346 FINAL EXAM

A 9-year-old child with a history of epilepsy is brought to the emergency department. The child has been having a series of tonic-clonic seizures over the past 5 minutes and has not recovered from them between episodes. Which medication would the nurse anticipate being used to control the child's seizures?

Lorazepam

A 17-year-old is brought to the emergency department with a fever, headache, and stiff neck. Bacterial meningitis is suspected. The nurse would anticipate preparing the adolescent for which test to confirm the diagnosis?

Lumbar puncture

When are the majority of infants infected with HIV?

a. During delivery; Higher maternal viral loads and lower CD4 counts are associated with increased risk for infection. b. 2nd testing before 36 weeks could prevent 46 infant infections annually c. 15-25% of infants will be infected without treatment

1. When does acquired immune deficiency syndrome (AIDS) usually develop?

a. HIV attacks and destroys a type of white blood cell called a CD4 cell. This cell's main function is to fight disease. When a person's CD4 cell count gets low, they are more susceptible to illnesses. b. AIDS is the final stage of HIV infection. When the immune system CD4 cells drop to a very low level, a person's ability to fight infection is lost. In addition, there are several conditions that occur in people with HIV infection with this degree of immune system failure -- these are called AIDS defining illnesses.

The nurse is performing a neurologic assessment on a 7-month-old infant. Which task should the nurse perform last?

Elicit the gag reflex.

A nurse is providing care for a 14-year-old child hospitalized after a motor vehicle accident that resulted in blunt head trauma. The nurse notes that the client appears to be sleeping and is lying with upper limbs flexed at the elbow and wrists while lower limbs are extended. Which action should the nurse take next?

Utilize the Glasgow Coma scale (GCS).

The nurse is conducting a class at a local community center for parents of preschool-aged and school-aged children. One of the topics is Reye syndrome. The nurse emphasizes the need to avoid the use of aspirin in children with a viral illness. Which virus(es) would the nurse address as commonly associated with this syndrome? Select all that apply.

Varicella Influenza

The nurse is teaching the parents of a 7-year-old client with head lice about permethrin therapy. What will the nurse include in the teaching? Select all that apply.

Wash hair before application. Apply enough cream to saturate hair and scalp. Itching may increase temporarily.

What is the biggest problem with treatment for gonorrhea?

a. Antibiotic resistance; The proportion of N. gonorrhoeae isolates in the United States with elevated cefixime minimum inhibitory concentrations (MICs) has increased. Higher MICs indicate that higher amounts or concentrations are needed to kill the bacteria.

The parent of a child with deep partial-thickness (second-degree) burns on the legs asks the nurse, "One of the staff told me that the dressings being used have silver in them. Why is that?" Which response by the nurse would be most appropriate?

"Dressings containing silver help prevent infection."

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?

"Herpes zoster is a reactivation of a previous varicella zoster infection."

A nurse is teaching a group of parents about burn safety. Which statement made by a parent requires intervention by the nurse?

"I had our plumber lower our water heater temperature to 130°F (53°C).

The nurse is providing discharge teaching to the parents of a child recently diagnosed with a seizure disorder. The nurse determines learning has occurred with which statement(s) by the parents? Select all that apply.

"We will be sure to keep the area safe and turn our child on the side during seizure activity." "We should time the seizure and write down what happens during the seizure."

An infant is diagnosed with nasolacrimal duct obstruction. The nurse is instructing the parents on how to perform lacrimal massage. The nurse determines the need for additional teaching based on which statement by the parents?

"We will press on the outer corner of the eye for several seconds."

A parent is observing a nurse provide care for the parent's 2-year-old toddler who was burned in a house fire. When the nurse is finished, the parent tells the nurse "I cannot believe this has happened. I should have been able to prevent this from happening." What is the best action for the nurse to take?

Encourage the parent to talk more about feelings.

A 30-month-old child has been discharged from the hospital after receiving treatment for second-degree (partial-thickness) burns over 6% of the body. One week later, the parent calls the nurse to say that the child has been drinking from a cup for one year, but is now constantly pulling at the mother's breast trying to nurse and refuses to drink from a cup. What is the best way for the nurse respond?

Explain that children who have had a serious injury sometimes exhibit regressive behavior.

The nurse is preparing a presentation for a group of parents at a local elementary school about seizures. Which information would the nurse likely include when describing this topic? Select all that apply.

Generalized seizures involve a loss of consciousness. Focal seizures may or may not involve a type of movement. Seizures are classified by the area of the brain affected.

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 unprovoked when he bit the girl

An intensive care nurse has received the above hand-off report from the emergency department nurse. Thirty minutes later, the nurse assesses the child again. Which assessment finding should the nurse investigate further?

temperature 100.5°F (38.1°C)

A nursing instructor is teaching about eye disorders in childhood. Which statement made by a student indicates a need for further instruction?

"Cataracts are only present in adults."

A child has been hospitalized with a diagnosis of severe impetigo. The nurse is interviewing the family. Which question will have the greatest impact on the child's care?

"Does your child have any allergies to medications?"

The nurse is assessing the skin of a 6-year-old child with urticaria. When interviewing the child and parents, which question would be most important for the nurse to ask?

"Is the child having any trouble breathing?"

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."

A new parent brings the 3-month-old infant to the clinic for a well-baby check up. During the visit, the parent asks the nurse, "I know the rays from the sun can be harmful, so what should I do to protect my infant?" Which suggestion by the nurse would be most appropriate?

"The best thing to do is keep any infant under the age of 6 months out of the sun."

The nurse is teaching the parents of a child diagnosed with erythema multiforme about the condition. The nurse determines that the teaching was successful based on which statement by the parents?

"The rash should go away in about 2 weeks."

A nurse is administering carbamazepine to a 4-year-old child diagnosed with epilepsy. The health care provider has prescribed 10 mg/kg/day by mouth. The child weighs 32 lb (14.52 kg). How many milligrams should the nurse administer? Record your answer rounded to the whole number.

145

What are the two HPV viruses that can cause cervical cancer?

16 & 18

The nurse is teaching a group of parents in the community about accident prevention. When describing accidental head trauma resulting in traumatic brain injury (TBI), the nurse would focus safety education on which age group(s)? Select all that apply.

Adolescents Toddlers

A nurse is providing care to an infant who is admitted with burns over the face, neck and chest. The nurse identifies which goal as priority for planning the infant's care?

Airway remains patent.

The nurse is preparing to perform a dressing change for a 9-year-old child with a severe burn injury. What nonpharmacologic intervention(s) will the nurse perform to decrease pain and discomfort for the child? Select all that apply.

Allow the child to choose means of distraction. Provide positive feedback. Allow the child to choose where on the body to start procedure.

During physical assessment of a 2-year-old child, the nurse suspects that the child may have a cataract in one eye based on assessment of which of the following?

Absence of the red reflex

The nurse is caring for a school-age child who has been having a continuous seizure for the last 40 minutes. What is the priority action by the nurse?

Administer lorazepam IV as prescribed.

The nurse is teaching the parents of a 7-year-old child on preventing integumentary disorders. What will the nurse include in the teaching? Select all that apply.

Apply sunscreen to your child. Teach your child to recognize and avoid poison oak. Teach your child to not approach strange pets without permission. Learn to identify infestations such as lice, scabies, and bed bugs.

The nurse is caring for a 2-month-old infant. What action(s) will the nurse take to help prevent skin breakdown? Select all that apply.

Assess the skin at regular intervals. Perform frequent diaper changes as appropriate. Note areas of redness on the skin.

31 year old client comes in with fish smelling creamy discharge. Denies itching. What does she have?

Bacterial vaginosis

The nurse is caring for a child with an external ventricular drainage device. The nurse is concerned about the minimal drainage in the past few hours. What action(s) by the nurse should be performed now? Select all that apply.

Check tubing clamps to ensure they are open. Ensure the tubing is not kinked.

The nurse is assessing a 9-year-old child who is suspected of having meningitis. The nurse assesses the child for meningeal irritation using the Kernig sign. Which result would the nurse interpret as positive?

Child reports pain behind the knee when leg is extended.

A school nurse has discovered that one of the children has acquired a case of head lice. The school principal asks the nurse to write a letter that will be sent to parents explaining about head lice and measures to prevent infestation. What information is important for the nurse to include in the letter? Select all that apply.

Children should avoid sharing personal items such as combs and hats. Parents should inspect their child's head for nits with a fine tooth comb. A second treatment one week after the first is recommended.

The nurse is caring for a 10-year-old child with bacterial conjunctivitis of the right eye. The eye is inflamed and drains a thick, yellow discharge. What should the nurse teach the client about the care of the eye?

Clean the discharge away from the inner to outer canthus.

Antibiotic therapy to treat meningitis should be instituted immediately after which event?

Collection of cerebrospinal fluid (CSF) and blood for culture

A child is hospitalized with a diagnosis of severe cellulitis. The nurse is preparing the family for discharge. Which instruction is most important for the nurse to convey to the family?

Complete the prescribed antibiotics

A young child in the clinic has watery eyes and reddened conjunctiva. The child keeps the eyes closed a lot, because it hurts to have them open. Which problem does the nurse suspect for this client?

Conjunctivitis

The nurse is providing care to an infant with microcephaly. When reviewing the prenatal and birth history, the nurse would identify the mother's exposure to which infection as a potential contributing factor?

Cytomegalovirus

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?

Decrease environmental stimulation

An adolescent is brought to the urgent care clinic for evaluation of the hands. The adolescent had been out snowboarding for the past several hours in 20oF (-6.7oC) temperatures. The adolescent was wearing gloves but took them off because they were wet and causing problems with holding onto the snowboard. The nurse completes an assessment and documents the findings. Based on the assessment findings above, which action would be appropriate as part of the plan of care?

Placing the hands in warm water for 30 minutes

A nurse is preparing a presentation on neurologic development in children. What information should the nurse include in the presentation?

Poverty and caregiver mental illness are shown to contribute to developmental delays in children.

A nurse is administering ear drops to a 7-year-old girl. What should the nurse do?

Pull the pinna of the ear up and back to straighten the external ear canal.

The nurse is administering a chickenpox vaccination to a 12-month-old girl. Which concern is unique to varicella?

This disease can reactivate years later and cause shingles.

True or False Most adults who get acute infections of Hepatitis B result in complete recovery with clearance of HBsAg from the blood and the production of anti-HBs

True

True or False: Antigens are foreign proteins.

True

The nurse is caring for a 4-year-old child with a full-thickness (third-degree) burn injury who was trapped in a bedroom during a house fire. What diagnostic testing will the nurse anticipate in the child's plan of care? Select all that apply.

carboxyhemoglobin level complete blood count with differential electrolyte panel arterial blood gases

A nursing student learning about childhood infectious diseases correctly identifies which of the following as the disease related to chickenpox, which tends to occur in older children or young adults?

herpes zoster

The most common complication of varicella is:

secondary bacterial infections.

A child has recently been diagnosed with cataracts. The treatment for cataracts is:

surgery.

A 5-year-old child is brought to the pediatric health clinic for evaluation. The nurse completes the assessment and documents the findings. Based on the assessment findings above, which condition would the nurse suspect?

Measles

A nurse is providing postoperative care for a newborn diagnosed with hydrocephalus. Which intervention should the nurse include in the plan of care?

Monitor for signs of peritonitis.

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?

Mumps

The nurse is performing a neurological assessment on a child. The previous examination noted the child to be alert but answering questions inappropriately. In this exam, the child only responds to vigorous stimuli. Which action should the nurse take first?

Notify the health care provider.

A nurse has received the above hand-off report for a client hospitalized with blunt head trauma following a motor vehicle accident. What is the nurse's priority in providing care for the client?

Observe for behavioral changes.

The parents of a 17-year-old adolescent diagnosed with bacterial meningitis tell the nurse, "We just do not understand how this could have happened. Our adolescent has always been healthy and just received a booster vaccine last year." How should the nurse respond?

"I understand your frustration. Unfortunately, immunizations are not 100% effective in preventing the infection."

A toddler is prescribed amoxicillin for bilateral otitis media. The parent reports that the toddler refuses to take the oral medication. The nurse knows that more education is needed when the parent makes which statement?

"I will shake the medication well, and draw up the medication to the top of the syringe. My spouse and I will hold our toddler down and force the medication down his throat."

A child is diagnosed with varicella zoster and has been prescribed acyclovir 15 mg/kg q 8 hours IV. The child weighs 61.7 lb (28 kg). How many milligrams should the nurse administer in each dose? Record your answer using a whole number.

420

A child weighing 66 lb (30 kg) with deep partial thickness burns is receiving fluid resuscitation. The nurse is monitoring the child's urine output via Foley catheter every hour and documenting the findings on the flowsheet above. The nurse would notify the health care provider about which urine output?

56 mL

The nurse is caring for a toddler who was just diagnosed with a hearing impairment. What would the nurse expect to assess in the child?

A delay or lack of clear, understandable speech pattern

The nurse has finished teaching the mother of a 5-year-old male diagnosed with bacterial conjunctivitis how to manage her son's infection at home. Which statement by the mother would indicate a need for further education?

"I will use Visine drops in his infected eye to help reduce redness."

The nurse provides education to the parent of an infant being treated for hydrocephalus with a ventriculoperitoneal (VP) shunt. Which statement by the parent indicates the need for further instruction?

"This shunt is the only surgery my baby will need."

The nurse is performing discharge teaching with the parents of a 3-month-old infant with deformational plagiocephaly (DP). Which statement by the parents requires further follow-up by the nurse?

"We do not have a bassinet, so we will use a car seat."

A nurse is providing discharge teaching to the parents of a child hospitalized with hydrocephalus, who had a ventriculoperitoneal (VP) shunt placed. The nurse should intervene if the parents make which statement?

"We expect our child to continue engaging in normal activities, including sports."

The nurse is teaching the parents of a 5-year-old child diagnosed with head lice about using permethrin. The nurse determines that the teaching was successful based on which statement by the parents?

"We need to leave the medication on for about 10 minutes before rinsing it off."

The nurse is reviewing the use of malathion for the treatment of head lice in an 8-year-old child with the child's parents. What statement requires further follow up by the nurse?

"We should apply the medication to wet hair."

The nurse receives a call from the parent of a 4-month-old infant who underwent endoscopic surgery for craniosynostosis 2 months earlier. The parent reports that the infant's skin appears red on the both temples. How should the nurse respond?

"Your infant should be evaluated in person, because a new helmet may be needed."

An infant is seen in the emergency department with several raised red welts over the abdomen and lower extremities. The parent states that the symptoms developed suddenly over the past few hours. The infant is fussy and has a low grade temperature. What assessment is most important for the nurse to perform?

Observe the infant's respiratory effort.

A parent calls the nurse triage line to say the child accidentally got hit in the eye and the parent believes the child will have a black eye. Which instruction is important for the nurse to provide this parent?

Place ice on the eye for 20 minutes/off the eye for 20 minutes for 24 hours.

A group of parents of young children are attending a class at the local community center on burn injury and burn prevention. The nurse emphasizes measures to prevent burns. Which information would the nurse likely include? Select all that apply.

Checking the temperature of the bath water before putting the child in it Avoiding drinking hot liquids while holding or snuggling the child

A nurse is providing care to a child with partial and full thickness burns over 26% of the body. In monitoring the child's output the nurse expects an output of 1 to 2 mL/kg/hr. The nurse has emptied 46 mL from the foley catheter for the past hour. The child weighs 62 lb (28 kg). What action should the nurse take?

Document the output and continue to monitor.

A nurse is caring for a 1-year-old child with a head injury. The child was previously unconscious but is now alert and oriented. Oral feedings are prescribed. The nurse determines that the child's risk for aspiration is low based on the presence of which reflex(es)? Select all that apply.

Gag Swallow Cough

The nurse is preparing a room for a child being admitted with meningitis. What is the appropriate action by the nurse?

Gather appropriate equipment and signage for respiratory isolation precautions.

What is the most common transmission of HIV for women?

Heterosexual contact

The nurse is teaching the parents of a 1-year-old child about how to prevent burns. What will the nurse include in the teaching? Select all that apply.

Keep the child away from hot liquids. Avoid drinking hot beverages while holding the child. Lock up cleaning fluids.

When describing measles to a local parent group, the nurse explains that which of the following is the hallmark clinical manifestation?

Koplik spots

A child is brought to the emergency department and is experiencing status epilepticus. The nurse would expect to administer which treatment as first-line therapy?

Lorazepam

To give eardrops to a 4-year-old child, what would be the best technique to use?

Pull the pinna of the ear up and back.

The nurse is planning care for a preschool-age child diagnosed with meningitis. What should the nurse identify as a priority goal for this client's care?

Reduce the pain related to nuchal rigidity.

What information should be included in the teaching plan for a child with varicella?

Remind the child not to scratch the lesions.

A nurse is preparing a presentation for a group of parents of toddlers at the local community center. The topic of the presentation is burn prevention. When describing burns in toddlers, which situation would the nurse likely identify as the most common cause of thermal burns?

Scalding from pulling a hot pan off the stove

What is a true statement regarding varicella zoster virus infection?

Secondary bacterial infections of the skin can occur.

The parents of a child diagnosed with varicella are concerned about their other children getting it. The nurse instructs the parents that their child is contagious for how much longer now that the rash has appeared?

Until there are no more new lesions and lesions have crusted over