Pre - schooler

Question 1 A preschool-age child scheduled for surgery in the morning is admitted to the facility for the first time. Which nursing action would ease the child's anxiety? Correct response: Having the child act out the surgical experience using dolls and medical equipment Explanation: Having the child act out the surgical experience using dolls and medical equipment would ease anxiety and give the nurse an opportunity to clarify the child's misconceptions. Preschoolers have a limited concept of time, so the nurse should provide preoperative teaching just before surgery rather than starting it as soon as possible; also, a delay between teaching and surgery may heighten anxiety by giving the child a chance to worry or fantasize. The nurse should avoid using such phrases as "put to sleep" because these may have a dual or negative meaning to a young child. Long explanations are inappropriate for the preschooler's developmental level and may increase anxiety. Question 2 When telling a 4-year-old child about an upcoming procedure, the nurse's most important consideration is to: Correct response: use simple terms. Explanation: When explaining a procedure to a 4-year-old child, the nurse must use simple terms that the child can understand. Speaking loudly may provoke anxiety. Distracting the child with a toy is more appropriate during the procedure rather than before it. Because preschoolers have a limited attention span, the nurse should provide only the necessary basic facts — not every detail — to prevent anxiety. Question 3 A nurse is teaching the parents of a young child how to handle suspected poisoning. If the child ingests poison, the parents should first: Correct response: call the poison control center. Explanation: Before intervening in any way, the parents should first call the poison control center for specific instructions. Ipecac syrup is no longer recommended for the ingestion of poisons. The parents may have to call an ambulance after calling the poison control center. Punishment for being bad isn't appropriate because the parents are responsible for making the environment safe. Add a Note Question 4 See full question 55s A nurse is preparing a child, age 4, for cardiac catheterization. Which explanation of the procedure is appropriate? You Selected: "The special medicine will feel warm when it's put in the tubing." Correct response: "The special medicine will feel warm when it's put in the tubing." Explanation: To prepare a 4-year-old child without increasing anxiety, the nurse should provide concrete information in small amounts about nonthreatening aspects of the procedure. Therefore, saying the special medicine will feel warm is most appropriate. Saying that it won't hurt may prevent the child from trusting the nurse in the future. Explaining the time needed for the procedure wouldn't provide sufficient information. Stating that the child will need to sleep isn't true and could provoke anxiety. Add a Note Question 5 See full question 1m A 4-year-old, 40-lb (18.1-kg) child is brought to the pediatrician's office. The child has upper respiratory symptoms and has had a fever for 2 days. The physician diagnoses a viral illness, and the mother is instructed to treat the child with rest, fluids, and antipyretics. The nurse is reviewing the orders and questions which of the following? You Selected: Acetaminophen 253 mg (10 to 15 mg/kg/dose) q4h with intermittent doses of ibuprofen 181 mg (10 mg/kg/dose) q6h for a temperature higher than 102.5° F (39.2° C) Correct response: Aspirin 294 mg (65 mg/kg/24 hours) q6h with intermittent doses of acetaminophen 217 mg q4h Explanation: The correct dosage schedule for acetaminophen is 10 to 15 mg/kg/dose every 4 hours, and for ibuprofen it's 10 mg/kg/dose every 6 hours for a temperature higher than 102.5°F (39.2°C). Aspirin shouldn't be given to children because of the association between aspirin use in children with influenza virus or chickenpox and Reye's syndrome (a life-threatening condition characterized by vomiting and lethargy that may progress to delirium and coma). Add a Note Question 6 See full question 35s A nurse is caring for a 5-year-old boy with end-stage acquired immunodeficiency syndrome (AIDS). The child confides that he is ready to go to heaven and see his grandpa. The nurse knows that the child's parents aren't comfortable with the idea of discontinuing treatment. What should she do? You Selected: Talk with the parents about the dying process and make them aware of what their child has confided. Correct response: Talk with the parents about the dying process and make them aware of what their child has confided. Explanation: Chronically ill children commonly recognize their fate, whereas their parents continue to believe they'll become well again. The nurse should talk with the parents about the child's concerns. It's possible that the parents don't know what their child is feeling. Chronically ill children tend to have a good understanding of death, and should have input into decisions about their care. The nurse shouldn't tell the child that she can change the parents' minds; she might not be able to keep that promise. It would be unethical for the nurse to call the physician and misrepresent the parents' wishes. Add a Note Question 7 See full question 39s The nurse assesses a child after heart surgery to correct tetralogy of Fallot. Which finding would the nurse report to the health care provider as an indication that the client has low cardiac output? You Selected: altered level of consciousness and thready pulse Correct response: altered level of consciousness and thready pulse Explanation: With a low cardiac output and subsequent poor tissue perfusion, signs and symptoms would include pale, cool extremities; cyanosis; weak, thready pulses; delayed capillary refill; and decrease in level of consciousness. Add a Note Question 8 See full question 6m 1s A child diagnosed with Wilms' tumor undergoes successful surgery for removal of the diseased kidney. When the child returns to the room, the nurse should place the child in which position? You Selected: semi-Fowler's Correct response: semi-Fowler's Explanation: The child who has undergone abdominal surgery is usually placed in a semi-Fowler's position to facilitate draining of abdominal contents and promote pulmonary expansion. The modified Trendelenburg position is used for clients in shock. The Sims' position is likely to be uncomfortable for this child because of the large transabdominal incision. The supine position, without the head elevated, puts the child at increased risk for aspiration. Add a Note Question 9 See full question 58s A parent tells the nurse that her 2-year-old continually hits her 4-year-old and asks the nurse what she should do. Which of the following is an appropriate response by the nurse? You Selected: "The 2-year-old's behavior should be addressed with timeouts." Correct response: "The 2-year-old's behavior should be addressed with timeouts." Explanation: The nurse should respond that the 2-year-old's behavior should be addressed with timeouts. To deal with misbehavior most successfully, parents should be firm and consistent when taking appropriate disciplinary action. Usually, parents should begin setting limits and implementing discipline, such as using timeouts for inappropriate behavior, around age 1, or when the child begins to crawl and explore the environment. The child will not "grow out of" hitting. There is no indication that the 4-year-old is aggravating the 2-year-old. Add a Note Question 10 See full question 50s A 5-year-old child has been placed on phenytoin for tonic-clonic seizures. The child weighs 42 lb (19.1 kg), and the maintenance dose prescribed for this child is 7.5 mg/kg/day. How many milligrams should the child receive each day? Record your answer using a whole number. Your Response: 143 Correct response: 143 Explanation: Determine the dose by multiplying the child's weight by the dose ordered: 19.1 kg x 7.5 mg = 143 mg/day.

LvL 0 to 1

Question 1 See full question 1m 12s When developing a care plan for a hospitalized child, the nurse knows that children in which age-group are most likely to view illness as a punishment for misdeeds? You Selected: Preschool age Correct response: Preschool age Explanation: Preschool-age children are most likely to view illness as a punishment for misdeeds. Separation anxiety, although seen in all age-groups, is most common in older infants. Fear of death is typical of older school-age children and adolescents. Adolescents also fear mutilation. Add a Note Question 2 See full question 32s A preschooler goes into cardiac arrest. When performing cardiopulmonary resuscitation (CPR) on a child, how should the nurse deliver chest compressions? You Selected: With the heel of one hand Correct response: With the heel of one hand Explanation: When performing CPR on a child between ages 1 and 8, the nurse should use the heel of one hand to compress the chest one-third to one-half the depth of the chest. Using only the fingers of one hand isn't appropriate for CPR. The use of two fingertips is appropriate for infant CPR but this method can't compress the chest sufficiently on an older child. The palm is never used for chest compressions in CPR. Add a Note Question 3 See full question 49s Parents of a 4-year-old child with acute leukemia ask a nurse to explain the concept of complementary therapy. The nurse should tell the parents that: You Selected: complementary therapy is an alternative to conventional medical therapies. Correct response: complementary therapy is an alternative to conventional medical therapies. Explanation: The nurse should tell the parents that complementary therapy is a form of alternative medicine. This type of therapy can include diet, exercise, herbal remedies, and prayer. Answering the parents' questions builds rapport and trust. The nurse shouldn't dismiss the parents' idea by telling them complementary therapy wouldn't help their child. The nurse doesn't need to direct the parents to the physician. She can provide the basic information and let the parents determine if they'd like to seek further assistance. Studies indicate that complementary therapies are beneficial to the child and the parents. Add a Note Question 4 See full question 1m 6s Which finding would most likely alert the nurse to the possibility that a preschooler is experiencing moderate dehydration? You Selected: absence of tear formation Correct response: absence of tear formation Explanation: The absence of tears is typically found when moderate dehydration is observed as the body attempts to conserve fluids. Other typical findings associated with moderate dehydration include a dry mouth, sunken eyes, poor skin turgor, and an increased pulse rate. Deep, rapid respirations are associated with severe dehydration. Decreased perspiration, not diaphoresis, would be seen with moderate dehydration. The specific gravity of urine increases with decreased output in the presence of dehydration. Add a Note Question 5 See full question 20s The nurse is caring for a lethargic but arousable preschooler who is a victim of a near-drowning accident. What should the nurse do first? You Selected: Administer oxygen. Correct response: Administer oxygen. Explanation: Near-drowning victims typically suffer hypoxia and mixed acidosis. The priority is to restore oxygenation and prevent further hypoxia. Here, the client has blunted sensorium, but is not unconscious; therefore, delivery of supplemental oxygen with a mask is appropriate. Warming protocols and fluid resuscitation will most likely be needed to help correct acidosis, but these interventions are secondary to oxygen administration. Intubation is required if the child is comatose, shows signs of airway compromise, or does not respond adequately to more conservative therapies. Add a Note Question 6 See full question 1m 4s A mother tells the nurse that her 4 1/2-year-old child "does not seem to know the difference between right and wrong." This behavior is typical of which levels as described by Kohlberg's theory of levels of moral development? You Selected: preconventional Correct response: preconventional Explanation: The preconventional level of Kohlberg's stages of moral development is typical of the preschool-aged child. Stage 1 behaviors of this preconventional level have a punishment-obedience orientation. Children at this stage avoid punishment and avoid those who have power. Autonomous, or postconventional, is the third stage of moral development as described by Kohlberg. These children are concerned with defining values and principles. The conventional level of morality development pertains to children aged 7 to 12 years who are concerned with loyalty and conformity. Principled is another name for the autonomous or postconventional stage, the third stage of moral development as described by Kohlberg. These children are concerned with defining values and principles. Add a Note Question 7 See full question 55s The mother asks the nurse why peanuts are one of the worst things a child can aspirate. What should the nurse include in the explanation as the main reason for the problem associated with aspirating peanuts? You Selected: They swell when wet. Correct response: They swell when wet. Explanation: Peanuts swell and become soft when moistened with bronchial secretions, making them difficult to remove. Although peanuts contain a fixed oil that can cause lipoid pneumonia, begin to decompose when wet, and contain sodium, these factors do not make them particularly dangerous when aspirated. Add a Note Question 8 See full question 2m 27s A nurse is caring preoperatively for a preschooler scheduled for a Wilms' tumor removal. When explaining the location of the tumor to the parents, identify the area of the urinary system impacted. You Selected: Your selection and the correct area, market by the green box. Explanation: A Wilms' tumor, also known as a nephroblastoma, is a tumor located on the kidney. The most common intra-abdominal tumor in children, Wilms' tumor usually affects children ages 6 months to 4 years and favors the left kidney. Add a Note Question 9 See full question 1m 38s When developing a plan of care that includes interventions aimed at preventing complications of a low platelet count in a child with leukemia, which intervention is most appropriate? You Selected: Consult with a primary care provider about the use of a stool softener. Correct response: Consult with a primary care provider about the use of a stool softener. Explanation: A stool softener would assist in preventing damage to the rectal mucosa due to hard stool, thereby decreasing the chances of rectal bleeding. Placing the child in protective isolation would be appropriate for the child if the neutrophil count was low. The use of heparin is contraindicated in situations in which there is a possibility of increased bleeding due to low platelets. Avoiding raw vegetables or fruits would be indicated if the child's neutrophil count were low. Add a Note Question 10 See full question 32s The nurse discovers that a young client has been given a dose of morphine four times the ordered dose. Which of the following is the immediate priority action for the nurse to take? You Selected: Obtain an order for naloxone and administer it promptly. Correct response: Obtain an order for naloxone and administer it promptly. Explanation: Naloxone is an opioid antagonist that is given as an antidote for morphine. An antidote is an agent that neutralizes a poison or counteracts its effects. This should be the immediate priority for the nurse.

LvL 5 to 6

Question 1 See full question 37s A preschool-age child underwent a tonsillectomy 4 hours ago. Which assessment finding should make the nurse suspect postoperative hemorrhage? You Selected: Frequent swallowing Correct response: Frequent swallowing Explanation: Frequent swallowing — an attempt to clear the throat of trickling blood — suggests postoperative hemorrhage. Emesis may be brown or blood-tinged after a tonsillectomy; only bright red emesis signals hemorrhage. The child may refuse fluids because of painful swallowing, not bleeding. Hemorrhage is associated with an increased, not decreased, heart rate. Add a Note Question 2 See full question 2m 2s Parents report that their daughter, age 4, resists going to bed at night. After instruction by the nurse, which statement by the parents indicates effective teaching? You Selected: "We'll read her a story and let her play quietly in her bed until she falls asleep." Correct response: "We'll read her a story and let her play quietly in her bed until she falls asleep." Explanation: Add a Note Question 3 See full question 1m 1s A preschooler has vomiting, diarrhea, and a potassium level of 3 mEq/L (3 mmol/L). The physician orders an I.V. infusion of 500 ml of dextrose 5% in water and half-normal saline solution with 20 mEq (20 mmol/L) of potassium chloride. The nurse knows that a child with vomiting and diarrhea needs fluids and potassium chloride to: You Selected: meet physiologic needs. Correct response: meet physiologic needs. Explanation: A child with vomiting and diarrhea loses excessive fluids and electrolytes, which must be replaced. Fluid and electrolyte replacement can't eliminate the cause of diarrhea, which may result from various factors. Administration of I.V. fluids that contain glucose (such as dextrose 5% in water) may induce, not prevent, hyperglycemia. Fluid and electrolyte replacement has no effect on stool elimination. Add a Note Question 4 See full question 2m 43s A nurse is providing cardiopulmonary resuscitation (CPR) to a child, age 4. The nurse should: You Selected: compress the sternum with both hands at a depth of 1½″ to 2″ (4 to 5 cm). Correct response: use the heel of one hand for sternal compressions. Explanation: The nurse should use the heel of one hand and compress one-third to one-half the depth of the chest. The nurse should use the heels of both hands clasped together and compress the sternum 1½″ to 2″ (at least 5 cm) for an adult. For a small child, two-person rescue may be inappropriate. For a child, the nurse should deliver 20 breaths/minute instead of 12 breaths/minute. Add a Note Question 5 See full question 30s A mother of a 4-year-old child asks the nurse how to talk with her daughter about strangers. The little girl is very friendly and her mother is concerned that her child could be abducted. The nurse should tell the mother: You Selected: to talk with her daughter about what she should do if a stranger talks to her. Correct response: to talk with her daughter about what she should do if a stranger talks to her. Explanation: Preschoolers can begin to take a role in their own safety. They must be taught what a stranger is and what to do if a stranger approaches them. Living in a safe town doesn't eliminate the need to warn a child about talking to strangers. Although it's appropriate for the mother to talk with her daughter about strangers and have the daughter tell her if a stranger approaches her, the child needs to be aware of what to do at the time that the situation occurs, not only afterward. Contacting social services isn't appropriate because the nurse is capable of answering the mother's questions. Add a Note Question 6 See full question 37s A 4-year-old child continues to come to the nurses' station after being told children are not allowed there. What behavior is the child exhibiting? You Selected: attention-seeking behavior Correct response: attention-seeking behavior Explanation: The child wants attention from the nurse, even if the behavior is met by a negative response. Aggression, resistance against authority, and exaggerated stress are behaviors that can be associated with a 4-year-old. However, coming to the nurses' station after being told not to do so is not an example of these behaviors. Add a Note Question 7 See full question 40s The nurse is caring for a 5-year-old child with a congenital heart defect. The nurse is reviewing with the parents the actions that would be necessary if the child experiences cardiopulmonary arrest and needs resuscitation. Which of the following statements by the parents indicate to the nurse that the teaching has been understood? Select all that apply. You Selected: "I have to use compressions to circulate the blood." "I will give two breaths for every 30 compressions." "I will check for responsiveness before starting CPR." Correct response: "I have to use compressions to circulate the blood." "I will give two breaths for every 30 compressions." "I will check for responsiveness before starting CPR." Explanation: The correct options indicate that the parents understand the procedure for performing CPR. For children CPR is initiated before calling 911. Children with any kind of heart disease are at high risk for cardiopulmonary arrest. Add a Note Question 8 See full question 4m 6s The nurse must administer a unit of packed red blood cells to a 4-year-old child. The child's blood type is Type B. When the unit of blood arrives, it is labeled as Type O. What is the appropriate action for the nurse to take? You Selected: Begin the administration of the blood as ordered. Correct response: Begin the administration of the blood as ordered. Explanation: Type O blood is the universal donor and therefore can be administered to a child who is Type B. Add a Note Question 9 See full question 2m 27s A nurse is assessing a 4-year-old child's peripheral IV line, observing that it is not infusing. What is the first action the nurse should take to correct this situation? You Selected: Reposition the child's extremity. Correct response: Reposition the child's extremity. Explanation: The most likely reason for difficulty running an IV in this age group is a positional issue of the child or extremity because of the child's activity level. Add a Note Question 10 See full question 41s While assessing a child experiencing respiratory distress, the nurse notes subcostal retractions. Which graphic highlights the area where subcostal retractions are seen? You Selected: Correct response: Explanation: Subcostal retractions are retractions seen below the lower costal margin of the rib cage. Option B highlights the area where subcostal retractions are seen. Option A shows the areas where intercostal retractions would be seen. Option C shows the area for suprasternal retraction. Option D shows the areas for clavicular retractions.

Level 2 to 3

Question 1 See full question 1m 3s A nurse is obtaining the history of a child, age 4. Which question best evaluates the child's developmental status? You Selected: "Can you ride a tricycle?" Correct response: "Can you ride a tricycle?" Explanation: Asking the child if he can ride a tricycle best helps evaluate the child's developmental status because a 4-year-old child should be able to perform such an action. A child may draw stick-like figures, but wouldn't be able to draw complicated pictures such as a school. A 4-year-old child may not be aware of his feelings, so asking whether he likes his brother wouldn't be appropriate. A 4-year-old child may not know his mother's first name, so asking it wouldn't evaluate developmental status. Add a Note Question 2 See full question 46s When assessing a child with hemophilia, the nurse identifies which condition as an early sign of hemarthrosis? You Selected: Joint stiffness Correct response: Joint stiffness Explanation: Joint stiffness is an early sign of hemarthrosis. Hemarthrosis doesn't affect pulses and bleeding into the joints can't be observed directly. Hematuria is incorrect because this sign indicates bleeding in the urinary tract. Add a Note Question 3 See full question 1m 43s A child is receiving peritoneal dialysis to treat renal failure. To detect early signs of peritonitis, the nurse should stay alert for: Correct response: abdominal tenderness. Explanation: The nurse should stay alert for abdominal tenderness because it's an early sign of peritonitis. Redness at the catheter site indicates a skin infection. Abdominal fullness is expected during dialysate infusion. Headache isn't associated with peritonitis. Add a Note Question 4 See full question 27s What is a normal systolic blood pressure for a 3-year-old child? Correct response: 93 mm Hg Explanation: The normal range for systolic blood pressure in preschoolers is 82 to 110 mm Hg. The normal range for diastolic blood pressure is 50 to 78 mm Hg. Correct Answer: 2 RATIONALES: Using the formula systolic blood pressure = 80 + (age in years × 2), the estimated blood pressure for a 3-year-old child is 80 + (3 × 2) = 86. Question 5 A mother of a child with sickle cell anemia confides in the nurse that she feels guilty about letting the child run and play with the neighborhood children and that if she had been a better mother, the child wouldn't have suffered a sickle cell crisis. Which response would be most appropriate? You Selected: "Tell me more about how you feel." Correct response: "Tell me more about how you feel." Explanation: Many parents feel guilty when their child is sick. Therefore, it's most appropriate to encourage parents to talk more about their feelings because doing so provides support and helps to develop a therapeutic relationship. Giving a stereotyped answer, such as "Don't worry," shows a lack of interest in what the parent is feeling. Commenting on the course of the disease doesn't address the parent's feelings. Being judgmental or offering an opinion can also block therapeutic communication by inhibiting the parent from discussing her feelings and developing solutions. Add a Note Question 6 See full question 3m 8s A 4-year-old, 40-lb (18.1-kg) child is brought to the pediatrician's office. The child has upper respiratory symptoms and has had a fever for 2 days. The physician diagnoses a viral illness, and the mother is instructed to treat the child with rest, fluids, and antipyretics. The nurse is reviewing the orders and questions which of the following? You Selected: Acetaminophen 253 mg (10 to 15 mg/kg/dose) q4h with intermittent doses of ibuprofen 181 mg (10 mg/kg/dose) q6h for a temperature higher than 102.5° F (39.2° C) Correct response: Aspirin 294 mg (65 mg/kg/24 hours) q6h with intermittent doses of acetaminophen 217 mg q4h Explanation: The correct dosage schedule for acetaminophen is 10 to 15 mg/kg/dose every 4 hours, and for ibuprofen it's 10 mg/kg/dose every 6 hours for a temperature higher than 102.5°F (39.2°C). Aspirin shouldn't be given to children because of the association between aspirin use in children with influenza virus or chickenpox and Reye's syndrome (a life-threatening condition characterized by vomiting and lethargy that may progress to delirium and coma). Add a Note Question 7 See full question 58s Which method is reliable for identifying a preschooler before administering a medication? You Selected: Check the hospital identification bracelet. Correct response: Check the hospital identification bracelet. Explanation: The only safe method for identifying the child is to check the identification band for the client's name and medical record number and then compare that information with the medication record. Children sometimes exchange beds during play, so checking the name on the bed isn't reliable. Infants are unable to give their names, toddlers or preschoolers may admit to any name, and school-age children may deny their identities in an attempt to avoid the medication. Parents aren't always at the bedside, so they shouldn't be relied on for identification. Add a Note Question 8 See full question 1m 3s A child with hemophilia is brought to the clinic with spontaneous soft tissue bleeding of the right knee. Immediately on the child's arrival, what should the nurse do? You Selected: Elevate the right knee. Correct response: Elevate the right knee. Explanation: The goal is to decrease the bleeding. This can be aided by decreasing circulation to the area. Elevating the part and applying cold decreases circulation to the area. The child will also receive cryoprecipitate. Aspirin is contraindicated for a child with a bleeding disorder because it increases capillary fragility. The dependent position will increase bleeding and swelling, and the goal is to decrease bleeding. Lack of clotting factors, not lack of platelets, is the problem in children with hemophilia. Add a Note Question 9 See full question 3m 12s A 4-year-old child is brought to the clinic for a checkup. It is determined that the family does not have fluoridated water. The nurse should give which instruction about using fluoride supplements? You Selected: Do not eat or drink for 30 minutes after the supplement. Correct response: Do not eat or drink for 30 minutes after the supplement. Explanation: Fluoride supplements should be administered on an empty stomach. No food or fluids should be ingested for 30 minutes after taking the supplement. Fluoride should not be given with calcium-rich foods. A 4-year-old child would probably not be able to take a tablet. A child who is able should chew the tablet and swish the pieces for 30 seconds before swallowing. Add a Note Question 10 See full question 1m 59s A 3-year-old client is admitted to the pediatric unit with pneumonia. The child has a productive cough and appears to have difficulty breathing. The parents tell the nurse that the child has not been eating or drinking much and has been very inactive. Which interventions to improve airway clearance should the nurse include in the care plan? Select all that apply. You Selected: Perform chest physiotherapy as ordered. Encourage coughing and deep breathing. Perform postural drainage. Maintain humidification with a cool mist humidifier. Correct response: Perform chest physiotherapy as ordered. Encourage coughing and deep breathing. Perform postural drainage. Maintain humidification with a cool mist humidifier. Explanation: Chest physiotherapy and postural drainage work together to break up congestion and then drain secretions. Coughing and deep breathing are also effective to remove congestion. A cool mist humidifier helps loosen thick mucous and relax airway passages. Fluids should be encouraged, not limited. The child should be placed in semi-Fowler's to high Fowler's position to facilitate breathing and promote optimal lung expansion.

LvL 6 to 7

Question 1 See full question 1m 6s A child with suspected rheumatic fever is admitted to the pediatric unit. When obtaining the child's history, the nurse considers which information to be most important? You Selected: a recent episode of pharyngitis Correct response: a recent episode of pharyngitis Explanation: A recent episode of pharyngitis is the most important factor in establishing the diagnosis of rheumatic fever. Although the child may have a history of fever or vomiting or lack interest in food, these findings are not specific to rheumatic fever. Add a Note Question 2 See full question 1m 6s A child, age 4, is hospitalized because of alleged sexual abuse. What is the best nursing intervention for this child? You Selected: Providing play situations that allow disclosure. Correct response: Providing play situations that allow disclosure. Explanation: The best nursing intervention is to provide play situations because through certain play situations, a sexually abused child can disclose information without actually talking about himself or herself. Avoiding touch would be inappropriate because an abused child needs to be touched and cared for like any other hospitalized child. The nurse cannot restrict visitation unless the threat of repeated abuse exists while the child is hospitalized. The nurse should not discourage discussion of the abuse if the child feels able to talk about it. Add a Note Question 3 See full question 54s A 3-year-old child of Vietnamese descent with a fever, decreased urine output, wheezing, and coughing is brought to the emergency department. On examination, the nurse discovers red, round, weltlike lesions on the child's upper back and chest. The nurse should consider that these lesions may be caused by: You Selected: cultural practice. Correct response: cultural practice. Explanation: The nurse should consider that the lesions may be caused by cultural practice. Many Vietnamese people perform coining, a cultural practice in which a coin is repeatedly rubbed lengthwise on the oiled skin to rid the body of a disease. Coining can produce weltlike lesions on the child's back or chest, and children subjected to the practice are commonly thought to have been abused. Interviewing the family and assessing its cultural background help distinguish between abuse and culture practice. Shingles, a form of herpes zoster, is a communicable disease usually affecting immunocompromised individuals and older adults. The disease produces small crusty pustules on the lower back and trunk. The description of the lesions doesn't fit those produced by an allergic reaction. Add a Note Question 4 See full question 14s A mother of a 4-year-old child asks the nurse how to talk with her daughter about strangers. The little girl is very friendly and her mother is concerned that her child could be abducted. The nurse should tell the mother: You Selected: to talk with her daughter about what she should do if a stranger talks to her. Correct response: to talk with her daughter about what she should do if a stranger talks to her. Explanation: Preschoolers can begin to take a role in their own safety. They must be taught what a stranger is and what to do if a stranger approaches them. Living in a safe town doesn't eliminate the need to warn a child about talking to strangers. Although it's appropriate for the mother to talk with her daughter about strangers and have the daughter tell her if a stranger approaches her, the child needs to be aware of what to do at the time that the situation occurs, not only afterward. Contacting social services isn't appropriate because the nurse is capable of answering the mother's questions. Add a Note Question 5 See full question 7m 30s When performing chest percussion on a child, which technique should the nurse use? You Selected: Firmly but gently strike the chest wall to make a popping sound. Correct response: Firmly but gently strike the chest wall to make a popping sound. Explanation: The nurse should firmly yet gently strike the chest wall with the hand cupped to make a hollow popping sound. A slapping sound indicates that an incorrect technique is being used. The area over the rib cage is percussed to loosen mucus from the underlying lung passages. The child should wear a thin piece of clothing (T-shirt) over the chest area to protect the skin without diminishing the effect of the percussion. Add a Note Question 6 See full question 1m 37s The parent of a preschool-age child tells the nurse that the child is hyperactive and something needs to be done. Which response by the nurse would be most appropriate initially? You Selected: "What makes you think your child is hyperactive?" Correct response: "What makes you think your child is hyperactive?" Explanation: The best approach by the nurse is to determine why the parent thinks the child is hyperactive. Some children are very active but do not have the necessary defining characteristics of hyperactivity. Asking what the parent thinks needs to be done, how the child behaves normally, and if the preschool teacher thinks the child is hyperactive would be an appropriate follow-up question once more information is gathered from the parent to determine whether the child indeed is hyperactive. Add a Note Question 7 See full question 29s The health care provider (HCP) has prescribed a sterile urine specimen for a 3-year-old boy with a history of recurrent urinary tract infections. The family is upset because the last time the child was catheterized, the procedure was very painful and traumatic. What is the nurse's best response? You Selected: "I'll get a prescription for a numbing lubricant to make the procedure more comfortable." Correct response: "I'll get a prescription for a numbing lubricant to make the procedure more comfortable." Explanation: Two percent lidocaine lubricants have been found to significantly reduce the pain of urinary catheter insertion in children. If the unit does not have a standing protocol to use the lubricant, the nurse should request a prescription. A sedative would carry with it additional risks that could be avoided with the use of other methods to reduce pain. The parents should be encouraged to hold the child in addition to other pain relief methods. Frequent urination would make the use of topical anesthetics that must be left in place for a period of time impractical. Add a Note Question 8 See full question 3m 32s A 5-year-old preschooler suspected of having leukemia is admitted to the hospital for diagnosis and treatment. The physician orders a bone marrow aspiration. Place the interventions below in ascending chronological order according to their importance. Use all options. You Selected: Discuss the procedure with his parents. Check the biopsy site for hemorrhage and infection. Explain the discomforts he'll feel. Act out the procedure using a doll and biopsy kit. Assure the child that the pain will go away. Correct response: Discuss the procedure with his parents. Act out the procedure using a doll and biopsy kit. Explain the discomforts he'll feel. Assure the child that the pain will go away. Check the biopsy site for hemorrhage and infection. Explanation: The nurse must first discuss the procedure with the parents and encourage them to get involved with the plan for preparing the child. Next, the nurse should use play to teach the child about the procedure to help gain the child's confidence and put the child at ease. After the child is comfortable, the nurse can explain the discomfort he'll feel and then assure him that the pain will go away. Lastly, after the procedure, the nurse needs to check for bleeding, inflammation, and signs and symptoms of pain and infection. Add a Note Question 9 See full question 53s The parents of a preschool child diagnosed with autism must take their child on a plane flight and are concerned about how they can make the experience less stressful for her and their fellow travelers. The nurse suggests a dry run to the airport in which they simulate going through security and boarding a plane. In addition, the nurse suggests taking items to help the child be calm during the flight. In what order of priority from first to last should the parents employ the items listed below? All options must be used. You Selected: a DVD player with headphones and favorite games, cartoons, and child films a favorite non-electronic game a favorite stuffed animal or other soft toy medication that can be given as needed to calm the child Correct response: a DVD player with headphones and favorite games, cartoons, and child films a favorite non-electronic game a favorite stuffed animal or other soft toy medication that can be given as needed to calm the child Explanation: Electronic games and stories are favorites of most children, but are particularly enjoyed by children on the autism spectrum. The headphones block out some of the noises that might be upsetting to a child on the autism spectrum. If the child cannot be engaged electronically, a favorite non-electronic toy would be the next choice. Stuffed animals or other soft toys can soothe a child who is starting to become upset. Medication should be a last resort as it can have a paradoxical effect if it is an antianxiety medication or may cause too much sedation during the flight. Add a Note Question 10 See full question 29s A 4-year-old child who has been ill for 4 hours is admitted to the hospital with difficulty swallowing, a sore throat, and severe substernal retractions. The child's temperature is 104° F (40° C), and the apical pulse is 140 bpm. The white blood cell count is 16,000/mm3 (16,000 X 109/L). What is priority for nursing intervention? You Selected: airway obstruction Correct response: airway obstruction Explanation: The child's signs and symptoms in conjunction with the acute onset suggest possible croup or epiglottitis. The priority diagnosis at this time is airway obstruction. The airway may become completely occluded by the epiglottis at any time. Although the child has an infection, and the client has respiratory distress, the immediate priority is to establish and maintain a patent airway. No evidence is provided to support the potential for aspiration.

LvL 7 to 8

Question 1 See full question 54s A child is being discharged with albuterol nebulizer treatments. The nurse should instruct the parents to watch for: You Selected: tachycardia. Correct response: tachycardia. Explanation: Albuterol is a beta-adrenergic blocker bronchodilator used to relieve bronchospasms associated with acute or chronic asthma or other obstructive airway diseases. Signs and symptoms of albuterol toxicity that the nurse should instruct the parents to watch for include tachycardia, restlessness, nausea, vomiting, and dizziness. Unusually slow respirations, urine retention, and constipation aren't associated with albuterol toxicity. Add a Note Question 2 See full question 1m 10s A nurse suspects that a child, age 4, is being neglected physically. To best assess the child's nutritional status, the nurse should ask the parents which question? You Selected: "What did your child eat for breakfast?" Correct response: "What did your child eat for breakfast?" Explanation: The nurse should ask what the child ate for breakfast in order to obtain objective information about the child's nutritional intake. Asking if the child has always been so thin, if he's a picky eater, or if he eats enough would elicit subjective replies that would be open to interpretation. Add a Note Question 3 See full question 2m 53s A nurse must administer an oral medication to a 3-year-old child. The best way for the nurse to proceed is by saying: You Selected: "Here is your medicine. Would you like apple juice or grape drink after?" Correct response: "Here is your medicine. Would you like apple juice or grape drink after?" Explanation: Asking the child if he would like apple juice or grape drink is the best approach because involving the child promotes cooperation, and permitting the child to make choices provides a sense of control. Telling a child to take the medicine "right now" could provoke a negative response. Promising that the child will go home sooner could decrease the child's trust in nurses and physicians. Telling the child to "see how Jimmy took his medicine" is inappropriate because it compares one child with another and doesn't encourage cooperation. Add a Note Question 4 See full question 31s An initial bolus of crystalloid fluid replacement for a child in shock is 20 ml/kg. The nurse is preparing to administer how many milliliters of fluid for a child weighing 30 kg? You Selected: 600 mls Correct response: 600 mls Explanation: Fluid volume replacement must be calculated using the child's weight to avoid overhydration. Initial fluid bolus is administered at 20 ml/kg, followed by another 20 ml/kg bolus if there is no improvement in fluid status. Add a Note Question 5 See full question 35s A 3-year-old Vietnamese child with a fever, decreased urine output, wheezing, and coughing is brought to the emergency department. On examination, the nurse discovers red, round, weltlike lesions on the child's upper back and chest. The nurse should consider that these lesions may be caused by: You Selected: cultural practice. Correct response: cultural practice. Explanation: The nurse should consider that the lesions may be caused by cultural practice. Many Vietnamese perform coining, a cultural practice in which a coin is repeatedly rubbed lengthwise on the oiled skin to rid the body of a disease. Coining can produce weltlike lesions on the child's back or chest, and children subjected to the practice are commonly thought to have been abused. Interviewing the family and assessing its cultural background help distinguish between abuse and culture practice. Shingles, a form of herpes zoster, is a communicable disease usually affecting immunocompromised individuals and older adults. The disease produces small crusty pustules on the lower back and trunk. The description of the lesions doesn't fit those produced by an allergic reaction. Add a Note Question 6 See full question 2m 7s A child with tetralogy of Fallot and a history of severe hypoxic episodes is to be admitted to the pediatric unit. What would be most important for the nurse to have at the bedside? You Selected: oxygen tubing and flow meter plugged in Correct response: oxygen tubing and flow meter plugged in Explanation: Because the child has a history of severe hypoxic episodes, having oxygen readily available at the bedside is most important. Should the child experience another hypoxic episode, oxygen could be administered easily and quickly. Although morphine causes peripheral dilation, which causes the blood to remain in the periphery, decreasing system volume and oxygen administration is the priority. Typically a child with tetralogy of Fallot with episodes of hypoxia does not require suctioning. Add a Note Question 7 See full question 51s Which finding would most likely alert the nurse to the possibility that a preschooler is experiencing moderate dehydration? You Selected: absence of tear formation Correct response: absence of tear formation Explanation: The absence of tears is typically found when moderate dehydration is observed as the body attempts to conserve fluids. Other typical findings associated with moderate dehydration include a dry mouth, sunken eyes, poor skin turgor, and an increased pulse rate. Deep, rapid respirations are associated with severe dehydration. Decreased perspiration, not diaphoresis, would be seen with moderate dehydration. The specific gravity of urine increases with decreased output in the presence of dehydration. Add a Note Question 8 See full question 40s During the acute stage of meningitis, a 3-year-old child is restless and irritable. Which intervention would be most appropriate to institute? You Selected: keeping extraneous noise to a minimum Correct response: keeping extraneous noise to a minimum Explanation: A child in the acute stage of meningitis is irritable and hypersensitive to loud noise and light. Therefore, extraneous noise should be minimized and bright lights avoided as much as possible. There is no need to limit conversations with the child. However, the nurse should speak in a calm, gentle, reassuring voice. The child needs gentle and calm bathing. Because of the acuteness of the infection, sponge baths would be more appropriate than tub baths. Although treatments need to be completed as quickly as possible to prevent overstressing the child, they should be performed carefully and at a pace that avoids sudden movements to prevent startling the child and subsequently increasing intracranial pressure. Add a Note Question 9 See full question 54s A 3-year-old with dehydration has vomited three times in the last hour and continues to have frequent diarrhea stools. The child was admitted 2 days ago with gastroenteritis caused by rotavirus. The child weighs 22 kg, has a normal saline lock in his right hand, and has had 30 mL of urine output in the last 4 hours. Using the situation-background-assessment-recommendation (SBAR) technique for communication, the nurse calls the health care provider (HCP) with the recommendation for which prescription? You Selected: starting a fluid bolus of normal saline. Correct response: starting a fluid bolus of normal saline. Explanation: The child is dehydrated, is not able to retain oral fluids, and continues to have diarrhea. A normal saline bolus should be given followed by maintenance of IV fluids. Antidiarrheal medications are not recommended for children and will prolong the illness. The child has gastroenteritis caused by a viral illness. IV antibiotics are not indicated for viral illnesses. Strict I&O;is important in all children with gastroenteritis. Add a Note Question 10 See full question 1m 48s The nurse is assessing a 4-year-old child who demonstrates unintelligible speech. The parents are concerned and ask about the cause of the speech problem. What is the most appropriate response by the nurse? You Selected: "Many speech problems are the result of a hearing deficit." Correct response: "Many speech problems are the result of a hearing deficit." Explanation: Many speech problems in children are related to hearing problems. When a child is unable to hear sounds or words to repeat them, speech may be delayed or impaired. Although other causes may exist for speech impairment, hearing disorders should be ruled out first.

LvL 1 to 2

Question 1 See full question 1m 28s A preschool-age child with sickle cell anemia is admitted to the health care facility in vaso-occlusive crisis after developing a fever and joint pain. What is the nurse's highest priority when caring for this child? You Selected: Providing fluids Correct response: Providing fluids Explanation: During a vaso-occlusive crisis, sickle-shaped red blood cells (RBCs) clump together and obstruct blood vessels, causing ischemia and tissue damage. Therefore, the highest priority is providing I.V. and oral fluids, which promotes hemodilution and aids the free flow of RBCs through blood vessels. The client must be kept away from known infection sources but doesn't require protective isolation. Warm compresses may be applied to painful joints to promote comfort; cool compresses would cause vasoconstriction, which exacerbates sickling. Antipyretics may be administered to reduce fever but don't play a crucial role in resolving the crisis. Add a Note Question 2 See full question 1m 42s A nurse is performing a respiratory assessment on a 5-year-old child diagnosed with pneumonia. Which assessment finding should be reported to the health care provider immediately? You Selected: irregular respirations while awake Correct response: moderate intercostal retractions Explanation: Normally, children and men use the abdominal muscles to breathe, whereas women use the thoracic muscles. Use of the accessory or intercostal muscles would indicate a respiratory problem and should be immediately reported to the physician. Mouth breathing and a foul odor from the mouth aren't cause for concern. Irregular respirations while awake are not an unusual finding in a young child. Add a Note Question 3 See full question 34s A preschool-age child refuses to take ordered medication. Which nursing strategy is most appropriate? You Selected: Showing trust in the child's ability to cooperate even with an unpleasant procedure Correct response: Showing trust in the child's ability to cooperate even with an unpleasant procedure Explanation: To gain a preschooler's cooperation, the most appropriate strategy is for the nurse to show trust and express faith in the child's ability to cooperate even with an unpleasant procedure. Hiding the medication in milk may foster mistrust. The nurse should provide simple, not detailed, explanations and should use terms the child can understand. Shaming the child is inappropriate and may lead to feelings of guilt. Add a Note Question 4 See full question 31s A nurse is assessing whether a child has received all recommended immunizations for his age. Which immunizations should he have received between ages 4 and 6? You Selected: Diphtheria, tetanus, and acellular pertussis (DTaP), MMR, and inactivated polio virus (IPV) Correct response: Diphtheria, tetanus, and acellular pertussis (DTaP), MMR, and inactivated polio virus (IPV) Explanation: Between ages 4 and 6, the child should receive DTaP, MMR, and IPV. Hepatitis A isn't a required immunization. MMR alone is incomplete and H. influenzae, type B immunization is completed by age 15 months. Add a Note Question 5 See full question 47s Parents of a 5-year-old call the clinic to tell the nurse that they think their child has been abused by her day-care provider. What should the nurse advise them to do? You Selected: Schedule an immediate appointment with their health care provider. Correct response: Schedule an immediate appointment with their health care provider. Explanation: Because more information needs to be obtained from the child and family, an immediate appointment is most appropriate. A health care provider can also document chief complaints, document recollections, gather physical evidence, and take photographs. It's unclear what type of abuse the parents are concerned about. Calling child protective services is appropriate but isn't the first action to take; neither is talking to an attorney or the day-care provider. Add a Note Question 6 See full question 1m 53s A nurse is caring for a child who was involved in a bus accident on his/her way home from preschool. Several people were killed in the accident. When talking with the child's parents about normal reactions to a traumatic event, the nurse should tell them that: You Selected: it is normal for their child to want to sleep with them at night. Correct response: it is normal for their child to want to sleep with them at night. Explanation: It is normal for children involved in traumatic events to experience regression in growth and development or the ability to perform physical tasks. For example, a child who has been in an accident may wish to sleep with his/her parents. Children recovering from traumatic events should have a routine for school, play, meals, and sleep. The parents should not let the child watch television or other media programs about the accident. Children are very resilient; there is no reason to assume this child needs immediate psychiatric counseling. Add a Note Question 7 See full question 31s The nurse is offering nutritional instruction to the parents of a preschooler who has undergone a tonsillectomy and adenoidectomy. What food choice by the parents would indicate successful teaching? You Selected: cream of chicken soup and orange sherbet Correct response: cream of chicken soup and orange sherbet Explanation: For the first few days after a tonsillectomy and adenoidectomy, liquids and soft foods are best tolerated by the child while the throat is sore. Children typically do not chew their food thoroughly, and solid foods are to be avoided because they are difficult to swallow. Although meat loaf would be considered a soft food, uncooked carrots would not be. Pork is frequently difficult to chew. Foods that have sharp edges, such as potato chips, are contraindicated because they are hard to chew and may cause more throat discomfort. Add a Note Question 8 See full question 1m 51s A child has had open heart surgery to repair a tetralogy of Fallot with a patch. Which instructions should the nurse give to the parents? You Selected: Notify all health care providers (HCP) before invasive procedures for the next 6 months. Correct response: Notify all health care providers (HCP) before invasive procedures for the next 6 months. Explanation: Children who have undergone open heart surgery with a patch are at risk for infection, especially subacute bacterial endocarditis (SBE), for the first 6 months following surgery. The newest evidence-based guidelines suggest that once the patch has epithelialized, these precautions are no longer necessary. Therefore, parents are instructed about SBE precautions including the need to notify providers before invasive procedures so antibiotics can be prescribed for that time period. Having the child drink a very large amount of water may lead to fluid overload. Children gear their rest schedule to their activities making it unnecessary to schedule frequent rest periods. Bananas and citrus fruit are high in potassium, but there is no evidence provided that the child has an elevated serum potassium requiring restriction. Add a Note Question 9 See full question 46s The nurse is admitting a 4-year old with a possible meningococcal infection. Which type of isolation is indicated? You Selected: airborne precautions Correct response: droplet precautions Explanation: Meningococcal infections are spread through close mucous membrane or respiratory contact with large respiratory droplets. Meningococcal infections are not spread by small airborne organisms or contact with a person's skin or contaminated items. Standard precautions, used when touching body fluids, are not sufficient to prevent the spread of meningitis. Add a Note Question 10 See full question 42s A nurse on the pediatric unit is caring for a group of preschool children. Which situation takes highest priority? You Selected: A child who develops a fever during a blood transfusion Correct response: A child who develops a fever during a blood transfusion Explanation: A fever indicates an adverse reaction to the blood transfusion and requires immediate intervention. The post-surgical child is losing blood through the surgical incision, which also requires attention. However, managing the bleeding may take significant time. Between these two priorities, stopping the transfusion and beginning normal saline should be accomplished first and takes minimal time. Postponing stopping the blood to manage the bleeding from the post-op patient will cause potentially life threatening complications for the blood transfusion patient. The telephone call is important for medication changes and to prevent a delay in treatment. Airway management is also a high priority. At this point, the child is compensating with a reasonable oxygen saturation. In this scenario, the most critical situation is the blood transfusion reaction, which requires the quickest intervention to stop potential complications.

LvL 4 to 5