Unit 7

The parents of a child with sickle cell disease are both carriers of the gene and ask the nurse how likely it is that they will have another biological child with the disease. What is the correct percent? Fill in the blank.

25%

The emergency department nurse is gathering initial data on a child suspected of epiglottitis. Which is the nurse's highest priority? Check for a patent airway. 2. Prepare the child for an x-ray. 3. Prepare the child for tracheotomy. 4. Assist the health care provider with intubation.

Check for a patent airway. Rationale: When epiglottitis is suspected, the priorities are to maintain a patent airway and to next obtain an x-ray to confirm the diagnosis. If epiglottitis is present, the child is taken promptly to the operating room for tracheal intubation. Although options 2, 3, and 4 may be components of care, they are not the priority.

A 4-year-old child is being transported to the trauma center from a local community hospital for treatment of a burn injury that is estimated as covering over 40% of the body. The burns are partial- and full-thickness burns. The nurse is asked to prepare for the arrival of the child and gathers supplies anticipating that which will be prescribed initially? Insertion of a Foley catheter 2. Insertion of a nasogastric tube 3. Administration of an anesthetic agent for sedation 4. Application of an antimicrobial agent to the burns

Insertion of a Foley catheter Rationale: A Foley catheter is inserted into the child's bladder so that urine output can be measured accurately on an hourly basis. Although pain medication may be required, the child would not receive an anesthetic agent and should not be sedated. The burn wounds would be cleansed and treated after assessment, but this would not be the initial action. Intravenous fluids are administered at a rate sufficient to keep the child's urine output at 1 mL/kg of body weight per hour, thus reflecting adequate tissue perfusion. A nasogastric tube may or may not be required but would not be the priority intervention.

A child is diagnosed with scarlet fever. The nurse collects data regarding the child. Which is characteristic of scarlet fever? Pastia's sign 2. Abdominal pain and flaccid paralysis 3. Dense pseudoformation membrane in the throat 4. Foul-smelling and mucopurulent nasal drainage

Pastia's sign Rationale: Pastia's sign is a rash seen among children with scarlet fever that will blanch with pressure, except in areas of deep creases and in the folds of joints. The tongue is initially coated with a white furry covering with red projecting papillae (white strawberry tongue). By the fourth to fifth day, the white strawberry tongue sloughs off and leaves a red, swollen tongue (strawberry tongue). The pharynx is edematous and beefy red in color. Option 2 is associated with poliomyelitis. Options 3 and 4 are characteristics of diphtheria.

The nurse working in the day care center is told that a child with autism will be attending the center. The nurse collaborates with the staff of the day care center and assists in planning activities that will meet the child's needs. The nurse understands that the priority consideration in planning activities for the child is to ensure which need is met? Safety with activities 2. Activities providing verbal stimulation 3. Social interactions with other children in the same age group 4. Familiarity with all activities and providing orientation throughout the activities

Safety with activities Rationale: Safety with all activities is a priority in planning activities with the child. The child with autism is unable to anticipate danger, has a tendency for self-mutilation, and has sensory-perceptual deficits. Although providing social interactions, verbal communications, and familiarity and orientation are also appropriate interventions, the priority is safety.

A diagnostic workup is performed on a 1-year-old child suspected of a diagnosis of neuroblastoma. Which finding specifically associated with this type of tumor would the nurse expect to find documented in the child's record? Positive Babinski's sign 2. The presence of blast cells in the bone marrow 3. Projectile vomiting occurring often in the morning 4. Elevated vanillylmandelic acid (VMA) levels in the urine

4. Elevated vanillylmandelic acid (VMA) levels in the urineRationale: Neuroblastoma is a solid tumor found only in children. It arises from neural crest cells that develop into the sympathetic nervous system and the adrenal medulla. Typically the tumor infringes on adjacent normal tissue and organs. Neuroblastoma cells may excrete catecholamines and their metabolites. Urine samples will indicate elevated VMA levels. The presence of blast cells in the bone marrow occurs in leukemia. Projectile vomiting occurring most often in the morning and a positive Babinski's sign are signs/symptoms of a brain tumor.