Sherpath for Pediatric Test 2
Which action by the nurse would be most appropriate when preparing the preschool child for a medical procedure?
Allow the child to practice the procedure on a stuffed bear Rationale: Allowing the child to practice the procedure on a stuffed bear can be therapeutic for the child and is the most appropriate action.
The nurse is discussing sleeping habits with the parents of a five-year-old child. Which assessment findings would be concerning to the nurse? Select all that apply.
Parents allow the child to stay up until tired Rationale: Children need a core routine during the day and night, and a regular bedtime should be set and followed every night. Parents offer the child snacks while in bed to encourage going to bed Rationale: Offering the child snacks while in bed may interfere with the bedtime routine. Moreover, if the snacks are sugary in nature, they may be detrimental to the deciduous teeth. Parents withhold playtime until the child agrees to go to bed at a certain time Rationale: Although it is important that the child have a nightly routine, it is more important that the parents interact and bond with the child. Parent-child playtime is an important act that should not be used as a reward or punishment.
Parents of a 6-year-old comment that their son enjoys playing outside most of the day during summer break. They apply SPF 10 sunscreen in the morning, and provide beverages to maintain the child's hydration. Which information is important to include in teaching for these parents? Select all that apply.
Sunscreen should be reapplied frequently Rationale: Parents should be told to reapply sunscreen frequently when their child is outside for an extended time. Avoid sun exposure between 1000 and 1500. Rationale: The nurse should teach parents to keep children out of the sun between 1000 and 1500 during the summer months. Sunscreen should be SPF 15 or higher to have UVA and UVB protection. Rationale: Parents should be encouraged to use sunscreen with SPF of at least 15 with UVA and UVB protection.
The nurse is evaluating the teaching provided to parents about fall prevention for toddlers. Which statement(s) by the parents indicate that the teaching was effective. Select all that apply.
"We need to install screen guards in our windows." Rationale: This is an important safety precaution. Toddlers can easily fall from windows, and screen guards are an important way to prevent these accidents. "We should remove any furniture that can be easily moved or tilted." Rationale: This is necessary to protect toddlers, especially as they grow more curious and begin to meet their motor development milestones. Toddlers often pull on furniture to stand, and furniture may topple and fall on them.
The parent of a 7-year-old with a deep partial thickness burns on the legs from a camping accident asks the nurse about the healing time for the child's injury. Which response by the nurse is most appropriate?
"You can expect it to take 30 days to several months for complete healing." Rationale: A deep partial thickness burn will heal in 30 days as long as it does not become infected.
The parents of a young child report that the child is not eating well during mealtime. What information should the nurse as certain to appropriately assess the eating concern. Select all the apply.
Accessibility to food. Rationale: Knowing if the child has easy access to food will help the nurse appropriately assess the eating concern. Limited access to food may lead to a problem with the child's nutrition. The nurse could assist the family in accessing resources. How the child snacks Rationale: Knowing how the child snacks will help the nurse appropriately assess the eating concern. Many children can fill up on snacks, then not want to eat their food at mealtime. Which foods are provided Rationale: Knowing what foods are provided will help the nurse appropriately assess the eating concern. There should be a variety of foods offered.
A 5 year-old with a severe burn weighs 25 kg. The child has urine output 30 mL in the last two hours, serum sodium of 122, and serum potassium of 5.1 Which action is most important for the nurse to take?
Administer IV fluids as ordered Rationale: The child with 30 mL of urine output in two hours, hyponatremia, and hyperkalemia has a fluid and electrolyte imbalance that should be treated with IV fluids
Upon entering the room of a child with minor burns on the back and anterior trunk after a trip to the beach, the child complains of itching to the area. Which actions should the nurse take? Select all the apply.
Administer PO Benadryl as ordered Rationale: The nurse should administer an antihistamine to a child with itching over a minor burn. Encourage parents to apply lotion to the area Rationale: The nurse should encourage parents to apply lotion to the area of a minor burn that itches. Explain that itching is a sign of normal healing Rationale: The nurse should teach parents that itching is a normal sign of healing for patients with minor burns.
A 9-year-old child with severe burns on the face, trunk, and abdomen is lethargic and pale 24 hours after the initial burn. The nurse notes edema in the extremities, HR 135, urine output 60 mL over the past 4 hours. Which actions should the nurse take? Select all that apply.
Administer colloids as ordered. Rationale: Pallor, tachycardia, decreased urine output and edema indicate poor organ perfusion and third spacing of fluid into the interstitial space. Colloids should be administered to help decrease cell permeability and force fluids back into the cell. Increase the rate of IV fluids as ordered Rationale: Pallor, tachycardia, decreased urine output and edema indicate poor organ perfusion and third spacing of fluid into the interstitial space. The IV fluid rate should be increased to help improve renal perfusion.
Which action by the nurse when caring for the preschool child is appropriate, given preschoolers' level of independence?
Allow the child to put on the exam gown by him or herself Rationale: The nurse should allow the child to undress him-/herself to put on the exam gown. Preschool children want to assert independence and undressing without assistance is appropriate given preschooler's level of independence
A 12-year-old child has burns to the face, hands, legs, and palms after a house fire. Which action by the nurse is most important?
Assess airway for patency. Rationale: The priority nursing action is to assess the airway for all patients with facial burns.
A child with electrical burns from touching an active power line reports numbness in the fingers. The nurse notes the hands and arms are edematous. Which actions should the nurse take? Select all that apply.
Assess capillary refill Rationale: When a child with electrical burns to the arm complains of numbness in the fingers, the nurse should assess the capillary refill. Assess the peripheral pulses Rationale: When a child with electrical burns to the arm complains of numbness in the fingers, the nurse should assess the peripheral pulses. Perform neurovascular checks Rationale: When a child with electrical burns to the arm complains of numbness in the fingers, the nurse should perform neurovascular checks.
A child who sustained an electrical burn reports shortness of breath and chest heaviness. The nurse notes diaphoresis, and pallor. Which additional assessment(s) are a priority for the nurse to obtain. Select all that apply.
Heart Rate Rationale: When a child with electrical burns complains of shortness of breath and chest heaviness, the heart rate should be assessed along with a full cardiac assessment. Obtain an order for an EKG Rationale: When a child with electrical burns complains of shortness of breath and chest heaviness, an ECG is a priority because the electricity can disrupt the electrical activity of the heart.
When educating a caregiver about personal safety for a preschooler, which information would the nurse indicate as most important for the child to learn?
Identification of a dangerous person Rationale: Distinguishing a stranger from a well-intentioned person is challenging and often difficult for the preschooler. Strangers are often portrayed as evil, and may not appear as such in a real-life situation. Therefore, it is appropriate to teach "stranger danger."
The nurse is caring for an 8-year-old patient with a second degree burns over 15% of the total body surface area (TBSA). On assessment, the nurse notes the following vitals: HR 134, RR 28, BP 82/48, Temp 97.4. Which action should the nurse take first?
Initiate IV fluid resuscitation as ordered. Rationale: A child with second degree burns and tachycardia should have IV fluid resuscitation.
What important parental guidance advisory needs should caregivers be reminded of when discussing motor development in the toddler?
Motor development in this age group is far ahead of development of judgement and perception. Rationale: This difference in timing of the development of different skills increases the risk for injury.
A child recovering from major burns four weeks ago complains of nausea, vomiting, and epigastric pain that worsen with eating. The nurse notes tenderness on palpation and positive gastric aspirate positive for blood. Which provider orders should the nurse anticipate? Select all that apply.
NPO Rationale: If a child with burn injury complains of epigastric pain that worsens with eating, the nurse would anticipate making the patient NPO to prevent pain. Endoscopy Rationale: If a child with burn injury complains of epigastric pain that worsens with eating, the nurse would anticipate sending the patient for an endoscopy to determine if a stress ulcer is present. IV Protonix Rationale: If a child with burn injury complains of epigastric pain that worsens with eating, the nurse would anticipate giving IV protonix to decrease the risk for worsening stress ulcer.
The parents of a toddler are worried that the child is not eating at meal times. Which suggestions should the nurse make to promote healthy eating for the child?
Offer three meals and two snacks per day. Rationale: This will help the child build a regular appetite. Setting meal times will train the toddler to eat at regular times, and limited snacks will help ensure an appetite at those times.
A parent of a four-year-old child is frustrated at the child's new habit of acting out and hitting other children. The nurse should recommend which actions to address this behavior? Select all that apply.
Offering hugs and physical encouragement when positive behavior is experienced Rationale: A time-in is often effective at enforcing positive behavior. Frequent, brief, nonverbal, physical contact should be provided when the child is acting appropriately. Explaining to the child the he/she will not be able to play with other children when the behavior occurs Rationale: A time-out is often effective in addressing child impulse control. The child should be removed from the situation for a short period and offered an explanation for the punishment.
Which motor skills should be developed in the preschool child? Select all that apply.
Playing hopscotch. Rationale: The preschool child can hop on one foot and jump forward, two skills used in hopscotch. Drawing a picture of his or her home and pets Rationale: Drawing objects that resemble familiar objects is a motor skill that should be developed in the preschool child. Balancing on each foot for one second Rationale: Balancing on each foot for one second is a motor skill that should be developed in the preschool child.
A patient who sustained an electrical injury from a toaster complains of pain 9/10 to the right arm. Lab results show pH of 7.2, HCO3 of 17, and PCO2 of 40. Normal saline is running 125 mL/hour, IV pain medications are ordered for every 4 hours. Which action should the nurse take first?
Change IV fluids to Ringer's Lactate as ordered. Rationale: The patient's lab results indicate metabolic acidosis. The nurse should change the fluids to ringer's lactate because it has a higher concentration of electrolytes and will help correct the problem.
The nurse makes which recommendation(s) to the parent of a three-year-old who throws a tantrum every night at bedtime? Select all that apply.
Set appropriate limits Rationale: Appropriate limit-setting will help the toddler better understand the boundaries with regard to his or her behavior. Establish a regular bedtime routine. Rationale: A regular bedtime routine will be predictable and thereby make the transition from waking to sleeping time smoother. Set a behavior expectation plan Rationale: Having a behavior expectation plan in place will help the parents respond in a consistent manner to the tantrums. It shows what behaviors the parents will not tolerate and the expected consequences. Identify the triggers for the tantrums. Rationale: It is important for the parents to identify specific triggers for the toddler's tantrums (eg., sleepiness) so that they can be addressed. Prevention is the best intervention.
A parent reports concern that her preschool child is not as coordinated at sports as other children. Which statement by the nurse is most appropriate to address this concern?
"Children develop differently and practicing will help." Rationale: This is the most appropriate statement to address the parent's concern because as long as the child has met critical motor milestones, other motor skill ability varies widely among children and practice may improve skills.
The nurse is educating new parents on environmental safety concerns to make in the home. A new mother states the she uses the microwave to heat the infant's bottle because it is convenient and quick. Which response by the nurse is most appropriate?
"The microwave heats unevenly and can cause scalding injuries o the mouth and throat." Rationale: The nurse should inform the patient that the microwave can lead to scalding injury.
Match the activity with the age at which it is first exhibited.
15 months: Walking independently 18 months: Turning pages as they are read to 24 months: Dressing themselves 36 months: Stacking multiple blocks to build towers
Which head circumference measurement would be expected for a two-year-old whose head circumference was 18 inches at the 12-month checkup?
19.5 inches Rationale: Head circumference increases approximately 1.5 inches from 12 months to 24 months.
The nurse is educating parents of a child with sunburn on the upper back and shoulders. Which statement, made by the parents, indicates the need for further teaching?
"My child needs to be on bedrest for 3-4 days." Rationale: When educating a parent about sunburn, the nurse knows further teaching is necessary if the parents say they will keep the child with minor burns on bed rest for 3-4 days.
The nurse is caring for a child with circumferential burns to the abdomen. On assessment, the nurse notes tachycardia, tachypnea, and diminished bowel sounds. Which additional questions should the nurse ask? Select all that apply.
"Have you expelled any gas?" Rationale: Circumferential burns to the abdomen and diminished bowel sounds, tachycardia, and tachypnea indicate abdominal compartment syndrome. The nurse should ask the patient about other GI activity such as expulsion of gas. "Are you experiencing any pain?" Rationale: The nurse would conduct a thorough pain assessment on a patient with circumferential burns to the abdomen and diminished bowel sounds, tachycardia, and tachypnea. "When was your last bowel movement?" Rationale: Circumferential burns to the abdomen and diminished bowel sounds, tachycardia, and tachypnea indicate abdominal compartment syndrome. The nurse should ask the patient about other GI activity such as bowel elimination patterns.
Which report by a parent would indicate normal social development of the 2-year-old patient?
"He will play next to another child and watch the child, but won't interact with the child." Rationale: Playing beside other children, or parallel play, indicates normal social development of the toddler.
The parent of a four-year-old child is concerned because the child has lost several teeth. What response by the nurse is most appropriate?
"It is normal at the age for your child to begin losing deciduous teeth." Rationale: Children may begin to lose deciduous teeth around four to five years of age. This is a normal occurrence, and the deciduous teeth should be replaced by permanent teeth.
A nurse is teaching caregivers appropriate safety guidelines for their four-year-old child regarding firearm safety, burn safety, and personal safety. Which teaching from the nurse is appropriate for all safety situations? Select all that apply.
"Make the child aware of the danger." Rationale: For any dangerous situation, it is important to communicate with the child so that they are informed and prepared if put in that situation. "The child should go to a trusted adult if there is a safety concern." Rationale: In every situation involving child safety, the child should understand that a trusted adult should be alerted. "Communicate your safety rules in a clear and precise manner." Rationale: When reviewing safety measures, communication is key. Clear and precise instructions can help a child understand the appropriate action.
What is the extent of injury for a 1-year-old with burns to the posterior trunk, buttocks, and bilateral thighs?
29% Rationale: The extent of injury for a 1-year-old with burns to the posterior trunk, buttocks, and bilateral thighs is 29% according to the Lund and Browder chart.
Which would be the expected adult height for a toddler who is 34 inches tall at the 30-month checkup?
68 Rationale: Children attain half their adult height between ages 2 and 3 years. A child who was 34 inches tall at the 30-month checkup would be expected to be approximately 68 inches tall as an adult.
A 17 year-old girl has burns to the face and neck after a kitchen accident. The parents tell the nurse that the girl does not interact with friends or family, spends most of her time in her room, and avoids going to school. Which action should the nurse take? Select all that apply.
Assess for suicidal ideation Rationale: If a 17-year-old is self-isolating after a burn injury, the nurse would assess for suicidal ideation. Incidence of suicide is high in adolescents. Consult with a child life specialist Rationale: If a 17-year-old is self-isolating after a burn injury, the nurse would consult a child life specialist to help the child explore their feelings. Encourage the patient to verbalize feelings about her appearance. Rationale: If a 17-year-old is self-isolating after a burn injury, the nurse would encourage the patient to verbalize feelings about her appearance. Discuss ways to use cosmetics to minimize the perceived disfigurement. Rationale: If a 17-year-old is self-isolating after a burn injury, the nurse would discuss ways to use cosmetics to minimize the perceived disfigurement.
The parent of a five-year-old child is frustrated by the child's tendency to hit and pull hair when angry. The nurse assures the parent that this lack of impulse control can be normal for children and to address the problem in which ways? Select all that apply
Clearly define rules Rationale: Clearly defining rules and setting boundaries for the child can help the child learn self-confidence, self-control, and family expectations. Enforce rules consistently Rationale: The child must be consistently disciplined for acts that are destructive, socially unacceptable, or morally wrong. To prevent confusion and anxiety, the consequences of misbehavior should be articulated in advance and carried out immediately after misbehavior occurs. When the child is disciplined for misbehavior, a simple, truthful explanation of why the behavior was unacceptable should be given. Explain truthfully why the rule is set Rationale: When the child is disciplined for misbehavior, a simple, truthful explanation of why the behavior was unacceptable should be given. This will help the child understand the rules better.
Which activity for play therapy would be most appropriate for the nurse to suggest for the hospitalized preschool child?
Coloring with colored pencils Rationale: Coloring with colored pencils is the most appropriate activity for the hospitalized preschool child
A three-year-old girl is brought to the emergency department with a third-degree burn on her hand. The mother is extremely distressed and says to the nurse: "My daughter is so active and curious - it is hard to predict her behavior." Why is it important to discuss developmental milestones when advising this parent about safety measures? Select all that apply.
Discussing developmental milestones will help the mother prepare for the type of behavior the child will exhibit now and in the future. Rationale: Preparing for the future by providing anticipatory (ie, anticipatory guidance) is an important reason for the nurse to discuss developmental milestones when advising this mom. This can help to prevent injury in the future anticipate behavior associated with. Discussing motor milestones, including increased motor capacity, explains why the child will be reaching and moving quickly, making the child more prone to accidents. Rationale: Motor milestones are important for the nurse to discuss when advising this mother about safety measures. This will help the mother consider ways to make the child's environment safe (eg, keeping poisonous substances out of reach, restricting access to climbing hazards). Discussing cognitive milestones, including curiosity and the desire to explore without understanding the consequences of actions, will help the parent understand the need for child-proofing the home and close supervision of the child at this age. Rationale: Cognitive milestones are important for the nurse to discuss when advising a parent about safety measures. At this age, children do not have the capacity to anticipate consequences so they should be watched closely, and appropriate measures should be taken to make her environment as safe as possible.
Which one of the following developmental characteristics explains why a toddler frequently uses the words me, I, and mine?
Egocentrism Rationale: Egocentrism is when a toddler views everything in relation to self and is unable to consider another's point of view, and it explains why the predominant words in the toddler's language are me, I, and mine.
A parent reports concern that his or her preschool child has difficultly following directions. The nurse should recommend which actions by the parent to help the child with this task?
Giving the child specific direction Rationale: The nurse should recommend the parent give specific direction because preschool children are often unable to follow directions unless they are given one step at a time.
The nurse is preparing a community program to decrease the incidence of water-related accidents and deaths. The nurse should plan to implement teaching about water-safety issues in which ways? Select all that apply.
Prepare handouts with parent education about home water safety precautions. Rationale: Handouts are a good way to provide water safety recommendations. The nurse can inform parents of simple in-home water safety precautions, including guidelines such as installing toilet lid locks and never allowing a child to bathe unattended. Promote education about life jacket use on boats among summer camp populations. Rationale: The nurse can target certain populations, such as summer camps and other communities where children are at a higher risk for water-related accidents, to provide educational materials to address this risk. Organize community outreach sessions and material on swimming classes for children and water safety programs. Rationale: The nurse can plan outreach education about swimming and water safety classes. The nurse can recommend certain organizations, such as the American Red Cross and the YMCA, for assistance. Provide pamphlet with information on preventing drowning deaths to community pool locations Rationale: Providing education to those using community pools will work to decrease the rates water-related injury.
Which physical changes are normally seen as an infant transitions into a toddler? Select all that apply.
Protruding abdomen Rationale: A potbellied abdomen due to immature abdominal muscles is a normal physical change as an infant transitions into a toddler. Excessive curve of the back Rationale: An exaggerated lumbar curve is a normal physical change as an infant transitions into a toddler. Wide gap between knees when standing erect Rationale: A gap between the knees is the result of short, bowed legs, which are a normal physical change as an infant transitions into a toddler.
A child recovering from a moderate burn to the anterior trunk and abdomen has Hgb 12, Na 140, and K 4.7, and serum albumin 2.8. Which action is most important for the nurse to take?
Provide high-calorie, high-protein foods Rationale: A serum albumin of 2.8 indicated malnutrition. Protein is necessary for wound healing.
A patient with burns on the face and neck has an order to apply moist sterile gauze and silver sulfadiazine to all burns. Which action should the nurse take first?
Question the order for Silvadene. Rationale: Silvadene cream is not typically used on facial burns. The nurse should question the order.
When caring for a toddler in the hospital, which nursing intervention is most developmentally appropriate?
Scheduling evening medications to follow the toddler's bedtime routine. Rationale: The toddler may experience distress when a routine is not followed. The nurse can provide care in the hospital that helps support routines, if possible.
The nurse is teaching the mother of a toddler about safety precautions necessary to prevent accidents and injuries. The nurse determines that the teaching has been effective when the mother identifies which situation(s) as requiring close supervision? Select all that apply.
Taking a bath Rationale: Infants, toddlers, and young children should be watched closely throughout their baths to prevent drowning. It takes only seconds to drown in only one inch of water. Taking medicine Rationale: Taking medicine is a situation that warrants close supervision. Children should be given medicine by a parent or another responsible adult. In addition, parents should be sure all medications and poisonous items are kept securely in a locked medicine box or cabinet. Climbing a tree Rationale: Toddlers should be watched closely when they are climbing. Toddlers are curious and as their gross motor skills increase, they are often eager to climb, making them prone to falls. Providing effective supervision is an excellent way to let children grow and explore yet keep them safe. Helping to cook in the kitchen Rationale: Helping prepare food is a situation that warrants close supervision. Toddlers and small children should not be left alone in the kitchen or around hot water to prevent thermal injuries such as scalds and burns.
Which role does the nurse play in toilet training? Select all that apply.
Teaching parents the importance of physical readiness Rationale: There are physical and psychological signs of readiness that the nurse can explain to the parents, such as voluntary control of the bladder and bowel and recognition of the need to void. This will help the parents determine when their child is ready and will decrease frustration. Teaching the parents about development signs of toilet training readiness Rationale: The nurse can inform the parents of physical and psychological signs of readiness, such as the child showing interest in the toilet or the child disliking a wet or soiled diaper.
The parent of a two-and-a-half-year-old with 19 teeth reports that they do not have fluoridate city water at home and do not have access to a dentist for preventative care. Which actions should the nurse take? Select all that apply.
Tell the parents to apply a topical fluoride varnish every six months. Rationale: The application of fluoride varnish should be every three to six months during early childhood if the child does not have access to a dentist. Recommend that the parents give the child an oral supplement of 0.25 mg of fluoride daily Rationale: A supplement containing 0.25 mg of fluoride is recommended for children without access to fluoridated water.
The parent of a toddler reports that the two-year-old sometimes screams and hits himself in the head with a toy when it is close to bedtime. How would the nurse describe this behavior?
Temper Tantrum Rationale: This child is having a temper tantrum, which is a common behavior pattern seen in toddlers. Children of this age lack the verbal ability to express themselves well or to reason with parents and often resort to tantrums and aggressive outbursts.
How does the ability for a 24-month-old to build a two-block tower demonstrate a toddler's fine motor development?
The ability to stack one block on top of another demonstrates an improvement in a toddler's hand-eye coordination. Rationale: An improvement in a toddler's hand-eye coordination is typical at this stage and stacking blocks demonstrates development of fine motor skills.
The pediatric nurse is teaching a new nurse how to recognize signs that a toddler is ready for toilet training. The nurse includes which indicators as signs of readiness for toilet training? Select all that apply.
The child shows an interest in toilets and putty chairs. Rationale: It is a sign of readiness when the toddler shows an interest in the toilet and how it works. This shows that the child may be ready to learn about the process and practice of using the toilet or potty chair. The child is able to pull up and remove his or her pants. Rationale: This demonstrates physical maturation and is one sign of readiness for toilet training. The child is eager to please the parents with a dry diaper. Rationale: This scenario reflects readiness for toilet training, since the child is showing signs of psychological maturation as well as the physical ability to hold their urine for a while. The child notices his or her own wet diaper and may try to remove it. Rationale: This reflects readiness for toilet training because the child understands the difference between being wet and dry and shows a preference for being clean and dry.
A young child explains to the nurse that her uncle often hits her on the bottom when she misbehaves. Which information is the most important for the nurse obtain from the child before action is taken?
The nature and circumstances of the physical contact Rationale: Preventing sexual abuse begins with teaching children the normal, healthy boundaries of their bodies and what constitutes inappropriate behavior. A spanking, while not encouraged, should be distinguished from sexual contact.
The parents of a four-year-old patient are concerned about their child's stuttering. The nurse should advise the parents to take which actions to address this problem?
Try to focus on the child's ideas, not the stutter Rationale: The nurse should advise the parents to try to focus on the child's ideas, not the stutter. This helps to minimize the stress.