Exam #2 Chapter Review Questions

CRITICAL THINKING EXERCISE: Describe the impact of a cerebral vascular accident in the child as compared with the adult. How does it affect the child's future? How will the nurse provide care differently for the child stroke victim as compared with the adult?

The outcomes reported for cerebral vascular disorders in children vary, but many children will develop some neurologic or cognitive deficit and this may alter growth and development. When caring for the child stroke victim, parental support and education will be essential in helping them care for a child who has new disabilities.

CRITICAL THINKING EXERCISE: A 6-month-old baby is brought to the physician's office with a history of diarrhea. She has had six watery stools in the past 18 hours. She is vomiting her formula. Her mother states that she has had no fever. Upon completion of the history and physical examination, what signs and symptoms would you expect to find that would indicate that the baby is experiencing mild dehydration?

a decrease in number of wet diapers, but otherwise normal examination findings (alert, oral mucosa moist and pink, skin pink with elastic turgor, fontanel soft and flat, normal pulse and blood pressure)

CRITICAL THINKING EXERCISE: A 13-month old has been diagnosed with severe visual impairment. Develop a list of sample nursing diagnoses for this situation.

a list of sampling nursing diagnoses for this patient include risk for injury, sensory/perceptual alteration (visual), altered family processes, fear, risk for altered growth and development, knowledge deficit, and inadequate coping

CRITICAL THINKING EXERCISE: How would you distinguish allergic conjunctivitis from acute bacterial conjunctivitis?

Allergic Conjunctivitis - may be more prevalent during allergy season, eye discharge is watery, eyes are itchy, the child is afebrile, and it may be accompanied by allergic rhinitis Acute Conjunctivitis - more prevalent when it is "going around" the school or day care setting, eye discharge is usually thick and mats, the eyes may hurt, the child may be febrile if the ears are also infected, and it may occur alone or in conjunction with acute otitis media

CRITICAL THINKING EXERCISE: A 4-year-old boy has parents with little education, and the child has Medicaid coverage. Another child is 7 years old and has well-educated parents with private insurance coverage. Both of these children need a heart transplant, and a heart is available that is a very good match for both children. Discuss some of the issues involved in deciding which child should receive the heart.

Allocation of health resources is a common bioethical issue experienced today. The students' answer should include a discussion of this dilemma and citation of current sources.

The nurse is caring for a child after a cardiac catheterization. What is the nursing priority? A. Allow early ambulation to encourage activity participation. B. Check pulses above the catheter insertion site for strength and quality. C. Assess extremity distal to the insertion site for temperature and color. D. Change the dressing to evaluate the site for infection.

C. Assess extremity distal to the insertion site for temperature and color. Vessel spasm or hematoma may occur after the catheterization, occluding circulation. The extremity may become pale, feel cool to the touch, and have diminished pulses distal to the insertion site.

The nurse is caring for an infant who has undergone surgery for infantile glaucoma. What is the priority nursing intervention? A. Place the child prone postoperatively for comfort. B. Teach the family use of the contact lens. C. Place elbow restraints on the infant. D. Provide a mobile for optical stimulation.

C. Place elbow restraints on the infant. It is very important to protect the operative site after any eye surgery. Elbow restraints prevent the infant from rubbing the eyes.

A neonate should be evaluated by a physician if which signs and symptoms are present? A. Acting fussier than normal B. Refusing the pacifier C. Rectal temperature above 38°C D. Mottling that is present during bathing

C. Rectal temperature above 38°C Neonates or young infants less than 3 months of age with a rectal temperature greater than 38° C are considered at risk for sepsis until proven otherwise and should be seen by a physician. Their immature immune system and inability to localize or handle infection put them at high risk for severe morbidity or mortality from bacterial infections.

CRITICAL THINKING EXERCISE: A baby boy was born at 26 weeks' gestation to 15-year-old unmarried parents who abuse drugs. The infant weighed 1.5 kg at birth and was diagnosed with AV canal defect and Down syndrome. Discuss some of the major issues in planning for care. Include a care plan and a list of teaching needs for the family.

Issues related to this infant's situation include: adolescent parents, prematurity, single motherhood, drug abuse, CHD, Down syndrome. The care plan should address those issues, and the teaching needs would include information related to caring for the premature infant, the child with Down syndrome, and should include pre- and postoperative care for the child with CHD.

CRITICAL THINKING EXERCISE: A 1-month-old infant is admitted to the hospital to rule out sepsis. What would be your priority nursing interventions?

PRIORITY nursing interventions include providing close monitoring (including vital signs) and initiate intravenous antibiotic therapy which will be started immediately after the blood, urine, & cerebrospinal fluid cultures have been obtained manage fever to promote comfort

CRITICAL THINKING EXERCISE: A 12-year-old boy presents with a very sore throat and fever. On assessment you find an erythematous rash on his face that feels like sandpaper. You obtain a throat culture, which is positive for group A streptococcus. What instructions would you give the parents regarding his care at home?

care at home would instruct the parents on the importance of taking the antibiotic as directed and finishing all the medicine, instruct them to encourage fluids to maintain adequate hydration due to fever, teach parents ways to provide comfort for the child, and discuss use of a cool mist humidifier to help soothe the child's sore throat; soft foods, warm liquids such as soup, or cold foods such as popsicles may also be helpful. trim the child's fingernails if the rash itches to help prevent infection due to breaks in the skin

CRITICAL THINKING EXERCISE: A 13-year-old boy was diagnosed with hypertension over 2 years ago. He is noncompliant with his antihypertensive medication regimen. He is 5 ft tall and weighs 170 lb. His favorite activity is video games. Develop a teaching plan for this teen, providing creative approaches at the appropriate developmental level.

The nurse should find common ground with the teen, in order to encourage adherence. Getting to know the teen will allow the nurse to understand what he values, and what his possible future plans might be. He should be educated at his developmental level. The plan should cover diet and exercise recommendations. Perhaps a video game incorporating exercise would be helpful.

CRITICAL THINKING EXERCISE: A 10-year-old child is admitted to the pediatric unit after experiencing a seizure. A complete, accurate, and detailed history from a reliable source is essential. What information would you ask for while obtaining the history?

"When did the event occur—while sleeping, eating, playing, just after waking? Provide a description of the child's behavior during the event—what types of movements; progression and length of seizure; respiratory status; any apnea? How did the child behave after the event? Have the episodes been recurrent, and if so how frequent? Have there been any precipitating factors, such as a fever, fall, activity, anxiety, infection, or exposure to strong stimuli such as flashing lights or loud noises?"

CRITICAL THINKING EXERCISE: A 6-year-old child is admitted to the hospital because of a possible seizure. The child's mother calls the nurse to the room because the child is "jerking all over" and won't respond when she calls the child's name. List appropriate nursing interventions for this child. Prioritize the list of interventions.

1. Assess ABC's in the child. 2. Prevent injury (loosen or remove tight clothing or necklaces if possible, turn child onto his side and open airway if possible, remove hazards). 3. Time the seizure. 4. Administer appropriate medication and treatments to stop seizure if ordered 5. Remain calm and provide education + support to the child plus family 6. Provide appropriate documentation (including a description of behavior seen, length of seizure, & response to interventions)

CASE STUDY: Sandra and Michael Graham have brought their 6-month-old son, Thomas, to the pediatric unit for observation. Thomas's head circumference has increased from the 25th percentile at the 4-month check-up to the 75th percentile at the 6-month check-up. Upon assessment, the nurse notes a bulging anterior fontanel and persistent primitive reflexes.

1. In the infant, the most obvious indication of hydrocephalus is often a rapid increase in head circumference. 2. In the infant early signs of increased intracranial pressure includes:Bulging, tense fontanel, wide sutures, dilated scalp veins, high-pitched cry. Other early signs include: Vomiting, possibly projectile, decreased pulse and respirations, increased blood pressure or pulse pressure, pupil reaction time decreased and unequal, sunset eyes, changes in level of consciousness, irritability, seizure activity. 3. Late signs of increased intracranial pressure include lowered level of consciousness, decreased motor and sensory responses, bradycardia, irregular respirations, Cheyne−Stokes respirations, decerebrate or decorticate posturing, fixed and dilated pupils.

CRITICAL THINKING EXERCISE (CONT.): The 4-year-old presented in Question 3 above was diagnosed with varicella zoster virus. Write a nursing care plan for a child with varicella.

A nursing care plan for a child with varicella will be individualize for the child. In addition, teach the family that the child remains contagious until all lesions have crusted over, so the child may not return to preschool or day care until that time.

A toddler has moderate respiratory distress, is mildly cyanotic, and has increased work of breathing, with a respiratory rate of 40. What is the priority nursing intervention? A. Airway maintenance and 100% oxygen by mask B. 100% oxygen and pulse oximetry monitoring C. Airway maintenance and continued reassessment D. 100% oxygen and provision of comfort

A. Airway maintenance and 100% oxygen by mask Priorities of care for the child with respiratory distress are to clear the airway and provide oxygen supplementation.

CASE STUDY: Jung Kim, 4 years old, is brought to the clinic by his parents with abdominal pain and a poor appetite. His mother states, "He cries when I put him on the toilet."

A. Ask when Jung achieved bowel continence via toilet teaching. Has he experienced incontinence since then, particular liquid stool leakage? What are his usual bowel movement patterns? Does he demonstrate stool withholding behaviors? How is his appetite? Explore dietary history for fiber and fluid intake. How long has this been going on? Has the mother tried any medications or other interventions, and what was the result? B. When the child is diagnosed with constipation, he may require disimpaction of stool which may include the use of laxatives and enemas. C. Provide guidelines for scheduling and supervising bowel habits. Reward the child with stickers or other rewards for compliance. Teach about high-fiber diets and increasing Jung's fluid intake (other than milk). Educate parents to assess for signs of constipation and stool withholding behaviors. Educate about the importance of compliance with medication use, if ordered. Childhood constipation can be a very stressful process for both the child and family. Refer for counseling as needed.

A 5-year old who had a renal transplant 9 months ago and has no history of chickenpox presents to the pediatric clinic for his vaccinations. Which is the most appropriate set to give? A. DTaP, IPV B. DTaP, IPV, MMR, varicella C. DTaP, IPV, varicella D. IPV only

A. DTaP, IPV The routine schedule for healthy 4- to 6-year-olds includes DTaP, IPV, and MMR. If the child had not had chickenpox in the past and was unvaccinated, then varicella would also be warranted. The child in this case is taking chronic immunosuppressive medications for his renal transplant, however, and immunosuppression is a contraindication for live vaccine use (measles and varicella are live vaccines).

CASE STUDY: Antonio Cruise, a 7-year-old boy, is brought to the clinic by his mother for his annual examination. During your assessment the mother brings up concerns that Antonio continues to wet the bed at night. She states, "I was hoping this would end on its own, but now I'm concerned that there is a problem."

A. Determine the age of toilet training and when or if the child achieved successful daytime and nighttime dryness. Inquire about urine-holding behaviors such as squatting, dancing, or staring as well as rushing to the bathroom. Inquire about the amount and types of fluid the child typically consumes before bedtime. Assess for risk factors such as family disruption or other stressors, chronic constipation, excessive family demands related to toileting patterns, history of being difficult to arouse from sleep, family history of enuresis. Determine his cognitive status, height, and blood pressure. B. Encourage him to increase the amount of fluid consumed during the day. Set a fixed schedule for him to attempt to void throughout the day. Teach the family that he is not lazy, nor does he wet the bed intentionally. Encourage the parents to limit intake of bladder irritants such as chocolate and caffeine. Teach parents to limit fluid intake after dinner and ensure that the child voids just before going to bed. Waking the child to void at 11 p.m. may also be helpful. Teach the parents to use bed pads and to make the bed with two sets of sheets and pads to decrease the workload in the middle of the night. When sleeping at home, the child should wear his or her usual underwear or pajamas. If away on a family vacation, pull-ups may decrease the stress on both the child and the parents. Teach about the use of an enuresis alarm system or medications as prescribed. C. Encourage the child and family to read books such as Dry All Night: The Picture Book Technique That Stops Bedwetting by Alison Mack or Waking Up Dry: A Guide to Help Children Overcome Bedwetting by Dr. Howard Bennett. On Antonio's developmental level, help him understand that he is not alone. Encourage his parents to use a positive reward system and not to be punitive about bed changes. Refer the parents to support groups as needed.

CASE STUDY: As the nurse in a pediatric clinic, you see a child who comes in because she is having extreme itching, especially at night. The child is diagnosed with scabies. The mother is upset and says to you, "We are clean people! I don't understand how this could happen!"

A. Explain that scabies can happen to anyone and it is not caused by being dirty. Scabies is contacted through direct close contact. B. Treatment: A scabicide, such as permethrin or lindane, should be applied to the entire body below the head. Treatment of infants and young children should include the head, neck, and body. The cream is left on for a specified time (usually 8 to 14 hours) depending on the type of scabicide. Careful instructions on proper use of any product should be given and strict adherence to application instructions should be urged. Itching may not subside for several weeks, even after successful treatment. C. Prophylactic therapy for household members. Bedding and clothing used by infested person or household or close contacts within 4 days before treatment should be laundered in hot water and dried on the hot cycle (mites do not survive more than 3 to 4 days without skin contact). Avoid direct skin-to-skin contact with person or items used by those infested. Room used by an infected person, especially if he or she had crusted scabies, should be thoroughly cleaned and vacuumed. Encourage adhering to instruction for application of treatment closely.

CRITICAL THINKING EXERCISE: A 4-year-old child presents with a fever and rash. What three of the following items should the nurse obtain during the health history? A. Immunization history B. Any exposure to communicable or infectious diseases C. Whether the child takes a daily vitamin D. Thorough description and history of the rash E. Mother's immunization history

A. Immunization history B. Any exposure to communicable or infectious diseases D. Thorough description and history of the rash Immunization history and any exposure to communicable or infectious diseases can help identify infectious or communicable diseases the child is at risk for. Many childhood infectious and communicable diseases involve a rash. Rashes can be difficult to identify, so obtaining a thorough description and history from the caregiver is important.

When compared with adults, why are infants and children at an increased risk of head trauma? A. The head of the infant and young child is large in proportion to the body and the neck muscles are not well developed. B. The development of the nervous system is complete at birth but remains immature. C. The spine is very immobile in infants and young children. D. The skull is more flexible due to the presence of sutures and fontanels.

A. The head of the infant and young child is large in proportion to the body and the neck muscles are not well developed. Infants and young children have a larger head size in relation to the body and a higher center of gravity. Both cause them to hit their head more readily when involved in motor vehicle accidents, bicycle accidents, and falls.

Compared with adults, why are infants and children at an increased risk for infection and communicable diseases? A. The infant has had limited exposure to disease and is losing the passive immunity acquired from maternal antibodies. B. The infant demonstrates an increased inflammatory response. C. Cellular immunity is not functional at birth. D. Infants have an increased risk for infection until they receive their first set of immunizations.

A. The infant has had limited exposure to disease and is losing the passive immunity acquired from maternal antibodies. The newborn displays a decreased inflammatory response to invading organisms, contributing to an increased risk for infection. Cellular immunity is generally functional at birth, and the humoral immunity system matures by encountering and then developing immunity to new diseases. Since the infant has had limited exposure to disease as well as losing the passive immunity acquired from maternal antibodies, the risk of infection is higher.

Which of these factors contributes to infants' and children's increased risk for upper airway obstruction as compared with adults? A. Underdeveloped cricoid cartilage and narrow nasal passages B. Small tonsils and narrow nasal passages C. Cylinder-shaped larynx and underdeveloped sinuses D. Underdeveloped cricoid cartilage and smaller tongue

A. Underdeveloped cricoid cartilage and narrow nasal passages Infants and children have smaller nasal passages than adults, thus making obstruction with mucus more common. The funnel shape of the larynx due to underdevelopment of the cricoid cartilage places children less than 10 years of age at increased risk of airway obstruction in the event of edema or mucus production.

CASE STUDY: Bradley is a 5-year-old with a history of moderate asthma who was started on oral steroids yesterday after visiting his pediatrician for an asthma exacerbation. In addition, he has been receiving aerosol treatments every 4 hours since yesterday. He received his last levalbuterol nebulizer treatment 3 hours ago. His mother has brought him back to the office because she is concerned that he does not seem to be getting any better.

A. Yes. Bradley should be placed on oxygen via face mask. Increased work of breathing and pallor indicate a need for oxygen supplementation. B. The nurse should note adequacy of breath sounds. Is Bradley aerating well in all lobes? Simple absence of wheezes is not enough information. C. The action of Beta-agonist bronchodilators is to relax smooth muscle. The albuterol treatment has eased bronchoconstriction somewhat, allowing for better air movement. Prolonged expiration occurs when bronchospasm is present. Bradley should continue to be observed very closely, as children may deteriorate quickly when suffering from an alteration in oxygenation or respiratory disorder.

The nurse is caring for a 5-year-old child with a congenital heart anomaly causing chronic cyanosis. When performing the history and physical examination, what is the nurse least likely to assess? A. obesity from overeating B. clubbing of the nail beds C. squatting during play activities D. exercise intolerance

A. obesity from overeating Children with CHD causing chronic cyanosis are likely to demonstrate failure to thrive, not obesity. They frequently develop clubbing of the nail beds and exercise intolerance, and those with tetralogy of Fallot or pulmonary stenosis may display hypercyanotic spells (squatting).

A 3-month-old infant presents with a history of vomiting after feeding. The plan for the infant is to rule out GER. What information from the history would lead the nurse to believe that this infant may need further intervention? A. poor weight gain B. small "spits" after feeding C. sleeps through the night D. difficult to burp

A. poor weight gain GER is considered a routine and benign occurrence unless it is significant enough to cause respiratory symptoms or, as in this infant, to interfere with growth, in which case it would be considered gastroesophageal reflux disease, and would warrant treatment.

Sam, age 11, has a diagnosis of rheumatic fever and has missed school for a week. What is the most likely cause of this problem? A. previous streptococcal throat infection B. history of open heart surgery at 5 years of age C. playing too much soccer and not getting enough rest D. exposure to a sibling with pneumonia

A. previous streptococcal throat infection Rheumatic fever occurs as a sequela to group A streptococcal infection.

CRITICAL THINKING EXERCISE: The nurse is caring for a 4-year-old girl who returned from the recovery room after a tonsillectomy 3 hours ago. She has cried off and on over the past 2 hours and is now sleeping. What areas should the nurse assess and focus on for this child?

Assess for frequent swallowing, as this may occur when early bleeding is present.Keep the child in a prone or side-lying position to facilitate drainage of secretions. If suction is required, do so carefully in order to avoid trauma to the surgical site. Adequate pain management is also critical in the postoperative period for tonsillectomy. When the child is awake again, encourage oral fluid consumption, avoiding red or brown fluids (so as not confuse emesis from them with blood) and citrus juices (which may irritate the throat).

Which situation would cause the nurse to become concerned about possible hearing loss? A. 12-month old who babbles incessantly, making no sense B. 8-month old who says only "da" C. 3-month old who startles easily to sound D. 3-year old who drops the letter "s"

B. 8-month old who says only "da" Infants should be babbling at the age of 8 months. Lack of babbling is an indicator of possible hearing loss.

A 4-year old complains of extreme pain when the tragus is touched. Though not diagnostic, this sign is most indicative of which disorder? A. acute otitis media B. acute tympanic effusion C. otitis interna D. otitis externa

D. otitis externa Otitis externa, infection and inflammation of the ear canal, results in significant pain, particularly if the tragus is touched.

A 6-month-old infant is admitted to the hospital with suspected bacterial meningitis. She is crying, irritable, and lying in the opisthotonic position. The priority nursing intervention would be? A. Educate the family on ways to prevent bacterial meningitis. B. Initiate appropriate isolation precautions and begin intravenous antibiotics. C. Assess the infant's fontanels. D. Encourage the mother to hold the infant and feed her.

B. Initiate appropriate isolation precautions and begin intravenous antibiotics. Bacterial meningitis is a medical emergency and requires prompt hospitalization and treatment. Deterioration may be rapid and may occur in less than 24 hours, leading to long-term neurologic damage, and even death. Intravenous antibiotics will be started immediately after the LP and blood cultures have been obtained. Appropriate isolation needs to be initiated in any child with suspected or diagnosed bacterial meningitis.

A 2-year old has been prescribed eye patching for strabismus 6 hours per day. What teaching does the nurse provide for the mother? A. Try to patch 6 hours per day, but if you miss some it is OK. B. Patching is necessary to strengthen vision in the weaker eye. C. Patching will keep the eye from turning in. D. Since the child is so young, patching can be delayed until school age.

B. Patching is necessary to strengthen vision in the weaker eye. Patching instructions must be complied with. Patching is done as early as possible to strengthen the acuity in the weaker eye while vision is still developing. Delay in strabismus treatment may lead to amblyopia and eventual blindness in one or both eyes.

CRITICAL THINKING EXERCISE: A 10-month-old girl is admitted to the pediatric unit with a history of recurrent pneumonia and failure to thrive. Her sweat chloride test confirms the diagnosis of cystic fibrosis. She is a frail-appearing infant with thin extremities and a slightly protuberant abdomen. She is tachypneic, has retractions, and coughs frequently. Based on the limited information given here and your knowledge of cystic fibrosis, choose three of the categories below as priorities to focus on when planning her care? A. Prevention of bronchospasm B. Promotion of adequate nutrition C. Education of the child and family D. Prevention of pulmonary infection E. Balancing fluid and electrolytes F. Management of excess weight gain G. Prevention of spread of infection H. Promoting adequate sleep and rest

B. Promotion of adequate nutrition C. Education of the child and family D. Prevention of pulmonary infection Children with cystic fibrosis require pancreatic enzyme supplementation with every meal and snack in order to achieve appropriate nutrient absorption. Additionally, supplemental fat-soluble vitamins are needed as well as a balanced high-calorie, high-protein diet in order for adequate growth to occur. Cystic fibrosis is a serious chronic illness that requires daily intervention throughout the individual's lifespan. The child and family experience continual changes and require intensive ongoing education and support. Vigorous pulmonary hygiene is critical in order to mobilize secretions and prevent pulmonary infection.

The public health nurse has been asked to provide information to local child care centers on controlling the spread of infectious diseases. What is the best information the nurse can provide? A. The etiology of common infectious diseases B. Proper handwashing techniques C. The physiology of the immune system D. Why children are at a higher risk of infection than adults

B. Proper handwashing techniques Frequent handwashing is the single most important way to prevent the spread of infection.

A 4-year-old girl presents with recurrent urinary tract infection. A prior workup did not reveal any urinary tract abnormalities. What is the priority nursing action? A. Obtain a sterile urine sample after completion of antibiotics. B. Teach appropriate toileting hygiene. C. Prepare the child for surgery to reimplant the ureters. D. Administer antibiotics intramuscularly.

B. Teach appropriate toileting hygiene. Inappropriate toileting hygiene is the cause of most UTIs in preschool girls. Although obtaining a urine specimen to insure eradication of bacteria after completion of the antibiotic course is important, the priority is with patient teaching. Infected urine may cause reflux and reflux may scar the kidneys, leading to hypertension later in life.

When the nurse is caring for a child with hemolytic-uremic syndrome or acute glomerulonephritis and the child is not yet toilet trained, which action by the nurse would best determine fluid retention? A. Test urine for specific gravity. B. Weigh child daily. C. Weigh the wet diapers. D. Measure abdominal girth daily.

B. Weigh child daily. The most accurate measure for determining fluid retention (or loss) is daily weight measured on the same scale, at the same time, in similar clothing or naked.

A child presents with a 2-day history of fever, abdominal pain, occasional vomiting, and decreased oral intake. Which finding would the nurse prioritize for immediate reporting to the physician? A. temperature 101.9°F B. rebound tenderness and abdominal guarding C. Parents will be leaving the child alone in the hospital. D. child can tolerate only sips of fluid without nausea.

B. rebound tenderness and abdominal guarding Rebound pain and abdominal guarding are signs of an acute abdomen and should be reported immediately to the physician; surgery may be needed.

The nurse is caring for a child who has had diarrhea and vomiting for the past several days. What is the priority nursing assessment? A. Determine the child's weight. B. Ask if the family has traveled outside of the country. C. Assess circulation and perfusion. D. Send a stool specimen to the lab.

C. Assess circulation and perfusion. Infants and children are at increased risk for dehydration and hypovolemia compared with adults. The nurse must quickly determine if the child with diarrhea and vomiting needs rehydration to prevent further (and usually quick) deterioration.

A 5-month-old infant with RSV bronchiolitis is in respiratory distress. The baby has copious secretions, increased work of breathing, cyanosis, and a respiratory rate of 78. What is the most appropriate initial nursing intervention? A. Attempt to calm the infant by placing him in his mother's lap and offering him a bottle. B. Alert the physician or nurse practitioner to the situation and ask for an order for a stat chest x-ray. C. Suction secretions, provide 100% oxygen via mask, and anticipate respiratory failure. D. Bring the emergency equipment to the room and begin bag-valve-mask ventilation.

C. Suction secretions, provide 100% oxygen via mask, and anticipate respiratory failure. Priorities of care for the child with respiratory distress are to clear the airway and provide oxygen supplementation. Children who experience respiratory distress often deteriorate very quickly, and the nurse must be prepared in the event of respiratory failure or arrest.

At a well-child visit, hydrocephalus may be suspected in an infant if upon assessment the nurse finds? A. narrow sutures B. sunken fontanels C. a rapid increase in head circumference D. increase in weight since last visit

C. a rapid increase in head circumference In the infant, the most obvious indication of hydrocephalus is often a rapid increase in head circumference. Assessment may also reveal bulging, tense fontanels with widening sutures.

A mother brings her 6-month-old infant to the clinic. The child has been vomiting since early morning and has had diarrhea since the day before. His temperature is 38°C, pulse 140, and respiratory rate 38. He has lost 6 oz since his well-child visit 4 days ago. He cries before passing a bowel movement. He will not breastfeed today. What is the priority nursing diagnosis? A. thermoregulation alteration B. pain (abdominal) related to diarrhea C. fluid volume deficit related to excessive losses and inadequate intake D. alteration in nutrition, less than body requirements, related to decreased oral intake

C. fluid volume deficit related to excessive losses and inadequate intake Infants are at significant risk for dehydration due to their increased proportion of body fluid as compared with adults. Although fever and pain are important, fluid volume takes priority in the infant with fluid losses or decreased intake.

CRITICAL THINKING EXERCISE: A boy with asthma is admitted to the pediatric unit for the fourth time this year. The mother expresses frustration that he is getting sick so often. Besides information about onset of symptoms and events leading up to this present episode, what other types of information would you ask for while obtaining the history?

Does the child experience episodes in relation to seasonal changes in pollen? Does the child also experience allergic rhinitis or atopic dermatitis? If so, what control measures are being used? Has the child been tested for allergies, and if these are known, what type of allergen control or prevention of exposure is being used? Is it on a consistent basis? Does the parent(s) smoke cigarettes, cigars, or a pipe? (Second-hand tobacco smoke is associated with an increase in asthma symptoms in children.) What is the child's socioeconomic status? (Poverty is a risk factor for increased asthma exacerbations.)

While assessing a 4-month-old infant, the nurse notes that the baby experiences a hypercyanotic spell. What is the priority nursing action? A. Provide supplemental oxygen by face mask. B. Administer a dose of IV morphine sulfate. C. Begin cardiopulmonary resuscitation. D. Place the infant in a knee-to-chest position.

D. Place the infant in a knee-to-chest position. Hypercyanotic spells are a dangerous event. Placing the infant in a knee-to-chest position increases systemic vascular resistance, thereby improving pulmonary blood flow. It is the first action the nurse should take.

Which is the most appropriate treatment for epistaxis? A. With the child lying down and breathing through the mouth, apply pressure to the bridge of the nose. B. With the child lying down and breathing through the mouth, pinch the lower third of the nose closed. C. With the child sitting up and leaning forward, apply pressure to the bridge of the nose. D. With the child sitting up and leaning forward, pinch the lower third of the nose closed.

D. With the child sitting up and leaning forward, pinch the lower third of the nose closed. The child must not lie down, to prevent risk of aspiration. Nosebleeds most often occur in the lower third of the nose, so pinching should occur there.

A 2-day-old infant was just diagnosed with aortic stenosis. What is the most likely nursing assessment finding? A. gallop and rales B. blood pressure discrepancies in the extremities C. right ventricular hypertrophy on ECG D. heart murmur

D. heart murmur Typically, children with aortic stenosis have a murmur that is best heard along the left sternal border. They do not commonly exhibit a gallop, rales, or right ventricular hypertrophy. Blood pressure and pulse discrepancies between the upper and lower extremities occur with coarctation of the aorta, not aortic stenosis.

A mother calls the clinic because her 2-year-old daughter has a rectal temperature of 37.8°C (100°F). She wonders how high a fever should be before she should give medications to reduce it. What is the best response by the nurse? A. "All fevers should be treated to prevent seizures." B. "Antipyretics should be used with any rise in temperature. They can help change the course of the infection." C. "Give your child aspirin when her fever is above 38°C (100.4°F)." D. "In a normal healthy child, if your child is not uncomfortable, fevers less than 39°C (102.2°F) do not require medication."

D. "In a normal healthy child, if your child is not uncomfortable, fevers less than 39°C (102.2°F) do not require medication." Health care providers need to remember and to educate parents that fever is a protective mechanism the body uses to fight infection. Evidence exists that elevated body temperatures enhance various components of the immune response. Studies have shown that the use of antipyretics may actually prolong illness. Concern also exists that reducing fever may hide signs of serious bacterial illness. Aspirin should never be administered to children to reduce fever due to the risk of Reye syndrome.

A 3-day-old infant presenting with physiologic jaundice is hospitalized and placed under phototherapy. Which response indicates to the nurse that the parent needs more teaching? A. "My infant is at risk for dehydration." B. "My infant needs to stay under the lights, except during feeding time." C. "My infant can continue to breastfeed during this time." D. "My infant has a serious liver disease."

D. "My infant has a serious liver disease." Physiologic jaundice is a self-limiting disease without long-term effects on liver function.

The nurse is caring for a child with cystic fibrosis who receives pancreatic enzymes. Which statement by the child's mother indicates an understanding of how to administer the supplemental enzymes? A. "I will stop the enzymes if my child is receiving antibiotics." B. "I will decrease the dose by half if my child is having frequent, bulky stools." C. "Between meals is the best time for me to give the enzymes." D. "The enzymes should be given at the beginning of each meal and snack."

D. "The enzymes should be given at the beginning of each meal and snack." The enzymes are necessary for appropriate digestion and absorption of food and nutrients. They must be given each time the child eats, usually in smaller doses for snacks than for meals.

The nurse is performing education for the parents of an infant with bladder exstrophy. Which statement by the parents would indicate an understanding of the child's future care? A. "Care will be no different than that of any other infant." B. "My infant will only need this one surgery." C. "My child will wear diapers all his life." D. "We will need to care for the urinary diversion."

D. "We will need to care for the urinary diversion." Management of exstrophy of the bladder requires some type of urinary diversion. It may be a continent, catheterizable stoma, or a stoma requiring pouching.

A 10-year-old child is admitted to the hospital due to history of seizure activity. As his nurse, you are called into the room by his mother, who states he is having a seizure. What would be the priority nursing intervention related to prevention of injury? A. Remove the child from his bed. B. Place a tongue blade in the child's mouth. C. Restrain the child. D. Place the child on his side and opening his airway.

D. Place the child on his side and opening his airway. Placing the child on his side and opening his airway can help prevent aspiration.

CASE STUDY: Bryn Carle, a 6-year old, is brought to the clinic by her mother. She presents with redness of the left eye, edema, and drainage. What other assessment information would be helpful? Based on the history and clinical presentation, Bryn is diagnosed with conjunctivitis. What education will be necessary for the family to assist in alleviating symptoms and preventing infectious spread?

Health History: does she attend school? Any cold symptoms, ear pain, or sore throat? Has here been any know infectious exposure? Does Bryn have any allergies? Ask Bryn if she has any eye pain, or if the eye itches. Determine the onset of symptoms and their progression as well as response to treatments used at home. Inspect the eye and drainage noting extent of edema and redness of the eyelid, and redness of conjunctivae. Note quantity, color, and consistency of discharge. Observe for signs of allergic or atopic disease, runny nose or cough. Teach parents how to apply eye drops or ointment and to use warm compresses to help loosen any crust that may accumulate on the eyelids overnight. Insure Bryn and her parents understand the importance of diligent handwashing in order to prevent spread. Discourage towel and washcloth spread. Bryn may return to school when mucopurulent drainage is no longer present (usually after 24 to 48 hours of treatment with a topical antibiotic).

CRITICAL THINKING EXERCISE: A child is seen in the doctor's office after hitting his head while skateboarding. The child suffered no loss of consciousness, and has no external injuries and no significant past medical history. He is acting appropriately at this time. His only complaint is a dull headache. What instructions would you give the parents regarding his care at home? Include when they should seek further medical care.

Instruct parents or caregiver that a responsible adult must stay with the child for the next 24 hours and be ready to take the child to the hospital if necessary. The child may require close observation for a few days. Wake the child every 2 hours to ensure that he moves normally, wakes enough to recognize the caregiver, and responds to the caregiver appropriately. Instruct parents to call their medical provider or bring the child to the emergency room if: the child complains of a constant headache that gets worse; presents with slurred speech, dizziness that does not go away or happens repeatedly, or extreme irritability or other abnormal behavior; vomits more than twice; is clumsy or has difficulty walking; is oozing blood or watery fluid from the ears or nose; has difficulty waking up, unequal-sized pupils, or unusual paleness that lasts longer than 1 hour; or experiences any seizure activity.

CRITICAL THINKING EXERCISE (CONT.): The mother of the boy in the previous question tells you that she smokes (but never around the boy), the family has a cat that comes inside sometimes, and she always gives her son the medication prescribed. She gives salmeterol and budesonide as soon as he starts to cough. When he is not having an episode, she gives him albuterol before his baseball games. Diphenhydramine helps his runny nose in the springtime. Based on this new information, what advice/instructions would you give the mother?

Salmeterol is a long-acting bronchodilator and is used for prevention of symptoms, not treatment when they occur. Budesonide is an inhaled steroid, also used for prevention, not acute treatment of symptoms. Salmeterol and budesonide should be given daily as prescribed (usually twice daily) in order to prevent the child from experiencing wheezing episodes. When wheeze or a cough does begin, then albuterol (short-acting bronchodilator) is the drug of choice. The mother may want to speak with the physician or nurse practitioner about whether a different type of antihistamine other than diphenhydramine might be helpful to prevent allergic response.

CRITICAL THINKING EXERCISE: A child is brought to the school nurse with intense itching. Upon assessment the nurse finds an erythematous, papular rash with excoriations on the child's hands and feet. As suspected, the diagnosis of scabies is confirmed. What teaching is necessary for the parents, family, and classmates of the child?

Teach the family how to apply the scabicide (entire body below head) and leave on for the prescribed amount of time. The entire family should be treated. Inform the family and child that despite successful treatment, itching may persist for several weeks. Any bedding or clothing worn within the 4 days prior to treatment should be washed in hot water and dried on the hot cycle. Classmates have already been exposed; if they develop a rash or itching, they should visit their pediatrician.

CRITICAL THINKING EXERCISE: A child with asthma has been prescribed Advair (fluticasone and salmeterol), albuterol, and prednisone. Develop a sample teaching plan for the child and family. Include appropriate use of the devices used to deliver the medications, as well as important information about the medications (uses and adverse effects).

the teaching plan should include information about the drug's uses, side effects and administration modes.

CRITICAL THINKING EXERCISE (CONT.): A 6-month-old baby is brought to the physician's office with a history of diarrhea. She has had six watery stools in the past 18 hours. She is vomiting her formula. Her mother states that she has had no fever. What is the priority nursing diagnosis for this infant?

deficient fluid volume

CRITICAL THINKING EXERCISE: Devise a developmental stimulation plan for an 11-month old who has had significant urinary tract reconstruction surgery and is facing a prolonged period of confinement to the crib.

developmental stimulation plan should include older infant age-appropriate activities (a large variety) that can be accomplished while confined to a crib

CRITICAL THINKING EXERCISE: A 4-month-old child with a history of hydrocephalus has undergone surgery for placement of a VP shunt. What information would you include in the teaching plan?

information included within the teaching plan includes signs & symptoms of a shunt infection, signs & symptoms of shunt malfunction, and signs & symptoms of increased ICP also include ways to promote growth + development, need for future revisions as the child grows, and a referral to support groups

CRITICAL THINKING EXERCISE: A 16-month-old toddler is being seen for his sixth ear infection. What particular information about his growth and development must the nurse ask about?

language development when obtaining the health history, the nurse should ask the parent questions about onset of cooing, babbling, jabbering, and word formation; recurrent Otitis Media causes intermittent bouts of hearing loss that can significantly hinder speech & language development

CRITICAL THINKING EXERCISE: Develop a discharge teaching plan for a 3-year old with nephrotic syndrome who will be taking corticosteroids long term.

the teaching plan should include information for the parent about infection exposure avoidance, signs and symptoms of infection, side effects of the medication, and strategies for insuring the young child actually takes all of the medication doses as ordered

CRITICAL THINKING EXERCISE: A 14-kg child with moderate dehydration has received two boluses of normal saline in the emergency room prior to being admitted to the pediatric nursing unit. The physician orders D5 ½ NS @ 1½ maintenance. What will the nurse assess for to determine whether the child is becoming overhydrated?

overhydration would be indicated by edema, weight gain, tachycardia, and excessive output of dilute urine.

CRITICAL THINKING EXERCISE: An infant requires a temporary colostomy. What discharge instructions would you provide to the parents about how to take care of the colostomy and when to call their child's physician or nurse practitioner?

teach the parents how to provide ostomy care and ensure that the parents are aware of how to obtain additional supplies and if skin irritation occurs, they should use a special powder or paste as directed by the physician the parents should observe the integrity of the stoma as well as the quality of stool output in the pouch (the stoma should appear moist & pink or red); the parents should notify the physician if the stoma's appearance changes, if it is prolapsed or retracted, or if the volume of stool output is greatly increased

CRITICAL THINKING EXERCISE: Observe peritoneal dialysis in the hospital or hemodialysis in a hospital or outpatient center. Record observations about the children's psychosocial and developmental status.

the answer will vary depending upon the child observed, the course the child has experienced with dialysis, family factors, and the length of time on dialysis (as well as severity of disease)

CRITICAL THINKING EXERCISE: Devise a meal plan for a 5-year-old child with a renal disorder that requires a 2-g sodium restriction per day. Keep in mind the child's developmental level and feeding idiosyncrasies at this age.

the meal plan should include the types of foods desired by young children, be reflective of the USDA pyramid for young child, and be limited to 2-g sodium per day

CRITICAL THINKING EXERCISE (CONT.): Identify a plan for this nursing diagnosis; include a teaching plan for the mother.

the plan should include oral rehydration (intravenous rehydration is not necessary in the case of mild dehydration), with instructions for clear liquids (preferably an oral rehydration solution) for the first 8 to 24 hours when vomiting resolves, the diet should include complex carbohydrates and fats to increase transit time, provide nutrition, and bulk up the stools

CRITICAL THINKING EXERCISE: Develop a sample plan for teaching a low-literacy parent about the etiology, treatment, and complications of recurrent acute otitis media.

the teaching plan should include SIMPLE explanations about etiology, treatment, and complications of recurrent Acute Otitis Media medical language should be avoided, pictures would be helpful