exam 2 peds

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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."

When educating the family of an infant with a small, asymptomatic atrial septal defect (ASD), which of the following would be included in the education?

"Most infants do not need surgical repair for this." Explanation: Most infants do not need surgical repair for an ASD unless they are symptomatic. The hole will close spontaneously 87% of the time. The medication indomethacin is used to help close the opening of a PDA and the medication prostaglandin E1 is used to keep a patent ductus arteriosus (PDA) open. These medications are not used for ASDs.

The nurse is educating a 13-year-old paintball enthusiast about sports-related injuries. Which comment is most likely to be accepted by the child?

"Play tough, but wear protective gear."

A nurse is taking the history of a 4-year-old boy who will undergo a cardiac catheterization. Which of the following statements by his mother may necessitate rescheduling of the procedure?

"He seems listless and slightly warm." Explanation: Fever and other signs and symptoms of infection may necessitate rescheduling the procedure. Although information about allergies is important, not all contrast media contain iodine as a base. The nurse should address the child's fears in a developmentally appropriate way, but fear of the procedure does not warrant rescheduling. Not using any medication would not be a reason for rescheduling the procedure.

The nurse is assessing the past medical history of an infant with a suspected cardiovascular disorder. Which of the following responses by the mother warrants further investigation?

"I am on a low dose of steroids" Explanation: Some medications, like corticosteroids, taken by pregnant women may be linked with the development of congenital heart defects. Reports of nausea during pregnancy and an Apgar score of eight would not trigger further questions. Febrile illness during the first trimester, not the third, may be linked to an increased risk of congenital heart defects.

The nurse is talking with a teen and her parents about triggers for her frequent headaches. Which statements indicate an understanding? Select all that apply.

"I may experience headaches during certain periods in my menstrual cycle." "Giving up cola may be beneficial to helping me avoid headaches." "Chocolate may trigger my headaches." Teaching about headaches should include a discussion about possible triggers. Foods containing chocolate and caffeine should be restricted in the diet as they may trigger headache pain. Changes in the menstrual cycle may also be tied to headaches. Spicy foods are not tied to headaches.

A child is having surgery for a congenital heart defect. The parent asks about their 1-year-old's growth and developmental delays and what they can expect after surgery. What is the best response by the nurse?

"After surgery, most children will catch up." Explanation: A child with a congenital heart defect who has growth and developmental delays will usually catch up after the defect is fixed. There is no way of predicting exactly what each child will do and it is not appropriate to tell a parent that these delays are permanent when that is unknown until the defect is corrected by surgery.

A child diagnosed with acute otitis media has been given a prescription for benzocaine. The nurse is correct when she makes which statement?

"Benzocaine drops should be placed in your ear to numb it and reduce pain."

"Sometimes it's hard to tell what products may contain aspirin." Salicylates are in a wide variety of products, so consumers must read the small print very carefully or they will miss the warning. The parent needs to be receptive to further education, and raising the possibility the child was responsible does not accomplish that goal. Don't state the obvious, but also don't minimize the situation. Encouraging the mother to ask for information and offering explanations in terms she will understand are important, but this response does not address the mother's assertion

The nurse is educating parents of a male infant with Chiari type II malformation. Which statement about their child's condition is most accurate?

"Take your time feeding your baby." One of the problems associated with Chiari type II malformation is poor gag and swallowing reflexes, so the infant must be fed slowly. There is a great risk of aspiration, requiring that the child be placed in an upright position after feeding. The goal of surgery is to prevent further symptoms, rather than to relieve existing ones. Infrequent urination is a problem associated with type I malformations

The nurse is providing education to the parents of a 2-year-old boy with hydrocephalus who has just had a ventriculoperitoneal shunt placed. Which information is most important for the parents to be taught?

"Watch for changes in his behavior or eating patterns." Changes in behavior or in eating patterns can suggest a problem with his shunt, such as infection or blockage. Irritability, lack of appetite, increased crying, or inability to settle down may indicate increased intracranial pressure. Any headache needs to be monitored, but if it goes away quickly, such as after eating, it probably isn't a problem. It is not necessary to keep the child's head raised 30 degrees. The child's shunt will not be affected by the amount of television viewed.

A child is home with the caregivers following a treatment for a head injury. If the child makes this statement, the caregiver should contact the care provider.

"You look funny. Well, both of you do. I see two of you." The caregiver should notify the health-care provider immediately if the child vomits more than three times, has pupillary changes, has double or blurred vision, has a change in level of consciousness, acts strange or confused, has trouble walking, or has a headache that becomes more severe or wakes him or her from sleep. These instructions should be provided in written form to the caregiver. Just feeling naueauted is not a reason to notify the provider.

The nurse is assessing the blood pressure of a toddler. Which finding would the nurse document as a normal finding?

90/64 mm Hg Explanation: The toddler's or preschooler's blood pressure averages 80 to 100/64 mm Hg. The normal infant's blood pressure is about 80/40 mm Hg. The school-age child's blood pressure averages 94 to 112/56 mm Hg. An adolescent's blood pressure averages 100 to 120/50 to 70 mm Hg.

In caring for a child with a seizure disorder, the highest priority goal is which of the following? a) The child will be free from injury during a seizure. b) The child will have an understanding of the disorder. c) The family will understand seizure precautions. d) The family caregivers anxiety will be reduced.

A Keeping the child free from injury is the highest priority goal. The other choices are important, but keeping the child safe is higher than the anxiety or knowledge deficit concerns. The physical always is a priority over the psychological.

In caring for a child with a seizure disorder, the highest priority goal is which of the following? a) The child will be free from injury during a seizure. b) The family caregivers anxiety will be reduced. c) The family will understand seizure precautions. d) The child will have an understanding of the disorder.

In understanding the nervous system, the nurse recognizes that the central nervous system is made up of which of the following? a) The brain and spinal cord b) Fluid that flows through the brain c) Nerves throughout the upper body d) A protective cushion for nerve cells

A The central nervous system is made up of the brain and spinal cord. The peripheral nervous system is made up of the nerves throughout the body. A fluid known as cerebrospinal fluid (CSF) flows through the chambers of the brain and through the spinal cord, serving as a cushion and protective mechanism for nerve cells.

To detect complications as early as possible in a child with meningitis who's receiving I.V. fluids, monitoring for which condition should be the nurse's priority? a) Cerebral edema b) Cardiogenic shock c) Renal failure d) Left-sided heart failure

A The child with meningitis is already at increased risk for cerebral edema and increased intracranial pressure due to inflammation of the meningeal membranes; therefore, the nurse should carefully monitor fluid intake and output to avoid fluid volume overload. Renal failure and cardiogenic shock aren't complications of I.V. therapy. The child with a healthy heart wouldn't be expected to develop left-sided heart failure.

The nurse is conducting a physical examination of a baby with a suspected cardiovascular disorder. Which of the following assessment findings is suggestive of sudden ventricular distention?

Accentuated third heart sound Explanation: An accentuated third heart sound is suggestive of sudden ventricular distention. Decreased blood pressure, cool, clammy, and pale extremities, and a heart murmur are all associated with cardiovascular disorders; however, these findings do not specifically indicate sudden ventricular distention.

The nurse is caring for a 20-month-old girl with equivocal bacterial otitis media, a severe earache, and a temperature of 39°C (102.2°F). Which intervention would the nurse expect to implement?

Administering antibiotics as soon as they're available

The treatment for children with seizures disorders is most often which of the following? a) Restricted fat diet b) Use of anticonvulsant medications c) Strict exercise regimen d) Surgical intervention

B Complete control of seizures can be achieved for most people through the use of anticonvulsant drug therapy. A few children may be candidates for surgical intervention but, in most cases, surgery is not the treatment. Ketogenic diets (high in fat and low in carbohydrates and protein) cause the child to have high levels of ketones, which help to reduce seizure activity. Exercise is not a treatment for seizure disorders.

The best way to evaluate a child's level of consciousness is through conversation. a) False b) True

B The best way to evaluate a child's level of consciousness is through conversation. Note any drowsiness or lethargy. Allow the child to answer questions without prompting, and listen carefully to be certain the answer is appropriate to the question.

The nurse is caring for a 14-year-old girl with atrial fibrillation. Which medication would the nurse expect to be prescribed?

Digoxin Explanation: Digoxin is indicated for atrial fibrillation. It increases the contractility of the heart muscle by decreasing conduction and increasing force. Alprostadil is indicated for temporary maintenance of ductus arteriosus patency in infants with ductal-dependent congenital heart defects. Furosemide is used for the management of edema associated with heart failure. Indomethacin is used to close a patent ductus arteriosus

A nurse admits an infant with a possible diagnosis of congestive heart failure. Which of the following signs and symptoms would the infant most likely be exhibiting?

Feeding problems Explanation: The indications of CHF vary in children of different ages. Signs in the infant may be hard to detect because they are subtle, but in infants, feeding problems are often seen. In infants and older children, tachycardia is one of the first signs of CHF. The heart beats faster in an attempt to increase blood flow. Failure to gain weight, weakness, and an enlarged liver and heart are other possible indicators of CHF but are not as common as tachycardia and may take longer to develop

The nurse knows that the heads of infants and toddlers are large in proportion to their bodies, placing them at risk for what problem?

Head trauma A larger head size in relation to the rest of their body size gives young children a higher center of gravity, which causes them to hit their head more readily, thus placing them at risk for head trauma. Fragile capillaries in the periventricular area of the brain put preterm infants at risk for intracranial hemorrhage. Congenital hydrocephalus may be caused by abnormal intrauterine development or infection. Positional plagiocephaly is caused by an infant's head remaining in the same position for too long.

A nurse is caring for a child with Kawasaki disease. Which assessment finding would the nurse expect to see?

Peeling hands and feet and fever Explanation: One of the signs of Kawasaki disease is the peeling hands and feet. The other symptoms are not necessarily characteristic of Kawasaki disease.

A child with heart disease is receiving digoxin and a diuretic. Which laboratory test result would be most important for the nurse to monitor?

Serum potassium level Explanation: Children receiving diuretics should have serum potassium levels obtained because diuretics tend to deplete the body of potassium. This is even more important if the child is also receiving digoxin because low serum potassium levels potentiate or increase the effect of the drug. Serum sodium levels may be obtained in children with heart failure to ensure that an increased sodium level is not causing edema. The erythrocyte sedimentation rate identifies inflammation and is unrelated to the use of diuretics and digoxin. Oxygen saturation levels may be done to evaluate for hypoxemia, but these results would be unrelated to the use of digoxin and diuretics.

The school nurse is instructing the classroom teacher regarding a student newly diagnosed with amblyopia. To prepare for classroom instruction, which concept is most important to understand?

Student placement in the room is important but all other teaching methods may remain the same.

A school nurse finds a 10-year-old's blood pressure is over the 95th percentile. The nurse advises the parent to seek medical attention for the child. What outcome would the nurse expect?

The child will need the blood pressure checked two more times. Explanation: The child will need the blood pressure checked two more times. It is routine to check the blood pressure on three separate occasions to get the most accurate analysis of the blood pressure. The child usually does not need surgery or need to go to the emergency room. This is not a normal result in a blood pressure finding

The nurse is caring for a child with congestive heart failure and is administering the drug digoxin. At the beginning of this drug therapy the process of digitalization is done for which of the following reasons?

To build the blood levels to a therapeutic level Explanation: The use of large doses of digoxin at the beginning of therapy, administered to build up the blood levels of the drug to a therapeutic level, is known as digitalization. A maintenance dose is given, usually daily, after digitalization. Digoxin is used to improve the cardiac efficiency by slowing the heart rate and strengthening the cardiac contractility. Digoxin is not indicated for relief of pain.

Which of these age groups has the highest actual rate of death from drowning?

Toddlers Toddlers and older adolescents have the highest actual rate of death from drowning.

The nurse is assessing a toddler for motor function. Which activity will be the most valuable?

Watch the child reach for a toy. Watching the child reach for a toy would be most valuable for assessing motor function because the infant should be able to extend extremities to a normal stretch. Catching a ball is too advanced for a toddler to accomplish. Looking at a picture book would help assess visual acuity and eye movement. Eating potato chips would help assess sensor function for taste.

be determined

The caregiver of a 2-year-old calls the clinic concerned that her child may have pushed paper into her ears, and she asks the nurse what to do. The mother found the child pushing on her ears with torn paper on the floor in front of her. What would be the appropriate response by the nurse?

"The child should be seen by a care provider. Don't put anything in her ear and bring her in right away."

The mother of a child having myringotomy tubes placed asks, "Will my son lose his hearing while the tubes are in place?" What is the nurse's best answer?

"The tubes are inserted into a section of eardrum in which the hearing is not affected."

A child having myringotomy tubes placed asks, "How and when will the tubes be removed?" What is your best response?

"The tubes remain in place for 6 to 12 months until they come out by themselves."

The nurse is educating the family of a 7-year-old with epilepsy about care and safety for this child. What comment will be most valuable in helping the parent and the child cope?

"Use this information to teach family and friends." Families need and want information they can share with relatives, childcare providers, and teachers. Wearing a helmet and having a monitor in the room are precautions that may need to be modified as the child matures. The boy may be able to bike ride and swim with proper precautions.

The nurse is assessing the neurological functioning of a preschool child. What actions will best review functioning of cranial nerve III?

A bright-colored toy is moved in the child's visual fields. Cranial nerve III, the oculomotor nerve, is assessed by using a brightly colored object to assess the child's ability to watch its movement. Cranial nerve I (olfactory nerve) controls the sense of smell. Asking the child to smell objects would be an assessment of this cranial nerve. Cranial nerve VII (facial nerve) is assessed by monitoring symmetry of facial movements. Cranial nerve VIII (acoustic nerve) is assessed by whispering.

The nurse is auscultating heart sounds of a child with a mitral valve prolapse. The nurse would expect which assessment finding?

A mild to late ejection click at the apex Correct Explanation: A mild to late ejection click at the apex is typical of a mitral valve prolapse. Abnormal splitting or intensifying of S2 sounds occurs in children with r heart problems, not mitral valve prolapse. Clicks on the upper left sternal border are related to the pulmonary area

Arteriovenous malformations (AVMs) Vascular malformations such as intracranial AVMs are a risk factor for hemorrhagic stroke. Sickle cell disease is a risk factor for ischemic stroke. Congenital heart defects are risk factors for ischemic stroke. Meningitis or other infection is a risk factor for ischemic stroke.

A group of students are reviewing information about acute rheumatic fever. The students demonstrate a need for additional review when they identify which of the following as a major Jones criterion?

Arthralgia Explanation: Arthralgia is considered a minor criterion. Carditis is a major criterion. Erythema marginatum is considered a major criterion. Subcutaneous nodules are considered a major criterion.

In caring for the child with rheumatic fever which medication would the nurse likely administer?

Aspirin Explanation: Salicylates are administered in the form of aspirin to reduce fever and to relieve joint inflammation and pain in the child with rheumatic fever. Although salicylates as a general rule are not given to children, they continue to be the treatment of choice for rheumatic fever. Tylenol is not effective for the inflammation. Insulin would be given for diabetes and dilantin for seizure disorders.

Which of the following is consistent with increased ICP in the child? a) Increased appetite b) Bulging fontanel c) Emotional lability d) Narcolepsy

B Children with increased ICP exhibit bulging fontanels. They typically have a decreased appetite, are restless, and have trouble sleeping.

Which nursing action should be included in the care plan to promote comfort in a 4-year-old child hospitalized with meningitis? a) Rock the child frequently b) Avoid making noise when in the child's room c) Have the child's 2-year-old brother stay in the room d) Keep the lights on brightly so that he can see his mother

B Meningeal irritation may cause seizures and heightens a child's sensitivity to all stimuli, including noise, lights, movement, and touch. Frequent rocking, presence of a younger sibling, and bright lights would increase stimulation.

The school nurse is assessing a student complaining of left eye pain. Upon visual inspection, the nurse notes left conjunctivae redness and thick, colored discharge. The nurse understands that these signs and symptoms are consistent with which diagnosis?

Bacterial conjunctivitis

An 8-year-old girl is diagnosed as having tonic-clonic seizures. You would want to teach her parents that a) their daughter should be kept quiet late in the day when she is most likely to have a seizure. b) if their daughter shows symptoms of beginning a seizure, immediately give her medication. c) their daughter should maintain an active lifestyle. d) their daughter should carry a padded tongue blade with her at all times.

C It is important for children with seizures to maintain as near normal a lifestyle as possible to maintain self-esteem and achievement. Most seizure medications must create a therapeutic level before they are effective.

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

Collection of cerebrospinal fluid (CSF) and blood for culture Antibiotic therapy should always begin immediately after the collection of CSF and blood cultures. After the specific organism is identified, bacteria-specific antibiotics can be administered if the initial choice of antibiotic therapy isn't appropriate. Admission and initiation of I.V. therapy aren't, by themselves, appropriate times to begin antibiotic therapy.

A 9-year-old diagnosed with neurofibromatosis is being evaluated for the presence of a brain tumor. What tests may be ordered to diagnose this condition? Select all that apply.

Computed tomography Magnetic resonance imaging Computed tomography is used for visualization of tumors, ventricles, brain tissue, CSF, hematomas, and cysts. Magnetic resonance imaging is also useful in tumor identification. Lumbar puncture is used to measure CSF pressure and collect CSF samples for laboratory tests. Electroencephalograms detect and locate abnormal electrical discharges produced in the brain. Radiology identifies the presence of fractures, widened skull sutures, calcifications, bone erosion, or skeletal anomalies.

The nurse is discussing with a parent the difference between a breath-holding spell and a seizure. The nurse would be correct in telling the parent what information in regard to seizures?

Convulsive activity occurs. During seizures convulsive activity is typically noted. During a breath-holding spell, the child is bradycardiac, cyanosis occurs at the onset, and the EEG is normal.

The nurse is collecting data from a child who may have a seizure disorder. Which of the following is a description of an absence seizure? a) Sudden, momentary loss of muscle tone, with a brief loss of consciousness b) Brief, sudden contracture of a muscle or muscle group c) Muscle tone maintained and child frozen in position d) Minimal or no alteration in muscle tone, with a brief loss of consciousness

D A child with an elevated temperature is at high risk for having seizures and therefore actions by the nurse include keeping the child in a safe situation to prevent any injury if the child should have a seizure.

Any individual taking phenobarbital for a seizure disorder should be taught a) never to go swimming. b) to avoid foods containing caffeine. c) to brush his or her teeth four times a day. d) never to discontinue the drug abruptly.

D Phenobarbital should always be tapered, not stopped abruptly, or seizures from the child's dependency on the drug can result.

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

The nurse is performing an ECG on a 12-year-old boy. On completion, she notices that boy's P-R interval is lengthened. Which of the following does this finding indicate?

Difficulty with coordination between the SA and AV nodes (first-degree heart block) Explanation: On an ECG tracing, a longer-than-usual P wave suggests the atria are hypertrophied making it take longer than usual for the electrical conduction to spread over the atria. A lengthened P-R interval suggests there is a difficulty with coordination between the SA and AV nodes (first-degree heart block). A heightened R wave indicates ventricular hypertrophy is present. An R wave which is decreased in height suggests the ventricles are not contracting fully, as happens if they are surrounded by fluid (pericarditis). Elongation of the T wave occurs in hyperkalemia; depression of the T wave is associated with anoxia; depression of the ST segment is associated with abnormal calcium levels.

The nurse is administering medications to the child with congestive heart failure. Large doses of which of the following medications are used initially in the treatment of CHF to attain a therapeutic level?

Digoxin (Lanoxin) Explanation: The use of large doses of digoxin, at the beginning of therapy, to build up the blood levels of the drug to a therapeutic level is known as digitalization.

Hearing aids can improve hearing for children who have inner ear or nerve deafness.

False

The nurse caring for a child with a cranial injury knows that broad-spectrum antibiotics are used to reduce cerebral edema.

False Antibiotics or antivirals are used to treat infectious disease processes. Glucocorticoids and diuretics are used to reduce cerebral edema.

The nurse performs a cardiac assessment and notes a loud heart murmur with a precordial thrill. This murmur would be classified as a:

Grade IV Explanation: A heart murmur characterized as loud with a precordial thrill is classified as Grade IV. Grade II is soft and easily heard. Grade I is soft and hard to hear. Grade III is loud without thrill

Preterm infants have more fragile capillaries in the periventricular area than term infants. This put these infants at risk for which problem?

Intracranial hemorrhaging Fragile capillaries in the periventricular area of the brain put preterm infants at risk for intracranial hemorrhage. Closure of the fontanels has nothing to do with fragile capillaries within the brain. Larger head size gives children a higher center of gravity which causes them to hit their head more readily. Congenital hydrocephalus may be caused by abnormal intrauterine development or infection

The nurse is observing an infant who may have acute bacterial meningitis. Which finding might the nurse look for?

Irritability, fever, and vomiting Findings associated with acute bacterial meningitis may include irritability, fever, and vomiting along with seizure activity. Fontanels would be bulging as intracranial pressure rises, and Kernig's sign would be present due to meningeal irritation. Jaundice, drowsiness, and refusal to eat indicate a GI disturbance rather than meningitis.

A client's newborn is diagnosed with Tetralogy of Fallot. When explaining this condition to the client, which of the following defects would the nurse's description include?

Overriding of the aorta Explanation: One of the components in the Tetralogy of Fallot is overriding of the aorta. Tetralogy of Fallot is a congenital heart disease with 4 components. The defects in the Tetralogy of Fallot include ventricular septal defect, overriding of the aorta, pulmonary stenosis, and right ventricular hypertrophy. Atrial septal defect, stenosis of the aorta and left ventricular hypertrophy are not components of Tetralogy of Fallot.

A child with a seizure disorder is being admitted to the inpatient unit. When preparing the room for the child, what should be included? Select all that apply.

Oxygen gauge and tubing Suction at bedside Padding for side rails When planning the client's environment it is imperative that both safety items and those to manage the seizure are present. The side rails should be padded to prevent injury during seizure activity. Oxygen setup should be provided. Suction may be needed. Tongue blades and smelling salts are not employed.

When educating the family of an ill infant with a large, symptomatic ventricular septic defect (VSD), which of the following would be included in the education if the doctor is planning on performing palliative care until the infant is healthier?

Palliative pulmonary artery banding should help the infant grow. Explanation: Palliative pulmonary artery banding should help the infant grow enough so that the large VSD can be repaired. The pulmonary artery banding will help, but the defect will still need to be fixed. Most infants will need surgery for a large, symptomatic VSD. The medication indomethacin is used for a PDA.

A child is diagnosed with tetralogy of Fallot and during a temper tantrum turns blue. Which of the following would the nurse do first?

Place child in the knee-to-chest position. Explanation: Place child in the knee-to-chest position. This position is the first priority of the child with tetralogy of Fallot. Cyanosis is caused by the heart defect and placing the child in this position will decrease the cyanosis.

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

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

A parent brings an infant in for poor feeding. Which of the following assessment data would most likely indicate a coarctation of the aorta?

Pulses weaker in lower extremities compared to upper extremities Explanation: An infant with coarctation of the aorta has decreased systemic circulation causing this problem. The cyanosis would be associated with tetralogy of Fallot.

A child with heart disease is receiving digoxin and a diuretic. Which laboratory test result would be most important for the nurse to monitor?

A nurse is caring for a newborn with congenital heart disease (CHD). Which of the following would the nurse interpret as indicating distress?

Subbcostal retraction at the time of feeding Explanation: Subcostal retraction during feeding is indicative of distress associated with feeding in newborn infants with CHD. Feeding can be a stress to newborns with CHD who are seriously compromised. Additional features indicating distress in infants with CHD include increased respiratory rate, perspiration along the hairline during feeding and feeding time longer than 30 minutes.

At 3 years of age, a child has a cardiac catheterization. After the procedure, which of the following interventions would be most important?

Taking pedal pulses for the first 4 hours Explanation: Insertion of a catheter into the femoral vein can cause vessel spasm, interfering with blood circulation in the leg. Assessing pedal pulses ensures circulation is adequate.

A 9-year-old boy is suffering from headaches but has no signs of physical or neurologic illness. Which intervention would be most appropriate?

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

A newborn has been diagnosed with a congenital heart disease. Which of the following congenital heart diseases is associated with cyanosis?

Tetralogy of Fallot Explanation: Tetralogy of Fallot is associated with cyanosis. The defects include ventricular septal defect (VSD), right ventricular hypertrophy, right outflow obstruction, and overriding aorta. Coarctation of aorta, pulmonary stenosis, and aortic stenosis are acyanotic heart diseases and are not associated with cyanosis.

The nurse is caring for a child admitted with simple partial motor seizures. Which clinical manifestation would likely have been noted in the child with this diagnosis?

The child had shaking movements on one side of the body. Simple partial motor seizures cause a localized motor activity, such as shaking of an arm, leg, or other part of the body. These may be limited to one side of the body. Myoclonic seizures are characterized by a sudden jerking of a muscle or group of muscles, often in the arms or legs, without loss of consciousness. Complex partial seizures may cause nonpurposeful movements, such as hand rubbing and lip smacking. During the prodromal period of the tonic-clonic seizure, the child might have a lack of coordination.

The child is in status epilepticus. Status epilepticus is the term used to describe a seizure that lasts longer than 30 minutes or a series of seizures in which the child does not return to his or her previous normal level of consciousness. The child likely is having generalized seizures, but the most accurate description of what is happening is status epilepticus. With infantile spasms, muscle contractions are sudden, brief, symmetrical, and accompanied by rolling eyes. With absence seizures the child loses awareness and stares straight ahead but does not fall.

During the trial period to determine the efficacy of an anticonvulsant drug, which caution should be explained to the parents?

The child shouldn't participate in activities that could be hazardous if a seizure occurs Until seizure control is certain, clients shouldn't participate in activities (such as riding a bicycle) that could be hazardous if a seizure were to occur. Plasma levels need to be monitored periodically over the course of drug therapy; daily monitoring isn't necessary. Dosage changes are usually based on plasma drug levels as well as seizure control. Anticonvulsant drugs should be withdrawn over a period of 6 weeks to several months, never immediately, as doing so could precipitate status epilepticus

A child is being placed on a cardiopulmonary bypass machine. The nurse understands the heart will pump again on its own when which of the following occurs?

The child starts getting warm again. Explanation: The child is placed in a hypothermic state when placed on a cardiopulmonary bypass. When the child is warmed, the heart starts pumping again.

After a cardiac catheterization, the nurse monitors the child's fluid balance closely based on the understanding of which of the following?

The contrast material used has a diuretic effect. Explanation: The contrast material has a diuretic effect so the nurse assesses the child closely for signs and symptoms of dehydration and hypovolemia. Although blood loss can occur, this is not the reason for monitoring the child's fluid balance. Catheter insertion into the heart does not initiate a diuretic response. Typically, food and fluid is withheld for 4 to 6 hours before the procedure.

A nurse is interviewing a mother who is about to deliver her baby. Which of the following responses would alert the nurse for a higher potential for a heart defect in the infant?

The mother states she has lupus. Explanation: Having lupus while pregnant could contribute to a congenital heart defect. Acetaminophen and sleeping do not have an effect on a child developing a heart defect. The seizure medication can have an impact on the child having a heart defect, but not necessarily a history of seizures in the mother.

The nurse is providing education to parents of a child with a blood pressure in the 90th percentile. Which of the following would be included in the intervention strategies?

The nurse would review the child's 24-hour diet recall. Explanation: With a child in the 90th percentile for blood pressure, diet and physical activity should be the main focus. Blood pressures should be measured, but daily is not necessary. Children are not routinely put on beta blockers and the child should be allowed to participate in sports if monitored.

A parent asks if the reason her infant has a congenital heart defect is because of something she did while she was pregnant. What is the best response by the nurse?

There are several reasons a baby can have a heart defect, let's talk about those causes. Explanation: Focus on the therapeutic communication in this situation, while still obtaining more information. This will help the nurse explore various options for the cause of the defect with the parent.

A parent asks why their infant with a cyanotic heart defect turns blue. What is the best response by the nurse?

This is due to a decreased amount of oxygen to the peripheral tissue. Explanation: Cyanosis associated with certain congenital heart defects is due to the body naturally compensating and decreasing the amount of oxygen to the peripheral tissue. This keeps the oxygen with the vital organs to sustain life. The lack of oxygen is not in the brain; it is in the systemic flow of the body. Cyanosis is a common finding with these types of heart defects and in general, does not usually need immediate surgery or is a sign of heart failure

A parent is told their infant has a heart defect with a left to right shunt. What is the best way for the nurse to explain this type of shunting to the parent?

This type of shunting causes an increase of blood to the lungs. Explanation: This type of shunting causes an increase of blood to the lungs. A right to left shunt causes an increase in blood to the systemic circulation that is mixed with deoxygenated blood.

The nurse has administered oral penicillin as ordered for prophylaxis of endocarditis. The nurse instructs the parents to immediately report which of the following reactions?

Wheezing Explanation: The nurse must report any hypersensitivity reactions such as wheezing and pruritus, as these could be a sign of anaphylaxis. Stomach upset is common with oral antibiotics and is not something that needs to be reported immediately. Nausea with diarrhea is common with oral antibiotics and does not need to be reported immediately. Abdominal distress is common with oral antibiotics and does not need to be reported immediately.

You would teach the mother of a boy with tetralogy of Fallot that if he suddenly becomes cyanotic and dyspneic to

place him in a knee-chest position. Correct Explanation: Placing a child in a knee-chest or squatting position traps blood in the legs, allowing the child to better oxygenate that remaining in the trunk.

The nurse is talking with the mother of a 4-year-old boy who will soon be going to a pre-kindergarten program. The child has had the Snellen vision test done at home, and he was unable to distinguish the pictures at the distance that would indicate his vision is normal. The child's mother asks the nurse if he will need glasses. Which statement made by the nurse would be most appropriate regarding the child's vision?

"Children's vision is not completely developed by this age. Your child might outgrow this nearsightedness."

A pregnant client tells her nurse that a friend of hers recently gave birth to an infant who was found to have congenital heart disease. She asks the nurse whether there is anything she can to reduce the risk of this type of condition occurring in her baby. Which of the following should the nurse mention to this patient?

"Make sure you are fully immunized." Explanation: The cause of congenital heart disease often cannot be documented, although it is associated with familial patterns of inheritance and possibly triggers such as rubella (German measles) and varicella (chickenpox) infection during pregnancy. Women need to enter pregnancy fully immunized to help prevent infection during pregnancy. Encouraging the child to eat a low-sodium diet and exercise as he grows up will help prevent acquired heart disease, not congenital heart disease

"Small increments in dosage lead to sharp increases in plasma drug levels." Within the therapeutic range for phenytoin, small increments in dosage produce sharp increases in plasma drug levels. The capacity of the liver to metabolize phenytoin is affected by slight changes in the dosage of the drug, not necessarily the length of time the client has been taking the drug. Large increments in dosage will greatly increase plasma levels, leading to drug toxicity.

When caring for a child who has a history of seizures, which of the following nursing interventions would be appropriate? (Select all that apply) a) The nurse has oxygen available to use during a seizure. b) The nurse positions the child on the side during a seizure. c) The nurse places a washcloth in the mouth to prevent injury during seizure. d) The nurse goes for help as soon as a seizure begins. e) The nurse pads the crib or side rails before a seizure. f) The nurse teaches the caregivers regarding seizure precautions.

A B E F Pad the crib sides and keep sharp or hard items out of the crib. Position the child to one side to prevent aspiration of saliva or vomitus. Have oxygen and suction equipment readily available for emergency use. Teach family caregivers seizure precautions so they can handle a seizure that occurs at home. Do not put anything in the child's mouth; doing so could cause injury to the child or to you. Stay with the patient

A child is home with the caregivers following a treatment for a head injury. If the child makes which of the following statements, the caregiver should contact the care provider. a) "You look funny. Well, both of you do. I see two of you." b) "I am glad that my headache is getting better." c) "It will be nice when you will let me take a long nap. I am sleepy." d) "My stomach is upset. I feel like I might throw up."

A The caregiver should notify the health-care provider immediately if the child vomits more than three times, has pupillary changes, has double or blurred vision, has a change in level of consciousness, acts strange or confused, has trouble walking, or has a headache that becomes more severe or wakes him or her from sleep. These instructions should be provided in written form to the caregiver. Just feeling naueauted is not a reason to notify the provider.

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

Administer oxygen. Explanation: If a child is experiencing heart failure, the infant will need oxygen. One of the medications the infant would be on is a diuretic. An infant with heart failure will need smaller, more frequent feedings to conserve energy for feeding. Infants are not usually put on fluid restriction.

The nurse is caring for a 10-year-old boy following a cardiac catheterization. Four hours after the procedure, the nurse notes some minor bleeding at the site. Which action would be most appropriate?

Apply pressure 1 inch above the site. Explanation: If bleeding occurs after a cardiac catheterization, apply pressure 1 inch above the site to create pressure over the vessel, thereby reducing the blood flow to the area. The nurse should first apply pressure and then notify the physician if this measure is ineffective or the bleeding increases. The child should maintain the leg in a straight position for about 4 to 8 hours. However, this would not address the bleeding assessed at the site. Changing the dressing would not be effective.

Absence seizures are marked by which of the following clinical manifestations? a) Sudden, brief jerks of a muscle group b) Loss of motor activity accompanied by a blank stare c) Loss of muscle tone and loss of consciousness d) Brief, sudden onset of increased tone of the extensor muscle

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

Any individual taking phenobarbital for a seizure disorder should be taught a) to brush his or her teeth four times a day. b) never to discontinue the drug abruptly. c) never to go swimming. d) to avoid foods containing caffeine.

B Phenobarbital should always be tapered, not stopped abruptly, or seizures from the child's dependency on the drug can result.

A school-aged girl with seizures is prescribed phenytoin sodium, 75 mg four times a day. An instruction you would want to give her parents regarding this is a) watching television while taking the drug may cause seizures. b) their child will have to practice good tooth brushing. c) even small doses may cause noticeable dizziness. d) numbness of the fingers is common while taking this drug.

B A side effect of phenytoin sodium is hypertrophy of the gumline. Good tooth brushing helps prevent inflammation under the hypertrophied tissue.

A nurse is palpating the pulse of a child with suspected aortic regurgitation. Which of the following assessment findings would the nurse expect to note?

Bounding pulse Explanation: A bounding pulse is characteristic of patent ductus arteriosis or aortic regurgitation. Narrow or thready pulses may occur in children with heart failure or severe aortic stenosis. A normal pulse would not be expected with aortic regurgitation.

The nurse is caring for an adolescent who suffered an injury during a diving accident. During assessment the client is demonstrating the posturing in the figure. The nurse is aware that this type of posturing is the result of injury to what area?

Brain stem Decerbrate posturing is seen with injuries occurring at the level of the brain stem. Decorticate posturing occurs with damage of the cerebral cortex. Both types of posturing are characterized by extremely rigid muscle tone. Injuries to the frontal lobe of the brain and the mid-cervical spine would not cause these types of posturing.

During the physical assessment of a 2½-month-old infant, the nurse suspects the child may have hydrocephalus. Which of the following signs or symptoms was observed? a) Pupil of one eye dilated and reactive b) Vertical nystagmus c) Dramatic increase in head circumference d) Posterior fontanel is closed

C A dramatic increase in head circumference is a symptom of hydrocephalus, suggesting that there is a build-up of fluid in the brain. Only one pupil that is dilated and reactive is a sign of an intracranial mass. Vertical nystagmus indicates brain stem dysfunction. A closed posterior fontanel would be frequently seen by this age.

Which of the following is consistent with increased ICP in the child? a) Narcolepsy b) Emotional lability c) Bulging fontanel d) Increased appetite

C Children with increased ICP exhibit bulging fontanels. They typically have a decreased appetite, are restless, and have trouble sleeping

The nurse is collecting data on a child being evaluated for rheumatic fever. The caregiver reports that over the past several weeks she has noticed that the child seems to have lack of coordination. In addition she reports the child has had facial grimaces and repetitive involuntary movements. The signs the caregiver reports indicate the child has which of the following?

Chorea Explanation: Chorea is a disorder characterized by emotional instability, purposeless movements, and muscular weakness. The onset of chorea is gradual, with increasing incoordination, facial grimaces, and repetitive involuntary movements.

After assessing a child, the nurse suspects coarctation of the aorta based on which of the following?

Femoral pulse weaker than brachial pulse Explanation: A femoral pulse that is weak or absent in comparison to the brachial pulse is associated with coarctation of the aorta. Bounding pulse is characteristic of patent ductus arteriosus or aortic regurgitation. A narrow or thread pulse is associated with heart failure or severe aortic stenosis. Hepatomegaly is a sign of right-sided heart failure

A 6-month-old infant is admitted with suspected bacterial meningitis. She is crying, irritable, and lying in the opisthotonic position. Which intervention should the nurse take initially?

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

A pregnant client asks if there is any danger to the development of her fetus in the first few weeks of her pregnancy. How should the nurse respond?

"During the first 3 to 4 weeks of pregnancy, brain and spinal cord development occur and are affected by nutrition, drugs, infection, or trauma." Brain and spinal cord development occur during the first 3 to 4 weeks of gestation. Infection, trauma, teratogens (any environmental substance that can cause physical defects in the developing embryo and fetus), and malnutrition during this period can result in malformations in brain and spinal cord development and may affect normal central nervous system (CNS) development. Good health before becoming pregnant is important but must continue into the pregnancy. Hardening of bones occurs during 13 to 16 weeks gestation, and the respiratory system begins maturing around 23 weeks' gestation.

The nurse has just admitted a 17-year-old diagnosed with bacterial meningitis. The parents of the adolescent tell the nurse, "We just don't understand how this could have happened. Our child has always been healthy and also 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." Showing empathy while letting the parents know that vaccines are not 100% effective is the best response. Questioning them about being sure would not be the best response unless there was reason to believe their information was not accurate. There is nothing to lead the nurse to believe that a different strain of bacteria caused the infection, or that the the child's immune system is compromised.

A 1-year-old has just undergone surgery to correct craniosynostosis. Which comment is the best psychosocial intervention for the parents?

"The surgery was successful. Do you have any questions?" Often what parents need most is someone to listen to their concerns. Although this is a good time for education, let the parents adjust to their baby's appearance and adapt your teaching to their questions, comments, and knowledge level.

An 8-year-old child is scheduled for an exercise stress test. Which instruction would be most important for the nurse to emphasize?

"You need to report any symptoms you are having during the test." Explanation: It is important for the child to report any symptoms felt during the test to help quantify the child's exercise tolerance. Exercise stress testing involves activity. Ambulatory electrocardiographic monitoring is performed over 24 hours. Sedation is not used for an exercise stress test. It is used for an arteriogram.

An 8-year-old child is scheduled for an exercise stress test. Which instruction would be most important for the nurse to emphasize?

The nurse has recently admitted a blind child to the pediatric unit. Which interventions should the nurse implement? Select all that apply.

- Identify herself to let child know she is there before touching the child. - Allow the child additional time to think about a response to a question. - Explain what individuals are doing.

A pregnant client asks if there is any danger to the development of her fetus in the first few weeks of her pregnancy. How should the nurse respond? a) "During the first 3 to 4 weeks of pregnancy brain and spinal cord development occur and are affected by nutrition, drugs, infection, or trauma." b) "As long as you were taking good care of your health before becoming pregnant, your fetus should be fine during the first few weeks of pregnancy." c) "The respiratory system matures during this time so good prenatal care during the first weeks of pregnancy is very important." d) "Bones begin to harden in the first 5 to 6 weeks of pregnancy so vitamin D consumption is particularly important."

A Brain and spinal cord development occur during the first 3 to 4 weeks of gestation. Infection, trauma, teratogens (any environmental substance that can cause physical defects in the developing embryo and fetus), and malnutrition during this period can result in malformations in brain and spinal cord development and may affect normal central nervous system (CNS) development. Good health before becoming pregnant is important but must continue into the pregnancy. Hardening of bones occurs during 13 to 16 weeks gestation, and the respiratory system begins maturing around 23 weeks' gestation.

The nurse is observing an infant who may have acute bacterial meningitis. Which finding might the nurse look for? a) Irritability, fever, and vomiting b) Jaundice, drowsiness, and refusal to eat c) Negative Kernig's sign d) Flat fontanel

A Findings associated with acute bacterial meningitis may include irritability, fever, and vomiting along with seizure activity. Fontanels would be bulging as intracranial pressure rises, and Kernig's sign would be present due to meningeal irritation. Jaundice, drowsiness, and refusal to eat indicate a GI disturbance rather than meningitis

A mother has brought her 5-month-old son to the clinic because he has been drowsy and unresponsive. The child has hydrocephalus and had a shunt placed about a month previously. Which of the following symptoms indicate that the shunt is infected? a) The child is not responding or eating well. b) The fontanels are bulging or tense. c) The child's pupil reaction time is rapid and uneven. d) The child has a high-pitched cry.

A Poor feeding and decreased responsiveness are signs of an infection. The nurse might also observe localized inflammation along the shunt tract. Bulging or tense fontanels suggest a shunt malfunction that is causing increased intracranial pressure. A high-pitched cry suggests increased intracranial pressure due to a shunt malfunction. Decreased and uneven pupil reaction times are symptoms of a shunt malfunction that is causing increased intracranial pressure.

Any individual taking phenobarbital for a seizure disorder should be taught a) never to discontinue the drug abruptly. b) never to go swimming. c) to avoid foods containing caffeine. d) to brush his or her teeth four times a day.

A Phenobarbital should always be tapered, not stopped abruptly, or seizures from the child's dependency on the drug can result.

A child is home with the caregivers following a treatment for a head injury. If the child makes which of the following statements, the caregiver should contact the care provider. a) "You look funny. Well, both of you do. I see two of you." b) "It will be nice when you will let me take a long nap. I am sleepy." c) "My stomach is upset. I feel like I might throw up." d) "I am glad that my headache is getting better."

The nurse is reinforcing teaching with the caregivers of a child who has had a head injury and is being discharged. Which of the following statements made by the caregiver indicate an accurate understanding of the follow-up care for their child? a) "Even if the flashlight bothers him, we will check his eyes." b) "If he vomits again, we will bring him back immediately." c) "We can give him Tylenol for a headache, but no aspirin." d) "If he falls asleep, we will wake him up every 15 minutes."A

A The child's pupils are checked for reaction to light every four hours for 48 hours. If the child falls asleep, he or she should be awakened every one to two hours to determine that the level of consciousness has not changed. No analgesics or sedatives should be administered during this period of observation. The caregiver should observe the child for at least six hours for vomiting or a change in the child's level of consciousness. The caregiver should notify the health-care provider immediately if the child vomits more than three times, but if the child vomits once, returning to the care provider immediately is not needed.

After teaching a group of students about neural tube disorders, the instructor determines that additional teaching is needed when the students identify this as a neural tube defect.

Arnold-Chiari malformation Arnold-Chiari malformation is a deformity of the cerebellar tonsils being displaced into the upper cervical canal. Anencephaly is a neural tube defect. Encephalocele is a neural tube defect. Spina bifida occulta is a neural tube defect.

What information is most correct regarding the nervous system of the child?

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

A group of nurses is reviewing the cardiovascular system and its function. Which of the following statements is the most accurate regarding the cardiovascular system in the child?

At birth the right and left ventricle are about the same size. Explanation: At birth, both the right and left ventricles are about the same size, but by a few months of age, the left ventricle is about two times the size of the right. If the infant has a fever, respiratory distress, or any increased need for oxygen, the pulse rate goes up to increase the cardiac output. Although the size is smaller, by the time the child is 5 years old, the heart has matured, developed, and functions just as the adult's heart.

Which statement about cerebral palsy would be accurate? a) "Cerebral palsy occurs because of too much oxygen to the brain." b) "Cerebral palsy is a condition that doesn't get worse." c) "Cerebral palsy means there will be many disabilities." d) "Cerebral palsy is a condition that runs in families."

B By definition, cerebral palsy is a nonprogressive neuromuscular disorder. It can be mild or quite severe and is believed to be the result of a hypoxic event during pregnancy or the birth process and doesn't run in families

The treatment for children with seizures disorders is most often which of the following? a) Strict exercise regimen b) Restricted fat diet c) Surgical intervention d) Use of anticonvulsant medications

D Complete control of seizures can be achieved for most people through the use of anticonvulsant drug therapy. A few children may be candidates for surgical intervention but, in most cases, surgery is not the treatment. Ketogenic diets (high in fat and low in carbohydrates and protein) cause the child to have high levels of ketones, which help to reduce seizure activity. Exercise is not a treatment for seizure disorders.

A school nurse is caring for a child with a severe sore throat and fever. Which of the following would be the best recommendation by the nurse to the parent?

Have the child be seen by the primary care provider. Explanation: Children with sore throats and fevers should be seen by their primary care provider to rule out strep throat. This is extremely important due to the fact they may contract an acquired heart disease called rheumatic fever. Taking acetaminophen, resting, and drinking fluids are all good recommendations, but the best recommendation is to see the provider. Going to the emergency room is not necessary at this time.

When developing a teaching plan for the parents of a child diagnosed with tricuspid atresia, the nurse would integrate knowledge of which of the following as the major mechanism involved?

Obstruction of blood flow to the lungs Explanation: Tricuspid atresia is a congenital heart defect in which the valve between the right atrium and right ventricle fails to develop, resulting in no opening to allow blood to flow from the right atrium to the right ventricle and subsequently through the pulmonary artery into the lungs. It is classified as a disorder of decreased pulmonary blood flow due to obstruction of blood flow to the lungs. Defects with connections involving the left and right sides, such as atrial or ventricular septal defects, will shunt blood from the higher-pressure left side to the lower-pressure right side and subsequently more blood will go to the lungs. A narrowed major vessel leads to an obstructive defect, interfering with the ability of the blood to flow freely through the vessel. Mixed defects such as transposition of the great vessels involve the mixing of well-oxygenated with poorly oxygenated blood, leading to a systemic blood flow that contains a lower oxygen content.

An infant with tetralogy of Fallot becomes cyanotic. Which nursing intervention would be the first priority?

Place the infant in the knee-chest position. Explanation: Placing the infant in the knee-chest position is the first priority when caring for an infant with tetralogy of Fallot. Starting IV fluids and preparing the child for surgery would not be necessary since it is known that the infant has a cyanotic birth defect. Raising the head of the bed would not be a priority since the infant needs to be placed in the knee-chest position.

A child with a congenital heart defect is getting an echocardiogram. How would the nurse describe this test to the parent?

This is a test that will check how blood is flowing through the heart. Explanation: Echocardiograms can determine the size of the heart and how the heart is pumping blood. An echocardiogram does not check the electrical impulses or the size of the heart. This is a non-invasive test.

A parent is asking for more information about their infant's patent ductus arteriosus (PDA). What would be included in the education?

This is caused by an opening that usually closes by 1 week of age. Explanation: A PDA is caused by an opening that usually closes by 1 week of age called the ductus arteriosus. The defect is usually fixed by a single surgery or during a cardiac catheterization procedure. IV fluids are not a routine intervention for the PDA. Most of the time a PDA occurs in premature infants.

Absence seizures are marked by which of the following clinical manifestations? a) Brief, sudden onset of increased tone of the extensor muscle b) Loss of motor activity accompanied by a blank stare c) Sudden, brief jerks of a muscle group d) Loss of muscle tone and loss of consciousness

The nurse is caring for an 8-year-old girl who was in a car accident. Which symptom suggests the child has a cerebral contusion? a) Bleeding from the ear b) Trouble focusing when reading c) Vomiting d) Difficulty concentrating

B Signs and symptoms for cerebral contusions include disturbances to vision, strength, and sensation. A child suffering a concussion will be distracted and unable to concentrate. Vomiting is a sign of a subdural hematoma. Bleeding from the ear is a sign of a basilar skull fracture.

A 5-year-old is being prepared for diagnostic cardiac catheterization, in which the catheter will be inserted in the right femoral vein. Which of the following interventions should the nurse take to prevent infection?

Avoid drawing a blood specimen from the right femoral vein before the procedure Explanation: Because the vessel site chosen for catheterization must not be infected at the time of catheterization (or obscured by a hematoma), never draw blood specimens from the projected catheterization entry site before the procedure (generally a femoral vein). The other interventions listed are performed for reasons other than prevention of infection. Children scheduled for the procedure are usually kept NPO for 2 to 4 hours beforehand to reduce the danger of vomiting and aspiration during the procedure. Be certain to record pedal pulses for a baseline assessment. The site for catheter insertion is locally anesthetized with EMLA cream or intradermal lidocaine.

The mother of a 12-year-old with Reye syndrome approaches the nurse wanting to know how this happened to her child, saying, "I never give my kids aspirin!" What could the nurse say to begin educating the woman? a) "Don't worry; you're in good hands. We have it under control now." b) "Sometimes it's hard to tell what products may contain aspirin." c) "Do you think that maybe your child took aspirin on his own?" d) "Aspirin in combination with the virus will make the brain swell and the liver fail."

B Salicylates are in a wide variety of products, so consumers must read the small print very carefully or they will miss the warning. The parent needs to be receptive to further education, and raising the possibility the child was responsible does not accomplish that goal. Don't state the obvious, but also don't minimize the situation. Encouraging the mother to ask for information and offering explanations in terms she will understand are important, but this response does not address the mother's assertion.

A 1-year-old has just undergone surgery to correct craniosynostosis. Which of the following comments is the best psychosocial intervention for the parents? a) "I told you yesterday there would be facial swelling." b) "The surgery was successful. Do you have any questions?" c) "I'll be watching hemoglobin and hematocrit closely." d) "This only happens in 1 out of 2,000 births."

B Often what parents need most is someone to listen to their concerns. Although this is a good time for education, let the parents adjust to their baby's appearance and adapt your teaching to their questions, comments, and knowledge level.

The nurse is reviewing the laboratory test results of several children who have come to the clinic for evaluation. Which child would the nurse identify as having the least risk for hyperlipidemia?

Child A with a total cholesterol of 150 mg/dL and low-density lipoprotein (LDL) of 80 mg/dL. Explanation: Total cholesterol levels below 170 mg/dL and LDL levels less than 100 mg/dL are considered within the acceptable range. Total cholesterol levels between 170 and 199 mg/dL and LDL levels between 100 and 129 mg/dL are considered borderline. Total cholesterol levels between 170 and 199 mg/dL and LDL levels between 100 and 129 mg/dL are considered borderline. Total cholesterol levels greater than or equal to 200 mg/dL and LDL levels greater than or equal to 130 mg/dL are considered elevated and place this child at greatest risk.

The nurse is caring for a 6-year-old child with a congenital heart defect. To best relieve a hypercyanotic spell, what action would be the priority?

Place the child in a knee-to-chest position. Explanation: The priority nursing action is to place the infant or child in a knee-to-chest position. Once the child has been placed in this position, the nurse should provide supplemental oxygen or administer medication as ordered. A calm, comforting approach should be used but is not the priority action. Once a child is placed in the knee-to-chest position, supplemental oxygen would be provided as ordered. Once a child is placed in the knee-to-chest position, medications would be given as ordered.

A child who has been having seizures is admitted to the hospital for diagnostic testing. The child has had laboratory testing and an EEG, and is scheduled for a lumbar puncture. The parents voice concern to the nurse stating, "I don't understand why our child had to have a lumbar puncture since the EEG was negative." What is the best response by the nurse?

"The lumbar puncture can help rule out any infection in fluid surrounding the brain and spinal cord as the cause of the seizures. Lumbar punctures are performed to analyze cerebrospinal fluid (CSF) to rule out meningitis or encephalitis as a cause of seizures. A normal EEG does not rule out epilepsy because seizure activity rarely occurs during the actual testing time. A 24-hour or longer EEG can help in diagnosing a seizure disorder. Just telling the parents that it needs to be done, to be patient, or it is a routine does not address the parents' concerns.

The nurse is caring for a child who had a seizure, fell to the ground, and hit and injured his face, head, and shoulders. This information indicates the child likely had which of the following types of seizures? a) Absence b) Myoclonic c) Atonic d) Infantile

C Atonic or akinetic seizures cause a sudden momentary loss of consciousness, muscle tone, and postural control and can cause the child to fall. They can result in serious facial, head, or shoulder injuries. In absence seizures the child loses awareness and stares straight ahead but does not fall. Myoclonic seizures are characterized by a sudden jerking of a muscle or group of muscles, often in the arms or legs, without loss of consciousness. With infantile spasms, muscle contractions are sudden, brief, symmetrical, and accompanied by rolling eyes.

A child was just brought into the emergency department after falling off a skateboard. The parents report that their child lost consciousness briefly and they noticed watery drainage coming from the nose. What action should the nurse take first?

Notify the emergency department physician of the information the parents reported If clear liquid fluid is noted draining from the ears or nose, the physician should be notified immediately. If the fluid tests positive for glucose, this is indicative of leaking. The other assessments can continue after notifying the physician of these findings.

The nurse is speaking with the mother of an infant being treated for hydrocephalus. Which statement by the mother indicates the need for further instruction?

"My baby's prematurity may have contributed to this condition." Hydrocephalus is not a specific illness, but results from underlying brain disorders. It results from an imbalance in the production and absorption of CSF. In hydrocephalus, CSF accumulates within the ventricular system and causes the ventricles to enlarge and increases in ICP to occur. Hydrocephalus may be congenital or acquired. Congenital hydrocephalus is present at birth and is often due to a genetic disposition or environmental influences during fetal development. Maternal conditions that may be associated with hydrocephalus include meningitis, prematurity with intracranial hemorrhage, and mumps encephalitis.

The nurse is caring for a 6-year-old child who has a history of febrile seizures and is admitted with a temperature of 102.2° F(39° C). The highest priority nursing intervention for this child would be which of the following? a) The nurse will encourage the child to do his or her own self-care. b) The nurse will institute safety precautions. c) The nurse will offer age appropriate activities. d) The nurse will provide family teaching related to the child's history

B A child with an elevated temperature is at high risk for having seizures and therefore actions by the nurse include keeping the child in a safe situation to prevent any injury if the child should have a seizure.

The parents of a child with a history of seizures who has been taking phenytoin (Dilantin) ask the nurse why it's difficult to maintain therapeutic plasma levels of this medication. Which statement by the nurse would be most accurate? a) "A drop in the plasma drug level will lead to a toxic state." b) "The capacity to metabolize the drug becomes overwhelmed over time." c) "Small increments in dosage lead to sharp increases in plasma drug levels." d) "Large increments in dosage lead to a more rapid stabilizing therapeutic effect."

C Within the therapeutic range for phenytoin, small increments in dosage produce sharp increases in plasma drug levels. The capacity of the liver to metabolize phenytoin is affected by slight changes in the dosage of the drug, not necessarily the length of time the client has been taking the drug. Large increments in dosage will greatly increase plasma levels, leading to drug toxicity.

The nurse is caring for a child admitted with complex partial seizures. Which of the following clinical manifestations would likely have been noted in the child with this diagnosis? a) The child was dizzy and had decreased coordination. b) The child had jerking movements and then the extremities stiffened. c) The child was rubbing the hands and smacking the lips. d) The child had shaking movements on one side of the body.

C Complex partial seizures, also called psychomotor seizures, change or alter consciousness. They cause memory loss and staring and nonpurposeful movements, such as hand rubbing, lip smacking, arm dropping, and swallowing. In the tonic phase of tonic-clonic seizures, the child's muscles contract, the child may fall, and the child's extremities may stiffen. During the prodromal period of the tonic-clonic seizure, the child might have a lack of coordination. Simple partial motor seizures cause a localized motor activity such as shaking of an arm, leg, or other part of the body

The nurse is collecting data from the caregivers of a child admitted with seizures. Which of the following statements indicates the child most likely had an absence seizure? a) "He kept smacking his lips and rubbing his hands." b) "He usually is very coordinated, but he couldn't even walk without falling." c) "His arms had jerking movements in his legs and face." d) "He was just staring into space and was totally unaware."

D Absence seizures rarely last longer than 20 seconds. The child loses awareness and stares straight ahead but does not fall. Absence seizures rarely last longer than 20 seconds. The child loses awareness and stares straight ahead but does not fall. Myoclonic seizures are characterized by a sudden jerking of a muscle or group of muscles, often in the arms or legs, without loss of consciousness. Complex partial seizures cause nonpurposeful movements, such as hand rubbing and lip smacking. During the prodromal period of the tonic-clonic seizure, the child might have a lack of coordination.

A nurse is giving discharge instructions to the parents of a newborn with a congenital heart disorder. Which of the following should the nurse instruct the parents to do in the event that the child becomes cyanotic?

Place him in a knee-chest position Explanation: Before parents leave the hospital with a newborn who has a congenital heart disorder, be certain they have the name and number of the health professional to call if they have a question about their infant's health. Review with them the steps to take if their child should become cyanotic, such as placing the child in a knee-chest position. "Hands on" CPR is not recommended for children as it is for adults. Remind parents that children with many types of congenital heart disorders or rheumatic fever need prophylactic low-dose aspirin therapy to avoid blood clotting; although becoming a controversial practice, they may be prescribed antibiotic therapy such as oral amoxicillin before oral surgery.

The nurse is educating parents of a male infant with Chiari type II malformation. Which of the following statements about their child's condition is most accurate? a) "Lay him down after feeding." b) "Take your time feeding your baby." c) "You won't need to change diapers often." d) "You'll see a big difference after the surgery."

B One of the problems associated with Chiari type II malformation is poor gag and swallowing reflexes, so the infant must be fed slowly. There is a great risk of aspiration, requiring that the child be placed in an upright position after feeding. The goal of surgery is to prevent further symptoms, rather than to relieve existing ones. Infrequent urination is a problem associated with type I malformations.

The nurse is caring for a near-term pregnant woman who has not taken prenatal vitamins or folic acid supplements. Which congenital defect is most likely to occur based on the mother's prenatal history? a) Neonatal conjunctivitis b) Incomplete myelinization c) A neural tube defect d) Facial deformities

C Folic acid supplementation has been found to reduce the incidence of neural tube defects by 50%. The fact that the mother has not used folic acid supplements puts her baby at risk for spina bifida occulta, one type of neural tube defect. Neonatal conjunctivitis can occur in any newborn during birth and is caused by virus, bacteria, or chemicals. Facial deformities are typical of babies of alcoholic mothers. Incomplete myelinization is present in all newborns.

Which of the following is most correct regarding the nervous system of the child? a) The child has underdeveloped fine motor skills and well-developed gross motor skills. b) The child's nervous system is fully developed at birth. c) The child has underdeveloped gross motor skills and well-developed fine motor skills. d) As the child grows, the gross and fine motor skills increase.

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

The nurse has developed a nursing plan for the care of a 6-year-old girl with congenital hydrocephalus whose shunt has become infected. The most important discharge teaching point for this family is: a) maintaining effective cerebral perfusion. b) encouraging development of motor skills. c) establishing seizure precautions for the child. d) ensuring the parents know how to properly give antibiotics.

D ensuring the parents know how to properly give antibiotics. Explanation: Educating parents how to properly give the antibiotics would be the priority intervention because the child's shunt has become infected. Maintaining cerebral perfusion is important for a child with hydrocephalus, but the priority intervention for the parents at this time is in regards to the infection. Establishing seizure precautions is an intervention for a child with a seizure disorder. Encouraging development of motor skills would be appropriate for a microcephalic child.

A nurse is providing information to the parents of a child diagnosed with absence seizures. What information would the nurse expect to include when describing this type of seizure? Select all that apply.

This type of seizure is more common in girls than it is in boys. You might see a blank facial expression after a sudden stoppage of speech. This type of seizure is usually short, lasting for no more than 30 seconds. You might have mistaken this type of seizure for lack of attention. Absence seizures are more common in girls than boys and are characterized by a sudden cessation of motor activity or speech with a blank facial expression or rhythmic twitching of the mouth or blinking of the eyelids. This type of seizure lasts less than 30 seconds and may have been mistaken for inattentiveness because of the subtle changes. Absence seizures are not associated with a postictal state.

The nurse is caring for a 6-year-old child with an external ventricular drainage device. The nurse is concerned about the minimal drainage in the past few hours. What actions by the nurse are indicated? Select all that apply.

Check tubing clamps to ensure they are open. Ensure the tubing is not kinked. Nursing care of an external ventricular drainage device requires the nurse ensure all connections are secure and labeled. The amount of drainage requires close observation. If drainage is absent or minimal the nurse must assess the tubing to make certain it is not clamped or kinked. The level of the drip chamber must be set at the height of the child (at the clavicle). Taking the temperature will be useful to assess for the presence of infection but that is not currently a concern. Asking the child to cough and deep breathe should not be done. Deep breathing is beneficial for all postoperative clients, but coughing may increase pressures and should be avoided.

A 10-year-old boy has been experiencing complex partial seizures and has not responded well to medication. Surgery is planned to remove brain tissue at the seizure foci. Which diagnostic test would be the most accurate in identifying the seizure foci?

Positron emission tomography (PET) The diagnostic technique of positron emission tomography (PET) involves imaging after injection of positron-emitting radiopharmaceuticals into the brain. These radioactive substances accumulate at diseased areas of the brain or spinal cord. PET is extremely accurate in identifying seizure foci. Brain scans identify possible tumor, subdural hematoma, abscess, or encephalitis. Echoencephalography is often used in neonatal ICUs to monitor intraventricular hemorrhages and other problems frequently encountered by preterm infants. Myelography is the x-ray study of the spinal cord following the introduction of a contrast material into the CSF by lumbar puncture to reveal the presence of space-occupying lesions of the spinal cord.

Seven-year-old Isabelle has been complaining of headache, coughing, and an aching chest. The care provider makes a diagnosis of a viral infection. The child's mother tells the nurse that when Isabelle first said she had a headache, the child's father gave her half of an adult aspirin. The mother has heard of Reye syndrome and asks the nurse if her child could get this. Which statement would be best for the nurse to say to this mother?

"This might or might not be a problem. Watch Isabelle for signs of lethargy, unusual irritability, confusion, or vomiting. If you notice any of these, bring her to the emergency room immediately so she can be checked for Reye syndrome." Reye syndrome usually occurs after a viral illness, particularly after an upper respiratory infection or varicella (chickenpox). Administration of aspirin during the viral illness has been implicated as a contributing factor. As a result, the American Academy of Pediatrics recommends that aspirin or aspirin compounds not be given to children with viral infections. The symptoms appear within three to five days after the initial illness: The child is recuperating unremarkably when symptoms of severe vomiting, irritability, lethargy, and confusion occur. Immediate intervention is needed to prevent serious insult to the brain including respiratory arrest.

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

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

A nurse is examining a 10-year-old girl who has a heart murmur. On auscultation, the nurse finds that the murmur occurs only during systole, is short, and sounds soft and musical. When she has the girl stand, she can no longer hear the murmur on auscultation. Which of the following should the nurse say to the girl's mother in response to these findings?

"Your daughter has an innocent heart murmur, which is nothing to worry about." Explanation: The symptoms described indicate an innocent heart murmur. Although innocent murmurs are of no consequence, parents need to be told when their child has one because this finding will undoubtedly be discovered again at a future health assessment or during a febrile illness, anxiety, or pregnancy. Activities need not be restricted when a child has an innocent murmur and the child requires no more frequent health appraisals than other children. If a murmur is present as the result of heart disease or a congenital disorder, it is an organic heart murmur.

Choice Multiple question - Select all answer choices that apply. A nurse is providing information to the parents of a child diagnosed with absence seizures. Which of the following would the nurse expect to include when describing this type of seizure? Select all that apply. a) This type of seizure is usually short, lasting usually for no more than 30 seconds. b) The child will commonly report a strange odor or sensation before the seizure. c) You might see a blank facial expression after a sudden stoppage of speech. d) Your child will probably sleep deeply for ½ to 2 hours after the seizure. e) You might have mistaken this type of seizure for lack of attention. f) This type of seizure is more common in girls than it is in boys.

A C E F Absence seizures are more common in girls than boys and are characterized by a sudden cessation of motor activity or speech with a blank facial expression or rhythmic twitching of the mouth or blinking of the eyelids. This type of seizure lasts less than 30 seconds and may have been mistaken for inattentiveness because of the subtle changes. Absence seizures are not associated with a postictal state.

The nurse is collecting data from the caregivers of a child admitted with seizures. Which of the following statements indicates the child most likely had an absence seizure? a) "His arms had jerking movements in his legs and face." b) "He was just staring into space and was totally unaware." c) "He kept smacking his lips and rubbing his hands." d) "He usually is very coordinated, but he couldn't even walk without falling."

B Absence seizures rarely last longer than 20 seconds. The child loses awareness and stares straight ahead but does not fall. Absence seizures rarely last longer than 20 seconds. The child loses awareness and stares straight ahead but does not fall. Myoclonic seizures are characterized by a sudden jerking of a muscle or group of muscles, often in the arms or legs, without loss of consciousness. Complex partial seizures cause nonpurposeful movements, such as hand rubbing and lip smacking. During the prodromal period of the tonic-clonic seizure, the child might have a lack of coordination.

The mother of a newborn with a caput succedaneum asks the nurse how this happened to her baby. Which response by the nurse would be most appropriate? a) "The forceps used during delivery caused this to happen." b) "During delivery, your vaginal wall put pressure on the baby's head." c) "It's normal for this to happen, but they don't really know why." d) "Your baby's head became blocked inside your vagina while you were pushing."

B Caput succedaneum results from pressure from the uterus or vaginal wall during a head-first delivery The use of forceps is associated with a cephalohematoma. Caput succedaneum is not due to the baby's head becoming blocked inside the vagina. The cause of caput succedaneum is known; it is caused by pressure from the uterus or vaginal wall during a head-first delivery.

The nurse is completing a nursing history on a female client who has just found out she is 6 weeks' pregnant. She reports that over the last 2 months she has been drinking excessive amounts of alcohol every weekend and smokes a half-pack of cigarettes per day. What is the nurse concerned with given this information? Select all that apply.

Brain development in the fetus Spinal cord development in the fetus The brain and spinal cord make up the central nervous system (CNS). Development of these structures begins in the first 3 to 4 weeks of gestation from the neural tube. Infection, trauma, teratogens (any environmental substance that can cause physical defects in the developing embryo and fetus), and malnutrition during this period can result in malformations in brain and spinal cord development and may affect normal CNS development.

The father of a 7-year-old boy reports to the nurse that two or three times over the past weeks he has observed his son seemingly staring into space and rubbing his hands. The behavior lasts for a minute or so, followed by an inability of the child to understand what's being said to him. When the nurse asks the child about his experience, he says he doesn't know what his father is talking about. What type of seizure do these symptoms indicate the child is experiencing?

Complex partial seizures Complex partial seizures, also called psychomotor seizures, begin in a small area of the brain and change or alter consciousness. They cause memory loss and staring. Nonpurposeful movements such as hand rubbing, lip smacking, arm dropping, and swallowing may occur. Following the seizure the child may sleep or be confused for a few minutes. The child is often unaware of the seizure. Simple partial sensory seizures may include sensory symptoms called an aura (a sensation that signals an impending attack) involving sight, sound, taste, smell, touch, or emotions (a feeling of fear, for example). The child may also have numbness, tingling, paresthesia, or pain. Simple partial motor seizures cause a localized motor activity such as shaking of an arm, leg, or other part of the body. Absence seizures rarely last longer than 20 seconds. The child loses awareness and stares straight ahead but does not fall. The child may have blinking or twitching of the mouth or an extremity along with the staring. Immediately after the seizure, the child is alert and continues conversation but does not know what was said or done during the episode.

The nurse is performing echocardiography on a newborn who is suspected of having a congenital heart defect. The child's mother is concerned about the safety of using this on a newborn and wants to know how this technology works. The nurse assures her that this technology is very safe and may be repeated frequently without added risk. Which of the following should the nurse mention in explaining how this diagnostic test works?

High-frequency sound waves are directed toward the heart Explanation: Echocardiography, or ultrasound cardiography, has become the primary diagnostic test for congenital heart disease. For this, high-frequency sound waves, directed toward the heart, are used to locate and study the movement and dimensions of cardiac structures, such as the size of chambers, thickness of walls, relationship of major vessels to chambers, and the thickness, motion, and pressure gradients of valves. You can remind parents echocardiography does not use x-rays so it can be repeated at frequent intervals without exposing their child to the possible risk of radiation. The other answers refer to other types of diagnostic tests, including X-ray studies, radioangiocardiography, and phonocardiography.

Dexamethasone is often prescribed for the child who has sustained a severe head injury. Dexamethasone is a(n):

steroid. A steroid may be prescribed to reduce inflammation and pressure on vital centers.

A school-aged girl with seizures is prescribed phenytoin sodium, 75 mg four times a day. An instruction you would want to give her parents regarding this is:

their child will have to practice good tooth brushing. A side effect of phenytoin sodium is hypertrophy of the gumline. Good tooth brushing helps prevent inflammation under the hypertrophied tissue.

An 8-year-old girl is diagnosed as having tonic-clonic seizures. You would want to teach her parents that:

their daughter should maintain an active lifestyle. It is important for children with seizures to maintain as near normal a lifestyle as possible to maintain self-esteem and achievement. Most seizure medications must create a therapeutic level before they are effective.

The nurse is caring for a child diagnosed with rheumatic fever. The nurse would do all of the following nursing interventions. Which two interventions would be the priority for the nurse? Select all that apply.

• Carefully handle the child's knees, ankles, elbows and wrists when moving the child. • Administer salicylates after meals or with milk Explanation: Pain control and relief are the highest priorities for the child with rheumatic fever. Position the child to relieve joint pain. Large joints, including the knees, ankles, wrists, and elbows, are usually involved. Carefully handle the joints when moving the child to help minimize pain. Salicylates are administered in the form of aspirin to reduce fever and relieve joint inflammation and pain

The nurse is assessing a child with suspected rheumatic fever. Which of the following would the nurse expect to find? Select all that apply.

• Involuntary limb movement • Macular rash on trunk • Tender swollen joints Explanation: Signs and symptoms of rheumatic fever include systolic murmur, involuntary limb movement, macular rash on the trunk, tender swollen joints, and subcutaneous nodules.

The parents of a 4-year-old boy tell the nurse, "We're really worried that our child doesn't have 20/20 vision. It seems that he doesn't always see clearly at a distance." What is the best response by the nurse?

"20/20 vision isn't usually achieved until the age of 6 or 7 years but I will let the physician know your concerns."

A 13-year-old reports she recently saw a television program showing surgery to correct vision problems. She states she hates wearing glasses and wants to have this procedure done. What is the best response by the nurse?

"Although there are surgeries for vision, they are not normally recommended for someone your age."

The nurse is teaching an inservice program to a group of nurses on the topic of children diagnosed with rheumatic fever. The nurses in the group make the following statements. Which statement is most accurate regarding the diagnosis of rheumatic fever?

"Children who have this diagnosis may have had strep throat." Explanation: Rheumatic fever is precipitated by a streptococcal infection, such as strep throat, tonsillitis, scarlet fever, or pharyngitis, which may be undiagnosed or untreated. Rheumatic fever is a chronic disease of childhood, affecting the connective tissue of the heart, joints, lungs, and brain. There is no immunization to prevent rheumatic fever. The onset of rheumatic fever is often slow and subtle.

A child is diagnosed with bacterial meningitis. The nurse would suspect which abnormality of cerebrospinal fluid (CSF)? a) Decreased pressure b) Cloudy appearance c) Elevated sugar d) Decreased leukocytes

B In the CSF of clients diagnosed with bacterial meningitis, the pressure is elevated, the appearance is cloudy, and the leukocytes are elevated. A decreased sugar content is noted.

A 6-year-old has had a viral infection for the past 5 days and is having severe vomiting, confusion, and irritability, although he is now afebrile. During the assessment, the nurse should ask the parent which question?

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

The mother of a toddler tells the nurse during a routine well-child appointment that she is concerned because, "It seems like my son is falling and hitting his head all of the time." What is the best response by the nurse?

"Due to the size of their heads and immature neck muscles falling is common, but I will let the physician know your concerns." The head of the infant and young child is large in proportion to the body, and is the fastest-growing body part during infancy and continues to grow until the child is 5 years old. In addition, the infant's and child's neck muscles are not well developed. Both of these differences lead to an increased incidence of head injury from falls. The nurse should still let the physician know the mother's concerns in case there is another issue causing the falls.

The mother of a newborn with a caput succedaneum asks the nurse how this happened to her baby. Which response by the nurse would be most appropriate?

"During delivery, your vaginal wall put pressure on the baby's head." Caput succedaneum results from pressure from the uterus or vaginal wall during a head-first delivery. The use of forceps is associated with a cephalohematoma. Caput succedaneum is not due to the baby's head becoming blocked inside the vagina. The cause of caput succedaneum is known; it is caused by pressure from the uterus or vaginal wall during a head-first delivery.

The nurse is collecting data from the caregivers of a child admitted with seizures. Which statement indicates the child most likely had an absence seizure?

"He was just staring into space and was totally unaware." Absence seizures rarely last longer than 20 seconds. The child loses awareness and stares straight ahead but does not fall. Absence seizures rarely last longer than 20 seconds. The child loses awareness and stares straight ahead but does not fall. Myoclonic seizures are characterized by a sudden jerking of a muscle or group of muscles, often in the arms or legs, without loss of consciousness. Complex partial seizures cause nonpurposeful movements, such as hand rubbing and lip smacking. During the prodromal period of the tonic-clonic seizure, the child might have a lack of coordination.

A 5-year-old develops an otitis media with effusion. Myringotomy tube insertion is scheduled. The mother asks, "Why does this have to be done at the hospital?" What would be your best response?

"He will need to lie still afterward, so he will need to remain at the hospital for a short time."

An otherwise healthy 18-month-old child with a history of febrile seizures is in the well-child clinic. Which statement by the father would indicate to the nurse that additional teaching should be done?

"I always keep phenobarbital with me in case of a fever." Anticonvulsants, such as phenobarbital, are administered to children with prolonged seizures or neurologic abnormalities. Ibuprofen, not phenobarbital, is given for fever. Febrile seizures usually occur after age 6 months and are unusual after age 5. Treatment is to decrease the temperature because seizures occur as the temperature rises.

The nurse has finished teaching the parents of a 10-month-old male ways to prevent another acute otitis media infection. Which statement by the mother indicates she has the correct understanding of the information provided?

"I should continue to breastfeed my son because it lowers the incidence of acute otitis media."

A mother has just given birth to an infant born with anencephaly. The mother states, "With all of the technological advances in medicine, I am hopeful of a good prognosis for my baby." How should the nurse respond?

"It must be very difficult to deal with this diagnosis. Tell me what you know about the prognosis." Anencephaly is a defect in brain development resulting in small or missing brain hemispheres, skull, and scalp. The majority of infants will be stillborn or die within hours to several days of birth. There have been a few cases in which the infant has lived for several months. Showing empathy and determining what the mother knows about the prognosis will help direct the conversation.

The nurse is providing child and family education prior to discharge following a cardiac catheterization. The nurse is teaching about signs and symptoms of complications. Which statement by the mother indicates a need for further teaching?

"The feeling of the heart skipping a beat is common." Explanation: Reports of heart "fluttering" or "skipping a beat" should be reported to the doctor as this can be a sign of a complication. This statement is appropriate because tub baths should be avoided for about 3 days. This statement is appropriate because strenuous activity is limited for about 3 days. Changes in skin color or difficulty breathing indicate potential complications that need to be reported.

A nurse is teaching the parents of a child diagnosed with rheumatic fever about prescribed drug therapy. Which statement would indicate to the nurse that additional teaching is needed?

"We can stop the penicillin when her symptoms disappear." Explanation: For a child with rheumatic fever, drug therapy must be given for the full 10 to 14 days to ensure complete eradication of the infection. The drug must not be stopped when the signs and symptoms disappear. To prevent recurrent attacks, prophylactic antibiotic therapy is prescribed for at least 5 years or until the child is 18 years old. Additional prophylactic therapy should be instituted when dental or tonsillar surgery is planned.

The parents of an 8-year-old child report that the child's teachers noted the child is having problems seeing the board in school but state they do not understand this since the child is able to read from the computer with no difficulty. Which response from the nurse is most appropriate?

"What you are describing may be what is called myopia."

The infant has been hospitalized and develops hypercyanosis. The physician has ordered the nurse to administer 0.1 mg of morphine sulfate per every kilogram of the infant's body weight. The infant weighs 15.2 pounds. Calculate the infant's morphine sulfate dose. Round your answer to the nearest tenth.

0.7 Explanation: The infant weighs 15.2 pounds (2.2 pounds = 1 kg.) 15.2 pounds x 1 kg/2.2 pounds = 6.818 kg The infant weighs 6.818 kg. For each kilogram of body weight, the infant should receive 0.1 mg of morphine sulfate. 6.818 kg x 0.1 mg/1 kg = 0.6818 mg Rounded to the tenth place = 0.7 mg The infant will receive 0.7 mg of morphine sulfate.

You take an infant's apical pulse before administering digoxin. What is the usually accepted level of pulse rate considered safe for administering digoxin to an 8-month-old infant?

100 beats per minute Explanation: Because digoxin slows the heart rate, it is important that it is not already beating at a slow rate before administration.

The health care provider orders amoxicillin 35 mg/kg/day in three divided doses for a child with otitis media. The child weighs 44 lb and the medication is available in a suspension of 50 mg/mL. What is the total daily dosage in mL for this child?

14 mL

Question: Put the following events of a generalized epileptic seizure in correct order: Postictal period Prodromal period Clonic stage Tonic stage

2 4 3 1 A tonic-clonic seizure is characterized by the following events: 1) prodromal period, 2) tonic stage, 3) clonic stage, and 4) postictal period.

The nurse and an adolescent are reviewing the adolescent's record of her headaches and activities surrounding them. Which of the following would the nurse identify as a possible trigger? a) Drinking three cans of diet cola b) Swimming twice a week c) 11 p.m. bedtime; 6:30 a.m. wake-up d) Use of nonscented soap

A Cola contains caffeine, which is an associated trigger. Intense activity, not regular exercise, may be a trigger. Odors, such as strong perfumes, may be a trigger. Changes in sleeping patterns may be a trigger.

A 6-month-old infant is admitted with a diagnosis of bacterial meningitis. The nurse would place the infant in which room? a) A private room near the nurses' station b) A two-bed room in the middle of the hall c) A room with a 12-month-old infant with a urinary tract infection d) A room with an 8-month-old infant with failure to thrive

A A child who has the diagnosis of bacterial meningitis will need to be placed in a private room until that child has received I.V. antibiotics for 24 hours because the child is considered contagious. Additionally, bacterial meningitis can be quite serious; therefore, the child should be placed near the nurses' station for close monitoring and easier access in case of a crisis.

The nurse knows that the heads of infants and toddlers are large in proportion to their bodies, placing them at risk for which of the following? a) Head trauma b) Positional plagiocephaly c) Congenital hydrocephalus d) Intracranial hemorrhaging

A A larger head size in relation to the rest of their body size gives young children a higher center of gravity, which causes them to hit their head more readily, thus placing them at risk for head trauma. Fragile capillaries in the periventricular area of the brain put preterm infants at risk for intracranial hemorrhage. Congenital hydrocephalus may be caused by abnormal intrauterine development or infection. Positional plagiocephaly is caused by an infant's head remaining in the same position for too long.

The nurse caring for a patient with a cranial injury knows that broad-spectrum antibiotics are used to reduce cerebral edema. a) False b) True

A Antibiotics or antivirals are used to treat infectious disease processes. Glucocorticoids and diuretics are used to reduce cerebral edema.

An otherwise healthy 18-month-old child with a history of febrile seizures is in the wellchild clinic. Which statement by the father would indicate to the nurse that additional teaching should be done? a) "I always keep phenobarbital with me in case of a fever." b) "The most likely time for a seizure is when the fever is rising." c) "I have ibuprofen available in case it's needed." d) "My child will likely outgrow these seizures by age 5."

A Anticonvulsants, such as phenobarbital, are administered to children with prolonged seizures or neurologic abnormalities. Ibuprofen, not phenobarbital, is given for fever. Febrile seizures usually occur after age 6 months and are unusual after age 5. Treatment is to decrease the temperature because seizures occur as the temperature rises.

Which of the following is most correct regarding the nervous system of the child? a) As the child grows, the gross and fine motor skills increase. b) The child has underdeveloped gross motor skills and well-developed fine motor skills. c) The child's nervous system is fully developed at birth. d) The child has underdeveloped fine motor skills and well-developed gross motor skills.

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

A child is diagnosed with aseptic meningitis. The child's mother states, "I don't know where she would have picked this up." The nurse prepares to respond to the mother, based on the understanding that this disorder is most likely caused by which of the following? a) Enterovirus b) Escherichia coli c) Streptococcus group B d) Haemophilus influenza type B

A Aseptic meningitis is the most common type of meningitis, and if a causative organism can be identified, it is usually a virus such as enterovirus. E. coli is a cause of bacterial meningitis. H. influenza type B is a cause of bacterial meningitis. Streptococcus group B is a cause of bacterial meningitis.

The eyes of a 9-year-old who suffered a head injury are crossed. Besides checking ICP, which of the following interventions would be most important for the nurse to perform? a) Assess the child's level of consciousness. b) Help the child cope with an altered appearance. c) Monitor core body temperature. d) Pull up the side rails on the bed

A Decreased level of consciousness is frequently the first sign of major neurologic problems after head trauma. While body temperature is an important indicator of infection, it is not a priority here. Preventing harm by setting the side rails is more important for a seizure patient. The child's eyes will correct themselves when ICP is reduced.

Which of the following age groups of children have the highest actual rate of death from drowning? a) Toddlers b) School-age children c) Preschool children d) Infants

A Toddlers and older adolescents have the highest actual rate of death from drowning.

A group of nursing students are reviewing cerebral vascular disorders and risk factors in children. The students demonstrate understanding of the material when they identify which of the following as a risk factor for hemorrhagic stroke? a) Arteriovenous malformations (AVMs) b) Sickle cell disease c) Meningitis d) Congenital heart defect

A Vascular malformations such as intracranial AVMs are a risk factor for hemorrhagic stroke. Sickle cell disease is a risk factor for ischemic stroke. Congenital heart defects are risk factors for ischemic stroke. Meningitis or other infection is a risk factor for ischemic stroke.

Choice Multiple question - Select all answer choices that apply. The nurse determines that a child is experiencing late signs of increased intracranial pressure based on assessment of which of the following? Select all that apply. a) Fixed dilated pupils b) Increased blood pressure c) Irregular respirations d) Sunset eyes e) Bradycardia

A E C Late signs of increased intracranial pressure include bradycardia, fixed and dilated pupils, and irregular respirations. Increased blood pressure and sunset eyes are early signs of increased intracranial pressure.

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

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

A child has been diagnosed with a basilar skull fracture. The nurse identifies ecchymosis behind the patient's ear. This would be documented as which of the following? a) Battle sign b) Rhinorrhea c) Otorrhea d) Raccoon eyes

A Two signs of basilar skull fracture include Battle sign (bruising or ecchymosis behind the ear) and "raccoon eyes" (blood leaking into the frontal sinuses causing an edematous and bruised periorbital area). Rhinorrhea is CSF leakage from the nose. Otorrhea is CSF leaking from the ear.

An infant born with congenital glaucoma is scheduled for surgery. Which preoperative order should the nurse question for this patient?

A preoperative injection of atropine

A 6-month-old infant is admitted with a diagnosis of bacterial meningitis. The nurse would place the infant in which room?

A private room near the nurses' station A child who has the diagnosis of bacterial meningitis will need to be placed in a private room until that child has received I.V. antibiotics for 24 hours because the child is considered contagious. Additionally, bacterial meningitis can be quite serious; therefore, the child should be placed near the nurses' station for close monitoring and easier access in case of a crisis.

The nurse is explaining possible side effects of corticosteroids to the caregiver of a child diagnosed with rheumatic fever. The caregiver comments, "I don't understand what hirsutism means." The nurse would be correct in explaining that hirsutism is which of the following?

Abnormal hair growth Explanation: The child whose pain is not con trolled with salicylates may be ad ministered corticosteroids. Side effects such as hirsutism (abnormal hair growth) and "moon face" may be noted. Facial grimaces and repetitive involuntary movements are symptoms of chorea.

Which of the following nursing diagnoses would best apply to a child with rheumatic fever?

Activity intolerance related to inability of heart to sustain extra workload Explanation: Children with rheumatic fever need to reduce activity to relieve stress during the course of the illness.

The 12-year-old child has developed a stye. Which may be included in the child's care?

Apply hot, moist compresses to the affected area.

The nurse is preparing a nursing care plan for a 2-year-old child with hearing impairment. Which intervention will be part of the plan?

Assess the child's ability to convey information.

The eyes of a 9-year-old who suffered a head injury are crossed. Besides checking ICP, which intervention would be most important for the nurse to perform?

Assess the child's level of consciousness. Decreased level of consciousness is frequently the first sign of major neurologic problems after head trauma. While body temperature is an important indicator of infection, it is not a priority here. Preventing harm by setting the side rails is more important for a seizure client. The child's eyes will correct themselves when ICP is reduced.

Coarctation of the aorta demonstrates few symptoms in newborns. Which of the following is an important assessment to make on all newborns to help reveal this condition?

Assessing for the presence of femoral pulses Explanation: Infants with a narrowing (coarctation) of the aorta have decreased pressure in the lower extremities or absence of femoral pulses.

The nurse is teaching a group of parents about eyes and eye concerns. The nurse tells these caregivers about a condition that occurs when unequal curvatures in the cornea bend the light rays in different directions and this causes images to be blurred. The condition the nurse is referring to is

Astigmatism

The nurse is preparing a toddler for a lumbar puncture. For this procedure, the nurse should place the child in which position? a) Lying prone, with the feet higher than the head b) Lying on one side, with the back curved c) Lying prone, with the neck flexed d) Sitting up, with the back straight

B Lumbar puncture involves placing a needle between the lumbar vertebrae into the subarachnoid space. For this procedure, the nurse should position the client on one side with the back curved because curving the back maximizes the space between the lumbar vertebrae, facilitating needle insertion. Prone and seated positions don't achieve maximum separation of the vertebrae.

The nurse and an adolescent are reviewing the adolescent's record of her headaches and activities surrounding them. Which of the following would the nurse identify as a possible trigger? a) Use of nonscented soap b) Drinking three cans of diet cola c) Swimming twice a week d) 11 p.m. bedtime; 6:30 a.m. wake-up

B Cola contains caffeine, which is an associated trigger. Intense activity, not regular exercise, may be a trigger. Odors, such as strong perfumes, may be a trigger. Changes in sleeping patterns may be a trigger.

Dexamethasone is often prescribed for the child who has sustained a severe head injury. Dexamethasone is a(n) a) antihistamine. b) steroid. c) anticonvulsant. d) diuretic.

B A steroid may be prescribed to reduce inflammation and pressure on vital centers.

The eyes of a 9-year-old who suffered a head injury are crossed. Besides checking ICP, which of the following interventions would be most important for the nurse to perform? a) Help the child cope with an altered appearance. b) Assess the child's level of consciousness. c) Monitor core body temperature. d) Pull up the side rails on the bed.

B Decreased level of consciousness is frequently the first sign of major neurologic problems after head trauma. While body temperature is an important indicator of infection, it is not a priority here. Preventing harm by setting the side rails is more important for a seizure patient. The child's eyes will correct themselves when ICP is reduced.

The nurse is discussing with a parent the difference between a breath-holding spell and a seizure. The nurse would be correct in telling the parent which of the following with regards to seizures? a) The patient is bradycardiac. b) Convulsive activity occurs. c) Cyanosis occurs at the onset of the seizure. d) The EEG is normal.

B During seizures convulsive activity is typically noted. During a breath-holding spell, the child is bradycardiac, cyanosis occurs at the onset, and the EEG is normal.

The nurse is educating the family of a 7-year-old epilepsy patient about care and safety for this child. Which of the following comments will be most valuable in helping the parent and the child cope? a) "If he is out of bed, the helmet's on the head." b) "Use this information to teach family and friends." c) "You'll always need a monitor in his room." d) "Bike riding and swimming are just too dangerous."

B Families need and want information they can share with relatives, childcare providers, and teachers. Wearing a helmet and having a monitor in the room are precautions that may need to be modified as the child matures. The boy may be able to bike ride and swim with proper precautions.

A child is diagnosed with bacterial meningitis. The nurse would suspect which abnormality of cerebrospinal fluid (CSF)? a) Elevated sugar b) Cloudy appearance c) Decreased leukocytes d) Decreased pressure

B In the CSF of clients diagnosed with bacterial meningitis, the pressure is elevated, the appearance is cloudy, and the leukocytes are elevated. A decreased sugar content is noted

The nurse is interviewing the caregivers of a child brought to the emergency unit. The caregiver states, "She has a history of seizures but this time it lasted more than 30 minutes and she just keeps having them." The most accurate description of this child's condition would be which of the following? a) The child's history indicates she has infantile seizures. b) The child is in status epilepticus. c) The child is having generalized seizures. d) The child may begin to have absence seizures every day.

B Status epilepticus is the term used to describe a seizure that lasts longer than 30 minutes or a series of seizures in which the child does not return to his or her previous normal level of consciousness. The child likely is having generalized seizures, but the most accurate description of what is happening is status epilepticus. With infantile spasms, muscle contractions are sudden, brief, symmetrical, and accompanied by rolling eyes. With absence seizures the child loses awareness and stares straight ahead but does not fall.

When assisting a child while she is having a tonic-clonic seizure, it would be important to a) turn the child onto her back and observe her. b) protect the child from hitting her arms against furniture. c) place a tongue blade between the child's teeth. d) restrain the child from all movement.

B protect the child from hitting her arms against furniture.

A nurse is assessing a 3-year-old child for possible bacterial meningitis. Which sign would indicate irritation of the meninges? a) Negative Kernig's sign b) Positive Kernig's sign c) Positive Homans' sign d) Negative Brudzinski's sign

B A positive Kernig's sign can indicate irritation of the meninges. A positive Brudzinski's sign also is indicative of the condition. A positive Homans' sign may indicate venous inflammation of the lower leg.

When assessing a neonate for seizures, which of the following would the nurse expect to find? Select all that apply. a) Tonic-clonic contractions b) Elevated blood pressure c) Ocular deviation d) Jitteriness e) Tachycardia

B C D E Neonatal seizures may be difficult to recognize but may be manifested by tremors, jitteriness, tachycardia and elevated blood pressure, and ocular deviation. Tonic-clonic contractions typically are more common in older children.

The mother of a 12-year-old with Reye syndrome approaches the nurse wanting to know how this happened to her child, saying, "I never give my kids aspirin!" What could the nurse say to begin educating the woman? a) "Aspirin in combination with the virus will make the brain swell and the liver fail." b) "Sometimes it's hard to tell what products may contain aspirin." c) "Do you think that maybe your child took aspirin on his own?" d) "Don't worry; you're in good hands. We have it under control now."

A child has been diagnosed with a basilar skull fracture. The nurse identifies ecchymosis behind the child's ear. This would be documented as:

Battle sign Two signs of basilar skull fracture include Battle sign (bruising or ecchymosis behind the ear) and "raccoon eyes" (blood leaking into the frontal sinuses causing an edematous and bruised periorbital area). Rhinorrhea is CSF leakage from the nose. Otorrhea is CSF leaking from the ear.

Which of the following would be included in the care of an infant in heart failure?

Begin formulas with increased calories. Explanation: Infants with heart failure need increased calories for growth. The infants are typically given smaller, more frequent feedings to decrease the amount given and to help conserve energy for feeding. They often times are given a higher-calorie formula. The infant should be placed in an upright position or in a car seat to increase oxygenation. The infant should not have any pressure on the diaphragm while in this position. Vomiting is a sign of digoxin toxicity and this should be considered before administering.

What finding is consistent with increased ICP in the child?

Bulging fontanel Children with increased ICP exhibit bulging fontanels. They typically have a decreased appetite, are restless, and have trouble sleeping.

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

C Keeping the child free of injury would be an appropriate nursing diagnosis. Surgery is not indicated for the child with meningitis, and the history of seizures does not impact the airway clearance. Growth and development issues are a concern but not likely delayed due to this diagnosis.

A 1-year-old has just undergone surgery to correct craniosynostosis. Which of the following comments is the best psychosocial intervention for the parents? a) "This only happens in 1 out of 2,000 births." b) "I'll be watching hemoglobin and hematocrit closely." c) "The surgery was successful. Do you have any questions?" d) "I told you yesterday there would be facial swelling."

C Often what parents need most is someone to listen to their concerns. Although this is a good time for education, let the parents adjust to their baby's appearance and adapt your teaching to their questions, comments, and knowledge level.

Signs of increased intracranial pressure for which you would assess are a) decreased level of consciousness, increased respiratory rate. b) numbness of fingers, decreased temperature. c) increased temperature, decreased respiratory rate. d) increased pulse rate, decreased blood pressure.

C Pressure on the vital-sign centers causes an elevated temperature and a decreased respiratory rate. Blood pressure increases; pulse decreases.

The nurse is preparing a toddler for a lumbar puncture. For this procedure, the nurse should place the child in which position? a) Sitting up, with the back straight b) Lying prone, with the feet higher than the head c) Lying on one side, with the back curved d) Lying prone, with the neck flexed

C Lumbar puncture involves placing a needle between the lumbar vertebrae into the subarachnoid space. For this procedure, the nurse should position the client on one side with the back curved because curving the back maximizes the space between the lumbar vertebrae, facilitating needle insertion. Prone and seated positions don't achieve maximum separation of the vertebrae.

During the physical assessment of a 2½-month-old infant, the nurse suspects the child may have hydrocephalus. Which of the following signs or symptoms was observed? a) Posterior fontanel is closed b) Vertical nystagmus c) Dramatic increase in head circumference d) Pupil of one eye dilated and reactive

Which nursing assessment data should be given the highest priority for a child with clinical findings related to meningitis? a) Occurrence of urine and fecal contamination b) Degree and extent of nuchal rigidity c) Signs of increased intracranial pressure (ICP) d) Onset and character of fever

C Assessment of fever and evaluation of nuchal rigidity are important aspects of care, but assessment for signs of increasing ICP should be the highest priority due to the life-threatening implications. Urinary and fecal incontinence can occur in a child who's ill from nearly any cause but doesn't pose a great danger to life.

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

Which nursing action should be included in the care plan to promote comfort in a 4-year-old child hospitalized with meningitis? a) Have the child's 2-year-old brother stay in the room b) Keep the lights on brightly so that he can see his mother c) Avoid making noise when in the child's room d) Rock the child frequently

C Meningeal irritation may cause seizures and heightens a child's sensitivity to all stimuli, including noise, lights, movement, and touch. Frequent rocking, presence of a younger sibling, and bright lights would increase stimulation.

The nurse is discussing with a parent the difference between a breath-holding spell and a seizure. The nurse would be correct in telling the parent which of the following with regards to seizures? a) The patient is bradycardiac. b) Cyanosis occurs at the onset of the seizure. c) Convulsive activity occurs. d) The EEG is normal.

C During seizures convulsive activity is typically noted. During a breath-holding spell, the child is bradycardiac, cyanosis occurs at the onset, and the EEG is normal.

A 4-year-old child is brought to the emergency department after being in a motor vehicle accident. The child experienced head trauma in the accident. When assessing the child, which will be the first change noted in the presence of increasing intercranial pressure?

Change in level of consciousness A change in the level of consciousness is the initial finding in the client who is experiencing an increase in intracranial pressure.

If the child is following a normal development process, visual acuity gradually increases from birth. What is most accurate regarding the age children develop 20/20 vision?

Children usually develop 20/20 vision by 5 years of age.

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 patient about the care of the eye?

Clean the discharge away from the inner to outer canthus.

When caring for a child that has just had a cardiac catheterization, which of the following would indicate a sign of hypotension?

Cold clammy skin and increased heart rate Explanation: Cold, clammy skin, increased heart rate, and dizziness are signs of hypotension that may be a complication after a cardiac catheterization. Decreased heart rate, syncope, and tachypnea would also be very concerning, but not necessarily a sign of hypotension.

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? a) Take vital signs every 4 hours b) Monitor temperature every 4 hours c) Encourage the parents to hold the child d) Decrease environmental stimulation

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

During the physical assessment of a 2½-month-old infant, the nurse suspects the child may have hydrocephalus. Which sign or symptom was observed?

Dramatic increase in head circumference A dramatic increase in head circumference is a symptom of hydrocephalus, suggesting that there is a build-up of fluid in the brain. Only one pupil that is dilated and reactive is a sign of an intracranial mass. Vertical nystagmus indicates brain stem dysfunction. A closed posterior fontanel would be frequently seen by this age.

In children with otitis media, a procedure known as a myringotomy may be performed. Which statement is most accurate regarding this procedure?

During this procedure, small tubes are inserted into the typmpanic membrane.

The care provider has ordered the drug furosemide (Lasix) to treat a child diagnosed with congestive heart failure. The nurse knows that this drug will be used to:

Eliminate excess fluids Explanation: Diuretics, such as furosemide (Lasix), thiazide diuretics, or spironolactone (Aldac tone), and fluid restriction in the acute stages of CHF help to eliminate excess fluids in the child with congestive heart failure. Vasodilators are used to dilate the blood vessels. Digoxin is used to improve the cardiac efficiency by slowing the heart rate and strengthening the cardiac contractility.

The nurse is teaching the family of a 6-year-old boy with allergic conjunctivitis how to minimize his exposure to allergens. What action would the nurse anticipate as being most difficult for the family to implement?

Encouraging the child to keep his hands away from his eyes.

The nurse is providing immediate postoperative care for a 3-month-old who had a cataract removed. Which intervention would be the priority?

Ensuring the protective eye patch is securely in place

The nurse is planning care for a school-age child with a black eye. Which outcome would be the most appropriate for this patient?

Evidence of bleeding will be reabsorbed within 1 to 3 weeks.

The nurse is using the pediatric Glasgow Coma Scale to assess a child's level of consciousness. What would the nurse assess? Select all that apply.

Eye opening Verbal response Motor response The pediatric Glasgow Coma Scale assesses level of consciousness using three parts: eye opening, verbal response, and motor response.

The nurse is assessing an infant for peripheral edema. Based on the nurse's knowledge, the nurse would expect edema to occur in which area first?

Face Explanation: In infants, peripheral edema occurs first in the face, then the presacral region, and then the extremities. Edema of the lower extremities is characteristic of right ventricular heart failure in older children.

The nurse is collecting data on a 5 year old child admitted with the diagnosis of congestive heart failure. Which of the following clinical manifestations would likely have been noted in the child with this diagnosis?

Failure to gain weight Explanation: In infants and older children, one of the first signs of CHF is tachycardia. Other signs of CHF often seen in the older child include failure to gain weight, weakness, fatigue, restlessness, irritability, and a pale, mottled, or cyanotic color. Rapid respirations or tachypnea, dyspnea, and coughing with bloody sputum also are seen. Edema and enlargement of the liver and heart may be present. Jerking movements indicate seizure activity. Scissoring of the legs is seen in cerebral palsy, and clubbing of the fingers is seen in cystic fibrosis.

During physical assessment of a 2-month-old infant, the nurse suspects the child may have a lesion on the brain stem. Which symptom was observed?

Horizontal nystagmus Horizontal nystagmus is a symptom of lesions on the brain stem. A sudden increase in head circumference is a symptom of hydrocephalus suggesting that there is a buildup of fluid in the brain. An intracranial mass would cause only one eye to be dilated and reactive. A closed posterior fontanel is not unusual at 2 months of age

On assessment immediately following cardiac surgery, which of the following conditions would you expect to find in an infant?

Hypothermia Explanation: Cardiac surgery is often performed under hypothermia to decrease the child's oxygen needs during surgery.

A nurse is reviewing blood work on a patient with a cyanotic heart defect. Which of the following results would most likely be seen in a patient experiencing polycythemia?

Increased RBC Explanation: Polycythemia can occur in patients with a cyanotic heart defect. The body tries to compensate for having low oxygen levels and produces more red blood cells (RBCs). This would cause an increased result on the lab tests. This problem does not affect the white blood cells (WBCs).

An 8-month-old has a ventricular septal defect. Which nursing diagnosis below would best apply?

Ineffective tissue perfusion related to inefficiency of the heart as a pump Explanation: A ventriculoseptal defect permits blood to flow across a septum, creating an ineffective pump.

A 6-year-old girl is diagnosed with pulmonary stenosis. The mother asks the nurse what the likely treatment for this condition will involve. The nurse should tell the mother which of the following?

Insertion of a catheter with an uninflated balloon tip into the affected valve, followed by inflation of the balloon to break up adhesions Explanation: Balloon angioplasty by way of cardiac catheterization is the procedure of choice for pulmonary stenosis. With this procedure, a catheter with an uninflated balloon at its tip is inserted and passed through the heart into the stenosed valve. As the balloon is inflated, it breaks valve adhesions and relieves the stenosis. The other answers refer to interventions related to patent ductus arteriosus, not pulmonary stenosis.

An 8-year-old boy comes to the emergency room with an eye injury after having a glass bottle shatter near his face. Which intervention should the nurse do first while assisting this client?

Instill a few drops of a topical anesthetic into the affected eye

An infant with poor feeding is suspected of having a congenital heart defect. The parents are asking why a chest x-ray is necessary in their infant. Which of the following is the best response from the nurse?

It will determine if the heart is enlarged. Explanation: Chest x-rays are performed to see if the heart is enlarged. This will determine if the heart muscle is increasing in size. Disturbances in heart conduction are detected by an EKG. Visualizing where blood is being shunted is through the echocardiogram. The image used to clarify the structures of the heart is the MRI.

A child returns to the clinic after an episode of otitis externa, which has resolved. What would the nurse emphasize as the priority for preventing future episodes?

Keeping ear canals dry,

Absence seizures are marked by what clinical manifestation?

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

The nurse is preparing a toddler for a lumbar puncture. For this procedure, the nurse should place the child in which position?

Lying on one side, with the back curved Lumbar puncture involves placing a needle between the lumbar vertebrae into the subarachnoid space. For this procedure, the nurse should position the client on one side with the back curved because curving the back maximizes the space between the lumbar vertebrae, facilitating needle insertion. Prone and seated positions don't achieve maximum separation of the vertebrae.

When caring for a child with Kawasaki Disease, the nurse would know which of the following?

Management includes administration of aspirin and IVIG. Explanation: Kawasaki disease is managed with IVIG and aspirin to prevent cardiac complications. Joint pain is not necessarily a permanent problem associated with Kawasaki disease. Antibiotics and steroid creams are not used for this disorder.

The nurse is conducting a physical examination of a 7-year-old girl prior to a cardiac catheterization. The nurse knows to pay particular attention to assessing the child's pedal pulses. How can the nurse best facilitate their assessment after the procedure?

Mark the child's pedal pulses with an indelible marker, then document Explanation: The nurse should pay particular attention to assessing the child's peripheral pulses, including pedal pulses. Using an indelible pen, the nurse should mark the location of the child's pedal pulses as well as document the location and quality in the child's medical records.

The nurse is taking a health history for a 9-year-old with conjunctivitis. Which finding would suggest that this is allergic conjunctivitis?

Recently helped clean the basement

The nurse caring for an infant with craniosynostosis, specifically positional plagiocephaly, should prioritize which activity?

Moving the infant's head every 2 hours Positional plagiocephaly can occur because the infant's head is allowed to stay in one position for too long. Because the bones of the skull are soft and moldable, they can become flattened if the head is allowed to remain in the same position for a long period of time. Massaging the scalp will not affect the skull. Measuring the intake and output is important but has no effect on the skull bones. Small feedings are indicated whenever an infant has increased intracranial pressure, but feeding an infant each time he fusses is inappropriate care.

A nurse is administering digoxin to a 3-year-old. Which of the following would be a reason to hold the dose of digoxin?

Nausea and vomiting Explanation: Nausea and vomiting are signs of digoxin toxicity. The other symptoms listed here are not necessarily signs of a digoxin toxicity.

A nurse suspects a child is experiencing cardiac tamponade after heart surgery. Which of the following would be the priority nursing intervention?

Notify the doctor immediately. Explanation: The nurse would notify the doctor immediately. Cardiac tamponade is a medical emergency and should be addressed. The child can die if intervention is postponed. It would not be appropriate to perform any interventions until confirming that this is the actual diagnosis.

The nurse is assessing a child following a head injury sustained in a bicycle accident. The child falls asleep frequently unless the parents are talking to the child or the nurse is asking the child questions. How should the nurse document the child's level of consciousness?

Obtunded Obtunded is defined as a state in which the child has limited responses to the environment and falls asleep unless stimulation is provided. Fully conscious describes a child who has no neurological changes. Stupor exists when the child only responds to vigorous stimulation. Decreased level of consciousness is a vague term that does not describe the assessment findings.

When assessing a neonate for seizures, what would the nurse expect to find? Select all that apply.

Ocular deviation Elevated blood pressure Jitteriness Tachycardia Neonatal seizures may be difficult to recognize but may be manifested by tremors, jitteriness, tachycardia and elevated blood pressure, and ocular deviation. Tonic-clonic contractions typically are more common in older children.

A nurse demonstrates understanding of the various levels of consciousness as they progress from most alert to least alert. Place the levels of consciousness in the order that reflects this progression.

Oriented to person, place, and time Disorientation Obtundation Stupor Coma Levels of consciousness in order from most alert to least alert are orientated to person, place, and time (full consciousness); confusion (disorientation); obtundation; stupor; and finally coma

Which of the following would be most important to implement for an infant who develops heart failure?

Placing her in a semi-Fowler's position Explanation: Placing an infant with heart failure in a semi-Fowler's position reduces the pressure of abdominal contents against the chest and gives the heart the opportunity to function more effectively.

When reviewing the record of a child with tetralogy of Fallot, which of the following would you expect to discover?

Polycythemia Explanation: Children who cannot oxygenate red cells well often produce excess red blood cells or develop polycythemia.

The nurse is caring for a preschool-aged child diagnosed with acute otitis media. Which intervention should be a priority for the nurse?

Relieving pain

The nurse is preparing a care plan for a child who has a seizure disorder. The child experiences tonic-clonic seizures. Which nursing diagnosis will the nurse identify as having the highest priority?

Risk for injury A seizure disorder is caused by a disruption in the electrical impulses in the brain. Tonic-clonic seizures is the most dramatic seizure disorder. It is characterized by a loss of consciousness, along with the entire body experiencing tonic contractions followed by rhythmic clonic contractions alternating with relaxation of all muscle groups. Cyanosis may be noted due to apnea, and saliva may collect in the mouth due to inability to swallow. All of these symptoms would make Risk for injury the highest priority.

In caring for the child with meningitis, the nurse recognizes that which nursing diagnosis would be the most important to include in this child's plan of care?

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

Which nursing assessment data should be given the highest priority for a child with clinical findings related to meningitis?

Signs of increased intracranial pressure (ICP) Assessment of fever and evaluation of nuchal rigidity are important aspects of care, but assessment for signs of increasing ICP should be the highest priority due to the life-threatening implications. Urinary and fecal incontinence can occur in a child who's ill from nearly any cause but doesn't pose a great danger to life.

An infant girl is prescribed digoxin. You would teach her parents that the action of this drug is to

Slow and strengthen her heartbeat. Explanation: Digoxin is a cardiac glycoside that slows and strengthens the heartbeat.

A group of students are reviewing the various causes of bacterial conjunctivitis in children. The students demonstrate understanding of this condition when they identify what as the most common cause?

Staphylococcus aureus

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

Tachycardia Explanation: If a child were experiencing heart failure, the most likely sign of this would be tachycardia, not bradycardia. The child may also experience hepatomegaly or oliguria, but not splenomegaly or polyuria.

When caring for a child with a congenital heart defect, which assessment finding may be a sign the child is experiencing heart failure?

Tachycardia Explanation: Tachycardia is one of the signs of heart failure. Bradycardia, inability to sweat, and splenomegaly are not necessarily signs of heart failure.

The nurse is providing education to the parents of a female toddler with hydrocephalus who has just had a shunt placed. Which statement is the best to make during a teaching session?

Tell me your concerns about your child's shunt. Always start by assessing the family's knowledge. Ask them what they feel they need to know. Knowing when to call the doctor and how to raise the child's head are important, but they might not be listening if they have another question on their minds. "Autoregulation" is too technical—base information on the parents' level of understanding.

A nurse is providing education to a family about cardiac catheterization. Which of the following would be included in the education?

The catheter will be placed in the femoral artery. Explanation: The femoral artery is the correct placement of the cardiac catheter. The child will need to lie still for several hours after the procedure. The procedure is usually postponed if the child has a fever.

A mother asks the nurse if there is any way to prevent acute otitis media. What would the nurse state to the mother?

The frequency of otitis media is reduced in breast-fed infants.

A nursing instructor is preparing for a class about the structural and functional differences in the cardiovascular system of infants and children as compared to adults. Which of the following would the instructor include in the class discussion?

The heart's apex is higher in the chest in children younger than the age of 7 years. Explanation: In infants and children younger than age 7 years, the heart lies more horizontally, resulting in the apex lying higher in the chest. Right ventricular function predominates at birth, and over the first few months of life, left ventricular function becomes dominant. A normal infant's blood pressure is about 80/40 mm Hg and increases over time to adult levels. Between the ages of 1 and 6 years, the heart is four times the birth size; between 6 and 12 years of age, the heart is 10 times its birth size.

The nurse is assessing a 5-month-old infant. What would cause the nurse to be concerned about a possible visual impairment?

The infant does not imitate facial expressions.

When examining a child with congenital heart disease, an organ in the upper right quadrant of the abdomen can be palpated at 4 cm below the rib cage. Which of the following would most likely explain this assessment finding?

The liver increases in right-sided heart failure. Explanation: The liver increases in size due to right-sided heart failure. This is one of the cardinal signs of congestive heart failure. The spleen is in the upper left quadrant of the abdomen and would increase in size under certain circumstances, but this is asking for the upper right quadrant information. There are certain medications that can affect the liver, but this would not be the most likely reason for hepatomegaly.

A parent asks about the risk of a congenital heart defect being passed on to another child since they already have one child that has it, but no one else in the family has one. What is the best response by the nurse?

There is a less than 7% chance a sibling would inherit a heart defect. Explanation: The risk to subsequent siblings of a child with CHD is approximately 2% to 6% so genetics can play a role in the child having a cardiac defect

When caring for a child who has a history of seizures, which nursing interventions would be appropriate? Select all that apply.

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

The nurse is caring for an 8-year-old hospitalized child who is visually impaired. Which nursing intervention would be the highest priority in helping this child reduce anxiety related to hospitalization?

The nurse talks to the child when entering and leaving the room.

A nurse is caring for a child that just had open-heart surgery and the parents are asking why there are wires coming out of the chest of the infant. What is the best response by the nurse?

These wires are connected to the heart and will detect if your child's heart gets out of rhythm. Explanation: The wires may be connected to a pacemaker. Connection to the temporary pacemaker is usually until the child is out of danger for arrhythmia.

Parents are told their infant has a hypoplastic left heart. What is the type of education that would be included for this family?

This is a problem where the left side of the heart did not develop properly. Explanation: This is a problem where the left side of the heart did not develop properly. There is a three-step palliative surgery that can be implemented or the child will need a heart transplant.

The nurse is educating the parents of a 7-year-old girl with epilepsy about managing treatment of the disorder at home. Which intervention is most effective for eliminating breakthrough seizures?

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

The outpatient care clinic receives the 2020 National Health Goals that focus on prevention, early detection, treatment, and rehabilitation of vision problems. What should the nurse remind each patient to do to ensure eye health?

Use personal protective eyewear during recreation and hazardous situations.

The nurse is caring for a 3-year-old boy who is experiencing seizure activity. Which diagnostic test will determine the seizure area in the brain?

Video electroencephalogram A video electroencephalogram can determine the precise localization of the seizure area in the brain. Cerebral angiography is used to diagnose vessel defects or space-occupying lesions. Lumbar puncture is used to diagnose hemorrhage, infection, or obstruction in the spinal canal. Computed tomography is used to diagnose congenital abnormalities such as neural tube defects.

The nurse is educating the parents of a 5-year-old girl with infectious conjunctivitis about the disorder. Which information is most important to provide to prevent the spread of the disorder?

Washing hands frequently

Infants with congenital heart disease should not be allowed to become dehydrated because this makes them prone to

cerebrovascular accident. Explanation: Children who have polycythemia from cardiovascular disease can develop thrombi if they become dehydrated.

When a child is scheduled for a cardiac catheterization, an important health teaching point for parents is that the

child will return with a bulky pressure dressing over the catheter insertion area. Explanation: Cardiac catheterization is typically performed with the child awake but using conscious sedation. A dressing will be placed on the catheter insertion site.

The nurse has developed a nursing plan for the care of a 6-year-old girl with congenital hydrocephalus whose shunt has become infected. The most important discharge teaching point for this family is:

ensuring the parents know how to properly give antibiotics. Educating parents how to properly give the antibiotics would be the priority intervention because the child's shunt has become infected. Maintaining cerebral perfusion is important for a child with hydrocephalus, but the priority intervention for the parents at this time is in regards to the infection. Establishing seizure precautions is an intervention for a child with a seizure disorder. Encouraging development of motor skills would be appropriate for a microcephalic child.

The most effective approach to prepare a school-aged boy for a myringotomy procedure is to

explain the procedure to the child using puppets.

i am not sure

idk

The nurse is educating the parents of a 4-year-old boy with strabismus. Teaching for the parents would include the

importance of patching as prescribed.

Any individual taking phenobarbital for a seizure disorder should be taught:

never to discontinue the drug abruptly. Phenobarbital should always be tapered, not stopped abruptly, or seizures from the child&'s dependency on the drug can result.

The nurse is implementing the plan of care for a child with acute rheumatic fever. Which of the following would the nurse expect to administer if ordered? Select all that apply.

• Nonsteroidal anti-inflammatory drugs • Penicillin • Corticosteroids Explanation: A full 10-day course of penicillin or equivalent is used. Corticosteroids are used as part of the treatment for acute rheumatic fever. Nonsteroidal anti-inflammatory drugs are used as part of the treatment for acute rheumatic fever. Digoxin is used to treat heart failure, atrial fibrillation, atrial flutter, and supraventricular tachycardia. Intravenous immunoglobulin is used to treat Kawasaki disease.

The nurse is reviewing the health history and physical examination of a child diagnosed with heart failure. Which of the following would the nurse expect to find? Select all that apply.

• Shortness of breath when playing • Crackles on lung auscultation • Tiring easily when eating Correct Explanation: Manifestations of heart failure include difficulty feeding or eating or becoming tired easily when feeding or eating, shortness of breath with exercise intolerance, crackles and wheezes on lung auscultation, tachycardia, and hypotension.

The pediatric nurse has digoxin ordered for each of the five children. The nurse will withhold digoxin for which of the following children? Select all that apply.

• The 16-year-old child has a heart rate of 54 beats per minute • The 5-year-old child has developed vomiting, diarrhea and is difficult to arouse • The 2-year-old child has a digoxin level of 2.4 ng/mL from a blood draw this morning Correct Explanation: The nurse should not administer digoxin to children with the following issues: The adolescent with an apical pulse under 60 beats per minute, the child with a digoxin level above 2 ng/mL, and the child who exhibiting signs of digoxin toxicity

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