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The nurse recommends rotavirus vaccine for which group of clients? preschoolers neonates infants toddlers

infants Explanation: The rotavirus vaccine is administered to infants. The vaccine is given in 2 or 3 doses depending on which brand of the vaccine is administered. The first dose is given at 2 months of age and the subsequent doses are given at 4 months or at 4 and 6 months.

The nurse is educating parents of a child admitted to the hospital with rubella (German measles). Which statement by the parents indicates the further education is needed? "Family members should wear a mask when coming to visit us." "Our child is contagious for 1 week after the rash appeared." "Acetaminophen or ibuprofen can be given to help with pain." "Antibiotics are needed to help our child recover from rubella."

"Antibiotics are needed to help our child recover from rubella." Explanation: Rubella (German measles) is caused by the rubella virus. Children will be contagious for 1 week before to approximately 1 week after the rash appears. Acetaminophen or ibuprofen can be given to help with pain or fever, and the child will be on droplet precautions (mask) while in the hospital.

A concerned mother brings her 3-year-old to the primary care office because of nighttime voiding. Which response made by the nurse is best? "Children are not expected to stay dry through the night until the age of 5." "Why is this such a big concern for you?" "We will do some further testing to see why this is happening." "I understand your concern, since 3-year-olds should be able to go through the night without voiding."

"Children are not expected to stay dry through the night until the age of 5." Explanation: Nighttime urinary control is not expected until a child reaches the age of 5. No testing is needed before that age. Asking why it is a concern is not effective therapeutic communication.

If the newborn is following a normal development process, the child will most likely void when which amount of urine is in the bladder? 6 ml 3 ml 25 ml 15 ml

15 ml Explanation: In the newborn, the bladder empties when about 15 ml of urine is present.

The parent of 6-month-old girl is concerned about the child getting a urinary tract infection. What should the nurse mention to the parent regarding this concern? Wipe from back to front when changing the girl's diaper. Discontinue prescribed antibiotics once symptoms of UTI have disappeared. Bathe the child with bubble bath once a week. Report any abnormally colored urine to the child's primary care provider.

Report any abnormally colored urine to the child's primary care provider. Explanation: Several important interventions can help prevent urinary and renal disease in children. The first intervention is to educate parents and caregivers about wiping from front to back (not back to front) when changing diapers of female infants. Remind parents of simple ways to prevent UTI, such as not allowing children to bathe with bubble bath. Teach parents to recognize that abnormally colored urine (red, black, or cloudy) should not be dismissed as this could be the beginning of a UTI or kidney disease. Educating parents about the importance of giving the full course of antibiotics prescribed for UTIs can help prevent return reinfection; giving the full course of antibiotics after a streptococcal infection can help prevent acute glomerulonephritis.

An 11-year-old client with cerebral palsy is having trouble adapting to middle school, saying the classrooms seem so far apart. The client is still making friends and says other students have been friendly. Which factor should the nurse suspect as a hindrance to this client's adjustment? discomfort self-concept social exclusion fatigue

fatigue Explanation: The distance between classrooms would likely lead to fatigue in a student with cerebral palsy. The degree of fatigue that a child experiences is instrumental in how well a child adjusts to a chronic illness, as chronic fatigue can play a large role in making even simple tasks seem monumental. There is no evidence in this scenario that the client is experiencing social exclusion or that his self-concept is a hindrance. There is no evidence of discomfort.

The immune system works to destroy pathogens by helping the body get rid of or resist the invasion of foreign materials The blood cells that surround, ingest, and neutralize the pathogens are: platelets. lymphocytes. erythrocytes. macrophages.

d

The parents ask how to assist their 8-year-old child with the impending death of their preschool-aged child due to cancer. They report that their 8-year-old child keeps asking questions about how the sibling will die and they are worried that there is a fixation about the death. How will the nurse respond? "We can refer your child to a pediatric psychologist for further assessment and to address these questions." "Providing distraction when there are questions will help your child to move on from this fixation." "Children at this age are curious about death; these questions are normal and answering will help with processing the grief." "Tell your child that this is for the grown-ups to worry about and not something they need to be concerned about."

"Children at this age are curious about death; these questions are normal and answering will help with processing the grief." Explanation: School-aged children are curious about death and may have many questions; this is a normal developmental reaction. Answering the questions honestly will help the child to understand and process the loss of a sibling. The parents should not avoid or distract from the questions and a psychologist referral is not required.

A nurse who is caring for a 7-year-old is providing client education to the child and caregiver. Which response by the caregiver demonstrates to the nurse that the caregiver understands the diagnosis of type 1 diabetes mellitus? "We will just have our child exercise and take medicine to cure this." "Her body fights against the insulin." "I will just feed my child healthy foods and sign her up for more sports." "Her body doesn't have any insulin."

"Her body doesn't have any insulin." Explanation: Type 1 diabetes mellitus (DM) is a disorder in which the child's body has a deficiency of insulin; children with type 1 DM cannot produce insulin. Type 2 DM is controlled through diet, medicine, and exercise. Type 2 DM can be prevented through diet and exercise, but type 1 DM cannot. Resistance to insulin is not the primary factor in type 1 DM.

What finding would the nurse expect to assess in a child with hypothyroidism? Heat intolerance Smooth velvety skin Weight gain Nervousness

Weight gain Explanation: Hypothyroidism is manifested by weight gain, fatigue, cold intolerance, and dry skin. Nervousness, heat intolerance, and smooth velvety skin are associated with hyperthyroidism.

A 2-year-old client is at the office for a follow-up visit. The client has had excessive hormone levels in recent bloodwork and the parents question why this was not found sooner. What is the best response by the nurse? "Have there been signs and symptoms that you should have reported to the doctor?" "Endocrine disorders are hard to detect and you are lucky that we have found it when we did." "It takes time to determine the level of functioning of endocrine glands." "As endocrine functions become more stable throughout childhood, alterations become more apparent."

"As endocrine functions become more stable throughout childhood, alterations become more apparent." Explanation: The endocrine glands are all present at birth; however, endocrine functions are immature. As these functions mature and become stabilized during the childhood years, alterations in endocrine function become more apparent. Thus, endocrine disorders may arise at any time during childhood development.

The parents ask how to assist their 8-year-old child with the impending death of their preschool-aged child due to cancer. They report that their 8-year-old child keeps asking questions about how the sibling will die and they are worried that there is a fixation about the death. How will the nurse respond? "We can refer your child to a pediatric psychologist for further assessment and to address these questions." "Tell your child that this is for the grown-ups to worry about and not something they need to be concerned about." "Children at this age are curious about death; these questions are normal and answering will help with processing the grief." "Providing distraction when there are questions will help your child to move on from this fixation."

"Children at this age are curious about death; these questions are normal and answering will help with processing the grief." Explanation: School-aged children are curious about death and may have many questions; this is a normal developmental reaction. Answering the questions honestly will help the child to understand and process the loss of a sibling. The parents should not avoid or distract from the questions and a psychologist referral is not required.

When providing care for a child with herpes zoster (shingles), the parents ask the nurse how the child contracted this infectious disorder. Which response by the nurse is most appropriate? "Children who are immunocompromised are more likely to contract shingles." "Your child must have been exposed to someone with herpes zoster." "Handwashing is an effective way to prevent the spread of infectious disorders." "Herpes zoster is a reactivation of a previous varicella zoster infection."

"Herpes zoster is a reactivation of a previous varicella zoster infection." Explanation: Herpes zoster (shingles) is reactivation of the latent varicella zoster (chickenpox) infection that occurs during times of immunosuppression and aging. Although it is possible to contract the varicella zoster virus from a person with herpes zoster or varicella zoster, a child diagnosed with herpes zoster has already been exposed to varicella zoster. Handwashing will not directly prevent herpes zoster.

The nurse is teaching a group of caregivers of children diagnosed with diabetes. The nurse is explaining insulin shock and the caregivers make the following statements. Which statement indicates the best understanding of a reason an insulin reaction might occur? "If my child eats as much as their older brother eats they could have an insulin reaction." "On the weekends we encourage our child to participate in lots of sports activities and stay busy so they don't have an insulin reaction." "My child monitors their glucose levels to keep them from going too high." "My child measures their own medication but sometimes doesn't administer the correct amount."

"My child measures their own medication but sometimes doesn't administer the correct amount." Explanation: Insulin reaction (insulin shock, hypoglycemia) is caused by insulin overload, resulting in too-rapid metabolism of the body's glucose. This may be attributable to a change in the body's requirement, carelessness in diet (such as failure to eat proper amounts of food), an error in insulin measurement, or excessive exercise.

The nurse is caring for an infant who is at risk for increased intracranial pressure. What statement by the parent would alert the nurse to further assess the child's neurological status? "She has been irritable for the last hour....seems like she is just upset for some reason." "She typically breastfeeds, but lately we have had to supplement with some oat cereal." "She is a pretty happy baby, unless her diaper is wet, then she cries until we change her diaper." "She always cries when the person holding her has on glasses...I guess glasses scare her."

"She has been irritable for the last hour....seems like she is just upset for some reason." Explanation: Irritability in an infant can be a sign of declining neurological function. Because infants are not able to answer questions pertaining to person, place and time, their neurological assessment must be catered to their level of development. The other responses would be typical and normal for an infant. Reference:

The school nurse is working with a 10-year-old girl with recurrent abdominal pain. The girl's teacher has been less than understanding about the frequent absences and trips to the nurse's office. How should the nurse respond? "Please do not add to this family's stress." "Be patient; she is trying some new medication." "The family is working toward improvement." "The pain she is having is real."

"The pain she is having is real." Explanation: It is important to educate the teacher that this recurrent abdominal pain is a true pain that the child feels and it is not "in her mind." Telling the teacher not to add to the family's stress or that the family is working toward improvement does not teach. The nurse must have the permission of the family to discuss the girl's medication.

The parents of a child diagnosed with a terminal illness tell the nurse, "This isn't fair!" What is the most therapeutic nursing response? "Would you like to talk to someone from a support group?" "I agree, this isn't fair for your family to go through this." "It is important for you to face the facts of this disease." "This must be very difficult for your child and family."

"This must be very difficult for your child and family." Explanation: Parents are expressing anger at the injustice of their child having a terminal illness. In this stage of grieving, it is best to just acknowledge that this is difficult. Agreeing with them is not therapeutic, nor is telling them to face the facts. Asking about a support group is helpful, but it is not a therapeutic nursing response. The nurse needs to acknowledge their difficult situation.

A child who is dying becomes restless and fidgety, then becomes calm and peaceful. The caregivers feel hopeful that the child seems "better." Which statement would be the best for the nurse to tell the caregivers about this pattern? "This pattern suggests that the child is feeling more comfortable and has less distress from the illness." "This pattern is consistent with medication cycles; the fidgeting is caused by pain, and the calmness is a sign that the pain has been controlled with medicine." "This pattern is not unusual in a dying child and might happen over and over again." "This pattern is part of dying; the child's death is imminent."

"This pattern is part of dying; the child's death is imminent." Explanation: Just before death, the child who has remained conscious may go through a period of restlessness, followed by a period of peace and calm. The nurse and family members should be aware of these reactions and know that death is near.

The nurse is working with a group caregivers of children who are diagnosed with autism. Which statement made by the parents shows an example of echolalia? "When she watches TV and hears a commercial, she repeats one word from the commercial but doesn't seem to understand what she is saying." "When reading her a story book about owls, her sister kept telling her that when owls made noises they sounded like an echo. She seemed to understand that animals sounded different from people." "When we were in a room with a high ceiling, she was so excited when she said hello and she heard her voice that she said it over and over." "She was at the park and the older kids were playing a game and she was staring at them as if she was wanted to try to copy what they were doing."

"When she watches TV and hears a commercial, she repeats one word from the commercial but doesn't seem to understand what she is saying." Explanation: Echolalia ("parrot speech") is typical of autistic children; they echo words they have heard, such as from a television commercial, but they offer no indication that they understand the words.

A nurse is reinforcing the diagnosis of constitutional delay by the health provider to a 13-year-old male adolescent. Which is the best approach for this teen? "It really doesn't matter how tall your dad is. The physician just looks at your height to make this diagnosis." "You will not need medication because your hormone levels are normal. I would be glad to discuss these findings with you." "If you think you want testosterone shots, then I will get them scheduled for you." "I would be worried about your short stature too and get a second opinion."

"You will not need medication because your hormone levels are normal. I would be glad to discuss these findings with you." Explanation: This diagnosis of "short stature" or constitutional delay may cause self-esteem issues with male teens. The nurse should explore the teen's feelings. Teens with a delay in puberty usually experience puberty late, so there is no need for a second opinion. Hormone therapy is not given until after age 14.

A school-aged child is recovering from varicella. The parent calls the school nurse and states, "my child is feeling much better" and asks when the child can return to school. What information does the nurse provide the parent? "Your child may return to school when a health care provider has given written permission." "Your child may return to school when there has been no fever for 48 hours." "Your child may return to school when free of any lesions." "Your child may return to school when all of the lesions have crusted over."

"Your child may return to school when all of the lesions have crusted over." Explanation: Varicella is a highly communicable disease. It is spread via airborne transmission or by direct contact with the nasopharyngeal secretions of an infected person. Varicella is communicable from 1 to 2 days before the rash occurs until all the vesicles have crusted over. The nurse would be correct in telling the parent the child cannot return to school, even though the child is feeling better, until all the vesicles have crusted over. The child does not have to be free of lesions. Being free of fever does not make the child less communicable. The child would not need a permission slip from the health care provider unless this is a specific requirement by the child's school district.

The nurse has admitted a child to the pediatric unit with diarrhea and vomiting. Accurate intake and output are important care measures for the child. The nurse correctly assesses that output parameters should be: 0.5 to 1 ml/kg/hr. 2 to 4 ml/kg/hr. 0.5 to 1 ml/kg/shift. 2 to 4 ml/kg/shift.

0.5 to 1 ml/kg/hr. Explanation: The child's hourly output should be 0.5 to 1 ml/kg/hour. Output of 0.5 to 1 mLl/kg/shift and 2 to 4 ml/kg/shift would be inadequate output for the child. Output of 2 to 4 ml/kg/hr is higher than necessary for adequate hydration.

The nurse is determining maintenance fluid requirements for a child who weighs 25 kg (55 lb). How much fluid would the child need per day? 1,650 ml 1,600 ml 1,560 ml 1,700 ml

1,600 ml Explanation: Using the following formula of 100 ml/kg for the first 10 kg, plus 50 ml/kg for the next 10 kg, and then 20 ml/kg for the remaining kg, the child would require (100 × 10) + (50 × 10) + (20 × 5) = 1,000 + 500 + 100 = 1,600 mL in 24 hours.

The parents of a child who was diagnosed with diabetes insipidus ask the nurse, "How does this disorder occur?" When responding to the parents, the nurse integrates knowledge that a deficiency of which hormone is involved? Thyroxine Antidiuretic hormone Insulin Growth hormone

Antidiuretic hormone Explanation: Diabetes insipidus results from a deficiency in the secretion of antidiuretic hormone (ADH). This hormone, also known as vasopressin, is produced in the hypothalamus and stored in the pituitary gland. Hypopituitarism or dwarfism involves a growth hormone deficiency. Diabetes mellitus involves a disruption in insulin secretion. Thyroxine is a thyroid hormone that if deficient leads to hypothyroidism.

The nurse is caring for an infant with a temporary ileostomy. As part of the plan of care, the nurse monitors for skin breakdown around the stoma. If redness occurs, what would be most appropriate to promote healing and prevent further skin breakdown? Clean the area well with a scented diaper wipe. Sanitize the area with an alcohol wipe after each diaper change. Apply a barrier/healing cream or paste on the skin. Use a barrier wafer to attach the appliance.

Apply a barrier/healing cream or paste on the skin. Explanation: The nurse should use a barrier/healing cream or paste on the skin around the stoma to promote healing and prevent further skin breakdown. Diaper wipes that contain fragrance or alcohol can sting if used on nonintact skin and can worsen skin breakdown. The barrier wafer would be helpful, but does not address the skin breakdown.

What information is most correct regarding the nervous system of the child? The child has underdeveloped gross motor skills and well-developed fine motor skills. The child's nervous system is fully developed at birth. As the child grows, the gross and fine motor skills increase. The child has underdeveloped fine motor skills and well-developed gross motor skills.

As the child grows, the gross and fine motor skills increase. Explanation: As the child grows, the quality of the nerve impulses sent through the nervous system develops and matures. As these nerve impulses become more mature, the child's gross and fine motor skills increase in complexity. The child becomes more coordinated and able to develop motor skills.

The nurse is caring for a child whose family recently emigrated from a developing country. While completing the admission history, the parents report all the child's immunizations are up to date. Which nursing action is most appropriate? Document that immunizations are up to date in the chart. Ask parents which immunizations have been given. Request parents follow WHO vaccine recommendations. Administer varicella and meningococcal vaccines.

Ask parents which immunizations have been given. Explanation: When caring for a child recently emigrated from a developing country, the nurse should be aware that WHO recommended vaccinations and U.S. recommended vaccinations may be different. The most appropriate action is for the nurse to determine which vaccinations have been given to decide if additional immunizations may be needed.

A child is diagnosed with intussusception. The nurse anticipates that what action would be attempted first to reduce this condition? Upper endoscopy Barium enema Surgery Endoscopic retrograde cholangiopancreatography

Barium enema Explanation: A barium enema is successful in reducing a large percentage of intussusception cases. Other cases are reduced surgically. Upper endoscopy is used to visualize the upper gastrointestinal tract from the mouth to the upper jejunum. Endoscopic retrograde cholangiopancreatography is used to view the hepatobiliary system

A teenage client active on the high school football team comes to the clinic with a cut on his leg that looks infected. The culture report returns information that leads to a diagnosis of methicillin-resistant Staphylococcus aureus (MRSA). What should the nurse use as preventive measures in this case? handwashing wearing a mask gloves droplet precautions contact precautions

Because MRSA is spread through the skin, contact precautions, gloves, and strict handwashing are recommended to prevent the spread to others.

A nurse is caring for a 7-year-old girl scheduled for an intravenous pyelogram (IVP). Which action would be the priority before the test? Checking with the parents for any allergies Ensuring adequate hydration Giving the girl an enema Screening her for pregnancy

Checking with the parents for any allergies Explanation: It is important to double-check whether the girl has any allergies. The test is contraindicated in children allergic to shellfish or iodine. Adequate hydration is also important, but the check for allergies is a priority. Only females of reproductive age must be screened for pregnancy. An enema is not necessary at all institutions.

The nurse is planning to provide education on injury prevention to caregivers of toddlers. Which information will the nurse include in the session? Select all that apply. water safety sports safety poisoning prevention car seat safety burn prevention

Common causes of unintentional injuries and death in the toddler age group include motor vehicle crashes, drowning, burns, and poisoning. Sports safety and the use of protective equipment are more important for older children.

A young child has presented to the pediatric unit with a swollen abdomen, edema, thin patchy hair, and irritability with growth retardation and muscle wasting. The nurse suspects a malnutrition disorder. The nurse identifies this child to most likely have which condition? Kwashiorkor vitamin D deficiency thiamine deficiency Marasmus vitamin C deficiency

Kwashiorkor Explanation: The symptoms presented are classic signs of Kwashiorkor due to the protein deficiency.

The nurse is providing education to the caregivers of a child recently diagnosed with tonic-clonic seizure disorder. What instructions should the nurse provide related to the tonic stage of this type of seizure? Be prepared for the child to be temporarily confused. Monitor the child's breathing closely. Be prepared for the child to report being dizzy. Ask the child whether he or she is experiencing any unusual sensory sensations.

Monitor the child's breathing closely. Explanation: Tonic-clonic seizures consist of four stages: the prodromal period, when the child may be drowsy or dizzy; the aura, which is sensory event that serves as a warning immediately before the seizure; the tonic-clonic movements, when the child's muscles contract, the child may fall, and the child's extremities may stiffen. The contraction of respiratory muscles during the tonic phase may cause the child to become cyanotic and appear briefly to have respiratory arrest. During the postictal period, the child may sleep soundly and may have a period of confusion or stupor.

The nurse is caring for an infant with increased intracranial pressure. The mother is preparing to feed the child. What action by the mother indicates an understanding of the proper care of this infant? placing the infant in an infant car seat after feeding the infant placing the infant in a Sims position in the crib after feeding the infant placing the infant supine in the crib after feeding the infant placing the infant prone in the crib after feeding the infant

Placing a child or infant in the semi-Fowler position can help reduce cerebral edema and pressure. Using an infant child seat helps to simulate the raised head of the bed. In the supine position, the client is completely flat on his or her spine. Prone is face down and flat. Sims is a side-lying position with one leg flexed. All of the described positions place the client flat, not with the head raised; that would be in the semi-Fowler position.

A nurse is assessing a 3-year-old child for possible bacterial meningitis. Which sign would indicate irritation of the meninges? Negative Kernig sign Positive Chadwick sign Negative Brudzinski sign Positive Kernig sign

Positive Kernig sign Explanation: A positive Kernig sign can indicate irritation of the meninges. A positive Brudzinski sign also is indicative of the condition. A positive Chadwick sign is a bluish discoloration of the cervix indicating pregnancy.

A nurse practitioner suspects that a child has scarlet fever based on which assessment finding? Severity of the sore throat An enanthematous rash Red, strawberry tongue White exudate on the tonsils

Red, strawberry tongue Explanation: The characteristic assessment finding that distinguishes scarlet fever from other disorders is the appearance of the red, strawberry tongue. Sore throat, an enanthematous and exanthematous rash, and white exudate on the tonsils are also seen with scarlet fever, but it is the strawberry tongue that helps to confirm the diagnosis.

A child who has type 1 diabetes mellitus is brought to the emergency department and diagnosed with diabetic ketoacidosis. What treatment would the nurse expect to administer? Detemir NPH Regular insulin Lispro

Regular insulin Explanation: Insulin for diabetic ketoacidosis is given intravenously. Only regular insulin can be administered by this route.

When providing care to a child with vesicoureteral reflux (VUR), which nursing diagnosis would be the priority? Risk for infection Imbalanced nutrition less than body requirements Activity intolerance Excess fluid volume

Risk for infection Explanation: When vesicoureteral reflux is present, the primary goal is to avoid urine infection so that infected urine cannot gain access to the kidneys. Fluid volume typically is not a problem associated with VUR. Nutritional problems are not associated with VUR. Activity intolerance is not associated with VUR.

Which treatment is the antidote for acetaminophen toxicity? naloxone activated charcoal sodium bicarbonate acetylcysteine

acetylcysteine Explanation: Acetylcysteine is utilized for acetaminophen toxicity. Sodium bicarbonate is used for metabolic toxicity. Naloxone is used for opioid overdose. Activated charcoal is used for salicylate toxicity such as aspirin.

A school-aged child with an infectious disease is placed on transmission-based precautions. If the child is not dehydrated or otherwise in distress, which nursing diagnosis would be the priority? Deficient knowledge related to how infection is transmitted Social isolation related to infectivity and inability to go to the playroom Impaired skin integrity related to trauma secondary to pruritus and scratching Fluid volume deficit related to increased metabolic demands and insensible losses

b

When the nurse is instructing on disease transmission, which is noted as the smallest infectious agent known? bacteria fungus yeast virus

d

The nurse has admitted a child with a diagnosis of severe gastroenteritis. To help prevent the risk of transmitting infection to other clients, the nurse should: wear a mask when handling articles contaminated with feces. sterilize thermometers between clients. follow standard precautions. discourage anyone from visiting.

follow standard precautions. Explanation: To prevent the spread of possibly infectious organisms to other pediatric patients, follow standard precautions issued by the Centers for Disease Control and Prevention. Gloves should be worn when handling items contaminated with feces, but masks are not necessary. Visitors should be limited to family only. Take the temperature with a thermometer that is used only for that child.

A 16-year-old girl is being seen for a long-overdue checkup. Her caregiver has come with her. She is calm, pleasant, and in good spirits. The caregiver reports to the nurse that she is relieved because for the past 6 months the teenager has been lethargic, angry, and sad. The mother reports that since she got her driver's license two days earlier, her child's mood has changed dramatically. Rather than resist this appointment, the girl had simply smiled and said, "It won't matter much, but okay, I'll be ready in a minute." The nurse recognizes that the child's seeming well-being and drastic change in behavior should be further investigated to determine if the child: is excited that she can drive now. is planning to commit suicide. has been smoking marijuana. is experimenting with alcohol.

is planning to commit suicide. Explanation: Attempted suicide rarely occurs without warning and usually is preceded by a long history of emotional problems, difficulty forming relationships, feelings of rejection, and low self-esteem. Suicidal adolescents may appear suddenly elated after a long period of acting dejected, and might verbalize their hopelessness with statements such as "I won't be around much longer," or "After Monday, it won't matter anyhow." Some deaths reported as accidents, particularly one-car accidents, are thought to be suicides.

What is the most frequently injured solid organ in a penetrating trauma? brain liver lungs pancreas

liver Explanation: The most frequently injured solid organ in a penetrating trauma is the liver.

Which situation requires parental permission to perform an autopsy on a child who has died? child dying within 24 hours of admission to the hospital child not under physician care dying at home suicide in a 13-year-old medical research and progress

medical research and progress Explanation: An autopsy that is used only to further medical progress and research requires parental consent. In all the other situations listed here, an autopsy may/will be performed without consent.

A 7-year-old has experienced severe diarrhea resulting from an intestinal virus. The nurse is concerned that the child will develop an acid-base imbalance. Which analysis of the blood gases indicates that the illness has progressed to metabolic acidosis? pH of 7.5, HCO3 of 29 mEq/L (29 mmol/L) pH of 7.25, HCO3 of 20 mEq/L (20 mmol/L) pH of 7.4, HCO3 of 26 mEq/L (26 mmol/L) pH of 7.35, HCO3 of 24 mEq/L (24 mmol/L)

pH of 7.25, HCO3 of 20 mEq/L (20 mmol/L) Explanation: The pH of blood is normally slightly alkaline, ranging from 7.35 to 7.45. The level of bicarbonate (HCO3) in arterial blood is normally 22 to 26 mEq/L. Metabolic acidosis results from diarrhea as a great deal of sodium is lost with stool. With metabolic acidosis, arterial blood gas analysis will reveal a decreased pH (under 7.35) and a low HCO3 value (near or below 22 mEq/L). With metabolic alkalosis, pH will be elevated (near or above 7.45), and HCO3 level will be near or above 28 mEq/L.

What is the priority nursing action for a dying child who is restless, moaning, and vomiting? pain assessment and control assessment of intake and output oral care administration of PO fluids

pain assessment and control Explanation: The priority of nursing care for a dying child is to provide comfort. Vomiting, along with moaning and restlessness, may indicate abdominal discomfort; therefore, assessing and treating pain is the priority. Assessing intake and output and providing oral care are needed but would not be priority actions. Administering PO fluids would not be indicated until vomiting subsides.

The nurse should be aware that the preschooler thinks of death as: punishment for thoughts and actions. a new experience of leaving their parents and loved ones. universal and irreversible. something that happens to another person.

punishment for thoughts and actions. Explanation: The egocentric thinking of preschool children contributes to the belief that they may have caused a person or pet to die by thinking angry thoughts.

The nurse is caring for a child who has just been diagnosed with nephrotic syndrome. What health education should the nurse provide to the child and family? the need to avoid high-sodium foods the importance of increasing fluid intake the advantage of peritoneal dialysis the need for hemodialysis

the need to avoid high-sodium foods Explanation: High sodium intake exacerbates the symptoms of nephrotic syndrome. Dialysis is not normally needed. Fluid balance must be carefully monitored and there is not normally a need to increase intake.

The parents of a 6-week-old boy come to the clinic for evaluation because the infant has been vomiting. The parents report that the vomiting has been increasing in frequency and forcefulness over the last week. The mother says, "Sometimes, it seems like it just bursts out of his mouth." A diagnosis of hypertrophic pyloric stenosis is suspected. When performing the physical examination, what would the nurse most likely find? Hard, moveable, olive-shaped mass in the right upper quadrant Abdominal pain in the epigastric or umbilical region Tenderness over the McBurney point in the right lower quadrant Sausage-shaped mass in the upper mid-abdomen

Hard, moveable, olive-shaped mass in the right upper quadrant Explanation: With hypertrophic pyloric stenosis, a hard, moveable, olive-shaped mass would be palpated in the right upper quadrant. A sausage-shaped mass in the upper mid-abdomen would suggest intussusception. Tenderness over the McBurney point would be associated with appendicitis. Epigastric or umbilical pain would be associated with peptic ulcer disease. Reference:

An adolescent male tells the nurse that he has been smoking cigarettes for the last 3 years. The nurse recognizes that this adolescent is at the greatest risk of substance abuse based upon what family history finding? He is a B to C student in school. He is the oldest child in the family. He has been previously diagnosed with depression. He is from a family of higher socioeconomic status.

He has been previously diagnosed with depression. Explanation: Children who are at greatest risk for becoming substance abusers are those who have a low self-esteem, have been diagnosed with depression, and have ADD or have learning disabilities. Lower socioeconomic level, birth order, or being an average student are not contributory factors.

most common cause of hyperthyroidism is: Addison disease Cushing disease Graves disease Plummer disease

Graves disease Explanation: Hyperthyroidism occurs less often in children than hypothyroidism. Graves disease, the most common cause of hyperthyroidism in children, occurs in 1 in 5,000 children between 11 and 15 years of age. Hyperthyroidism occurs more often in females, and the peak incidence occurs during adolescence.

The nurse is caring for an infant brought to the clinic for a rash. The nurse notes a blanchable, rose-pink macular rash on the trunk. The nurse obtains the following vital signs: temperature 99.0°F (37°C), pulse 100 bpm, respiratory rate 22 breaths/minute, and oxygen saturation 100% on room air. Which question by the nurse will be most helpful when planning interventions? "Is your child more fussy than normal?" "Has your child had a recent fever?" "Do you have family history of seizures?" "Are your child's vaccinations up to date?"

"Has your child had a recent fever?" Explanation: For a child with a rash resembling roseola, it is important to ask about recent fever because the hallmark rash appears suddenly after the sharp decline in fever. This can be useful in helping the nurse determine the child needs only standard precautions. Asking about fussiness may not be helpful because many illnesses can cause the child to be more fussy than normal. Asking about history of seizures is useful, but it not the most important question to ask when the rash of roseola appears because once the fever subsides there is minimal risk of febrile seizures. Because there is not immunization for roseola, asking about vaccination status is not the most helpful.

A dying child has cool, clammy skin and a weak pulse of 60 beats per minute. The parents are at the bedside and ask the nurse what they should do. What nursing response would be most helpful at this time? "Please feel free to hold your child and speak softly to comfort him." " I know this must be very difficult for both of you to lose your child." "I am going to leave you alone with your child so you can say goodbye." "Many parents want to take time to pray over their child at this time."

"Please feel free to hold your child and speak softly to comfort him." Explanation: Children can still hear and feel their parents' touch even when near death, and it is a comfort to both to be able to hold them and comfort them. Praying over the child is a personal decision and not something that everyone would choose to do. Acknowledging feelings is important, but the parents need the opportunity to hold their child one last time. Leaving them alone is not always what the parents want, so it is best to ask if they want the nurse to stay or go.

The nurse is teaching parents about the pattern of heredity of metabolic conditions. The nurse realizes that further teaching is needed when the parent makes which statement? "The pattern of heredity for all metabolic conditions is dominant." "The pattern of heredity for some metabolic conditions is dominant." "Not all metabolic conditions are clinically evident during the neonatal period." "The pattern of heredity for many metabolic conditions is recessive."

"The pattern of heredity for all metabolic conditions is dominant." Explanation: The pattern of heredity for many metabolic conditions is recessive. The statement that all are dominant conditions is false, because some conditions may be caused by a dominant gene. Not all metabolic conditions are evident during the neonatal period. Some manifest themselves in early childhood.

A 13-year-old adolescent has had a near-drowning experience. The nurse notices the client has labored breathing and a cough. What is the priority intervention? Perform postural drainage every hour. Administer 100% oxygen by mask. Check the client's capillary refill time. Have the client sit up straight in a chair.

Administer 100% oxygen by mask. Explanation: Management of the near-drowning victim focuses on assessing the client's airway, breathing, and circulation (ABCs) and correcting hypoxemia. Administering oxygen is the primary intervention to assist breathing. It is best to let the adolescent assume the most comfortable position for him or her. Checking capillary refill time helps determine ineffective tissue perfusion, but it does not provide an intervention for the labored breathing. Postural drainage techniques to remove water from the lungs are of no proven value in a near-drowning experience.

A child is diagnosed with an enterovirus infection. Which type of infection control precaution would be most important for the nurse to use? Standard Droplet Airborne Contact

Contact Explanation: For the child with an enterovirus infection, contact precautions are used during the illness. Standard precautions are followed at all times and are appropriate for any child. Droplet precautions would be used for a child infected with pertussis. Airborne precautions would be indicated for the child with varicella.

The nurse is discussing with a parent the difference between a breath-holding spell and a seizure. The nurse will be correct in telling the parent which information in regard to seizures? The electroencephalogram (EEG) is normal during a seizure. Seizures are typically provoked by pain. Convulsive activity often occurs in seizures. Seizures are typically outgrown by 4 years of age.

Convulsive activity often occurs in seizures. Explanation: During seizures, convulsive activity is typically noted. Breath-holding spells are typically provoked by pain or the child being upset, have a normal EEG pattern, and are typically outgrown by the time the child reaches preschool age.

A child is diagnosed with hyperthyroidism. Which agent would the nurse expect the physician to prescribe? Dexamethasone Methimazole Levothyroxine Mineralocorticoid

Methimazole Explanation: Methimazole is an antithyroid drug that is used to treat hyperthyroidism. Mineralocorticoid is used to treat adrenal insufficiency. Levothyroxine is used to treat hypothyroidism. Dexamethasone is used to treat congenital adrenal hyperplasia.

A child with an intellectual disability is evaluated and found to have an intelligence quotient (IQ) of 65. The nurse interprets this as reflecting which category of intellectual disability? Profound Mild Severe Moderate

Mild Explanation: Mild intellectual disability involves an IQ from 50 to 70. Moderate intellectual disability involves an IQ from 35 to 50. Severe intellectual disability involves an IQ from 20 to 35. A profound intellectual disability involves an IQ less than 20. Reference:

A child is diagnosed with scarlet fever. The nurse is reviewing the child's medical record, expecting which medication to be prescribed for this child? Acyclovir Penicillin V Doxycycline Ibuprofen

Penicillin V Explanation: Penicillin V is the antibiotic of choice for the treatment of scarlet fever. Ibuprofen is used to treat fever. Acyclovir is used to treat viral infections. Doxycycline, a tetracycline, is the drug of choice for treating Rocky Mountain spotted fever.

A 6-year-old child has undergone a renal transplant and is receiving cyclosporine. The nurse instructs the parents to be especially alert for which complication? Hair loss Hypotension Weight loss Signs of infection

Signs of infection Explanation: The parents should be especially alert for signs of infection as cyclosporine is an immunosuppressant drug. Weight gain instead of weight loss, hypertension instead of hypotension, and increased facial hair instead of hair loss are some other potential side effects.

A young client arrives at the clinic with a rash on the trunk and flexor surfaces of the extremities. The parent informs the nurse that the rash started a day before on the exterior surfaces of the extremities; 2 days before, the child had a really bad rash on the face. The health care provider diagnoses the child with erythema infectiosum. The nurse tells the parent that this is also known as: fifth disease. pityriasis rosea. enterovirus. rosacea.

fifth disease. Explanation: Erythema infectiosum is also known as "fifth disease." It starts with a fever, headache, and malaise. One week later, a rash appears on the face. A day later, the rash appears on the extensor surfaces of the extremities. One more day later, the rash appears on the trunk and flexor surfaces of the extremities. Pityriasis rosea is a skin rash that begins with a large spot on the chest, abdomen, or back that is followed by a pattern of small lesions. It is self-limiting and can be treated with steroid creams. Rosacea is a chronic inflammatory skin condition that causes redness to the face. An enterovirus infection can many times cause the same symptoms as the common cold or it can include the respiratory system. It is contagious.

The most common complication of varicella is: secondary bacterial infections. pneumonia. encephalitis. scarring.

secondary bacterial infections. Explanation: Varicella starts with lesions that appear first on the scalp, face, trunk, and then extremities. The lesions begin as macules then develop into papules and finally clear, fluid-filled vesicles. These lesions are intensely pruritic. The most common complication of varicella is secondary bacterial infection caused by the child scratching the lesions. Other complications include pneumonia, scarring, and encephalitis.

The nurse working with the child diagnosed with type 2 diabetes recognizes the disorder can be managed by: decreasing amounts of daily insulin. increasing carbohydrates in the diet, especially in the evening. taking oral hypoglycemic agents. conserving energy with rest periods during the day.

taking oral hypoglycemic agents. Explanation: Oral hypoglycemic agents, such as metformin, are often effective for controlling blood glucose levels in children diagnosed with type 2 diabetes. Insulin may be used for a child with type 2 diabetes if oral hypoglycemic agents alone are not effective, but "decreasing" the daily insulin would not help treat this disorder. Lifestyle changes such as increased exercise (not conserving energy by resting during the day), and limiting large amounts of carbohydrates are important aspects of treatment for the child.

A neonatal nurse teaches students how to recognize gastrointestinal disorders in infants. The nurse tells the students that failure of the newborn to pass meconium in the first 24 hours after birth may indicate what disease? Hirschsprung disease Gastroenteritis Short bowel syndrome (SBS) Ulcerative colitis (UC)

Hirschsprung disease Explanation: The nurse should suspect Hirschsprung disease when the newborn does not pass meconium in the first 24 hours after birth, and has bilious vomiting or abdominal distention and feeding intolerance with bilious aspirates and vomiting. Typical signs and symptoms of gastroenteritis include diarrhea, nausea, vomiting, and abdominal pain. The characteristic GI manifestation of UC is bloody diarrhea accompanied by crampy, typically left-sided lower abdominal pain. Clinical manifestations of untreated SBS include profuse watery diarrhea, malabsorption, and failure to thrive.

A parent of a 6-year-old client states, "I have heard of cases of West Nile virus in the area. What can I do to protect my child?" Which recommendation by the nurse is appropriate? "Avoid using mosquito repellants that contain DEET on your child." "Keep your child inside from 1100 to 1500 each day." "Dress your child in light-colored clothing when going outside." "Be sure to drain any standing water in your yard."

"Be sure to drain any standing water in your yard." Explanation: The nurse is correct to provide instruction to the parent for the child's safety. The best recommendation is to eliminate a place for mosquito breeding. Overall, parents can help prevent the spread of West Nile disease by adhering to the "5D's": Instruct children to stay inside between dusk and dawn (not 11 am to 3 pm) when mosquitoes are most prevalent. Drain standing water so there are few opportunities for mosquitoes to breed. Dress should include long pants and long sleeves when outside (not light-colored clothing). Apply mosquito repellant that contains DEET (use a concentration under 30% and apply only once a day. Don't place it on children's hands in case they ingest it, and don't use it with infants under 2 months of age).

A 9-year-old mentally challenged client is hospitalized for gallbladder surgery. The client tells the nurse that she is afraid to be in the hospital and doesn't know anyone. Which is the best response by the nurse? "Don't be worried, you won't be here that long." "Would you like to draw or color?" "Have you told your mom that you are afraid?" "Describe to me a normal day at your house."

"Describe to me a normal day at your house." Explanation: When a child has special needs, it is helpful to try to make as close to a normal routine or structure as possible. If the child describes to the nurse what a normal day is like, then the nurse may be able to follow that schedule or make the day in the hospital similar to home. If the nurse simply distracts the child or tells the child it won't be long, the nurse is not addressing the child's concerns. Asking the child whether she told her mother does not help comfort the child at the present time.

A 6-year-old has had a viral infection for the past 5 days and is having severe vomiting, confusion, and irritability, although he is now afebrile. During the assessment, the nurse should ask the parent which question? "How high did his temperature rise when he was ill?" "Did you give your child any acetaminophen, such as Tylenol?" "What type of fluids did your child take when he had a fever?" "Did you use any medications, like aspirin, for the fever

"Did you use any medications, like aspirin, for the fever?" Explanation: Severe and continual vomiting, changes in mental status, lethargy, and irritability are some of the signs and symptoms of Reye syndrome, which can occur as a result of ingesting aspirin or aspirin-containing products during a viral infection. Tylenol (acetaminophen) is allowed for viral infections in the school-age child. The type of fluids consumed during the illness has nothing to do with Reye syndrome. The temperature rise would be important for a much younger child because of the chance of febrile seizures, but not in this age child.

Parents of a 36-month-old child confide in the clinic nurse that their child does not speak and spends hours staring at their ceiling fan. They are worried that their child may have autism spectrum disorder. Which question would be important for the nurse to ask the parents? "Does your child come and hug you or seek comfort from you?" "Do you have trouble keeping child care providers for your child?" "Does your child already attend therapies such as speech therapy?" "Does your child have siblings?"

"Does your child come and hug you or seek comfort from you?" Explanation: Children with autism spectrum disorder lack communication and social skills. These children often will not seek comfort, make eye contact, or develop peer relationships. It is important during the health history for the nurse to focus on the findings the parents are presenting and not on extra information that may or may not be helpful.

A parent asks for help explaining the death of a sibling to a 5-year-old. Which response by the nurse is most appropriate? "Wait to talk about the death until the sibling recognizes that the child is not there anymore." "Use phrases like, "your sibling is an angel now," to soften the reaction to the death." "Explain that the sibling is in a 'special sleep,' where he won't breathe or eat anymore." "Explain the death using past experiences, such as when a pet died."

"Explain the death using past experiences, such as when a pet died." Explanation: By relating the sibling's death to previous experiences, the child can process the death at his developmental level. The use of euphemisms and of avoidance may worsen confusion for the child.

The nurse helps position a child for a lumbar puncture. Which statement describes the correct positioning for this procedure? "The child will be placed in the prone position with the nurse holding the child still." "For a lumbar puncture, the child will be placed in a side-lying position with knees bent and neck flexed to assist with arching the back." "The child will be held by the mother on her lap with his back toward the health care provider." "When positioning the child, the nurse needs to assist the child to a side-lying position and keep his back as flat as much as possible."

"For a lumbar puncture, the child will be placed in a side-lying position with knees bent and neck flexed to assist with arching the back." Explanation: Correct positioning for a lumbar puncture is to place the child on his or her side with the neck flexed and knees bent and drawn up to their chest. This helps to keep the back arched as much as possible. Newborns may be seated upright with their head bent forward. The child is not placed prone; this does not allow the back to be arched.

A parent phones the nurse stating their 5-year-old child has lesions similar to those of varicella. The parent states the child is itchy and uncomfortable. Which statement by the parent will the nurse clarify? "I have placed gloves on both of my child's hands so they will not scratch and cause an infection." "I will try an oatmeal bath or oatmeal cream with an antihistamine to soothe the child's lesions." "I am going to give my child a baby aspirin to decrease their itchiness and so they can rest better." "I will keep my child home from school until all of the lesions have completely crusted

"I am going to give my child a baby aspirin to decrease their itchiness and so they can rest better." Explanation: Varicella is caused by a virus that causes chickenpox. Because it is a virus, the nurse will clarify the parent's comment about administering aspirin and teach that administering aspirin could cause Reye syndrome. Offering options of acetaminophen or diphenhydramine are better options for the child. The parent may place gloves on the hands as a means to remind the child that they should not scratch. Oatmeal is soothing for the lesions, and the child should remain home until all of the lesions are crusted over.

A child hospitalized with cancer expresses fear about going to sleep, that the child might die during the night. Which is the best nursing response? "Don't worry, it is safe for you to sleep." "I can sit with you while you are falling asleep tonight." "Turning on the lights in the room may be helpful." "It sounds like you are worried you might die tonight."

"I can sit with you while you are falling asleep tonight." Explanation: Many children assume they will die at night. Children may be afraid to fall asleep and benefit from having someone sit beside them while they fall asleep. Telling them not to worry does not acknowledge their fears. Turning on a night light may help, but all the lights may prevent sleep. Questioning if they feel they are going to die tonight may give them an opportunity to express their fears, but staying with them is a better option.

The nurse is caring for a child who has suffered a febrile seizure. While speaking with the child's parents, which statement by a parent indicates a need for further education? "The next time he has a fever, I need to make sure I read the dosage on the acetaminophen bottle carefully." "When he gets his next set of immunizations, I need to make sure I give him some ibuprofen so he doesn't spike a fever." "I need to set an alarm to wake up and check his temperature during the night when he is sick." "I hate to think that I will need to be worried about my child having seizures for the rest of his life."

"I hate to think that I will need to be worried about my child having seizures for the rest of his life." Explanation: Febrile seizures occur most often in preschool children but can occur as late as 7 years of age. They occur when the child has a rapid rise in temperature and are not associated with the development of seizures later in life. Administering correct dosages of acetaminophen and ibuprofen, checking temperatures at night, and anticipating fevers associated with the administration of live vaccines are all ways to prevent the development of febrile seizures.

The nurse is providing teaching to the parents of a child recently prescribed carbamazepine for a seizure disorder. Which statement by a parent indicates successful teaching? "I'm glad to know he will only need this medication for a short time to stop his seizures." "This medication may cause him to have trouble sleeping. He may need something else to help him sleep." "I need to watch for any new bruises or bleeding and let my health care provider know about it." "I will give the medication to him when I first wake him up in the morning."

"I need to watch for any new bruises or bleeding and let my health care provider know about it." Explanation: Carbamazepine is an antiseizure medication. It can cause bone marrow depression, so parents need to watch for any signs of bruising, bleed, or infection and notify their health care provider if this happens. Administer this medication with food to minimize GI upset. This medication can cause drowsiness, so do not give any sleep-inducing or other sedative type medications. Antiseizure medication does not cure seizures; it only controls the seizures. Lifelong antiseizure medication may be needed.

A staff nurse is assigned to care for a terminally ill child and has been scheduled for this every day for the past month. The staff nurse requests a different assignment, stating, "I just can't handle it today." What is the best response by the charge nurse? "I will do this for you today but I cannot support this in the future." "It is in the best interest of the child to have the same nurse." "I will adjust your assignment for a couple days to give you a break." "If you cannot handle it today, I will reassign the care of the client to another nurse."

"I will adjust your assignment for a couple days to give you a break." Explanation: The charge nurse needs to respect the feelings of the nurse, if possible. The staff nurse may personally recognize and verbalize overwhelming grief that may interfere with providing quality care. Consistency of care is needed, but quality care may not be delivered at this time by this nurse because of the nurse's grief response. Using terminology that the charge nurse "cannot support" or will "reassign" does not support the nurse in needing respite time. It may also make the staff nurse feel that they are abandoning the client and family.

While caring for a child who will be undergoing a lumbar puncture, the nurse explains the procedure to the infant's mother. Which statement by the mother would indicate a need for further education? "My child may have a headache after the procedure. If she does, she can have something for the pain." "I will cradle her in my arms after the procedure for at least 30 minutes." "During the test, the health care provider will most likely take 3 tubes of spinal fluid to test for several things." "I need to encourage my child to drink at least 1 glass of water after the procedure."

"I will cradle her in my arms after the procedure for at least 30 minutes." Explanation: During the procedure, typically 3 tubes of cerebrospinal fluid (CSF) are removed for testing. After the procedure, the child is encouraged to lay flat for at least 30 minutes. During that time, the child is also encouraged to drink a glass of water to help prevent cerebral irritation. Even when all proper procedures are followed, some children develop a headache following the test. An analgesic may be given for pain relief.

The nurse is giving medication education to the parent of a child with newly diagnosed growth hormone deficiency. Which statement made by the parent indicates that further education is needed? "I will ask my child's preference when choosing injection sites." "I will give the subcutaneous medication every morning." "I will need to give the medication every day." "Treatment will continue until my child's growth is complete."

"I will give the subcutaneous medication every morning." Explanation: Growth hormone is given subcutaneously every night until the child's growth is complete. The child's growth plates in the bones will eventually close during puberty, and the growth hormone will no longer be effective. The other answers indicate understanding about the medication.

The nurse is educating a child and his family about what to expect during the child's electroencephalogram (EEG) exam. Which statement by a parent suggests a need for further education? "If my child can't stay still during the procedure, they may have to give him medication to help him be still." "The procedure will determine the electrical patterns of his brain." "The room will be dark during the procedure." "I will make sure my child goes to bed early the night before the exam."

"I will make sure my child goes to bed early the night before the exam." Explanation: During an EEG, the client needs to be cooperative and quiet. Typically, parents are asked to keep their child up later the night before so that the child will fall asleep during the procedure. The room is also darkened to help them rest. If the child is unable to remain still, sedation may be used. The EEG reflects the electrical patterns of the brain.

The new nurse is being mentored by an experienced neurologic nurse. The new nurse is preparing to perform a neurologic exam on a 4-year-old child. Which statement by the nurse would require an intervention by the mentor? "This child may not know both his first and last name." "Immediate memory is tested by asking the child to remember and recite 3 words." "I will test the child's remote memory by showing the child my car keys and asking him to remember it and recall it in about 5 minutes." "It's normal for a 4-year-old not to know the days of the week when I test for orientation."

"I will test the child's remote memory by showing the child my car keys and asking him to remember it and recall it in about 5 minutes." Explanation: Remote memory is long-term recall and is tested at this age by asking what they ate for breakfast or the night before. Showing a child an object and asking for them to recall it in 5 minutes is a way to test recent memory. Immediate recall is tested at this age by asking the child to remember and recite three words. Preschool-aged children may not know the days or the week, and they may not know both their first and last names.

The nurse is providing client education to an adolescent newly diagnosed with type 1 diabetes mellitus. Which statement by the adolescent indicates that the nurse's teaching has been effective? "I will pack a snack to eat right after my gym class." "I will have to decrease my carbohydrates and increase the amount of protein that I eat." "Since I will be losing lots of weight, I probably won't have to take so much insulin." "If I take my insulin, I can eat any kind of carbohydrate I want."

"If I take my insulin, I can eat any kind of carbohydrate I want." Explanation: Insulin doses in type 1 diabetes mellitus are based on blood glucose levels and carbohydrates to be eaten, so it is true that a carbohydrate could be any carbohydrate. Snacks should always be consumed before exercise, not afterward. A child with or without diabetes mellitus should have the same nutritional needs. Weight loss usually occurs before the diagnosis of type 1 diabetes mellitus. Clients with type 2 diabetes mellitus must manage weight loss.

After teaching the parents of a child with attention deficit hyperactivity disorder about ways to control the child's behavior, the nurse determines a need for additional teaching when the parents state: "We need to help him set realistic goals that he can achieve." "If he misbehaves, we need to punish him instead of reward him." "We can use a reward system when he behaves appropriately." "If he starts to act out, we'll have him do a time-out to help him refocus."

"If he misbehaves, we need to punish him instead of reward him." Explanation: Punishment for misbehaving would be inappropriate because it would lead to negative feelings and further decrease self-esteem. Appropriate behavior management strategies include time-outs, positive reinforcement, reward or privilege withdrawal, or a token system. Setting realistic goals also is helpful to foster self-esteem and independence.

A child with a seizure disorder has been prescribed phenytoin to control the seizures. While providing teaching about the medication, what dietary instructions should the nurse provide the parent? "Increase your child's intake of cheese and spinach." "Increase your child's intake of yogurt and broccoli." "Increase your child's intake of eggs and beans." "Increase your child's intake of whole milk and orange juice."

"Increase your child's intake of whole milk and orange juice." Explanation: Phenytoin is a drug used to control seizures. There are several things a parent needs to be taught about the drug. One fact is that it requires a correct therapeutic level, so laboratory tests will be necessary. Another is that it can cause gingival hyperplasia, so good mouth care and oral hygiene are essential. The third thing is that it interferes with vitamin D, so an intake of food containing vitamin D is essential in the diet. The foods that have the highest amount of vitamin D are fatty fish such as salmon. The most common foods a child could eat to increase vitamin D are whole milk, orange juice, yogurt, cheese, and eggs. Spinach and broccoli are both high in vitamin C, not vitamin D. Beans contain no vitamin D. They are high in iron, B6, and magnesium.

The nurse is teaching an in-service program to a group of nurses on the topic of children diagnosed with Kwashiorkor. The nurses in the group make the following statements. Which statement is most accurate related to the diagnosis of Kwashiorkor? "The highest incidence of this disease is seen in children who are adolescents." "It is important to increase the intake of protein for these children." "The cause of this disease can be treated very simply." "These children have a severe deficiency of vitamin D."

"It is important to increase the intake of protein for these children." Explanation: Kwashiorkor results from severe deficiency of protein with an adequate caloric intake. It accounts for most of the malnutrition in the world's children today. The highest incidence is in children 4 months to 5 years of age. Although strenuous efforts are being made around the world to prevent this condition, its causes are complex.

A young male client comes to the emergency department after being hit in the head while playing football. The client states not remembering anything from a few minutes before to a few minutes after the injury. The client reports a slight headache and vomiting once on the way to the hospital. The nurse observes the parents shaking the client to keep them awake. Which instruction from the nurse is appropriate at this time? "Let your child doze off but awaken the child hourly for a neurologic assessment." "It is not necessary for your child to remain awake. You need to awaken the child once during the night." "It must be difficult to keep the child awake. Do what you need to do to get a response." "I realize you are trying to keep the child awake. Just gently touch your child and call their name."

"It is not necessary for your child to remain awake. You need to awaken the child once during the night." Explanation: A concussion is a temporary and immediate impairment of neurologic function caused by a hard, jarring shock. The client may vomit and show irritability after regaining consciousness. Typically clients with concussions have no memory of the events leading up to the injury or of the injury itself. A common misconception is that the client has to remain awake continuously or be awakened hourly for any neurologic change to be determined. This is untrue. The client may sleep and be awakened once during the night.

A 3-year-old who has been attending preschool has been diagnosed with leukemia. The caregivers of this child ask the nurse what they can do to help their child feel secure. Which recommendation could the nurse make to these caregivers that would be helpful in making the child feel secure? "Let your child continue to attend preschool as much as possible." "Keep your child at home and spend as much one-on-one time with her as possible." "Keep your child out of school but invite some friends over for play dates." "Plan special outings with just the family during the time the child would normally have been at school."

"Let your child continue to attend preschool as much as possible." Explanation: Maintaining routine as much as possible helps to give the ill or dying toddler a greater sense of security.

The nurse is preparing a 7-year-old girl for discharge after treatment for nephrotic syndrome. Which instructions would the nurse include in the discharge teaching plan for the parents? "Here is some written information from the dietitian." "She should try to avoid protein." "She must severely restrict her sodium intake." "Let's meet with the dietitian and plan some meals."

"Let's meet with the dietitian and plan some meals." Explanation: Consultation with a dietitian would be most helpful for meal planning because so many of children's favorite foods are high in sodium. Restricting sodium may not be necessary if the child is not edematous; in addition, the statement does not teach. Protein-rich snacks should be encouraged. The nurse needs to provide the parents with specific instructions, assistance, and resources in addition to simple written instructions.

The nurse is preparing a 7-year-old girl for discharge after treatment for nephrotic syndrome. Which instructions would the nurse include in the discharge teaching plan for the parents? "She should try to avoid protein." "Let's meet with the dietitian and plan some meals." "Here is some written information from the dietitian." "She must severely restrict her sodium intake."

"Let's meet with the dietitian and plan some meals." Explanation: Consultation with a dietitian would be most helpful for meal planning because so many of children's favorite foods are high in sodium. Restricting sodium may not be necessary if the child is not edematous; in addition, the statement does not teach. Protein-rich snacks should be encouraged. The nurse needs to provide the parents with specific instructions, assistance, and resources in addition to simple written instructions.

A 10-year-old girl with ADHD has been on methylphenidate for 6 months. The girl's mother calls and tells the nurse that the medication is ineffective and requests an immediate increase in the child's dosage. What should the nurse say? "What does the teacher say?" "Let's set up an appointment as soon as possible." "Let's wait a few more weeks before we do anything." "Let me talk to the doctor about this."

"Let's set up an appointment as soon as possible." Explanation: The nurse plays a vital role in administering medicines and observing and reporting responses. A face-to-face appointment with the family and the doctor or advance practice mental health nurse can help uncover client and parental factors that may be preventing success. Once it is established that the family is using the medication properly as well as instituting structure within the home, it can be determined if an increased dosage or alternate medicine would be appropriate. Deferring to the doctor will not elicit any information from the mother, and waiting will not address the current concerns. The teacher can only reveal partial information about the effectiveness of the medication, which can be reviewed once other factors have been addressed in a face-to-face visit with the family and client.

The nurse is caring for a child diagnosed with hand-foot-mouth disease. When educating the family about this disease, which education by the nurse is most important? "You can give acetaminophen every 4 to 6 hours for pain." "Make sure your child drinks plenty of nonirritating fluid." "The lesions should disappear in a few days without scarring." "Hand-foot-mouth disease is associated with a high fever."

"Make sure your child drinks plenty of nonirritating fluid." Explanation: Children with hand-foot-mouth disease can experience dehydration related to the high fever, anorexia, and painful mouth lesions. The nurse should educate the family to provide nonirritating fluids to encourage the child to drink to avoid dehydration. Hand-foot-mouth disease is associated with a high fever, and parents can provide acetaminophen. The lesions should disappear in a few days; however, the most important education is aimed at prevention of dehydration.

The nurse is providing education to the parents of a child diagnosed with pinworms. Which statement is most important for the nurse to include in the teaching? "Seal the child's clothing in a plastic bag for at least 10 days." "Be sure your child wears shoes at all times." "Make sure your child washes hands before eating." "After applying this special cream, leave it on for about 8 to 10 hours."

"Make sure your child washes hands before eating." Explanation: The most effective measure to prevent pinworms or a recurrence is good hand hygiene, especially after using the bathroom and before eating. Sealing the child's clothing in a plastic bag is appropriate for pediculosis capitis. Having the child wear shoes at all times is helpful in preventing hookworm. Use of a cream that remains on for a specified time is associated with scabies.

The nurse has recently started caring for a dying child. The nurse has not yet had a chance to discuss the family's beliefs with the child's caregivers. In the middle of the night, the child awakens and is frightened. She asks the nurse what the nurse's religious beliefs are about death. Which response would be appropriate? "I don't have any religion but I don't think you should be scared of dying." "I believe that good people, like you, go to heaven." "I like to keep my beliefs to myself. Are you having trouble sleeping?" "Most religions seem to believe that spirits live on after the body dies. What are you thinking about?"

"Most religions seem to believe that spirits live on after the body dies. What are you thinking about?" Explanation: Nighttime is especially frightening for children because they often think they will die at night. Provide company and comfort. Be alert for periods of wakefulness when the child may need someone to talk to. Be honest and straightforward; avoid injecting your beliefs into the conversation.

The nurse is caring for a child with gastrointestinal concerns. What statement by the parent would indicate a need for the nurse to further assess the child for constipation? "My child has such large bowl movements that it clogs the toilet." "My child eats vegetables and fresh fruit, but does not like beans." "My child only has a bowel movement about four times a week." "My child does not have liquid stool or leak liquid stools that I am aware of."

"My child has such large bowl movements that it clogs the toilet." Explanation: Constipation may manifest by bowel movements that are large enough to clog the toilet, fewer bowel movements than normal, and bowel movements that are hard and pellet-like. Constipation is not likely if the child eats fruits and vegetables, even when beans are not incorporated into the child's diet. Passage of liquid stools can be a sign of constipation.

A child is newly diagnosed with tinea capitis. Which parent statement helps the nurse identify the likely source of the condition? "My child is in the band where they share meals together after band practice." "My child plays on a basketball team where they use the facility to shower." "My child was in a play where they shared a variety of clothes and hats." "My child volunteers at a soup kitchen where people may have hygiene issues."

"My child was in a play where they shared a variety of clothes and hats." Explanation: Tinea capitis (head lice) is commonly transmitted when children share personal items such as combs, brushes, or other personal objects such as hats or pillow cases. Sharing hats during a play could be a source of this child's condition. Direct contact is needed to spread the lice. Lice do not jump from one person to another. Showering in a common facility does not transmit the lice. Sharing meals does not transmit the lice. Being nearby another person does not transmit the lice.

The nurse is caring for a 14-year-old client who has a gunshot wound and whose prognosis is poor. The client will have testing to determine if brain death has occurred. The parents ask if organ donation will be an option if the client is determined to be brain dead. How will the nurse reply? "Organ donation is usually not possible after a traumatic injury due to organ damage." "Organ donation cannot be done without client consent or an advanced directive." "Organ donation may be an option; we can discuss this with your child's primary health care provider." "Organ donation is only possible in clients older than 18 years who are registered organ donors."

"Organ donation may be an option; we can discuss this with your child's primary health care provider." Explanation: Organ donation is possible with parental consent; this should be discussed with the primary health care provider. It is possible to donate organs after traumatic injury. In the case of a minor, the parent/guardian may provide consent for the organ donation. Advance registration or advance directives are not required.

A nurse is providing teaching to a group of parents on poisoning prevention. The nurse is evaluating the parents' understanding of the teaching. Which statement by a parent requires action by the nurse? "We have hanging plants inside and outside." "I do not allow my toddler to play with the baby powder container." "Our child helps by bringing the vitamin bottle to me every morning." "We have placed childproof locks on our lower cabinets."

"Our child helps by bringing the vitamin bottle to me every morning." Explanation: If the child can reach the vitamins, the child is at risk for an overdose, in this case possible iron poisoning. All medications, including vitamins, should be kept out of reach of children. Childproof locks on cabinets restrict access to harmful chemicals as well as medications. Keeping plants high up prevents young children from "sampling" potentially poisonous plants. Baby powder is toxic if ingested and can cause respiratory problems if inhaled.

A 13-year-old adolescent with hyperthyroidism who takes antithyroid medication has a sore throat and a fever. The parent calls the nurse and asks what to do. Which is the best response from the nurse? "Fever and sore throat may be side effects of the medication." "Offer your child at least 8 ounces of clear fluids and call back tomorrow." "Give your child ibuprofen according to the instructions on the box." "Please take your child straight to the emergency department."

"Please take your child straight to the emergency department." Explanation: A side effect of antithyroid medications is leukopenia. Signs and symptoms that include fever and sore throat need to be seen immediately. These instructions should be reviewed with parents upon discharge. The question includes information about Graves disease, so ibuprofen would not be the treatment. The question centers around drug therapy, not the child's fluid status.

The nurse is caring for a 10-year-old girl with a history of inappropriate behavior. Which statement by the mother would lead the nurse to suspect possible conduct disorder? "She argues excessively with her teachers." "She blames everyone else for her problems." "She recently trampled our neighbor's flower bed." "She has frequent temper tantrums."

"She recently trampled our neighbor's flower bed." Explanation: Destruction of the property of others points to conduct disorder. Frequent temper tantrums, blaming others for problems, and excessive arguing with adults suggest oppositional defiant disorder.

A 10-year-old child has been diagnosed with type 1 diabetes. The child is curious about the cause of the disease and asks the nurse to explain it. Which explanation will the nurse provide? "The part of your body called the pancreas is broken and produces too much chemical called glucagon, which makes you really thirsty and have to go to the bathroom a lot." "The pancreas inside your belly makes enough chemical called insulin, but your body does not want to use it to keep your blood sugar level normal." "The alpha and beta cells in your pancreas are fighting against each other; that is why your blood sugar stays high and you need insulin injection." "Special cells in a part of your body called the pancreas cannot make a chemical called insulin, which helps control the sugar level in your blood."

"Special cells in a part of your body called the pancreas cannot make a chemical called insulin, which helps control the sugar level in your blood." Explanation: When providing instruction to a child, the nurse must consider the developmental age. Type 1 diabetes is a disorder that involves an absolute or relative deficiency of insulin, thus the blood glucose level remains high if an appropriate amount of insulin is not administered to the client. With type 2 diabetes, the body produces an adequate amount of insulin; however, the body is resistant to using the insulin properly to keep circulating blood glucose levels at a normal level. The rest of the statements provide incorrect information regarding the pathophysiology of type 1 diabetes.

A child with attention deficit/hyperactivity disorder is prescribed long-acting methylphenidate. What information would the nurse include when teaching the child and his parents about this drug? "Some increase in appetite may occur, so watch how much you eat." "This drug may cause drowsiness, so be careful when doing things." "Give the drug three times a day: morning, midday, and after school." "Take this drug every day in the morning when you wake up."

"Take this drug every day in the morning when you wake up." Explanation: Long-acting methylphenidate is administered once daily in the morning, whereas the other forms are given three times a day. The drug typically causes difficulty sleeping and decreased appetite.

The nurse is collecting data on a 2-year-old child admitted with a diagnosis of gastroenteritis. When interviewing the caregivers, which question is most important for the nurse to ask? "What foods has your child eaten during the last few days?" "Tell me about the types of stools your child has been having." "How many times a day does your child urinate?" "How long has your child been toilet trained?"

"Tell me about the types of stools your child has been having." Explanation: For the child with gastroenteritis, the interview with the family caregiver must include specific information about the history of bowel patterns and the onset of diarrheal stools, with details on the number and type of stools per day. Recent eating patterns, determining if the child is toilet trained, and how many times a day the child urinates are important questions, but the highest priority is gathering data regarding the stools and stool pattern.

A nurse is conducting a discussion group with parents of children who have genitourinary disorders. As part of the discussion, the nurse reviews the major functions of the kidneys. The nurse determines that the teaching was successful based on which statement by the group? "Problems with the kidneys raise the risk for infection because there is a problem with producing white blood cells." "We should expect problems with too much fluid in the brain because the kidneys are not able to keep the fluid in balance." "The kidneys help control blood pressure, so our child's blood pressure needs to be checked often." "The kidneys help get rid of carbon dioxide from the body, so kidney problems can affect our child's breathing."

"The kidneys help control blood pressure, so our child's blood pressure needs to be checked often." Explanation: Functions of the kidney include regulating blood pressure by making the enzyme renin and also making erythropoietin, which helps stimulate the production of red blood cells. Therefore, monitoring blood pressure is important. The kidney also excretes excess water and waste products and maintains a balance of electrolytes and acids-bases. White blood cells are formed in the bone marrow. Carbon dioxide is removed by the alveoli in the lungs. Cerebrospinal fluid circulates through the brain and spinal cord.

The father of a 10-year-old who has recently been diagnosed with a terminal illness tells the nurse that his family had been working together for the previous year trying to get the 10-year-old and his 6-year-old sister to play better together and to share with each other. Which statement would be most appropriate for the nurse to tell the father regarding children and the diagnosis of an illness? "It will be important that the children learn to play well together while the older child is alive so that the younger child will have positive memories of the older child." "The younger child might believe that her anger at her brother caused his illness; she will need reassurance that she does not have that power." "Both children are likely to be more cooperative and pleasant with each other as they deal with this crisis." "The older child might believe that his sister's anger caused his illness; he will nee

"The younger child might believe that her anger at her brother caused his illness; she will need reassurance that she does not have that power." Explanation: When a child dies, young siblings who are still prone to magical thinking may feel guilty, particularly if a strong degree of rivalry existed before the illness. These children need continued reassurance that they did not cause nor help to cause their sibling's death. Reactions to the illness and its accompanying stresses can cause classroom problems for school-aged siblings; these may be incorrectly labeled as learning disabilities or behavioral disorders unless school personnel are aware of the family situation.

The nurse is educating the parent of a child who will receive a kidney transplant. Which statement made by the parent indicates further teaching is needed? "This surgery will cure my child's condition." "My child will need to take medication for life." "My child will need dialysis until the new kidney is placed." "This surgery will give my child a chance at a normal life."

"This surgery will cure my child's condition." Explanation: Most children waiting for a kidney transplant will need to undergo dialysis until they receive their new kidney. Once a kidney transplant has been completed, the child will remain on immunosuppression medication for life. Most children can lead a normal life after successful kidney transplantation. Kidney transplantation is not a cure, however. The child will need medical attention and medication for the remainder of their life.

A nurse is educating a family about the Chvostek sign after their teen tested positive for Chvostek sign. Which statements by the caregivers shows the nurse that they understand the Chvostek sign? "The sign means my child is not getting enough vitamin D." "The sign occurs when there is muscle pain and the muscle is stimulated." "The sign occurs because my child is having increased intracranial pressure." "When I tap on my child's facial nerve, the reaction is a facial muscle spasm."

"When I tap on my child's facial nerve, the reaction is a facial muscle spasm." Explanation: The Chvostek sign is a facial muscle spasm that occurs when the facial nerve is tapped. This can indicate heightened neuromuscular activity, possibly caused by hypocalcemia. Hypoparathyroidism may be suspected.

The nurse is monitoring the fluid balance of a 9-year-old child. When evaluating urine output for the day, which output would the nurse identify as being within normal limits? 2000 mL 1200 mL 800 mL 600 mL

1200 mL Explanation: The typical 24-hour urine output for a 9 year old would range from 1000 to 1500 mL. Therefore, a urine output of 1200 mL would be within normal limits.

A charge nurse in a pediatric emergency room is arranging staffing for clients injured in an explosion. Which client does the charge nurse direct the staff to assess first? infant with superficial (first-degree) burns to the hands and feet 4-year-old child with full-thickness (third-degree) burns to the right arm and hand 14-year-old child with superficial (first-degree) burns to the face and neck 8-year-old child with partial-thickness (second-degree) burns to the back and pelvis

14-year-old child with superficial (first-degree) burns to the face and neck Explanation: The charge nurse is correct to identify the child with burns to the face and neck as the highest priority and the child needing assessment first. When a child has burns to the face, head, or neck, no matter the extent or depth, there is a potential for unseen burns to the respiratory tract. Swelling in this area may lead to respiratory tract obstruction, particularly in a child. The other locations are not as critical. The extent and depth of the burn are the next concern, with a full-thickness (third-degree) wound being more involved.

The nurse is assessing a child with a suspected head injury. The child opens the eyes only in response to the nurse placing pressure in the child's nail bed. What score on the Glasgow coma scale for eye opening should the nurse assign based on this assessment finding? 1 4 3 2

2 Explanation: In the eye opening section of the Glasgow coma scale, eye opening only in response to painful stimuli would be a score of 2. Spontaneous eye opening is a 4, opening in response to speech is a 3, and no eye opening in response to painful stimuli is a 1.

When collecting data on a child diagnosed with diabetes mellitus, the nurse notes that the child has had weight loss and other symptoms of the disease. The nurse would anticipate which finding in the child's fasting glucose levels? 100 mg/dl 220 mg/dl 60 mg/dl 140 mg/dl

220 mg/dl Explanation: A fasting blood sugar result of 200 mg/dL or more almost certainly is diagnostic for diabetes when other signs, such as polyuria and weight loss despite polyphagia, are present.

The health care provider orders phenytoin 4 mg/kg/day in three divided doses for a child who has a seizure disorder. The child weighs 35 lb and the medication is available at 30mg/5ml. What is the amount in ml for one dose of this child's medication? Round to the nearest tenth. 35 ml 30 ml 0.5 ml 3.5 ml

3.5 ml Explanation: The child weighs 15.9 kg. The total daily dose would be 63.6 mg of medication. One dose would be 21.2 mg, which is 3.5 ml of medication.

A child who weighs 53 lbs (24 kg) is receiving fluid volume replacement as part of the treatment for shock. The nurse is evaluating the child's hourly urinary output to determine if the child's condition is improving. Which output would the nurse interpret as most indicative of improvement? 15 ml 30 ml 22 ml 12 ml

30 ml Explanation: Improved urinary output of 1 to 2 ml/kg/hour is the goal. The child weighs 53 pounds, which is equivalent to 24 kg. Thus, improvement in this child would be noted by an hourly urinary output between 24 and 48 ml/hour.

The nurse is teaching an in-service program to a group of colleagues on the topic of children diagnosed with acute glomerulonephritis. In which age range is the peak incidence of this disorder noted? 12 to 13 years of age 2 to 4 years of age 15 to 17 years of age 6 to 7 years of age

6 to 7 years of age Explanation: Acute glomerulonephritis has a peak incidence in children 6 to 7 years of age and occurs twice as often in boys.

The nurse is caring for a 6-year-old male child who was brought to the pediatrician's office by the parent for a fever for the past few days. Click to highlight the findings that will require follow-up. Assessment reveals the client has also been experiencing increased urinary frequency , dysuria , and costovertebral pain . Vital signs: temperature, 101.2°F (38.4°C) ; heart rate, 110 beats/min ; blood pressure, 88/48 mm Hg; respiratory rate, 22 breaths/min ; oxygen saturation, 98% room air. Laboratory results: urinalysis, positive for leukocytes; white blood cell (WBC) count, 12 × 103/mm3 (12 × 109/l) .

A change in urinary frequency requires further assessment. Painful urination (dysuria) is an abnormal finding requiring further assessment. Costovertebral pain requires further follow-up, because it may indicate a complicated urinary tract infection (UTI). A temperature of 101.2°F (38.4°C) is an abnormal finding requiring further assessment. The presence of leukocytes in urinalysis indicates urinary tract infection (UTI). An elevated white blood cell (WBC) count of 12 × 103/mm3 (12 × 109/l) indicates infection and requires follow-up. A heart rate 110 beats/min is within normal range (70 to 110 beats/min). A respiratory rate 22 breaths/min is within normal range (20 to 30 breaths/min). A blood pressure 88/48 mm Hg is within normal range (the systolic blood pressure normal range is 80 to 120 mm Hg).

A child with liver cirrhosis is admitted to the acute care facility in preparation for a liver transplant. What finding(s) would the nurse document after completing this child's assessment? Select all that apply. confused mental status fatty, foul-smelling stool liver palpable yellow skin and sclera palms of hands reddened

A child with cirrhosis would have symptoms of nausea and vomiting, jaundice, palmar erythema, ascites, weight loss, and an enlarged liver. The child's mental status could be clear or it could be confused if hepatic encephalopathy is present. The nurse would document the findings as to the amount of jaundice present, the weight of the child, the measurement of the abdomen to determine ascites, the amount of redness in the palms, and whether the liver is palpable or not. Fatty, foul-smelling stools are not seen with cirrhosis. These would be more likely in conditions like cystic fibrosis or celiac disease.

The parents of a child with a malignancy disagree with each other about the treatment plan, then express frustration at the staff for not answering call lights quickly enough. Which nursing intervention will best address their needs? Request assistance of the chaplain to help the parents come to an agreement. Offer to come to their room more often to check on their child. Ask the parents if they have anyone they can talk to about their child. Accept the parents' anger and respond with empathy and acceptance.

Accept the parents' anger and respond with empathy and acceptance. Explanation: When parents are angry about a diagnosis, they may be unable to direct their anger appropriately. They may be angry with the nurse (e.g., for not answering the child's call light immediately). It can be difficult for the nurse to react to this kind of anger because it seems unjustified. The nurse's first reaction is not to be angry in response. A more therapeutic reaction is to accept the parents' explicit emotions and anger and respond with empathy and acceptance. Although the chaplain may be helpful, the question is directed toward nursing interventions. Asking them about having someone to talk to is not responding to the immediate issue, their grief and inability to cope. Offering to come by more often does not address their fears and only reinforces their frustration with the nursing staff.

The nurse is preparing to transfer a child from the busy emergency department to an inpatient pediatric unit. What action by the nurse is best? Accompany the child and parents to the pediatric unit after calling verbal report to the unit and providing hand-off to the client's new nurse. Ask the unlicensed assistive personnel who has cared for the child to take the child and parents to the pediatric unit with a printed copy of the chart. Find another licensed nurse in the emergency department who is not as busy to transport the child and parents to the pediatric unit and call a verbal report. Instruct the hospital's transport team to take the child and parents to the pediatric unit and call a verbal report to the receiving nurse.

Accompany the child and parents to the pediatric unit after calling verbal report to the unit and providing hand-off to the client's new nurse. Explanation: When a child is admitted to the hospital from the emergency department, it is helpful to the child and parents for the nurse to accompany them to the hospital unit. This allows a transition period or "passing of care" that helps the parents accept the new caregivers as dependable and trustworthy. None of the other transport options allow this personal passing of care. Calling report and providing copies of information from the emergency department chart are also important steps in transferring care from one unit to another but lack the psychosocial benefit.

40 minutes. What is the priority action by the nurse? Perform a glucose finger stick to determine the child's blood sugar level. Administer lorazepam IV as prescribed. Administer carbamazepine as prescribed. Observe and document the length of time of the seizure and type of movement observed.

Administer lorazepam IV as prescribed. Explanation: A seizure lasting longer than 30 minutes is considered status epilepticus and is an emergency situation. An IV benzodiazepine such as lorazepam is administered to help stop the seizure. Checking blood glucose levels, monitoring length and type of seizure, and administration of anti-seizure medication such as carbamazepine all are correct interventions for clients with seizures, but these are not the priority action.

The nurse is caring for a 14-year-old boy with hyperpituitarism. What would be the priority treatment? Teaching the child and family about proper treatment Administering octreotide acetate as ordered Assessing the child's self-image due to the disorder Treating the child according to his chronological age

Administering octreotide acetate as ordered Explanation: Administering octreotide acetate as ordered is the priority intervention and treatment for acromegaly. Assessing the child's self-image is appropriate but would not be the priority. Treating the child according to his chronological age would be appropriate but not the priority. Teaching the child and family about proper treatment is appropriate and important but not the immediate priority.

A nurse is preparing a presentation for a group of parents with children diagnosed with type 1 diabetes. The children are all adolescents. What issues would the nurse address related to their developmental level? Select all that apply. Self-monitoring of blood glucose levels Deficient decision-making skills Feelings of being different Body image conflicts Struggle for independence

Adolescents are undergoing rapid physical, emotional, and cognitive growth. Working toward a separate identity from parents and the demands of diabetic care can hinder this. This struggle for independence can lead to nonadherence of the diabetic care regimen. Conflicts develop with self-management, body image, and peer group acceptance. Teens may acquire the skills to perform tasks related to diabetic care but may lack decision-making skills needed to adjust treatment plan. Teens do not always foresee the consequences of their activities. Self-monitoring of blood glucose levels and feelings of being different are issues common to school-age children.

What information is most correct regarding the nervous system of the child? The child's nervous system is fully developed at birth. The child has underdeveloped gross motor skills and well-developed fine motor skills. As the child grows, the gross and fine motor skills increase. The child has underdeveloped fine motor skills and well-developed gross motor skills.

As the child grows, the gross and fine motor skills increase. Explanation: As the child grows, the quality of the nerve impulses sent through the nervous system develops and matures. As these nerve impulses become more mature, the child's gross and fine motor skills increase in complexity. The child becomes more coordinated and able to develop motor skills.

A nurse is performing a complete neurological examination of a 7-year-old boy. She will now test his cerebellar function. Which of the following tests would be appropriate for this purpose? Ask the boy to close his eyes and then touch his skin with a cotton wisp; ask him to point to where he was touched. Ask the boy to touch each finger on one hand with the thumb of that hand in rapid succession. Ask the boy who he is, where he is, and what day it is. Measure the circumference of the calves and thighs with a tape measure.

Ask the boy to touch each finger on one hand with the thumb of that hand in rapid succession. Explanation: Tests for cerebellar function are tests for balance and coordination, such as asking the child to touch each finger on one hand with the thumb of that hand in rapid succession. Motor function is measured by evaluating muscle size, strength, and tone. Begin by comparing the size and symmetry of extremities. If in doubt about either of these, measure the circumference of the calves and thighs or upper and lower arms with a tape measure. If children's sensory systems are intact, they should be able to distinguish light touch, pain, vibration, hot, and cold. Have a child close his eyes and then ask him to point to the spot where you touch him with an object. Orientation, which is one measure of cerebral function, refers to whether children are aware of who they are, where they are, and what day it is (person, place, and time).

The nurse is caring for a child diagnosed with hydrocephalus following ventriculoperitoneal shunt placement. The child is currently on a ventilator. Which nursing action is priority? Educate the family on the shunt. Assess the client's respiratory status. Measure the client's head circumference. Monitor the client for signs of infection.

Assess the client's respiratory status. Explanation: The nurse would place priority on monitoring the client's respiratory status since the client is on a ventilator and at risk for intracranial pressure. The nurse would educate the family on the shunt, monitor for infection, and measure head circumference; however, these actions are not priority over ensuring the client maintains a patent airway.

A 9-year-old client who suffered a head injury has strabismus. The nurse assesses the client for intracranial pressure (ICP). Which additional intervention is most important for the nurse to perform? Assess the level of consciousness (LOC). Notify the primary health care provider. Place the child on fall precaution. Place a patch over the client's affected eye.

Assess the level of consciousness (LOC). Explanation: Decreased LOC is frequently the first sign of a major neurologic problem after head trauma. The nurse would assess the client's LOC before notifying the health care provider. The child may need to be placed on fall precaution, depending on the results of the assessment. The child's eyes will correct themselves when the ICP is reduced; therefore, an eye patch is not necessary.

The nurse is triaging a child diagnosed with poliomyelitis. After ensuring appropriate precautions are in place, what will the nurse do next? Administer an antipyretic. Begin physical therapy. Place the child on bed rest. Auscultate the child's lungs.

Auscultate the child's lungs. Explanation: Because poliomyelitis can cause motor paralysis of the respiratory muscles, assessing respiratory status is priority. Once the nurse has ensured respiratory function is intact, the nurse can place the child on bed rest, administer an antipyretic, and begin physical therapy.

The nurse is caring for a pediatric client with idiopathic celiac disease. Which meal will the nurse select for this client? Ham and cheese sandwich, orange slices, chips, and whole milk Whole wheat pasta, meatballs, carrot sticks, apple, and water Meatloaf, green beans, peanut butter cookie, and fat-free milk Baked salmon, potato slices, vanilla ice cream, and apple juice

Baked salmon, potato slices, vanilla ice cream, and apple juice Explanation: Celiac disease is an autoimmune condition where contact with gluten causes a reaction from the body's immune system. Clients with celiac disease should be educated to eat a gluten-free diet to decrease symptoms and limit small intestine irritation. Gluten is a protein found in wheat, barley, and rye. Most commercially used flour contains wheat and should be avoided. The nurse would select foods such as meats/fish (salmon), fruits, vegetables (potatoes), and rice. Single flavor ice creams, such as chocolate, vanilla, and strawberry are gluten free, while cookies contain flour and should be avoided. Fruit juices, water, and milk are all gluten free. Meatloaf may contain oats; however, studies suggest oats are fine to consume, as long as the oats did not come into contact with wheat during processing. Reading the label would indicate if wheat was contacted. Sandwich bread and pastas contain gluten unless special gluten-free products are purchased or it is homemade. The nurse would not assume those items were gluten-free.

A child who suffered a blow to the abdomen while snowboarding comes to the emergency department with severe abdominal pain, especially on inspiration. The child is tachycardic, hypotensive, anxious, and very pale. The hematocrit is falling quickly. The health care provider indicates a liver rupture. What is the initial nursing action? Place a Foley catheter. Obtain surgical consent. Medicate for pain. Begin an intravenous line.

Begin an intravenous line. Explanation: When communicating with the health care provider in an emergency situation, the nurse uses clinical judgment to prioritize treatment options. In this case, it is an initial priority to begin an intravenous (IV) line so that fluids for hypotension or blood products can be instilled. The health care provider performing the procedure will obtain the consent from the parent. Medicating for pain and placing a Foley catheter may be completed following IV placement.

The nurse is collecting data on a 6-year-old child admitted with acute glomerulonephritis. Which vital sign would the nurse anticipate with this child's diagnosis? Blood pressure 136/84 Respirations 24 per minute Pulse rate 112 bpm Pulse oximetry 93% on room air

Blood pressure 136/84 Explanation: Hypertension appears in 60% to 70% of clients during the first 4 or 5 days with a diagnosis of acute glomerulonephritis. The pulse of 112 would be a little high for a child this age, but not a concern with this diagnosis. The other vital signs are within normal limits for a child of this age.

A 14-year-old girl arrives at the hospital in a comatose state. Her father, who found her comatose in her room, tells the nurse that she has an opiate addiction. Which of the following would confirm that the coma was caused by opiate intoxication? One pupil is dilated and the other deviates downward. Both pupils are dilated. One pupil is dilated and the other is normal. Both pupils are pinpoints.

Both pupils are pinpoints. Explanation: Observe the child's eyes for signs of dilated pupils from increased intracranial pressure (ICP). If both pupils are dilated, irreversible brainstem damage is suggested, although such a finding may also be present with poisoning with an atropine-like drug. Pinpoint pupils suggest barbiturate or opiate intoxication. One pupil dilated or the eye deviated downward or laterally more than the other suggests third cranial nerve compression or a tentorial tear (laceration of the membrane between the cerebellum and cerebrum) with herniation of the temporal lobe into the torn membrane. Reference:

A parent is asking how to help the child deal with the peer ridicule at school in regards to enuresis. What is the best response by the nurse? Demonstrate how to urinate in the bathroom every time the child has an occurrence. Take away a toy every time the child urinates in his or her pants. Discuss how the child can continue to go to the bathroom instead of in his or her underwear. Demonstrate love and acceptance at home.

Demonstrate love and acceptance at home. Explanation: Enuresis is the continued incontinence of urine past the age of toilet training. It is a source of shame and embarrassment. It affects the child's life emotionally, behaviorally, and socially. It causes the child to have low self-esteem. Demonstrating love and acceptance at home will help counteract the ridicule the child is getting at school. The child should not be punished for a behavior he or she cannot control. Demonstrating how to use the toilet and going to the bathroom to void are good subjects but they do not help a child who has no control of the enuresis. Testing may need to be done to see if there are anatomical reasons, and medications may be needed to correct the problem.

The nurse is providing care to a child with an intussusception. The child has a bowel movement and the nurse inspects the stool. The nurse would most likely document the stool's appearance as having what quality? Clay-colored Bloody Greasy Currant jelly-like

Currant jelly-like Explanation: The child with intussusception often exhibits currant jelly-like stools that may or may not be positive for blood. Greasy stools are associated with celiac disease. Clay-colored stools are observed with biliary atresia. Bloody stools can be seen with several gastrointestinal disorders, such as inflammatory bowel disease.

The nurse knows that which condition is caused by excessive levels of circulating cortisol? Cushing syndrome Turner syndrome Graves disease Addison disease

Cushing syndrome Explanation: Cushing syndrome is a characteristic cluster of signs and symptoms resulting from excessive levels of circulating cortisol. Addison disease is caused by autoimmune destruction of the adrenal cortex, which results in dysfunction of steroidogenesis. Graves disease is the most common form of hyperthyroidism. Turner syndrome is the deletion of the entire X chromosome.

A 6-year-old girl who is visiting the pediatrician's office is suspected of having Cushing syndrome. For which tests to aid in the diagnosis should the nurse prepare the child and family? Select all that apply. 24-hour urine for 17-hydroxycorticoids urine culture thyroid panel complete blood count cortisone suppression test

Cushing syndrome is defined as an overproduction of the adrenal hormone cortisol. The peak age at which this occurs is 6 to 7 years. A thyroid panel does not show an excess of cortisol production in the body. Urine culture does not show an excess of cortisol production in the body. A 24-hour urine sample for 17-hydroxycorticoids or a cortisone suppression test is used to show an excess of cortisol produced in the body. A complete blood count can assess overall health but will not show excess cortisol production in the body.

A 15-year-old girl is brought to the clinic by her mother because the girl has been experiencing irregular and sporadic menstrual periods and excessive body hair growth. Polycystic ovary syndrome is suspected. Which additional assessment finding would help to support this suspicion? Darkened pigmentation around the neck area Body mass index as normal Short stature Decreased serum levels of free testosterone

Darkened pigmentation around the neck area Explanation: Acanthosis nigricans (darkened, thickened pigmentation, particularly around the neck or in the axillary region) is associated with polycystic ovary syndrome. Serum levels of free testosterone typically are elevated with polycystic ovary syndrome. With polycystic ovary syndrome, body mass index indicates overweight or obesity. Short stature typically is associated with growth hormone deficiency.

A preschool-age child has just been admitted to the pediatric unit with a diagnosis of bacterial meningitis. The nurse would include which recommendation in the nursing plan? Monitor temperature every 4 hours Take vital signs every 4 hours Encourage the parents to hold the child Decrease environmental stimulation

Decrease environmental stimulation Explanation: A child with the diagnosis of meningitis is much more comfortable with decreased environmental stimuli. Noise and bright lights stimulate the child and can be irritating, causing the child to cry, in turn increasing intracranial pressure. Vital signs would be taken initially every hour and temperature monitored every 2 hours. Children with bacterial meningitis are usually much more comfortable if allowed to lie flat because this position doesn't cause increased meningeal irritation.

The nurse is reviewing the laboratory test results of a child with nephrotic syndrome. What would the nurse least likely expect to find? Hyperlipidemia Decreased blood urea nitrogen (BUN) Hypoproteinemia Hypoalbuminemia

Decreased blood urea nitrogen (BUN) Explanation: With nephrotic syndrome, proteinuria, hyperlipidemia, decreased serum protein levels (hypoproteinemia), and decreased serum albumin levels (hypoalbuminemia) are present. BUN typically becomes elevated.

The nurse is developing a plan of care for a 7-year-old boy with diabetes insipidus. What is the priority nursing diagnosis? Deficient fluid volume related to dehydration Excess fluid volume related to edema Imbalanced nutrition, more than body requirements related to excess weight Deficient knowledge related to fluid intake regimen

Deficient fluid volume related to dehydration Explanation: The priority nursing diagnosis most likely would be deficient fluid volume related to dehydration, due to a deficiency in the secretion of antidiuretic hormone (ADH). Excess fluid would result from a disorder that leads to water retention, such as syndrome of inappropriate antidiuretic hormone (SIADH). Deficient knowledge related to fluid intake regimen is a nursing diagnosis for this child, but a secondary one. Imbalanced nutrition, more than body requirements related to excess weight would be inappropriate for this child since he probably has lost weight secondary to the fluid loss.

A young client in the intensive care unit is in a coma after a severe head injury. The primary nurse is teaching a nursing student how to assess the client's level of consciousness using a coma scale. What type of scale could be used for this purpose? Wong-Baker FACES scale Visual analogue scale Apgar scale Glasgow scale

Glasgow scale Explanation: The Glasgow Coma Scale is used to grade comas according to level of consciousness. The Apgar score is assigned immediately after birth to determine how the infant tolerated the birth. Wong-Baker FACES and the visual analogue scales are used to rate pain.

An adolescent has been diagnosed with bulimia, and the parents are asking how to best deal with this problem. What suggestion should the nurse make to the parents to help care for the adolescent? Develop a contract with the adolescent, setting goals of behavior and her diet, as well as privileges gained by meeting the contracted goals. Monitor the adolescent constantly to ensure that she is not binge eating. Minimize or ignore any comments made by the adolescent about body image distortion or being overweight and dieting. Administer antiemetics on a regular basis to reduce the urge to vomit after eating.

Develop a contract with the adolescent, setting goals of behavior and her diet, as well as privileges gained by meeting the contracted goals. Explanation: Developing a contract with the adolescent, as part of a behavior modification program, lays out clearly defined behaviors and the child's responsibilities related to bulimia and its management. Parents need to be aware and report any verbalizations about being overweight or altered body image. Antiemetics are not appropriate for this disorder since there is not nausea associated with it and it is impossible to monitor the adolescent continually.

The nurse is seeing a new client in the clinic who reports polyuria and polydipsia. These conditions are indicative of which endocrine disorder? Precocious puberty Diabetes insipidus (DI) Hypopituitarism Syndrome of inappropriate antidiuretic hormone (SIADH) secretion

Diabetes insipidus (DI) Explanation: The most common symptoms of central DI are polyuria (excessive urination) and polydipsia (excessive thirst). Children with DI typically excrete 4 to 15 L per day of urine despite the fluid intake. The onset of these symptoms is usually sudden and abrupt. Ask about repeated trips to the bathroom, nocturia, and enuresis. Other symptoms may include dehydration, fever, weight loss, increased irritability, vomiting, constipation, and, potentially, hypovolemic shock.

An adolescent is having an annual physical. The adolescent has a documented weight loss of 9 lb (4.08 kg). The parent states, "He eats constantly." Exam findings are normal overall, except that the child reports having trouble sleeping, and the child's eyeballs are noted to bulge slightly. Which interventions would the nurse perform based on these findings? Prepare the parent for a neurology consult. Explain the preparation for an 8-hour fasting blood glucose test. Explain why the child might need to schedule an eye exam. Discuss preparing for a thyroid function test.

Discuss preparing for a thyroid function test. Explanation: The child exhibits signs and symptoms of Graves disease (hyperthyroidism). A thyroid function test would show an elevation in T4 and T3 levels caused by overfunctioning of the thyroid. Neither a neurology consult nor an eye exam would be needed. A fasting blood glucose test is used to test for Cushing syndrome and diabetes mellitus.

Jill is 20 weeks' gestation, and the fetus is diagnosed with anencephaly. Jill has decided to continue the pregnancy and donate the fetus's organs. Which action by the nurse would be most appropriate? Ask Jill what her family and minister think about her choice. The nurse must explore her/his own feelings about donation of the organs of a fetus. Document the information on Jill's electronic health record and alert the health care provider about Jill's decision. Ask Jill how she will cope during the remainder of the pregnancy.

Document the information on Jill's electronic health record and alert the health care provider about Jill's decision. Explanation: Jill knows what she would like to do so notification of the physician and documentation in the electronic health record serves to help the staff and physician(s) to prepare for the birth and organ donation. The fetus's organs that will be harvested will need to be perfused until the harvest.

The nurse is caring for a child admitted with gastroesophageal reflux (GER). Which clinical manifestation would likely be seen in this child? Effortless vomiting just after the child has eaten Forceful vomiting followed by the child being eager to eat again Severe constipation with occasional ribbon-like stools Bouts of diarrhea with failure to gain weight

Effortless vomiting just after the child has eaten Explanation: The child with GER usually gains weight and feeds well. It must be determined if there are underlying symptoms or complications that might suggest GERD. In the child with GERD, almost immediately after feeding, the child vomits the contents of the stomach. The vomiting is effortless, not projectile in nature. The child with GERD is irritable and hungry, but may refuse to eat. Aspiration after vomiting may lead to respiratory concerns, such as apnea, wheezing, cough, and pneumonia. Failure to thrive and lack of normal weight gain occurs. Symptoms seen in the older child may include heartburn, nausea, epigastric pain, and difficulty swallowing. Forceful vomiting with the child wanting to eat shortly after vomiting is associated with pyloric stenosis. Severe constipation with ribbon-like stools would be indicative of Hirschsprung disease. Bouts of diarrhea with failure to gain weight is associated with Crohn disease.

A nurse is reviewing with an 8-year-old how to self-administer insulin. Which of the following is the proper injection technique for insulin injections? Aspirate the syringe for blood return before the injection. Place the needle with the bevel facing down before the injection. Spread the skin before the injection. Elevate the subcutaneous tissue before the injection.

Elevate the subcutaneous tissue before the injection. Explanation: Insulin injections are always given subcutaneously. Elevating the skin tissue prevents injection into muscles when subcutaneous injections are given. The needle bevel should face upward. The skin is spread in intramuscular, not subcutaneous, injections. It is no longer recommended to aspirate blood for subcutaneous injections.

A school nurse is trying to prevent poststreptococcal glomerulonephritis in children. What would be the best way to prevent this? Tell parents to give ibuprofen if their child has a sore throat. Encourage the child to take all the antibiotics if diagnosed with strep throat. Prophylactic antibiotics after strep throat are important. All children in the child's class should be tested for strep throat if one child has a positive test.

Encourage the child to take all the antibiotics if diagnosed with strep throat. Explanation: Encouraging the child to take all the antibiotics if diagnosed with strep throat is important. It is not necessary to test the people in the community with whom the child came in contact unless they are symptomatic. Ibuprofen does not cure strep throat, and strep infection is what usually causes poststreptococcal glomerulonephritis. Prophylactic antibiotics after a strep infection are not necessary.

A 4-year-old child is facing death and cries frequently for the parents. What is the nurse's most therapeutic action? Acknowledge that death is imminent for the child. Encourage the parents to remain with their child. Explain that the parents will be here soon. Recognize this is a normal response for this age.

Encourage the parents to remain with their child. Explanation: The separation anxiety preschoolers experience can complicate their response to death. When confronted with their own death, their main concern may be separation from their parents. Constant reassurances and having a caregiver present with the child helps mitigate these fears. Telling the child the parents will be there soon is helpful, but having the parents plan to stay is more helpful. Recognizing this is normal helps the nurse, but not the child. Acknowledging the death is imminent does not help the child, who is in need of the parents.

A 10-year-old girl has been referred for evaluation due to difficulties integrating with her peers at her new school. The counselor believes she is at risk for situational low self-esteem due to problematic relationships with both family members and peers. What is the best approach? Remind her of the importance of good hygiene for better appearance. Explore the girl's feelings about changes in her body with the onset of puberty. Introduce the concept of accepting differences to reduce conflict. Engage the girl in dialogue regarding feelings about self/personal appearance.

Engage the girl in dialogue regarding feelings about self/personal appearance. Explanation: Engaging the child in dialogue about self and personal appearance may reveal self-perceptions and allow discussion of reality versus perception; this enables discussion of methods to address perceived weaknesses and to focus on strengths. Appearance may reflect self-perception, and a comment regarding hygiene might be poorly received. While pubertal changes can be stressful, a 10-year-old girl may not have entered puberty and the question may not be relevant. The concept of accepting differences is secondary to engaging the child in dialogue about self and appearance.

A nurse witnesses a child get hit by a car while riding a bike. The child is lying motionless in the street. What action should the nurse take next? Check for visible injuries. Ensure a safe environment. Check the vital signs. Assess the level of consciousness.

Ensure a safe environment. Explanation: The nurse should ensure that the area is safe before approaching the child. The nurse can then assess the child's cardiac status, breathing, other vital signs, disability, and stabilize the cervical spine.

Infectious mononucleosis ("mono") is caused by which of the following? Epstein-Barr virus Treponema pallidum Microsporum canis Streptococcal bacterium

Epstein-Barr virus Explanation: Infectious mononucleosis ("mono") is caused by the Epstein-Barr virus, one of the herpes virus groups. The organism is transmitted through saliva.

A nurse is preparing a presentation for a local parent group about urinary tract infections (UTIs) in children. Which organism would the nurse incorporate into the presentation as the most common cause? Pseudomonas Klebsiella Staphylococcus aureus Escherichia coli

Escherichia coli Explanation: E. coli most commonly causes UTI. Other less common causative organisms include Klebsiella, S. aureus, and Pseudomonas.

A 12-year-old boy has broken his arm and is showing signs and symptoms of shock. Which action should the nurse take first? Draw blood for type and cross-match. Begin hyperventilation. Provide oral analgesics as ordered. Establish a suitable IV site.

Establish a suitable IV site. Explanation: The goal of treating shock is to restore circulating blood volume. This requires that vascular access be obtained to administer fluids and vasoactive drugs. Hyperventilation is reserved for temporary treatment of severe intracranial pressure. Analgesics should not be administered prior to neurologic and cardiovascular examination being performed. Chelation therapy is a treatment for metallic poisoning.

Which action should the nurse take first to effectively care for a dying child? Plan an interdisciplinary team meeting. Complete an evaluation of the family's cultural views. Attend a seminar about pediatric deaths. Evaluate personal views of death and dying.

Evaluate personal views of death and dying. Explanation: If a nurse is not aware of her own personal beliefs related to death and dying, this may negatively impact the effectiveness of care. All the other answers are needed to effectively care for a dying child, but self-evaluation should be the first step taken.

The home health care nurse is visiting a child undergoing continuous ambulatory peritoneal dialysis (CAPD). Which of the following would lead the nurse to identify a nursing diagnosis of fluid overload related to CAPD? Select all that apply. redness at the tube insertion site fever shortness of breath weight gain poor skin turgor

Evidence of fluid overload would be indicated by weight gain, moist cough, and shortness of breath. Fever and redness at the tube insertion site suggest infection. Poor skin turgor suggests fluid deficit.

.A nurse is assessing the urine of a school-age child and notes that the urine is brown. Which assessment question(s) will the nurse use to help identify the contributing factor to this color change? Select all that apply. "Has your skin had a tanned look or a yellowish appearance in the eyes?" "Have you been drinking iced tea throughout the day?" "Have you been hit in the belly or back recently?" "Are you having pain when you pee or hesitancy when you try to go to the bathroom?" "Do you notice being shaky or very thirsty throughout the day?"

Explanation: The nurse is trying to identify the rationale for the brown urine. Asking background questions may provide clues as to the cause of the urine color. Bile pigments stain urine green, yellow, or brown, which occurs when the child has elevated levels of indirect or direct bilirubin. A tan color to the skin or yellowing sclera also indicated elevated bilirubin levels. Old blood from kidney or bladder trauma may leave residual red blood cells in the urine that can cause the urine to be brown or black. Drinking iced tea, which is brown, would not cause the urine to be brown. Glucose present during hyperglycemia as noted with shakiness and thirst does not change the urine color. A urinary tract infection, with symptoms of dysuria, typically makes the color of the urine cloudy.

Which nursing concern(s) is common when caring for an infant with exstrophy? Select all that apply. oliguria pelvic bone defects urinary tract infections skin irritation cognitive deficits

Exstrophy of the bladder is a midline closure defect that occurs during the 10th week of pregnancy. As a result, the bladder lies exposed on the abdominal wall of the infant. When caring for the infant, the nurse is concerned about frequent urinary tract infections, skin irritation from the dripping of acidic urine on the abdominal skin, and pelvic bone defect, which often accompany the disorder. Oliguria is not anticipated because the kidneys are functional and the infant is able to eat normally. Cognitive deficits are also not common.

A nurse is talking with the parents of a child who has had a febrile seizure. The nurse would integrate an understanding of what information into the discussion? Febrile seizures are benign in nature. The child's risk for epilepsy is now increased. The child's risk for cognitive problems is greatly increased. Structural damage occurs with febrile seizure.

Febrile seizures are benign in nature. Explanation: Parents need reassurance that febrile seizures, although frightening, are benign in nature. Children who experience one or more febrile seizures are at no greater risk of developing epilepsy than the general population. No evidence exists that febrile seizures cause structural damage or cognitive declines.

While observing the parents feeding a neonate with pyloric stenosis, the nurse notes that the parents are becoming frustrated. The nurse identifies a nursing diagnosis of risk for impaired parenting related to frustration and difficulty feeding the neonate. Which would be appropriate for the nurse to include in the plan of care? Select all that apply. assisting the parents in holding and feeding their neonate informing the parents that the condition will require them to adjust their lifestyles pointing out positive aspects about their neonate helping them understand their stress level contributes to the neonate's vomiting encouraging rooming in with the neonate

For a nursing diagnosis of risk for impaired parenting, appropriate interventions include encouraging the parents to room in with their neonate, helping them understand that the cause of the condition is a physical problem, not something they did, assisting the parents in holding and feeding their neonate, and pointing out positive aspects about their neonate.

The nurse is doing teaching with the caregivers of toddler and preschool aged-children. One of the caregivers tells the group that her child had diarrhea and she was told that it was caused by giardiasis. Which statement made by the caregiver indicates the most likely situation in which the child contacted the disorder? "My son spent time with a neighbor who was diagnosed with pinworms." "I won't let his sister take bubble baths but I do let him take one a few times a week." "My mother is in a nursing home but I always make the kids wash their hands before we leave her." "He attends a day care center four days a week while I am at work."

Giardiasis is caused by the protozoan parasite Giardia lamblia. It is a common cause of diarrhea and is prevalent in children who attend day care centers and other types of residential facilities; it may be found in contaminated mountain streams or pools frequented by diapered infants. Bubble baths can lead to urinary tract infections, but are not the cause of Giardiasis infestations. It is not related to either C. Diff or pinworms.

A pediatric nurse is discharging a 1-month-old infant. The infant was diagnosed with congenital hypothyroidism on this admission and will be treated with levothyroxine. The nurse knows it is important to teach the parent about medication administration. Which process will the nurse include in the teaching? Give the crushed medication in a syringe mixed with a small amount of formula. Administer the medication every other day. Crush the medication and put it in the full bottle of formula so it tastes better. Explain that this treatment is administered until the child is 3 years of age.

Give the crushed medication in a syringe mixed with a small amount of formula. Explanation: The medication should be mixed in a small amount of food to make sure the infant receives the whole dose. It should not be placed in a whole bottle because the infant may not drink the entire bottle. This medication is prescribed for daily use, and hypothyroidism is a lifelong condition.

Parents of a school-age child experiencing encopresis are discussing the problem with the child's health care team. Their understanding of this problem is indicated when the parents respond in what manner? Encopresis always indicates that the child is constipated and needs nutritional counseling. They can help the child by trying to control his stooling pattern with medications. If there is no organic cause for the problem, the family may need to explore counseling for an emotional problem. He needs to be allowed to make his own decisions or choices about his life.

If there is no organic cause for the problem, the family may need to explore counseling for an emotional problem. Explanation: If a child is experiencing encopresis and there is no organic problem found such as constipation, inadequate fiber in the child's diet, or not drinking enough liquids to soften the stool, the child and family may need counseling for an emotional problem. It is thought that either over-controlling or under-controlling the child's life may be a contributory factor, along with emotional stressors in the child's life.

The nurse is caring for a child with a diagnosis of pyloric stenosis during the preoperative phase of the child's treatment. What is the highest priority at this time? Maintaining skin integrity Promoting comfort Improving hydration Preparing family for home care

Improving hydration Explanation: Preoperatively, the highest priority for the child with pyloric stenosis is to improve nutrition and hydration. Maintaining mouth and skin integrity, and relieving family anxiety are important, but these are not the priority. The child will not likely have intense pain. Preparing the family for home care would be a postoperative goal.

A 15-year-old adolescent is brought to the emergency department by his parents. The adolescent is febrile with chills that started suddenly. He states, "I had a sinus infection and sore throat a couple of days ago." The nurse suspects bacterial meningitis based on which findings? Select all that apply. Photophobia Absent headache Negative Brudzinski sign Complaints of stiff neck Vomiting

In addition to the adolescent's complaints and history, other findings suggesting bacterial meningitis include complaints of a stiff neck, photophobia, headache, positive Brudzinski sign, and vomitin

The nurse is teaching an in-service program to a group of nurses on the topic of gastrointestinal disorders. The nurses in the group make the following statements. Which statement is most accurate related to the diagnosis of gastroesophageal reflux? In this disorder the sphincter that leads into the stomach is relaxed. A thickened, elongated muscle causes an obstruction at the end of the stomach. There are recurrent paroxysmal bouts of abdominal pain. A partial or complete intestinal obstruction occurs.

In this disorder the sphincter that leads into the stomach is relaxed. Explanation: Gastroesophageal reflux (GER) occurs when the sphincter in the lower portion of the esophagus, which leads into the stomach, is relaxed and allows gastric contents to be regurgitated back into the esophagus. Congenital aganglionic megacolon is characterized by persistent constipation resulting from partial or complete intestinal obstruction of mechanical origin. Colic consists of recurrent paroxysmal bouts of abdominal pain. Pyloric stenosis is characterized by hypertrophy of the circular muscle fibers of the pylorus, which leads to an obstruction at the distal end of the stomach.

Nursing students are learning about the infectious process. They correctly identify the first stage of an infectious disease to be which period? Convalescent period Incubation period Illness period Prodromal period

Incubation period Explanation: Infection occurs when an organism invades the body and multiplies, causing damage to the tissue and cells. The infectious process goes through four stages. The incubation period is the first stage of the infectious disease. It is the time between the invasion of an organism and the onset of symptoms of infection. The prodromal period is the time from the onset of nonspecific symptoms to specific symptoms, for example, cold/flu-like symptoms before Koplik spots occur in measles. The illness is the time during which symptoms of the specific illness occur. The convalescent stage is the time when the acute symptoms disappear.

The nurse is assessing a child diagnosed with autism spectrum disorder (ASD). Which finding will the nurse expect to assess? Frequently losing things Slow motor actions Engaging in dangerous activities Indifferent attachment to a parent

Indifferent attachment to a parent Explanation: A child with autism spectrum disorder can show a lack of or no attachment to parents. Motor skills are not expected to be slowed or delayed, because a child with ASD tends to spend hours in repetitive play and may display bizarre motor and stereotypic behavior. The child may become completely absorbed in strange repetitive behaviors such as spinning an object, flipping an electrical switch on and off, or walking around the room feeling the walls. Frequently losing things can be associated with attention deficit hyperactivity disorder. Engaging in dangerous activities could be related to a conduct disorder.

A 9-year-old boy was in a car accident. The child is suffering from posttraumatic stress disorder. Which would be the best approach for treatment? Sensory integration technique Antipsychotic medications Individual psychotherapy sessions Psychostimulant medications

Individual psychotherapy sessions Explanation: Management of anxiety disorders consists of the use of medication at times but can also include cognitive behavioral therapy and individual, family, or group psychotherapy sessions. Psychostimulants would be used in ADHD. Antipsychotics help with children who have aggressive or repetitive behaviors. Sensory integration has been tried for the treatment of autism.

The nurse is caring for a child who has suffered a head injury and has had an ICP monitor placed. Which prescription by the health care provider would the nurse question? Administer mannitol IV, dosage determined by the pharmacist. Place in an indwelling urinary catheter. Initiate an IV of 0.9% NS to run at 250 ml/hr. Administer dexamethasone, dosage determined by the pharmacist.

Initiate an IV of 0.9% NS to run at 250 ml/hr. Explanation: Rapid administration of IV fluids may increase ICP. An IV rate of 250 ml/hr of normal saline can be considered a rapid infusion. Corticosteroids such as dexamethasone can reduce cerebral edema. Osmotic diuretics, such as mannitol, can reduce pressure. Because of the administration of the osmotic diuretic, indwelling urinary catheters are typically inserted.

A nurse is instructing the parents of a child who is suspected of having pinworms on how to check their child. Which instruction is appropriate? Observe the characteristics of the child's stool, which will be watery. Inspect the child's anus with a flashlight 2 to 3 hours after the child is asleep. Look on the child's bed linens for evidence of black dots. Check the washcloth after having the child wipe themselves during bathing.

Inspect the child's anus with a flashlight 2 to 3 hours after the child is asleep. Explanation: Diagnosis is confirmed by direct visualization of worms by the parents or by microscopy. The nurse will tell parents to view the child's anus with a flashlight 2 to 3 hours after the child is asleep. The worm is white, thin, and about 1/2 inch (1.25 cm) long, and it moves. Pinworms are not identified as black dots on bed linens. Specimens are best obtained as the child awakens before toileting or bathing. Checking the washcloth would be of no benefit. Pinworms do not change the appearance of the stool.

A 6-month-old infant is admitted with suspected bacterial meningitis. She is crying, irritable, and lying in the opisthotonic position. Which intervention should the nurse take initially? Educate the family about preventing bacterial meningitis. Palpate the child's fontanels (fontanelles). Encourage the mother to hold and comfort the infant. Institute droplet precautions in addition to standard precautions.

Institute droplet precautions in addition to standard precautions. Explanation: Bacterial meningitis is a medical emergency. The child must be placed on droplet precautions until 24 hours of antibiotics have been given. Encouraging the mother to hold and comfort the child is an intervention but not the priority one; the focus is to get the infant the appropriate medications to fight the infection and to prevent its spread. Educating the family about preventing bacterial meningitis would be appropriate later once the initial infection has been controlled. Palpating the fontanels (fontanelles) is used to assess for hydrocephalus.

A 9-month-old girl is brought to the emergency room with what appears to be bouts of intense abdominal pain 15 minutes apart in which she draws up her legs and cries, often accompanied by vomiting. In between the bouts, the child recovers and appears to be without symptoms. Blood is found in the stool. What condition should the nurse suspect in this case? Short-bowel/short-gut syndrome Intussusception Necrotizing enterocolitis Volvulus with malrotation

Intussusception Explanation: Intussusception, the invagination of one portion of the intestine into another, usually occurs in the second half of the first year of life. Children with this disorder suddenly draw up their legs and cry as if they are in severe pain; they may vomit. After the peristaltic wave that caused the discomfort passes, they are symptom-free and play happily. In approximately 15 minutes, however, the same phenomenon of intense abdominal pain strikes again. After approximately 12 hours, blood appears in the stool and possibly in vomitus, described as a "currant jelly" appearance. Volvulus with malrotation and necrotizing enterocolitis typically occur in the first 6 months of life and do not match the symptoms described above. Short-bowel/short-gut syndrome typically occurs when a large portion of the intestine has been removed due to a previous disease or trauma.

The nurse is planning care for a family whose 3-year-old child is in the final stages of dying. Which outcome demonstrates that the interventions have been successful? Select all that apply. The parents identify coping measures that are helping. The family prepares a scrapbook with favorite photos. The parents identify a support group for their family. The child expresses emotions related to impending death. The parents express hope their child will go into remission. The child remains free of pain during the end stage of life.

It is an expected outcome that parents will identify coping measures that are helpful, and many families begin preparing scrapbooks or collecting pictures prior to their child's death. This is something that brings comfort and keeps their memories alive. It is also a goal to keep the child as pain free as possible during the stages of dying. Identifying a support group is something that families do as they begin to accept the reality of the death of their child. A 3-year-old child is not going to be able to express emotions about impending death because it is not mature enough to conceptualize death as a permanent situation. Although parents may express hope that their child will go into remission, this would not be an outcome that is realistic if the child is actively dying.

A child was recently diagnosed with type 1 diabetes. The nurse is preparing to teach the child and their parents about the insulin therapy the health care provider has prescribed. What should the nurse ensure is included in this training? Once glucose control is established, there will not be a need for an increase in the amount of insulin administered. It is normal for the growing child to require an increase in insulin; this does not mean their condition is getting worse. All children should be on at least two types of insulin to establish glucose control. Children show an increased need for insulin during the first months after glucose control is established.

It is normal for the growing child to require an increase in insulin; this does not mean their condition is getting worse. Explanation: Children show a decreased need for insulin shortly after glucose control has been established, which is referred to by some as the "honeymoon phase" and should be described to parents so that they do not get any false hope that the child does not need insulin. As children grow, they will require increased doses of insulin to maintain glucose control, and not all children need to receive two types of insulin. Insulin treatment should be based on each individual child.

A nurse is educating a parent about caring for a newborn baby. What should the nurse teach the client as a precautionary measure to protect the infant from burns? Keep hot substances on the table. Monitor the activities of the infant closely. Keep the infant away from the kitchen. Keep hot substances away from the baby.

Keep hot substances away from the baby. Explanation: The nurse should teach the client to keep hot substances away from the baby to prevent burns on the baby. Infants are not very mobile and depend on their parents for their care. Keeping hot substances on the table, monitoring the activities of the infant closely, and keeping the infant away from the kitchen are important, but may not be appropriate as the baby is not yet mobile.

A 9-year-old girl who is suspected of having an infection of the central nervous system (CNS) is undergoing a lumbar puncture to withdraw cerebrospinal fluid (CSF) for analysis. The nurse knows that the needle will be introduced into the subarachnoid space at the level of which of the following vertebrae? T3 or T4 L4 or L5 C1 or C2 L1 or L2

L4 or L5 Explanation: Lumbar puncture, the introduction of a needle into the subarachnoid space (under the arachnoid membrane) at the level of L4 or L5 to withdraw CSF for analysis, is used most frequently with children to diagnose hemorrhage or infection in the CNS or to diagnose an obstruction of CSF flow.

The nurse is assessing the neurologic status of an infant. What would the nurse identify as an abnormal finding? Soft, flat anterior fontanel (fontanelle) Vigorous crying Making eye contact with the nurse Lack of interest in surroundings

Lack of interest in surroundings Explanation: An infant who is not interested in the environment is a cause for concern. Vigorous crying is a reassuring sign. Making eye contact with the nurse is a reassuring finding. A normal anterior fontanel (fontanelle) is soft and flat and would be considered a reassuring finding.

When reviewing the medical record of a child, what would the nurse interpret as the most sensitive indicator of intellectual disability? Language delay Vision deficit Preterm birth History of seizures

Language delay Explanation: Due to the extent of cognition required to understand and produce speech, the most sensitive early indicator of intellectual disability is delayed language development. A history of seizures, preterm birth, and vision deficit may be associated with intellectual disability but are not the most sensitive indicators.

Absence seizures are marked by what clinical manifestation? Loss of muscle tone and loss of consciousness Brief, sudden onset of increased tone of the extensor muscle Sudden, brief jerks of a muscle group Loss of motor activity accompanied by a blank stare

Loss of motor activity accompanied by a blank stare Explanation: An absence seizure consists of a sudden, brief arrest of the child's motor activity accompanied by a blank stare and loss of awareness. A tonic seizure consists of a brief onset of increased tone or muscle. A myoclonic seizure is characterized by sudden, brief jerks of muscle groups. An atonic seizure involves a sudden loss of muscle tone and loss of consciousness.

The nurse is caring for a child diagnosed with low functioning parathyroid. Which is a treatment goal of a child with hypoparathyroidism? Provide the child and parent with a referral to a pediatric gastrointestinal specialist. Maintain the child's calcium level at a normal level with calcium replacement as prescribed. Provide the parents a specific dietary plan for high-phosphorus foods to be eaten. Assure the parents have a plan in place for periods of low glucose levels if noted

Maintain the child's calcium level at a normal level with calcium replacement as prescribed. Explanation: Hypoparathyroidism will manifest as a low calcium level, so the nurse would expect the provider to provide a prescription to maintain the calcium level within normal range. Glucose is not a concern with parathyroid function. A referral would be made to a pediatric endocrinologist, not a gastrointestinal specialist. Phosphorus and calcium have an inverse proportion, so the nurse would recommend a low-phosphorus diet.

The nurse has developed a plan of care for a 12-month-old hospitalized with dehydration as a result of rotavirus. Which intervention would the nurse include in the plan of care? Offering Kool-Aid or popsicles as tolerated Maintaining the intravenous (IV) fluid rate as ordered Encouraging milk products to boost caloric intake Encouraging consumption of fruit juice

Maintaining the intravenous (IV) fluid rate as ordered Explanation: The nurse should maintain an IV line and administer the IV fluid as ordered to maintain fluid volume. High-carbohydrate fluids like fruit juice, Kool-Aid, and popsicles should be avoided as they are low in electrolytes, increase simple carbohydrate consumption, and can decrease stool transit time. Milk products should be avoided during the acute phase of illness as they may worsen diarrhea.

A nurse is caring for a 17-year-old female client with bulimia. Which complication of this disease may the nurse see in this child? Menstrual problems Severe acne Hernia Partial paralysis

Menstrual problems Explanation: Paralysis, hernia, and acne are not distinguishing features of bulimia. Bulimia is an eating disorder that has assessment findings of menstrual problems, esophagitis, cardiac arrhythmias, and fluid and electrolyte imbalance.

A group of students are reviewing information about oral diabetic agents. The students demonstrate understanding of these agents when they identify which agent as reducing glucose production from the liver? Glyburide Glipizide Metformin Nateglinide

Metformin Explanation: Metformin, a biguanide, reduces glucose production from the liver. Glipizide, glyburide, and nateglinide all stimulate insulin secretion by increasing the response of β cells to glucose.

The nurse is assessing the respiratory status and lungs of a 6-year-old child. What finding would the nurse report immediately? High-pitched breath sounds over the trachea Resonance over the lungs on percussion Minimal air movement through the lungs Low-pitched bronchial sounds over the periphery

Minimal air movement through the lungs Explanation: Minimal or no air movement requires immediate intervention because this child's status is severely compromised. Breath sounds over the trachea typically are high pitched. Breath sounds over the peripheral lung fields are lower pitched. Normally percussion over air-filled lungs reveals resonant sounds.

The nurse is collecting data from a child who may have a seizure disorder. Which nursing observations suggest an absence seizure? Muscle tone maintained and child frozen in position Brief, sudden contracture of a muscle or muscle group Minimal or no alteration in muscle tone, with a brief loss of responsiveness or attention Sudden, momentary loss of muscle tone, with a brief loss of consciousness

Minimal or no alteration in muscle tone, with a brief loss of responsiveness or attention Explanation: Absence seizures are characterized by a brief loss of responsiveness with minimal or no alteration in muscle tone. They may go unrecognized because the child's behavior changes very little. A sudden loss of muscle tone describes atonic seizures. A frozen position describes the appearance of someone having akinetic seizures. A brief, sudden contraction of muscles describes a myoclonic seizure.

A 7-year-old child with an earache comes to the clinic. The child's parent reports that 1 day ago the child had a fever and headache and did not want to play. When the nurse asks where it hurts, the child points to the jawline in front of the earlobe. What does the nurse expect the diagnosis will be for this child? Fifth disease Mononucleosis Measles Mumps

Mumps Explanation: Mumps begins with a fever, headache, anorexia, and malaise. Within 24 hours an earache occurs. When pointing to the site of pain, however, the child points to the jawline just in front of the earlobe. Mumps is contagious 1 to 7 days prior to the onset of symptoms and 4 to 9 days after the parotid swelling begins. Fifth disease is also known as the "slapping disease," as the rash on the cheeks look like someone slapped the child's face. Measles does not involve parotid swelling or earaches. Mononucleosis does involve swollen lymph nodes but they are in the neck and the axillary area.

The nurse is caring for an adolescent brought to the emergency department with an acetaminophen overdose. The nursing care begins with an assessment and intravenous catheter (IV) placement and includes the anticipated administration of which agent? diazepam N-acetylcysteine flumazenil naloxone

N-acetylcysteine Explanation: Treatment of acetaminophen overdose includes administration of N-acetylcysteine. N-acetylcysteine helps to reduce the extent of liver injury. Flumazenil is administered in the treatment of nonbarbituate sedative overdoses. Naloxone is administered in the treatment of opioid overdoses. Diazepam may be administered to treat uncontrolled hyperactivity in the client with a hallucinogen overdose.

The nurse is assessing a child who presents with a history of fever, malaise, fatigue, and headache. The nurse notes a bulls-eye rash on the child's right leg. Which action will the nurse take? Place the child on contact precautions. Notify the primary health care provider. Clean the rash with rubbing alcohol. Obtain an electrocardiography (ECG).

Notify the primary health care provider. Explanation: The nurse would suspect the child has Lyme disease and notify the health care provider for additional testing and potential antibiotic therapy. Precautions are not indicated for clients with Lyme disease. An ECG would only be needed if cardiac symptoms were noted. It is recommended to clean the site of the tick bite with rubbing alcohol when the tick is removed, not at a later time.

A mother calls the doctor's office and tells the nurse that she is concerned because her 4-month-old keeps "spitting up" with every feeding. What would indicate that the child is regurgitating as opposed to vomiting? Is projected 1 ft away from infant Only occurs with feeding Is curdled and extremely sour smelling Continues until stomach is empty

Only occurs with feeding Explanation: Regurgitation typically occurs only with feeding, runs out of the mouth with little force, smells barely sour and is only slightly curdled, appears to cause no pain or distress, occurs only once per feeding, and amounts to only about 1 to 2 tsp. Vomiting may occur at times other than feeding, is forceful and is typically projected 1 ft or more away from infant, is extremely sour smelling and curdled, is typically accompanied by crying, continues until the stomach is empty, and amounts to the full stomach contents.

The nurse is conducting a community educational program for parents of school-aged children. What would the nurse include in education plan in regards to the potential for drug and alcohol consumption in the school-age population? When discussing drugs and alcohol consumption, keep the conversation light and avoid hard facts. Parental modeling of drug and alcohol avoidance is vital at this age. If the child is experimenting with drugs or alcohol, parental anger is the best approach. Peer groups have little influence on this age group, so allowing freedom of friends is important.

Parental modeling of drug and alcohol avoidance is vital at this age. Explanation: Parents need to model good behavior (avoidance) of drugs and alcohol when parenting school-aged children. Peer groups are the most influential at this age, so assuring the child's friends are not involved in dangerous use of drugs and alcohol is vital. Anger will not result in a candid conversation with the child and all discussions about the dangers of drug and alcohol consumption should involve factual statements that the child will understand. Reference:

In caring for the child with meningitis, the nurse recognizes that which nursing diagnosis would be most important to include in this child's plan of care? Risk for acute pain related to surgical procedure Risk for injury related to seizure activity Ineffective airway clearance related to history of seizures Delayed growth and development related to physical restrictions

Risk for injury related to seizure activity Explanation: The child's risk for injury would be an appropriate nursing diagnosis. Surgery is not indicated for the child with meningitis, and if the child has a history of seizures, it would specifically impact airway clearance. Growth and development issues are a concern but not likely delayed due to this diagnosis.

The nurse determines that interventions for a voiding disorder have been effective when the family of a child with enuresis demonstrates evidence of which of the following? Parents/family use positive coping mechanisms in response to the child and the voiding disorder. Parents/family accept the child and the voiding disorder. Parents take the child for surgery. Parents administer medications for enuresis.

Parents/family use positive coping mechanisms in response to the child and the voiding disorder. Explanation: The family caregiver may become extremely frustrated dealing with wet bedding every morning. Health care personnel must facilitate coping and take a supportive and understanding attitude toward the caregiver and child. Surgery is not needed—fluid restrictions, bladder training, and alarms are the most common approaches. Medications are sometimes used with alarms and positive reinforcement. Parents usually accept the voiding disorder and often have a family member with a history of enuresis.

When the nurse is caring for a child presenting with a traumatic injury, which action is priority? Notify the primary health care provider Apply an oxygen saturation monitor Perform a primary assessment Ensure the code cart is available

Perform a primary assessment Explanation: The nurse would perform a primary assessment. When assessing a child with a traumatic injury, airway (A), breathing (B), and circulation (C) are assessed first: assess the patency of the airway and establish the effectiveness of breathing, examining the child's respiratory effort, breath sounds, and color; evaluate the circulation, noting pulse rate and quality and observing the color, skin temperature, and perfusion. Once this is accomplished, the nurse would notify the health care provider and apply monitors as needed. The nurse should ensure a code cart is available before the start of the shift.

The nurse is triaging clients as they come in to an urgent care facility. Which assessment finding is clinically significant for early nephrotic syndrome? Edema in the hands Sacral edema Periorbital edema Facial puffiness

Periorbital edema Explanation: Periorbital edema and edema in the ankles are the initial presenting symptoms. As the swelling advances, the edema becomes generalized with a pendulous abdomen full of fluid. Edema in the scrotum also appears. Edema in the hands, sacrum and facial puffiness can be a progression of the disease.

A child is to receive peritoneal dialysis while waiting for a kidney transplant. When teaching the child about the procedure, which action would the nurse likely include? Select all that apply. Infusing a hypertonic glucose solution into the peritoneal cavity by gravity flow. Inserting a large-bore needle into the peritoneal cavity. Warming the infusion fluid to room temperature. Assessing for a thrill over the arteriovenous fistula to ensure that the connection is patent. Inserting a double-lumen central catheter into the jugular vein for blood removal. Asking the child to void to reduce bladder size before the procedure.

Peritoneal dialysis is a skilled procedure. Dialysis is the separation and removal of solutes from body fluid by diffusion through a semipermeable membrane. Peritoneal dialysis uses the membrane of the peritoneal cavity to do this and involves having the child void ahead of time to reduce bladder size and inserting a large-bore needle into the peritoneal cavity to remove ascites fluid and to infuse a warmed (body temperature) solution into the cavity by gravity flow. The volume of ultrafiltration depends on the elevated glucose concentration in the dialysis solution used. Insertion of a double-lumen central catheter into the jugular vein for blood removal and assessing for a thrill over an arteriovenous fistula would be done in hemodialysis (dialysis involving a machine), not in peritoneal dialysis.

In caring for an infant diagnosed with pyloric stenosis the nurse would anticipate which intervention? Prepare the infant for surgery. Assist in doing a barium enema procedure on the infant. Medicate the infant with analgesics. Change the infant's diet to one that is lactose-free.

Prepare the infant for surgery. Explanation: In pyloric stenosis, the thickened muscle of the pylorus causes gastric outlet obstruction. The treatment is a surgical correction called a pyloromyotomy. The condition is not painful, so no analgesics would be needed until after surgical repair. The condition is not related to lactose in the diet, so changing to lactose-free formula would not correct the condition. A barium enema would be used to diagnose intussusception.

A 12-year-old boy has just undergone a liver transplantation and is recovering. After performing a fingerstick puncture and assessing the results, the nurse administers a 10% solution of dextrose IV. What is the correct rationale for this intervention? Reduction of hypertension Maintenance of electrolyte balance Prevention of T-cell rejection of the transplanted liver Prevention of hypoglycemia

Prevention of hypoglycemia Explanation: Hypoglycemia is a major danger following liver transplantation because glucose levels are regulated by the liver, and the transplanted organ may not function efficiently at first. Assess serum glucose levels hourly by fingerstick puncture. A 10% solution of dextrose IV may be necessary to prevent hypoglycemia. Careful tissue matching before the transplantation is needed to reduce the possibility of stimulating T-cell rejection. Sodium, potassium, chloride, and calcium levels are evaluated approximately every 6 to 8 hours to be certain electrolyte balance is maintained, but potassium is rarely added to IV solutions because of the risk that renal failure has occurred. IV therapy with hypotensive agents such as hydralazine and nitroprusside may be needed to reduce hypertension.

The nurse is caring for a child admitted with pyloric stenosis. Which clinical manifestation would likely have been noted in the child with this diagnosis? Frequent urination Severe abdominal pain Explosive diarrhea Projectile vomiting

Projectile vomiting Explanation: During the first weeks of life, the infant with pyloric stenosis often eats well and gains weight and then starts vomiting occasionally after meals. Within a few days the vomiting increases in frequency and force, becoming projectile. The child may have constipation, and peristaltic waves may be seen in the abdomen, but the child does not appear in severe pain. Urine output is decreased and urination is infrequent.

The nurse is caring for a child admitted with pyloric stenosis. Which clinical manifestation would likely have been noted in the child with this diagnosis? Projectile vomiting Explosive diarrhea Severe abdominal pain Frequent urination

Projectile vomiting Explanation: During the first weeks of life, the infant with pyloric stenosis often eats well and gains weight and then starts vomiting occasionally after meals. Within a few days the vomiting increases in frequency and force, becoming projectile. The child may have constipation, and peristaltic waves may be seen in the abdomen, but the child does not appear in severe pain. Urine output is decreased and urination is infrequent.

A 4-year-old boy has a febrile seizure during a well-child visit. What action would be a priority? Hyperextending the child's head while placing him on his side Loosening the child's clothing to ensure a patent airway Protecting the child from harm during the seizure Using a tongue blade to pry open the child's jaw

Protecting the child from harm during the seizure Explanation: During a seizure, the child should not be held down in a specific position. Protecting the child's head and body during the seizure is the priority. Ensuring a patent airway is an important intervention but is not accomplished by loosening the child's clothing or hyperextending his head. The child should be placed on his side and nothing should be inserted into his mouth to forcibly open the jaw.

The parents of a dying child have expressed the desire to have hospice care at home. What is the nurse's priority responsibility at this time? Review all available options. Provide names of area hospices. Express sympathy to the parents. Contact the hospital chaplain.

Provide names of area hospices. Explanation: In this situation, the nurse needs to respect the family's decision and provide names of hospice agencies in the area. It is not necessary to contact the hospital chaplain unless the family requests a visit. At this point, the parents have most likely reviewed all available options and have come to the decision about hospice care. Reviewing the options again might give the impression the nurse does not approve of the decision. Expressing sorrow is helpful, but it is not the priority when parents have made this difficult decision for their child.

A 7-year-old girl is in the intensive care unit following a bicycle accident. Which would be most helpful in providing support to the girl's parents? Providing honest answers in a reassuring manner Describing the treatment plan for their daughter Encouraging them to read to their daughter Giving them brief explanations of procedures

Providing honest answers in a reassuring manner Explanation: Providing honest answers to the parents' questions and concerns in a reassuring manner will provide the most support. Procedures and treatment plans should be explained in terms they can understand and repeated patiently, if need be. Encouraging the parents to read to their daughter will involve them in their child's care and help normalize the situation for the child.

A single parent of a dying child has told the nurse she would like to take care of her daughter at home. What would be best for the nurse to do to help the mother reach a decision that will be good for both the mother and the child? The nurse should: Validate her courageous idea and say that the staff at the hospital will always be available to answer her questions. Put the mother in touch with the department of a hospital that can help her sort out the availability of home nursing care, insurance coverage, and respite care. Remind the mother that the number of staff people caring for the child in the hospital is unlikely to be duplicated at home, making the hospital a better choice. Suggest that she look into a hospice residence, which is often a good alternative to caring for the child alone at home or having the child remain in the hospital.

Put the mother in touch with the department of a hospital that can help her sort out the availability of home nursing care, insurance coverage, and respite care. Explanation: The home can be a more loving and caring environment but this choice must be considered carefully in terms of financial, health care, and caregiver health concerns. This is an extremely difficult decision for a family. Family members need support and guidance from health care personnel while they are trying to make the decision, after the decision is made, and even after the child dies.

A 6-year-old child is brought to the clinic by his parents. The parents state, "He had a sore throat for a couple of days and now his temperature is over 102°F (38.9°C). He has this rash on his face and chest that looks like sunburn but feels really rough." What would the nurse suspect? Pertussis Scarlet fever Community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA) Diphtheria

Scarlet fever Explanation: Scarlet fever typically is associated with a sore throat, fever greater than 101° F (38.9° C), and the characteristic rash on the face, trunk, and extremities that looks like sunburn but feels like sandpaper. CAMRSA is typically manifested by skin and tissue infections. Diphtheria is characterized by a sore throat and difficulty swallowing but fever is usually below 102°F (38.9°C). Airway obstruction is apparent. Pertussis is characterized by cough and cold symptoms that progress to paroxysmal coughing spells along with copious secretions. Reference:

The mother of a child newly diagnosed with an intellectual disability tells the nurse that her partner disagrees with the diagnosis and believes that the child is perfectly normal. The mother shares with the nurse that she finds this reaction frustrating and confusing. Which action by the nurse would be appropriate in supporting this mother? Reassure the mother that her partner's reaction is a normal stage in the grieving process. Offer to speak with the partner to explain how the diagnosis was reached. Suggest that the couple get a second opinion about the child's condition. Recommend that the couple consider placing the child in foster care until they adjust to the diagnosis.

Reassure the mother that her partner's reaction is a normal stage in the grieving process. Explanation: The family's first reaction to learning that the child may have cognitive impairment is grief because this is not the perfect child of their dreams. A parent may feel shame, assuming that he or she cannot produce a perfect child. Some rejection of the child is almost inevitable at least in the initial stages, but this must be worked through for the family to cope.

he mother of a child newly diagnosed with an intellectual disability tells the nurse that her partner disagrees with the diagnosis and believes that the child is perfectly normal. The mother shares with the nurse that she finds this reaction frustrating and confusing. Which action by the nurse would be appropriate in supporting this mother? Reassure the mother that her partner's reaction is a normal stage in the grieving process. Offer to speak with the partner to explain how the diagnosis was reached. Recommend that the couple consider placing the child in foster care until they adjust to the diagnosis. Suggest that the couple get a second opinion about the child's condition.

Reassure the mother that her partner's reaction is a normal stage in the grieving process. Explanation: The family's first reaction to learning that the child may have cognitive impairment is grief because this is not the perfect child of their dreams. A parent may feel shame, assuming that he or she cannot produce a perfect child. Some rejection of the child is almost inevitable at least in the initial stages, but this must be worked through for the family to cope.

An adolescent has been hospitalized for several weeks following a traumatic brain injury. The adolescent's school-aged siblings, who often visit with the parents, are disruptive, have temper tantrums, and are rude while visiting the hospital. When the nurse sees this behavior, what is the nurse's best response to the parents? Suggest to the parents that the siblings are kept at home with a family member. Have the parents ask the children to be more respectful while at the hospital. Ask the parents to remind the children to be quiet while around sick children. Recommend that the parents make time for daily activities focused on the siblings.

Recommend that the parents make time for daily activities focused on the siblings. Explanation: Siblings' reactions to a child with a long-term or terminal illness are influenced by individual circumstances; however, their chief reaction is most profoundly affected by the reactions and perceptions of the parents. Without counseling, siblings may react with jealousy, anger, hostility, resentment, competition, guilt, or withdrawal. They may feel they take "second place" to the ill child who needs more care. These reactions are common when parents focus most of their attention on the ill child, allow the health problem and its treatment to disrupt family life significantly, or grant the ill child special privileges and minimal discipline. It is helpful for parents to make it a point to set aside time each day for special activities with the healthy siblings—such as playing a table game, walking in the park, etc. The parents should carefully explain the condition and the necessity for the ill child's special care, including these siblings in that care, providing them with respite from care if needed, and establishing realistic rules for all family members. Sending the siblings away does not solve the problem, as they need attention from their parents as well. It is helpful to explain that their older sibling needs their parents' help, but they benefit from spending time with their parents also.

Following the health care provider's diagnosis of gastroesophageal reflux disease (GERD), a nurse is reinforcing the results of a client's endoscopy and treatment plan with an adolescent client and parent. The adolescent and parent are correct when they identify that which strategy(ies) will be incorporated in the daily plan? Select all that apply. The adolescent states, "I will sit upright for 1 hour after eating." The adolescent states, "I will take omeprazole for 2 to 3 weeks." The parent states, "I will provide smaller portions of food at multiple times." The parent states, "I will buy apples and strawberries instead of oranges and grapefruits." The adolescent states, "I will try to sleep on a foam wedge behind me."

Reinforcement and assessment of the knowledge base of a new diagnosis is an important nursing function. Adolescents with gastroesophageal reflux should avoid lying down until 3 hours after a meal and should sleep at night with the upper body elevated on a foam wedge. Acidic foods such as citrus fruits and tomatoes should be avoided. Eating smaller portions may be helpful. Medications like omeprazole typically are prescribed for more than 8 weeks and up to 8 months until esophageal healing is complete.

A nurse has rushed to the site of an accident where members of a family have suffered carbon monoxide poisoning. What is the highest priority action that must take place during carbon monoxide poisoning? Open the doors and windows of the room. Give oxygen to the individual. Remove the individual from the room. Begin CPR.

Remove the individual from the room. Explanation: The first step in handling accidental carbon monoxide poisoning is to remove the individual from the site. If moving the person out of doors is impossible, rescuers should open windows and doors to reduce the level of toxic gas and promote the client's ventilation of air. Once emergency personnel arrive, they administer oxygen. CPR may or may not be necessary. In the case of extremely high blood levels of carbon monoxide, the victim may be treated with hyperbaric oxygen at a hospital. Reference:

What is a true statement regarding varicella zoster virus infection? It tends to be more severe in children. Secondary bacterial infections of the skin can occur. It is transmitted by fecal-oral route. The incubation period is 7 days.

Secondary bacterial infections of the skin can occur. Explanation: Varicella zoster virus infection carries with it the complication of a secondary bacterial infection of the skin. The lesions are intensely pruritic, making the child want to scratch the lesions and opening them to a variety of organisms to invade. The incubation period is 10 to 21 days. It is transmitted by direct contact with the vesicles and by airborne route. It tends to be more severe in adolescents and adults.

A child is brought to the emergency department by their parents. After an initial assessment, the nurse is concerned this child is experiencing moderate dehydration. Which assessment finding(s) will confirm the nurse's suspicions for this diagnosis? Select all that apply. child difficult to arouse increased urine specific gravity very poor skin turgor mouth and tongue appear dry capillary refill of 5 seconds

Signs and symptoms of moderate dehydration include mild thirst; poor skin turgor; cool, dry skin; decreased urine output; irritability; increased urine specific gravity, and normal serum sodium level. Difficulty to arouse the child and very poor skin turgor indicates severe dehydration.

A 6-year-old child has undergone a renal transplant and is receiving cyclosporine. The nurse instructs the parents to be especially alert for which complication? Hair loss Signs of infection Weight loss Hypotension

Signs of infection Explanation: The parents should be especially alert for signs of infection as cyclosporine is an immunosuppressant drug. Weight gain instead of weight loss, hypertension instead of hypotension, and increased facial hair instead of hair loss are some other potential side effects.

The nurse recognizes that what would be a likely physiologic cause for a child to have enuresis? Stress and stressful situations Sleeping too soundly Sexual abuse Regression to get attention

Sleeping too soundly Explanation: Physiologic causes may include a small bladder capacity, urinary tract infection, and lack of awareness of the signal to empty the bladder because of sleeping too soundly. Psychological causes might include rigorous toilet training, resentment toward family caregivers, a desire to regress to an earlier level of development to receive more care and attention, or emotional stress and stressful situations. Enuresis can be a symptom of sexual abuse.

The nurse is caring for a 10-year-old boy with end-stage kidney disease (ESKD) with metabolic acidosis. What would the nurse expect to administer if ordered? Ferrous sulfate Vitamin D Erythropoietin Sodium bicarbonate tablets

Sodium bicarbonate tablets Explanation: Bicitra or sodium bicarbonate tablets are used for the correction of acidosis. Ferrous sulfate is used for the treatment of anemia. Vitamin D and calcium are used for the correction of hypocalcemia and hyperphosphatemia. Erythropoietin stimulates red blood cell growth.

The incidence of vitamin D deficiency in the United States is less than in many countries. What is the most likely reason for this? Many children in the U.S. take daily vitamin supplements. The amount of ultraviolet sunlight each day in the U.S. is adequate to provide needed vitamin D. The water in many towns and cities in the U.S. has vitamin D added. Some foods in the U.S. have been fortified with vitamin D.

Some foods in the U.S. have been fortified with vitamin D. Explanation: Whole milk and evaporated milk fortified with 400 U of vitamin D per quart are available throughout the United States, which decreases the vitamin D deficiency of children in the U.S. Vitamin D can be administered orally in the form of fish liver oil or synthetic vitamin, but this is not common for children in the U.S. Water is not fortified with vitamin D, and some communities in the U.S. do not get adequate sunshine to meet vitamin D needs.

A nurse is assessing a little boy who has been diagnosed with Tourette syndrome. Which finding would the nurse expect to see? Spinning and hand-flapping Toe walking Speaks sudden, fast phrases out of context Lack of eye contact

Speaks sudden, fast phrases out of context Explanation: In Tourette syndrome, children have uncontrolled vocal tics. Toe walking and hand flapping/spinning is seen more in children with autism spectrum disorder. Lack of eye contact can also be found in children with autism spectrum disorder, but also can be normal in kids.

A 3-year-old child has sustained injuries from a fall. Once the airway is secured, what interventions would be next? Stabilize the cervical spine. Set up antecubital IV access. Check mouth for debris. Administer 100% oxygen.

Stabilize the cervical spine. Explanation: If head or spine injuries are suspected, then after the airway is opened, the cervical spine must be stabilized to prevent damage. Checking the mouth for debris is part of securing an airway. Administering oxygen and IV access occur after the C-spine is stabilized.

A nurse is assessing a 5-year-old client and suspects that the child may have an autism spectrum disorder. Which assesment(s) supports the nurse's suspicions? Select all that apply. lack of facial expression hypersensitivity to touch distinct interest in others around them easily distracted from playing inability to make eye contact

Symptoms associated with autism spectrum disorder include deficits in nonverbal communicative behaviors (such as abnormalities in eye contact and lack of facial expression) and hyper- or hyposensitivity to sensory input such as touch. In addition, children may demonstrate stereotyped or repetitive motor movement, use of object, or speech.

A nurse is preparing discharge instructions for a child treated for ingestion of an unknown amount of ibuprofen. The child was treated with an activated charcoal gastric lavage. Which piece of information should the nurse include to provide anticipatory guidance to the parent? The child will continue taking the chelating agent. Stools will be black in color for the next few days. The mouth sores will heal over several weeks. Blood tests will be needed to check liver function.

Stools will be black in color for the next few days. Explanation: Activated charcoal is a gritty black substance that binds with the ingested substance in the bowel and is excreted in the stools. It is important to give parents this information so they do not mistake the color for tarry stools, which indicate blood. The child would return for liver function tests if acetaminophen had been ingested. A chelating agent is treatment for lead poisoning and is not associated with ibuprofen ingestion or treatment with activated charcoal. Mouth sores are not associated with ibuprofen ingestion or activated charcoal. However, they are associated with the ingestion of corrosive agents such as batteries and some household cleaners.

The nurse is working on forming a contract with a hospitalized adolescent diagnosed with anorexia nervosa. Which information should the nurse prioritize with the client when making the contract? Remind the adolescent about the consequences of misbehavior. Encourage the caregivers to take responsibility for the adolescent. Stress to the client that he or she is in control of the outcome of the care. Reward the client after several days of successful behavior.

Stress to the client that he or she is in control of the outcome of the care. Explanation: Contract agreements are often recommended for people with eating disorders. These agreements, which are usually part of a behavioral modification plan, specify the client's and the staff's responsibilities for the diet, activity expectations for the client, and other aspects of the client's behavior. The contract also may spell out specific privileges that can be gained by meeting the contract goals. This places the client in greater control of the outcome. Some type of reward should be achieved daily to encourage continued participation in the agreement.

The nurse inspects the eyes of a child and observes that the sclera is showing over the top of the iris. The nurse documents this finding as: Sunsetting Nystagmus Decorticate posturing Doll's eye

Sunsetting Explanation: Sunsetting is when the sclera of the eyes is showing over the top of the iris. Decorticate posturing includes adduction of the arms, flexion at the elbows with the arms held over the chest, and flexion of the wrists with both hands fisted and the lower extremities adducted and extended. Nystagmus is manifested by involuntary rapid rhythmic eye movements. Doll's eye is a maneuver that tests for symmetric eye movement to the opposite side when the head is turned in the other direction.

The nurse is caring for an 8-year-old boy who has chronic epilepsy. What would be most important to address when teaching the child and parents about living with this condition? Physical, occupational, and speech therapy to maximize his potential Hyperventilation therapy to counteract the periods of decreased oxygenation Support for maintaining self-esteem because of his altered lifestyle Multiple corrective surgeries to slowly remove diseased parts of his brain

Support for maintaining self-esteem because of his altered lifestyle Explanation: The effects of living with a seizure disorder can be devastating, and it is essential for the child to receive support to maintain self-esteem. While corrective surgery is possible, it would only be performed once. Physical, occupational, speech, and hyperventilation therapy are not indicated for treatment of epilepsy.

The nurse is caring for an infant immediately after pyloromyotomy surgery has been performed to treat pyloric stenosis. The infant's parents are understandably anxious about their child. Given the situation, what is the most appropriate way for the nurse to position the infant during the anesthesia recovery period? Support the infant and place them on their side. Place the infant on the back. Allow the parents to hold their infant Lay the infant on their stomach.

Support the infant and place them on their side. Explanation: Postoperatively, the child should be placed on his side to prevent aspiration of mucus or vomitus, especially during the anesthesia recovery period. After fully waking from the surgery, he can be held by a family caregiver in a position that does not interfere with IV infusions and is comforting to both caregiver and child.

The nurse is performing a physical examination of an 8-year-old girl who was bitten by her kitten. Which assessment would lead the nurse to suspect cat-scratch disease? Infected tonsils Strawberry tongue Swollen lymph nodes Swollen neck

Swollen lymph nodes Explanation: Lymph nodes, especially under the arms, can become painful and swollen due to cat-scratch disease. Strawberry tongue is typical of scarlet fever. Infected tonsils and an edematous neck are symptoms of diphtheria.

A child with diabetes insipidus is being treated with vasopressin. The nurse would assess the child closely for signs and symptoms of which condition? Vitamin D toxicity Syndrome of inappropriate antidiuretic hormone (SIADH) Cushing syndrome Thyroid storm

Syndrome of inappropriate antidiuretic hormone (SIADH) Explanation: SIADH, although rare in children, is a potential complication of excessive administration of vasopressin. Thyroid storm may result from overadministration of levothyroxine (thyroid hormone replacement). Cushing syndrome is associated with corticosteroid use. Vitamin D toxicity may result from the use of vitamin D as treatment of hypoparathyroidism.

The nurse is caring for a 6-month-old infant who was admitted to the emergency department 24 hours ago with signs of severe diarrhea. The infant's rectal temperature is 104°F (40°C), with weak and rapid pulse and respirations. The skin is pale and cool. The child is on IV rehydration therapy, but the diarrhea is persisting. The infant has not voided since being admitted. Which is the priority nursing intervention? Feed the child a cracker Administer IV potassium Take a stool culture Administer antibiotic therapy

Take a stool culture Explanation: Treatment of severe diarrhea focuses on regulating electrolyte and fluid balance by initiating a temporary rest for the gastrointestinal tract, oral or IV rehydration therapy, and discovering the organism responsible for the diarrhea. All children with severe diarrhea or diarrhea that persists longer than 24 hours should have a stool culture taken to determine if bacteria are causing the diarrhea; if so, a definite antibiotic therapy can be prescribed. Because a side effect of many antibiotics is diarrhea, antibiotics should not routinely be used to treat diarrhea without an identifiable bacterial cause. Before the initial IV fluid is changed to a potassium solution, be certain the infant or child has voided—proof that the kidneys are functioning; in this case, the child is not voiding yet. The child should not be fed a cracker, as the gastrointestinal tract should be rested until the diarrhea stops.

The caregiver of a child being treated at home for acute glomerulonephritis calls the nurse reporting that her daughter has just had a convulsion. The child is resting comfortably but the caregiver would like to know what to do. The nurse would instruct the caregiver to take which action? Give the child a diuretic and report back to the nurse in a few hours. Give the child fluids and report back to the nurse in a few hours. Take the child's blood pressure and report the findings to the nurse while the nurse is still on the phone. Weigh the child in the same clothes she had been weighed in the day before and report the two weights to the nurse while the nurse is on the phone.

Take the child's blood pressure and report the findings to the nurse while the nurse is still on the phone. Explanation: Blood pressure should be monitored regularly using the same arm and a properly fitting cuff. If hypertension develops, a diuretic may help reduce the blood pressure to normal levels. An antihypertensive drug may be added if the diastolic pressure is 90 mm Hg or higher. The concern is immediate so reporting the findings in a few hours could delay needed treatment. The child should be weighed daily in the same clothes and using the same scale, but the blood pressure is the priority in this situation.

The caregiver of a child being treated at home for acute glomerulonephritis calls the nurse reporting that her daughter has just had a convulsion. The child is resting comfortably but the caregiver would like to know what to do. The nurse would instruct the caregiver to take which action? Weigh the child in the same clothes she had been weighed in the day before and report the two weights to the nurse while the nurse is on the phone. Give the child a diuretic and report back to the nurse in a few hours. Take the child's blood pressure and report the findings to the nurse while the nurse is still on the phone. Give the child fluids and report back to the nurse in a few hours.

Take the child's blood pressure and report the findings to the nurse while the nurse is still on the phone. Explanation: Blood pressure should be monitored regularly using the same arm and a properly fitting cuff. If hypertension develops, a diuretic may help reduce the blood pressure to normal levels. An antihypertensive drug may be added if the diastolic pressure is 90 mm Hg or higher. The concern is immediate so reporting the findings in a few hours could delay needed treatment. The child should be weighed daily in the same clothes and using the same scale, but the blood pressure is the priority in this situation.

The nurse is teaching parents about talking with children about death. Which principle should the nurse include in the teaching? Answer the child's questions only once to avoid confusion about death. Use euphemisms when talking about death. Give long, detailed explanations about death. Talk about death when the child wants to talk about death

Talk about death when the child wants to talk about death. Explanation: Forcing or avoiding a conversation about death with a child could lead to false imaginings or resistance in dealing with feelings about death. Children may need their questions answered several times to understand the concept. Explanations about death and dying should be simple and brief and appropriate to the developmental level of the child. Words like "death" and "dying" should be used, and euphemisms should be avoided.

The nurse performs an abdominal assessment of an infant and observes a prominentc venous pattern. The nurse documents the findings and anticipates that this is a sign of which? Hirschsprung disease malnourishment cirrhosis of the liver pyloric stenosis

cirrhosis of the liver Explanation: Upon assessment, a prominent venous pattern may be seen in children with cirrhosis of the liver. Peristalsis may be visible in the thin, malnourished infant or in the infant with obstruction caused by pyloric stenosis.

A 9-year-old boy is suffering from headaches but has no signs of physical or neurologic illness. Which intervention would be most appropriate? Have the parents call the doctor if the child vomits more than twice. Have the child sleep without a pillow under his head. Review the signs of increased intracranial pressure with parents. Teach the child and his parents to keep a headache diary.

Teach the child and his parents to keep a headache diary. Explanation: A headache diary can help identify any triggers so that the child can avoid them. Triggers can include foods eaten, amount of sleep the night before, or activities at home or school that might be causing stress. Reviewing signs of increased intracranial pressure would be inappropriate because increased intracranial pressure is not associated with headaches. Having the child sleep without a pillow is an intervention to reduce pain from meningitis. Vomiting more than twice is an indication that the parents should notify the physician or nurse practitioner when the child has a head injury.

A 13-year-old client suffered a serious fall while hiking with friends and suffered a head injury. Upon arrival to the emergency department, the nurse notices clear fluid from the nose. A friend said that the client had been sneezing a lot from a pollen allergy. Which intervention will the nurse implement to determine whether the fluid is cerebrospinal fluid (CSF) or mucus from allergic rhinitis (hay fever)? Assess the nasal mucosa for inflammation. Assess for further rhinitis symptoms such as sneezing. Test the secretions with a glucose reagent strip. Evaluate the client's level of consciousness.

Test the secretions with a glucose reagent strip. Explanation: Rhinorrhea or otorrhea (clear fluid draining from the nose or ear, respectively) may be noticeable following a head injury. If the fluid is cerebrospinal fluid (CSF), this is a serious finding because it means that the client's central nervous system is open to infection. To determine if the fluid is CSF or mucus from allergic rhinitis (hay fever), the nurse will test the fluid with a glucose reagent strip. CSF will test positive for glucose, whereas the clear, watery drainage from an upper respiratory tract infection or allergy will not. Waiting for further symptoms of rhinitis may delay needed care. Assessing for inflammation is not definitive and could be present due to the recent allergy. Level of consciousness may be impaired with or without cerebrospinal drainage. Reference:

A voiding cystourethrogram (VCUG) is prescribed for a child. What education should be provided to the parents? The VCUG will detect if the infection is gone. The VCUG will rule out vesicoureteral reflux. The VCUG will rule out kidney stones. The VCUG will prevent further complications of a urinary tract infection (UTI).

The VCUG will rule out vesicoureteral reflux. Explanation: A voiding cystourethrogram (VCUG) is performed by having the bladder filled with a contrast medium via catheterization. Under fluoroscopy, the bladder is visualized filling and emptying. A VCUG is used to rule out reflux in the urinary tract, causes of hematuria, urinary tract infection, and structural anomalies. Reflux may cause frequent infections and scarring in the urinary tract if not diagnosed and treated. A VCUG will not diagnose kidney stones. Kidney stones would be detected by computed tomography. A VCUG would not be performed to detect if infections of the urinary tract have cleared. This would be done by urinalysis.

A nurse in a primary care provider's office is performing a comprehensive assessment on a 16-year-old adolescent diagnosed with anorexia. Click to highlight the findings that will require follow up. Adolescent is awake, alert, and oriented. Lungs are clear, abdomen is concave with hyperactive bowel sounds. Pulses are weak and thready . Vital signs: temperature, 95.9°F (35.5°C); heart rate, 55 beats/min; blood pressure, 88/49 mm Hg ; oxygen saturation, 98% on room air. Adolescent has a body mass index (BMI) of 15.2 . Laboratory values: sodium, 149 mEq/l (149 mmol/l); potassium, 2.9 mEq/l (2.9 mmol/l); hemoglobin, 9 g/dl (90 g/l); hematocrit, 45% (0.45).

The abdomen should be flat, not concave. This is a common finding in an adolescent with anorexia.Hyperactive bowel sounds are an abnormal finding and should be assessed further.Weak, thready pulses are an abnormal finding and may indicate dehydration.A temperature of 95.9°F (35.5°C) is subnormal (normal: 97.7°F to 98.6°F; 36.5°C to 37.0°C).A heart rate of 55 beats/min indicates bradycardia, which is often seen in an adolescent with anorexia (normal: 60 to 79 beats/min). A blood pressure of 88/49 mm Hg indicates hypotension (normal: 112-128/66-80 mm Hg).A body mass index (BMI) of 15.2 indicates the adolescent is significantly underweight for their height and weight (normal: 18.5 to 24.9).A serum sodium of 149 mEq/l (149 mmol/l) may indicate dehydration (normal: 135 to 145 mEq/l [135 to 145 mmol/l]).A serum potassium of 2.9 mEq/l (2.9 mmol/l) is an abnormal finding and places the adolescent at high risk for developing a cardiac arrhythmia (normal: 3.5 to 5.2 mEq/l [3.5 to 5.2 mmol/l]).A hemoglobin of 9 g/dl (90 g/l) indicates anemia (normal: 11.1 to 15.7 g/dl [111 to 157 g/l]). Awake, alert, and oriented is a normal finding.Lungs that are clear to auscultation is a normal finding.An oxygen saturation of 98% on room air is a normal finding (normal: 95% to 100%).

An 8-year-old child is receiving end-of-life care for a terminal illness. The nurse observes that the caregivers are sitting nervously at the side of the room. What suggestion(s) will the nurse make to the caregivers to support the needs of the child? Select all that apply. Turn on the ceiling lights. Play quiet music. Speak softly to the child. Gently touch or hold the child's hand. Apply lip balm to the child's lips.

The caregivers can be encouraged to play quiet music and to speak softly to the child, as hearing remains as one of the final senses at the end of life. Gentle touch and hand-holding are also felt by the child. The lips are often dry at the end of life, and the caregiver can apply lip balm to moisturize. Ceiling lights are typically bright and should be avoided when possible. A lamp is preferred.

The nurse is assessing a child who has been injured. What assessment finding would support the need to initiate a notification to the abuse registry so that child protection specialists can investigate? The child and parent have conflicting stories on what caused the injury. The child has a greenstick fracture. There is bruising to various parts of the body after reported fall from a swing. The child and both parents' descriptions of the accident are the same.

The child and parent have conflicting stories on what caused the injury. Explanation: Conflicting descriptions of the event or how the injuries occurred is a hallmark sign of maltreatment. Nurses are mandated to report child maltreatment. Bruising to multiple parts of the body may occur with accidents. Greenstick fractures are fractures in which the bone is not completely broken; these fractures are not always associated with maltreatment.

The nurse knows that which statement is a description of peritoneal dialysis when compared to hemodialysis: The child can live a more normal lifestyle. The child must go into a facility to get peritoneal dialysis. There are strict diet and fluid restrictions. Therapy is only 3 to 4 days per week.

The child can live a more normal lifestyle. Explanation: The child can live a more normal lifestyle with peritoneal dialysis. This is a 7-day-a-week procedure, but there are less diet restrictions and more freedom with this type of procedure. Peritoneal dialysis can be performed at home.

What is an example of impaired adaptive functioning in an 8-year-old girl with a developmental disorder? The child cannot properly dress herself. The child cannot correctly copy a sentence. The child cannot correctly copy a phone number. The child's vision is fine but she is a poor reader.

The child cannot properly dress herself. Explanation: A child with impaired adaptive functioning would not be able to dress herself properly, if at all. The inability to copy a phone number or sentence, or to read well, reflects learning disorders.

Which sign or symptom suggests that a 5-year-old child who does not maintain eye contact or speak may have autism spectrum disorder (ASD)? The child is highly active and inattentive. The child has a slight decrease in head circumference. The child constantly pats his or her legs. The child has a long face and prominent jaw.

The child constantly pats his or her legs. Explanation: Repetitive motor mannerisms such as the child constantly patting his or her legs are a typical behavior pattern for autism spectrum disorder. Typical behavior for these children is repetitive activity. They demonstrate bizarre motor and stereotypic behaviors. A high level of activity and inattentiveness are typical symptoms of cognitive impairment. A decrease in head circumference suggests malnutrition or decelerating brain growth. A long face and prominent jaw are symptoms of Fragile X syndrome.

A nurse is promoting vaccine administration. When instructing on the physiological changes, which statement best explains what occurs in the child when vaccines are administered? The child develops a passive immunity. The child becomes a host for the disease. The child becomes a carrier of the disease. The child develops an active immunity.

The child develops an active immunity. Explanation: When a vaccine is given, active immunity occurs which then stimulates the development of antibodies to destroy infective agents without causing the disease.

A pediatric client is scheduled for an intravenous pyelogram (IVP) of the kidney this afternoon. Which situation would require immediate attention by the nurse? The child is diapered. The child's appetite is poor. The child does not have intravenous access. The child is unable to ambulate.

The child does not have intravenous access. Explanation: An intravenous pyelogram is an X-ray study of the upper urinary tract in which a radio opaque dye is injected into a peripheral vein, requiring intravenous access. The other choices are not a priority for this client. Reference:

The location of the kidneys in the child in relationship to the location of the kidneys in the adult makes which fact a greater likelihood in the child? The child has a greater risk for trauma to the kidney. The child has more frequent urges to empty the bladder. The adult has less fat to cushion the kidney. The adult has a greater chance of retaining fluids than the child.

The child has a greater risk for trauma to the kidney. Explanation: The kidneys in children are located lower in relationship to the ribs than in adults. This placement and the fact that the child has less of a fat cushion around the kidneys cause the child to be at greater risk for trauma to the kidneys. The location of the kidneys does not affect the urges to empty the bladder nor the retaining of fluids.

The location of the kidneys in the child in relationship to the location of the kidneys in the adult makes which fact a greater likelihood in the child? The child has more frequent urges to empty the bladder. The child has a greater risk for trauma to the kidney. The adult has a greater chance of retaining fluids than the child. The adult has less fat to cushion the kidney.

The child has a greater risk for trauma to the kidney. Explanation: The kidneys in children are located lower in relationship to the ribs than in adults. This placement and the fact that the child has less of a fat cushion around the kidneys cause the child to be at greater risk for trauma to the kidneys. The location of the kidneys does not affect the urges to empty the bladder nor the retaining of fluids.

A caregiver brings her 7-year-old son to the pediatrician's office, concerned about the child's bedwetting after being completely toilet trained even at night for over 2 years. The caregiver further reports that the child has wet the bed every night since returning home from a 1-week fishing trip. The child refuses to talk about the bedwetting. The nurse notes the child is shy, skittish, and will not make eye contact. Further evaluation needs to be done to rule out what possible explanation for the bedwetting? The child has been sexually abused, maybe on the fishing trip. The child has a urinary tract infection due to not bathing while on the fishing trip. The child is out of the habit of waking himself up during the night to void. The child did not want to go on the fishing trip and is now retaliating against being made to go.

The child has been sexually abused, maybe on the fishing trip. Explanation: Enuresis may have a physiologic or psychological cause and may indicate a need for further exploration and treatment. Enuresis in the older child may be an expression of resentment toward family caregivers or of a desire to regress to an earlier level of development to receive more care and attention. Emotional stress can be a precipitating factor. The health care team also needs to consider the possibility that enuresis can be a symptom of sexual abuse. Bruising, bleeding, or lacerations on the external genitalia, especially in the child who is extremely shy and frightened, may be a sign of child abuse (child mistreatment) and should be further explored.

A child with severe diarrhea cannot drink and requires intravenous rehydration. After beginning the therapy, the nurse determines that potassium can be added to the intravenous fluid because which of the following has occurred? The child is now vomiting. The child has voided. The child's stool is becoming soft. The child has dry mucous membranes.

The child has voided. Explanation: Potassium cannot be given until it is established that the child is not in renal failure. Giving potassium IV when the body has no outlet for excessive potassium can lead to excessively high potassium levels and heart block. Before initial IV fluid is changed to a potassium solution, the nurse must be certain that the infant or child has voided—proof that the kidneys are functioning.

The nurse is caring for a school-aged child hospitalized with an infectious disease. The child is placed on transmission-based precautions. What would the nurse include in the plan of care? Select all that apply. Permit the immediate family to avoid wearing the gown and mask during visits in the room. Provide the child with age-appropriate games and toys for his or her room. Plan for extra time to visit the child throughout the shift between assessments and procedures. Monitor the child for changes in mood or level of aggression. Allow the child to view the staff's face through the door window before entering the room. Encourage the parents to contact friends and classmates so cards can be sent and displayed.

The child in transmission-based isolation may experience feelings of isolation and sensory deprivation because of restricted visiting and the use of personal protective gear (gown, mask and gloves) by those in the child's hospital room. The use of age appropriate toys and games dedicated to the child's room, extra time spent with the child by staff, the display of cards from friends and classmates, and allowing the child to view staff members' faces from outside the room all promote sensory stimulation and lessen the feeling of isolation. The family would be taught to follow the same precautions as the staff. Sensory overload is not a concern for a child in transmission-based precautions.

What finding would suggest that a 5-year-old boy might have a developmental disorder? The child knows what a dog and a cat sound like. The child is not able to follow directions. The child must be supervised when brushing his teeth. The child has trouble with R, L, and Y sounds.

The child is not able to follow directions. Explanation: A 5-year-old child should be able to follow simple directions. If he is unable to do this, he has not yet achieved a developmental milestone. Brushing his teeth with supervision and knowing cat and dog sounds are normal for this age. Having trouble with R, L, and Y sounds is not unusual and may continue until age 7.

The nurse is reinforcing dietary teaching with the caregiver of a child diagnosed with celiac syndrome. Which foods would be permitted in the diet of the child with celiac syndrome? Select all that apply. wheat bread skim milk bananas applesauce rye bread

The child is usually started on a gluten-free, low-fat diet. Skim milk and bananas are usually well tolerated. Lean meats, puréed vegetables, and fruits are gradually added to the diet. Wheat, rye, and oats (unless specifically gluten free) are not included in the diet.

In collecting data on a 7-year-old child with a possible diagnosis of school phobia, the nurse directs questions related to the following topics. Which would most likely be a cause of the child having school phobia? The child may be bored and feels more intellectually stimulated at home. The child may have a language barrier. The child may have a fear of being separated from the parent. The child may be a poor student and be afraid of failing grades.

The child may have a fear of being separated from the parent. Explanation: School-phobic children may have a strong attachment to one parent, usually the mother, and they fear separation from that parent, perhaps because of anxiety about losing her or him while away from home. Being a poor student and worrying about grades would be more common in the later school age and adolescence. A child may be anxious about language but that is generally not enough to cause phobias. If the child is bored at school the parents should ask to meet the teacher and define the child's needs. Many children need extra stimulation but that is not the same as having a phobia.

A 9-year-old child with Graves disease is seen at the pediatrician's office reporting sore throat and fever. The nurse notes in the history that the child is taking propylthiouracil. Which of the following would concern the nurse? The child may not be taking the medication. The child must be participating in sports. The child needs to be started on an antibiotic drug. The child may have developed leukopenia.

The child may have developed leukopenia. Explanation: Graves disease is defined as an overproduction of thyroid hormones. Propylthiouracil is used to suppress thyroid function. A complication of Graves disease is leukopenia.

The nurse is collecting data for a child diagnosed with acute glomerulonephritis. What would the nurse likely find in this child's history? The child had a congenital heart defect. The child is being treated for asthma. The child recently had an ear infection. The child has a sibling with the same diagnosis.

The child recently had an ear infection. Explanation: In the child with acute glomerulonephritis, presenting symptoms appear 1 to 3 weeks after the onset of a streptococcal infection, such as strep throat, otitis media, tonsillitis, or impetigo. There is not a family history of the disorder, a history of congenital concerns or defects, nor asthma in children with acute glomerulonephritis.

The nurse is working with school-aged children who are having enuresis or encopresis. What will most likely be the first step in this child's treatment? The child will be given a strict daily schedule. The child will be taken to a therapist. The child will be given medications. The child will have a complete physical exa

The child will have a complete physical exam. Explanation: The child with enuresis or encopresis may have a physiologic or psychological cause and may indicate a need for further exploration and treatment. A complete physical exam and assessment is done first to rule out any physical cause.

Which goal of therapy would be appropriate for a nurse to establish with a client's family and a client who has a diagnosis of enuresis? The child wakes up once during the night for a glass of water. The client remains continent throughout the night. The parent takes the client to the bathroom at night. The client wets only when involved in an activity.

The client remains continent throughout the night. Explanation: The goal of therapy is for the client to be continent of urine throughout the night. The nurse should encourage the child to awaken and void and not have any fluids before bedtime. During an activity, the child should be encouraged to void before and after the activity to prevent incontinence.

Which goal of therapy would be appropriate for a nurse to establish with a client's family and a client who has a diagnosis of enuresis? The parent takes the client to the bathroom at night. The client remains continent throughout the night. The client wets only when involved in an activity. The child wakes up once during the night for a glass of water.

The client remains continent throughout the night. Explanation: The goal of therapy is for the client to be continent of urine throughout the night. The nurse should encourage the child to awaken and void and not have any fluids before bedtime. During an activity, the child should be encouraged to void before and after the activity to prevent incontinence.

A nurse in the emergency department (ED) is assessing a 2-year-old male child. The parents state the child "has been very feverish the past few days, and today the child developed a purple rash on the chest. The child is now very sleepy." Click to highlight the findings that will require immediate follow-up. The assessment reveals the child is lethargic but opens eyes and answers yes and no to questions. The child is unable to lie with hips flexed and straighten the leg out , and states their neck hurts when trying to move it. Vital signs: temperature, 102.4°F (39.1°C) ; heart rate, 120 beats/min; blood pressure, 78/45 mm Hg; respirations, 28 breaths/min ; oxygen saturation, 92% on room air .

The client's temperature of 102.4°F (39.1°C) indicates a fever. This will require the nurse to follow up to determine the underlying cause for the fever. A purple (purpuric) rash appearing during a febrile state requires follow-up, because it may indicate meningitis. The child reporting a stiff neck may indicate meningeal irritation. The child's inability to straighten the leg when lying flat with hips flexed indicates meningeal irritation; it is referred to as a positive Kernig sign. Lethargy indicates decreased level of consciousness; the nurse should closely monitor the child's level of consciousness. The child's oxygen saturation of 92% on room air indicates decreased oxygen levels. The child's blood pressure of 78/45 mm Hg and respiratory rate of 28 breaths/min are within normal range for a 2-year-old child.

A young girl arrives at the emergency room after being bitten by a neighbor's dog. The mother is concerned her daughter will get rabies. The nurse carefully examines and treats the bite and questions the mother and daughter about the details surrounding the dog biting her. What information would most strongly indicate a risk for rabies infection in this client? The dog was properly immunized for rabies The dog belonged to a neighbor There have been no other reported instances in the area The dog was unprovoked when he bit the girl

The dog was unprovoked when he bit the girl Explanation: An unprovoked attack is much more suggestive that the animal is rabid, rather than if the bite happens during a provoked attack. The dog being immunized for rabies and there being no other reported instances of rabies in the area would indicate a lower risk that the dog was rabid. The fact that the dog belonged to a neighbor does not necessarily indicate a lower risk for rabies infection.

A nurse is providing care to a child with a depressed skull fracture. The child has fluid draining from the nose. The nurse confirms the fluid is cerebrospinal fluid based on which finding? The fluid is light yellow in color. The fluid is thick with red specks. The fluid is clear and watery. The fluid tests positive for glucose.

The fluid tests positive for glucose. Explanation: To confirm if the fluid is CSF or rhinitis from nasal secretions, the nurse would test the fluid with a glucose reagent strip. CSF will test positive for glucose, whereas the clear, watery drainage from an upper respiratory tract infection or allergy will not. The color of the fluid does not confirm if it is CSF. Cerebrospinal fluid is thin and watery, not thick.

A nurse is providing discharge teaching to the parent of a child hospitalized after experiencing respiratory arrest. The parent expresses concerns about the child's well-being. Which action(s) is appropriate for the nurse take? Select all that apply. Review signs and symptoms of respiratory distress with the parent. Reinforce when the health care provider should be called. Encourage the parent to discuss specific concerns about the child. Reassure the parent that the child's infection has been cured. Tell the parent that the child's provider will address any concerns during the follow-up visit.

The most appropriate actions would be for the nurse to reinforce signs and symptoms of respiratory distress, and when the health care provider or 911 should be called. The nurse should also encourage the parent to share specific concerns about the child and address them at that moment instead of delaying until the follow-up visit. Providing reassurance that the respiratory infection has been cured does not address the parent's expressed concerns.

A nurse is providing discharge teaching to the parent of a child hospitalized after experiencing respiratory arrest. The parent expresses concerns about the child's well-being. Which action(s) is appropriate for the nurse take? Select all that apply. Tell the parent that the child's provider will address any concerns during the follow-up visit. Review signs and symptoms of respiratory distress with the parent. Reinforce when the health care provider should be called. Encourage the parent to discuss specific concerns about the child. Reassure the parent that the child's infection has been cured.

The most appropriate actions would be for the nurse to reinforce signs and symptoms of respiratory distress, and when the health care provider or 911 should be called. The nurse should also encourage the parent to share specific concerns about the child and address them at that moment instead of delaying until the follow-up visit. Providing reassurance that the respiratory infection has been cured does not address the parent's expressed concerns.

The nurse is discussing urinary tract infections (UTI's) in children with a group of peers. Which fact is the most accurate regarding urinary tract infection seen in children? Girls who have gone through puberty most commonly get UTIs. Males between the ages of 10 to 12 years of age commonly get UTIs. The most common age for UTIs in children is 2 to 6 years of age. Urinary tract infections are rarely seen after toilet training

The most common age for UTIs in children is 2 to 6 years of age. Explanation: Urinary tract infections (UTIs) are fairly common in the "diaper age," in infancy, and again between the ages of 2 and 6 years. Older school-aged and adolescent girls are not as prone to UTIs.

The nurse is discussing urinary tract infections (UTI's) in children with a group of peers. Which fact is the most accurate regarding urinary tract infection seen in children? Males between the ages of 10 to 12 years of age commonly get UTIs. Urinary tract infections are rarely seen after toilet training. The most common age for UTIs in children is 2 to 6 years of age. Girls who have gone through puberty most commonly get UTIs.

The most common age for UTIs in children is 2 to 6 years of age. Explanation: Urinary tract infections (UTIs) are fairly common in the "diaper age," in infancy, and again between the ages of 2 and 6 years. Older school-aged and adolescent girls are not as prone to UTIs. Reference:

An emergency department nurse is caring for a 5-year-old child who was just brought in by ambulance with partial-thickness (second-degree) and full-thickness (third-degree) burns to their face, neck, and chest. The client is awake and alert. Vital signs: temperature, 97.2°F (36.2°C); heart rate, 148 beats/min; blood pressure, 68/39 mm Hg; respiratory rate, 32 breaths/min; oxygen saturation, 90% on 2 liters by nasal cannula. The nurse receives prescriptions for the client. Click to highlight the prescription(s) that requires immediate implementation. Prescriptions: Apply oxygen to maintain oxygen saturations 95% or greater. Administer 100 mcg/kg morphine via intravenous push (IVP) for pain prn q4 hour. Initiate fluid resuscitation per Lund and Browder chart using Parkland formula with 0.9% saline. Administer acetaminophen by mouth (PO) 325 mg q6h prn for fever. Initiate a regular diet as tolerated.

The nurse applies oxygen to maintain an oxygen saturation of 95% or greater. The nurse will need to monitor the child's airway closely because the burns are on the chest and neck.Partial-thickness (second-degree) burns are very painful. The nurse administers 100 mcg/kg morphine via intravenous push (IVP) for pain prn q4 hours.Fluid resuscitation is implemented promptly to prevent shock. Fluid resuscitation for children is determined using the Lund and Browder chart and Parkland formula. Because the child sustained burns to the neck and chest, the nurse would not administer anything by mouth including medications such as acetaminophen PO 325 mg q6h prn for fever or a regular diet as tolerated.

An adolescent comes to the clinic reporting a sore throat and chills. The nurse suspects that the adolescent has infectious mononucleosis. Which instruction(s) will the nurse provide to this adolescent? Select all that apply. Eat soft, nonirritating foods. Rest and sleep when possible. Take acetaminophen for fever and pain. Sleep in a high Fowler position. Increase acidic fluid intake.

The nurse is correct to instruct on minimizing the symptoms of mononucleosis. Common pain relievers such as acetaminophen or nonsteroidal anti-inflammatory agents ease the symptoms of the disease. Resting and increasing the amount of sleep help to decrease fatigue. Eating soft and nonirritating foods decreases throat pain. The adolescent should drink cool, nonacidic fluids. There is no benefit to sleeping in a high Fowler position. A semi-Fowler position or lower is most comfortable depending on airway status.

When caring for a child who has a history of seizures, which nursing interventions would be appropriate? Select all that apply. The nurse positions the child on the side during a seizure. The nurse has oxygen available to use during a seizure. The nurse stays with the child and calls for help when a seizure begins. The nurse pads the crib or side rails before a seizure. The nurse teaches the caregivers regarding seizure precautions. The nurse places a washcloth in the mouth to prevent injury during seizure.

The nurse should pad the crib sides and keep sharp or hard items out of the crib. The nurse should also position the child to one side to prevent aspiration of saliva or vomitus and have oxygen and suction equipment readily available for emergency use. The nurse should teach family caregivers seizure precautions so they can handle a seizure that occurs at home. The nurse should not put anything in the child's mouth; doing so could cause injury to the child or to the nurse. It is important for the nurse to promptly inform other members of the care team when a child is experiencing seizure activity, but leaving the bedside to do so would be unsafe.

A nurse on a pediatric unit finds a 3-year-old child unconscious. The child does not respond to stimuli. The nurse calls a code and starts to perform cardiopulmonary resuscitation (CPR). Complete the following sentence(s) by choosing from the lists of options. The nurse should first address the child's Select...breathinglevel of consciousnessperfusionairwaySelect... followed by the child's Select...perfusionbreathinglevel of consciousnessairwaySelect..., then Select...breathinglevel of consciousnessperfusionairwaySelect....

The nurse should prioritize care based on the ABCs (airway, breathing, then circulation), especially with children because respiratory arrest is most often caused choking. The nurse must ensure a patent airway first.Breathing is addressed after airway.Perfusion or circulation is addressed after airway and breathing. Level of consciousness is assessed after the ABCs and prior to initiating cardiopulmonary resuscitation (CPR).

Parents bring their 9-year-old child to the clinic for a well-child visit. They are concerned because several children in the neighborhood have developed Lyme disease and ask for suggestions on what to do to reduce their child's risk. What would be appropriate for the nurse to suggest? Select all that apply. Dressing the child in dark clothing when going outdoors. Contacting the health care provider if there is any area of inflammation that might be a bite. Inspecting the skin closely for ticks after the child plays in wooded areas. Removing ticks by rubbing them away from the skin with a credit card. Wearing protective clothing when playing in wooded areas.

The nurse should teach the parents to have the child wear protective clothing and dress the child in light clothing when playing in wooded areas or going outdoors. The parents should inspect the child's skin closely for ticks after being outside in wooded areas and if any ticks are found, remove them with a tweezer, not rub them with a credit card. The parents also should be instructed to contact their health care provider if they notice any area of inflammation that might be a tick bite.

The nurse has been providing support to a family facing the imminent death of their child. How does the nurse know this intervention has been successful? Siblings express concern that the child not suffer during death. The parents use the internet to research possible cures for their child. The child remains comfortable after receiving pain medication. The parents agree to donate their child's organs after passing away.

The parents agree to donate their child's organs after passing away. Explanation: Many parents are able to cope by searching for the meaning of life or death in philosophical, spiritual, or religious terms. For these parents, body organ donation may be a meaningful way to give themselves some solace that their child will in some way continue to live and contribute to others. Researching information about the child's illness may be helpful, but continuing to look for a cure is a form of denial. Siblings are often involved in the care of a dying child, but expressing concern about suffering shows that they need further information. Physical comfort is important during the dying process, but it does not show that parents are coming to terms with the child's imminent death.

The nurse is assessing a 13-year-old boy with type 2 diabetes mellitus. What would the nurse correlate with this disorder? Auscultation reveals Kussmaul breathing. Blood pressure is decreased when checking vital signs. The parents report that their child had "a cold or flu" recently. The parents report that their son "can't drink enough water."

The parents report that their son "can't drink enough water." Explanation: Unquenchable thirst (polydipsia) is a common finding associated with diabetes mellitus, type 1 and 2. However, reports of flu-like illness and Kussmaul breathing are more commonly associated with type 1 diabetes. Blood pressure is normal with type 1 diabetes and elevated with type 2 diabetes.

A child is brought to the emergency center after sustaining a seizure at home. When taking the child's history, which question(s) would the nurse ask the parents? Select all that apply. "How long did the seizure last?" "Can you describe to me the movements your child experienced?" "What time did the seizure occur?" "Did your child lose bladder or bowel control?" "Did your child stop breathing during the seizure?" "Did you give your child any fever medicine prior to the seizure?"

There are many types of seizures. After a child has experienced a seizure, it is helpful to know the details as much as possible so these can aid in the diagnosis. The health history becomes very important to gather this information. The nurse would obtain information from the parents as to the time the seizure occurred and note how long the seizure lasted. The parents could supply a description of the child's behavior during the seizure. This would include a description of the child's movements, any loss of bowel or bladder control, if the child became cyanotic, or any other characteristics the parents observed. The nurse would also ask the parents about any precipitating events before the seizure occurred such as a fever, a fall, anxiety, or exposure to strong stimuli. Giving an antipyretic medication to the child would not interfere with the seizure.

What occurs in the gastrointestinal system of the child with Hirschsprung disease? There is a severe narrowing of the lumen of the pylorus. There is an invagination or telescoping of one portion of the bowel into a distal portion. There is a relaxed sphincter in the lower portion of the esophagus. There is a partial or complete mechanical obstruction in the intestine.

There is a partial or complete mechanical obstruction in the intestine. Explanation: Congenital aganglionic megacolon, also called Hirschsprung disease, is characterized by persistent constipation resulting from partial or complete intestinal obstruction of mechanical origin. A narrowing of the lumen of the pylorus is associated with pyloric stenosis in young infants. The telescoping of the bowel is intussusception. The relaxed sphincter in the lower portion of the esophagus is related to gastrointestinal reflux disorder.

A child is being evaluated for an autism spectrum disorder. The parents question how their child could possibly have "caught" this disorder. What information should the nurse provide? Select all that apply. "Autism spectrum disorders are thought to be the result of a bacterial infection that attacks the brain." "Viral illness theories are supported by some researchers." "Most research point to immunizations given in infancy." "There are various theories about how it develops." "Some scientists support genetic connections."

There is no theory fully supported by all researchers and health care providers about the exact cause of autism spectrum disorders. Autism spectrum disorders are traditionally diagnosed early in childhood. The causes that are strongly considered at this time include viral infection, genetic factors, and biochemical factors. Researchers do not support ties to immunizations and bacterial infections.

A child is having the urine checked for a routine well visit. When analyzing the results, what would positive leukocytes indicate? This may indicate a urinary tract infection. This determines the presence of red blood cells in the urine. This indicates renal disease. This determines the presence of sugar in the urine.

This may indicate a urinary tract infection. Explanation: A leukocyte is a white blood cell and is normally not present in the urine. Positive leukocytes may indicate a urinary tract infection. Red blood cells in the urine equate to bleeding. Glucose in the urinalysis would be identified as such and may be a concern for diabetes. Urine that is positive for leukocytes would also need to be cultured to determine the type and amount of bacteria growth so the appropriate antibiotic can be administered.

The nurse is assessing a 6-year-old with attention deficit/hyperactivity disorder (ADHD). The nurse observes the boy making repeated clicking noises and notes he has a slight grimace. The nurse recommends the boy receive further evaluation for: Tourette syndrome. Asperger syndrome. autism spectrum disorder. anxiety disorder.

Tourette syndrome. Explanation: Repeated vocal tics such as sniffling, grunting, clicking, or word utterances are associated with Tourette syndrome. The syndrome consists of multiple motor tics and one or more motor tics occurring simultaneously at different times. ADHD and obsessive-compulsive disorder occur in 90% of children with Tourette syndrome. Vocal and motor tics are not typical indicators of Asperger syndrome, anxiety disorder, or autism spectrum disorder.

During a well-child visit, the nurse assesses an infant's ability to suck on a pacifier. The nurse is assessing which cranial nerve? Accessory Trigeminal Facial Olfactory

Trigeminal Explanation: To test the trigeminal nerve, the nurse would note the strength of the infant's suck on a pacifier, thumb, or bottle. The olfactory nerve is not assessed in infants and young children. The facial nerve is assessed by noting the symmetry of facial expressions. For the infant, this would be assessed during spontaneous crying or smiling. The accessory nerve is assessed when the infant is in the sitting position and symmetry of the head position is noted.

A 6-year-old boy has a moon-face, stocky appearance but with thin arms and legs. His cheeks are unusually ruddy. He is diagnosed with Cushing syndrome. What is the most likely cause of this condition in this child? Tumor of the pancreas Tumor of the thyroid Tumor of the parathyroid Tumor of the adrenal cortex

Tumor of the adrenal cortex Explanation: Cushing syndrome is caused by overproduction of the adrenal hormone cortisol; this usually results from increased ACTH production due to either a pituitary or adrenal cortex tumor. The peak age of occurrence is 6 or 7 years. The overproduction of cortisol results in increased glucose production; this causes fat to accumulate on the cheeks, chin, and trunk, causing a moon-faced, stocky appearance. Cortisol is catabolic, so protein wasting also occurs. This leads to muscle wasting, making the extremities appear thin in contrast to the trunk, and loss of calcium in bones (osteoporosis). Other effects include hyperpigmentation (the child's face is unusually red, especially the cheeks).

A child presents to the primary care setting with enuresis, nocturia, increased hunger, weight loss, and increased thirst. What does the nurse suspect? Hypothyroidism Syndrome of inappropriate diuretic hormone Diabetes insipidus Type 1 diabetes mellitus

Type 1 diabetes mellitus Explanation: Signs and symptoms of type 1 diabetes mellitus include polyuria, polydipsia, polyphagia, enuresis, and weight loss.

Which findings should the nurse expect to assess when completing the health history of a child admitted for possible type 2 diabetes? Select all that apply. Abrupt onset of symptoms Polyuria Polyphagia Marked weight loss Polydipsia

Type 2 diabetes mellitus is characterized by a gradual onset and is most often associated with obesity and not marked weight loss. Type 1 diabetes is most often abrupt and associated with marked weight loss. Polyuria, polydipsia, and polyphagia are frequent assessment findings in both types of diabetes mellitus.

The nurse is educating the parents of a 7-year-old girl with epilepsy about managing treatment of the disorder at home. Which intervention is most effective for eliminating breakthrough seizures? Instructing her teacher how to respond to a seizure Understanding the side effects of medications Treating the child as though she did not have epilepsy Placing the child on her side on the floor

Understanding the side effects of medications Explanation: The most common cause of breakthrough seizures is noncompliance with medication administration, which may occur if the parents do not understand what side effects to expect or how to deal with them. Treating the child as though she did not have epilepsy helps improve her self-image and self-esteem. Placing the child on her side on the floor is an intervention to prevent injury during a seizure. Instructing the teacher on how to respond when a seizure occurs will help relieve anxiety and provide a sense of control.

A 5-year-old girl catches the flu from a friend at day care after the friend sneezed and wiped mucus on a toy that the girl subsequently played with. In this case, what is the portal of exit in the chain of infection? The friend The 5-year-old girl Upper respiratory excretion Toy

Upper respiratory excretion Explanation: The portal of exit is the route by which an organism leaves an infected child's body to be spread to others. An organism can be carried out of the body by upper respiratory excretions, feces, vomitus, saliva, urine, vaginal secretions, blood, or lesion secretions. The friend would be the reservoir, which is the container or place in which an organism grows and reproduces. The toy would be the means of transmission. The 5-year-old girl would be the susceptible host.

An infant on the pediatric floor has diabetes insipidus. Which assessment data are important for the nurse to monitor while the infant is on strict fluid precautions? Temperature and heart rate Urine output Oral intake Color of mucous membranes

Urine output Explanation: An infant with diabetes insipidus has a decrease in antidiuretic hormone. Strict fluid precautions will not alter urine formation. This assessment is important because the infant will be at great risk for dehydration and electrolyte imbalance. It is part of a basic assessment to monitor heart rate, temperature, skin turgor, and mucous membranes. These are important but may not indicate the infant's overall health. On fluid restriction, oral intake will be specified.

A 15-year-old girl is brought to the clinic by her mother because the girl has been experiencing irregular and sporadic menstrual periods and excessive body hair growth. Polycystic ovary syndrome is suspected. Which additional assessment finding would help to support this suspicion? Darkened pigmentation around the neck area Body mass index as normal Short stature Decreased serum levels of free testosterone

Urine output Explanation: An infant with the diagnosis of diabetes insipidus has decreased secretion of antidiuretic hormone (ADH). The infant is at risk for dehydration so monitoring urinary output is the most important intervention. The child's oral intake has been ordered. Monitoring a child who is under fluid restriction includes assessing the oral mucosa; however, urine output is the most important assessment for this patient. Vital signs are part of a basic assessment.

A nurse is taking care of an infant with diabetes insipidus. Which assessment data are most important for the nurse to monitor while the infant has a prescription for fluid restriction? Vital signs Oral intake Urine output Oral mucosa

Urine output Explanation: An infant with the diagnosis of diabetes insipidus has decreased secretion of antidiuretic hormone (ADH). The infant is at risk for dehydration so monitoring urinary output is the most important intervention. The child's oral intake has been ordered. Monitoring a child who is under fluid restriction includes assessing the oral mucosa; however, urine output is the most important assessment for this patient. Vital signs are part of a basic assessment.

A 4-year-old child is hospitalized for a new diagnosis of type 1 diabetes. When the nurse enters the room to assess the blood glucose, the client yells "No needles, go away!" How should the nurse respond? Tell the child that there are no needles needed today. Use a calm and consistent approach with the child. Send a different nurse in to assess the blood glucose. Provide a treat to the child after the glucometer testing.

Use a calm and consistent approach with the child. Explanation: A child with a chronic illness may associate the nurse with the pain from interventions such as injections. The nurse should use a calm and gentle approach with the child to reduce the stress of the glucose assessment and to support the development of a positive relationship. The nurse should not lie about the need for needles or provide a treat for the testing. Sending a different nurse does not solve the challenge of the association of nurses with pain.

Parents report that their child has been vomiting for the past several hours. The nurse determines that the parents' terminology is accurate when they describe the vomiting in which manner? Select all that apply. "It is really sour and curdled." "It seems to be quite forceful." "It seems to occur with feedings." "The amount is about 1 to 2 teaspoons at a time." "He seems to cry just before it occurs."

Vomiting needs to be distinguished from regurgitation. Vomiting is unrelated to feeding, forceful, often projected 1 foot away from the infant, extremely sour smelling, and curdled in appearance. The infant may cry just before vomiting, as if abdominal pain is present, and after vomiting, as if the force of action is frightening. Vomiting continues until the stomach is empty and is followed by dry retching. The amount typically involves the full contents of the stomach. Regurgitation occurs with feeding, runs out of the mouth with little force, smells barely sour, is only slightly curdled, is non-painful, and occurs once per feeding. Regurgitation typically averages about 1 to 2 teaspoons.

plan of care? Weighing on the same scale each day Increasing fluid intake by 50 ml per hour Testing the urine for glucose levels regularly Ambulating 3 to 4 times a day

Weighing on the same scale each day Explanation: The child with nephrotic syndrome is weighed every day using the same scale to accurately monitor the child's fluid gain and loss. The child with nephrotic syndrome is very edematous so increasing fluid intake would be counterproductive to care needed. In nephrotic syndrome the urine is tested for protein, not glucose. Ambulation is important for all but it is not specific to the child with nephrotic syndrome.

A nurse correctly identifies which data as needing to be obtained from an injured child in relation to his or her respiratory status? Select all that apply. Skin color Pulse rate Rate of respirations Sound of obstruction Quality of respirations

When a child is assessed for respiratory distress it is important to first establish there is airway patency. Then assess by "Look, Listen, Feel" — is the chest rising, is there air escaping, is there air movement out of the nose and mouth. This quick assessment should be followed by assessing the quality of the respirations, the rate of respirations, color of the skin, the depth of respirations, and chest rise. The nurse should also assess for the adequacy of airflow in the lungs and for adventitious breath sounds. Pulse is assessed with the cardiovascular/circulatory system.

The nurse is caring for a child with a suspected head injury. The nurse observes for what response to the child's eye reflex examination that would indicate potential increased intracranial pressure (ICP)? While assessing the child's pupils, there is no change in diameter in response to a light. While stimulating the child's foot, the big toe points upward and other toes fan outward. While calling the child's name, the child stares straight ahead and does not turn to the sound. While turning the child's head to the left, the eyes turn to the right.

While assessing the child's pupils, there is no change in diameter in response to a light. Explanation: To perform the child's eye reflex examination, the nurse will shine a penlight into the eyes and observe if the pupils constrict, which is a normal response. Lack of pupillary light reflex can indicate increased intracranial pressure (ICP). To perform the "doll's eye" reflex examination, the nurse will place the child in a supine position and move the head gently but rapidly to one side. During this movement, it is normal for the child's eye to move to the opposite side. If the child has increased ICP, this response will be absent. While the other options are potential signs of increased ICP, they do not demonstrate the child's eye reflex examination.

The nurse is observing a group of 2- and 3-year-olds in a play group. Which behavior noted in one of the children indicates to the nurse that the child may have autism spectrum disorder (ASD)? A child flips the light switch off and on until the caregiver asks her to stop and join the other children in playing. While the other children are eating a snack, the child walks around the room feeling the walls and ignores the caregiver who offers him a snack. A child playing in the kitchen area pretends to pour a glass of milk and repeats this over and over. After another child takes a toy, the child cries and stomps his feet.

While the other children are eating a snack, the child walks around the room feeling the walls and ignores the caregiver who offers him a snack. Explanation: Children with ASD become completely absorbed in strange repetitive behaviors such as spinning an object, flipping an electrical switch on and off, or walking around the room feeling the walls. If these movements are interrupted or if objects in the environment are moved, a violent temper tantrum may result. These tantrums may include self-destructive acts such as hand biting and head banging. Although infants and toddlers normally are self-centered, ritualistic, and prone to displays of temper, autistic children show these characteristics to an extreme degree coupled with an almost total lack of response to other people.

The parents of a 10-month-old child bring the infant to the emergency department after finding the infant face down in the bathtub. The parent states, "I just left the bathroom to answer the phone." Which assessments are priority for the nurse to complete? Select all that apply. airway sgns of child abuse (child mistreatment) circulation respiratory status level of consciousness pupillary response vital signs

With a submersion injury, hypoxia is the primary problem. Therefore, assessment of the airway, breathing, and circulation (ABCs) are the primary assessments the nurse will complete. These guide implementation of resuscitative measures. Other assessments such as level of consciousness, vital signs, and pupillary response would be done once the child is stable. The nurse would also perform a complete assessment, looking for signs of child abuse (child mistreatment) once the child is stable.

Which child will the nurse identify as at greatest risk for developing a urinary tract infection? an 8-month-old bottle-fed female with HIV a 6-month-old breastfed female a 2-year-old male with otitis media a 1-year-old formula-fed male

a

Which child will the nurse identify as being at greatest risk for developing a hospital-acquired infection (HAI)? an 18-month-old child receiving chemotherapy over 5 days a 2-year-old child with HIV being discharged later that day a 3-year-old child with malnutrition and poor weight gain a 1-year-old receiving oral amoxicillin for otitis media

a

A nurse is educating the family of a small child with phenylketonuria about meal choices. Which meal choice by the parents indicates to the nurse that they understand the dietary management of this disease? a steak, mashed potatoes, and orange juice a milkshake and a grilled cheese sandwich a bowl of dry cereal with strawberries and apple juice a hamburger and a diet soda sweetened with aspartame

a bowl of dry cereal with strawberries and apple juice Explanation: The nurse is able to evaluate parental understanding of meal choices by having the parent select appropriate meals. The nurse confirms understanding when the parent selects foods low in phenylalanine, which include vegetables, fruits, juices, some breads, and some cereals. Steak and aspartame are high in phenylalanine and should be avoided. Hamburger may have high phenylalanine levels. Dairy products are high in phenylalanine and should be avoided. Mashed potatoes, if made from scratch, and orange juice are acceptable foods.

The nurse is caring for multiple clients on the pediatric unit. Which child will the nurse see first? a child diagnosed with measles experiencing photophobia and coryza a child with erythema infectiosum experiencing fatigue and confusion a child diagnosed with chicken pox reporting nausea and malaise a child with herpes simplex who is reporting mouth pain and pruritis

a child with erythema infectiosum experiencing fatigue and confusion Explanation: A child with erythema infectiosum experiencing fatigue and confusion is showing signs of decreased oxygenation, possibly related to aplasia of erythrocytes caused by the virus. A child with signs and symptoms of decreased oxygenation should be seen first. Nausea and malaise are symptoms of chicken pox. A child with herpes simplex will most likely report pain an pruritis. Signs and symptoms of measles include photophobia and coryza.

The nurse is discussing the treatment for a child with attention deficit hyperactivity disorder (ADHD) with a group of school nurses. What would be an appropriate learning setting for a child with ADHD? a classroom with windows facing a playground a classroom with a plan of study that is followed each day a classroom in which children self-select their activities a classroom with tables and chairs rather than individual desks

a classroom with a plan of study that is followed each day Explanation: For the child with ADHD, the learning situations should be structured so that the child has minimal distractions and a supportive teacher. Special arrangements can be made to provide an educational atmosphere that is supportive for the child without the need for the child to leave the classroom. Having the child with ADHD face the playground would provide the child with too much distraction. Having the child with ADHD select his or her own activities or placing the child at tables instead of an individual desk means the child would not stay on task. Giving the child too many choices only serves to confuse the child and leads to increasing hyperactivity and loss of control.

A client has just been admitted to the unit with a history of recent streptococcal infection, hematuria, and proteinuria. Based on these findings, the nurse suspects which condition? prune belly syndrome acute glomerulonephritis urinary tract infection acute kidney injury

acute glomerulonephritis Explanation: Recent streptococcal infection, hematuria, and proteinuria are indicative of acute glomerulonephritis. These symptoms do not suggest acute kidney injury, prune belly syndrome, or urinary tract infection.

The caregiver of a child with a history of ear infections calls the nurse and reports that her son has just told her his urine "looks funny." He also has a headache, and his mother reports that his eyes are puffy. Although he had a fever 2 days ago, his temperature is now down to 100℉ (37.8℃). The nurse encourages the mother to have the child seen by the care provider because the nurse suspects the child may have: a urinary tract infection. lipoid nephrosis (idiopathic nephrotic syndrome). acute glomerulonephritis. rheumatic fever.

acute glomerulonephritis. Explanation: Acute glomerulonephritis is a condition that appears to be an allergic reaction to specific infections, most often group A beta-hemolytic streptococcal infections such as rheumatic fever. Presenting symptoms appear 1 to 3 weeks after the onset of a streptococcal infection such as strep throat, otitis media, tonsillitis, or impetigo. Usually the presenting symptom is grossly bloody urine. Periorbital edema may accompany or precede hematuria. Fever may be 103℉ to 104℉ (39.4℃ to 40℃) at the onset, but decreases in a few days to about 100℉ (37.8℃). Slight headache and malaise are usual, and vomiting may occur.

The caregiver of a child with a history of ear infections calls the nurse and reports that her son has just told her his urine "looks funny." He also has a headache, and his mother reports that his eyes are puffy. Although he had a fever 2 days ago, his temperature is now down to 100℉ (37.8℃). The nurse encourages the mother to have the child seen by the care provider because the nurse suspects the child may have: a urinary tract infection. rheumatic fever. acute glomerulonephritis. lipoid nephrosis (idiopathic nephrotic syndrome).

acute glomerulonephritis. Explanation: Acute glomerulonephritis is a condition that appears to be an allergic reaction to specific infections, most often group A beta-hemolytic streptococcal infections such as rheumatic fever. Presenting symptoms appear 1 to 3 weeks after the onset of a streptococcal infection such as strep throat, otitis media, tonsillitis, or impetigo. Usually the presenting symptom is grossly bloody urine. Periorbital edema may accompany or precede hematuria. Fever may be 103℉ to 104℉ (39.4℃ to 40℃) at the onset, but decreases in a few days to about 100℉ (37.8℃). Slight headache and malaise are usual, and vomiting may occur.

The nurse is caring for an 18-year-old client who has sustained a deep partial-thickness (third-degree) burn. In arranging the priorities for the plan of care, which concern will the nurse assign as the highest priority? activity intolerance acute pain anxiety nutrition

acute pain Explanation: Pain is inevitable during recovery from any burn injury. Pain for a client with a burn injury has been described as one of the most severe causes of acute pain. Management of the often-severe pain is one of the most difficult challenges facing the burn team. Although the other priorities listed will need the nurse's attention, the presence of pain may contribute to the other concerns; management of the client's pain is a priority.

The nurse is caring for an adolescent diagnosed with genital herpes. The drug of choice for treating genital herpes is: ceftriaxone griseofluvin penicillin acyclovir

acyclovir Explanation: The drug acyclovir is useful in relieving or suppressing the symptoms of genital herpes.

An 8-year-old child is brought to the emergency department by paramedics who report the child has second-degree (partial-thickness) burns on the chest and legs. The child has also suffered smoke inhalation. What is the nursing priority in the care of this child? fluid balance maintenance airway management pain management anxiety management

airway management Explanation: Burn injuries are more serious in children than in adults, because the same size burn covers a larger surface area on the child's body. In addition, the inhalation of smoke can cause thermal injury to the lungs as well as inhalation of toxic fumes. Although the nurse will perform all actions listed, pain, fluid balance, and anxiety do not take precedence over airway management. Reference:

When caring for a child diagnosed with West Nile virus, the nurse will question which prescription from the primary health care provider? amoxicillin 40 mg/kg/day orally every 8 hours Monitor the client's cardiac status. acetaminophen every 4 to 6 hours PRN fever Place client on fall precautions.

amoxicillin 40 mg/kg/day orally every 8 hours Explanation: West Nile virus is transmitted to humans primarily through the bite of infected mosquitoes and manifestations include: fever, weakness, fatigue, balance problems, memory impairment, headache, myocarditis, hepatitis, myositis and orchitis, and rhabdomyolysis. Treatment is symptomatic. Since this is a viral illness, antibiotics would not be given and the nurse would question such prescriptions. It is appropriate to give acetaminophen for the fever or pain; place on fall precautions due to fatigue, balance problems, and weakness; and monitor the cardiac status for the development of myocarditis.

The nurse is caring for an infant born at 34 weeks' gestation who has developed necrotizing enterocolitis (NEC). When meeting the infant's nutritional needs, which type of supplies will be needed? an intravenous pole and pump for total parenteral nutrition (TPN) a nasogastric tube and a watch for use with "trophic feeds" a gastric tube for regularly scheduled gavage feedings an oral syringe for oral breastfeeding

an intravenous pole and pump for total parenteral nutrition (TPN) Explanation: The nurse gathers intravenous supplies for the administration of total parenteral nutrition (TPN). TPN should be administered to preterm infants with necrotizing enterocolitis (NEC). In NEC, there is acute inflammation of the bowel associated with ischemia. This can lead to bowel necrosis and perforation. Preterm infants are at higher risk of developing NEC due to gastric immaturity and an increased risk for infections. When NEC is detected in the preterm infant, TPN should be administered and enteral feeding should be withheld until the condition stabilizes. Gavage feeding and "trophic feeds" are different forms of enteral feeding given to preterm infants, but not to those having NEC. Oral breastfeeding should also be withheld in NEC. NEC is treated with IV fluids, antibiotics, blood transfusion, and surgical resection of the segment.

An adolescent has been diagnosed with oppositional defiant disorder. Which symptom does the nurse anticipate? typical teenage defiance behavior with parents angry outbursts directed at authority figures frequent arrests and conflict with legal authorities disruptive behavior toward siblings and peers

angry outbursts directed at authority figures Explanation: Oppositional defiant disorders (ODD) consist of a pattern of irritability, defiant behaviors, and vindictiveness that result in disturbed functioning in academic and social domains. Children and adolescents with ODD typically have difficulty controlling their temper; such anger is often directed at an authority figure. It is important to distinguish behavior that is within normal limits from behavior that is symptomatic. Many teens demonstrate some defiance toward their parents, but it typically does not disrupt their academic and social relationships like ODD. Problems do not typically occur between siblings and peers, rather with authority figures. Children with ODD may have conflict with legal authorities, but this is not something the nurse would anticipate.

A nurse is caring for a 17-year-old child with Guillain-Barré syndrome who has been in the hospital with this condition for 3 weeks. Which nursing intervention will the nurse implement to prevent deep vein thrombosis (DVT) in this child? completing lower extremity-assisted range-of-motion twice daily having the child perform leg exercises while awake rubbing the child's legs four times daily applying support stockings daily

applying support stockings daily Explanation: Treatment of Guillain-Barré syndrome is supportive until the paralysis peaks at 3 weeks and then is followed by gradual recovery. The child should be given subcutaneous fractionated or unfractionated heparin and support stockings until the child is able to walk independently to prevent deep vein thrombosis (DVT). This is a continuous intervention to prevent DVT. Rubbing the legs and performing assisted range-of-motion exercises are good interventions but not as helpful in preventing DVT. Because the child would likely still be paralyzed at 3 weeks, the child would not be able to perform leg exercises.

The nurse completes a 1-month-old's feeding and sits the infant up to burp. The infant vomits back the feeding. Which is the nurse's primary concern? nutritional deficiency stunted growth stomach irritation aspiration

aspiration Explanation: The primary concern for the nurse is that the infant aspirates vomit into the lungs. Aspiration after vomiting may lead to respiratory concerns such as apnea and pneumonia. Nutritional deficiencies may occur if the vomiting continues. This is a concern but not the primary concern. Stomach irritation and stunted growth is not a typical concern at this time.

A child with a history of diabetes insipidus is admitted with polyuria, polydipsia, and mental confusion. Which is the priority intervention for this child? weigh the client check vital signs measure urine output encourage increased fluid intake

check vital signs Explanation: Central diabetes insipidus is a disorder of the posterior pituitary. The fluid status of the child can be assessed first by assessing the vital signs. The large amounts of fluid loss can cause fluid and electrolyte imbalance that should be corrected. Urine output is important but not the priority. Encouraging fluids will not correct the problem, and weighing the client is not necessary at this time. Diabetes insipidus is managed by decreasing the protein and sodium in the diet and daily replacement of the antidiuretic hormone.

The nurse in the well-child clinic observes that a 5-year-old child in the waiting room is having trouble using a crayon to color. During the visit, the same child climbs off the table several times even after the nurse has asked him to stay on the table. Each time the nurse reminds him he says, "Oh, yeah," and happily climbs back up. The nurse suspects that the child has: attention deficit hyperactive disorder (ADHD). an addicted caregiver. failure to thrive. autism spectrum disorder.

attention deficit hyperactive disorder (ADHD). Explanation: The child with ADHD may have these characteristics: Impulsiveness, easy distractibility, frequent fidgeting or squirming, difficulty sitting still, problems following through on instructions despite being able to understand them, inattentiveness when being spoken to, frequent losing of things, going from one uncompleted activity to another, difficulty taking turns, frequent excessive talking, and engaging in dangerous activities without considering the consequences.

A parent brings a preschooler to the behavioral clinic for evaluation. Upon entering the room, the child appears not to notice the nurse's presence. The child screams upon the nurse's touch. What condition should the nurse suspect? Findings are normal for a preschooler. learning disability autism spectrum disorder Down syndrome

autism spectrum disorder Explanation: Autistism spectrum disorder is characterized by markedly abnormal or impaired development in social interaction and communication. Social impairment is sustained and includes such things as poor eye contact, not liking to be touched, and preferring solitary activities. The findings are not indicative of Down syndrome or a learning disability. Down syndrome children are usually very friendly and like to be hugged and touched. A child with a learning disability does not have problems with socialization. These symptoms are not normal findings in preschoolers. Preschoolers are very interested in their surroundings and very interactive.

A 13-year-old boy who recently immigrated to the United States from India is found to be infected by a strain of the poliovirus. After initial symptoms of fever, headache, nausea, vomiting and abdominal pain subside, the virus proceeds to his central nervous system. Which of the following would be the best intervention for this client at this point? salicylic acid solution antibiotics vaccination bed rest, analgesia

bed rest, analgesia Explanation: Treatment for poliomyelitis is bed rest with analgesia. Vaccination would be too late at this point, as the infection has already occurred. Antibiotics would be ineffective as this is a viral, not a bacterial, infection. Salicylic acid solution is used to treat warts.

The nurse is educating a family on celiac disease. Which is conclusive and confirms the diagnosis? improvement of general well-being when on a gluten-free diet noted symptoms of steatorrhea biopsy of the intestine through endoscopy showing changes in villi serum screening of immunoglobulin G

biopsy of the intestine through endoscopy showing changes in villi Explanation: All of the options relate to ways of determining if there is a possibility that a client has celiac syndrome. Conclusive diagnosis is made with an endoscopy and biopsy of the intestine.

The nurse is collecting data on a child recently diagnosed with acute glomerulonephritis. Which clinical manifestation was likely noted in this child? decreased specific gravity bloody urine hypotension increased nocturia

bloody urine Explanation: The presenting symptom in the child with acute glomerulonephritis is grossly bloody urine. The caregiver may describe the urine as smoky or bloody.

The nurse is providing teaching to the parents of a child with varicella. Which statement by the parents indicates the teaching was successful? "If our child has a fever, we can give them some aspirin." "The lesions should eventually form soft crusts that drain." "We need to make sure that our child washes their hands frequently." "We should apply alcohol to the lesions every 4 hours."

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Nurses will need to teach the parents of the infant being treated for Hirschsprung disease (aganglionic megacolon) to: avoid use of a pacifier. carefully monitor heart rate. thicken formula feedings. care for a temporary colostomy.

care for a temporary colostomy. Explanation: The aganglionic portion of the infant's colon will need to be removed. In most cases, bowel is allowed to rest and recoil for a period of time, necessitating a temporary colostomy. Later the colostomy can be closed and the two ends of the intestine rejoined. Thickening feedings will not relieve the colon distention and obstruction with stool. Pacifiers may be used and are soothing. Monitoring heart rate should not be necessary.

When caring for an infant who is hospitalized with Haemophilus influenzae meningitis, an important nursing intervention for the child would be for the nurse to: place the child in a side-lying position and keep the position using pillows. monitor intake and output and increase fluid intake every 4 hours. restrain the child before and during a seizure. check the child's neurologic status every 2 hours.

check the child's neurologic status every 2 hours. Explanation: The nursing interventions for the child with meningitis are related to the goals for this child, which include monitoring for complications related to neurologic compromise, preventing aspiration, keeping the child safe from injury during a seizure, and monitoring fluid balance. During a seizure, stay with the child, protect the child from injury, but do not restrain him or her. To prevent aspiration, position the child in a side-lying position, watch for and remove excessive mucus as much as possible, and use suction sparingly. Every 2 hours, observe the child for seizure activity, vital signs, neurologic changes, and change in level of consciousness. The child is placed on fluid restrictions if he or she has decreased urinary output, hyponatremia, increased weight, nausea, and irritability.

An 8-year-old child arrives at the emergency department with vomiting, seizures, and irritability for the last 8 hours. A radiograph confirms bleeding into the space between the dura and arachnoid membrane. Which symptom indicates a deterioration in status? a dull headache photophobia confusion pupil constriction when examining with a penlight

confusion Explanation: Frequent nursing assessment is needed with a diagnosis of a subdural hematoma. Subdural hematoma is venous bleeding into the space between the dura and arachnoid membrane. Signs and symptoms include seizures, increased intracranial pressure, vomiting, hyperirritability, and enlargement of the head. A dull headache and photophobia may or may not be present. Pupil constriction is a normal neurologic sign. Confusion is not normal and indicates declining neurologic status. The health care provider would be notified immediately.

A child needs to collect urine for 24 hours. The nurse explains to the parents and child that this test assesses glomerular filtration rate and how the kidneys are functioning. What results would be expected in this type of test? red blood cell (RBC) casts creatinine clearance casts and bacteria culture and sensitivity

creatinine clearance Explanation: A 24-hour urine collection is performed to obtain information about the creatinine clearance. This demonstrates information about the glomerular filtration rate. Urine is collected and kept on ice for a 24-hour period. During that time a serum creatinine is obtained. The presence of creatinine in the urine is compared with the serum to determine the amount of creatinine clearance. Casts, bacteria, and a culture and sensitivity are used to evaluate for infection and the antibiotics needed to treat the infection. RBCs are used to look for bleeding in the urine.

The nurse is doing an in-service training on clinical manifestations seen in communicable diseases. Which skin condition best describes erythema? small elevation of epidermis filled with a viscous fluid discolored skin spot not elevated at the surface small, circumscribed, solid elevation of the skin redness of the skin produced by congestion of the capillaries

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A child is brought to the emergency department (ED) from the site of a chemical fire. The paramedics report that the child has a burn that involves the epidermis, dermis, and the muscle and bone of the right arm. During assessment, the child verbalizes no pain in the right arm and the skin appears charred. When planning care for this child, what wound care supplies will the nurse use? dry gauze dressing and tape debridement tools and saline solution wound irrigation supplies with tap water adherent occlusive dressing

debridement tools and saline solution Explanation: It is important for the nurse to use the assessment findings to prepare for care. Utilizing all of the data from the paramedic, the nurse can make decisions about the nature of the burn and then care for the wound with needed supplies. A full-thickness (third-degree) burn involves total destruction of the epidermis and dermis and, in some cases, underlying tissue as well. Wound color ranges widely from white to red, brown, or black. The burned area is painless because the nerve fibers are destroyed. The wound can appear leathery; hair follicles and sweat glands are destroyed. Edema may also be present. Wound care will require removal of the dead epidermis and dermis by debridement, which includes moistening with saline solution before tissue removal. Wound care is more extensive than covering with a dressing such as a dry dressing, which may stick to the wound, or an occlusive dressing, which provides an environment for bacterial growth. Although irrigation may be necessary, saline or sterile water, not tap water, would be used.

In understanding the disease of marasmus when seen in children, the nurse recognizes that the disease is caused because of which of the following? excess of protein and calories deficiency of vitamin C and iron deficiency of protein and calories excess of vitamin C and iron

deficiency of protein and calories Explanation: Marasmus is a deficiency in calories as well as protein. Scurvy is caused by inadequate intake of vitamin C, and anemia is caused by lack of iron. Excess calories add to the concern of obesity in children. Excess vitamin C is excreted, and it is unusual to have an excess of iron or protein in the diet of children; those nutrients are more often inadequate in children's diets.

A 3-year-old client is on a ventilator after drowning, with fixed pupils and absence of reflexes. The primary health care provider informs the parents that testing showed an absence of cranial blood flow and brain death. The parents respond by requesting a second opinion, because "our child could recover and wake up." What stage of grief are these parents demonstrating? depression bargaining denial complicated grief

denial Explanation: The parents are experiencing denial in response to the sudden and unexpected diagnosis. In this stage, the parents have difficulty recognizing and acknowledging what has occurred, believing the child is just sleeping. Bargaining is the attempt to make a "deal" to get out of the situation. Depression is demonstrated by sadness, feeling overwhelmed, or feeling helpless. Complicated grief is severe or prolonged grief over time.

Insulin deficiency, in association with increased levels of counter-regulatory hormones and dehydration, is the primary cause of: glucosuria. ketonuria. diabetic ketoacidosis. ketone bodies.

diabetic ketoacidosis. Explanation: Insulin deficiency, in association with increased levels of counter-regulatory hormones (glucagon, growth hormone, cortisol, catecholamines) and dehydration, is the primary cause of diabetic ketoacidosis (DKA), a life-threatening form of metabolic acidosis that is a frequent complication of diabetes. Liver converts triglycerides (lipolysis) to fatty acids, which in turn change to ketone bodies. The accumulation and excretion of ketone bodies by the kidneys is called ketonuria. Glucosuria is glucose that is spilled into the urine.

The nurse is caring for a child diagnosed with a urinary tract infection. The caregiver asks the nurse why it is so important for the child to have so much fluid. The nurse tells the caregiver that the most important reason the child needs increased fluids is to: prevent the child from developing a fever. decrease the pain of urination. fill the bladder so a specimen can be obtained. dilute the urine and flush the bladder.

dilute the urine and flush the bladder. Explanation: Increasing the child's fluid intake is necessary to help dilute the urine and flush the bladder. An increase in fluid intake also helps decrease the pain experienced in urination, but this is not the most important reason the child needs increased fluids. Fluids may help decrease the chance of the child developing a fever, but this is not the most important reason fluids are given.

The nurse is providing care for a child who has been diagnosed with rickets. What is the nurse's priority intervention? administration of a high-calorie diet administration of thiamine supplements administration of adequate vitamin D increased protein intake

dministration of adequate vitamin D Explanation: Rickets results from inadequate vitamin D; supplements are necessary. There is no direct need to increase calorie, thiamine or protein intake.

The nurse is observing a group of 2- and 3-year-olds in a play group. Which behavior noted in one of the children indicates to the nurse that the child may have autism spectrum disorder (ASD)? While the other children are eating a snack, the child walks around the room feeling the walls and ignores the caregiver who offers him a snack. After another child takes a toy, the child cries and stomps his feet. A child flips the light switch off and on until the caregiver asks her to stop and join the other children in playing. A child playing in the kitchen area pretends to pour a glass of milk and repeats this over and over.

ect response: While the other children are eating a snack, the child walks around the room feeling the walls and ignores the caregiver who offers him a snack. Explanation: Children with ASD become completely absorbed in strange repetitive behaviors such as spinning an object, flipping an electrical switch on and off, or walking around the room feeling the walls. If these movements are interrupted or if objects in the environment are moved, a violent temper tantrum may result. These tantrums may include self-destructive acts such as hand biting and head banging. Although infants and toddlers normally are self-centered, ritualistic, and prone to displays of temper, autistic children show these characteristics to an extreme degree coupled with an almost total lack of response to other people.

During a routine well-child check the caregiver of a 10-year-old tells the nurse that her child has recently starting passing stool into his underwear. This behavior indicates a symptom of which disorder? encephalopathy encopresis echolalia enuresis

encopresis Explanation: Encopresis is chronic involuntary fecal soiling beyond the age when control is expected (about 3 years of age).

A nurse is developing a teaching plan for the parents of an 8-year-old experiencing nocturnal enuresis. The nurse determines that additional teaching is needed when the parents state that ___________ is appropriate? practicing bladder-stretching exercises encouraging fluid intake after dinner giving desmopressin intranasally engaging the child in stress-reduction measures

encouraging fluid intake after dinner Explanation: In many children, limiting fluids after dinner can be helpful for nocturnal enuresis. Bladder-stretching exercises also can be helpful. If these measures are ineffective, desmopressin may be prescribed. Stress factors may be contributing to the child's condition. Therefore, measures to address stress and promote coping are appropriate.

A 14-year-old adolescent admitted to the hospital is diagnosed with a terminal illness. Which nursing intervention would be most effective in fostering communication about the terminal illness? reading a book about dying to the adolescent suggesting the adolescent keep a journal to record thoughts related to the diagnosis encouraging the adolescent to attend a peer support group encouraging the adolescent to use a doll for role play

encouraging the adolescent to attend a peer support group Explanation: An adolescent will relate to the situation better when interacting with peers who are experiencing a similar situation. Playing with a doll and reading a book are not developmentally appropriate interventions. Keeping a journal may help the adolescent work through thoughts, depending on the adolescent's age; however, this action most likely will not encourage communication with others.

A 14-year-old adolescent admitted to the hospital is diagnosed with a terminal illness. Which nursing intervention would be most effective in fostering communication about the terminal illness? encouraging the adolescent to use a doll for role play encouraging the adolescent to attend a peer support group reading a book about dying to the adolescent suggesting the adolescent keep a journal to record thoughts related to the diagnosis

encouraging the adolescent to attend a peer support group Explanation: An adolescent will relate to the situation better when interacting with peers who are experiencing a similar situation. Playing with a doll and reading a book are not developmentally appropriate interventions. Keeping a journal may help the adolescent work through thoughts, depending on the adolescent's age; however, this action most likely will not encourage communication with others. Reference:

The nurse admits an infant who is nutritionally deprived. The infant is weak and seems somewhat uninterested in food. In developing the infant's plan of care, how often will the nurse most likely plan to feed this infant? every 4 hours on demand every hour every 2 or 3 hours

every 2 or 3 hours Explanation: For the child who is nutritionally deprived, scheduling feedings every 2 or 3 hours is best because most weak babies can handle frequent, small feedings better than feedings every 4 hours. Feeding every hour would not give the weak child an adequate amount of time to rest and sleep between feedings.

A pediatric client has just been diagnosed with diabetes insipidus. What is the primary consideration for this client? weight loss headache polydipsia fluid replacement

fluid replacement Explanation: Children with diabetes insipidus lose tremendous amounts of fluid, so fluid replacement is the priority consideration for this client. Excessive fluid loss can lead to seizures and death. Headache and polydipsia can be relieved with fluid replacement. Children will requirement a nutritional consultation for weight loss, but it is not the main consideration.

An 18-month-old infant is brought to the emergency department with flu-like symptoms. The infant is diagnosed with pneumonia secondary to aspiration of stomach contents. The nurse explains to the parents that pneumonia is a condition that often occurs secondary to: cystic fibrosis. gastroesophageal reflux disease. Hirschsprung disease. inflammatory bowel disease.

gastroesophageal reflux disease. Explanation: Gastroesophageal reflux (GER) is the passage of gastric contents into the esophagus. These refluxed contents may be aspirated into the lungs. The child with gastroesophageal reflux disease may present with the physical findings of pneumonia or GER-induced asthma. GER may cause apnea or an apparent life-threatening event in the younger infant. Pneumonia can occur in children with cystic fibrosis, but the child would need to have the cystic fibrosis diagnosis first. Hirschsprung and inflammatory bowel diseases are diseases of the gastrointestinal tract that do not present with respiratory symptoms.

The nurse is caring for a 12-month-old infant diagnosed with Haemophilus influenzae meningitis. Which clinical manifestation would likely have been noted in this child? severe vomiting and confusion shaking the head and pulling the ear high-pitched cry and nuchal rigidity body stiffening and loss of consciousness

high-pitched cry and nuchal rigidity Explanation: Children with meningitis may have a characteristic high-pitched cry, fever, and irritability. Other symptoms include headache, nuchal rigidity (stiff neck) that may progress to opisthotonos (arching of the back), and delirium.

The parent reports that the health care provider said that the infant had a hernia but cannot remember which type. When recalling what the health care provider said, the parent said that a surgeon will repair it soon and there is no problem with the testes. Which hernia type is anticipated? inguinal hernia hiatal hernia diaphragmatic hernia umbilical hernia

inguinal hernia Explanation: An inguinal hernia occurs primarily in males and allows the intestine to slip into the inguinal canal, resulting in swelling. If the intestine becomes trapped and circulation is impaired, surgery is indicated within a short period of time. The diaphragmatic hernia has implications with the respiratory system. An umbilical hernia typically spontaneously closes by age 3. A hiatal hernia produces digestive issues.

The nurse is interpreting the negative feedback system that controls endocrine function. What secretion will the nurse correlate as decreasing while blood glucose levels decrease? glucagon insulin glycogen adrenocorticotropic hormone

insulin Explanation: Feedback is seen in endocrine systems that regulate concentrations of blood components such as glucose. Glucose from the ingested lactose or sucrose is absorbed in the intestine and the level of glucose in blood rises. Elevation of blood glucose concentration stimulates endocrine cells in the pancreas to release insulin. Insulin has the major effect of facilitating entry of glucose into many cells of the body; as a result, blood glucose levels fall. When the level of blood glucose falls sufficiently, the stimulus for insulin release disappears and insulin is no longer secreted. Glycogen is stored in the liver and muscles. It is released to provide energy when the blood glucose levels fall. Glucagon is also produced by the pancreas. Its job is to force the liver to release stored insulin when the body has a need for more insulin. The adrenocorticotropic hormone is produced by the anterior pituitary. Its function is to regulate cortisol. This is needed so the adrenal glands can function properly. It also helps the body respond to stress.

The caregivers of a dying 9-year-old boy are in his hospital room. Death is near and the child has drifted in and out of consciousness for several days. The caregivers are at two different stages of anticipatory grief and are arguing in whispers in the room. The best response in this situation would be for the nurse to: interrupt their conversation, acknowledge that their feelings are valid, and let them know that the child can hear them and might be upset by their discord. recognize that their differences are normal and leave them to their argument. call a chaplain to come and speak with them. interrupt their conversation, acknowledge that their feelings are valid, and ask them to leave the room

interrupt their conversation, acknowledge that their feelings are valid, and let them know that the child can hear them and might be upset by their discord. Explanation: Even though the dying child may have a decreased level of consciousness, his or her hearing remains intact. Family members at the bedside as well as health care personnel may need to be reminded to avoid saying anything that would not be said if the child were fully conscious. Discourage whispered conversations in the room. Emotions and fears must be acknowledged, and caregivers should be reassured that their reactions are normal. The support of a member of the clergy may be helpful during this time. Help family members contact their own spiritual counselor or offer to contact the hospital chaplain if the family desires.

Most urinary tract infections seen in children are caused by: fungal infections. intestinal bacteria. hereditary causes. dietary insufficiencies.

intestinal bacteria. Explanation: Although many different bacteria may infect the urinary tract, intestinal bacteria, particularly Escherichia coli, account for about 80% of acute episodes. Hereditary and dietary concerns are not causes of urinary tract infections.

Pyloric stenosis has been diagnosed in a 3-week-old male infant who has frequent vomiting after feedings. An important preoperative nursing intervention is: maintaining NPO status while restoring hydration and electrolyte balance. assessing the abdomen hourly for distention and bowel sounds. reducing vomiting by feeding small amounts of clear liquids or breast milk frequently. providing adequate pain control.

maintaining NPO status while restoring hydration and electrolyte balance. Explanation: NPO is needed to avoid vomiting and aspiration during surgery. Hydration and electrolyte replacement is often needed because of the history of vomiting, which causes loss of both fluid and electrolytes. Feeding when surgery is pending would not be safe. Hourly abdominal assessment would not yield needed information and would further disturb the infant. Pain is not the source of crying. The infant is hungry.

A child is diagnosed with giardiasis. The physician prescribes medication to treat the infection. Which of the following would the nurse anticipate being prescribed? griseofulvin clotrimazole metronidazole mebendazole

metronidazole Explanation: Treatment of giardiasis is with metronidazole for 7 days. Griseofulvin is used to treat tinea capitis. Mebendazole is used to treat pinworms. Clotrimazole is used to treat tinea cruris and tinea corporis.

The nurse is performing a physical assessment of 16-year-old girl who is intellectually disabled. This client attended her local public elementary school through fifth grade and has since been enrolled at a special education school where she has received social and vocational training. She plans on getting a job in the coming month and on living independently in a few years. The nurse recognizes this client's level of intellectual disability as: profound. moderate. severe. mild.

mild. Explanation: Children with mild intellectual disability exhibit difficulties in acquisition of academic skills and are typically more concrete in their problem solving. Socially, they are observed as less mature, have a limited understanding of risk, and demonstrate poorer affect regulation than similarly aged peers. As adults, they can usually achieve adequate social and vocational skills for minimum self-support and independent living but need guidance and assistance with complex daily living tasks. During early years, these children learn social and communication skills and are often not too distinguishable from average infants or toddlers. They continue to learn academic skills up to about a sixth-grade level. As adults, they can usually achieve social and vocational skills adequate for minimum self-support. They're able to live independently but need guidance and assistance when faced with new situations or unusual stress.

A child in the clinic has a fever and reports a sore neck. Upon assessment the nurse finds a swollen parotid gland. The nurse suspects which infectious disease? whooping cough scabies measles mumps

mumps Explanation: Mumps is an infectious disease with a primary symptom of a swollen parotid gland. It is a contagious disease spread by droplets. The child is contagious 1 to 7 days prior to the onset of the swelling and 4 to 9 days after the onset of the swelling. Pertussis (whooping cough) is a respiratory disorder that causes severe paroxysmal coughing, which produces a whooping sound. Measles is recognized by Koplik spots in the mouth and the classic maculopapular rash that starts on the head and spreads downward. Scabies is a skin condition where lice lay eggs under the skin. The rash is very pruritic and is seen on the hands, feet, and folds of the skin.

The nurse is discussing the disease known as pellagra. This disease is due to a deficiency in which of the following? vitamin C niacin thiamine iron

niacin Explanation: Niacin insufficiency in the diet causes a disease known as pellagra, which presents with GI and neurologic symptoms. A diet deficient in thiamine causes beriberi. Lack of vitamin C causes scurvy, and lack of iron causes anemia.

A 3-year-old girl was in the hospital for a week following open heart surgery. By the end of the week, she had contracted an infection. The nurse recognizes this type of infection as a: viral infection. bacterial infection. nosocomial (health care-associated) infection. fungal infection.

nosocomial (health care-associated) infection. Explanation: Nosocomial (health care-associated) infections are contracted while in a hospital or other health care setting. Children younger than 2 years, children with a nutritional deficit, those who are immunosuppressed, those who have indwelling vascular lines or catheters, those who are receiving multiple antibiotic therapy, or those who remain in the hospital for longer than 72 hours are at highest risk for contracting such an infection. The infection could be viral, bacterial, or fungal, but not enough information is provided in the scenario to determine this.

The nurse is discussing medications to be given to a child who has been diagnosed with oral candidiasis (thrush). Which medication would most likely be prescribed for the child? aspirin ampicillin acetaminophen nystatin

nystatin Explanation: Application of nystatin to the oral lesions every 6 hours is an effective treatment for oral candidiasis (thrush). Treatment for diaper rash caused by Candida albicans is nystatin ointment or cream applied to the affected area.

The nurse is reviewing lab work prior to shift handoff on a client with a subnormal urine output. Which is the nurse most correct to report? polyuria oliguria glycosuria pyuria

oliguria Explanation: A subnormal urine output is termed as oliguria. Polyuria is the excessive or abnormally large production of urine. Pyuria is the presence of pus in the urine. Glycosuria is the excretion of glucose in the urine.

The nurse is caring for a client newly diagnosed with acute glomerulonephritis? When receiving the pediatric client's history, which is anticipated? onset of a streptococcus infection last week increased thirst, sweating, and shakiness since yesterday fatigue from viral infection onset 3 days ago a sports injury to the kidney two weeks ago

onset of a streptococcus infection last week Explanation: The nurse is correct to anticipate a streptococcus infection 1 to 3 weeks prior to the diagnosis of acute glomerulonephritis. The presenting symptom is typically gross bloody urine. Acute glomerulonephritis is not related to a kidney infection, does not exhibit symptoms similar to diabetes, or a recent viral infection.

Which type of nutrition does the nurse anticipate initiating when an infant with gastroenteritis and dehydration begins solid foods? half strength infant formula clear liquids the normal formula oral rehydration solutions

oral rehydration solutions Explanation: The nurse is correct to anticipate that oral rehydration fluids such as Pedialyte, Rehydralyte, or Infalyte are initiated. Once the infant is able to tolerate the solution, either a half-strength formula or full-strength formula will be considered. Typical clear liquids such as apple juice or broths are not part of the rehydration diet.

A child is diagnosed with group A streptococcal pharyngitis. The nurse would teach the parents to be alert for signs and symptoms of: impetigo. osteomyelitis. scarlet fever. pneumonia.

orrect response: scarlet fever. Explanation: Group A streptococcal pharyngitis can progress to scarlet fever with the rash appearing in about 12 hours after the onset of the disease. Group A streptococcal pharyngitis is not associated with pneumonia. Impetigo is a group A strep infection involving the skin. Osteomyelitis can occur with an infection by group B streptococcus.

The nurse caring for an 18-month-old infant with Meckel diverticulum knows that the most common clinical manifestation of this condition is: respiratory distress. ischemia. painless rectal bleeding. dehydration.

painless rectal bleeding. Explanation: With Meckel diverticulum, most symptomatic children present younger than age 2 years. Intermittent, painless rectal bleeding is the most common clinical manifestation of Meckel diverticulum. The blood is most often bright red or maroon and may be passed independent of stool due to ulceration at the junction of the ectopic tissue and the normal ileal mucosa.

A nursing instructor is teaching students about childhood infectious diseases. Which of the following would the instructor identify as the cause of warts in children? coxsackievirus papillomavirus herpes virus rubella virus

papillomavirus Explanation: Warts, one of the most common dermatologic diseases in children, are caused by the papillomavirus.

A child diagnosed with AIDS comes to the clinic for routine immunizations. In giving immunizations to the child who has AIDS, the nurse can safely administer the injectable vaccine given for which disease? poliomyelitis chickenpox measles mumps

poliomyelitis Explanation: Live vaccines can not be given to the child with AIDS because of the child's compromised immune system. Inactivated oral poliovirus vaccine (IPV) is not a live vaccine and therefore could be given.

The nurse is caring for a child diagnosed with Sturge-Weber syndrome. Which assessment finding supports this diagnosis? pigmented nevi or café-au-lait spots on the child's chest and arms port-wine birthmark on the upper part of the face irregular but excessive skin pigmentation all over the child's body soft cutaneous tumors on the child's skin along nerve pathways

port-wine birthmark on the upper part of the face Explanation: A congenital port-wine birthmark on the upper part of the face that follows the trigeminal nerve is an indication of Sturge-Weber syndrome. Soft cutaneous tumors, irregular but excessive skin pigmentation, and pigmented nevi are all symptoms of neurofibromatosis (von Recklinghausen disease).

A 17-year-old is diagnosed with infectious mononucleosis. The nurse should discuss which intervention with the teenager's caregiver to best assure an uncomplicated recovery? a 10-day course of antibiotics a high-protein, high-fiber, low-fat diet precautions to avoid secondary infections admission to the hospital for about 7 days

precautions to avoid secondary infections Explanation: No cure exists for infectious mononucleosis; treatment is based on symptoms. An analgesic-antipyretic, such as acetaminophen, usually is recommended for fever and headaches. Fluids and a soft, bland diet are encouraged to reduce throat irritation. Because the immune system is weakened, the child must take precautions to avoid secondary infections.

The premise behind using plasmapheresis in a client diagnosed with Guillain-Barré syndrome includes which of the following? prevention of demyelination prevention of deep vein thrombosis prevention of joint contractures prevention of skin breakdown

prevention of demyelination Explanation: The immune basis for GBS suggests use of intravenous immune globulins or plasmapheresis to prevent demyelination. Plasmapheresis does not prevent joint contractures, skin breakdown, or deep vein thrombosis.

The nurse is providing care to a child with acute kidney injury. What assessment is priority for the nurse to determine if this child is developing hyperkalemia? blood pressure pulse rate and rhythm muscle tone abdominal pain

pulse rate and rhythm Explanation: Hyperkalemia occurs when the potassium levels rise above normal laboratory values. Although it varies among laboratories, a normal potassium range is generally between 3.5 and 5 mEq/l (3.5 and 5 mmol/l). When the potassium levels rise, the child will develop symptoms such as a weak, irregular pulse, muscle weakness and abdominal cramping. The priority assessment is the pulse rate and rhythm, because potassium is directly linked to heart functioning. Increased muscle tone would be associated with hypocalcemia. The blood pressure is not directly affected by the potassium levels. It could be altered indirectly if arrhythmia occurs or the heart starts to fail.

The nurse is working with a child diagnosed with encopresis. After a complete medical workup has been done, no organic cause has been found for the disorder. What follow-up will the nurse expect? put on a high-calorie, high-protein diet administered antidiarrheal medications referred for counseling started on methylphenidate

referred for counseling Explanation: Encopresis is the repeated involuntary passage of feces of normal or near-normal stool in places not appropriate for that purpose. If no organic causes (e.g., worms, megacolon) exist, encopresis indicates a serious emotional problem and a need for counseling for the child and the family caregivers. Medications such as methylphenidate are used for hyperactivity. The diet needs to be high fiber. Antidiarrheals are contraindicated because they can cause more constipation. Lubricant laxatives should be used.

The nurse is caring for a child who is in the dying process. What intervention should the nurse prioritize? offering honest and straightforward information to caregivers providing social interaction with family and peers relieving the child's pain and discomfort encouraging family to express feelings openly

relieving the child's pain and discomfort Explanation: All of the listed interventions are appropriate for a child who is dying. However, social interaction, family interventions, and education are unlikely to be beneficial if the child remains in acute pain.

A 16-year-old girl has had several cases of cystitis in the past year. Which of the following should the nurse suspect as the cause, based on this finding? regular participation in a strenuous sport frequent voiding sexual activity wiping from front to back after voiding

sexual activity Explanation: When cystitis is seen in adolescent girls, it is an alert a girl may be sexually active. Wiping from front to back after voiding helps prevent urinary tract infections, not cause them. Frequent voiding does not cause cystitis, nor does regular participation in a strenuous sport.

A nurse is examining a boy with cerebral palsy (CP). He has hypertonic muscles and abnormal clonus in his legs and walks on his toes. Which of the following is the type of cerebral palsy that this boy is demonstrating? ataxic athetoid dyskinetic spastic

spastic Explanation: Spasticity is excessive tone in the voluntary muscles that results from loss of upper motor neurons. A child with spastic CP has hypertonic muscles, abnormal clonus, exaggeration of deep tendon reflexes, abnormal reflexes such as a positive Babinski reflex, and continuation of neonatal reflexes, such as the tonic neck reflex, well past the age at which these usually disappear. Dyskinetic or athetoid type CP involves abnormal involuntary movement. Ataxic type CP involves an awkward, wide-based gait.

A nursing instructor is teaching students about pediatric emergencies. Which does the instructor identify as the most frequently injured organ following abdominal trauma in children? kidney liver spleen pancreas

spleen Explanation: In children, the spleen is the most frequently injured organ in abdominal trauma because it is usually palpable under the lower left ribs.

A 10-year-old boy who was in a car wreck has been brought to the emergency room for evaluation. He appears to have suffered abdominal trauma due to his seat belt. He has tenderness in the left upper quadrant of the abdomen, especially on deep inspiration. Given these circumstances, the nurse should suspect injury to which of the following organs? stomach pancreas spleen liver

spleen Explanation: In children, the spleen is the most frequently injured organ when there is abdominal trauma because it is usually palpable under the lower left rib. Frequent causes of injury are inappropriately applied seat belts in automobiles, handlebar injuries in bicycle accidents, or skateboard or snowboard accidents. The child will have tenderness in the left upper quadrant of the abdomen, especially on deep inspiration, when the diaphragm moves down and touches the spleen. Reference:

A child is diagnosed with intussusception. The nurse would prepare the child and family for which of the following? upper endoscopy abdominal computed tomography surgery barium swallow

surgery Explanation: Intussusception is a surgical emergency and must be promptly reduced either by instillation of a water-soluble solution, barium enema, or air into the bowel, or surgery to reduce the invagination before necrosis of the affected portion of the bowel occurs. The point of invagination is usually at the juncture of the distal ileum and proximal colon. Therefore, an upper endoscopy or barium swallow would be inappropriate. The condition must be reduced; thus, an abdominal computed tomography would be ineffective.

A 12-year-old client arrives at the emergency room experiencing nausea, vomiting, headache, and seizures. The client is diagnosed with bacterial meningitis. Other findings include a decrease in urine production, hyponatremia, and water intoxication. Which pituitary gland disorder is most associated with these symptoms? diabetes insipidus (DI) syndrome of inappropriate antidiuretic hormone (SIADH) hyposecretion of somatotropin hypersecretion of growth hormone

syndrome of inappropriate antidiuretic hormone (SIADH) Explanation: Syndrome of inappropriate antidiuretic hormone (SIADH) is a rare condition in which there is overproduction of antidiuretic hormone by the posterior pituitary gland. This results in a decrease in urine production and water intoxication. As sodium levels fall in proportion to water, the child develops hyponatremia or a lowered sodium plasma level. It can be caused by central nervous system infections such as bacterial meningitis. As the hyponatremia grows more severe, coma or seizures occur from brain edema. Diabetes insipidus is characterized by polyuria, not decreased urine production. Hyposecretion of somatotropin (growth hormone) results in undergrowth; hypersecretion results in overgrowth.

A 12-year-old client arrives at the emergency room experiencing nausea, vomiting, headache, and seizures. The client is diagnosed with bacterial meningitis. Other findings include a decrease in urine production, hyponatremia, and water intoxication. Which pituitary gland disorder is most associated with these symptoms? hypersecretion of growth hormone syndrome of inappropriate antidiuretic hormone (SIADH) diabetes insipidus (DI) hyposecretion of somatotropin

syndrome of inappropriate antidiuretic hormone (SIADH) Explanation: Syndrome of inappropriate antidiuretic hormone (SIADH) is a rare condition in which there is overproduction of antidiuretic hormone by the posterior pituitary gland. This results in a decrease in urine production and water intoxication. As sodium levels fall in proportion to water, the child develops hyponatremia or a lowered sodium plasma level. It can be caused by central nervous system infections such as bacterial meningitis. As the hyponatremia grows more severe, coma or seizures occur from brain edema. Diabetes insipidus is characterized by polyuria, not decreased urine production. Hyposecretion of somatotropin (growth hormone) results in undergrowth; hypersecretion results in overgrowth.

A nurse is preparing to discharge a neonate diagnosed with maple syrup urine disease. Which nursing instruction is essential for care of the neonate in the home? informing the parents that protein should be increased in times of crises teaching the parents that crises increase with growth emphasizing the need to reduce calorie intake when the child is ill reinforcing the need for the prescribed lifelong dietary regimen

the need for the prescribed lifelong dietary regimen Explanation: Family education goals should focus on reinforcing the need for the prescribed dietary regimen, the importance of follow-up appointments, and sick-day management. This is daily information that needs to be understood. Once routine care is understood, then future care can be addressed. As the child grows, the frequency and severity of crisis events decrease, but lifelong dietary management is still required. When the child is ill, protein intake should be reduced, and caloric intake should be increased from 80 to 120 kcal/kg per day to 120 to 140 kcal/kg per day by encouraging consumption of carbohydrate- and fat-containing foods.

The nurse is working with a support group for parents who have lost children. Which parent may have experienced anticipatory grief? the parent of an adolescent who died suddenly in a car accident the parent of a child who had a near-drowning and died years later as a result of a complication the parent of a child who died following an anaphylactic reaction from a previously unknown allergy the parent of a child who died soon after a fall from a piece of playground equipment

the parent of a child who had a near-drowning and died years later as a result of a complication Explanation: Anticipatory grieving is a type of grief that occurs when the death is predicted or known to occur, such as with a terminal illness or death that is known will occur in the long term. Death from a car accident, anaphylactic shock or sudden death from an accident would not allow time to anticipate the death and therefore anticipatory grieving would not occur.

Assessment of a child reveals black burrows of about 1-inch long between the fingers and toes and in the axilla. A diagnosis of scabies is made. When planning this child's care, the nurse anticipates which medication being prescribed? oral nitazoxanide oral albendazole topical permethrin oral pyrantel pamoate

topical permethrin Explanation: Topical permethrin 5% cream is the drug of choice for treating scabies. The oral medications albendazole, pyrantel pamoate and nitazoxanide are used to treat helminthic (parasitic worm) infections.

The nurse cares for a 7-year-old child with new-onset seizure disorder. Which prescription will the nurse anticipate for this client? vagus nerve stimulation ketogenic diet frequent temperature assessment use of anticonvulsant medications

use of anticonvulsant medications Explanation: Complete control of seizures can be achieved for most people through the use of anticonvulsant drug therapy. These medications are typically used first as treatment for seizure disorders. Frequent temperature assessment would only be useful in febrile seizures. Ketogenic diets (high in fat, low in carbohydrates, and adequate in protein) cause the child to have high levels of ketones, which help to reduce seizure activity. Diet is generally used when medications cannot control a child's seizure activity. Stimulating the left vagus nerve intermittently with electrical pulses may reduce seizure frequency. This requires surgically implanting a stimulator under the skin and is approved for children 12 and older.

A 5-year-old child is exhibiting manifestations of hypotension. What is the first-line treatment for poor perfusion and hypotension? epinephrine atropine sodium bicarbonate volume replacement

volume replacement Explanation: Volume replacement is the first-line treatment for poor perfusion and hypotension. Atropine is used for symptomatic bradycardia that is unresponsive to ventilation and oxygenation. Sodium bicarbonate is used for metabolic acidosis. Epinephrine is the drug of choice for children during and immediately after resuscitation.

A child is hospitalized with nephrotic syndrome. Which measurement is best for the nurse to determine the child's edema? abdominal circumference amount of protein in the urine urine output, every shift weight, daily

weight, daily Explanation: The classic sign of nephrotic syndrome is edema. It is usually generalized, but may be manifested as ascites or be periorbital depending on the seriousness of the disease. The easiest way to determine edema is by weighing the child. The child should be weighed on the same scale, at the same time daily, and with the same amount of clothing. The abdomen would only need to be measured if ascites was suspected or known. Measuring urine output will not determine edema, although it should be done to determine if urine is being produced in adequate amounts. Measuring the amount of protein in the urine will also not determine edema. The measurement is important to determine the progress of the disease, however.