Peds Questions

A nurse is teaching the parent of a child who has type 1 diabetes mellitus how to manage the child's disorder during an illness such as a cold. Which of the following statements by the parent indicates an understanding of the teaching? "I'll reduce my child's food intake." "I'll check his blood glucose more often." "I'll limit his fluid intake between meals." "I won't administer his long-acting insulin dose."

"I'll check his blood glucose more often." The parent should check the child's blood glucose every 3 hours during an illness because the level tends to rise even if the child eats less food.

A nurse is teaching the guardian of an 18-month-old toddler about otic medication administration. Which of the following statements should the nurse make? "Administer the drops immediately after removing the medication from the refrigerator." "Place the child in a seated position with the head tilted to the side for administration." "Gently pull the ear cartilage down and back when administering the medication." "Position the medication bottle so the drops do not touch the side of the ear canal."

"Gently pull the ear cartilage down and back when administering the medication." The nurse should instruct the guardian to pull the pinna gently down and back to straighten the eustachian tube when administering the medication.

A nurse in the emergency department is caring for a 12-year-old child who has ingested bleach. Which of the following statements by the nurse indicates an understanding of this ingestion? "The absence of oral burns excludes the possibility of esophageal burns." "Treatment focuses on neutralization of the chemical." "Injury by a corrosive liquid is more extensive than by a corrosive solid." "Immediate administration of activated charcoal is warranted."

"Injury by a corrosive liquid is more extensive than by a corrosive solid." The coating action of liquids permits larger areas of contact with tissues and results in more extensive injury.

A nurse is teaching the parents of a toddler who had an anaphylactic reaction to peanut butter about administering injectable epinephrine. Which of the following instructions should the nurse include? "Common sites for an injection of epinephrine are the fatty tissue found in the upper arm and in the lower abdomen." "Administer epinephrine prior to giving your child peanut products in the future." "No further treatment is needed after injecting the epinephrine." "You will need to increase the dosage as your child gains weight."

"You will need to increase the dosage as your child gains weight." Epinephrine is a weight-based medication that is available in dosages of 0.15 mg and 0.3 mg. As the child grows, it will be necessary to change the epinephrine dosage that is administered.

A nurse is caring for a 4-month-old child who is hospitalized. Which of the following toys should the nurse provide for the child? A board book with large pictures A toy with movable parts A plastic mirror Push-pull toy

A plastic mirror A 4-month-old infant can recognize herself and will also attempt to play with "the baby in the mirror." A mirror is a bright object that provides appropriate visual stimulation for this age group. For the infant's safety, however, the mirror must be unbreakable.

A nurse is providing teaching to the guardians of an infant who has failure to thrive (FTT). Which of the following pieces of information should the nurse include in the teaching? Add fortified rice cereal to the infant's formula Alternate feedings between several family members Offer the infant juice between feedings Provide feedings on demand rather than on a schedule

Add fortified rice cereal to the infant's formula The nurse should inform the guardians that adding fortified rice cereal or vegetable oil to the infant's formula helps promote weight gain.

A nurse is performing a physical assessment on a 6-month-old infant. Which of the following reflexes should the nurse expect to find? Stepping Babinski Extrusion Moro

Babinski The Babinski reflex, which is elicited by stroking the bottom of the foot and causing the toes to fan and the big toe to dorsiflex, should be present until the age of 1 year. Persistence of neonatal reflexes might indicate neurological deficits.

A nurse is providing discharge teaching to the guardian of an adolescent who is postoperative following a tonsillectomy. Which of the following manifestations should the guardian report to the provider? Nasal secretions containing dark brown blood Constant clearing of the throat Unpleasant odor from the oral cavity Temperature of 37.7°C (99.8°F) at 48 hr postoperative

Constant clearing of the throat A manifestation of hemorrhage following a tonsillectomy is the constant clearing of blood that is draining in the back of the throat. Therefore, it should be reported to the provider if the adolescent begins constantly clearing the throat following a tonsillectomy.

A nurse is caring for a 6-year-old child who is experiencing encopresis. Which of the following actions should the nurse take? Instruct the child's guardian to limit stool softener use to no more than twice per week Encourage the child to attempt to have a bowel movement 4 times per day Determine if there are any recent stressors in the child's environment Urge the child's guardian to provide negative consequences when the child has a bowel accident

Determine if there are any recent stressors in the child's environment Encopresis can be caused by stress or changes in the child's environment.

A nurse is planning care for a school-aged child who has juvenile idiopathic arthritis (JIA). Which of the following actions should the nurse include in the plan? Encourage the child to sleep for 1 hour each afternoon Apply cold compresses to the child's affected joints each morning Encourage the child to participate in physical activities Limit the child's intake of foods that are high in uric acid

Encourage the child to participate in physical activities The nurse should encourage the child to remain physically active to promote mobility and joint function.

A nurse is assessing a 4-year-old child. The nurse should expect the child to be able to perform which of the following activities? Fastening buttons on a shirt Tying shoelaces Parting and combing hair Cutting the meat at dinner

Fastening buttons on a shirt The nurse should expect a 4-year-old child to have the fine motor ability to fasten buttons on a shirt; however, the child may have difficulty if the buttons are small.

A nurse working on a maternal-newborn unit is teaching a group of newly licensed nurses about assisting new mothers with breastfeeding. The nurse should include which of the following infant conditions as a contraindication for breastfeeding? Galactosemia Hyperbilirubinemia Glycogen storage disease Hypothyroidism

Galactosemia An infant who has galactosemia cannot metabolize lactose. Breast milk contains lactose, which can cause failure to thrive, cirrhosis, developmental delays, and even death in affected infants. An infant who has galactosemia is fed with formula made with milk substitutes.

A nurse is assessing a 24-month-old toddler who has a new diagnosis of autism spectrum disorder (ASD). Which of the following findings should the nurse expect? Wanting to be held frequently Ability to build a tower of 10 cubes Impaired language skills Ability to stand on 1 foot

Impaired language skills The nurse should expect a 24-month-old toddler who has ASD to exhibit impaired language skills (e.g. failing to respond to his or her name, pointing to objects instead of speaking).

A nurse is performing a well-child assessment on a 7-year-old client who takes great pride in bringing school papers home. The nurse recognizes that this behavior demonstrates which of the following of Erikson's stages of psychosocial development? Initiative vs. guilt B Industry vs. ineriority Identity vs. role confusion Autonomy vs. shame and doubt

Industry vs. inferiority The developmental task of industry vs. inferiority is reflected by a child's level of motivation in relation to personal achievements that build good character during the school-age years (ages 6 to 12 years).

A nurse is providing teaching to a parent of a preschooler who has tinea capitis. Which of the following instructions should the nurse include in the teaching? Apply aluminum acetate solution compresses to the lesions Apply hydrocortisone cream to the lesions twice daily Seal nonwashable toys in a plastic bag for 2 weeks Leave the medicated shampoo on the scalp for 5 to 10 minutes

Leave the medicated shampoo on the scalp for 5 to 10 minutes The nurse should instruct the parent to use a shampoo made of 2% ketoconazole or 1% selenium sulfide for the treatment of tinea capitis. For the shampoo to be effective, the parent should leave it on the child's scalp for 5 to 10 minutes prior to rinsing.

A nurse is creating a plan of care for a child who has leukopenia secondary to chemotherapy. Which of the following interventions should the nurse include in the plan? Maintain the child on bed rest Monitor the child for increased temperature Administer oxygen to the child Monitor the child for bleeding

Monitor the child for increased temperature Leukopenia places the child at risk of infection; therefore, the nurse should monitor the child for a fever.

A nurse is caring for a preschooler who is immediately postoperative following the removal of a brainstem tumor. Which of the following actions should the nurse take? Have the child deep-breathe and cough every hour Offer the child clear liquids 4 hours after the procedure Monitor the child's temperature every 30 minutes Place the child in Trendelenburg position

Monitor the child's temperature every 30 minutes The nurse should monitor the child's temperature every 15 to 30 minutes. Surgery on the brainstem can cause hyperthermia.

A nurse is observing a mother who is playing peek-a-boo with her 8-month-old child. The mother asks if this game has any developmental significance. The nurse should reply that peek-a-boo helps develop which of the following concepts in the child? Hand-eye coordination Sense of trust Object permanence Egocentrism

Object permanence Object permanence refers to the cognitive skill of knowing an object still exists even when out of sight. By discovering a hidden object while playing peek-a-boo, the infant experiences validation of this concept.

A nurse is caring for a 5-year-old child who has a fever and begins to have a seizure. Which of the following actions should the nurse take? Give acetaminophen 240 mg PO immediately following the seizure Sponge the child's skin with a mixture of cold water and rubbing alcohol Administer rectal diazepam if the seizure lasts longer than 2 minutes Place the child in a side-lying position

Place the child in a side-lying position The nurse should place the child in a side-lying position to facilitate drainage of oral secretions, which decreases the risk of aspiration.

A nurse is planning care for a 10-month-old infant who has suspected failure to thrive (FTT). Which of the following interventions should the nurse include in the plan of care? (Select all that apply.) Observe the parents' actions when feeding the child Maintain a detailed record of food and fluid intake Follow the child's cues to time food and fluids Sit beside the child's high chair for feedings Play music videos during scheduled meal times

Observe the parents' actions when feeding the child Maintain a detailed record of food and fluid intake Inappropriate feeding techniques and meal patterns provided by parents can contribute to a child's growth failure. A nutritional goal for this child who has suspected FTT is to correct nutritional deficiencies, which can be identified by recording all food and fluid intake.

A nurse is caring for a 4-month-old infant who has tetralogy of Fallot and experiences a hypercyanotic spell. Which of the following actions should the nurse take? Place the infant in knee-chest position Begin CPR Prepare to intubate the infant Administer IV adenosine

Place the infant in knee-chest position The nurse should identify that a hypercyanotic spell occurs when a vascular spasm reduces pulmonary blood flow and forces blood to shunt from the right ventricle to the left ventricle through the ventricular septal defect. The nurse should place the infant in a knee-chest position to increase systemic vascular resistance, which will help force more blood through the pulmonary artery.

A nurse is discussing play activities with a group of parents of toddlers. Which of the following activities should the nurse recommend for this age group? Jumping rope Pushing a toy lawn mower Sorting colored marbles Playing a board game

Pushing a toy lawn mower The nurse should recommend pushing a toy lawn mower as a play activity for a toddler. Toddlers are developmentally ready for push-pull toys, and they enjoy play activities that allow imitation of adults.

A nurse is caring for a child who has tetralogy of Fallot. Which of the following laboratory values should the nurse expect to find? Platelet count of 20,000/mm^3 WBC 4,000/mm^3 Thyroid stimulating hormone 7.0 microunits/mL RBC 6.8 million/uL

RBC 6.8 million/uL A child who has tetralogy of Fallot experiences cyanosis; therefore, the body responds by increasing RBC production (polycythemia) in an attempt to supply oxygen to all body parts.

A nurse in a pediatric clinic is talking with the parent of a toddler who states that her child will not sit at the table to eat with the family. She asks the nurse for recommendations for "finger foods" for her child. Which of the following foods should the nurse suggest? Slices of ripe banana Popcorn Slices of hot dogs Raw carrots

Slices of ripe banana Toddlers should have about 8 oz (1 cup) of fruit per day. Bananas are nutritious and, as long as they are soft, do not present a choking hazard for young children.

A nurse is caring for a 6-week-old infant following a pyloromyotomy. Which of the following forms of feeding should the nurse anticipate for the infant 6 hr after the procedure? Bottle formula with added protein Small, frequent bottle feedings of electrolyte solution Continuous nasoduodenal tube feedings Bolus feedings via gastrostomy tube

Small, frequent bottle feedings of electrolyte solution Feedings begin 4 to 6 hours after the surgical procedure. The nurse should anticipate feeding the infant small, frequent increments of an electrolyte solution or sterile water.

A nurse is admitting a child who has a history of tonic-clonic seizures. Which of the following items is the priority to have in the child's room? Pulse oximeter Oxygen therapy Bag valve mask Suction equipment

Suction equipment When using the airway, breathing, and circulation (ABC) approach to client care, the nurse should determine that the priority item to have in the child's room is suction equipment. If the child experiences a tonic-clonic seizure, the child is at risk for aspiration and airway occlusion due to secretions, food, or fluids. The nurse should have suction equipment available to maintain a patent airway for effective respiration, administration of oxygen, and use of a bag valve mask if needed.

A nurse in a provider's office receives a phone call from the guardian of an infant who just vomited after the administration of digoxin. Which of the following actions should the nurse take first? Tell the guardian that a repeat dose of medication should not be given Verify the prescribed medication regimen Determine if the infant has been exposed to others who are ill Ask the guardian about the infant's urinary output

Tell the guardian that a repeat dose of medication should not be given The greatest risk to this infant is an injury from digoxin toxicity. Therefore, the priority action for the nurse to take is to instruct the guardian not to administer another dose of medication. The nurse should follow-up with the guardian frequently to determine if the child has further episodes of vomiting. If so, the nurse should notify the provider immediately because vomiting is a possible indication of digoxin toxicity.

A nurse in a provider's office enters an examination room to assess an 8-month-old infant for the first time. Which of the following reactions by the infant should the nurse expect? The infant gives the nurse a social smile. The infant turns away when the nurse approaches. The infant reaches out to the nurse to be held. The infant is responsive and alert as the nurse comes closer.

The infant turns away when the nurse approaches. The nurse should expect an 8-month-old infant to have a heightened fear of strangers. The infant is expected to cling to her parent and turn away when approached by a stranger.

A nurse is assessing a school-age child who reports horseback riding 3 times per week and has injuries reportedly related to a fall from a horse. Which of the following findings should the nurse investigate further as an indication of child maltreatment? Bruising of the right elbow Dislocated left shoulder revealed by X-ray Thin, frail extremities Abrasions on both wrists

Thin, frail extremities The nurse should identify that thin, frail extremities are related to malnourishment and can indicate child maltreatment. The nurse should investigate this finding further and report the results to the provider.

A nurse is caring for a 15-month-old client who requires droplet precautions. Which of the following actions should the nurse take? Have the toddler wear a disposable gown when in the unit's playroom. Wear sterile gloves when changing the toddler's diapers. Wear a mask when assisting the toddler with meals. Ask visitors to wear an N-95 mask when entering the toddler's room.

Wear a mask when assisting the toddler with meals. The nurse should wear a mask within 3 to 6 feet of the toddler to prevent the transmission of infections that are spread via large-droplet particles expelled in the air.

A nurse on a pediatric mental health unit is caring for a school-age child. Which of the following questions or statements should the nurse provide to foster a rapport and encourage conversation? "Do you like school?" "Tell me about your favorite video game." "We have another child your age on the unit." "Would you like your friends to visit you?"

"Tell me about your favorite video game." The nurse should use the therapeutic communication technique of exploring to encourage the child to respond with more than just the name of the game. This type of communication fosters a rapport and encourages communication.

A nurse is teaching the parent of a 12-month-old infant about nutrition. Which of the following statements by the parent indicates a need for further teaching? "I can give my baby 4 oz of juice to drink each day." "I will offer my baby dry cereal and chilled banana slices as snacks." "I am introducing my baby to the same foods the family eats." "My infant drinks at least 2 qt of skim milk each day."

"My infant drinks at least 2 qt of skim milk each day." As the infant transitions into toddlerhood, whole milk intake should average 24 to 30 oz per day. Too much milk can affect the child's intake of solid foods and result in iron deficiency anemia. Skim milk is not recommended until after age 2 since it lacks essential fatty acids, which are needed for growth and development.

A nurse is providing teaching to the parent of a child who has ADHD and a new prescription for methylphenidate sustained-release tablets. Which of the following statements by the parent indicates an understanding of the teaching? "I should expect my child to gain weight while taking this medication." "I should expect this medication to decrease my child's heart rate." "I should crush the medication and put it in my child's food." "I should give this medication to my child half an hour before breakfast."

"I should give this medication to my child half an hour before breakfast." The parent should administer the medication to the child on an empty stomach.

A nurse is teaching the parent of an infant about injury prevention. Which of the following statements by the parent indicates an understanding of the teaching? "I should lightly shake talcum powder on my baby's skin after each diaper change." "I should use a drop-side crib after my baby is 6 months old." "I should make sure my baby's clothing does not have buttons." "I should ensure the crib slats are no more than 3 inches apart."

"I should make sure my baby's clothing does not have buttons." The nurse should instruct the parent to avoid clothing with buttons to reduce the risk of choking and aspiration.

A nurse is teaching the parents of a 4-month-old infant who has gastroesophageal reflux. Which of the following statements by a parent indicates an understanding of the teaching? "I will add 1 teaspoon of rice cereal per ounce to my baby's formula." "I will place my baby on her side when sleeping." "I will decrease the number of feedings my baby receives per day." "I will give my baby loperamide with each feeding."

"I will add 1 teaspoon of rice cereal per ounce to my baby's formula." The parents can give the infant thickened feedings with rice cereal to help decrease reflux. The added calories also can help infants who are underweight due to gastroesophageal reflux.

A nurse is caring for a child who has bacterial endocarditis. The child is scheduled to receive moderate-term antibiotic therapy and requires a peripherally inserted central catheter (PICC). Which of the following statements should the nurse include when teaching the child's parent? "The PICC line will last for several weeks with proper care." "The public health nurse will rotate the insertion site every 3 days." "You will need to ensure the arm board is in place at all times." "Your child will go to the operating room to have the line placed."

"The PICC line will last for several weeks with proper care." A PICC line is the preferred venous access device for short- to moderate-term IV therapy. It can remain in place for long periods with proper care

A nurse is reviewing the medical record of a 2-month-old infant who has rotavirus. The nurse notes a hemoglobin level of 12 g/dL and a hematocrit of 51%. Which of the following statements by the nurse indicates an understanding of the laboratory values? "The infant might be dehydrated." "The infant might be anemic." "The infant might have received too much fluid." "The infant might have leukemia."

"The infant might be dehydrated." An increased hematocrit level indicates dehydration. Hematocrit levels rise when blood volume is decreased during dehydration.

A nurse in the emergency department is admitting a child who has full-thickness burns over 45% of his body. Which of the following actions should the nurse take first? Administer IV morphine Administer topical antimicrobials Administer IV fluid replacement Administer tetanus prophylaxis

Administer IV fluid replacement The greatest risk to this child is an injury from hypovolemic shock; therefore, the first action the nurse should take after ensuring the child has a patent airway is to administer IV fluid replacement therapy.

A nurse is providing education about the introduction of solid foods for the parent of an infant. Which of the following instructions should the nurse include? Begin after the extrusion reflex has diminished. Introduce solids between 2 and 3 months of age. Wait until the infant's first tooth erupts. Add a sweetener such as light corn syrup to bland foods.

Begin after the extrusion reflex has diminished. The nurse should explain that the extrusion reflex results in food being pushed out of the mouth instead of being swallowed. The tongue extrusion reflex diminishes after 4 months of age.

A nurse is caring for a preschooler who has a terminal illness. The nurse should expect the preschooler to have which of the following perspectives about death? Believes that her own thoughts can cause death Has an understanding of the finality of death Exhibits curiosity about what happens to the body after death Views funeral services as unnecessary

Believes that her own thoughts can cause death The nurse should expect preschoolers to believe that their own thoughts or actions can cause death, and they might believe that death is a punishment for wrong-doing.

A nurse is caring for a 2-year-old child who has cystic fibrosis. The nurse is planning to take the child to the playroom. Which of the following activities would be appropriate for the child? Cutting figures from colored paper Drawing stick figures using crayons Riding a tricycle Building towers with blocks

Building towers with blocks Building towers with blocks is an appropriate activity for a 2-year-old child. and promotes fine-motor development. Also, knocking blocks down provides a means of dealing with the stress of hospitalization.

A nurse is caring for an infant who has a tracheoesophageal fistula. Which of the following actions should the nurse take? Place the infant in a lateral position Perform oropharyngeal suctioning Administer ranitidine orally Thicken the infant's formula

Perform oropharyngeal suctioning When caring for an infant who has a tracheoesophageal fistula, the nurse should perform frequent oropharyngeal suctioning to decrease the infant's risk of aspiration.

A nurse is teaching a school-age child and his parents how to self-administer insulin. Which of the following actions should the nurse take first? Allow a parent to administer an injection to the nurse Have the child teach the injection technique to the parents Have a parent administer the insulin injection to the child Demonstrate the injection technique on an orange

Demonstrate the injection technique on an orange The nurse should apply the safety and risk-reduction priority-setting framework. This framework assigns priority to the factor or situation posing the greatest safety risk to the client. When there are several risks to client safety, the one posing the greatest threat is the highest priority. Demonstrating the injection technique on an orange poses no risk to the client and is the first action the nurse should take. The nurse should use Maslow's hierarchy of needs, the ABC priority setting framework, and/or nursing knowledge to identify which risk poses the greatest threat to the client.

A nurse in an emergency department is caring for a 4-year-old child who has burns to the neck and face following a house fire. Which of the following actions should the nurse take first? Cover the child's wounds with a clean, dry cloth Establish IV access with a large-bore catheter Provide reassurance to the child's parents Determine the child's breathing pattern

Determine the child's breathing pattern The nurse should apply the ABC priority-setting framework, which emphasizes the basic core of human functioning: having an open airway, being able to breathe in adequate amounts of oxygen, and circulating oxygen to the body's organs via the blood. An alteration in any of these areas can indicate a threat to life and is the nurse's priority concern. When applying the ABC priority-setting framework, airway is always the highest priority because the airway must be clear for oxygen exchange to occur. Breathing is the second-highest priority because adequate ventilatory effort is essential in order for oxygen exchange to occur. Hence, determining the child's breathing pattern is the first action the nurse should take. Circulation is the third-highest priority because the delivery of oxygen to critical organs only occurs if the heart and blood vessels are capable of efficiently carrying oxygen to them.

A nurse is assessing a 4-year-old child's cognitive development during a well-child visit. Which of the following should the nurse expect the child to display? Conservation Development of the superego Concrete operational thought Separation anxiety

Development of the superego This is the development of a conscience. Preschoolers begin to develop an understanding of right from wrong. While they might be unable to understand the "why" of acceptable vs unacceptable behaviors, they learn the concept through punishment and reward and the principles to which their parents adhere.

A nurse is providing preoperative education for an 8-year-old child prior to cardiac surgery. Which of the following actions should the nurse take? Provide education for the child immediately before the surgery. Plan a teaching session that will last no longer than 60 min. Use a doll with tubes and an incision to explain the surgery. Discuss methods to cover the scar once healing has occurred.

Use a doll with tubes and an incision to explain the surgery. Play involving visual and interactive approaches is appropriate for a school-age child's level of understanding.

A nurse is creating a plan of care for an 18-month-old toddler who has cerebral palsy. Which of the following interventions should the nurse include? Use a mobile walker for the toddler Discourage activities involving repetitive joint movement Use manual jaw control when feeding the toddler Discourage the use of wrist splints

Use manual jaw control when feeding the toddler The nurse should encourage the parent to include the use of manual jaw control during feedings. Children diagnosed with cerebral palsy can lose jaw control, and more effective control can be achieved by providing stability to the jaws during feeding.

A clinic nurse is providing teaching to the parent of a 1-month-old infant who has gastroesophageal reflux. Which of the following statements by the parent indicates an understanding of the teaching? "I will give lansoprazole 30 min after my baby's feedings." "I will lay my baby on her right side after feedings." "I will give my baby a bottle just before bedtime." "I will add rice cereal to my baby's feedings."

"I will add rice cereal to my baby's feedings." The parent should add 1 tsp to 1 tbsp of rice cereal per ounce of formula or expressed breast milk to thicken the feedings and decrease the number of vomiting episodes.

A nurse is teaching the parent of a preschool-aged child about the treatment for pinworms. Which of the following statements by the parent indicates an understanding of the teaching? "I will give my child a dose of albendazole today and again in 2 weeks." "I will collect specimens immediately after my child has a bowel movement." "I will give my child a tub bath twice each day." "I will place my child's bed linens in a sealed plastic bag for 7 days."

"I will give my child a dose of albendazole today and again in 2 weeks." The nurse should instruct the parent to repeat the dose of albendazole in 2 weeks to eradicate the parasite and prevent reinfection.

A nurse is providing education to the parent of a toddler who is about to receive an MMR (measles, mumps and rubella) immunization. Which of the following statements by the parent indicates an understanding of the teaching? "My child should not play with other children for 2 days." "I will need to return in 2 weeks for my child to receive the varicella immunization." "I will help my child to blow bubbles during the injection." "My child may have some drainage from the injection site."

"I will help my child to blow bubbles during the injection." Providing distraction, such as helping or allowing a child to blow bubbles while receiving an injection, is a technique that can minimize pain and discomfort for the child.

A nurse is providing teaching to the parent of a 2-year-old toddler about nutrition. Which of the following statements by the parent indicates an understanding of the teaching? "My child should consume 1,000 calories per day." "My child should have 4 oz of protein per day." "I should give my child 32 oz (4 cups) of milk per day." "I should feed my child 4 oz (1/2 cup) of vegetables per day."

"My child should consume 1,000 calories per day." Toddlers who are 2 years old should consume 1,000 calories daily

A nurse is providing teaching to the parent of a toddler who is undergoing insertion of tympanostomy tubes. Which of the following statements should the nurse include? "The doctor will replace the tubes routinely about every 2 years." "If your child gets water in her ears will not cause any further problems." "The tubes should stay in place until they fall out on their own." "Now that the tubes are in place, she should not have any further problems with hearing."

"The tubes should stay in place until they fall out on their own." Tympanostomy tubes allow drainage from and ventilation to the middle ear. They usually fall out on their own within 6 to 12 months after insertion.

A nurse is assessing an adolescent who has appendicitis. Which of the following manifestations should the nurse expect? Upper right quadrant abdominal pain Rigid abdomen Hyperactive bowel sounds Bradycardia

Rigid abdomen A rigid abdomen is an expected manifestation of appendicitis

A nurse is providing teaching to the parent of a child who has cystic fibrosis and a prolapsed rectum. The nurse should identify that which of the following is a cause of this complication? Bulky stools Weakened rectal sphincter Elevated pancreatic enzymes Decreased intra-abdominal pressure

Bulky stools The nurse should identify that bulky stools can cause a child who has cystic fibrosis to develop a prolapsed rectum. The nurse should implement interventions to help decrease the bulk of the child's stools.

A nurse in the emergency department is reviewing laboratory results for several children who have manifestations of influenza. Which of the following children should the nurse report to the provider immediately? A school-age child with a urine specific gravity of 1.035 A toddler with a BUN of 25 mg/dL and a creatinine of 0.5 mg/dL An infant with a WBC count of 24,000/mm3 An adolescent with a positive beta human chorionic gonadotropin test

An infant with a WBC count of 24,000/mm3 The nurse should apply the safety and risk-reduction priority-setting framework. This framework assigns priority to the factor or situation posing the greatest safety risk to the client. When there are several risks to client safety, the one posing the greatest threat is the highest priority. The nurse should use Maslow's Hierarchy of Needs, the ABC priority-setting framework, and/or nursing knowledge to identify which risk poses the greatest threat to the client. This WBC count is high and indicates infection and possibly sepsis, which poses the greatest risk. The provider must initiate blood, urine, and spinal fluid cultures and begin antimicrobial therapy.

A nurse is caring for a preschooler who was brought to an outpatient clinic with a 2-day history of a vesicular, honey-colored crusty region around the nose and mouth. If the provider determines the lesions to be impetigo contagiosa, what should the nurse anticipate teaching the child's parent about the illness? (Select all that apply.) Apply a topical antibacterial ointment to the lesions Wash the child's bed linens daily with hot water Administer acyclovir oral suspension to prevent recurrence Allow the crust covering the infected lesions to remain intact Wash hands before and after contact with the affected area

Apply a topical antibacterial ointment to the lesions Wash the child's bed linens daily with hot water Wash hands before and after contact with the affected area Impetigo contagiosa is a bacterial infection of the skin. Therefore, the nurse should plan on teaching the child's parents about topical application of an antibacterial ointment. The parents should wash their hands before and after contact with the affected area and wash the child's bed linens daily in hot water to decrease the risk of reinfection or transmission.

A nurse is caring for a school-aged child who has hemophilia and fell on the playground. The child reports a pain level of 4 on a scale of 0 to 10. Which of the following actions should the nurse take? Administer an NSAID Perform passive range-of-motion exercises on the joint Administer cryoprecipitate Apply an ice pack to the joint

Apply an ice pack to the joint Immediately following an injury, a joint should be rested, elevated, and have ice applied to minimize bleeding into the joint.

A nurse is providing discharge teaching to the guardian of an infant following a hypospadias repair. Which of the following instructions should the nurse include? Clamp the infant's catheter for 30 minutes each day Give the infant a tub bath once per day Apply antibacterial ointment to the infant's penis once per day Decrease the infant's fluid intake for 3 days

Apply antibacterial ointment to the infant's penis once per day The nurse should instruct the guardian to apply an antibacterial ointment to the infant's penis once daily to decrease the risk of infection.

A nurse is planning to assess an 8-year-old child who was brought to the clinic by a parent. The parent reports the child has missed school for 3 weeks and refuses to go back due to "not feeling well." Which of the following actions should the nurse perform during the initial interview with the child? Ask the child to describe what things were like right before not wanting to go to school Use a direct question and ask the child why going to school is no longer fun Tell the child it is okay not to like school, but she has to go back Reassure the child that things might not be going well right now, but they will soon improve

Ask the child to describe what things were like right before not wanting to go to school The nurse should ask the child to describe what things were like before she stopped going to school to help determine whether this behavior is related to a long-term issue or a critical incident that caused intense discomfort.

A nurse is caring for a 7-year-old child who is in skeletal traction following a complete fracture of the femur. Which of the following diversional activities should the nurse offer the child? Puzzle with large pieces Building blocks Finger paints Chapter books

Chapter books The nurse should offer chapter books as an appropriate diversional activity for a school-age child who has limited movement due to skeletal traction.

A nurse is teaching the parent of a school-age child who has celiac disease. Which of the following foods selected by the parent indicates an understanding of the teaching? Corn tortilla with black beans Pizza Canned soup Hot dogs

Corn tortilla with black beans Children who have celiac disease are placed on a gluten-free diet. Gluten is found in wheat, rye, and barley. Selecting products made from corn indicates an understanding of the teaching, as corn and beans are gluten-free foods.

A nurse is preparing to administer acetaminophen 240 mg PO daily to a child who has a temperature of 38.9°C (102°F). The amount available is acetaminophen oral solution 160 mg/5 mL. How many mL should the nurse administer per dose? (Fill in the blank with the numeric value only, round the answer to the nearest tenth, and use a leading zero if applicable. Do not use a trailing zero.)

Correct Answer: 7.5 Have/Quantity = Desired/X 160 mg/5 mL = 240 mg/X mL X = 7.5 mL

A nurse is caring for an infant who has a cleft palate. The parents ask the nurse how long they should wait before the child can have corrective surgery. The nurse should explain that the parents should wait no longer than 6 to 12 months for surgery to prevent which of the following outcomes? Repeated ear infections Nutritional deficits Immune system deficits Difficulty with language acquisition

Difficulty with language acquisition Clients who have a cleft palate can have difficulty acquiring language because they need to use the palate for vocalizing sounds. Because of the cleft in the palate, these infants could develop poor speech habits.

A nurse is providing teaching to the parent of a school-aged child who has pediculosis. Which of the following instructions should the nurse include? Machine-wash clothing in cold water Dry clothing in a hot dryer for at least 20 min Soak combs and brushes for 5 min in boiling water Seal nonwashable items in a bag for 7 days

Dry clothing in a hot dryer for at least 20 min The nurse should instruct the parent to dry the child's clothing in a hot dryer for at least 20 minutes.

A nurse is caring for an adolescent who has sickle cell anemia. Which of the following manifestations is/are the result of chronic vaso-occlusive phenomena? (Select all that apply.) Enlarged heart Enuresis Leg ulcers Extrahepatic cholestasis Retinal detachment

Enlarged heart Enuresis Leg ulcers Retinal detachment Chronic vaso-occlusive phenomena result from the obstruction of organs by red blood cells, leading to stasis and enlargement of the organs, infarction due to ischemia, and scarring. An enlarged heart, enuresis, leg ulcers, and retinal detachment are manifestations of chronic vaso-occlusive phenomena.

A nurse is preparing to assess an 11-month-old infant during a well-child examination. Which of the following actions should the nurse take? Pull the infant's pinna up and back when examining the ears Palpate and count the infant's radial pulse for 15 seconds Examine the infant's throat at the end of the examination Check the infant's blood pressure in both arms

Examine the infant's throat at the end of the examination The nurse should perform noninvasive assessments first to avoid causing the infant to cry, which can make the remainder of the examination difficult.

A nurse in a provider's office is assessing a client. The nurse determines the client's body mass index is 21.2. This finding is classified as which of the following? Underweight Healthy weight Overweight Obese

Healthy weight Body mass index (BMI) is a measure of an individual's weight relative to height. A BMI from 18.5 to 24.9 is in the healthy range. Therefore, this client's weight is considered healthy.

A nurse is teaching a newly hired nurse about caring for an infant who is postoperative following myelomeningocele repair. The nurse should teach the newly hired nurse to monitor the infant for which of the following complications? Hydrocephalus Congenital hypotonia Otitis media Osteomyelitis

Hydrocephalus In the surgical repair of the myelomeningocele, the pathway for the cerebral spinal fluid is altered. Therefore, the infant is at risk of hydrocephalus, and the nurse should monitor the infant for this condition.

A nurse is caring for a toddler who has gastroenteritis caused by Salmonella. Which of the following is the priority action for the nurse? Weigh the child Initiate contact precautions Establish a skin care routine Obtain a recent food history

Initiate contact precautions Salmonella is a type of bacteria that is transmitted via contaminated feces, making contact precautions essential for preventing transmission. This client is at greatest risk for transmission of Salmonella to others; therefore, contact precautions are the nurse's priority.

A nurse is creating a plan of care for a child who has aplastic anemia. Which of the following interventions should the nurse include? Initiate protective-environment isolation for the child Apply pressure for 1-2 min at the puncture site following blood specimen collection Mix the child's ferrous sulfate elixir twice per day into a glass of milk for administration Check the child's blood glucose level every 4 hr

Initiate protective-environment isolation for the child The nurse should suggest protective-environment isolation for the child, which consists of a private room with positive air pressure and no live flowers; nurses must don a respirator mask, gloves, and gown prior to entering the child's room. A child who has aplastic anemia has decreased RBCs, platelets, and WBCs, causing immune suppression and increasing susceptibility to infection.

A nurse is providing discharge teaching to the parents of a child who has nephrotic syndrome. Which of the following instructions should the nurse include in the teaching? Restrict the child's potassium intake Administer acetaminophen to the child twice daily Weigh the child once each week Keep the child away from people who have an infection

Keep the child away from people who have an infection Children who have nephrotic syndrome are at increased risk for infection and should avoid contact with people who have infections.

A nurse is assessing an adolescent who has a new diagnosis of anorexia nervosa. Which of the following findings should the nurse expect? Increased blood pressure Lanugo over the back Oily skin with acne Elevated body temperature

Lanugo over the back The nurse should expect an adolescent who has anorexia nervosa to have lanugo present on the skin as a result of impaired metabolic activity. Other manifestations of anorexia nervosa include hypothermia, hypotension, and dry skin.

A nurse is planning care for an adolescent who has sickle cell anemia and is experiencing a vaso-occlusive crisis. Which of the following interventions should the nurse include in the plan? Apply cold compresses to the child's extremities Adminster meperidine every 4 hr until the crisis has resolved Maintain the child on bed rest Decrease the child's fluid intake for 8 hr

Maintain the child on bed rest The nurse should maintain bed rest for this child who is experiencing a vaso-occlusive crisis to minimize energy expenditure and avoid additional oxygen needs.

A nurse is teaching the parents of an infant who has acute otitis media about how to administer antibiotic eardrops. Which of the following instructions should the nurse include? Chill the medication prior to administration Massage the anterior area of the infant's ear following administration Hyperextend the infant's neck during administration Pull the auricle up and back during medication administration

Massage the anterior area of the infant's ear following administration The nurse should instruct the parents to massage the anterior area of the ear following the administration of eardrops to facilitate instillation of the medication.

A nurse is caring for an 18-year-old adolescent who is up-to-date on immunizations and is planning to attend college. The nurse should recommend which of the following immunizations prior to moving into a campus dormitory? Pneumococcal polysaccharide Meningococcal polysaccharide Rotavirus Herpes zoster

Meningococcal polysaccharide The meningococcal polysaccharide immunization is used to prevent infection by certain groups of meningococcal bacteria. Meningococcal infection can cause life-threatening illnesses, such as meningococcal meningitis (which affects the brain) and meningococcemia (which affects the blood). Both of these conditions can be fatal. College freshmen, particularly those who live in dormitories, are at an increased risk for meningococcal disease relative to other persons their age. Therefore, the Centers for Disease Control and Prevention issued a recommendation that all incoming college students receive the meningococcal immunization.

A nurse is reviewing laboratory findings of an adolescent who has acute renal failure. Which of the following findings should the nurse expect? Hypokalemia Hypercalcemia Decreased plasma creatinine level Metabolic acidosis

Metabolic acidosis Metabolic acidosis is an expected finding for clients who have acute renal failure.

A nurse is assessing a 6-month-old infant. The guardian reports that the infant does not appear interested in the brightly colored mobile hanging above the crib at home. Which of the following techniques should the nurse use to check the infant's visual acuity? Shine a penlight briefly into the left eye and then the right eye Move a brightly colored toy from side to side in front of the infant's face Ask the guardian to sit in front of the infant and nod his head up and down Observe the infant's ability to grasp the feet and pull them to the mouth

Move a brightly colored toy from side to side in front of the infant's face The nurse should check the infant's ability to see by positioning the infant upright and holding a brightly colored toy or object in front of the infant's face and moving it from side to side. The nurse should observe the infant's ability to fixate on the toy and track its movement. The nurse can also perform this assessment using the human face as a visual target.

A nurse is planning care for a toddler who has acute gastroenteritis and was recently admitted. Which of the following should the nurse plan to provide for the child? Oral rehydration solution Bananas or applesauce Chicken or beef broth Hypertonic IV solution

Oral rehydration solution The nurse should plan to provide an oral rehydration solution (ORS) to this child who has acute gastroenteritis. ORS promotes the body's reabsorption of water and sodium and is more effective and less traumatic than the administration of IV fluids for the treatment of dehydration due to diarrhea and emesis.

A nurse is assessing an adolescent who is receiving fentanyl via epidural. Which of the following assessments should the nurse identify as the priority? Skin around the catheter site Blood pressure Pain level Oxygen saturation

Oxygen saturation When using the airway, breathing, and circulation (ABC) lapproach to client care, the nurse should identify that checking the adolescent's oxygen saturation level is the priority. By monitoring the adolescent's oxygen saturation level and respiratory status, the nurse can identify if the client has developed opioid-induced respiratory depression.

A nurse is planning care for an infant with an unrepaired myelomeningocele. Which of the following actions should the nurse take? Fasten the diaper loosely Cleanse the meningeal sac with povidone-iodine daily Palpate the abdomen for bladder distension Cover the sac with a dry, sterile gauze dressing

Palpate the abdomen for bladder distension A neurogenic bladder is a common complication of a myelomeningocele. Even if the infant is having wet diapers, the nurse should assess for bladder distension due to the possibility of incomplete emptying of the bladder.

A nurse is teaching a group of parents and guardians about otitis media. Which of the following should the nurse identify as a risk factor for this illness? Summer months Breastfeeding Ages 7 to 10 years Passive smoking

Passive smoking The nurse should identify passive smoking as a risk factor for otitis media. Exposure to secondhand smoke promotes the attachment of pathogens to the middle ear, extends the inflammatory response, and impairs drainage through the Eustachian tube. Each of these effects increases the risk for development of otitis media.

A nurse is planning care for a child who has hyperthermia. Which of the following actions should the nurse take? Administer antipyretics to the child every 4 to 6 hr Position the child on a cooling blanket and cover her with a sheet Place the child in a tub filled with water cooled to 26.7° to 29.4°C (80° to 85°F) Assess the child's temperature every 2 hr during the cooling process

Position the child on a cooling blanket and cover her with a sheet A cooling blanket will lower the temperature of the blood circulating at the skin's surface. This cooler blood will circulate to the viscera and lower the temperature of the organs and tissues. Heat from the internal organs will be circulated to the skin and dispensed to the cooler outside surface.

A nurse is reviewing the morning laboratory results of an infant who is receiving digoxin and furosemide for the treatment of heart failure. Which of the following findings should the nurse report to the provider? Sodium 140 mEq/L Calcium 10.2 mg/dL Chloride 100 mEq/L Potassium 3.2 mEq/L

Potassium 3.2 mEq/L The nurse should identify that a potassium level of 3.2 mEq/L is below the expected reference range of 4.1 to 5.3 mEq/L for an infant. Therefore, the nurse should report this finding to the provider.

A nurse is caring for a 6-month-old infant who has intussusception. Which of the following actions should the nurse take? Prepare to administer high-dose steroids Give the child magnesium hydroxide PO Prepare the child for a barium enema Inform the parents that the child will need a colostomy

Prepare the child for a barium enema The pressure created by a barium enema might force the bowel to resume a normal configuration. Some children with intussusception are treated with the barium enema and do not require surgical intervention.

During a well-child visit, the guardian of a toddler reports that the toddler takes several hours to fall asleep at night. Which of the following recommendations should the nurse make? Vary the time the toddler goes to bed each night. Allow the toddler to watch television before bedtime. Provide the toddler with a favorite stuffed animal at bedtime. Increase the toddler's activity prior to bedtime.

Provide the toddler with a favorite stuffed animal at bedtime. Providing the toddler with a favorite soft toy at bedtime can help the toddler feel more secure and facilitate sleep.

A nurse is planning care for a 4-year-old child who has nephrotic syndrome. Which of the following actions should the nurse take? Provide thorough skin care Test for blood type and cross-match Allow ample hydrating fluids Maintain a low-carbohydrate diet

Provide thorough skin care The nurse should provide thorough skin care for this child who has nephrotic syndrome. Skin care is especially important due to edema and the risk of infection.

A nurse is admitting a child who has acute lymphocytic leukemia. Which of the following laboratory values should the nurse expect? Platelets 500,000 mm^3 RBCs 2.5 million/uL WBCs 4,000/mm^3 Hct 60%

RBCs 2.5 million/uL An RBC count of 2.5 million/uL is below the expected reference range. A child who has acute lymphocytic leukemia has a low RBC count.

A nurse is caring for a child who has a tracheostomy. Which of the following techniques should the nurse use to suction the child's tracheostomy? Insert the catheter to 2 cm (0.79 in) beyond the end of the tracheostomy tube Remove the catheter while applying intermittent suction Instill 0.9% sodium chloride irrigation to loosen secretions while suctioning Continue suctioning until the secretions are removed

Remove the catheter while applying intermittent suction The nurse should insert the catheter without suction and then withdraw the catheter while applying intermittent suction.

A nurse is planning to implement relaxation strategies with a young child prior to a painful procedure. Which of the following actions should the nurse take? Ask the child to hold a breath and blow it out slowly Ask the child to describe a pleasurable event Bounce the child gently while holding him upright Rock the child using long, rhythmic movements

Rock the child using long, rhythmic movements The nurse can implement relaxation strategies by sitting with the child in a well-supported position such as against the chest and rocking or swaying back and forth in long, wide movements.

A nurse is caring for a child who has suspected nephrotic syndrome. Which of the following laboratory values should the nurse expect? Platelets 120,000/mm^3 Serum sodium 160 mEq/L Hgb 9 g/dL Serum cholesterol 700 mg/dL

Serum cholesterol 700 mg/dL A serum cholesterol level of 700 mg/dL is above the expected reference range. A child who has nephrotic syndrome will have high serum cholesterol findings because of the increase in plasma lipids.

A nurse is providing teaching to the guardian of a school-age child who has hearing loss. Which of the following techniques should the nurse recommend to facilitate communication with the child? Exaggerate the pronunciation of each word Keep hands still when speaking Speak at the child's eye level Avoid using facial expressions when speaking

Speak at the child's eye level The nurse should instruct the guardian to speak at the child's eye level and ensure there is adequate lighting on the speaker's face to facilitate lip-reading and communication.

A nurse is caring for a 2-year-old child who has frequent urinary tract infections. When educating the parents about the prevention of urinary tract infections, which of the following instructions should the nurse include? Teach the child to wipe from front to back Give the child frequent bubble baths Urge the child to urinate every 6 hr Administer oxybutynin daily

Teach the child to wipe from front to back The child should be taught to wipe from front to back in order to prevent bacterial contamination from the anal area entering the urethra.

A nurse is taking the history of and performing a physical on a school-age child who has attention deficit hyperactivity disorder (ADHD). Which of the following findings in the child's medical record should the nurse identify as a risk factor for ADHD? The child's family has a middle-class socioeconomic background. The child had prenatal exposure to alcohol on a regular basis. Both siblings of the child show moderate activity levels in school and play activities. The child's mother currently has diabetes mellitus.

The child had prenatal exposure to alcohol on a regular basis. Prenatal exposure to alcohol on a regular basis is a contributing factor to ADHD, along with prenatal nicotine exposure and exposure to lead or mercury.

A nurse is preparing to assess a 2-year-old toddler. Which of the following behaviors should the nurse expect during the examination? The child prefers to sit on the parent's lap during the examination The child is interested in how the examination equipment works The child asks specific questions about body functions The child questions how her development compares to other children at the same age

The child prefers to sit on the parent's lap during the examination Toddlers and infants who are able to sit typically prefer to sit in their parents' lap throughout the examination.

A nurse is caring for a preschool-age child who is dying. Which of the following findings is an age-appropriate reaction to death by the child? (Select all that apply.) The child views death as similar to sleep. The child is interested in what happens to the body after death. The child recognizes that death is permanent. The child believes his thoughts can cause death. The child thinks death is a punishment.

The child views death as similar to sleep. The child believes his thoughts can cause death. The child thinks death is a punishment. Preschool-age children may think of death like sleep. Preschool-age children also believe that their thoughts and wishes can make things happen since they are egocentric. This is part of why the death of a family member can be difficult for a child at this age. Finally, preschool-age children sometimes believe that death is the result of guilt or a punishment for something they did, said, or thought.

A nurse is discussing disciplinary techniques with the guardian of a preschooler. Which of the following actions indicates to the nurse that the guardian is using an age-appropriate disciplinary technique? The guardian explains to the child why her behavior is unacceptable The guardian places the child in time-out after misbehaving The guardian allows the child to choose the consequence of her misbehavior The guardian assigns an extra chore for the child's misbehavior

The guardian places the child in time-out after misbehaving The nurse should encourage the guardian to continue to use time-out as a form of discipline. This technique is effective with a preschooler if carried out correctly. The nurse should review the process of using time-outs with the guardian (e.g. ensuring the time-out takes place in a safe and quiet location) and recommend that the length of the time-out is 1 minute for each year of the child's age.

A nurse is assessing a 6-month-old infant at a well-child visit. Which of the following findings indicates the need for further assessment? The infant is grabbing the feet and pulling them to the mouth. The infant has a closed posterior fontanel. The infant's legs remain crossed and extended when supine. The infant's birth weight has doubled.

The infant's legs remain crossed and extended when supine. Legs that are crossed and extended when supine is an unexpected finding and requires further assessment. At 6 months of age, the infant's legs flex at the knees when the infant is supine. Crossed and extended legs when supine is associated with cerebral palsy.

A nurse is assessing a school-aged child who is 30 minutes postoperative following a cardiac catheterization using the left femoral artery. Which of the following findings should the nurse identify as the priority to report to the provider? The child rouses to verbal stimuli The pulse strength of the child's left popliteal artery site is decreased The child's respiratory rate is 20/min The child rates his pain at the catheter insertion site at a 7 on a scale of 0 to 10

The pulse strength of the child's left popliteal artery site is decreased When using the greatest risk framework, the nurse should identify that the greatest risk to the child is a decrease or loss of circulation below the catheter insertion site. This can indicate hemorrhage or a thrombus at the site and can result in neurovascular impairment.

A nurse is assessing an 18-month-old toddler during a well-child examination. Which of the following findings should the nurse report to the provider? The toddler is unable to remove his shoes The toddler is unable to draw a plus sign The toddler is unable to jump off a step The toddler is unable to turn 1 page of a book at a time

The toddler is unable to remove his shoes An 18-month-old toddler should be able to remove his or her own shoes, socks, and gloves. The nurse should report this finding to the provider.

A nurse at a community health department is discussing the nutritional needs of children with a group of parents and guardians. Which of the following pieces of information should the nurse include? Infants should be transitioned to low-calorie milk at 12 months. Preschoolers need 10-12 g of protein per day. Toddlers can be given up to 120-180 mL (4-6 oz) of juice per day. School-age children should be encouraged to avoid afternoon snacks.

Toddlers can be given up to 120-180 mL (4-6 oz) of juice per day. Parents should limit a toddler's juice intake to 120 to 180 mL per day because juice is high in sugar and should not replace more important nutrients.