply. a) Hard foods such as nuts, raw carrots, and popcorn b) Sticky foods like peanut butter alone, gummy candies, and marshmallows c) Round foods such as hot dogs, whole grapes, and cherry tomatoes d) Vegetables such as corn, green beans, and peas e) Fruits such as peaches, pears, and kiwi

• Hard foods such as nuts, raw carrots, and popcorn • Sticky foods like peanut butter alone, gummy candies, and marshmallows • Round foods such as hot dogs, whole grapes, and cherry tomatoes

The nurse is caring for a child diagnosed with acute post-streptococcal glomerulonephritis. When assessing the child, what findings does the nurse anticipate?

• Headache • Generalized edema • Weight gain Acute post-streptococcal glomerulonephritis often follows a respiratory infection caused by one of the strains of group A beta-hemolytic streptococcus. With kidney function being decreased the nurse expects to assess signs and symptoms such as weight gain from edema and headache. Urine will likely be concentrated causing it to be dark in color.

A mother is concerned because her 2-year-old daughter is not speaking much. What should the nurse suggest to the mother? Select all that apply. a) Read books aloud to her. b) Name aloud the objects that she is playing with. c) Use baby talk when speaking to her. d) Have her watch educational television. e) Use pronouns when speaking to her. f) Always answer her questions.

• Read books aloud to her. • Name aloud the objects that she is playing with. • Always answer her questions.

A nurse is presenting a class on toilet training to a group of parents with toddlers. Which of the following would the nurse include in the class? Select all that apply. a) Using training pants that slide down easily and quickly b) Keeping the child on the potty chair for as long as necessary c) Putting the child on the potty chair at regular intervals during the day d) Allowing at least 6 weeks to prepare the child psychologically for the training e) Praising the child when he or she urinates or defecates

• Using training pants that slide down easily and quickly • Putting the child on the potty chair at regular intervals during the day • Praising the child when he or she urinates or defecates

The parents of a child receiving chemotherapy for leukemia notice "certified pediatric hematology/oncology nurse" on the nurse's name badge. The parents ask the nurse about this. What is the best response by the nurse?

"This certifies that I have specialized in the field of oncology/hematology care of children." While all statements may be accurate, the statement that best defines the certification, "This certification represents specialized learning that I have in the field of oncology/hematology care of children," also ensures the parents that the nurse is not just obtaining this certification for job requirements or a pay increase, but that the nurse is best prepared to care for their child.

A woman has presented to the clinic with her sick school-aged child. The child's mother reports she rarely has enough money to meet the health care needs of her chronically ill child. What information should be provided to the woman?

Medicaid may be available to low-income parents and their children. Medicaid is a joint federal and state program that provides health insurance to low-income parents and their children. It is state-administered, and each state has its own set of guidelines.

The nurse is talking with an adopted child and the family. Which statement represents "positive" adoption language?

The birth mother was how old when your child was born? Birth mother, not natural or real mother, is a positive term for the biological parent, as is simply parent for the adoptive mother or father. The adopted child is just a child and not someone given up or given away. Saying an adoption plan was followed makes a positive statement.

The parents of a child on a pediatric unit are concerned with the plan of care the physician has provided. The parents ask the nurse if they may seek a second opinion if they are not in agreement with the plan of care. How should the nurse respond?

"You can always seek a second opinion if not in agreement with the current plan of care." As a child and family advocate, the nurse safeguards and advances the interests of children and their families by knowing their needs and resources, informing them of their rights and options, and assisting them to make informed decisions. The nurse in this situation has listened to the concerns of the parents and provided information to help assist them to make an informed decision about seeking a second opinion.

During the first visit to the pediatrician's practice the nurse is performing an admission interview and assessment of a 4-week-old infant. The mother states, "I am sure my baby girl knows my smell because she is much more settled in my arms rather than my mother's arms when she is upset." What is an appropriate response by the nurse?

"You may be right since infants can sense their mother's smell as early as 7 days old. The sense of smell develops rapidly: the 7-day-old infant can differentiate the smell of his or her mother's breast milk from that of another woman and will preferentially turn toward the mother's smell.

A nurse is determining whether or not informed consent has been obtained from the family of a child who is going to have abdominal surgery. Which statement by the family would lead the nurse to suspect that informed consent is lacking?

"We had to sign the form right away so the surgery could get scheduled." The statement about signing the form right away suggests that the family was coerced into agreeing to the surgery without being fully informed about the risks and benefits. The key ethical issues related to informed consent for treatment have similarities to those required for research participation: Consent must be voluntary and based upon shared information about the risks and benefits of the treatment. Furthermore, the parent must understand the information and be cognitively and mentally competent to make the decision. The statements about risks, activity limitations, and postoperative care indicate that information was shared with them and that they understood it.

The parents of a 16-year-old child are meeting with the pediatrician to discuss behavior problems of their teen. Which statements by the parents about their parenting style are consistent with an authoritarian style? Select all that apply.

"We tell our teen the rules of the household and the importance of her complying." "It is important that our daughter follow the rules of the household." "She will thank us one day for outlining clear expectations for her behavior." The authoritarian parent expects obedience from the child and discourages the child from questioning the family's rules. The parent provides low support and high control over the child (Cherry, 2014). The rules and standards set forth by the parents are strictly enforced and firm. The parents expect the child to accept the family's beliefs and values and demand respect for these beliefs. The parents are the ultimate authority and allow little, if any, participation by the child in making decisions.

The mother of two school-age children is getting divorced. Which would be the best advice for the nurse to give?

"Discuss how things will work after the divorce." Both parents together should discuss with the children how things will work after the divorce. The children should not be expected to act like adults because they are not. Tell them about the divorce ahead of time, and tell them the reasons in nonjudgmental terms that they can understand.

A 14-year-old child shares with the nurse that she is adopted. She reports she was born in another country and now wishes she had more information about her ethnic and cultural background. She states her parents are not comfortable with this. What response by the nurse is most appropriate?

"Finding out about your culture may be enlightening for you." The child of adoption will understandably have questions about their background. It is helpful for them to know about their culture and ethnicity. Open communication about this is helpful to them. Sympathizing with the parents is not indicated or helpful.

A student nurse shares an interest in pediatric nursing. When discussing her thoughts about pediatric nursing, which statements are consistent with the philosophies of pediatric nursing care? Select all that apply.

"I believe the family should be included in all aspects of the plan of care and treatment." "Since health care can be scary for a child, it's important to make them feel secure." "The child should be included as much as possible in the plan of care." The three general concepts that form the philosophy of pediatric nursing care are family-centered care, atraumatic care, and evidence-based care. Pediatric nurses use these three concepts to provide quality, cost-effective care that is continuous, comprehensive, and compassionate.

The mother of a 6-week-old infant reports she doesn't know if her child recognizes her face yet. What response by the nurse is most appropriate?

"Since about 4 weeks of age your child has been able to recognize those who are around him often." At 1 month of age the infant can recognize by sight the people he or she knows best. Telling the child's mother that this will come with time is not correct as this developmental milestone has already occurred. Telling her not to worry minimizes her questions and concerns.

The nurse is caring for a child of Asian descent. The nurse is trying to ensure that the family's cultural practices are supported. Which statement by the nurse indicates a lack of understanding regarding cultural competence?

"Since your child is only 8, I doubt that your child has any cultural practices we need to be aware of." Typically, a child begins to understand his or her culture at approximately 5 years of age, so stating that the child does not have any cultural practices at the age of 8 is inaccurate. Diet, cultural practices, and religious practices related to culture are important for the nurse to know so that the nursing staff can support as many of these practices as possible.

The mother of a 15-year-old child reports that her husband is very strict with her son. She voices concerns about the future impact of this style of parenting on him later in life. What response by the nurse is most appropriate?

"The children who have parents who are authoritarians often are resentful later in life." Parenting style has an impact on the future of children. The authoritative parenting style is associated with negative effects on self-esteem, happiness, and social skills and increased aggression and defiance.

The nurse is caring for a 16-year-old female who has been brought to the clinic by her mother seeking information about contraceptives. What action by the nurse will best promote the client's autonomy?

After a review of suitable contraceptive options, ask the client which is of the greatest interest. Autonomy refers to self determination and inclusion in decision making. Sharing information and allowing the teen to participate will promote autonomy. Encouraging the decision to be made by the teen does not embrace the decision making abilities of the teen. A discussion on abstinence is appropriate for inclusion but does not promote autonomy or address the reason for seeking health care.

The school nurse is caring for several children who witnessed an 8-year-old girl get hit by car on the way to school. Which intervention is least important to the nursing plan of care for these children?

Making phone calls to the parents of the children counseled Making phone calls to the parents of the children who were determined to need counseling is least important to the nursing plan of care. It is, no doubt, mandatory for the nurse to inform and support the parents. However, this intervention is the least important based on the nursing diagnosis of the children's need for counseling, the intervention to arrange for a counselor, and the adaptation of the intervention by providing counseling for the friends of the injured child.

Personal space and distance is a cultural perspective that can impact nurse-client interactions. What is the best way for the nurse to interact with a client who has a different cultural perspective on space and distance?

Allow the client to adopt a position that is comfortable for him or her. If the client appears to position himself or herself too close or too far away, the nurse should consider cultural preferences for space and distance. Ideally, the client should be permitted to assume a position that is comfortable to him or her in terms of personal space and distance. "Realizing" and "remembering" are not interactions. It is also incorrect to attempt to adopt someone else's cultural preference as this can be very uncomfortable for the nurse, which adds a barrier to nurse-client interactions.

Which child represents an increasingly common pediatric medical scenario currently present in the United States?

9-year-old girl diagnosed with type 2 diabetes The incidence of diabetes is rising in the United States. This is not noted to be the case with congenital anomalies, trauma or lymphoma.

What is the key nursing role when managing the health care of a child living with a foster family?

Advocating for the child and the services needed Advocating for the child is the overarching nursing role. Unmet health needs are likely. Advocacy gives the child a "voice" so that the wide range of health care needs often prevalent in foster children can be met. Determining presence of mental health issues and developmental status as well as securing educational placement are specific issues among many that advocacy would address.

The nurse is caring for a child who underwent an appendectomy 12 hours ago. The child has reported incisional pain. When the nurse attempts to administer the prescribed analgesic the child's mother declines the medication. What initial action by the nurse is most appropriate?

Ask the child's mother to elaborate on her concerns about the medication. Some people may not approve of the administration of narcotics or medications containing alcohol. The nurse must first determine the cause of the concern. Then action can be taken to best provide care to the child. Continuing observation of the child does not address the needs related to pain management. Although the client's physician or the nursing supervisor may be contacted, it is not the initial action in this scenario.

The nurse is assessing a woman who is pregnant. Her health history reveals she has three young adult children. Which nursing intervention would be most appropriate according to Duvall's developmental theory?

Assessing the parent's coping abilities It would be most appropriate to assess the parent's coping abilities because they are in the wrong stage of the family life cycle to be having another child. Providing anticipatory guidance, describing the nutritional value of breastfeeding, and promoting the importance of vaccinations are interventions for younger parents.

The nurse is caring for a 7-year-old child who is being treated for multiple fractures after being involved in an automobile accident. The nurse observes that the father frequently takes on the role of nurturer in the family. When planning care, which nursing intervention would most involve the father?

Bathing the child. The nurse would focus on the father for decisions about the course of treatment. Assuring medications are received on time is the family health manager's role. Staying with the child in the hospital will be handled by the family nurturer. All clinical input will be provided to the family gatekeeper for dissemination

An infant is breastfed. When assessing her stools, which findings would be typical?

Breastfed infants are less likely to be constipated than bottle-fed infants. The stools of breastfed infants tend to be yellow and looser than those of bottle-fed babies.

A nurse is providing care to a child on an oncology unit. The nurse is both administering chemotherapy to the child and teaching the parents about the actions, side effects, and complications of the drug. These actions best describe which nursing role?

Clinical nurse specialist The clinical nurse specialist has a master's degree and provides expertise as an educator, clinician, or researcher, meeting the needs of staff, children, and families, as demonstrated in this scenario by both administering and providing information regarding the chemotherapy. The clinical coordinator typically holds a baccalaureate degree and fills a leadership role in a variety of settings. The case manager, also usually a baccalaureate-prepared nurse, is responsible for integrating care from before admission to after discharge. The pediatric nurse practitioner provides health maintenance care for children (such as well-child examinations and developmental screenings) and diagnoses and treats common childhood illnesses. He or she manages children's health in primary, acute, or intensive care settings or provides long-term management of the child with a chronic illness.

The nurse is teaching techniques for effective discipline to the parents of a 9-year-old girl. The girl is misbehaving, and the parents wish to use the extinction method. Which action is an example of extinction?

Going home early from shopping Going home early from shopping if the child misbehaves is an example of extinction discipline. Positive reinforcement is eliminated for inappropriate behavior. Going out for ice cream, praising her for polite behavior, and letting her go to a friend's house are all types of positive reinforcement.

In 2007 the World Factbook published statistics that showed the United States still lagged behind other industrialized nations in the incidence of infant mortality. What is one reason that the United States has a higher infant mortality rate than other countries?

Low birth weight Many factors may be associated with high infant mortality rates and poor health. Low birth weight and late or nonexistent prenatal care are the main factors in the poor rankings in infant mortality.

The nurse is assessing the oral cavity of a 6-month-old child. When palpating the location in which the first primary teeth erupt, which location is being assessed?

Lower central gumline The lower central incisors are usually the first to appear, followed by the upper central incisors.

The father of a 12-year-old child who has low resiliency has asked for tips in working with his son to promote the improvement of this trait. What would be the most effective advice the nurse can provide to the parent?

Encourage the child's father to assist his son to set short-term goals for identified projects. The term resilience refers to the qualities that enable an individual to cope with significant adverse events or stresses and still function competently and have positive outcomes. Various internal and external protective factors promote resiliency. Internal factors include the person's ability to take control and be proactive, to be responsible for his or her own decisions, to understand and accept his or her own limits and abilities, and to be goal directed, knowing when to continue or when to stop. External factors include caring relationships with a family member; a positive, safe learning environment at school (including clubs and social organizations); and positive influences in the community. Dietary supplementation and exercise can promote overall health but working on goal setting will provide a direct impact on the process.

The nurse is caring for a 16-year-old boy with injuries from a car accident. Which activity describes the nurse's manager role?

Facilitating return to school by working with the school nurse Much of an adolescent's life revolves around school and peers. In helping the teen return to school and friends, the nurse and the school nurse are achieving continuity of care and a supportive environment for healing. Teaching the mother cast care addresses the mother's learning needs and the teaching role of the nurse. Discussing driving safety with the teen is important and a factor in many adolescent injuries and deaths but is not a management activity. Changing dressings is a direct care activity of the nurse. pg 14

Following the discharge of a child who has a chronic health condition from the hospital, the nurse case manager follows up with a visit to the home and meets with the family and child. This visit best represents which philosophy of pediatric nursing?

Family-centered care The home visit by the case manager to some degree meets principles of each type of care, but is most representative of family-centered care because family-centered care is described as a mutually beneficial partnership between the child, the family, and health care professionals.

The parent of an 11-year-old girl with an inoperable brain tumor confides to the nurse that her daughter's physician is "pushing them" to convince their daughter to participate in a controversial treatment that has a high risk for side effects. She further states that she told him twice that they were not interested. What would be the nurse's best response to this situation?

Meet with the physician and disclose the concerns of the family; refer the case to the institutional ethics committee if not resolved. When a nurse believes the physician has unduly coerced parents in their treatment decision, the nurse would be obliged to intervene and disclose any concerns. Such intentional or unintentional action would violate ethical principles of conduct. pg 18

The mother of a 12-year-old boy is concerned about the dangers of the Internet. Which suggestion by the nurse best targets safety related to this?

Never share personal information online. Protecting personal information is key to computer safety. Having the computer in a common family area allows adults to monitor the child's activities and promotes some level of safety. Limiting time spent online is a wise overall strategy to encourage physical activity but not safety. Using the phone also limits computer time but does not address safety.

The nurse is caring for a 12-year-old African American girl. The child is in pain as a result of a back injury. The nurse correctly recognizes which belief regarding pain to be most consistent with the child's culture?

Pain may be relieved through prayer and folk healing. African American traditional beliefs include the use of prayer, folk healing and home remedies to promote a return to health and reduction of discomfort.

A 4-year-old boy is residing permanently with his grandparents. Which situation is unique to this type of family or living arrangement?

Physical and financial stress on the caregivers Grandparents, due to age and income levels, are uniquely prone to this type of stress. Difficulty obtaining an accurate health history or records is common in foster families. Obstacles to obtaining informed consent for treatment and gaining consensus between caregivers regarding treatment occur most often in the binuclear family.

The mother of a school-aged child is discussing parenting behaviors with the nurse. She questions the nurse about the best way to provide feedback to her child. What suggestion by the nurse is most appropriate?

Positive reinforcement is more valuable than negative feedback It is most important that feedback is consistent and timely. It is important to focus most on positive feedback rather than the reinforcement of negative problematic behaviors.

The nurse is focusing on health promotion for a 6-year-old girl. Which intervention best supports Healthy People goals?

Recommending a helmet for biking Recommending that the child wear a protective helmet best supports the goals of Healthy People because unintentional injury remains a leading cause of mortality and morbidity for children. Proper diet, adequate sleep, and after-school child care are important but do not affect child health status as much as injury prevention does.

A nurse is preparing discharge teaching for a client being discharged with her newborn baby. What is the highest priority item that must be included in the teaching plan?

Restrain the baby in a car seat. The client should restrain the baby in a car seat when driving. Infants are especially vulnerable to injuries resulting from falling off changing tables or being unrestrained in automobiles. Locking the cabinets and giving warm bottles of formula to the baby are secondary teachings.

The nurse is talking with the mother of a 2-year-old girl during a scheduled visit. Which teaching subject best supports the emphasis on preventive care?

Showing the mother how to teach hand washing to her child. Teaching hand washing helps to prevent infection, emphasizes preventive care, and is basic to avoiding many common illnesses. Reminding the mother that the child will imitate her may promote safe parental role-modeling but does not reach the level of prevention that hand washing does. Knowing about developmental milestones and typical physical changes in toddlers does not directly promote preventive care.

The nurse is caring for a 5-year-old girl with meningitis. What action by the nurse may be considered ethical behavior?

Starting intravenous fluids even though the child protests Ignoring the child's dissent regarding proposed therapy is ethically sound. The treatment will benefit the child, and at 5 years of age the decision maker is nearly always the parent or legal guardian. However, the nurse must use developmentally appropriate techniques to inform the child about the therapy and to carry it out. Telling her an intramuscular injection won't hurt lacks veracity. Referring to the girl as "her" when she is present shows disrespect. Scheduling a laboratory procedure at lunchtime is unfair to the child and lacks justice.

The public health nurse is aware suicide in teens is a significant health issue. Which child is most at risk?

The 17-year-old American Indian boy American Indian/Alaskan Natives have the highest rate of suicide while Hispanic youth are more likely to report attempting suicide. Male rates exceed those of females. Suicide is the third-leading cause of death in people ages 10 to 24 years (CDC, 2012a).

The public health nurse is conducting a clinic to help identify those children who are most at risk of becoming obese due to poor nutrition. Which children does the nurse correctly identify as being at a high risk? Select all that apply.

The child whose guardians are elderly grandparents living in senior government housing The child whose father and mother earn minimum wage at their jobs and have 3 younger siblings The child with 2 younger siblings whose father is single and has been out of work for 6 month Certain health concerns, such as poor nutrition, obesity, infections, lead poisoning, and asthma, affect poor children at higher rates and with greater severity than affluent and middle-class children. The child with elderly grandparents living in government housing, parents working for minimum wage, and a father unemployed for 6 months pose a high risk of obesity due to the likelihood of poor nutrition from the financial situation. pg 14

A group of students are reviewing information about Medicaid. Which statement shows inadequate knowledge of the topic?

The federal government is responsible for administering it. Medicaid is a form of health insurance for low-income and disabled individuals. It is financed by federal and state funds and administered by the states. Medicaid is not a direct provider of service, but rather provides compensation for health care services. Federal guidelines define the scope of basic services, the extent of coverage, and certain administrative requirements. The states administer the program and determine income eligibility criteria, specific services to be covered, and payment levels and methods. pg 8

The nurse is running an education program for early grade-school children. Which topic would address the number one cause of death for this age group?

The importance of crossing streets safely Motor-vehicle accidents are a leading cause of death in this age group. p 10

The nurse is assessing for violence in the home. Which response by the mother represents the greatest risk to the child?

The mother's partner calls the child names. If the mother's partner is being verbally abusive of the child, there is risk of physical violence. There could be a number of reasons other than violence to dread going home. Strictness is not necessarily a sign of abuse. The boyfriend's absence may only be a sign or irresponsibility and not of a violent nature.

According to the pediatric patient's Bill of Rights, the nurse manager should privately counsel a staff nurse to change their behavior in which of these situations? Select all that apply.

The nurse manager hears the staff nurse call the patient "kiddo." The nurse manager hears the parents ask the name of the surgeon that has been consulted and the staff nurse responding, "I'm not sure, it's best if you ask your doctor." A patient's Bill of Rights helps to ensure that the patient's needs are being met in an ethical and legal manner. The staff nurse calling the child "kiddo" and not informing the parents of a child the name of the care provider consulted violates the bill of rights, requiring counseling my the nurse manager.

The quality assurance nurse in a hospital is evaluating the care provided on a pediatric surgical unit. When evaluating if the nurses on the unit are using best evidence-based practice guidelines, the nurse questions which actions by the nursing staff on the pediatric surgical unit? Select all that apply

The nurse performs hand hygiene using alcohol-based hand gel before and after performing a physical assessment on a child. The nurse performs hand hygiene using soap and water prior to charting in the electronic medical record. The nurse takes the child to the sink to perform hand hygiene using soap and water prior to the child eating lunch. The nurse teaches the family to perform hand hygiene before and after changing their child's surgical dressing at home. The nurse asks the family to perform hand hygiene prior to entering the room of the child receiving chemotherapy for cancer treatment. Based on evidence-based practice guidelines for infection control, the nurse demonstrates evidence-based practice interventions in each scenario.

The nurse is making a home visit and observes the 7-month-old pulling the family dog's hair and ears. Which parenting skill does the nurse determine is most effective?

The parent tells the child "no" with a stern voice and pulls the child's hand away from the dog Providing a safe environment, redirection away from undesirable behaviors, and saying "no" in appropriate instances are effective forms of discipline for an infant's developmental level. Infants are at an increased risk for injury from spanking and do not understand the reason for the spanking. Infants do not understand time-outs or the reason for this type of discipline.

The parents of a 9-year-old agree to allow their child to participate in a research project involving drug trials for a new drug for attention deficit hyperactivity disorder. Which rights of the child are related to beneficence? Select all that apply.

The parents and child are told of the physical and nonphysical risks associated with the research. The parents and child are informed of the possible adverse effects of the research. The parents and child are told of the direct and indirect benefits of participation. For issues related to beneficence, the parents and child should know the risks, adverse effects, and expected benefits of the research. Being fully informed of strategies to safeguard identity is an issue of confidentiality. Knowing they can withdraw at any time is a right of refusal, and knowing whom to contact for information is a basic right.

The nurse providing care to the fifth-grade child and his family reviews the nursing care plan, noting that teaching about pubertal changes is one of the individualized interventions. The nurse chooses not to address this. How should the nurse's action be evaluated?

This nurse has not met the standard of care that constitutes adequate nursing practice identified in Pediatric Nursing: Scope of Standards and Practice. The nurse is not meeting professional role expectations. Implementing the interventions identified in the plan of care is expected. Nurses include families in developing the care plan. This is part of family-centered care. Nurses make clinical decisions but would omit teaching only if data indicated it a wise choice. Sexuality education falls to the school, family, and nurse. pg 14

What was the primary goal for the establishment of the Children's Bureau?

To improve the standards of health care he establishment of the Children's Bureau in 1912 began a period of studying economic and social factors related to infant mortality, infant care in rural areas, and other factors related to children's health. The goal of these legislative efforts was to improve the standards of health care.

Over coffee following a worship service, parents ask the parish nurse for guidance in disciplining their children ages 4 years, 9 years, and 14 years. What concepts will guide the nurse's response? Select all that apply.

Use parental attention as positive reinforcement for desired behaviors. Maintain consistency in expectations at all ages. Role model appropriate behavior in word and deed. Attention, consistency, and role modeling are all appropriate disciplinary concepts. Showing anger can cause the child to believe the parent is angry at him or her as a person. A calm demeanor helps indicate displeasure with the behavior. Delaying punishment interferes with connecting the behavior to the consequence.

The nurse provides soy milk and fresh vegetables to a pregnant woman who is single, and the mother of a toddler. Which federal program is the nurse implementing?

WIC Food Package Revised WIC Food Package Revised was designed to improve nutritional intake of the original WIC program (1966/1974) by supporting and promoting long-term breastfeeding and adding fruits and vegetables, whole grains, soy-based foods and a variety of culturally appropriate foods to recipients. In 1921 the Maternity & Infancy (Sheppard-Towner) Act provided grants to states to establish maternal and child health divisions in state health departments. Expansion of Lunch & Nutrition Act provides food for low income school age children year round along with low income children in daycare and Head Start programs. The No Child Left Behind Act of 2002 was enacted to ensure that all children in all classrooms have a research-based curriculum, well-prepared teachers, and a safe learning environment.

While caring for a hospitalized child, the nurse notes the father does not take into consideration the wishes or opinions of the child. During a period of discussion the father explains to the nurse that he feels his child is best served having clearly outlined rules and expectations. This is most consistent with which style of parenting?

authoritarian Authoritarian parenting style consists of the parents making the rules for the child to follow. There is little to no flexibility or decision making by the child. Authoritative parenting is also referred to as democratic parenting. In this style of parenting the there are rules and expectations of behavior but the parents embrace the individuality of the child and do allow some input by the child. There is no "strict" parenting style.

The nurse is assessing an adolescent. When discussing his parents, the adolescent states that his parents have very strict rules and he is expected to follow them. If he breaks a rule, he is punished. The nurse is aware that this is which parenting style?

authoritarian The authoritarian parent expects obedience from the child and punishes when rules are broken. The authoritative or democratic parent shows some respect for the child's opinions. Permissive or laissez-faire parents have little control over the behavior of their children. Uninvolved parents are indifferent. They do not provide rules or standards.

A child in an elementary school visits the school nurse frequently reports being tired. Upon questioning, the child says that when at the mother's house there is no set time for bed, but at the father's house there is a set bedtime. Before discussing this issue with the parents, the nurse determines that the child is living in which type of family structure?

binuclear

When caring for a woman in her sixth month of pregnancy, the client reports her plans to nurse her baby for at least 2 to 3 years like the rest of the women in her family. Based upon the nurse's knowledge, the nurse should:

document her report but do nothing as this is a cultural belief that should be respected. Culturally specific decisions should be respected and incorporated into the plan of care.

A boy tells you that his family celebrates the Fourth of July by eating out at a local restaurant. He tells you this is a better way to celebrate the holiday than having a picnic like his neighbors. This statement is an example of:

ethnocentrism. Ethnocentrism is a belief that one's own culture or customs are superior to those of others.

In order to advocate for children and families, the nurse must first acknowledge that the basic system in which health behavior and care are organized, secured, and performed is the:

family. The family is the basic system in which health behavior and care are organized, secured, and performed. In most families, the parents or guardians, as advocates for their child, provide health promotion and health prevention care, as well as primary management of care when the child is sick. Parents and guardians have the prime responsibility for initiating and coordinating services rendered by health professionals.

A nurse is considering employment in a practice that promotes family-centered care. When considering this position, the nurse recognizes that this philosophy will:

promote the involvement of the child and parents as members of the health care team. Family-centered care involves a mutually beneficial partnership between the child, the family, and health care professionals. It applies to the planning, delivery, and evaluation of health care for children of all ages in any setting.