Women and Children Exam 8

A community health nurse is conducting a parenting class on respiratory syncytial virus (RSV). What statement made by a parent indicates that the teaching has been successful?

"Exposure to second- or third-hand smoke increases the risk for developing RSV."

A child with asthma has been monitoring his peak expiratory flow rate (PEFR) and has been maintaining it within 90% of his personal best. Today, the child is experiencing symptoms and his PEFR is at 40% of his personal best. The child's mother calls the office and asks the nurse what she should do. What would the nurse instruct the mother to do first?

"Have him use his short-acting bronchodilator right away."

Which measure would be most effective in aiding bronchodilation in a child with laryngotracheobronchitis?

Assisting with racemic epinephrine nebulizer therapy

What will the nurse include in the feeding plan for a breastfed infant with congenital heart disease?

Breastfeed with small, frequent feeds.

Some children with iron-deficiency anemia may be prescribed iron dextran by injection. This should be injected:

via Z-track technique.

The nurse is caring for children at a local hospital. Which child warrants immediate attention from the nurse?

1-week-old newborn whose oxygenation is not improving with oxygen

A school-aged child is diagnosed with streptococcal pharyngitis. What should the nurse teach the parents about the care that this child will need at home?

Complete the entire course of antibiotics to prevent rheumatic fever.

An 8-year-old with cystic fibrosis has had a noted decline on the growth chart. Which nursing intervention is best for maintaining adequate nutrition?

Encourage high calorie, high protein snacks.

A child with hemophilia A is scheduled for surgery. Which precautions would the nurse institute with this client?

Handle the child gently when transferring to a stretcher.

What measure at home could help a child with an upper respiratory infection breathe more easily?

Increasing room humidity

Upon providing discharge instructions home after a tonsillectomy and adenoidectomy, which is most important?

The child is in tripod position.

The nurse is caring for a 10-year-old girl with cystic fibrosis who receives pancreatic enzymes. Which comment by a parent demonstrates understanding of the instructions regarding the medication?

"I should give the enzymes before each meal or snack."

The parents of a 6-year-old child with idiopathic thrombocytopenic purpura (ITP) ask the nurse, "What causes this disease?" Which response by the nurse would be most appropriate?

"ITP is primarily an autoimmune disease in that the immune system attacks and destroys the body's own platelets, for an unknown reason."

A nurse is providing teaching to the parents of a child diagnosed with sickle cell anemia. The discussion is focused on precipitating factors for sickle cell crisis. Which statement by the parents requires the nurse to reinforce the teaching?

"Our family is taking a fun hiking trip up in the mountains next week."

An 8-year-old client is suffering from allergic rhinitis (hay fever). Which statement will the nurse include when providing education to the client's caregiver?

"Pollen is a cause of these symptoms. Allergy medicine may help your child."

A parent with a child who has cystic fibrosis asks the nurse how to determine if the child is receiving an adequate amount of pancreatic enzymes. How should the nurse respond? Select all that apply.

"The dose is adequate when your child is only having 1 to 2 stools per day." "The dose is adequate when your child's weight is improving." "When your child starts to eat more quantities of food you will need to adjust the amount of enzyme pills."

A 5-year-old girl is diagnosed with iron-deficiency anemia and is to receive iron supplements. The child has difficulty swallowing tablets, so a liquid formulation is prescribed. After teaching the parents about administering the iron supplement, which statement by the parents indicates the need for additional teaching?

"We will place the liquid in the front of her gums, just below her teeth."

The nurse is preparing a presentation for a local parent group about nutritional measures to prevent anemia. The group of parents have children between the ages of 4 and 8. The nurse would recommend a daily iron intake of which amount?

10 mg

The nurse is caring for a child in sickle cell crisis. To best promote hemodilution, the nurse would expect to administer how much fluid per day intravenously or orally?

150 ml/kg of fluids

The nurse is working with a child who is in sickle cell crisis. Treatment and nursing care for this child include which actions? Select all that apply.

Administering oxygen Administering analgesics Maintaining fluid intake

The nurse is preparing the room for a client admitted from the emergency department with suspected tuberculosis (TB). Which type of infection control precautions would the nurse anticipate?

Airborne precautions

A school-aged child is admitted to the hospital with a vaso-occlusive sickle cell crisis. Which measure in the child's care plan should be given priority?

Maintaining fluids through an intravenous line

The nurse is caring for a 7-year-old boy who has just had a tonsillectomy. Which intervention is least appropriate for this child?

Providing fluids by straw

The nurse is caring for a newly admitted 3-year-old child who has been diagnosed with tuberculosis. When reviewing the child's records which finding(s) is consistent with this disease? Select all that apply.

The child has been experiencing night sweats. The child and the family were homeless for a period of time in the past 3 months. The child has had recent weight loss.

The nurse is evaluating teaching provided to a school-age child and parents about the medication pancrelipase for cystic fibrosis. Which observation indicates that the teaching has been effective?

The child takes a dose before having an afternoon snack.

The nurse is teaching a 12-year-old with asthma about possible side effects of drug therapy. Which of the following would the nurse identify as a possible side effect of a beta-adrenergic agonist used for bronchodilation?

jitteriness

The nurse sees a school-aged child in an ambulatory setting because of rheumatic fever. Which of the following would the nurse expect to find revealed by the health history?

knee pain, abdominal rash, subcutaneous nodules

The nurse is caring for an infant who has an unrepaired congenital heart defect. What assessment finding(s) will the nurse report to the health care provider? Select all that apply.

448 g (16 oz) weight gain tolerates 20 ml of formula per feed moist skin

The nurse is reviewing the results of a sweat test done a child who is suspected of having cystic fibrosis. Which sweat chloride level would the nurse identify as a positive result?

65 mEq/L (65 mmol/L)

A nurse is reviewing laboratory test results from several children, looking specifically at their thrombocyte levels. The nurse would identify that the child with which platelet level might be at risk for bleeding? Select all that apply.

80,000 per cubic millimeter 110,000 per cubic millimeter Normal thrombocyte level ranges from 150,000 to 300,000 per cubic millimeter.

A nurse is caring for an infant who is experiencing heart failure. What would be the most appropriate care for this infant?

Administer oxygen.

A 3-year-old child with asthma and a respiratory tract infection is prescribed an antibiotic and a bronchodilator. The nurse notes the following during assessment: oral temperature 100.2°F (37.9°C), respirations 52 breaths/minute, heart rate 90 beats/minute, O2 saturation 95% on room air. Which action will the nurse take first?

Administer the bronchodilator via a nebulizer.

A nurse is preparing a 7-year-old girl for bone marrow aspiration. Which site should she prepare?

Iliac crest

After teaching a group of students about acute rheumatic fever, the instructor determines that the teaching was successful when the students identify which assessment finding?

Jerky movements of the face and upper extremities

The nurse is examining an 8-year-old boy with tachycardia and tachypnea. The nurse anticipates which test as most helpful in determining the extent of the child's hypoxia?

Pulse oximetry

Which electrolyte does the client with cystic fibrosis need in abundance?

Sodium

When conducting a physical examination of a child with suspected Kawasaki disease, which finding would the nurse expect to assess?

Strawberry tongue

The nurse sees a 3-year-old child in the ambulatory setting for localized wheezing on auscultation. Which statement by the parent would be most important to report to the health care provider?

The child was eating peanuts yesterday.

A nurse is caring for an infant admitted with a diagnosis of bronchiolitis. After completing an assessment, the nurse creates a plan of care for the infant. Which client goal would be priority in the plan of care?

The infant's airway will remain clear and free of mucus.

The nurse admits a 5-year-old child to the pediatric unit with a history of fever for 1 week (above). The child has been unresponsive to antibiotics for suspected strep throat. What medication(s) does the nurse anticipate in the child's plan of care? Select all that apply.

acetaminophen aspirin intravenous immunoglobulin (IVIG)

Which postoperative nursing intervention is most appropriate for the preschool child following tonsillectomy and adenoidectomy?

assessing for frequent swallowing

A nurse is caring for a child who is experiencing heart failure. Which assessment data was most likely seen when initially examined?

tachycardia

A nurse is conducting an in-service program for a group of pediatric nurses working in the community clinics. When discussing bronchitis in children, the nurse would identify which of the following as the peak season for this condition?

winter/spring

The nurse is caring for a preschooler with acute nasopharyngitis. Which information should the nurse include when teaching the parents about this health problem?

A cough that accompanies a cold should rarely be suppressed.

The nurse is administering medications to a child with cystic fibrosis. Which method would the nurse most likely use to give medications to treat the pancreatic involvement seen in this disease?

Open capsule and sprinkle on food.

Which nursing diagnosis would best apply to a child experiencing rheumatic fever?

Activity intolerance related to increased cardiac workload

A 4-year-old child has been admitted to the hospital with a diagnosis of pneumococcal pneumonia. The parents are extremely distraught over the child's condition and the fact that the child has not wanted to eat anything for the past 2 days. Which nursing approach would be most important to take to help alleviate the high anxiety level of the parents?

Allow the parents to remain with the child as much as possible.

A school nurse is caring for a child with a severe sore throat and fever. What is the nurse's best recommendation to the parent?

Have the child be seen by the primary care provider.

A 3-year-old child is hospitalized with a diagnosis of sickle cell anemia and is experiencing a pain crisis. Using the FACES scale, the nurse assesses the child's pain to be a 10 on a scale of 1 to 10. The child is receiving intravenous fluids and oxygen at 2 L/min via nasal cannula. The parent is at the bedside holding the child's hand and has a concerned look. What is the nurse's priority in caring for the child?

Implement strategies to address the child's pain.

Which nursing diagnosis would be most appropriate for a child with idiopathic thrombocytopenic purpura?

Ineffective tissue perfusion related to poor platelet formation

A nurse is teaching the parents of a child with sickle cell disease about factors that predispose the child to a sickle cell crisis. The nurse determines that the teaching was successful when the parents identify what as a factor?

Infection

A child is brought to the emergency department by his parents because he suddenly developed a barking cough. Further assessment leads the nurse to suspect that the child is experiencing croup. What would the nurse have most likely assessed?

Inspiratory stridor

The nurse is caring for a child diagnosed with tonsillitis. Which nursing action is most helpful prior to the tonsillectomy?

Instruct on salt water gargling.

The nurse is caring for a 6-week-old with symptoms of irritability, nasal stuffiness, difficulty drinking and occasional vomiting. Which assessment finding produces important information regarding the medical and nursing treatment plan?

Obtain testing for respiratory syncytial virus.

The nurse is caring for a child with thickened pulmonary secretions. Which action(s) would the nurse use to assist the child breathe with less effort? Select all that apply.

Perform chest physiotherapy Encourage oral fluids

A 2-year-old toddler is seen for acute laryngotracheobronchitis. What observation would lead the nurse to suspect airway occlusion?

The respiratory rate is gradually increasing.

A child with a congenital heart defect is to undergo an echocardiogram. When teaching the parent about this test, which of the following would the nurse use to explain the procedure?

This is a test that will check how blood is flowing through the heart.

A child is hospitalized with pneumonia. The nurse assesses an increase in the work of breathing and in the respiratory rate. What intervention should the nurse do first to help this child?

elevate the head of the bed

The nurse is collecting data on a child admitted with a respiratory concern. The nurse notes that the child is anxious and sitting forward with the neck extended to breathe. The signs the nurse noted indicate the child likely has:

epiglottitis.

An 11-year-old male is diagnosed with mild hemophilia. Upon review of the child's factor assay, the nurse identifies which factor level for this category of hemophilia?

factor level of 5% to 50%

To prevent further sickle cell crisis, the nurse would advise the parents of a child with sickle cell anemia to:

notify a health care provider if the child develops an upper respiratory infection.

The nurse is assessing a child and notices pinpoint hemorrhages appearing on several different areas of the body. The hemorrhages do not blanch on pressure. The nurse documents this finding as:

petechiae.