Adaptive quizing
A nurse is caring for a school-aged child with Reye syndrome. For what complication should the nurse be particularly alert? 1 Bladder distention and overflow 2 Macular rash on the face and trunk 3 Bleeding and ecchymoses from liver involvement 4 Systemic and periorbital edema from renal shutdown
3 Bleeding and ecchymoses from liver involvement
A nurse explains to the parents of a 6-year-old child with a pinworm infestation how pinworms are transmitted. What statement indicates that the teaching has been understood? 1 "We need to keep the cat off the bed." 2 "She needs to wash her hands before eating anything." 3 "She needs to cover her mouth whenever she coughs." 4 "We need to tell the school so that the cafeteria can be cleaned."
2 "She needs to wash her hands before eating anything." Pinworm infestation is transferred by way of the oral-anal route, and effective hand washing is the best way to prevent transmission. Cats do not transmit pinworms. The hands should be kept away from the nose and mouth; the child should be taught to cough into a tissue or the inside elbow of the arm. Cleaning the cafeteria is not an effective means of preventing the transmission of pinworms.
An emergency tracheotomy has been performed on a 6-year-old child with acute epiglottitis, and the child is receiving humidified air through a tracheotomy collar. What early clinical manifestations of hypoxia should alert the nurse to suction the tracheotomy? 1 Dyspnea and cyanosis 2 Agitation and diaphoresis 3 Restlessness and increase in pulse 4 Severe substernal retractions and stridor
3 Restlessness and increase in pulse Restlessness and increase in pulse are some of the first signs of hypoxia; the airway must be kept patent to promote oxygenation. The other options are late signs of respiratory difficulty; suctioning and other measures should have been implemented before this time.
A 5-year-old child undergoes cardiac catheterization. The child is in the post-cardiac catheterization unit for 2 hours when the incoming nurse receives the report from the outgoing nurse. Which part of the child's report should the incoming nurse question? 1 Vital signs every 30 minutes 2 Voided 100 mL since admission 3 Pressure dressing over entry site 4 Bed rest with bathroom privileges
4 Bed rest with bathroom privileges Children are kept on complete bed rest for 4 to 6 hours after cardiac catheterization to reduce the risk of bleeding or trauma at the insertion site; the report regarding bathroom privileges should be questioned. Frequent assessment of vital signs is part of routine postcatheterization care. Urine output of 100 mL is within acceptable limits for a child of this age; oral fluids are encouraged to promote hydration and urination. A pressure dressing is placed over the insertion site to prevent bleeding. This is routine postcatheterization care.
A nurse who has agreed to serve as camp nurse for a week has an influx of children with abdominal pain late in the week. The nurse encourages the camp cook to increase the amounts of fruits and vegetables, whole grains, and other high-fiber foods in the meals. The nurse knows that this will help decrease the incidence of abdominal pain caused by which symptom? 1 Hunger 2 Vomiting 3 Appendicitis 4 Constipation
4 Constipation Children at camp tend to withhold stool because of a lack of privacy and embarrassment; they may then become constipated and experience abdominal pain. Hunger, vomiting, and appendicitis are not common occurrences at camp.
A nurse is caring for a school-aged child with type 1 diabetes. There have been problems maintaining euglycemia. What laboratory test does the nurse expect to be prescribed that will reveal the effectiveness of the diabetic regimen over time? 1 Serum glucose 2 Glucose tolerance 3 Fasting blood sugar 4 Glycosylated hemoglobin
4 Glycosylated hemoglobin The glycosylated hemoglobin test provides an accurate long-term index of the average blood glucose level for the 100 to 120 days before the test; the test is not affected by short-term variations. A result of less than 8% for this child indicates that the diabetic regimen is effective. Serum glucose reflects short-term (hours) variations in blood glucose. Glucose tolerance reveals carbohydrate metabolism in response to a glucose load. Fasting blood sugar is a screening test to rule out diabetes mellitus.
What safety instruction should a nurse teach a 10-year-old child with diminished sensation in the legs because of cerebral palsy? 1 Test the temperature of the water before a bath. 2 Tighten brace straps securely before ambulating. 3 Set the clock twice during the night to change position. 4 Look down at the legs when crutch-walking to check how they are positioned.
1. Test the temperature of the water before a bath. Individuals whose thermoreceptive senses are impaired are unable to detect changes or degrees of temperature. They must be taught to first test the temperature in any water-related activity to prevent scalding and burning. Overtightening of brace straps may lead to circulatory impairment or skin breakdown. The child with cerebral palsy has uncontrolled movement of voluntary muscles and does not need to change positions at night to prevent skin breakdown. Looking down at the legs when crutch-walking is dangerous because this action alters the center of gravity; with practice the child will be able to place the legs in the appropriate position for walking without looking down.
A client attending a prenatal class about nutrition tells the nurse that she is a strict vegetarian (vegan). What should the nurse encourage the client to eat that includes all of the essential amino acids? 1 Macaroni and cheese 2 Whole-grain cereals and nuts 3 Scrambled eggs and buttermilk 4 Brown rice and whole-wheat bread
2 Whole-grain cereals and nuts This combination provides a complete protein for vegans because they do not eat foods from animal sources, which contain all of the essential amino acids. Macaroni and cheese provides a complete protein and is acceptable to ovo-lacto-vegetarians, who eat milk, eggs, and cheese, but is not acceptable to vegans. Eggs are a complete protein, but are not acceptable to vegans, only to ovo-lacto-vegetarians, who eat milk, eggs, and cheese. Brown rice and whole-wheat bread are both unrefined grains, but together they do not provide a complete protein.
What nursing intervention will be most effective in helping relieve the anxiety of a young school-aged child during the postoperative period? 1 Encouraging the child to talk about feelings 2 Having the child and a parent room together 3 Telling the child a story about a child with similar surgery 4 Providing the child with sterile dressing equipment and a doll
4 Providing the child with sterile dressing equipment and a doll Because young children have difficulty verbalizing their fears or anxiety, therapeutic play helps them express these feelings. A child of this age is unable to express feelings entirely through words. Rooming with a parent may be helpful for a toddler or preschooler; school-aged children need to act out their fears. Young school-aged children are still somewhat egocentric and therefore interested in their own experiences and sensations. Telling a story about another child will not be beneficial.
A school-aged child with acute glomerulonephritis has fluid intake restricted to the previous day's output plus 40 mL. The child's output over the past 24 hours was 140 mL. From 3:00 PM to 11:00 PM the child is to receive one-third of the total daily fluid permitted. How much fluid should the nurse provide for the evening intake? 1 60 mL 2 70 mL 3 80 mL 4 90 mL
1 60 mL The child should receive 60 mL from 3 PM to 11 PM. 40 mL + 140 mL = 180 mL per day. There are three 8-hour segments in a day; 180 divided by 3 equals 60 mL for the 8-hour segment from 3 to 11 PM. Seventy, 80, and 90 mL are all more than the amount of fluid the child may safely receive.
A nurse is planning to teach self-administration of insulin to a school-aged child with newly diagnosed diabetes mellitus. What is the nurse's first action? 1 Assessing the child's developmental level 2 Determining the family's understanding of the procedure 3 Discussing community resources for the child in the future 4 Collaborating with the school nurse to ensure continuity of care in school
1 Assessing the child's developmental level Teaching methods in each age group are different, depending on the children's cognitive ability; individual differences depend on a variety of factors, including intelligence and emotional status. The child's readiness to learn must be assessed before a teaching plan that will bring success is developed. Determining the family's understanding, discussing community resources, and collaborating with the school nurse will be important later but not initially.
A school-aged child is to receive a blood transfusion. What should the nurse do first if an allergic reaction to the blood occurs? 1 Shut off the infusion. 2 Slow the rate of flow. 3 Administer an antihistamine. 4 Call the healthcare provider.
1 Shut off the infusion. The child is experiencing an allergic reaction, and the infusion must be stopped immediately to prevent serious complications. Slowing the rate of infusion will not halt the allergic reaction to the transfused blood. Administering an antihistamine is dangerous as an initial action because the degree of allergic reaction cannot be determined at this time. Also, it requires a healthcare provider's prescription. The healthcare provider should be notified after the infusion has been stopped.
After multiple upper respiratory infections, a school-aged child undergoes a tonsillectomy and adenoidectomy. Two weeks after surgery the nurse assesses the child's condition. On what should the nurse focus? Select all that apply. 1 Taste 2 Smell 3 Hearing 4 Breathing 5 Facial symmetry
1 Taste 2 Smell 3 Hearing 4 Breathing Edematous adenoids interfere with nasal breathing, which affects the sense of taste. Enlarged adenoids usually cause mouth breathing, which affects the sense of smell. Because hearing usually is affected by repeated oropharyngeal infections, this is an important postoperative assessment. Breathing is an important postoperative assessment because one goal of a tonsillectomy and adenoidectomy is to convert mouth breathing to nasal breathing. Facial symmetry is not affected by these procedures.
After surgical repair of a urinary tract malformation, a school-aged child is to be discharged with an indwelling catheter. The nurse teaches the parents the necessary interventions if urine does not appear in the drainage bag for 1 hour or more. Place the interventions in the order that they should be performed. (put in order) 1. Offering more fluids 2. Calling the practitioner 3. Checking for blocked drainage tubing 4. Pressing on the abdominal wall just above the bladder
1. Checking for blocked drainage tubing 2. Pressing on the abdominal wall just above the bladder 3. Offering more fluids 4. Calling the practitioner Kinking or twisting of the tubing can result in obstruction of urine flow; the parents can solve this problem by unkinking the tube. If the tubing is not kinked, the bladder should be checked for distention. Slight pressure on the abdominal wall just above the bladder may increase intra-abdominal pressure, promoting urine flow. Fluids should be offered because the child should be kept hydrated to produce urine. If no urine is produced within 1 hour, the practitioner should be called because the parents have been unable to solve the problem.
A nurse plans to teach a school-aged child with type 1 diabetes who is receiving both intermediate-acting insulin (Novolin N) and regular insulin (Novolin R) daily how to self-administer the insulin before discharge. What should the nurse teach the child? 1 Practice using the nonmedicated insulin pen first. 2 Alternate sites until the best one to use is found. 3 Draw up the Novolin N first and then draw up the regular insulin. 4 Self-inject the insulin immediately after being taught the technique.
1. Practice using the nonmedicated insulin pen first. The child's confidence, readiness, and skill for giving self-injections are essential in the long-term management of diabetes, and the child should be taught to practice using the nonmedicated insulin pen. Learning responsibility for injections should be a gradual process that takes place with continuous support and guidance. The sites must be rotated. The recommended procedure is to draw up the regular insulin first and then the intermediate-acting insulin to prevent contamination of the multidose vial of regular insulin with the intermediate-acting insulin.
An 8-year-old boy is found to have a mild concussion and is to be discharged home. The mother is instructed to check her child for responsiveness every 2 hours and to wake him up for this assessment after he goes to sleep. She telephones the nurse and says that she is afraid to allow him to go to sleep. How should the nurse respond? 1 "You can bring him to the hospital before bedtime, if you prefer." 2 "If your son becomes difficult to awaken, bring him to the hospital." 3 "There's no need to worry, because your son is past the critical period." 4 "Awakening your son throughout the night should alert you to any change."
2 "If your son becomes difficult to awaken, bring him to the hospital." A decreasing level of consciousness is a sign of neurological impairment necessitating medical attention. Because there is no change warranting care by health professionals, hospitalization is unnecessary. Telling the mother not to worry is false reassurance; a change in the child's condition is possible. Telling the mother she should not awaken her son during the night does not allow for periodically evaluating responsiveness.
A 5-year-old girl is undergoing a course of chemotherapy. One day the nurse sees the child crying. The child tells the nurse, "All my hair is gone, and everyone stares at me." What is the best response by the nurse? 1 "Let's take the hair off your doll so you two will look alike." 2 "Let's ask your mother to bring in a hat for you to wear until your hair grows back." 3 "You just think that everyone is staring at you because you feel funny without your hair." 4 "You shouldn't have to look at yourself without hair, so I'm going to take this mirror out of your room."
2 "Let's ask your mother to bring in a hat for you to wear until your hair grows back." Having the child wear a hat until her hair regrows meets the her current needs while assuring her that her hair loss is temporary. Removing the doll's hair demeans the child's feelings. Denying the child's feelings by stating that she just thinks that everyone is staring at her is not the best response. Taking the mirror out of the room demeans the child's feelings and implies that the hair loss is unsightly.
A school nurse is teaching a group of parents about pediculosis capitis (head lice). What common secondary infection does the nurse teach the parents to identify? 1 Eczema 2 Impetigo 3 Cellulitis 4 Folliculitis
2 Impetigo Impetigo may develop as a secondary bacterial infection because of breaks in the skin caused by scratching. Eczema is an allergic response, not an infection. Cellulitis is an extended inflammation that is not commonly found in children with pediculosis. Folliculitis is a pimple or an infection of the hair follicle; it does not occur as a result of pediculosis.
The nurse is rendering preoperative care to a child with a Wilms tumor. What is the most important aspect of this care? 1 Palpating for liver size 2 Monitoring blood pressure 3 Obtaining urine for a culture 4 Maintaining the prone position
2 Monitoring blood pressure Blood pressure monitoring is important because the tumor is of renal origin, and the renin-angiotensin mechanism may be involved. Palpating the liver should be avoided; it puts pressure on the involved area, increasing the risk of rupture of the tumor and seeding of cancer cells. There are no data to indicate that the child has a urinary tract infection. Lying in the prone position puts pressure on the involved area, increasing the risk of rupture of the tumor and seeding of cancer cells.
Medication is prescribed for a 7-year-old child with attention deficit-hyperactivity disorder (ADHD). What information should the school nurse emphasize when discussing this child's treatment with the parents? 1 Tutoring their child in the subjects that are troublesome 2 Monitoring the effects of the drug on their child's behavior 3 Explaining to their child that the behavior can be controlled if desired 4 Avoiding imposing too many rules because these will frustrate the child
2 Monitoring the effects of the drug on their child's behavior By monitoring and reporting changes in the child's behavior, the healthcare provider can determine the effectiveness of the medication and the optimal dosage. Parents should not be encouraged to tutor their children because there may be too much emotional interaction. This child's behavior is not deliberate or easily controllable; this type of statement may lead to diminished self-esteem in the child if control does not occur. Children, especially children with ADHD, need more structure than do adults.
An infant is diagnosed with failure to thrive, has been receiving tube feedings for 3 days, has very dry skin and mucous membranes. The nurse verifies that all feedings have been retained, but the daily urine output is consistently 250 mL, and the infant has lost weight. What does the nurse conclude? 1 This is an expected finding in an infant with failure to thrive. 2 The infant is dehydrated, and the fluid intake needs to be increased. 3 This finding is a reflection of the infant's inability to absorb nutrients. 4 The infant is undernourished, and a higher caloric intake will be required.
2 The infant is dehydrated, and the fluid intake needs to be increased. These are classic signs of dehydration; the healthcare provider should be notified because a prescription to increase fluids is needed. It is not common for the condition of an infant with failure to thrive to continue to deteriorate once therapy has been implemented. Although the infant may have a gastrointestinal problem, the classic signs of dehydration must be addressed before this conclusion is reached. These signs indicate dehydration, not under nutrition.
After a craniotomy a child is returned to the postanesthesia care unit. What is the rationale for the nurse's positioning of the child in the semi-Fowler position? 1 Cardiac workload is decreased, and oxygenation is facilitated. 2 Cranial drainage is increased, thus preventing cerebral fluid accumulation. 3 Subdural pressure is decreased, and recovery from anesthesia is enhanced. 4 Thoracic cavity expansion is increased, and pressure on the diaphragm is reduced.
2. Cranial drainage is increased, thus preventing cerebral fluid accumulation. With the semi-Fowler position, gravity aids drainage of fluid from the head, which helps prevent cerebral edema. Although the semi-Fowler position helps decrease cardiac workload and facilitate oxygenation compared with the supine position, these are not the reasons that this position is used. Although the semi-Fowler position reduces subdural pressure, it does not enhance recovery from anesthesia. Although diaphragmatic pressure is reduced and there is thoracic cavity expansion, these are not the reasons that this position is used.
An 11-year-old boy who has stepped on a rusty nail is given tetanus immune globulin in the emergency department. The nurse knows that the immune globulin injection will confer what type of immunity? 1 Longer-lasting active immunity 2 Temporary passive acquired immunity 3 Passive immunity throughout the child's life 4 Active natural immunity throughout the child's life
2. Temporary passive acquired immunity Temporary passive immunity is provided by tetanus immune globulin, which is administered immediately after an injury like the one the child sustained. If the child has not had a tetanus toxoid booster, it is given at another site at the same time. Longer-lasting active immunity is conferred by tetanus toxoid, which is a modified toxin that stimulates the body to form antibodies that last as long as 10 years. Passive immunity, even the natural type derived from the mother, is temporary. Only by having the disease is lifelong natural immunity made possible.
A school nurse is teaching a unit on nutrition to a sixth-grade class. Why should the nurse include that eating in fast-food restaurants should be limited? 1 Eating is rushed. 2 Portions are too large. 3 Food is high in calories. 4 Sanitation is inadequate.
3 Food is high in calories. The American Dietetic Association (Canada: Public Health Agency of Canada) has indicated that the food in fast-food restaurants is calorie dense and higher in fat, sugar, and sodium than the food served at home or in other restaurants. Although fast-food restaurants encourage patrons to eat quickly, this is not the major reason that their food is discouraged. Portions in fast-food restaurants are not large; they are smaller than those in diners and many other restaurants. Fast-food restaurants encourage safe food handling to meet the standards of local health departments.
The mother of 10-year-old twin boys tells the nurse in the pediatric clinic that she is concerned because the boys want to spend all their time with their father. What is the best response regarding this behavior? 1 It is typical of twins. 2 It indicates that they dislike girls. 3 Gender identification is natural at this age. 4 Counseling should be considered at this time.
3 Gender identification is natural at this age. During the school-aged years, learning of the sex role becomes more prominent. At this age children prefer friendships with children of the same sex and spend more time with the parent of the same sex. This behavior is not because they are twins but because they are boys. Their behavior is unrelated to a dislike of girls. There is no need for counseling, because this behavior is expected at this age.
An 8-year-old child admitted to the hospital 2 days ago tells the nurse, "I'm too sick to feed myself." The nurse recognizes that this statement most likely indicates what emotional state? 1 Rebellion 2 Loneliness 3 Regression 4 Immaturity
3 Regression Regression is the retreat to a past level of behavior as a way of minimizing stress or controlling anxiety. Increased dependence, such as being fed by another person, is a form of regression. The child's statement does not indicate rebellion against those who are providing care. Although loneliness may be a factor, it is not the key factor in the child's statement. The child's statement reflects not immaturity but rather an assumption of the sick role to reduce stress.
What is the first activity of daily living (ADL) that the nurse should help teach a developmentally disabled 8-year-old child? 1 Dressing 2 Toileting 3 Self-feeding 4 Combing hair
3 Self-feeding Self-feeding is an early step in the progression of growth and developmental skills. All the steps for acquiring the skills needed to fulfill ADLs should progress in the same order as they do for a child who is not mentally challenged. The difference is the age when the skill is acquired and the difficulty in learning to acquire the skill. Dressing is a more advanced skill than self-feeding; it requires mastery of gross and fine motor skills and hand-eye coordination. Toileting is a more advanced skill than self-feeding; it requires control of the anal and urethral sphincters, readiness of psychophysiological factors, and motivation. Combing the hair is a more advanced skill than self-feeding. It requires control of gross and fine motor skills and muscle coordination.
After a 5-year-old child's tonsillectomy, the nurse notes that the child swallows frequently. What should the nurse conclude about the child's behavior? 1 This is a sign of respiratory distress. 2 The child is experiencing throat pain. 3 The child is bleeding from the surgical site. 4 This is a reaction from the general anesthesia.
3 The child is bleeding from the surgical site. A trickle of blood from the surgical site will cause the child to swallow frequently; usually this is the first sign of hemorrhage. If the child were experiencing respiratory distress the clinical manifestations would include dyspnea, tachycardia, and changes in behavior or skin color. The child with a sore throat tries not to swallow. Frequent swallowing is not a usual response on awakening from general anesthesia.
A nurse is caring for several school-aged children with cystic fibrosis. Why does the nurse anticipate that these children will probably be small and underdeveloped for their age? 1 There is muscle atrophy from lack of motor activity. 2 There is decreased secretion of pituitary growth hormone. 3 These children digest little food because pancreatic enzymes are blocked. 4 These children have anorexia with minimal amounts of nutritional intake.
3 These children digest little food because pancreatic enzymes are blocked. The production of tenacious mucus in the pancreatic ducts prevents the flow of digestive enzymes into the intestines. Therefore fats, proteins, and, to a lesser extent, carbohydrates cannot be digested and absorbed. Muscle atrophy from a lack of motor activity is not a problem associated with cystic fibrosis. Cystic fibrosis does not influence secretion of the growth hormone. Anorexia is not a usual problem in children with cystic fibrosis; usually they are ravenously hungry.
A nurse must restart a peripheral intravenous infusion on a hospitalized 5-year-old child. What should the nurse do to promote the child's sense of security? 1 Inform the child that it will feel like a bee sting. 2 Ask the child if the parents should leave the room. 3 Take the child to the treatment room for the procedure. 4 Tell the child that it is important to have a new IV started.
3. Take the child to the treatment room for the procedure. The child's bed offers a sense of security during the stress of hospitalization. If painful invasive procedures are performed in the bed, the child will be left with no refuge, so painful procedures should be performed away from the child's bed when possible. Although telling the child that the procedure will feel like a bee sting is an honest statement, it will not promote a feeling of security. The child should not be asked whether the parents should leave; the parents should be encouraged to stay to provide support for the child. Intellectual rationalization for a painful procedure will not provide security for a 5-year-old child who must cope with the reality of the pain to be experienced.
A nurse in the pediatric clinic is planning care for a 7-year-old boy with enuresis. What is an appropriate short-term goal for this child? 1 Groin rash will resolve in 1 week. 2 Continence will be maintained throughout the night. 3 The interval between voidings will increase by 1 hour. 4 Self-esteem enhancement will occur when the child is given praise.
3. The interval between voidings will increase by 1 hour. Lengthening the time between voidings is a short-term goal that can be measured in increments of 1 or more hours between each voiding, providing a measurable sign of improvement. There are no data to indicate that the child has a groin rash. Remaining continent is a long-term goal. Enhanced self-esteem is a long-term goal and can be measured only indirectly by evaluating the child's behavior.
The nurse is caring for a child with spasmodic croup. The nurse knows that which symptom requires immediate nursing intervention? 1 Irritability 2 Hoarseness 3 Barking cough 4 Rapid respiration
4 Rapid respiration Rapid respiration may be a sign of impending airway obstruction. Unless irritability is accompanied by severe restlessness, symptomatic care should be given. Unless accompanied by signs of respiratory embarrassment, hoarseness needs no immediate intervention. A barking cough may sound ominous, but it is not a sign of respiratory compromise, as is rapid respiration.
