Toddler - ML8

To treat a child's atopic dermatitis, a physician orders a topical application of hydrocortisone cream twice daily. After medication instruction by the nurse, which statement by the parent indicates effective teaching? "I will gently scrape the skin before applying the cream to promote absorption." "I will avoid using soap and water on the affected area and will apply an emollient cream on this area frequently." "I will spread a thick coat of hydrocortisone cream on the affected area and will wash this area once a week." "I will apply a moisturizing cream sparingly and will wash the affected area frequently."

"I will avoid using soap and water on the affected area and will apply an emollient cream on this area frequently." Avoiding the use of soap and water reflects effective teaching because such washing removes moisture from the horny layer of the skin. Applied in a thin layer, emollient cream holds moisture in the skin, provides a barrier to environmental irritants, and helps prevent infection. Spreading a thick coat of hydrocortisone cream shows ineffective teaching because topical steroid creams such as hydrocortisone should be applied sparingly as a light film; the affected area should be cleaned gently with water before the cream is applied. Scraping or abrading the skin may actually increase the risk of infection and alter drug absorption. Excessive application of steroidal creams may result in systemic absorption and Cushing's syndrome. Frequent washing dries the skin, making it more susceptible to cracking and further breakdown.

A parent tells the nurse that the parent wants to begin toilet training the 22-month-old child. Which statement by the parent indicates the greatest likelihood of success? "I bought a jar of candy to use when my child is successful." "I'm out of work right now so I'm home all day to work with my child." "My sister potty-trained her son at 22 months of age and it worked really well." "My child says "pee-pee" and runs to the potty chair."

"My child says "pee-pee" and runs to the potty chair." The most important factor is developmental readiness because if the child is not developmentally ready, both the child and parent will become frustrated. Consistency is important when toilet training is started; the parent's positive attitude is important when the child is determined to be ready. Developmental levels of children are individualized and comparison to peers is not useful.

The parent of a toddler hospitalized for episodes of diarrhea reports that when the toddler cannot have things the way they want, they throw their legs and arms around, scream, and cry. The parent says, "I don't know what to do!" After the nurse teaches the parent about ways to manage this behavior, which statement by the parent indicates that the nurse's teaching was successful? "I'll allow them to have what they want once in a while." "Next time my child screams and throws their legs, I'll ignore the behavior." "I'll explain why they cannot have what they want." "When they behave like this, I'll tell them that they are being a bad child."

"Next time my child screams and throws their legs, I'll ignore the behavior." The child is demonstrating behavior associated with temper tantrums, which are relatively frequent normal occurrences during toddlerhood as the child attempts to develop a sense of autonomy. The development of autonomy requires opportunities for the child to make decisions and express individuality. Ignoring the outbursts is probably the best strategy. Doing so avoids rewarding the behavior and helps the child to learn limits, promoting the development of self-control. However, the parent should intervene in a temper tantrum if the child is likely to injure themself. Allowing the child to have what they want occasionally would typically add to the problems associated with temper tantrums because doing so rewards the behavior and prevents the child from developing self-control. Toddlers do not possess the capacity to understand explanations about behavior. Expressing disappointment in the child's behavior or telling them that they are being bad reinforces feelings of guilt and shame, thus interfering with the child's ability to develop a sense of autonomy.

A 2-year-old child is prescribed cyclosporine. The parent says the child doesn't like taking the liquid medication. Which statement by the nurse is most appropriate? "Offer the medication diluted with chocolate milk or orange juice to make it more palatable." "Give your child some control over what time the medication is taken during the day." "We can inquire about inserting a nasogastric (NG) tube to administer the medication." "Give the ordered dose in small amounts over 2 hours to make it less unpleasant."

"Offer the medication diluted with chocolate milk or orange juice to make it more palatable." Because liquid cyclosporine has a very unpleasant taste, diluting it with chocolate milk or orange juice will lessen the strong taste and help the child take the medication as ordered. It is not acceptable to miss a dose, because the drug's effectiveness is based on therapeutic blood levels, and skipping a dose could lower the level. It is also very important that the dosage be given at the same time every day. If it is given in the morning, it should always be given in the morning. Unfortunately, the child does not get to pick and choose when they will take the medication. Cyclosporine should not be given by NG tube, because it adheres to the plastic tube and, thus, some of the drug may not be administered. Taking the medication over a period of time could negatively affect the blood level. Cyclosporine comes in pill form, but a 2 year old is generally too young to swallow pills.

While interviewing a preschool-age girl who has been sexually abused about the event, which approach would be most effective? Draw a picture and explain what it means. Name the perpetrator. Describe what happened during the abusive act. "Play out" the event using anatomically correct dolls.

"Play out" the event using anatomically correct dolls. A 3-year-old child has limited verbal skills and should not be asked to describe an event, explain a picture, or respond verbally or nonverbally to questions. More appropriately, the child can act out an event using dolls. The child is likely to be too fearful to name the perpetrator or will not be able to do so.

A nurse in a clinic finds the mother of a 15-month-old child in tears. The mother states that her child doesn't love her, because the child says "no" to everything. Which response is appropriate? "Saying 'no' is part of toddler development and is normal at this age." "This is normal at this age. It's best to ignore the behavior." "This is unusual. Toddlers are usually very agreeable." "Explain to your child what the word 'no' means."

"Saying 'no' is part of toddler development and is normal at this age." Telling the mother that saying "no" is normal for a 15-month-old child is an appropriate response. The child's behavior doesn't mean that the child doesn't love the mother; it means the child is attempting to exert independence. Saying that it's best to ignore the behavior is inappropriate because the child needs to learn about limits. Saying that saying "no" is unusual is incorrect and may further frighten the mother that something is wrong with her child. A 15-month-old child already has a concrete understanding of the word "no."

A parent voices concern to the nurse that a 2-year-old toddler never seems to want to play with other children at the park. What would be the nurse's best response? "Don't worry, it's probably because your child is shy." "You should arrange a play date with another toddler." "You should model playing behaviors for your child." "That is considered normal at this age."

"That is considered normal at this age." Two-year-olds engage in parallel play, in which they play side by side but rarely interact. Associative play is characteristic of preschoolers, in which they are all engaged in a similar activity but with little organization. School-age children engage in cooperative play, which is organized and goal-directed. Children do not need to have play modeled for them. The ability to play and interact with other children will improve as the child grows.

A toddler is admitted to the emergency department with a suspected seizure disorder. When informing the parents about necessary diagnostic procedures, which statement is most appropriate for the nurse? "We will prepare your child to have spinal fluid withdrawn and analyzed." "The best way to diagnose seizures is through a computed tomography (CT) scan." "It's important to confirm a previous history of seizures for the child." "The child will need to have skull X-rays performed to verify the seizures."

"The best way to diagnose seizures is through a computed tomography (CT) scan." CT scans provide the most benefit of the list provided in determining irregular brainwave activity. None of the other options would be used to measure brain wave activity.

A mother expresses concern because her 3-year-old son frequently fondles his penis. The mother does not know the best approach for the child's behavior. What is the nurse's best response to the mother? "This is a strong sign that he is ready for toilet training." "You should discourage this behavior now before it worsens as he gets older." "This behavior is normal for a child of his age." "We should obtain a urine sample to assess for an infection."

"This behavior is normal for a child of his age." Children ages 1 to 3 years enjoy fondling their genitals. Punishment for genital fondling may lead to guilt and shame regarding sexual behavior later in life.

Which statements would indicate that the parents of a child being treated with antibiotics for an ear infection understand the reason for a follow-up visit after the child completes the course of therapy? "Her hearing needs to be checked to see if the infection has done any damage." "We need to make sure that her ear infection has completely cleared." "She needs to get another prescription for second course of antibiotics." "The health care provider wants to make certain she has taken all the antibiotics."

"We need to make sure that her ear infection has completely cleared." Because ear infections are sometimes difficult to treat, determining if the antibiotic has resolved the infection is essential. If the child is not rechecked, it will be difficult to determine if another infection is a continuation of a previous infection or a separate, new infection.Although studies may be done to determine if an infection has impaired the child's hearing, they are not done routinely after each course of antibiotic therapy.A visit to the primary care provider's office cannot validate that all the medication was taken.A follow-up visit helps to determine if the infection has completely cleared. If the infection is resolved with one course of antibiotics, another course would not be prescribed.

A 15-month-old client is being discharged after treatment for severe otitis media and bacterial meningitis. Which statement by the caregivers indicates effective discharge teaching? "We're just so glad this is all behind us." "We'll go to the physician if our child pulls on the ears or won't lie down." "We should have gone to the physician sooner. Next time, we will." "We'll take our child to the physician's office every week until everything is okay."

"We'll go to the physician if our child pulls on the ears or won't lie down." The caregivers indicate full understanding of discharge teaching by repeating the specific, common signs of otitis media in toddlers, such as pulling on the ears and refusing to lie down, and by verbalizing the need for immediate follow-up care if these signs arise. Expressing that they should have gone to the physician sooner doesn't indicate effective teaching because it implies a sense of guilt - a feeling not promoted through teaching. Stating that they'll take the client to the physician's office every week addresses only weekly follow-up care and expressing that they're happy the problem is behind them is unrealistic because the client's condition may recur.

A nurse is providing health teaching about pediatric immunizations to the parents of a child. Which of the following is the most appropriate information for the nurse to give the parents about immunizations? "Your child may need medication for a low-grade fever." "Children rarely experience pain at the injection site." "The fear of needles is usually overcome after the first shot." "Refusal of vaccinations is very common among children."

"Your child may need medication for a low-grade fever." Fever with most vaccines begins within 24 hours, lasts 2 to 3 days, and may require pharmacologic intervention. The other options are incorrect.

The mother calls the nurse to report that her toddler has just been burned on the arm. What should the nurse advise the mother to do first? Run cool water over the burned area and then wrap it in a clean cloth. Pack the arm in ice and then take the child to the closest emergency department. Call the child's health care provider (HCP) immediately and then wrap the arm in a clean cloth. Rub the burned area with an antibacterial ointment and then call the child's health care provider (HCP).

Run cool water over the burned area and then wrap it in a clean cloth. The best advice for the nurse to give the child's mother is to run cool water over the burned area to stop the burning process. Then the area should be wrapped in a clean cloth. Once these initial actions are completed, the mother can call the child's HCP. Packing the arm in ice may cause more damage to the burned area because cold can cause burns just as heat can. For most burns, it is not advised to apply ointment until the area has been evaluated.

Parents ask the nurse for advice about handling their 2-year-old's negativism. What is the best recommendation? Ignore this behavior because it is a stage the child is going through. Punish the child for misbehaving or violating set, strict limits. Set realistic limits for the child, and then be sure to stick to them. Encourage the grandmother to visit frequently to relieve them.

Set realistic limits for the child, and then be sure to stick to them. A characteristic of 2-year-olds is negativism, a response to their developing autonomy. Setting realistic limits is important so that the toddler learns what behavior is and is not acceptable.Ignoring the behavior may lead the child to believe that there are no limits. As a result, the child does not learn appropriate behavior.Having the grandmother visit will give the parents a break, but setting limits is more important to the child's development.Limits need to be realistic to ensure that the child learns appropriate behavior. Limits that are too strict are inappropriate, interfering with learning appropriate behavior.

A toddler is scheduled to have tympanostomy tubes inserted. When the nurse is approaching the toddler for the first time, which should the nurse do? Hold the toddler so they become more comfortable. Talk to the parent first so the toddler can get used to the new person. Pick up the toddler and take the child to the play area so the parent can rest. Walk over and pick the toddler up right away so the parent can relax.

Talk to the parent first so the toddler can get used to the new person. Toddlers should be approached slowly because they are wary of strangers and need time to get used to someone they do not know. The best approach is to ignore them initially and to focus on talking to the parents. The child will likely resist being held by a stranger, so the nurse should not pick up or hold the child until the child indicates a readiness to be approached or the parent indicates that it is okay.

The nurse prepares a 3-year-old child to have blood specimens drawn for laboratory testing. What intervention should the nurse employ? Use distraction techniques during the procedure. Provide verbal explanations about what will occur. Explain the procedure in advance. Explain why the blood needs to be drawn.

Use distraction techniques during the procedure. A 3-year-old child responds best to distraction during a procedure because of the typical level of cognitive development of a 3-year-old and the fear of painful events. Preparation for the procedure should be done immediately beforehand, so that the child will not become too frightened. A 3-year-old is not concerned about the why of the procedure but about whether the procedure will hurt. This child is too young for verbal explanations alone because of the limited verbal abilities at this age and the fear of a painful event.

Which family should the nurse determine as most in need of follow-up? a single parent with a toddler who has third-degree burns over 20% of the body a two-parent family whose 3-year-old has a fractured leg from an automobile accident a two-parent family with a foster child who has a history of caustic liquid ingestion a single mother with a 7-month-old child whose immunizations are delayed

a single parent with a toddler who has third-degree burns over 20% of the body Toddlers receive burns usually as the result of not being closely supervised. Toddlers are very inquisitive and need constant supervision; therefore, close follow-up is necessary. In addition, the child probably will need some type of wound care requiring involvement of the parent and possibly others. The amount of support available to the single parent of the 7-month-old child is not known. Although immunization schedules need to be adhered to, it is very possible for a 7-month-old to be delayed in receiving immunizations because of illness or other conflicts. An automobile accident can happen to anyone and does not indicate a lack of safety or supervision. A history of caustic liquid ingestion in a foster child may have been from a time before the child began living with the foster parents; it does not indicate a lack of safety or supervision.

A young child with sickle cell anemia prefers a side-lying position with the knees sharply flexed. The nurse should assess further for: abdominal pain. backache. emotional regression. nausea.

abdominal pain. The child's self-positioning on the side with the knees sharply flexed strongly suggests the possibility of abdominal pain. The child assumes this position to decrease the discomfort. Thus, the nurse should assess for further evidence of abdominal pain.Nausea usually causes a young child to refuse nourishment.A backache would most probably cause the young child to lie supine to relieve discomfort.Regression is common in acutely ill hospitalized children, but insufficient data are given to confirm regression.

Which behavior in a 20-month-old would lead the nurse to suspect that the child is being abused? talking easily with the nurse absence of crying during the examination playing with toys on the examination room floor clinging to the parent during the examination

absence of crying during the examination Children who are being abused may demonstrate behaviors such as withdrawal, apparent fear of parents, and lack of an appropriate reaction, such as crying and attempting to get away when faced with a frightening event (an examination or procedure).

Twelve hours after cardiac surgery, the nurse is assessing a 3-year-old who weighs 15 kg. The nurse should notify the surgeon about which clinical finding? alterations in levels of consciousness a urine output of 60 mL in 4 hours fluctuations of fluid in the collection chamber of the chest drainage system strong peripheral pulses in all four extremities

alterations in levels of consciousness Clinical signs of low cardiac output and poor tissue perfusion include pale, cool extremities, cyanosis or mottled skin, delayed capillary refill, weak, thready pulses, oliguria, and alterations in level of consciousness.An adequate urine output for a child over 1 year should be 1 mL/kg/h. Therefore 60 mL/4 h is satisfactory.Strong peripheral pulses indicate adequate cardiac output.Drainage from the chest tube should show fluctuation in the drainage compartment of the chest drainage system. The fluid level normally fluctuates as proof that the apparatus is airtight. On about the 3rd postoperative day, the fluctuation ceases indicating the lungs have fully expanded.

An emergency department nurse suspects neglect in a 3-year-old child admitted for failure to thrive. What assessment finding would the nurse apply as supporting physical neglect? is excessively friendly appears dirty and unkempt is not talking avoiding eye contact

appears dirty and unkempt Children who fail to thrive have a weight, height, and head circumference smaller than average on the standard growth charts. Their weight falls below the 3% on the standard growth charts. Failure to thrive (FTT) can be caused by many things, such as chromosomal anomalies, neglect, heart and lung problems, or GI problems that cause malabsorption. The nurse should never assume the infant or child with FTT is neglected. One major sign of neglect is that the child is dirty and smells of body odor. Coupled with weight loss, it suggests a high probability of neglect. A 3-year-old child should be talking, but not talking may be a sign of a developmental delay and not related to FTT. An infant or child with FTT is lethargic, very quiet and afraid, and pays no attention to toys or surroundings.

When assessing a toddler's growth and development, the nurse understands that a child in this age group displays behavior that fosters which developmental task? autonomy trust initiative industry

autonomy The toddler's developmental task is to achieve autonomy while overcoming shame and doubt. Developing initiative is the preschooler's task whereas developing trust is the infant's task. Developing industry is the task of the school-age child.

The nurse teaches the three cardinal signs of choking and total airway blockage to the parents of a toddler who was treated for a foreign body obstruction. When asked to repeat the signs, the parents identify "turn blue" and "cannot speak." What third sign would the parents identify if teaching was successful? vomits collapses gasps gags

collapses The three cardinal signs indicating that a child is truly choking and requires immediate life-saving interventions include an inability to speak, blue color (cyanosis), and collapse. Vomiting does not occur while a child is unable to breathe. Once the object is dislodged, however, vomiting may occur. Gasping, a sudden intake of air, indicates that the child is still able to inhale. When a child is choking, air is not being exchanged, so gagging will not occur.

A nurse observes two 2-year-old children playing. The nurse documents what form of play as normal for this age group? playing a game of catch with a ball digging side-by-side in a sandbox pretending to "race" toy cars with each other riding tricycles near each other

digging side-by-side in a sandbox Two-year-old children exhibit parallel play. They engage in similar activity, side by side. Two-year-old children have very short attention spans, so they change toys easily when playing. Taking turns in games does not occur until age 3 years, and playing catch is a "take turns" activity. Pretending to "race" toy cars is more suggestive of cooperative play, in which the children work together. Cooperative play is more typical of children 4 to 5 years of age. Riding tricycles near each other represents independent play. While the children are performing the same activity, they do not maintain the constant proximity ("side-by-side") exhibited in the parallel play that is common among 2-year-olds.

A young child who has been sexually abused has difficulty putting feelings into words. Which approach should the nurse employ with the child? engaging in play therapy reporting the abuse to a prosecutor role-playing giving the child's drawings to the abuser

engaging in play therapy The dolls and toys in a play therapy room are useful props to help the child remember situations and reexperience the feelings, acting out the experience with the toys rather than putting the feelings into words. Role-playing without props commonly is more difficult for a child. Although drawing itself can be therapeutic, having the abuser see the pictures is usually threatening for the child. Reporting abuse to authorities is mandatory, but does not help the child express feelings.

A nurse is teaching a group of parents about otitis media. When discussing why children are predisposed to this disorder, the nurse should mention the significance of which anatomical feature? tympanic membrane nasopharynx external ear canal eustachian tubes

eustachian tubes The nurse should mention the importance of the eustachian tubes because they're short in a child and lie in a horizontal plane, promoting entry of nasopharyngeal secretions into the tubes and thus setting the stage for otitis media. The nasopharynx, tympanic membrane, and external ear canal have no unusual features that would predispose a child to otitis media.

A toddler is brought to the clinic with symptoms of weakness and sores at the corners of the mouth. The parent states that the child eats poorly and will drink only cow's milk. Based on this information, which of the following laboratory tests would be a priority for the nurse to evaluate? Coombs test ferritin level vitamin B-12 level neutrophil count

ferritin level Iron deficiency anemia is commonly caused by an insufficient dietary intake of iron. The parent indicates that the child's diet may be deficient in iron. The ferritin level would be essential in helping to determine whether the child has iron deficiency anemia. Testing for vitamin B-12 is done to determine megaloblastic anemia. The Coombs test is used to determine hemolytic anemia. Neutrophils are white blood cells that are elevated in infection.

The nurse develops the plan of care for a toddler with an acetaminophen overdose. Which intervention should the nurse expect to include as part of the initial treatment? gastric lavage electrocardiogram frequent serum drug levels tracheostomy

gastric lavage Initial management of a child who has ingested a large amount of acetaminophen would include inducing vomiting or performing gastric lavage with or without activated charcoal to aid in the removal of the substance. Frequent blood level determinations may be obtained during the follow-up phase, but they are not done as part of the initial treatment. Tracheostomy is not typically part of the initial treatment for acetaminophen overdose. However, it may be necessary later if respiratory distress develops. Acetaminophen primarily affects the liver, not the heart. Therefore, an electrocardiogram would not be considered part of the initial treatment plan.

The nurse is caring for a toddler in contact isolation for respiratory syncytial virus (RSV). In what order from first to last should the nurse remove personal protective equipment (PPE)? All options must be used.

gloves gown goggles mask There are two acceptable ways of removing PPE. The nurse should remove the dirtiest items first. Typically, these items are the gloves followed by the gown. In the alternative method, the gloves and gown may be removed at the same time. It is then recommend that the nurse perform hand hygiene and remove the goggles, which may fit over the mask. Finally, the mask is removed from behind. The nurse should then again perform hand hygiene when all PPE has been removed.

A client with Down syndrome is admitted to the pediatric unit with asthma. The client does not enunciate words well and holds onto furniture when walking. The nurse should ask the caregiver how the client's condition today differs from their normal condition. how long the client has been like this. if the client always drools. if the client is able to walk without holding onto furniture.

how the client's condition today differs from their normal condition. The nurse should ask how the client's condition differs from their normal condition in order to identify the chief complaint. Asking how long the client has been like this may be interpreted poorly by the caregiver. The nurse shouldn't ask if the client can walk without holding onto furniture because focusing on what the client can do — not on what the client can't do — preserves the family's self-esteem. Focusing on negative aspects of the client's behavior, such as constant drooling, is inappropriate.

The nurse is admitting a toddler with the diagnosis of near-drowning in a neighbor's heated swimming pool to the emergency department. The nurse should assess the child for which complication? hypothermia cutaneous capillary paralysis hypoxia fluid aspiration

hypoxia Hypoxia is the primary problem because it results in brain cell damage. Irreversible brain damage occurs after 4 to 6 minutes of submersion. Hypothermia occurs rapidly in infants and children because of their large body surface area. Hypothermia is more of a problem when the child is in cold water. Although fluid aspiration occurs in most drownings and results in atelectasis and pulmonary edema, further aggravating hypoxia, hypoxia is the primary problem. Cutaneous capillary paralysis is not a problem.

The nurse is caring for a child in the early stages of burn recovery. Which nursing diagnosis does the nurse prioritize? impaired skin integrity constipation disturbed body image impaired physical mobility

impaired skin integrity Impaired skin integrity is a serious problem for the burned child. The open skin causes fluid to leak and can contribute to fluid and electrolyte issues. Also, because the skin is open there is a portal for infectious organisms. The diagnoses of impaired physical mobility, disturbed body image, and constipation are relevant in the care of the child with burns, but they are concerns for later in the recovery process.

A toddler is admitted to the facility for treatment of a severe respiratory infection. The child's recent history includes fatty stools and failure to gain weight steadily. The physician diagnoses cystic fibrosis. By the time of the child's discharge, the child's parents must be able to perform which task independently? performing postural drainage maintaining the child on a fat-free diet maintaining the child in an oxygen tent allergy-proofing the home

performing postural drainage The child with cystic fibrosis is at risk for frequent respiratory infections secondary to increased viscosity of mucus gland secretions. To help prevent respiratory infections, caregivers must perform postural drainage several times daily to loosen and drain secretions. Because exocrine gland dysfunction, not an allergic response, causes bronchial obstruction in cystic fibrosis, allergy-proofing the home isn't necessary. Oxygen therapy may be indicated, but only during acute disease episodes. Also, such therapy must be supervised closely; home oxygen therapy is inappropriate because chronic hypoxemia poses the risk of oxygen toxicity. If steatorrhea can't be controlled, the child should reduce, but not eliminate, dietary fat intake.

The nurse assesses a child with celiac disease. The nurse would most likely note which physical finding? periorbital edema tender inguinal lymph nodes enlarged liver protuberant abdomen

protuberant abdomen The intestines of a child with celiac disease fill with accumulated undigested food and flatus, causing the characteristic protuberant abdomen. Celiac disease is not usually associated with any liver dysfunction, including poor liver functioning leading to liver enlargement. Tender inguinal lymph nodes are often associated with an infection. Periorbital edema, swelling around the eyes, is associated with nephritis.

A 2 1/2-year-old child and his 2-month-old sibling are brought to the clinic by their father, who explains that the older child says "no" whenever asked to do something. The nurse should explain that the negativism demonstrated by toddlers is frequently an expression of which characteristic? sibling rivalry pursuit of autonomy separation anxiety need to expend excess energy

pursuit of autonomy According to Erikson, the developmental task of toddlerhood is acquiring a sense of autonomy while overcoming a sense of doubt and shame. Characteristics of negativism and ritualism are typical behaviors in this quest for autonomy. The toddler commonly does the opposite of what others request.Hyperactivity, or the need to expend excess energy, is a typical behavior that may be demonstrated by a toddler; separation anxiety and siblings rivalry may also be demonstrated by the toddler. However, none of these three behaviors is the basis for the toddler's negativism.

What should the nurse teach the parent of a 3-year-old child with eczema to remove from the child's environment at home? wooden blocks plastic figures stuffed animals metal toy trucks

stuffed animals For the child with eczema, which is commonly related to an allergic response, stuffed animals should be avoided because they tend to collect dust and are difficult to clean.Metal toy trucks, plastic figures, and wooden blocks are suitable toys for a 3-year-old child. They are easy to keep clean.

The parent asks the nurse for advice about discipline for their 18-month-old child. Which discipline strategy should the nurse suggest that the parent use? spanking reprimand reasoning time-out

time-out Time-out is the most appropriate discipline for toddlers. It helps to remove them from the situation and allows them to regain control. Structuring interactions with 3-year-olds helps minimize unacceptable behavior. This approach involves setting clear and reasonable rules and calling attention to unacceptable behavior as soon as it occurs. Reprimanding a young child can reinforce undesirable behavior over time because it provides attention. Physical punishment, such as spanking, has limited effectiveness and serious negative effects. Reasoning is more appropriate for older children, such as preschoolers and those older, especially when moral issues are involved. Unfortunately, reasoning combined with scolding often takes the form of shame or criticism, and children take such remarks seriously, believing that they are "bad."

A child, age 2, with a history of recurrent ear infections is brought to the clinic with a fever and irritability. To elicit the most pertinent information about the child's ear problems, the nurse should ask the parent: "Does your child's ear hurt?" "Does your child have any hearing problems?" "Does anyone in your family have hearing problems?" "Does your child tug at either ear?"

"Does your child tug at either ear?" Although all of the options are appropriate questions to ask when assessing a young child's ear problems, questions about the child's behavior, such as "Does your child tug at either ear?" are most useful because a young child usually can't describe symptoms accurately.

For a client with a circumferential chest burn, what is the most important factor for the nurse to assess? body temperature wound characteristics heart rate breathing pattern

breathing pattern Breathing pattern is the most important factor to assess because eschar impedes chest expansion in a client with a circumferential chest burn, causing breathing difficulty. Wound characteristics, body temperature, and heart rate are also factors that should be assessed, but they aren't as important as breathing pattern.

The nurse is caring for a 3-year-old child with iron deficiency anemia and providing dietary instructions to the parents. Which of the following should be a priority for the nurse to include in the teaching? insisting on a banana each day urging pasta with tomato sauce encouraging milk products recommending lean meats

recommending lean meats From the list, meat is the food source with the highest iron content.

A nurse is preparing to give an I.M. injection in the left leg of a 2-year-old child. Identify the area where the nurse should give the injection.

The vastus lateralis muscle, located in the thigh, is the muscle into which the nurse should administer an I.M. injection in the leg of a toddler. To give an injection into the vastus lateralis muscle, the nurse should divide the distance between the greater trochanter and the knee joints into quadrants. The injection should be given in the center of the upper quadrant.

A nurse manager is reviewing charts of several toddlers on a pediatric unit. The manager notices that the weight of the toddlers has not been documented and decides to address the issue with the staff. Which is the most critical information for the nurse manager to share with the staff regarding this situation? Undocumented weights could result in medication errors. Failing to chart weights will lead to a work suspension. Documenting weights helps parents see a child's progress. Weights are necessary to plan pediatric meals accurately.

Undocumented weights could result in medication errors. A child whose weight has not been documented is at great risk for a medication error because many medication dosages are related to the child's weight. Although the other options may be shared by the nurse manager, they are not as critical to the safety of the child.

A 2-year-old child always puts their teddy bear at the head of the bed before they go to sleep. The parents ask the nurse if this behavior is normal. The nurse should explain to the parents that toddlers use ritualistic patterns to establish which factor? control over adults in their environment a sense of security a sense of identity sequenced patterns of learning behavior

a sense of security Toddlers establish ritualistic patterns to feel secure, despite inconsistencies in their environment. Establishing a sense of identity is the developmental task of the adolescent. The toddler's developmental task is to use rituals and routines to help make autonomy easier to accomplish. Ritualistic patterns involve patterns of behavior, but they are not utilized to develop learning

Which toy should the nurse give to a toddler to use in the hospital playroom? wheelbarrow truck with four wheels. blocks tricycle

blocks As toddlers begin imaginative play, blocks are an excellent toy choice. Children can use blocks any way they desire, thus fostering imaginative play.A tricycle, wheelbarrow, or truck is an appropriate toy for a preschooler because it requires the use of specific motor skills developed during the preschool period. These motor skills are lacking in a toddler.

A toddler hospitalized with nephrotic syndrome has marked dependent edema and hypoalbuminemia. His urine is frothy. When assessing the child's vital signs, the nurse should report which finding to the health care provider? body temperature of 102.8° F (39.3° C) blood pressure of 80/45 mm Hg pulse rate of 85 bpm respiratory rate of 28 breaths/minute

body temperature of 102.8° F (39.3° C) Temperature of 102.8° F (39.3° C) is elevated, suggesting an infection. The nurse should notify the health care provider.The child is displaying signs and symptoms of nephrotic syndrome. With this disorder, blood pressure is characteristically normal or slightly low. The other vital signs are likely to be normal unless edema causes respiratory distress and respirations increase and become labored. The blood pressure reading, heart rate, and respiratory rate here are within the normal range for a toddler.A pulse rate of 85 bpm is normal for a toddler. In nephrotic syndrome, the pulse rate would be normal unless other problems arise.A respiratory rate of 28 is normal for a toddler. In nephrotic syndrome, the respiratory rate would be normal unless edema causes respiratory distress and the respirations increase and become labored.

The nurse is attempting to reduce the risk for impaired skin integrity related to immobility in a toddler. Which actions does the nurse include in the plan of care? Select all that apply. promote good nutrition wipe pressure points with alcohol wipes change position frequently clean skin only when soiled massage skin with a lubricating substance

change position frequently clean skin only when soiled promote good nutrition Using a lotion on the pressure points will soften the skin and promote its breakdown, so it should be avoided. The use of alcohol is drying and should also be avoided. Changing the toddler's position frequently will help minimize pressure, prevent edema, and stimulate circulation. Keeping the skin clean will lessen the chances of irritation and breakdown. Providing nutrition that includes adequate vitamins, minerals, and protein will also help healing and prevent breakdown.

A mother brings a 15-month-old child to the well-baby clinic. She states the child has been taking approximately 18 to 20 oz (540 to 600 mL) of whole milk per day from a bottle with meals and at bedtime. The nurse should suggest that she begin weaning the child from the bottle to avoid risking: anemia. dental caries. malocclusion. malnutrition.

dental caries. Nursing bottle caries occur when a child is routinely given a bottle of milk or juice at nap and bedtime. When teeth become coated in sugar before sleep, the lack of activity in the child's mouth for several hours during sleep allows the sugar to convert to acid, leading to decay. A child drinking 18 to 20 oz of whole milk in a day should not be malnourished, although she may lack essential vitamins and iron. Anemia may occur if she is only drinking milk because it contains no iron; however, the mother indicates she is eating meals. Regardless, children of this age should be taking no more than 16 oz of milk per day, and most children at this age should be drinking from a cup. The mother should be instructed to wean the child to a cup one feeding at a time until the child is completely weaned to a cup for all feedings. The last bottle-feeding to be replaced is usually the night bottle. Malocclusion of the teeth does not occur at 15 months. If the child were to continue to suck on a bottle until age 4 years or later, then malocclusion may occur.

A 14-month-old child with acquired immunodeficiency syndrome (AIDS) is admitted to the facility with an infection. When developing a care plan, the nurse must keep in mind that AIDS in children commonly is associated with: developmental delays. Kaposi's sarcoma. Wiskott-Aldrich syndrome. congenital heart anomalies.

developmental delays. Children with AIDS commonly exhibit developmental delays or regression. To plan developmentally appropriate care and establish realistic goals, the nurse must obtain information about the child's developmental status. Unlike adults with AIDS, children with this disease rarely develop Kaposi's sarcoma. AIDS isn't associated with congenital heart anomalies. Clinical manifestations of Wiskott-Aldrich syndrome, an X-linked recessive disorder characterized by immunodeficiency, resemble those of AIDS; however, the two syndromes aren't related.

The nurse is planning care for a toddler with a seizure disorder. Which item in the care plan should the nurse revise? oxygen mask and bag system at bedside lorazepam for seizure lasting longer than 5 minutes padded tongue blade at the bedside padded side rails

padded tongue blade at the bedside The nurse should revise a care plan that includes padded tongue blades. Nothing should be placed in the mouth during a seizure. Padded side rails will protect the child from injury during a seizure. The bag and mask system should be present in case the child needs oxygen during a seizure. Most seizures resolve in under 5 minutes. If they do not, then a dose of lorazepam can be administered. The healthcare provider will prescribe the correct dosage for weight and the parameters for administering.

A nurse is planning a health teaching session for a group of parents with toddlers. When describing a toddler's typical eating pattern, the nurse should mention that many children of this age exhibit: consistent table manners. strong food preferences. a preference for eating alone. an increased appetite.

strong food preferences. A toddler can't be expected to use consistent table manners and, generally, the appetite decreases during the toddler stage because of a slowed growth rate. A toddler typically enjoys socializing during meals and commonly imitates others.

A nurse is auscultating for heart sounds in a client. The nurse notes a grade 1 heart murmur. Which characteristic best describes a grade 1 heart murmur? associated with a precordial thrill softer than the heart sounds equal in loudness to the heart sounds can be heard without a stethoscope

softer than the heart sounds A grade 1 heart murmur is commonly difficult to hear and softer than heart sounds. A grade 2 murmur is usually equal in sound to the heart sounds. A grade 4 murmur is associated with a precordial thrill (a palpable manifestation associated with a loud murmur). A grade 6 murmur can be heard without a stethoscope.

A parent of a 2-year-old child states the child cries when being dropped off at daycare but seems happy when being picked up later in the day. What is the best advice the nurse can give the parent related to this behavior? "It would help if you make a game of going to daycare." "Send your child's favorite toy to daycare as a comfort object." "Your child is likely afraid of something at the daycare." "This is a normal stage of development that toddlers go through."

"This is a normal stage of development that toddlers go through." Separation anxiety starts as early as 5 months old and is most evident in toddlers and preschoolers. It occurs after the child has gained an understanding of object permanence. Once the toddler learns the parent is really gone, crying and temper tantrums ensue. Because the toddler has a short attention span, once their attention is diverted to another activity the anxiety is reduced. Taking a favorite toy or blanket with the child may be helpful but does not solve the child's anxiety. It might be good for the parent to discuss the situation with the daycare personnel, but it still does not prevent the child from having separation anxiety.

When a client with croup is admitted to the facility, a physician orders treatment with a mist tent. As the caregiver attempts to put the client in the crib, the client cries and clings to the caregiver. What should the nurse do to gain the client's cooperation with the treatment? Turn off the mist so the noise doesn't frighten the client. Let the client sit on the caregiver's lap next to the mist tent. Encourage the caregiver to stand next to the crib and stay with the client. Put the side rail down so the client can get into and out of the crib unaided.

Encourage the caregiver to stand next to the crib and stay with the client. The nurse should encourage the caregiver to stand next to the crib and stay with the client. This approach promotes compliance with treatment while minimizing the client's separation anxiety. Because the mist helps thin secretions and make them easier to clear, turning off the mist or letting the client sit next to the mist tent defeats the treatment's purpose. To prevent falls, the nurse should keep the side rails up and shouldn't permit the client to climb into and out of the crib.

What advice should a nurse give to the caregivers of a 2-year-old client who frequently throws temper tantrums? Allow the client more choices. Give into the client's demands. Move the client to a different setting. Ignore the behavior when it happens.

Ignore the behavior when it happens. Ignoring tantrums is the best advice because paying attention to the undesirable behavior can reinforce it. Changing settings can actually increase the tantrum behavior. Allowing the client more choices may also increase tantrum behavior if the client is unable to follow through with choices. It's ill-advised to give into the client's demands because doing so only promotes tantrum behavior.

The nurse is reviewing the laboratory data for a young client in acute kidney failure and notes an elevated serum potassium level. What is the priority assessment action for the nurse based on the laboratory data? Frequently assess breath sounds. Institute telemetry monitoring. Monitor for changes in motor reflexes. Monitor urine output every 4 hours.

Institute telemetry monitoring. Slow, weak, irregular pulse; lethal arrhythmias; and sudden cardiac collapse are serious complications of an elevated potassium level. The elevated value will have less impact on renal, respiratory, and neurologic function.

A nurse is caring for an infant being treated for an upper respiratory infection. The physician would like to order a series of X-rays for the infant, who has been in a foster home for 4 months. How should the nurse obtain consent? Contact the unit's director of nursing. Obtain consent from the foster parents. Call Child Protective Services. Contact the child's biological parent.

Obtain consent from the foster parents. Foster parents have the right to consent to medical care of minors in their care. The parents of a minor in foster care don't have authority to make decisions regarding the child's care. The nurse should call Child Protective Services only if she has concerns about a foster parent's authenticity. The nurse needn't notify the director of nursing unless complications occur.

The nurse is caring for a child whose mother is deaf and untrusting of staff. She frequently cries at the bedside, but refuses intervention from the social worker or the chaplain. Which issue is most important for the nurse to address with the mother to promote a trusting relationship? lack of knowledge about the child's illness and treatment the mother's feelings of loss of control over her child the mother's fear that the staff do not respect her communication barriers between the mother and staff

communication barriers between the mother and staff The communication barrier is the most significant and would require immediate attention. Strategies need to be implemented that include taking the time to share information via the written word with all new members of the healthcare team and the mother. Fear, loss of control, and lack of knowledge about the illness of the child may contribute to the overall stress of the situation.

The nurse is caring for a young child who has been admitted to the hospital with pertussis. To prevent the spread of the infection, which of the following is the most important action of the nurse? place the child in a negative pressure room provide masks for everyone entering the room wear gloves when providing care for the child use eye protection for direct contact with the child

provide masks for everyone entering the room Pertussis is spread via droplet transmission, so droplet precautions are necessary for the first 5 days after the child has begun medical treatment. This requires that everyone entering the room wears a mask. When administering direct care, eye protection can be worn to prevent coughing of droplets into the eyes. The child does not need a negative pressure room, because the disease is not spread via aerosoled droplets. These types of droplets can travel for long distances. Diseases needing this type of isolation are tuberculosis, measles, and varicella. The droplets of pertussis are larger and travel only 3 feet. Gloves should always be worn as part of standard precautions when providing client care.

When teaching caregiver of a client with congenital heart disease, the nurse should explain all medical treatments and emphasize which instruction? "Make sure your child avoids contact with small children to reduce overstimulation." "Try to maintain your child's usual lifestyle to promote normal development." "Relax discipline and limit-setting to prevent crying." "Reduce your child's caloric intake to decrease cardiac demand."

"Try to maintain your child's usual lifestyle to promote normal development." The nurse should encourage the caregivers of a client with a congenital heart defect to treat the client normally and allow self-limited activity. Telling the caregivers to reduce the client's caloric intake isn't appropriate because doing so wouldn't necessarily reduce cardiac demand. Telling the caregivers to alter disciplinary patterns and deliberately prevent crying or interactions with other children could foster maladaptive behaviors. Contact with peers promotes normal growth and development.

The nurse is calculating the digoxin dose for a pediatric client who weighs 11.36 kg (25 lb). The dose for the client is 30 mcg/kg. How many mcg will the client receive per dose? Record your answer using one decimal place.

340.8 The order is for 30 mcg/kg/dose. Multiplying 11.36 kg by 30 mcg/kg yields a dose of 340.8 mcg (when rounded to one decimal place).

Which suggestion would be most helpful to the parents of a 2-year-old child when managing separation anxiety during hospitalization? Bring the child's favorite toys from home. Keep the visit time short. Tell the child the time they are leaving and returning. Leave while the child is sleeping.

Bring the child's favorite toys from home. Bringing a child's favorite toys, security blanket, or familiar objects from home can make the transition from home to hospital less stressful. The child receives comfort and reassurance from these items.Leaving without explaining may decrease the child's trust in the parents, ultimately adding to the child's level of anxiety.The parents should tell their toddler when they are leaving and when they will return, not by time but in relation to the child's usual activities (e.g., by bedtime). Typically, 2-year-old children have a limited sense of time.Short parental visits do not satisfy a toddler's overwhelming need for comfort because toddlers need to spend lots of time with parents due to separation anxiety.

A toddler diagnosed with nephrotic syndrome has a fluid volume excess related to fluid accumulation in the tissues. Which measure should the nurse anticipate including in the child's plan of care? Weigh the child before breakfast. Limit visitors to 2 to 3 hours a day. Test urine specific gravity every shift. Maintain strict bed rest.

Weigh the child before breakfast. The best indicator of fluid balance is weight. Therefore, daily weight measurements help determine fluid losses and gains. Although limiting visitors to 2 to 3 hours per day or maintaining strict bed rest would help ensure that the child gets adequate rest, this is unrelated to the child's fluid balance. In nephrotic syndrome, urine is tested for protein, not specific gravity.

Intraosseous infusion of a medication would be most appropriate for which client? an 18-month-old client with cystic fibrosis a 2-year-old client with a ruptured spleen and hypovolemia a 5-year-old client with status asthmaticus a 4-year-old client with celiac disease

a 2-year-old client with a ruptured spleen and hypovolemia In an emergency, intraosseous drug administration is typically used when a client is critically ill and younger than age 3. The 2-year-old client with a ruptured spleen and hypovolemia meets these criteria.

An 18-month-old child is admitted to the pediatric unit. Which of the following can the nurse do to reduce the stress on the client during this hospitalization? Encourage the client's caregivers to be with the client as much as possible Allow the child to explore the environment Encourage play times with other children on the unit Minimize needle sticks to the client

Encourage the client's caregivers to be with the client as much as possible For infants through preschoolers, separation from the family is the major stressor posed by hospitalization. To minimize the effects of separation, the nurse may suggest that a family member stay with the child as much as possible. Reducing this stressor may help a young child withstand other possible stressors of hospitalization, such as fear of bodily injury, loss of control, and fear of pain. Allowing the child to explore their environment would not impact potential stressors, and at this age the child engages in parallel play; therefore, encouraging play times would not reduce stressors.

A nurse is caring for a child with intussusception. Which of the following is an expected client outcome related to the nursing diagnosis Acute pain related to cramping, which might be made for this child? The child is very still. The child exhibits no manifestations of discomfort. The child has a normal bowel movement. The child has not vomited in 3 hours.

The child exhibits no manifestations of discomfort. Clients may experience severe pain from intussusception, a condition in which part of the bowel telescopes or invaginates into another part. Children often indicate this pain by screaming, drawing the legs up to the abdomen, and turning pale and diaphoretic. A nursing diagnosis of Acute pain is made, and an expected client outcome from treatment for pain is that the client exhibits no manifestations of discomfort. Being very still may indicate either a pain state or a state of relaxation and thus is not determinative.

A parent brings a child to the clinic with symptoms of weight loss, paleness, fatigue, and not growing. What question about the child's environment should the nurse ask the parent based on these symptoms? "Do you have pets in your home?" "How old is the house that you live in?" "Do you live near a hydroelectric facility?" "Are you a single parent?"

"How old is the house that you live in?" The nurse should suspect lead poisoning in this situation. Many of the symptoms are the same as other illnesses, but the key is living in the older home. Lead poisoning occurs through older lead pipes and drinking water from those pipes. Lead is also found in the dirt in areas surrounding homes where lead pipes and lead paint have been used. The symptoms of lead poisoning include weight loss, being tired all the time, difficulty concentrating, and abdominal pain. The concern for living near a hydroelectric facility would be methylmercury poisoning. The symptoms of this would include lack of coordination, speech impairments and muscle weakness. The type of pets in the home could indicate symptoms of a disease such as asthma. The concern for being a single parent would be one of financial need and not being able to purchase nutritious foods for the child.

A toddler is in the hospital. The parents tell the nurse they are concerned about the seriousness of the child's illness. Which response to the parents is most appropriate? "It must be difficult for you when your child is ill and hospitalized. Tell me your concerns." "If you look around, you'll see other children who are much sicker." "What seems to concern you about your child being hospitalized?" "Please try not to worry. Your child will be fine."

"It must be difficult for you when your child is ill and hospitalized. Tell me your concerns." Expressing concern is the most appropriate response because it acknowledges the parents' feelings. False reassurance, such as telling parents not to worry, is not helpful because it does not acknowledge their feelings. Encouraging parents to look at how ill other children are also isn't helpful because the focus of the parents is on their own child. Asking what the concern is merely reinforces the parents' concern without addressing it.

A nurse is caring for a pediatric client wearing diapers. The nurse must calculate the urine output for the client. The dry diaper weighs 35 g. The wet diaper weighs 250 g. How much urine output has the client had? Record your answer using a whole number.

215 One gram of urine is equivalent to 1 mL of urine. Output = (wet diaper weight) - (dry diaper weight) = 250 - 35 = 215 mL.

A 3-year-old child is to receive 500 ml of dextrose 5% in normal saline (D5NSS) solution over 8 hours. At what rate (in milliliters/hour) would the nurse set the infusion pump? Record your answer using one decimal place.

62.5 To calculate the infusion rate per hour to one decimal place for this pediatric client, the nurse would divide 500 ml by 8 hours:500 ml ÷ 8 hours = 62.5 ml/hour.

A nurse is providing health teaching to the parents of a 2-year-old child who has been diagnosed with benign febrile seizures. What is the most important information for the nurse to give the parents about this disorder? This diagnosis often progresses to one of epilepsy. The seizures will continue throughout the child's life. A respiratory or ear infection is usually present. Benign febrile seizures will result in a developmental delay for the child.

A respiratory or ear infection is usually present. An underlying infectious process is often a stimulating factor that triggers the febrile seizures. Parents should be aware of and instructed in how to treat a febrile child. The other options are not accurate in their presentation of febrile seizures.

A client is brought to the emergency department with suspected croup. Which assessment finding reflects increasing respiratory distress? decreased level of consciousness (LOC) bradycardia flushed skin intercostal retractions

intercostal retractions Clinical manifestations of respiratory distress include tachypnea, tachycardia, restlessness, dyspnea, intercostal retractions, and cyanosis. Bradycardia, LOC, and flushed skin aren't signs of increasing respiratory distress.

When developing a teaching plan for parents of toddlers about poisonous substances, the nurse should emphasize which safety points? Select all that apply. Syrup of ipecac should be administered following all ingestions of poisonous substances. All poisonous substances should be kept out of the reach of children and stored in a locked cabinet if necessary. Following any poisoning, the parents should call the Poison Control Center for instructions for appropriate treatment. The difference between pediatric and adult dosages of medicines is significant, and adult dosages given to children can have serious, harmful effects. Toddlers should be adequately supervised at all times.

All poisonous substances should be kept out of the reach of children and stored in a locked cabinet if necessary. Following any poisoning, the parents should call the Poison Control Center for instructions for appropriate treatment. The difference between pediatric and adult dosages of medicines is significant, and adult dosages given to children can have serious, harmful effects. Toddlers should be adequately supervised at all times. Safety measures for poisonous substances include close supervision of children, safely storing toxic substances, teaching proper dosages and differences between adult and child doses, and the proper way to contact the Poison Control Center for instructions. Poison Control should be notified as soon as the poisoning has occurred and airway and circulation have been assessed. Poison Control will direct any further treatment. Syrup of ipecac is rarely used today in the treatment of ingested substances due to the potential for aspiration. It is contraindicated in cases of arsenic poisoning, seizures, and the ingestion of petroleum or corrosive substances.

A nurse on the pediatric floor is caring for a toddler refusing to take liquid acetaminophen for fever. What would be the best option? Give it up and try again in a couple hours. Allow the parent to hold the child and give the medication. Explain to the child why it is important. Call the healthcare provider to change the order.

Allow the parent to hold the child and give the medication. Toddlers' increasing autonomy is commonly expressed by negativism. They are unreliable in expressing pain — they respond just as strongly to painless procedures as they do to painful ones. Toddlers have little concept of danger and have common fears. The toddler may be more willing to take the medication from a trusted parent.

A pediatric nurse preceptor working on an oncology floor goes to see if the new graduate nurse caring for a 3-year-old terminally ill child requires assistance. The preceptor finds the new nurse in the lounge crying. What is the preceptor's best action? Ask the graduate what has caused the crying. Give the graduate some privacy. Offer to call the chaplain to offer the graduate support. Let the nurse manager know about the situation.

Ask the graduate what has caused the crying. Caring for acute or chronically ill children can be emotionally and physically stressful. A preceptor to a new nurse should be supportive and empathetic by asking about the new nurse's feelings. It is not appropriate for the preceptor to make judgments about the new nurse, and it is not acceptable for the preceptor to talk with the nurse manager about the issue at this time. It is not unusual for a nurse to need time to emotionally adjust to a new situation or new client population. Many times the chaplain can offer emotional and spiritual support that the nurse needs, but the preceptor offering support is the primary need.

A toddler is receiving an infusion of total parenteral nutrition via a Broviac catheter. As the child plays, the I.V. tubing becomes disconnected from the catheter. What should the nurse do first? Position the child on the side. Clamp the catheter. Flush the catheter with heparin. Turn off the infusion pump.

Clamp the catheter. First, the nurse must clamp the catheter to prevent air entry, which could lead to air embolism. If an air embolism occurs, the nurse should position the child on the side after clamping the catheter. The nurse may turn off the infusion pump after ensuring the child's safety. If blood has backed up in the catheter, the nurse may need to flush the catheter with heparin; however, this isn't the initial priority.

Which action should the nurse take when suspecting that a child has been abused by the mother? Ensure that any and all findings are reported to the proper authorities. Report the findings to the primary care provider so the primary care provider can report the suspected abuse. Keep the findings confidential because they represent legal privileged communication between the nurse and the mother. Continue to collect information until there is no doubt in the nurse's mind that abuse has occurred.

Ensure that any and all findings are reported to the proper authorities. Evidence of child abuse is legally reportable by anyone who works with children. The nurse should ensure that the findings are reported to the proper authorities. Laws ordinarily provide immunity from legal actions for people who are required to report suspicion of child abuse, if the report is done in good faith.Suspicion, not absolute proof, is necessary for reporting abuse.The nurse's primary responsibility is to the primary client, the child, and not the mother.Any professional who works with children can report suspected child abuse, not just a primary care provider.

The nurse develops the preoperative teaching plan for a 14-month-old child with an undescended testis who is scheduled to have surgery. Which method is most appropriate? Tell the child that they will not see any incisions after surgery. Tell the child that their penis and scrotum will be "fixed." Use an anatomically correct doll to show the child what will be "fixed." Explain to the parents how the defect will be corrected.

Explain to the parents how the defect will be corrected. Preoperative teaching would be directed at the parents because the child is too young to understand the teaching. Telling the child that their penis and scrotum will be "fixed," telling the child they will not see incisions after surgery, and using a doll to illustrate the surgery are appropriate interventions for a preschool-age child.

When performing a physical assessment on an 18-month-old child, which measure would be best? Have a parent hold the toddler. Carry out the assessment from head to toe. Assess motor function by having the child run and walk. Assess the ears and mouth first.

Have a parent hold the toddler. The best strategy for assessing a toddler is to have the parent hold the toddler. Doing so is comforting to the toddler.Assessment should begin with noninvasive assessments first while the child is quiet. Typically, these include assessments of the cardiac and respiratory systems. The ears and throat are typically examined last.Using a head-to-toe approach is more appropriate for an older child. For a toddler, assessment should begin with noninvasive assessments first while the child is quiet.Having a toddler run and be active may make it difficult to settle the child down after the physical exertion.

A nurse is teaching parents about accident prevention for a toddler. Which guideline is most appropriate? Always make the toddler wear a seat belt when riding in a car. Never leave a toddler unattended on a bed. Make sure all medications are kept in containers with childproof safety caps. Teach rules of the road for bicycle safety.

Make sure all medications are kept in containers with childproof safety caps. Making sure all medications are kept in containers with childproof safety caps is the most appropriate guideline, because poisoning accidents are common with toddlers owing to the child's curiosity, increasing mobility, and ability to climb. When riding in a car, a toddler should be strapped into a car seat, not restrained by a seat belt. A seat belt is an appropriate guideline for a school-age child. Never leaving a child alone on a bed is an appropriate guideline for parents of infants. Toddlers already have the ability to climb on and off of beds and other furniture by themselves. Note, however, that toddlers should never be left unattended on high surfaces, such as an examining table in a health care provider's office. Teaching the rules of the road for bicycle safety is an appropriate safety measure for a school-age child. Toddlers should not be allowed in the road unsupervised.

When developing the postoperative plan of care for a child who is scheduled to have a tympanostomy tube inserted into the right ear, which intervention should the nurse identify to facilitate drainage? Apply an ice pack to the left ear. Apply a gauze dressing to the left ear. Position the child to lie on the right side. Apply warm compresses to the right ear.

Position the child to lie on the right side. Positioning the child on the affected side, in this case the right side, will promote drainage from the middle ear by gravity.Application of heat, such as in the form of warm compresses, may facilitate drainage of exudate from the ear but only if the child is lying on the affected side.A gauze dressing is not applied after surgery. However, a loose wick may be inserted into the external ear canal to absorb drainage from the right, not left, ear.Application of an ice bag may help reduce pressure and edema. However, the ice bag would be applied to the right ear.

The nurse in the emergency department is caring for a preschool-age child with a fractured humerus. The child is crying and screaming, "I hate you!" Which action would be most appropriate? Reassure the parents that this is normal behavior under the circumstances. Ask the charge nurse to assign this client to another nurse. Tell the parents they will need to wait out in the lobby. Ask the parents to discipline the child so that the team can treat her.

Reassure the parents that this is normal behavior under the circumstances. Explaining to the parents that this is a normal reaction under the circumstances is most appropriate. The child's outburst is related to the child's fears of the unknown. The child is scared and anxious and needs the parents for support. Asking the parents to wait outside would only add to the child's fear and anxiety. The reaction is normal for a child that age and does not usually call for a change in staff assignments. Asking the parents to discipline their child for the child's behavior is inappropriate. The nurse needs to handle the situation.

The parents of a child with diarrhea report to the nurse that they have treated the child with home remedies, including herbal medicine. What is the most important information for the nurse to communicate to the parents regarding the use of home remedies? Read the labels to know what ingredients the child is taking. Share home remedy information with healthcare professionals. Closely monitor and record the number of stools. Ensure the home remedy dosage is correct for age.

Share home remedy information with healthcare professionals. The most important information related to home herbal remedies is to make sure the parents are sharing this information with medical professionals. This is to ensure that the child does not receive two different forms of the same drug and to prevent potential interactions between drugs and the home remedy. The other choices are also important actions, but not the most critical to discuss with the nurse during the health care visit for a sick child. The parents should monitor the number of stools daily to make sure they are not worsening. Parents should read the labels on all remedies and understand how the ingredients work before administering to their child. Many home remedies do not have dosages for children, so parents should look for these before administering to their child.

A child with a tracheostomy suddenly becomes diaphoretic and has an increased heart rate, an increased work of breath, and a decreased oxygen saturation level. What should the nurse do first? Perform chest physiotherapy. Suction the tracheostomy. Administer pain medication. Turn the child to a side-lying position.

Suction the tracheostomy. Diaphoresis, increased heart rate, increased respiratory effort, and decreased oxygen saturation are signs that mucus is partially occluding the airway. Therefore, the nurse should suction the tracheostomy first to prevent full occlusion. Turning the client to a side-lying position won't remove mucus from the airway. The client may require pain medication after the airway has been cleared if the client's condition warrants it. Chest physiotherapy will help drain excess mucus from the lungs but not from a tracheostomy.

Which approach by a nurse is the best for trying to take a crying toddler's temperature? Bring extra help so it can be done quickly. Talk to the caregiver first and then to the client. Tell the caregiver not to hold the client. Ignore the crying and screaming.

Talk to the caregiver first and then to the client. When dealing with a crying client, the best approach is to talk to the caregiver first then to the toddler. This approach helps the client get used to the nurse before attempting any procedures. It also gives the client an opportunity to see that the caregiver trusts the nurse. Ignoring the crying and screaming may be the second step. The nurse should encourage the caregiver to hold the client because it will likely help the situation. The last resort is to bring in assistance so the procedure can be completed quickly.

The parent of a 2-year-old is concerned because the child's right eye seems to turn in toward the nose when the child is tired. The nurse should: Assure the parent that this is a normal event when the child is tired. Test the child with the cover-uncover test and refer the parent and child to an ophthalmologist if the test is abnormal. Advise the parent to continue to watch the child's eyes closely and, if the problem persists, to call the clinic. Explain to the parent that the child will probably outgrow the weakness and the parent need not be concerned.

Test the child with the cover-uncover test and refer the parent and child to an ophthalmologist if the test is abnormal. Strabismus is diagnosed through observation and use of the corneal light reflex test. The cover-uncover test will reveal movement of the affected eye when the unaffected eye is covered, indicating abnormal fixation of the affected eye. The child should be referred to an ophthalmologist as soon as possible so that the correct vision in the affected eye can be restored. It is never normal for one eye to turn inward or outward even if the child is tired. If this condition is not corrected early, blindness can result in the unaffected eye due to the brain suppressing the double vision. Thus, telling the parent to watch the child and call later with concerns is not an appropriate response. The child will not grow out of this type of condition and may need surgery, an eye patch, daily exercises, or a combination of these interventions.

A nurse is caring for a client with tetralogy of Fallot. The client's caregiver becomes concerned when visiting the client and notices the client thumb sucking, a behavior that had been previously given up. What does this behavior indicate? The client wants attention. The client is in pain. The client is responding to stress. The client is depressed.

The client is responding to stress. This behavior indicates the client is responding to stress. Regression (reverting back to previously outgrown behaviors) is a common response to stressful situations. The nurse should reassure the caregivers that thumb sucking and other regressive behaviors should disappear after the stressful situation is resolved. Thumb sucking isn't a sign of depression or pain or an attention-seeking behavior.

The nurse develops a teaching plan for the parent of a toddler diagnosed with scabies. What information should the nurse expect to include? Hold the child frequently. Itching should cease in a few days. Disinfect all hard surfaces in the home. Treat the entire family.

Treat the entire family. Scabies is caused by the scabies mite, Sarcoptes scabiei. The mite burrows into the stratum corneum of the epidermis, where the female deposits eggs and fecal material. These burrows are linear. Scabies is highly contagious. The length of time from infestation to physical symptoms is 30 to 60 days, so everyone in close contact with the child will need to be treated. The bed linens and the child's clothing should be washed in hot water and dried on the hot setting. Disinfect all hard surfaces to prevent the spread of scabies. The child should be held minimally until treatment is completed. Family members should wash their hands after contact with the child. Itching lasts for 2 to 3 weeks until the stratum corneum is replaced.

A parent tells the nurse that the primary discipline method used in the home is corporal punishment. What should the nurse tell the parent about corporal punishment? It reinforces the idea that violence is not acceptable. Use can result in children becoming accustomed to spanking. Use can be beneficial in teaching children what they should do. It does not physically harm the child.

Use can result in children becoming accustomed to spanking. Corporal punishment is an aversion technique that teaches children what not to do. Children can commonly become accustomed to physical punishment, so the punishment must be more severe to get the same results. Parents commonly use physical punishment when they are in a rage; injury to the child can result. Corporal punishment, such as spanking, can reinforce the idea that violence is acceptable in certain circumstances. Corporal punishment is not beneficial. It causes children to be fearful and may lead children to redirect their anger in destructive ways.

The nurse teaches the mother of a toddler who has had cleft palate repair that her child is at risk for developing which problem in the future? a speech defect poor self-concept hearing problems chronic sinus infections

a speech defect The most common long-term problem experienced by children with cleft palate repair is speech problems. These children frequently need speech therapy for a period of time. Hearing problems may occur as a result of chronic ear infections and the placement of myringotomy tubes. A poor self-concept may develop in any child. However, if a child with a cleft palate receives adequate parenting and support, this should not occur. Chronic sinus infections are more commonly associated with asthma, not with this defect.

For a client with a Wilms' tumor, which preoperative nursing intervention takes highest priority? avoiding abdominal palpation monitoring acid-base balance restricting oral intake maintaining strict isolation

avoiding abdominal palpation Because manipulating the abdominal mass may disseminate cancer cells to adjacent and distant sites, the most important intervention for a client with a Wilms' tumor is to avoid palpating the abdomen. Restricting oral intake and monitoring acid-base balance are routine interventions for all preoperative clients; they have no higher priority in one with a Wilms' tumor. Isolation isn't required because a Wilms' tumor isn't infectious.

A toddler with a ventricular septal defect is receiving digoxin to treat heart failure. Which assessment finding should be the nurse's priority concern? tachycardia hypertension bradycardia hyperactivity

bradycardia Digoxin enhances cardiac efficiency by increasing the force of contraction and decreasing the heart rate. An early sign of digoxin toxicity is bradycardia (an abnormally slow heart rate). To help detect digoxin toxicity, the nurse always should measure the apical heart rate before administering each digoxin dose. Other signs and symptoms of digoxin toxicity include arrhythmias, vomiting, hypotension, fatigue, drowsiness, and visual halos around objects. Tachycardia, hypertension, and hyperactivity aren't associated with digoxin toxicity.

A caregiver brings a 19-month-old client to the clinic for a regular checkup. When palpating the client's fontanels, what should the nurse expect to find? open anterior fontanel and closed posterior fontanel closed anterior and posterior fontanels closed anterior fontanel and open posterior fontanel open anterior fontanel and closed posterior fontanel

closed anterior and posterior fontanels By age 18 months, the anterior and posterior fontanels should be closed. The diamond-shaped anterior fontanel normally closes between ages 9 and 18 months. The triangular posterior fontanel normally closes between ages 2 and 3 months.

Which is a priority nursing action for a child with croup? encouraging parents to stay with their child giving antipyretics to alleviate fever continually assessing respiratory status delivering oxygen as prescribed

continually assessing respiratory status Respiratory status should be assessed continually as the child may have laryngeal spasms without notice. Antipyretics may be given as well as oxygen, but respiratory status takes priority. Parents would be encouraged to stay with their child but this is not an immediate priority.

A 3-year-old child with cystic fibrosis is admitted to the hospital with bronchopneumonia. Identifying which factors would be most helpful in planning care for this child? Select all that apply. cough constipation weight gain dysuria fever

cough fever As a result of the infectious process and mucus accumulation, classic signs of pneumonia include fever and cough.Weight loss may occur in a child with cystic fibrosis because of the energy expenditure needed to fight the infection.Constipation is not a common manifestation of pneumonia. However, vomiting may occur, especially if the child is coughing frequently and has a lot of mucus.Dysuria is not associated with pneumonia.

A nurse is caring for a 34-month-old who is hospitalized for a lengthy illness. Which behaviors would the nurse identify as examples of expected developmental regression for the child's age group? Select all that apply. enuresis encopresis one to two word expressions altered gait loss of fine motor skills

enuresis encopresis one to two word expressions Enuresis (uncontrolled voiding) and encopresis (uncontrolled stooling) are often seen in toddlers who were previously toilet trained and return to diapers during hospitalization. Language regression with one to two word expressions ("baby talk") is often observed during hospitalization. Altered gait and loss of fine motor skills are not typical regressive behaviors; when seen in a child, they may indicate musculoskeletal or neurological problems.

The nurse advises a mother with a 2-year-old child to avoid encouraging excessive milk consumption by the toddler because excess milk consumption can lead to which problem? vitamin C deficiency biotin deficiency iron deficiency folate deficiency

iron deficiency Excessive milk consumption can lead to the displacement of iron-rich foods in the diet. This can result in iron deficiency anemia. Drinking excess milk will not cause vitamin C, biotin, or folate deficiencies.

A nurse manager of the pediatric unit is responsible for making sure that each staff member reviews the unit policies annually. What policy should the nurse manager emphasize with the clerical support staff? proper documentation of a verbal order from a physician logging off a computer containing client information policy changes in the administration of opioids new education materials for the management of diabetes

logging off a computer containing client information All members of the healthcare team are required to maintain strict client confidentiality, including securing electronic client information. Therefore, the clerical support staff should be instructed about the importance of logging off a computer containing client information immediately after use. Taking a verbal order, administering medications, and client education aren't within the scope of practice of the clerical support staff.

While examining a 2-year-old client, the nurse sees that the anterior fontanel is open. The nurse should look for other signs of abuse. notify the physician. recognize this as a normal finding. ask about a family history of Tay-Sachs disease.

notify the physician. Because the anterior fontanel normally closes between ages 12 and 18 months, the nurse should notify the physician promptly of this abnormal finding. An open fontanel doesn't indicate abuse and isn't associated with Tay-Sachs disease.

A 14-month-old child returns from surgery for an undescended testicle. When planning for the child's discharge, the nurse should remind the parents to observe their child for which complication? normal bowel movement within 24 hours ability to ambulate redness or swelling at the incision site ability to take clear liquids well

redness or swelling at the incision site As with any surgery or invasive procedure, a priority goal at this time would be to prevent infection at the operative site. The nurse should instruct the parents to observe the incision and report redness or swelling.The child can usually begin to take fluids and solids shortly after surgery and should be able to tolerate them prior to discharge.Defecation is not a usual problem after this type of surgery because the bowel is not involved.Usually the child can get up as soon as comfort allows.

Which of the following objects poses the most serious safety threat to a 2-year-old client in the hospital? crayons and paper side rails in the halfway position stuffed teddy bear in the crib mobile hanging over the crib

side rails in the halfway position Side rails in the halfway position pose the biggest threat because the most common accidents in hospitals are falls. To prevent falls, the crib rails always should be raised and fastened securely unless an adult is at the bedside. Crayons and paper and a stuffed teddy bear are safe toys for a 2-year-old client. Although a mobile could pose a safety threat to this client, the threat is less serious than that posed by an incorrectly positioned side rail.