School aged peds
A 10-year-old boy arrives with his mother at the emergency department after being bitten by a stray dog. He has sustained a soft tissue injury on the inner aspect of the left forearm, and it is bleeding. What is the priority nursing action? 1 Asking the mother whether her son is allergic to horse serum 2 Assessing the injury and the child's vital signs and health history 3 Inoculating the child with human rabies immunoglobulin 4 Notifying the police department to capture and test the dog
2 For effective decisions to be made, baseline information on the child's condition, extent of injury, and significant health history are required first. Hyperimmune antirabies serum is not a preferred treatment. Inoculation for establishment of short-term, passive immunity to rabies follows initial care of injuries; the priority is assessment and treatment of the injury. Authorities should be notified after the injured child has received care.
A nurse is caring for a 6-year-old child with sickle cell anemia. What is the priority nursing intervention to prevent thrombus formation? 1 Encouraging fluids 2 Encouraging bed rest 3 Administering oxygen 4 Administering prescribed anticoagulants
1 Dehydration, stress, infection, and electrolyte imbalance can trigger the sickling process. Red blood cells (RBCs) change to the sickle shape when deoxygenated because of polymerization of the abnormal hemoglobin. This process damages the RBC membrane, which causes the cells to become entangled in the blood vessels, depriving the tissues that are distal to the occlusion of oxygen, resulting in ischemia and infarction, which can in turn cause organ damage. The child's condition determines the activity level; although bed rest may be required during a pain episode, at other times it is not necessary. Administering oxygen will not prevent thrombus formation. Anticoagulants do not help prevent thrombus formation in sickle cell anemia.
A 6-year-old child begins sucking her thumb after surgery. The child did not engage in this behavior before the surgery. What is the best action for the nurse to take? 1 Accepting the thumb-sucking 2 Distracting the child by playing checkers 3 Reporting this behavior to the healthcare provider 4 Telling the child that thumb-sucking causes buck teeth
1 Regression is expected in times of stress. It is a transient need that should be accepted because it will help reduce the child's anxiety. Distraction works only as long as it is employed. It is the nurse's responsibility to identify the child's response to hospitalization and address the child's needs at this time. Cause (thumb-sucking) and future effect (buck teeth) will not be meaningful to a 6-year-old child; furthermore, thumb-sucking may or may not cause malocclusion.
A school-aged child is being observed overnight for responses to a closed head injury sustained when the child fell off a piece of playground equipment. The nurse knows to call the healthcare provider immediately if which symptom occurs? 1 The child begins vomiting. 2 The child's pupils measure 3 mm. 3 The respiratory rate is 24 breaths/min. 4 The systolic blood pressure falls below 110 mm Hg.
1 Vomiting is a sign of increased intracranial pressure. Normal pupil size ranges from 2.0 to 5.0 mm. The expected respiratory rate for a school-aged child is 20 to 30 breaths/min. The systolic blood pressure range for a school-aged child is 80 to 120 mm Hg.
As the nurse is teaching a child's parents about celiac disease, the mother sighs and says, "My neighbor told me that I'll only need to monitor the diet until our child is 8 years old. I'm so relieved. You know how kids are about eating!" On what fact should the nurse's response be based? 1 The basic defect of celiac disease is lifelong. 2 Susceptibility to celiac crisis lessens with age. 3 The diet is relatively easy to follow for a growing child. 4 The child will be able to tolerate small amounts of gluten by school age.
1 The diet must continue to be followed because the child will always have an absence of peptidase; some variations in the diet may be allowed, but this should not be promised. Each phase of child development may have problems related to dietary management; follow-up care is needed to prevent crises. A restricted diet is never easy to follow, especially for a growing child. Gluten must be avoided for a prolonged period and perhaps indefinitely.
A 9-year-old child is found to have acute glomerulonephritis after a recent infection. What microorganism should the nurse suspect as the cause of the child's current health problem? 1 Haemophilus 2 Streptococcus 3 Pseudomonas 4 Staphylococcus
2 Acute glomerulonephritis, an immune complex disease, is a reaction that occurs as a sequela of streptococcal infection; it is known as acute poststreptococcal glomerulonephritis. Haemophilus is associated with conjunctivitis and meningitis, not with glomerulonephritis. Pseudomonas is associated with many diseases of human beings but not with glomerulonephritis in children. Staphylococcus is associated with localized suppurating infections, not with glomerulonephritis.
A child returns to his room after left-side cardiac catheterization. What is involved in the postprocedure nursing care? 1 Encouraging early ambulation 2 Monitoring the insertion site for bleeding 3 Comparing blood pressures in the two extremities 4 Restricting fluids until the blood pressure has stabilized
2 Postprocedure hemorrhage, a life-threatening complication after cardiac catheterization, is possible because arterial blood is under pressure and the catheter has entered an artery. Rest will be encouraged; flexion of the insertion site should be avoided to prevent disturbance of the clot. Comparing blood pressures in the two extremities is unnecessary; the pulse distal to the catheterization insertion site is monitored. The blood pressure will not be unstable unless a problem develops; fluid intake should be encouraged.
An 8-year-old girl who is hospitalized for intravenous antibiotic therapy tells the nurse that she is bored. The nurse has a discussion with the father about appropriate activities. Which activity suggested by the father indicates a need for further teaching? 1 "I'll bring a radio and CD player." 2 "I'll bring homework and school supplies." 3 "She'll enjoy having a rubber baseball and plastic bat." 4 "She'll enjoy rubber stamps and a pretty box to keep them in."
3 Playing with a bat and ball is an unsafe activity in a hospital setting; the IV catheter could be dislodged, and boisterous activity is dangerous to the other children on the unit. A radio and CD player, homework and school supplies, and rubber stamps and a collection box are all appropriate for the school-aged child.
A nurse is preparing a 10-year-old child for a tonsillectomy and adenoidectomy to be performed later in the day. What information should the nurse share with the child? 1 How the surgical procedure will be performed 2 The type of surgical equipment that will be used 3 What the child will experience before and after the procedure 4 The changes in the child's nose and throat during the procedure
3 The explanation should be based on the sensations the child will experience. Discussing how the procedure is performed, the type of equipment that is used, or the changes in the child's anatomy during the procedure shortly before surgery may increase the child's anxiety.
The mother of an 8-year-old child with the diagnosis of acute poststreptococcal glomerulonephritis (APSGN) is concerned that a 4-year-old sibling may also have the disorder. What does the nurse recall when preparing to explain the cause of the disease process? 1 A systemic infection causing clots in the small renal tubules 2 A factor that is unknown and therefore is difficult to prevent 3 An immune complex disorder occurring after a group A β-hemolytic Streptococcus infection 4 An autosomal recessive trait, meaning that there is an increased probability that a sibling will also have the disease
3 The β-hemolytic Streptococcus immune complex becomes trapped in the glomerular capillary loop, causing acute poststreptococcal glomerulonephritis. APSGN is usually precipitated by a localized pharyngitis. Clots do not form in the small renal tubules with APSGN. Prevention depends on treating an individual with a group A β-hemolytic Streptococcus infection with antibiotics to eliminate the organism before an immune response can occur. APSGN is an acquired, not an inherited, disorder.
A 5-year-old child is admitted to the pediatric unit with a diagnosis of acute poststreptococcal glomerulonephritis. What assessment data lead the nurse to conclude that the child has a fluid volume excess? 1 Dysuria, rash, pruritus 2 Diarrhea, polyuria, weight loss 3 Hypotension, tachycardia, proteinuria 4 Periorbital edema, smoky urine, headaches
4 Periorbital edema indicates fluid retention, and headaches are a symptom of hypertension. Glomeruli are edematous and infiltrated with white blood cells that occlude the capillary lumen; hematuria results from kidney damage. Skin disorders and dysuria are not related to fluid overload. Diarrhea, polyuria, and weight loss are not related to fluid volume excess. Nor are hypotension and proteinuria related to a fluid volume excess; however, cardiac problems are complications that occur if the fluid overload is not corrected or becomes severe.
What statement by the nursing student indicates understanding of the precautions needed in the provision of care to a 7-year-old child who is HIV positive? 1 "I'll put on a mask." 2 "I'll put on an N-95 mask." 3 "I'll put on a gown and gloves." 4 "I'll put on gloves if I'm going to be in contact with body fluids."
4 The Centers for Disease Control and Prevention (Canada: Public Health Agency of Canada) recommends standard precautions for the care of individuals with HIV infection or AIDS without opportunistic infections. Droplet precautions are not necessary because HIV is not transmitted in large-particle respiratory droplets. Contact precautions are not necessary unless the HIV infection or AIDS is complicated by the presence of disease or infection, necessitating the addition of these precautions to standard precautions. Airborne precautions are unnecessary because HIV is not spread in airborne droplet nuclei; these precautions are used in addition to standard precautions if an opportunistic infection such as Mycobacterium tuberculosis is present.
