School-age Child
Compared to the food requirements of preschoolers and adolescents, the food requirements of school-age children are not as great because these children have a lower: A) Growth rate. B) Metabolic rate. C) Level of activity. D) Hormonal secretion rate.
A) Growth rate. Reason: Children ages 6 to 12 have a slower growth rate than do younger children and adolescents. As a result, their food requirements are comparatively less.
A parent asks the nurse about head lice (pediculosis capitis) infestation during a visit to the clinic. Which of the following symptoms should the nurse tell the parent is most common in a child infected with head lice? A) Itching of the scalp. B) Scaling of the scalp. C) Serous weeping on the scalp surface. D) Pinpoint hemorrhagic spots on the scalp surface.
A) Itching of the scalp. Reason: The most common characteristic of head lice infestation (pediculosis capitis) is severe itching. The head is the most common site of lice infestation. If the child scratches, scaling may occur. Itching also occurs when lice infest other parts of the body. Scratch marks are almost always found when lice are present. Weeping on the scalp surface may be an indication of an infection or other dermatologic condition. Hemorrhagic spots are not a symptom of head lice, but may be caused by scratch marks.
On initial assessment of a 7-year-old child with rheumatic fever, which of the following would require contacting the primary care provider immediately? A) Heart rate of 150 beats/minute. B) Swollen and painful knee joints. C) Twitching in the extremities. D) Red rash on the trunk.
A)Heart rate of 150 beats/minute. Reason: A heart rate of 150 beats/minute is very high for a 7-year-old child and may indicate carditis. For this age group, the normal heart rate while awake is 70 to 110 beats/minute. Swollen and painful joints such as the knee are characteristic findings in the child with rheumatic fever and do not require immediate physician notification. Twitching in the extremities, known as chorea, is a characteristic finding in a child with rheumatic fever and does not require immediate physician notification. A red rash on the trunk typically indicates rheumatic fever and does not require immediate physician notification.
After staying several hours with her 9-year-old daughter who is admitted to the hospital with an asthma attack, the mother leaves to attend to her other children. The child exhibits continued signs and symptoms of respiratory distress. Which of the following findings should lead the nurse to believe the child is experiencing anxiety? A) Not able to get comfortable. B) Frequent requests for someone to stay in the room. C) Inability to remember her exact address. D) Verbalization of a feeling of tightness in her chest.
B) Frequent requests for someone to stay in the room. Reason: A 9-year-old child should be able to tolerate being alone. Frequently asking for someone to be in the room indicates a degree of psychological distress that, at this age, suggests anxiety. The inability to get comfortable is more characteristic of a child in pain. Inability to answer questions correctly may reflect a state of anoxia or a lack of knowledge. Tightness in the chest occurs as a result of bronchial spasms.
A 7 year old with a history of tonic-clonic seizures has been actively seizing for 10 minutes. The child weighs 22 kg and currently has an intravenous (IV) line of D5 1/2 NS + 20 meq KCL/L running at 60 ml/hr. Vital signs are a temperature of 38 degrees C, heart rate of 120, respiratory rate of 28, and oxygen saturation of 92%. Using the SBAR (Situation-Background-Assessment-Recommendation) technique for communication, the nurse calls the primary healthcare provider with a recommendation for: A) Rectal diazepam (Diastat). B) IV lorazepam (Ativan). C) Rectal acetaminophen (Tylenol). D) IV fosphenytoin.
B) IV lorazepam (Ativan).Reason: IV ativan is the benzodiazepine of choice for treating prolonged seizure activity. IV benzodiazepines potentiate the action of the gamma-aminobutyric acid (GABA) neurotransmitter, stopping seizure activity. If an IV line is not available, rectal Diastat is the benzodiazepine of choice. The child does have a low-grade fever; however, this is likely caused by the excessive motor activity. The primary goal for the child is to stop the seizure in order to reduce neurologic damage. Benzodiazepines are used for the initial treatment of prolonged seizures. Once the seizure has ended, a loading dose of fosphenytoin or phenobarbital is given.
A 10-year-old with glomerulonephritis reports a headache and blurred vision. The nurse should immediately: A) Put the client to bed. B) Obtain the child's blood pressure. C) Notify the physician. D) Administer acetaminophen (Tylenol).
B) Obtain the child's blood pressure. Reason: Hypertension occurs with acute glomerulonephritis. The symptoms of headache and blurred vision may indicate an elevated blood pressure. Hypertension in acute glomerulonephritis occurs due to the inability of the kidneys to remove fluid and sodium; the fluid is reabsorbed, causing fluid volume excess. The nurse must verify that these symptoms are due to hypertension. Calling the physician before confirming the cause of the symptoms would not assist the physician in his treatment. Putting the client to bed may help treat an elevated blood pressure, but first the nurse must establish that high blood pressure is the cause of the symptoms. Administering Tylenol for high blood pressure is not recommended.
Which of the following measures should the nurse include in the care plan for a child who is receiving high-dose methotrexate (amethopterin) therapy? A) Keeping the child in a fasting state. B) Obtaining a white blood cell (WBC) count. C) Preparing for radiography of the spinal canal. D) Collecting a specimen for urinalysis.
B) Obtaining a white blood cell (WBC) count. Reason: Methotrexate is not highly toxic in low doses but may cause severe leukopenia at higher doses. It is customary and recommended for blood tests to be done before therapy to provide a baseline from which to study the effects of the drug on WBC count. Maintaining a fasting state, radiography of the spinal canal, and urinalysis are not necessary when this drug is administered.
According to Erikson's psychosocial theory of development, an 8-year-old child would be in which stage? A) Trust versus mistrust B) Initiative versus guilt C) Industry versus inferiority D) Identity versus role confusion
C) Industry versus inferiority Reason: In middle childhood, the 6- to 12-year-old child is mastering the task of industry versus inferiority. The trust versus mistrust task is in infancy (birth to 1 year). In early childhood, the 1- to 3-year-old child is in the stage of initiative versus guilt. Identity versus role confusion occurs during adolescence.
An 8-year-old child is suspected of having meningitis. Signs of meningitis include: A) Cullen's sign. B) Koplik's spots. C) Kernig's sign. D) Chvostek's sign.
C) Kernig's sign. Reason: Signs and symptoms of meningitis include Kernig's sign, stiff neck, headache, and fever. To test for Kernig's sign, the client is in the supine position with knees flexed; a leg is then flexed at the hip so that the thigh is brought to a position perpendicular to the trunk. An attempt is then made to extend the knee. If meningeal irritation is present, the knee can't be extended and attempts to extend the knee result in pain. Cullen's sign is the bluish discoloration of the periumbilical skin caused by intraperitoneal hemorrhage. Koplik's spots are reddened areas with grayish blue centers that are found on the buccal mucosa of a client with measles. Chvostek's sign is elicited by tapping the client's face lightly over the facial nerve, just below the temple. A calcium deficit is suggested if the facial muscles twitch.
The nurse should instruct the family of a child with newly diagnosed hyperthyroidism to: A) Keep their home warmer than usual. B) Encourage plenty of outdoor activities. C) Promote interactions with one friend instead of groups. D) Limit bathing to prevent skin irritation.
C) Promote interactions with one friend instead of groups. Reason: Children with hyperthyroidism experience emotional labiality that may strain interpersonal relationships. Focusing on one friend is easier than adapting to group dynamics until the child's condition improves. Because of their high metabolic rate, children with hyperthyroidism complain of being too warm. Bright sunshine may be irritating because of disease-related ophthalmopathy. Sweating is common and bathing should be encouraged.
