exam 2 prep u peds

The clinic nurse is assessing a 12-year-old client. The client reports having dandruff and asks the nurse what can be done for it. Which response by the nurse is best? "Wash your hair vigorously twice a day for one week." "Wash your hair with a gentle shampoo daily." "Apply warm baby oil to your scalp once a day for a few days." "I will let your primary health care provider know you need prescription shampoo."

ANSWER In the older child and adolescent, a gentle shampoo should be used daily to control scaling caused by dandruff. A medicated shampoo may be indicated if shampooing with a gentle formula shampoo does not provide relief. Washing hair vigorously twice a day is not recommended. Warm baby oil is recommended for infants with cradle cap (seborrhea).

The nurse is discussing acne vulgaris with a group of adolescents. The teenagers make the following statements regarding the topic. Which statement is the most accurate regarding acne vulgaris? "My next door neighbor told me that acne was caused by a fungus." "My mom says I have acne because I eat too much chocolate." "Sometimes I get acne when I use my sister's makeup." "There is a new immunization that you can get to keep from having acne."

ANSWER Irritation and irritating substances, such as vigorous scrubbing and cosmetics with a greasy base, can cause acne vulgaris. Increased hormone levels, hereditary factors, and anaerobic bacteria can cause acne vulgaris as well. Eating chocolate and fatty foods does not cause acne, but a well-balanced, nutritious diet does promote healing.

The nurse is caring for a 13-year-old client who asks about acne prevention. Which would be most appropriate for the nurse to suggest? Wash the face twice a day with a mild soap then pat dry. Avoid chocolate and greasy foods. Pop the pimples to make them go away. Wash the face with abrasive soaps three times a day.

ANSWER The face should be washed twice per day with a mild soap and lukewarm water then patted dry. Avoiding certain foods will not prevent acne. Popping pimples does not make acne go away and can cause scarring. Washing the face with abrasive soaps can aggravate the acne and cause more flare-ups.

A child is hospitalized with a diagnosis of severe cellulitis. The nurse is preparing the family for discharge. Which instruction is most important for the nurse to convey to the family? Complete the prescribed antibiotics. Monitor for signs of worsening condition. Perform proper hand hygiene. Keep follow-up appointments.

ANSWER The instruction that is most important for the nurse to convey is to complete the prescribed course of antibiotics. Many times, once the child feels better, the parent stops the medication; this action, though, can cause a rebound infection. Instructing the family to keep follow-up appointments, perform good hand hygiene, and look out for signs of worsening condition are all appropriate, but the most important instruction is to make sure the child completes the course of antibiotics.

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 Treating the child as though she did not have epilepsy Instructing her teacher how to respond to a seizure Placing the child on her side on the floor

ANSWER A 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.

A nurse is assessing a child with a tick-borne disease. What finding would indicate to the nurse that the child has developed ehrlichiosis and not Rocky Mountain spotted fever? fever absence of rash headache malaise

ANSWER B Both Rocky Mountain spotted fever and ehrlichiosis are manifested by fever, headache, and malaise. However, there is rarely a rash with ehrlichiosis, which helps to differentiate it from Rocky Mountain spotted fever.

What is the best technique to perform an assessment of the skin? Skin assessment involves inspection and palpation in a room with yellow walls and bright white light. Skin assessment involves inspection and palpation in a room with natural daylight. Skin assessment involves inspection and palpation using latex gloves. Skin assessment involves inspection and palpation using vinyl gloves.

ANSWER

A nurse is providing care to an infant who is admitted with burns over the face, neck and chest. The nurse identifies which goal as priority for planning the infant's care? Airway remains patent. Fluid balance is maintained. Wounds remain infection-free. Pain is at a tolerable level.

ANSWER Airway remains patent

The appearance of which hallmark clinical manifestation occurs in measles? Conjunctivitis Cough Fever Koplik spots

ANSWER D The hallmark symptom of measles is the appearance of Koplik spots. These occur a few days before the outbreak of the rash. They are classic in appearance, described as a red ring around white dots. They occur on the buccal mucosa generally around the first and second molars. Measles has fever, conjunctivitis, and a cough as prodromal symptoms, but these are not definitive for measles as they can occur with many other illnesses.

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." "If he is out of bed, the helmet's on the head." "You'll always need a monitor in his room." "Bike riding and swimming are just too dangerous."

Answer Families need and want information they can share with relatives, child care 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 child may be able to bike ride and swim with proper precautions.

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? increase in heart rate decline in respiratory rate change in level of consciousness reduction in heart rate

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

A 12-year-old child has suffered a concussion after being in an automobile accident. What will be included in the plan of care/treatment? Select all that apply. observation of level of consciousness administration of intravenous fluids strict monitoring of intake and output assessment of serum electrolyte levels rest

Answer A concussion is a common head injury. The injury is caused by a bump, blow, jolt, jarring, or shaking and results in disruption or malfunction of the electrical activities of the brain. Treatment includes rest and monitoring for neurologic changes that could indicate a more severe injury.

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." "Has your physician led you to believe that the prognosis is good for your baby?" "Some babies live for several months. Let's hope this is true for your baby." "We will all hope for the best that your baby will be just fine."

Answer 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.

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) Onset and character of fever Degree and extent of nuchal rigidity Occurrence of urine and fecal contamination

Answer 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 9-year-old client who suffered a head injury has strabismus. The nurse assesses the client for intracranial pressure (ICP). Which additional intervention is most important for the nurse to perform? Assess the level of consciousness (LOC). Place the child on fall precaution. Notify the primary health care provider. Place a patch over the client's affected eye.

Answer Decreased LOC is frequently the first sign of a major neurologic problem after head trauma. The nurse would assess the client's LOC before notifying the health care provider. The child may need to be placed on fall precaution, depending on the results of the assessment. The child's eyes will correct themselves when the ICP is reduced; therefore, an eye patch is not necessary.

A child is diagnosed with scarlet fever. History reveals that the child has no known drug allergies. When preparing the child's plan of care, the nurse would anticipate administering which agent as the drug of choice? trimethoprim-sulfamethoxazole clarithromycin penicillin V erythromycin

Answer Penicillin V is the antibiotic of choice. In those sensitive to penicillin, erythromycin may be used. Trimethoprim-sulfamethoxazole and clarithromycin are not used.

The nurse is taking a health history for an 8-year-old boy who is hospitalized. Which is a risk factor for sepsis in a hospitalized child? use of immunosuppression drugs lack of juvenile immunizations resuscitation or invasive procedures maternal infection or fever

Answer a Answer: bThe use of immunosuppression drugs is a risk factor for the hospitalized child. Maternal infection or fever and resuscitation or invasive procedures are sepsis risk factors related to pregnancy and labor. Lack of juvenile immunizations is a risk factor affecting the overall health of the child but does not impact the chance of sepsis.

The nurse knows that the heads of infants and toddlers are large in proportion to their bodies, placing them at risk for what problem? positional plagiocephaly congenital hydrocephalus head trauma intracranial hemorrhaging

answer C 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 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. padding for side rails smelling salts oxygen gauge and tubing tongue blade suction at bedside

Answer 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.

The nurse and an adolescent are reviewing the adolescent's record of her headaches and activities surrounding them. What activity would the nurse identify as a possible trigger? 11 p.m. bedtime; 6:30 a.m. wake-up use of nonaccented soap swimming twice a week drinking three cans of diet cola

Answer 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.

Which child will the nurse identify as at greatest risk for developing a urinary tract infection? a 2-year-old male with otitis media a 6-month-old breastfed female a 1-year-old formula-fed male an 8-month-old bottle-fed female with HIV

answer D Factors that make an individual more prone to a urinary tract infection include young age, female gender, and immunosuppression. Infants who are formula-fed are at greater risk than infants who are breastfed. To determine the child at greatest risk, the nurse should count risk factors and determine which child has the most risk factors.

The nurse admits a child who has sustained a severe burn. The child's immunizations are up to date. Which immunization would the child most likely be given at this time? tetanus toxoid vaccine hepatitis B vaccine Haemophilus influenzae type B vaccine hepatitis A vaccine

ANSWER

A child is admitted to the acute care facility with a burn injury. The nurse would check the child's immunization status, specifically for which of the following? meningitis pertussis diphtheria tetanus

ANSWER Tetanus For any burn, check the child's tetanus immunization status on admission and ensure that tetanus toxoid is given if the child's immunizations are not up to date, because anaerobic and aerobic bacteria can grow at the interface between burned and healthy tissue. Pertussis, diphtheria and meningitis are not important immunizations to check for with a burn patient.

The nurse has completed client teaching with a 16-year-old female who has been prescribed isotretinoin for cystic acne. Which statements indicate learning has occurred? Select all that apply. "This is not a drug to be used for all forms of acne. My sister has minor acne so I told her this wasn't for her." "It's important I get my CBC blood test when my doctor orders it." "As long as I use two forms of birth control I don't need to have monthly pregnancy testing." "If I am sexually active I need to let my doctor know." "I am young so I won't need to have the liver tests the pamphlet suggests."

ANSWER • "If I am sexually active I need to let my doctor know."• "This is not a drug to be used for all forms of acne. My sister has minor acne so I told her this wasn't for her."• "It's important I get my CBC blood test when my doctor orders it. ---"Accutane (isotretinoin) is a powerful medication used for severe forms of acne and cystic acne when other treatment methods are not effective. Sexual activity should be reported to the physician. Some physicians may order monthly pregnancy tests even if the client says she is not sexually active because of the risk of birth defects to a fetus. No matter what form of birth control is used, pregnancy is possible, so monthly pregnancy tests are still necessary. Liver function tests are important regardless of age because of the side effects of the medication. Any labs ordered, such as the CBC, by the physician to monitor the medication's side effects should be obtained

The nurse is conducting a physical examination of a boy with erythema multiforme. Which assessment finding should the nurse expect? superficial tan or hypopigmented oval-shaped scaly lesions especially on upper back and chest and proximal arms thick or flaky/greasy yellow scales silvery or yellow-white scale plaques and sharply demarcated borders

ANSWER Erythema multiforme typically manifests in lesions over the hands and feet, and extensor surfaces of the extremities with spread to the trunk. Thick or flaky/greasy yellow scales are signs of seborrhea. Silvery or yellow-white scale plaques and sharply demarcated borders define psoriasis. Superficial tan or hypopigmented oval-shaped scaly lesions, especially on the upper back and chest and proximal arms, are indicative of tinea versicolor.

The nurse is caring for a 2-year-old boy with a burn. What finding would warrant referral to a burn unit? a chemical burn a superficial or first-degree burn on the hand a superficial or first-degree burn on the chest a superficial or first-degree burn on the upper arm

ANSWER A

The nurse is doing an in-service training on clinical manifestations seen in communicable diseases. Which skin condition best describes pustule? redness of the skin produced by congestion of the capillaries small, circumscribed, solid elevation of the skin discolored skin spot not elevated at the surface small elevation of epidermis filled with a viscous fluid

ANSWER D A pustule is a small elevation of epidermis filled with pus.

chapter 37

Chapter 37

Chapter 38

Chapter 38

CHAPTER 45

Chapter 45

An adolescent is prescribed isotretinoin. Which statement indicates that the adolescent understands the necessary precautions associated with this drug? "I have to make sure that I do not become pregnant while taking this drug." "This drug can affect my lungs so I need a chest radiograph done first." "I'm going to have to have a blood count done every couple of months." "The drug might cause staining of my clothing."

ANSWER a

Which of these age groups has the highest actual rate of death from drowning? infants preschool children school-aged children toddlers

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

An infant has presented at the clinic with impetigo. Which organism usually causes impetigo in infants? Escherichia coli Methicillin-resistant Staphylococcus aureus (MRSA) Group A beta hemolytic strep Staphylococcus aureus

answer D Staphylococcus aureus is the most common cause of impetigo in infants. MRSA is a hospital-associated infection (HAI), group A beta hemolytic strep is seen in older children, and Escherichia coli is not frequently associated with impetigo.

What accurately depicts the hemodynamic changes that occur in the body within the first 24 to 48 hours after a burn? Hematocrit increases and white blood cell (WBC) count decreases. Hematocrit and white blood cell (WBC) counts decrease. Hemoglobin and white blood cell (WBC) counts decrease. Hematocrit and white blood cell (WBC) counts increase.

answer d In the first 24 to 48 hours after a burn, the hematocrit will often be elevated secondary to fluid loss and the WBC count may also be elevated as an acute-phase reaction, which later could indicate infection.

The nurse caring for a child with a skin allergy recognizes that the highest priority in the treatment for skin allergies is aimed at: managing pain and discomfort. reducing swelling and relieving itching. regulating skin and body temperature. controlling nausea and vomiting.

ANSWER Reducing swelling and relieving itching CorrectExplanation:Treatment for skin allergies is aimed at reducing the swelling and relieving the itching. With swelling in various parts of the body, the child may have pain, nausea and vomiting, but reducing the swelling would prevent those symptoms from occurring.

An adolescent girl is going to be treated for a severe case of acne vulgaris. A pregnancy test should be done prior to the adolescent starting treatment with: tretinoin. isotretinoin. erythromycin. benzoyl peroxide.

ANSWER

A chief danger of scarlet fever is that children may develop:

Acute glomerulonephritis

A child has an order for an erythrocyte sedimentation rate (ESR). The child's mother asks what the purpose of the test is. What is the best response by the nurse? "This is a test to determine if your child has a skin infection." "This test will tell if your child has an infection or inflammation somewhere in their body." "This test will tell if your child has a fungus somewhere in their body." "This test will tell if your child has allergies."

ANSWER

A nurse is assessing a neonate with sepsis. The nurse understands that most commonly the cause involves: enterovirus. protozoa. herpes virus. bacteria.

ANSWER D Neonatal sepsis can be caused by viruses such as herpes simplex or enteroviruses and by protozoa (e.g., oxoplasma gondii). However, bacteria are typically the culprits.

The mother of a 10-year-old child diagnosed with rubella asks what can be done to help her child feel better during her illness. What information can be provided? Range of motion to prevent contractures. Antibiotic therapy may be initiated. Encourage rest and relaxation. Antiviral medications can be prescribed.

Answer C

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. motor response fontanels (fontanelles) eye opening verbal response posture

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

The nurse provides education to the parent of an infant being treated for hydrocephalus with a ventriculoperitoneal (VP) shunt. Which statement by the parent indicates the need for further instruction? "I will watch my baby for irritability and difficulty feeding." "The VP shunt will help drain fluid from my baby's brain." "This shunt is the only surgery my baby will need." "My baby's cerebrospinal fluid is increasing intracranial pressure."

Answer C Hydrocephalus 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 subsequently occur. A VP shunt can be used to drain excess CSF, but it will need to be replaced as the child grows, requiring shunt revision surgery at various times during the client's life. The parent should be taught to monitor for signs and symptoms of increased ICP, which include irritability and vomiting. Increased ICP indicates the shunt is not functioning properly.

The client is scheduled to have potassium hydroxide testing performed. What will be needed to complete this test? a blood specimen a urine specimen skin scrapings a strand of hair with the root attached

answer Potassium hydroxide (KOH) testing is done to assess for the presence of a fungal infection. Skin scrapings are placed on a microscope slide and a drop of KOH 20% drop is added.

The nurse is providing teaching to the parents of a child with varicella. Which statement indicates that the parents have understood the instructions? "If he has a fever, we can give him some aspirin." "The lesions should eventually form soft crusts that drain." "We need to make sure that he washes his hands frequently." "We should apply alcohol to the lesions every four hours."

answer The child with varicella needs to wash his hands frequently with antibacterial soap to reduce bacterial colonization. A cool bath with soothing colloidal oatmeal may help the skin discomfort. Alcohol would be too drying to the skin. Acetaminophen, not aspirin, should be used to reduce fever. The lesions should eventually crust over. Soft crusts with drainage may suggest an infection.

The camp nurse is caring for a child who was bitten on the leg by a dangerous spider. The child is being taken to a health care provider. What is the most appropriate action for the nurse to do with this child? Administer pain medication. Apply ice to the affected area. Splint the leg. Briskly scrub the site.

ANSWER

The nurse is evaluating the parents' understanding of atopic dermatitis. Which statement shows their understanding? "Hydrocortisone cream may lead to kidney disease." "Atopic dermatitis follows a streptococcal infection." "Flare-ups of lesions are not uncommon following therapy." "Atopic dermatitis turns to asthma later in life."

ANSWER

A nurse is caring for a child with a wasp sting. Which nursing intervention is a priority? Cleanse wound with mild soap and water. Remove jewelry or restrictive clothing. Administer diphenhydramine per protocol. Apply ice intermittently.

ANSWER The nurse should administer diphenhydramine as soon as possible after the sting in an attempt to minimize a reaction. The other actions are important for an insect sting, but the priority intervention is to administer diphenhydramine.

A nurse is providing care to a 3-year-old child hospitalized with second-degree (partial-thickness) and deep partial-thickness burns to the dorsal portion of both legs. The nurse is preparing to change the child's dressings. Which action(s) should the nurse take to elicit the child's cooperation in the dressing change? Select all that apply. Allow the child to decide which leg's dressing to change first. Encourage the parent to hold the child's hand during the dressing change. Tell the child to watch television while the dressing is changed. Permit the child to choose a method of distraction. Have the parent instruct the child to cooperate with the nurse.

ANSWER Infantile seborrheic dermatitis usually responds well to cleansing the scalp with a mild shampoo. The thick, scaling lesions on the child's scalp can be treated by applying baby oil, salicylic acid in mineral oil, or a corticosteroid gel on the scalp for 10 to 15 minutes. The area is gently massaged with a soft toothbrush; then the scales can be rinsed away. A fine-toothed comb helps rid the hair of scale debris. Antiseborrheic shampoo is not recommended for infants. Accusing a parent of poor hygiene is inappropriate. Infantile seborrheic dermatitis is not a result of poor hygiene.

A 15-year-old boy visits his primary care physician's office with fever, headache, and malaise, along with complaints of pain on chewing and pain in the jawline just in front of the ear lobe. The boy asks his mother to leave the exam room for a minute and then tells the nurse that he is also experiencing testicular pain and swelling. The nurse recognizes that this client most likely has which condition? Herpes zoster Infectious mononucleosis Poliomyelitis Mumps

ANSWER Initial symptoms of mumps include fever, headache, anorexia, and malaise. Within 24 hours, pain on chewing and an "earache" occurs. When the child points to the site of the earache, however, he points to the jawline just in front of the ear lobe, the site of the parotid gland. By the next day, the gland appears swollen and feels tender; the ear becomes displaced upward and backward. Boys may also develop testicular pain and swelling (orchitis). None of the other conditions listed matches the symptoms indicated.

The nurse is providing teaching on ways to maintain skin integrity and prevent infection for the parents of a boy with atopic dermatitis. Which response indicates a need for further teaching? "We should avoid using petroleum jelly." "We should keep his fingernails short and clean." "We should avoid tight clothing and heat." "We need to develop ways to prevent him from scratching."

ANSWER It is important to apply moisture multiple times throughout the day. Petroleum jelly is a recommended moisturizer that is inexpensive and readily available. The other statements are correct.

An adolescent with tinea versicolor is admitted for treatment of the disorder. Which nursing diagnosis will the nurse identify as having the highest priority for this client? Risk for fluid volume deficit Pain Altered nutrition Disturbed body image

ANSWER Tinea versicolor is a superficial tan or hypopigmented oval scaly lesions, especially on upper back and chest and proximal arms. It may take several months for pigmentation to return to normal; therefore, disturbed body image is going to be a high priority for an adolescent client.

An adolescent is diagnosed with psoriasis. After speaking with the nurse about treatment options suggested by the primary health care provider, the adolescent states, "Since ultraviolet rays help, I am going to buy a tanning package so I can tan year round." How will the nurse respond? "I do not think the health care provider meant for you to tan year round. Is that exactly what your health care provider said to you?" "Be sure to not get burned while you are tanning. Sunburns can significantly increase your chances of getting skin cancer." "I know it must be tempting, especially at your age. However, please understand that a tanning salon is not a good option for your health." "Year round tanning is not what your health care provider intended. Tanning puts you at high risk for skin cancer and other problems."

ANSWER Acknowledging that ultraviolet therapy is an option while clarifying what is meant by ultraviolet therapy and the risks of tanning year round addresses all concerns. Asking if that is what the doctor said may lead the adolescent to think year-round tanning is a viable option. Advising the adolescent to not get burned is giving approval for tanning. Simply telling the adolescent it is not a good option will be ineffective.

The nurse is interviewing the mother of a 6-month-old being seen at a well-child visit. The mother reports she has used an over-the-counter topical ointment intended for adults on her child for a skin rash. What is the most appropriate response by the nurse? "Children have thin skin and can absorb medications differently than adults." "How often do you use this medication?" "Why did you do that instead of contacting your doctor?" "This is dangerous so please do not do this again."

ANSWER Children have thinner skin than adults. They will absorb topical medications more rapidly than adults. Medications concentrated for adults should not be used on children. It is important to explain this to the parent. It is confrontational to tell her this is dangerous or to tell her to contact the physician. The frequency of use is information that should be obtained but the education is most important in this scenario.

The nurse is conducting a physical examination of a boy with erythema multiforme. Which assessment finding should the nurse expect? silvery or yellow-white scale plaques and sharply demarcated borders lesions over the hands and feet, and extensor surfaces of the extremities with spread to the trunk thick or flaky/greasy yellow scales superficial tan or hypopigmented oval-shaped scaly lesions especially on upper back and chest and proximal arms

ANSWER Erythema multiforme typically manifests in lesions over the hands and feet, and extensor surfaces of the extremities with spread to the trunk. Thick or flaky/greasy yellow scales are signs of seborrhea. Silvery or yellow-white scale plaques and sharply demarcated borders define psoriasis. Superficial tan or hypopigmented oval-shaped scaly lesions, especially on the upper back and chest and proximal arms, are indicative of tinea versicolor.

The nurse is conducting a physical examination of a boy with erythema multiforme. Which assessment finding should the nurse expect? thick or flaky/greasy yellow scales lesions over the hands and feet, and extensor surfaces of the extremities with spread to the trunk superficial tan or hypopigmented oval-shaped scaly lesions especially on upper back and chest and proximal arms silvery or yellow-white scale plaques and sharply demarcated borders

ANSWER Erythema multiforme typically manifests in lesions over the hands and feet, and extensor surfaces of the extremities with spread to the trunk. Thick or flaky/greasy yellow scales are signs of seborrhea. Silvery or yellow-white scale plaques and sharply demarcated borders define psoriasis. Superficial tan or hypopigmented oval-shaped scaly lesions, especially on the upper back and chest and proximal arms, are indicative of tinea versicolor.

Which assessment finding by the nurse would warrant immediate action? A child with periorbital cellulitis reports changes in vision and pain with eye movement. A child with impetigo has honey-colored drainage noted on the skin area. A child has a red, warm, edematous area over an old spider bite. A child with cellulitis has a temporal temperature of 101°F (38.3°C).

ANSWER In a child with periorbital cellulitis, the nurse musty notify the health care provider immediately if signs of progression to orbital cellulitis occur, such as conjunctival redness, change in vision, pain with eye movement, eye muscle weakness or paralysis, or proptosis. This assessment finding warrants immediate action. In nonbullous impetigo, a honey-colored exudate when the vesicles or pustules rupture may be noted on the skin. This assessment finding would be expected. A localized cellulitis will present with erythema, pain, edema, and warmth at the site of the skin disruption (such as a cut or spider bite). This assessment finding warrants further follow-up but not immediate attention. Fever may occur with bullous impetigo or cellulitis and is common with scalded skin syndrome; therefore, this assessment finding also warrants further, but not immediate, follow-up.

A parent expresses a concern about white scales that have begun to flake off the 1-week-old infant's scalp. The parent asks, "What can I do to prevent this?" Which response by the nurse would be most appropriate? "Your child most likely has dandruff. You can treat it with daily with antiseborrheic shampoo, like Head and Shoulders." "How often do you bathe your infant? The infant should have a thorough shampooing every day to prevent things like this." "Your child most likely has infantile seborrheic dermatitis, or cradle cap. You can care for it by cleansing the hair and scalp daily with baby shampoo. You can also apply baby oil to the area for 10 to 15 minutes and then rinse away the flakes." "Your child most likely has infantile seborrheic dermatitis, or cradle cap. There is no intervention needed and it should resolve in 1 week."

ANSWER Infantile seborrheic dermatitis usually responds well to cleansing the scalp with a mild shampoo. The thick, scaling lesions on the child's scalp can be treated by applying baby oil, salicylic acid in mineral oil, or a corticosteroid gel on the scalp for 10 to 15 minutes. The area is gently massaged with a soft toothbrush; then the scales can be rinsed away. A fine-toothed comb helps rid the hair of scale debris. Antiseborrheic shampoo is not recommended for infants. Accusing a parent of poor hygiene is inappropriate. Infantile seborrheic dermatitis is not a result of poor hygiene.

A parent expresses a concern about white scales that have begun to flake off the 1-week-old infant's scalp. The parent asks, "What can I do to prevent this?" Which response by the nurse would be most appropriate? "Your child most likely has infantile seborrheic dermatitis, or cradle cap. There is no intervention needed and it should resolve in 1 week." "How often do you bathe your infant? The infant should have a thorough shampooing every day to prevent things like this." "Your child most likely has infantile seborrheic dermatitis, or cradle cap. You can care for it by cleansing the hair and scalp daily with baby shampoo. You can also apply baby oil to the area for 10 to 15 minutes and then rinse away the flakes." "Your child most likely has dandruff. You can treat it with daily with antiseborrheic shampoo, like Head and Shoulders."

ANSWER Infantile seborrheic dermatitis usually responds well to cleansing the scalp with a mild shampoo. The thick, scaling lesions on the child's scalp can be treated by applying baby oil, salicylic acid in mineral oil, or a corticosteroid gel on the scalp for 10 to 15 minutes. The area is gently massaged with a soft toothbrush; then the scales can be rinsed away. A fine-toothed comb helps rid the hair of scale debris. Antiseborrheic shampoo is not recommended for infants. Accusing a parent of poor hygiene is inappropriate. Infantile seborrheic dermatitis is not a result of poor hygiene.

When teaching a group of caregivers of infants, the nurse is discussing the topic of diaper rash. The caregivers in the group make the following statements. Which statement is the most accurate related to the child with diaper rash. "They told me to use baby powder every time I change her so she won't get diaper rash." "The formula she drinks sometimes causes her to have a diaper rash." "My child gets diaper rash if I wash her clothes in the same detergent we use for the family." "Sometimes if I leave the diaper off and let him be in the sunshine he gets diaper rash."

ANSWER Infants may have a sensitivity to some soaps or disposable diaper perfumes, and the use of strong laundry detergents without thorough rinsing can cause diaper rash. Diarrheal stools, prolonged exposure to wet or soiled diapers, use of plastic or rubber pants, infrequently changed disposable diapers, inadequate cleansing of the diaper area (especially after bowel movements), and yeast infections are also causative factors. Exposing the diaper area to the air helps clear up the dermatitis. The use of baby powder when diapering is discouraged because caked powder helps create an environment in which organisms thrive.

The nurse is examining a child for indications of frostbite and notes blistering with erythema and edema. The nurse notes which degree of frostbite? fourth-degree frostbite second-degree frostbite third-degree frostbite first-degree frostbite

ANSWER Second-degree frostbite demonstrates blistering with erythema and edema. First-degree frostbite results in superficial white plaques with surrounding erythema. In third-degree frostbite, the nurse would note hemorrhagic blisters that would progress to tissue necrosis and sloughing when the fourth degree is reached.

A nurse completes an assessment on an 8-month-old infant seen in the pediatrician's office for a well-child visit. The nurse notes that the infant's buttocks, perineum and inner thighs are covered in a thick coating of white ointment. When questioned, the parent says the infant has a diaper rash and the ointment is to protect the infant's skin. What is the best action for the nurse to take? Provide instruction on how to care for a diaper rash. Explain that frequent diaper changes will prevent diaper rash. Tell the parent that he or she has used too much ointment. Commend the parent on addressing the infant's diaper rash.

ANSWER The best action for the nurse to take is to provide instruction on how to care for a diaper rash. This would include changing diapers frequently to prevent a rash, how to apply rash ointment, and how using too much ointment can cause the infant's skin to absorb the ointment. It is important to praise parents on taking good care of their child, but the best action is to provide instruction on the correct way to do so.

The nurse is monitoring the intake and output of a client with deep partial-thickness or second-degree burns. The child weighs 75 lb (34 kg). The nurse will contact the physician if the child's urine output drops below how many milliliters per hour? (Round you answer to the nearest whole number.)

ANSWER The child with burns should have a urine output of at least at least 1 ml/kg/hour. The calculations for this scenario are: 1 ml X 34 kg= 34 ml/hour

The nurse is caring for a 9-year-old child with partial-thickness (second-degree) burns. The client rates the pain at an 8 on a 1 to 10 numerical pain scale. The nurse notes the client is sitting in the bed playing with toys and smiling. Which action will the nurse take? Ask the parents to rate the client's pain. Reassess the client's pain in 30 minutes. Use another pain scale to measure the client's pain. Administer pain medication as prescribed.

ANSWER The nurse would administer the client pain medication as prescribed. Pain is how a client describes and rates it, regardless of outward appearances. The nurse should not allow the child to continue to feel pain while waiting an additional 30 minutes, asking the parents their opinion, or using a different pain scale.

A parent brings an infant to the clinic for a well child visit. During the assessment, the parent asks the nurse why the infant never seems to sweat. What action should the nurse take? Make a note to inform the health care provider of the parent's concern. Explain that this normal mechanism keeps the infant from losing too much water through the skin. Tell the parent that the infant will need to see an endocrine specialist about the problem. Explain that this is because an infant's temperature normally runs lower than an adult's.

ANSWER The sweat glands of an infant are immature and this normal mechanism keeps the infant from losing too much insensible water. Because this is a normal occurrence, there is no reason to make a note to inform the health care provider or to refer the infant to a specialist. An infant's temperature does not run lower than an adult's temperature.

The parents of a child diagnosed with atopic dermatitis ask the nurse, "My child has a skin disorder. I don't understand why a complete blood count (CBC) was ordered?" What is the appropriate response by the nurse? "This test will help in determining the type of bacteria that is causing this infection." "Eosinophils are a type of white blood cell that are often elevated with atopic dermatitis. These are part of the CBC and helps in making the diagnosis." "The complete blood count is a routine test used anytime there is an abnormal condition in the body." "This is just another tool to help rule out any other disorders that can be causing this skin disorder. There will be other lab tests ordered as well."

ANSWER The sweat glands of an infant are immature and this normal mechanism keeps the infant from losing too much insensible water. Because this is a normal occurrence, there is no reason to make a note to inform the health care provider or to refer the infant to a specialist. An infant's temperature does not run lower than an adult's temperature.

A 10-year-old has been bitten on the lower posterior arm by a dog, requiring several stitches. The child was just admitted to the hospital for 3 days of antibiotic therapy. When developing the care plan, the nurse identifies which nursing diagnoses as being the top 2 priorities? Risk for infection Risk for fluid volume deficit Disturbed body image Knowledge deficit regarding care of wound Impaired skin integrity

ANSWER The wound was not a clean wound, such as a surgical wound, so risk for infection would be a top priority. The child has impaired skin integrity from the wound and from the IV. Since the wound is new and on the arm the nursing diagnosis disturbed body image would not be a top 2 priority at this time. It is unlikely that a great deal of fluid has been lost from this wound. Knowledge deficit of wound care would not be a top 2 priority at this time, but would be an important nursing diagnosis to address later.

The nurse is caring for a child with urticaria. What is the priority action? obtaining a detailed history of new foods, medications, stress, or changes in environment Noting whether hives are pruritic, blanch when pressed, or are migrating assessing the child's airway and breathing and noting any wheezing or stridor inspecting the skin and noting evidence of raised, edematous hives anywhere on the body

ANSWER Urticaria is a type I hypersensitivity reaction. Therefore, the priority nursing assessment is to carefully assess airway and breathing, as hypersensitivity reactions may affect respiratory status. A detailed history, skin inspection, and evaluation of the hives are other appropriate assessments, but determining respiratory status is the priority.

A mother brings her 4-month-old infant to the doctor's office due to vesicular lesions that have appeared on the child's scalp and face. The mother says that the child will not stop scratching at the lesions and that she is concerned that he is having some kind of allergic reaction. What should the nurse recommend to the mother to help reduce pruritus in this child? Bathe the child twice a day. Put the child on elimination diets. Have the child retested for PKU. Have the child undergo skin testing.

ANSWER A A major consideration in the treatment of atopic dermatitis is aimed at reducing pruritus so children do not irritate lesions and cause secondary infections by scratching. Hydrating the skin by bathing twice daily in warm (not hot) water, followed by application of moisturizer such as Eucerin is helpful. Skin testing is usually ineffective because, although the allergen causing infantile atopic dermatitis may be pollen, dust, or a mold spore, it is often a food allergen. Elimination diets can help identify an allergen, but do not directly help reduce pruritus; in any case, a 4-month-old should not be eating solid foods. Because untreated phenylketonuria (PKU) can lead to atopic dermatitis, children with infantile atopic dermatitis need to have a repeat test for PKU to be certain this is ruled out—however, this intervention does not directly reduce pruritus.

The nurse is caring for a school-age child who has been having a continuous seizure for the last 40 minutes. What is the priority action by the nurse? Administer lorazepam IV as prescribed. Perform a glucose finger stick to determine the child's blood sugar level. Administer carbamazepine as prescribed. Observe and document the length of time of the seizure and type of movement observed.

ANSWER A A seizure lasting longer than 30 minutes is considered status epilepticus and is an emergency situation. An IV benzodiazepine such as lorazepam is administered to help stop the seizure. Checking blood glucose levels, monitoring length and type of seizure, and administration of anti-seizure medication such as carbamazepine all are correct interventions for clients with seizures, but these are not the priority action.

The nurse is caring for a child with suspected child abuse (child mistreatment)-induced burns. Which assessment findings would support this? a burn to the entire right hand up to 2 cm above wrist with consistent edges 911 called immediately after the burn occurred consistent history given by all caregivers splattered-looking, small burned areas to both legs

ANSWER A A stocking/glove pattern on the hands or feet (circumferential ring appearing around the extremity, resulting from a caregiver forcefully holding the child under extremely hot water) is one sign of child abuse (child mistreatment)-induced burns. Inconsistent history given by caregivers, delay in seeking treatment by caregivers, and a lack of splattering of water burns are all indicators of child abuse (child mistreatment)-induced burns.

A 1-year-old child was brought to the clinic for evaluation of dry, itchy red patches of skin on the arms and legs. A diagnosis of atopic dermatitis (eczema) is made. Which would be an essential element to include in the plan of care for this child? Frequently rehydrating the skin. Teaching the child not to scratch the "itchy" skin. Applying topical antibiotics routinely. Administering daily oral corticosteroid therapy.

ANSWER A Frequently rehydrating the skin is a key element of the treatment regimen. To maintain healthy skin in the child with atopic dermatitis, hydration practices should be implemented to replace moisture in the stratum corneum and prevent transdermal water losses. Scratching itchy skin is a reflex that is very difficult to stop; preventing the itch is more effective. Topical antibiotics and oral corticosteroids are not treatments for atopic dermatitis.

The nurse is assessing a child who has had an open wound for the last 2 weeks with no signs of healing. The parents report they have been using over-the-counter antibiotic ointment with no signs of improvement. The child is active in football in the fall and the swim team in the winter. What disorder does the nurse suspect? community acquired MRSA folliculitis impetigo staphylococcal scalded skin syndrome

ANSWER A Risk factors for community-acquired MRSA (CA-MRSA) are turf burns, towel sharing, participation in team sports, or attendance at day care or outdoor camps. The condition usually presents with a moderate to severe skin infection or with an infection that is not responding as expected to therapy. Impetigo is a readily recognizable skin rash infection. Staphylococcal scalded skin syndrome results from infection with S. aureus that produces a toxin, which then causes exfoliation, and it has abrupt onset. Folliculitis is an infection of a hair follicle. Reference:

A 6-year-old child is brought to the clinic by his parents. The parents state, "He had a sore throat for a couple of days and now his temperature is over 102°F (38.9°C). He has this rash on his face and chest that looks like sunburn but feels really rough." What would the nurse suspect? Scarlet fever Pertussis Community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA) Diphtheria

ANSWER A Scarlet fever typically is associated with a sore throat, fever greater than 101° F (38.9° C), and the characteristic rash on the face, trunk, and extremities that looks like sunburn but feels like sandpaper. CAMRSA is typically manifested by skin and tissue infections. Diphtheria is characterized by a sore throat and difficulty swallowing but fever is usually below 102°F (38.9°C). Airway obstruction is apparent. Pertussis is characterized by cough and cold symptoms that progress to paroxysmal coughing spells along with copious secretions.

A nurse completes an assessment on an 8-month-old infant seen in the pediatrician's office for a well-child visit. The nurse notes that the infant's buttocks, perineum and inner thighs are covered in a thick coating of white ointment. When questioned, the parent says the infant has a diaper rash and the ointment is to protect the infant's skin. What is the best action for the nurse to take? Provide instruction on how to care for a diaper rash. Tell the parent that he or she has used too much ointment. Commend the parent on addressing the infant's diaper rash. Explain that frequent diaper changes will prevent diaper rash.

ANSWER A The best action for the nurse to take is to provide instruction on how to care for a diaper rash. This would include changing diapers frequently to prevent a rash, how to apply rash ointment, and how using too much ointment can cause the infant's skin to absorb the ointment. It is important to praise parents on taking good care of their child, but the best action is to provide instruction on the correct way to do so.

The nurse caring for a child with a skin allergy recognizes that the highest priority in the treatment for skin allergies is aimed at: reducing swelling and relieving itching. regulating skin and body temperature. controlling nausea and vomiting. managing pain and discomfort.

ANSWER A Treatment for skin allergies is aimed at reducing the swelling and relieving the itching. With swelling in various parts of the body, the child may have pain, nausea and vomiting, but reducing the swelling would prevent those symptoms from occurring.

The nurse is caring for a child on the burn unit weighing 100 lb (45.5 kg) who has second-degree (partial-thickness) burns over 30% of the body. During the beginning shift assessment, which assessment finding is of most concern to the nurse? Urine output of 15 ml per hour over the last 4 hours Weight gain of 0.9 kg over the last 2 days Refused dinner due to nausea Pain at a 7 on a 0 to 10 scale

ANSWER A Fluid and electrolyte imbalance is a primary concern when caring for the client with burns. The urine output should be a minimum of 1 ml/kg/hour. The client weighs 45.5 kg, so output should equal approximately 45 ml/hour. Pain is a major concern, but the higher priority at this time is the decreased output. Refusal of one meal is not a high priority. Weight gain of 0.9 kg over 2 days is not a concern at this time.

The nurse is caring for a hospitalized infant at risk for developing increased intracranial pressure. Which assessment finding(s) would the nurse communicate to the health care provider for further intervention? Select all that apply. increased head circumference pulse rate of 60 beats/min and regular vomiting parent states, "My infant does not act right." blood pressure decreased from baseline

ANSWER A-B-C-D Signs of increased intracranial pressure include bulging fontanel ([fontanelle] increased head circumference), decreased pulse, vomiting, increased blood pressure and behavior changes. The nurse must listen to the parents if concerns about behavior are mentioned. The blood pressure would increase, not decrease. The nurse would alert the health care provider immediately of these signs so intervention can be started if needed.

A child is brought to the emergency center after sustaining a seizure at home. When taking the child's history, which question(s) would the nurse ask the parents? Select all that apply. "How long did the seizure last?" "What time did the seizure occur?" "Can you describe to me the movements your child experienced?" "Did your child lose bladder or bowel control?" "Did your child stop breathing during the seizure?" "Did you give your child any fever medicine prior to the seizure?"

ANSWER A-B-C-D-E There are many types of seizures. After a child has experienced a seizure, it is helpful to know the details as much as possible so these can aid in the diagnosis. The health history becomes very important to gather this information. The nurse would obtain information from the parents as to the time the seizure occurred and note how long the seizure lasted. The parents could supply a description of the child's behavior during the seizure. This would include a description of the child's movements, any loss of bowel or bladder control, if the child became cyanotic, or any other characteristics the parents observed. The nurse would also ask the parents about any precipitating events before the seizure occurred such as a fever, a fall, anxiety, or exposure to strong stimuli. Giving an antipyretic medication to the child would not interfere with the seizure.

Parents bring their 9-year-old child to the clinic for a well-child visit. They are concerned because several children in the neighborhood have developed Lyme disease and ask for suggestions on what to do to reduce their child's risk. What would be appropriate for the nurse to suggest? Select all that apply. Inspecting the skin closely for ticks after the child plays in wooded areas. Removing ticks by rubbing them away from the skin with a credit card. Wearing protective clothing when playing in wooded areas. Contacting the health care provider if there is any area of inflammation that might be a bite. Dressing the child in dark clothing when going outdoors.

ANSWER A-C-D The nurse should teach the parents to have the child wear protective clothing and dress the child in light clothing when playing in wooded areas or going outdoors. The parents should inspect the child's skin closely for ticks after being outside in wooded areas and if any ticks are found, remove them with a tweezer, not rub them with a credit card. The parents also should be instructed to contact their health care provider if they notice any area of inflammation that might be a tick bite.

A 10-year-old has been bitten on the lower posterior arm by a dog, requiring several stitches. The child was just admitted to the hospital for 3 days of antibiotic therapy. When developing the care plan, the nurse identifies which nursing diagnoses as being the top 2 priorities? Risk for infection Disturbed body image Risk for fluid volume deficit Knowledge deficit regarding care of wound Impaired skin integrity

ANSWER A-E The wound was not a clean wound, such as a surgical wound, so risk for infection would be a top priority. The child has impaired skin integrity from the wound and from the IV. Since the wound is new and on the arm the nursing diagnosis disturbed body image would not be a top 2 priority at this time. It is unlikely that a great deal of fluid has been lost from this wound. Knowledge deficit of wound care would not be a top 2 priority at this time, but would be an important nursing diagnosis to address later.

The nurse is caring for multiple clients on the pediatric unit. Which child will the nurse see first? a child diagnosed with measles experiencing photophobia and coryza a child with erythema infectiosum experiencing fatigue and confusion a child with herpes simplex who is reporting mouth pain and pruritis a child diagnosed with chicken pox reporting nausea and malaise

ANSWER B A child with erythema infectiosum experiencing fatigue and confusion is showing signs of decreased oxygenation, possibly related to aplasia of erythrocytes caused by the virus. A child with signs and symptoms of decreased oxygenation should be seen first. Nausea and malaise are symptoms of chicken pox. A child with herpes simplex will most likely report pain an pruritis. Signs and symptoms of measles include photophobia and coryza.

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? Palpate the child's fontanels (fontanelles). Institute droplet precautions in addition to standard precautions. Educate the family about preventing bacterial meningitis. Encourage the mother to hold and comfort the infant.Absence seizures are characterized by a brief loss of responsiveness with minimal or no alteration in muscle tone. They may go unrecognized because the child's behavior changes very little. A sudden loss of muscle tone describes atonic seizures. A frozen position describes the appearance of someone having akinetic seizures. A brief, sudden contraction of muscles describes a myoclonic seizure.

ANSWER B 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 (fontanelles) is used to assess for hydrocephalus.

The nurse is teaching parents about the care of diaper rash. The nurse would be concerned about the parents' level of understanding if they made which statement? "I should only use ointments and creams as instructed by the health care provider." "I should be certain to use fabric softener in the care of the infant's clothes." "I should not overdress the infant." "I need to wash and rinse clothes thoroughly to be sure all of the detergent is washed out."

ANSWER B Fabric softeners should be avoided because their use can result in skin irritation in the infant. Clothing and other baby items should be washed and rinsed thoroughly. Overdressing should be avoided as sweating irritates the rash, and only ointments and creams that are recommended by health care personnel should be used on the infant.

A child has been diagnosed with hookworm. The nurse is teaching the parent about the treatment for the condition. Which statement made by the parent confirms that further education is needed? "The medications should be taken for 2 weeks." "My child can play outside bare footed when treatment is done." "I should have my other children tested." "I should have my child eat more foods with iron."

ANSWER B Hookworms are found in soil, especially in areas with warmer climates. They enter the body through the skin, pores and hair follicles. The treatment is with the drug albendazole. The duration is from 7 to 14 days of treatment. Most importantly, besides medication, good handwashing and sanitation practices are needed. Children should wear shoes and not go barefoot outside since the worms can enter through the soles of the feet. The worms attach themselves to the walls of the small intestine where they feed and reproduce. This can cause anemia. The child's diet should include foods high in iron or iron supplements. All children who are suspected or at high risk should be evaluated for hookworms.

The nurse caring for an infant with craniosynostosis, specifically positional plagiocephaly, should prioritize which activity? giving the infant small feedings whenever he is fussy moving the infant's head every 2 hours measuring the intake and output every shift massaging the scalp gently every 4 hours

ANSWER B 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.

The nurse is speaking with the mother of a child diagnosed with contact dermatitis from poison ivy. Which statement by the mother indicates a need for further education? "When he plays in the woods again, I will make sure he wears long pants and long sleeves." "As long as he takes a shower as soon as he gets inside, he shouldn't get this again." "I can buy a medicine to put on him before he goes out to prevent him from getting this again." "I will need to make sure the dog gets a bath if he goes in the woods."

ANSWER B Prevention of contact dermatitis from poison ivy, poison oak, or poison sumac includes wearing long pants and long sleeves on outings in the wood. If contact occurs, wash vigorously with soap and water within 10 minutes of contact. The plant's oil residue may be on clothes, pets, toys, and other objects, so these must be washed well with soap and water. Ivy Block is the only preventive treatment approved by the US FDA. It is applied to the skin before exposure.

What is the leading cause of neonatal sepsis and death? Neisseria meningitidis Group B streptococcus Epstein-Barr virus infection cytomegalovirus infection

ANSWER B Sepsis is a systemic overresponse to infection. It is very serious and can produce septic shock and death. In infants under the 3 months of age the most causative agents are group B streptococcus, Escherichia coli, Staphylococcus aureus, enteroviruses, and the herpes simplex virus. Any time a febrile, ill-appearing neonate is seen, a full septic work-up is done. Neonates have the poorest outcomes from sepsis. Neisseria meningitidis is one cause of sepsis in older children. The Epstein-Barr virus is a herpes virus that causes mononucleosis. The cytomegalovirus is a common herpes virus. It is spread through bodily fluids and is not necessarily a concern unless the person is immunocompromised or is pregnant.

An infant has presented at the clinic with impetigo. Which organism usually causes impetigo in infants? Group A beta hemolytic strep Staphylococcus aureus Methicillin-resistant Staphylococcus aureus (MRSA) Escherichia coli

ANSWER B Staphylococcus aureus is the most common cause of impetigo in infants. MRSA is a hospital-associated infection (HAI), group A beta hemolytic strep is seen in older children, and Escherichia coli is not frequently associated with impetigo.

The nurse at the pediatrician's office receives a call from the mother of a child who has just been bitten by the neighbor's dog. What action would be the priority? Explain how to educate the child about animals. Tell the mother to seek medical help immediately. Explain how to care for the dog bite. Describe methods of managing a fever.

ANSWER B The mother should seek medical help for her child immediately. Once the child has been seen by a physician, it can be determined whether immunoprophylaxis is necessary. Education about animals is important to prevent any recurrent bites, but this is appropriate only after the child has been seen and a plan has been determined. Flu-like symptoms such as fever occur early in rabies infection. However, the child must be seen first. Explaining how to care for the bite would be done only after the child is seen and an appropriate plan is determined.

The nurse is caring for a child brought to the emergency department by the parents. Upon assessment the physician suspects the child has been bitten by a spider. While obtaining the nursing history of the present condition, which statement by the parent will require clarification from the nurse? "My child plays in our woods a lot so I need to be sure protective clothing and shoes are worn." "I cleaned the wound with soap and water right away. I hope that's okay." "Since my child just has a rash around the area of the bite there is nothing to worry about." "I put ice on the bite to try to keep the swelling down."

ANSWER C A rash could be an indication of a systemic reaction and the child should be monitored closely for other signs of a systemic, or possible anaphylactic, reaction. Protective clothing for the prevention of insect or spider bites, cleansing the wound to help with infection control, and ice for prevention of swelling are all effective actions.

The nurse is collecting data from a child who may have a seizure disorder. Which nursing observations suggest an absence seizure? Sudden, momentary loss of muscle tone, with a brief loss of consciousness Muscle tone maintained and child frozen in position Minimal or no alteration in muscle tone, with a brief loss of responsiveness or attention Brief, sudden contracture of a muscle or muscle group

ANSWER C Absence seizures are characterized by a brief loss of responsiveness with minimal or no alteration in muscle tone. They may go unrecognized because the child's behavior changes very little. A sudden loss of muscle tone describes atonic seizures. A frozen position describes the appearance of someone having akinetic seizures. A brief, sudden contraction of muscles describes a myoclonic seizure.

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? Always keep her head raised 30º. Her autoregulation mechanism to absorb spinal fluid has failed. Tell me your concerns about your child's shunt. Call the doctor if she gets a persistent headache.

ANSWER C 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.

The parents of a child diagnosed with atopic dermatitis ask the nurse, "My child has a skin disorder. I don't understand why a complete blood count (CBC) was ordered?" What is the appropriate response by the nurse? "The complete blood count is a routine test used anytime there is an abnormal condition in the body." "This test will help in determining the type of bacteria that is causing this infection." "Eosinophils are a type of white blood cell that are often elevated with atopic dermatitis. These are part of the CBC and helps in making the diagnosis." "This is just another tool to help rule out any other disorders that can be causing this skin disorder. There will be other lab tests ordered as well."

ANSWER C Atopic dermatitis is a type of allergic skin disorder, not a bacterial infection, in which the eosinophil count is often elevated. This is one test that will help in diagnosing the disorder. This explanation addresses the parents' question.

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

Answer 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.

The dermatologist treating a 16-year-old girl with a history of severe acne has ordered a pregnancy test so she can be started on a course of isotretinoin. The teen's caregiver has said that her daughter is a virgin and she refuses to allow her to have the required pregnancy testing. What would be the best action for the nurse to take? Arrange for the daughter to have the pregnancy testing without the caregiver's knowledge. Speak with the teen alone to ask her if she is sexually active. If she says she is not sexually active, let the provider know that it is okay to write the prescription. Acknowledge the caregiver's discomfort about the pregnancy testing but encourage her to allow the daughter to have the testing so that she can use the medication. Have the caregiver sign a permission form acknowledging that the girl has been given the drug without pregnancy testing.

ANSWER C Isotretinoin is a pregnancy category X drug: It must not be used at all during pregnancy because of serious risk of fetal abnormalities. To rule out pregnancy, a urine test is done before beginning treatment. For the sexually active adolescent girl, an effective form of contraception must be used for a month before beginning and during isotretinoin therapy. The risk to the fetus, should pregnancy occur, should be discussed with the girl whether she is sexually active or not.

What is a true statement regarding measles? It is not contagious. Peak outbreaks are in the summer. The incubation period is 10 to 12 days. It is transmitted by the fecal-oral route.

ANSWER C Measles is a highly contagious disease spread via droplets from the nasopharyngeal secretions. The typical incubation period is 10 to 12 days. Outbreaks peak in the winter and spring. It is communicable 1 to 2 days before the onset of symptoms. The initial symptoms are fever, cough, coryza and conjunctivitis. These symptoms are followed by Koplik spots seen in the mouth. A rash develops on the head and spreads downward and outward.

The nurse is caring for a child with a second-degree (partial-thickness) burn. What assessment findings would the nurse expect to observe? Edema with dry or waxy-looking skin Peeling skin with eschar Edema with wet blistering skin Reddened and leathery skin

ANSWER C Partial-thickness or second-degree burns are very painful and edematous and have a wet appearance or the presence of blisters. Third-degree (full-thickness) burns appear red, edematous, leathery, dry, or waxy and may display red or charred skin (eschar).

A 7-year-old client 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 she 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 the best response by the nurse? "This might or might not be a problem. Watch your daughter for signs of nasal discharge, sneezing, itching of the nose, or dark circles under the eyes. If you notice any of these, bring her to the emergency room immediately so she can be checked for Reye syndrome." "This might or might not be a problem. Watch your daughter 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." "This is unlikely to be a problem. Half an aspirin is not enough to cause harm. Reye syndrome generally only develops from prolonged use of aspirin in connection with a virus." "This is a serious problem. Aspirin is likely to cause Reye syndrome, and she should be admitted to the hospital for observation as a precaution."

ANSWER C 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 3 to 5 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 9-month-old child has been admitted to rule out sepsis. Which finding offers the most support to the presence of this disorder? The child cries when his mother is not in sight. The child's birth history indicates he was born at 42 weeks' gestation. The child has had 8 ounces of formula in the past 24 hours. The child has had 7 wet diapers in the past 24 hours.

ANSWER C Sepsis is a systemic overresponse to infection resulting from bacteria and viruses, which are the most common fungi, viruses, rickettsia, or parasites. It can lead to septic shock, which results in hypotension, low blood flow, and multisystem organ failure. Signs of sepsis include a lack of appetite, lethargy, hypotonia, and temperature elevations.

A parent brings an infant to the clinic for a well child visit. During the assessment, the parent asks the nurse why the infant never seems to sweat. What action should the nurse take? Make a note to inform the health care provider of the parent's concern. Explain that this is because an infant's temperature normally runs lower than an adult's. Explain that this normal mechanism keeps the infant from losing too much water through the skin. Tell the parent that the infant will need to see an endocrine specialist about the problem.

ANSWER C The sweat glands of an infant are immature and this normal mechanism keeps the infant from losing too much insensible water. Because this is a normal occurrence, there is no reason to make a note to inform the health care provider or to refer the infant to a specialist. An infant's temperature does not run lower than an adult's temperature.

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 as a risk factor for hemorrhagic stroke? congenital heart defect meningitis arteriovenous malformations (AVMs) sickle cell disease

ANSWER C 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.

An 8-year-old child requires wet dressings four times a day as treatment for a skin disorder. What would be most important for the nurse to do? Ensure that the temperature of the solution is 120°F (48.9°C). Use a fragrance-free, dye-free soap to clean the wound. Elevate the area after performing the dressing change. Premedicate the child before changing the dressing.

ANSWER D Premedicating the child before changing the dressing is crucial to providing atraumatic care. Elevating the area may or may not be appropriate depending on the problem and its location. A temperature of 120°F (48.9°C) is the recommended maximal hot water heater temperature. The solution for a wet dressing should not be this hot. There is no indication that the wound should be cleaned.

A 9-year-old boy is suffering from headaches but has no signs of physical or neurologic illness. Which intervention would be most appropriate? Review the signs of increased intracranial pressure with parents. Have the child sleep without a pillow under his head. Have the parents call the doctor if the child vomits more than twice. Teach the child and his parents to keep a headache diary.

ANSWER D 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.

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? lumbar puncture computed tomography cerebral angiography video electroencephalogram

ANSWER D 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.

A nurse is caring for a child with second- and third-degree (partial- and full-thickness) burns over 15% of the body. The child reports severe itching in and around the burn sites. Which action would be most appropriate for the nurse to perform? Soak the child in a colloidal bath. Provide diversional activities. Turn the child every 2 hours. Administer diphenhydramine.

ANSWER D As nerve endings heal they cause intense itching that can be relieved with the use of medications (e.g., diphenhydramine hydrochloride, loratadine) and by applying soothing lotions such as Nivea or Eucerin. Turning the child every two hours will not relieve the itching. Soaking in a colloidal bath is contraindicated with burn clients. Although diversional activities can help somewhat, they will not relieve the child's itching.

The nurse is providing teaching to the parents of a child recently prescribed carbamazepine for a seizure disorder. Which statement by a parent indicates successful teaching? "I will give the medication to him when I first wake him up in the morning." "This medication may cause him to have trouble sleeping. He may need something else to help him sleep." "I'm glad to know he will only need this medication for a short time to stop his seizures." "I need to watch for any new bruises or bleeding and let my health care provider know about it."

ANSWER D Carbamazepine is an antiseizure medication. It can cause bone marrow depression, so parents need to watch for any signs of bruising, bleed, or infection and notify their health care provider if this happens. Administer this medication with food to minimize GI upset. This medication can cause drowsiness, so do not give any sleep-inducing or other sedative type medications. Antiseizure medication does not cure seizures; it only controls the seizures. Lifelong antiseizure medication may be needed.

A young client arrives at the clinic with a rash on the trunk and flexor surfaces of the extremities. The parent informs the nurse that the rash started a day before on the exterior surfaces of the extremities; 2 days before, the child had a really bad rash on the face. The health care provider diagnoses the child with erythema infectiosum. The nurse tells the parent that this is also known as: enterovirus. rosacea. pityriasis rosea. fifth disease.

ANSWER D Erythema infectiosum is also known as "fifth disease." It starts with a fever, headache, and malaise. One week later, a rash appears on the face. A day later, the rash appears on the extensor surfaces of the extremities. One more day later, the rash appears on the trunk and flexor surfaces of the extremities. Pityriasis rosea is a skin rash that begins with a large spot on the chest, abdomen, or back that is followed by a pattern of small lesions. It is self-limiting and can be treated with steroid creams. Rosacea is a chronic inflammatory skin condition that causes redness to the face. An enterovirus infection can many times cause the same symptoms as the common cold or it can include the respiratory system. It is contagious.

When providing care for a child with herpes zoster (shingles), the parents ask the nurse how the child contracted this infectious disorder. Which response by the nurse is most appropriate? "Handwashing is an effective way to prevent the spread of infectious disorders." "Your child must have been exposed to someone with herpes zoster." "Children who are immunocompromised are more likely to contract shingles." "Herpes zoster is a reactivation of a previous varicella zoster infection."

ANSWER D Herpes zoster (shingles) is reactivation of the latent varicella zoster (chickenpox) infection that occurs during times of immunosuppression and aging. Although it is possible to contract the varicella zoster virus from a person with herpes zoster or varicella zoster, a child diagnosed with herpes zoster has already been exposed to varicella zoster. Handwashing will not directly prevent herpes zoster.

The nurse is discussing acne vulgaris with a group of adolescents. The teenagers make the following statements regarding the topic. Which statement is the most accurate regarding acne vulgaris? "My next door neighbor told me that acne was caused by a fungus." "My mom says I have acne because I eat too much chocolate." "There is a new immunization that you can get to keep from having acne." "Sometimes I get acne when I use my sister's makeup."

ANSWER D Irritation and irritating substances, such as vigorous scrubbing and cosmetics with a greasy base, can cause acne vulgaris. Increased hormone levels, hereditary factors, and anaerobic bacteria can cause acne vulgaris as well. Eating chocolate and fatty foods does not cause acne, but a well-balanced, nutritious diet does promote healing.

A young client in the clinic has a rash, cough, and fever that the parent says spiked on day 5 of the rash. The client also had conjunctivitis. What illness would the nurse expect the health care provider to diagnose? Rubella Scarlet fever Chickenpox Measles

ANSWER D Measles are diagnosed based on the symptoms. Measles is a viral illness. The prodromal period includes 2 to 4 days of rising fevers, cough, coryza, and conjunctivitis. Following this, Koplik spots develop followed by an erythematous maculopapular rash. The rash starts on the head and spreads downward and outward. Rubella, also viral, begins with the rash starting first and the child will have a low-grade fever. Scarlet fever is a bacterial illness generally occurring after strep throat. It is accompanied by high fevers and a generalized rash over the entire body. Varicella is also caused by a virus but the rash differs in that it has fluid-filled vesicles.

The nurse admits a 10-year-old who has just eaten lobster and has hives over much of the body. In collecting data regarding this child, which question should the nurse ask the caregiver first? "Have you ever given your child antihistamines?" "Does anyone in your family have any food allergies?" "Is your child allergic to peanuts or other foods?" "Has the child ever eaten shellfish before now?"

ANSWER D The first time the child comes in contact with an allergen, no reaction may be evident, but an immune response is stimulated—helper lymphocytes stimulate B lymphocytes to make the immunoglobulin E (IgE) antibody. The IgE antibody attaches to mast cells and macrophages. When contacted again, the allergen attaches to the IgE receptor sites, and a response occurs in which certain substances, such as histamine, are released; these substances produce the symptoms known as allergy. Asking the other questions is important, but the first question the nurse should ask is related to this child and this situation.

The nurse is caring for an infant who has impetigo and is hospitalized. Which nursing action is priority? The nurse follows contact precautions. The nurse soaks the skin with warm water. The nurse applies topical antibiotics to the lesions. The nurse applies elbow restraints to the infant.

ANSWER \ Impetigo is highly contagious and can spread quickly. The nurse should follow contact (skin and wound) precautions, including wearing a cover gown and gloves. The nurse will soak the crusts with warm water, apply topical antibiotics, and apply elbow restraints, but these are not as high a priority as trying to prevent the spread of the infection by following contact precautions.

The nurse is caring for a client brought to a pediatric clinic for swelling in the lower extremities with reddened skin that has undefined borders and pits slightly when pressed. What is the most likely diagnosis of the client's skin alteration? cat scratch disease cellulitis impetigo staphylococcal scalded skin syndrome

ANSWER b Cellulitis is characterized by reddened or lilac-colored swollen skin that pits when pressed by the fingertips. Impetigo has superficial lesions that can be bulbous or nonbulbous. SSSS involves bullae that enlarge and rupture, leaving a red, scalded-looking lesion. Cat scratch disease involves a benign, subacute, chronic course of lymphadenopathy that usually resolves spontaneously in 2 to 3 months

The nurse is caring for a 2-year-old boy with a burn. What finding would warrant referral to a burn unit? a superficial or first-degree burn on the hand a superficial or first-degree burn on the chest a superficial or first-degree burn on the upper arm a chemical burn

ANSWER d

A 1-year-old infant 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?" "I will be watching hemoglobin and hematocrit closely." "I told you yesterday there would be facial swelling." "This only happens in 1 out of 2,000 births."

Answer

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 smelling salts suction at bedside tongue blade padding for side rails

Answer

Preterm infants have more fragile capillaries in the periventricular area than term infants. This put these infants at risk for which problem? intracranial hemorrhaging congenital hydrocephalus early closure of the fontanels (fontanelles) moderate closed-head injury

Answer

The nurse helps position a child for a lumbar puncture. Which statement describes the correct positioning for this procedure? "When positioning the child, the nurse needs to assist the child to a side-lying position and keep his back as flat as much as possible." "For a lumbar puncture, the child will be placed in a side-lying position with knees bent and neck flexed to assist with arching the back." "The child will be placed in the prone position with the nurse holding the child still." "The child will be held by the mother on her lap with his back toward the health care provider."

Answer

The nurse is collecting data on an 18-month-old child admitted with a diagnosis of possible seizures. When interviewing the caregivers, which questions would be most important for the nurse to ask? "Has anyone in your family been sick recently" "What type of activities was your child doing today?" "Is your child up to date on his immunizations?" "Have you checked your child's temperature?"

Answer

The nurse is providing education to the parents of a 3-year-old girl with hydrocephalus who has just had an external ventricular drainage system placed. Which question is best to begin the teaching session? "What questions or concerns do you have about this device?" "What do you know about her autoregulation mechanism failing?" "Do you understand why you clamp the drain before she sits up?" "Why do you always keep her head raised 30 degrees?"

Answer

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? Encourage the parents to hold the child Take vital signs every 4 hours Decrease environmental stimulation Monitor temperature every 4 hours

Answer 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 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 delayed development Risk for self-care deficit: bathing and dressing Risk for ineffective tissue perfusion: cerebral Risk for injury

Answer A seizure disorder is caused by a disruption in the electrical impulses in the brain. Tonic-clonic seizures are 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 an inability to swallow. All of these symptoms would make Risk for injury the highest priority.

The nurse is collecting data from a child who may have a seizure disorder. Which nursing observations suggest an absence seizure? Muscle tone maintained and child frozen in position Brief, sudden contracture of a muscle or muscle group Minimal or no alteration in muscle tone, with a brief loss of responsiveness or attention Sudden, momentary loss of muscle tone, with a brief loss of consciousness

Answer Absence seizures are characterized by a brief loss of responsiveness with minimal or no alteration in muscle tone. They may go unrecognized because the child's behavior changes very little. A sudden loss of muscle tone describes atonic seizures. A frozen position describes the appearance of someone having akinetic seizures. A brief, sudden contraction of muscles describes a myoclonic seizure.

The nurse is collecting data from a child who may have a seizure disorder. Which nursing observations suggest an absence seizure? Muscle tone maintained and child frozen in position Minimal or no alteration in muscle tone, with a brief loss of responsiveness or attention Brief, sudden contracture of a muscle or muscle group Sudden, momentary loss of muscle tone, with a brief loss of consciousness

Answer Absence seizures are characterized by a brief loss of responsiveness with minimal or no alteration in muscle tone. They may go unrecognized because the child's behavior changes very little. A sudden loss of muscle tone describes atonic seizures. A frozen position describes the appearance of someone having akinetic seizures. A brief, sudden contraction of muscles describes a myoclonic seizure.

The nurse helps position a child for a lumbar puncture. Which statement describes the correct positioning for this procedure? "For a lumbar puncture, the child will be placed in a side-lying position with knees bent and neck flexed to assist with arching the back." "The child will be placed in the prone position with the nurse holding the child still." "The child will be held by the mother on her lap with his back toward the health care provider." "When positioning the child, the nurse needs to assist the child to a side-lying position and keep his back as flat as much as possible."

Answer Correct positioning for a lumbar puncture is to place the child on his or her side with the neck flexed and knees bent and drawn up to their chest. This helps to keep the back arched as much as possible. Newborns may be seated upright with their head bent forward. The child is not placed prone; this does not allow the back to be arched.

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? "Bike riding and swimming are just too dangerous." "Use this information to teach family and friends." "If he is out of bed, the helmet's on the head." "You'll always need a monitor in his room."

Answer Families need and want information they can share with relatives, child care 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 child may be able to bike ride and swim with proper precautions.

Preterm infants have more fragile capillaries in the periventricular area than term infants. This put these infants at risk for which problem? congenital hydrocephalus early closure of the fontanels (fontanelles) moderate closed-head injury intracranial hemorrhaging

Answer Fragile capillaries in the periventricular area of the brain put preterm infants at risk for intracranial hemorrhage. Closure of the fontanels (fontanelles) 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 caring for an infant who is at risk for increased intracranial pressure. What statement by the parent would alert the nurse to further assess the child's neurological status? "She typically breastfeeds, but lately we have had to supplement with some rice cereal." "She has been irritable for the last hour....seems like she is just upset for some reason." "She is a pretty happy baby, unless her diaper is wet, then she cries until we change her diaper." "She always cries when the person holding her has on glasses...I guess glasses scare her."

Answer Irritability in an infant can be a sign of declining neurological function. Because infants are not able to answer questions pertaining to person, place and time, their neurological assessment must be catered to their level of development. The other responses would be typical and normal for an infant.

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

Answer 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 child who has suffered a head injury and has had an ICP monitor placed. Which prescription by the health care provider would the nurse question? Place in an indwelling urinary catheter. Administer dexamethasone, dosage determined by the pharmacist. Administer mannitol IV, dosage determined by the pharmacist. Initiate an IV of 0.9% NS to run at 250 ml/hr.

Answer Rapid administration of IV fluids may increase ICP. An IV rate of 250 ml/hr of normal saline can be considered a rapid infusion. Corticosteroids such as dexamethasone can reduce cerebral edema. Osmotic diuretics, such as mannitol, can reduce pressure. Because of the administration of the osmotic diuretic, indwelling urinary catheters are typically inserted.

The parents of a 17-year-old adolescent diagnosed with bacterial meningitis tell the nurse, "We just do not understand how this could have happened. Our adolescent has always been healthy and just received a booster vaccine last year." How should the nurse respond? "Meningococcal conjugate vaccine covers only two types of bacterial meningitis." "Your child may have been exposed to the type of meningitis that is not covered by the vaccine received." "Maybe your child's immune system is not strong enough to fight off the infection, even with having received the vaccine." "I understand your frustration. Unfortunately, immunizations are not 100% effective in preventing the infection."

Answer Showing empathy while letting the parents know that vaccines are not 100% effective is the best response. Meningococcal conjugate vaccine protects against four types of meningitis. There is nothing in the scenario to lead the nurse to believe that a different strain of bacteria caused the infection, or that the adolescent's immune system is compromised.

The nurse is caring for a school-aged child hospitalized with an infectious disease. The child is placed on transmission-based precautions. What would the nurse include in the plan of care? Select all that apply. Monitor the child for changes in mood or level of aggression. Permit the immediate family to avoid wearing the gown and mask during visits in the room. Provide the child with age-appropriate games and toys for his or her room. Plan for extra time to visit the child throughout the shift between assessments and procedures. Encourage the parents to contact friends and classmates so cards can be sent and displayed. Allow the child to view the staff's face through the door window before entering the room.

Answer The child in transmission-based isolation may experience feelings of isolation and sensory deprivation because of restricted visiting and the use of personal protective gear (gown, mask and gloves) by those in the child's hospital room. The use of age appropriate toys and games dedicated to the child's room, extra time spent with the child by staff, the display of cards from friends and classmates, and allowing the child to view staff members' faces from outside the room all promote sensory stimulation and lessen the feeling of isolation. The family would be taught to follow the same precautions as the staff. Sensory overload is not a concern for a child in transmission-based precautions.

The young child has been diagnosed with bacterial meningitis. Which nursing interventions are appropriate? Select all that apply. Initiate droplet isolation. Initiate seizure precautions. Administer antibiotics as ordered. Monitor the child for signs and symptoms associated with decreased intracranial pressure. Identify close contacts of the child who will require post-exposure prophylactic medication.

Answer The child with bacterial meningitis should be placed in droplet isolation until 24 hours following the administration of antibiotics. Close contacts of the child should receive antibiotics to prevent them from developing the infection. The nurse should administer antibiotics and initiate seizure precautions. Children with bacterial meningitis have an increased risk of developing problems associated with increased intracranial pressure.

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." "You probably don't have anything to worry about. It is common for toddlers to fall." "Most mothers are concerned because their toddlers fall a lot. As long as your child seems to be developmentally normal it shouldn't be a concern." "I understand your concern, but toddlers fall and hit their heads a lot since they are not very coordinated yet."

Answer 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.

During the newborn examination, the nurse notes that an infant who is appropriate for gestational age by birth weight has a head circumference below the 10th percentile and the fontanels (fontanelles) are not palpable. What action would the nurse take? Tell the parent the infant's brain is underdeveloped. Report the findings to the pediatric health care provider. Document that the infant has microcephaly. Reassess the head circumference in 24 hours.

Answer These findings are consistent with craniosynostosis, or premature fusion of the cranial sutures. Intervention is needed to prevent damage to the growing brain. Waiting 24 hours to reassess will delay treatment. In microcephaly, the head circumference is small, but the fontanels (fontanelles) and suture line are palpable.

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. padding for side rails oxygen gauge and tubing suction at bedside smelling salts tongue blade

Answer 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

The nurse is caring for a child admitted to the hospital for sepsis. Which assessment finding is the most concerning? white blood cell count 18,000/mm3 oral temperature 102.3°F (39°C) urine output of 10 ml over 3 hours apical heart rate 120 beats per minute

Answer urine output of 10 ml over 3 hours

The nurse is reinforcing teaching with the caregivers of a child being discharged from the urgent care setting following a mild head injury that occurred in a roller skating accident. What should the caregivers be instructed to do? Select all that apply. Administer acetaminophen for headache. Check the pupil reaction to light every 15 minutes for 12 hours. Observe and report any vomiting that occurs within 6 hours. Observe for and report to provider any double or blurred vision. Wake the child every 1 to 2 hours to check level of consciousness.

Answer A child with a concussion should be observed for at least 24 hours and the caregiver should be prepared to bring the child to the hospital if symptoms worsen. The child should be awakened every 2 hours to assess that the child wakes easily and has not developed neurological symptoms. The child should be brought back to the hospital if the child vomits within 6 hours of the injury or more than two times. Other signs for parents to watch for are increased sleepiness, a worsening headache, confusion, or poor balance or walking. No analgesics or sedatives should be administered during this period of observation. In the home the parents would not be checking pupil reaction.

The nurse is preparing a room for a child being admitted with meningitis. What is the appropriate action by the nurse? Ensure that lights and televisions work properly to provide stimulation while the child is hospitalized. Provide information regarding policies of the unit's playroom for the parents to review. Place multiple pillows in the room to assist with propping the child's head up. Gather appropriate equipment and signage for respiratory isolation precautions.

Answer Children with meningitis are placed on respiratory precautions for 24 hours after the start of antibiotic therapy to prevent transmission of the infection to other family members or health care providers. While a child is on respiratory isolation, they will typically not be allowed out of their rooms to play. Due to pain when their neck is flexed, most children are most comfortable without a pillow. Reducing stimulation can help to promote rest for the child.

The nurse is preparing a room for a child being admitted with meningitis. What is the appropriate action by the nurse? Place multiple pillows in the room to assist with propping the child's head up. Provide information regarding policies of the unit's playroom for the parents to review. Ensure that lights and televisions work properly to provide stimulation while the child is hospitalized. Gather appropriate equipment and signage for respiratory isolation precautions.

Answer Children with meningitis are placed on respiratory precautions for 24 hours after the start of antibiotic therapy to prevent transmission of the infection to other family members or health care providers. While a child is on respiratory isolation, they will typically not be allowed out of their rooms to play. Due to pain when their neck is flexed, most children are most comfortable without a pillow. Reducing stimulation can help to promote rest for the child.

with new-onset seizure disorder. Which prescription will the nurse anticipate for this client? frequent temperature assessment use of anticonvulsant medications ketogenic diet vagus nerve stimulation

Answer Complete control of seizures can be achieved for most people through the use of anticonvulsant drug therapy. These medications are typically used first as treatment for seizure disorders. Frequent temperature assessment would only be useful in febrile seizures. Ketogenic diets (high in fat, low in carbohydrates, and adequate in protein) cause the child to have high levels of ketones, which help to reduce seizure activity. Diet is generally used when medications cannot control a child's seizure activity. Stimulating the left vagus nerve intermittently with electrical pulses may reduce seizure frequency. This requires surgically implanting a stimulator under the skin and is approved for children 12 and older.

The nurse is preparing a care plan for a toddler diagnosed with cerebral palsy (CP). Which intervention would be appropriate for the nursing diagnosis of Risk for disuse syndrome related to spasticity of muscle groups? Select all that apply. Administer benzodiazepines as prescribed. Educate the child's parents that CP is a single name for a wide variety of disorders. Teach parents exercises and games to help prevent contractures. Encourage the parents to participate in speech therapy sessions to assist with speech development. Administer carbidopa/levodopa as prescribed.

Answer Dopaminergic drugs such as carbidopa/levodopa can help to reduce muscle rigidity and spasticity. Benzodiazepines also help with smoother muscle movement and reduce spasticity. Exercises and games, done daily, can help to prevent contractures from disuse. Interventions such as education about the disease and speech therapy are appropriate for clients with cerebral palsy but are not appropriate for the nursing diagnosis of Risk for disuse syndrome related to spasticity of muscle groups.

The nurse is caring for a child who has suffered a febrile seizure. While speaking with the child's parents, which statement by a parent indicates a need for further education? "The next time he has a fever, I need to make sure I read the dosage on the acetaminophen bottle carefully." "I need to set an alarm to wake up and check his temperature during the night when he is sick." "I hate to think that I will need to be worried about my child having seizures for the rest of his life." "When he gets his next set of immunizations, I need to make sure I give him some ibuprofen so he doesn't spike a fever."

Answer Febrile seizures occur most often in preschool children but can occur as late as 7 years of age. They occur when the child has a rapid rise in temperature and are not associated with the development of seizures later in life. Administering correct dosages of acetaminophen and ibuprofen, checking temperatures at night, and anticipating fevers associated with the administration of live vaccines are all ways to prevent the development of febrile seizures.

The nurse is discussing fever with the parents of a child who is in the emergency department with a temperature of 101°F (38.3°C). Which statement by a parent indicates an understanding of fevers and their management in the ill child? "Fevers can be beneficial because they can slow down the growth of the bacteria or virus that may be causing the infection." "My wife and I have been using cold water and washcloths on him because of the fever." "We've had to wake him up in the night to give him more medicine to reduce his temperature." "We've been giving him a little extra acetaminophen to help bring his fever down."

Answer Fevers can be protective and can help the body fight the infection. Fevers slow down bacterial or viral growth. Mismanaging fevers include inappropriate dosing of antipyretics, awakening a child at night to administer antipyretics, and using cold water or sponging the child with alcohol to reduce the temperature.

The nurse provides education to the parent of an infant being treated for hydrocephalus with a ventriculoperitoneal (VP) shunt. Which statement by the parent indicates the need for further instruction? "The VP shunt will help drain fluid from my baby's brain." "My baby's cerebrospinal fluid is increasing intracranial pressure." "This shunt is the only surgery my baby will need." "I will watch my baby for irritability and difficulty feeding."

Answer Hydrocephalus 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 subsequently occur. A VP shunt can be used to drain excess CSF, but it will need to be replaced as the child grows, requiring shunt revision surgery at various times during the client's life. The parent should be taught to monitor for signs and symptoms of increased ICP, which include irritability and vomiting. Increased ICP indicates the shunt is not functioning properly.

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

Answer Increased intracranial pressure (ICP) may be caused by several factors: head trauma, birth trauma, hydrocephalus, infection, and/or tumors. Whatever the reason, the brain swells and becomes inflamed. Dexamethasone is a steroid. A steroid may be prescribed to reduce inflammation and pressure on vital centers of the brain. The diuretic mannitol may be used to decrease edema. An anticonvulsant is used with increased ICP to prevent seizures. An antihistamine would not be warranted for the treatment of a head injury.

A nurse is preparing a presentation for parents about common childhood infectious diseases. What conditions would the nurse include as being caused by a tick bite? Select all that apply. Psittacosis Ascariasis Rocky Mountain spotted fever Lyme disease Scabies

Answer Infectious diseases caused by tick bites include Lyme disease and Rocky Mountain spotted fever. Psittacosis is transmitted to children by birds. Ascariasis is a roundworm infection. Scabies is a parasitic infection caused by a female mite

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? "A lumbar puncture is a routine test that is performed anytime someone has a seizure disorder." "I know it must be frustrating not having a diagnosis yet, but you have to be patient. Seizure disorders are difficult to diagnose." "The lumbar puncture can help rule out any infection in fluid surrounding the brain and spinal cord as the cause of the seizures." "Since the EEG was negative there must be some other cause for the seizures. The lumbar puncture is necessary to determine what the cause is."

Answer 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.

A nurse is reviewing the results of a lumbar puncture of a child. The nurse identifies which results as being abnormal? Select all that apply. cloudy in color trace amounts of protein specific gravity of 1.011 trace amounts of glucose granulocytes are present

Answer Normal appearance of cerebrospinal fluid (CSF) is clear and colorless. The presence of granulocytes suggests a cerebrospinal fluid infection. Normal specific gravity is 1.004 to 1.008. Trace amounts of protein, glucose, lymphocytes, and body salts are normal.

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." "Lay him down after feeding." "You'll see a big difference after the surgery." "You won't need to change diapers often."

Answer 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.

A 6-year-old boy is suspected of having late-stage Lyme disease. Which assessment should the nurse use to produce findings supporting this concern? observing for facial palsy examining for conjunctivitis inspecting for erythema migraines asking the child if his knees hurt

Answer Recurrent arthritis in large joints such as the knees is an indication of late-stage Lyme disease. The appearance of erythema migraines would suggest early-localized stage of the disease. Facial palsy or conjunctivitis would suggest the child is in the early disseminated stage of the disease.

The parents of a 17-year-old adolescent diagnosed with bacterial meningitis tell the nurse, "We just do not understand how this could have happened. Our adolescent has always been healthy and just received a booster vaccine last year." How should the nurse respond? "Meningococcal conjugate vaccine covers only two types of bacterial meningitis." "Maybe your child's immune system is not strong enough to fight off the infection, even with having received the vaccine." "I understand your frustration. Unfortunately, immunizations are not 100% effective in preventing the infection." "Your child may have been exposed to the type of meningitis that is not covered by the vaccine received."

Answer Showing empathy while letting the parents know that vaccines are not 100% effective is the best response. Meningococcal conjugate vaccine protects against four types of meningitis. There is nothing in the scenario to lead the nurse to believe that a different strain of bacteria caused the infection, or that the adolescent's immune system is compromised.

The nurse is caring for a hospitalized infant at risk for developing increased intracranial pressure. Which assessment finding(s) would the nurse communicate to the health care provider for further intervention? Select all that apply. pulse rate of 60 beats/min and regular increased head circumference vomiting blood pressure decreased from baseline parent states, "My infant does not act right."

Answer Signs of increased intracranial pressure include bulging fontanel ([fontanelle] increased head circumference), decreased pulse, vomiting, increased blood pressure and behavior changes. The nurse must listen to the parents if concerns about behavior are mentioned. The blood pressure would increase, not decrease. The nurse would alert the health care provider immediately of these signs so intervention can be started if needed.

The nurse at an outpatient facility is obtaining a blood specimen from a 9-year-old girl. Which technique would most likely be used? Accessing an indwelling venous access device. Using an automatic lancet device on the heel. Puncturing a vein on the dorsal side of the hand. Administering sucrose prior to beginning.

Answer The usual sites for obtaining blood specimens are veins on the dorsal side of the hand or the antecubital fossa. Administration of sucrose prior to beginning helps control pain for young infants. Accessing an indwelling venous access device may be appropriate if the child is in an acute care setting. An automatic lancet device is used for capillary puncture of an infant's heel.

During the newborn examination, the nurse notes that an infant who is appropriate for gestational age by birth weight has a head circumference below the 10th percentile and the fontanels (fontanelles) are not palpable. What action would the nurse take? Report the findings to the pediatric health care provider. Tell the parent the infant's brain is underdeveloped. Document that the infant has microcephaly. Reassess the head circumference in 24 hours.

Answer These findings are consistent with craniosynostosis, or premature fusion of the cranial sutures. Intervention is needed to prevent damage to the growing brain. Waiting 24 hours to reassess will delay treatment. In microcephaly, the head circumference is small, but the fontanels (fontanelles) and suture line are palpable.

The nurse is caring for a child with a suspected head injury. The nurse observes for what response to the child's eye reflex examination that would indicate potential increased intracranial pressure (ICP)? While stimulating the child's foot, the big toe points upward and other toes fan outward. While calling the child's name, the child stares straight ahead and does not turn to the sound. While turning the child's head to the left, the eyes turn to the right. While assessing the child's pupils, there is no change in diameter in response to a light.

Answer To perform the child's eye reflex examination, the nurse will shine a penlight into the eyes and observe if the pupils constrict, which is a normal response. Lack of pupillary light reflex can indicate increased intracranial pressure (ICP). To perform the "doll's eye" reflex examination, the nurse will place the child in a supine position and move the head gently but rapidly to one side. During this movement, it is normal for the child's eye to move to the opposite side. If the child has increased ICP, this response will be absent. While the other options are potential signs of increased ICP, they do not demonstrate the child's eye reflex examination.

The nurse is caring for a child with a suspected head injury. The nurse observes for what response to the child's eye reflex examination that would indicate potential increased intracranial pressure (ICP)? While turning the child's head to the left, the eyes turn to the right. While stimulating the child's foot, the big toe points upward and other toes fan outward. While assessing the child's pupils, there is no change in diameter in response to a light. While calling the child's name, the child stares straight ahead and does not turn to the sound.

Answer To perform the child's eye reflex examination, the nurse will shine a penlight into the eyes and observe if the pupils constrict, which is a normal response. Lack of pupillary light reflex can indicate increased intracranial pressure (ICP). To perform the "doll's eye" reflex examination, the nurse will place the child in a supine position and move the head gently but rapidly to one side. During this movement, it is normal for the child's eye to move to the opposite side. If the child has increased ICP, this response will be absent. While the other options are potential signs of increased ICP, they do not demonstrate the child's eye reflex examination.

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? "You'll always need a monitor in his room." "Bike riding and swimming are just too dangerous." "Use this information to teach family and friends." "If he is out of bed, the helmet's on the head."

Answer 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

child has been diagnosed with a basilar skull fracture. The nurse identifies ecchymosis behind the child's ear. This would be documented as: raccoon eyes. Battle sign. rhinorrhea. otorrhea.

Answer 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

A child has been having episodes of diarrhea. The health care provider prescribes stool collection to assess for parasites. Before obtaining the stool specimen, what question should the nurse ask? "Have you given your child any antidiarrheal medication containing bismuth?" "How many doses of antidiarrheal medications have you given your child in the last 24 hours?" "Has your child taken any antidiarrheal medications today?" "Has your child taken any antidiarrheal medications containing loperamide?"

Answer A "Have you given your child any antidiarrheal medication containing bismuth ?

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) Occurrence of urine and fecal contamination Degree and extent of nuchal rigidity Onset and character of fever

Answer A 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 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. rhinorrhea. raccoon eyes. otorrhea.

Answer 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.

A 10-year-old child has an unknown infection and will need to provide a urine specimen for culture and sensitivity. To assure that the sensitivity results are accurate, which step is most important? Obtain specimen before antibiotics are given. Use aseptic technique when getting the specimen. Collect three specimens on three different days. Ensure that the specimen is obtained from proper area.

Answer a In order to ensure a successful culture, the nurse must determine if the child is taking antibiotics. Throat cultures require specimens taken from the pharyngeal or tonsillar area. Stool cultures may require three specimens, each on a different day. The nurse would use aseptic technique when getting a blood specimen as well as the urine, but antibiotics cannot be received by the child prior to the test being done.

A 6-year-old child is being treated for a parasitic infection. When reviewing results from the child's white blood cell count, which finding would be anticipated? reduced neutrophil levels elevated monocytes reduced basophil levels increased eosinophil levels

Answer d Eosinophils are the first line of defense against parasitic infections and allergic reactions and will be elevated. Monocytes are a second line of defense and will be elevated in response to leukemias, lymphomas, and chronic inflammation. Basophils respond to allergic disorders and hypersensitivity reactions. Neutrophils are the first line of defense upon invasion of bacteria, fungus, cell debris, and other foreign substances.

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

Answer d Increased intracranial pressure (ICP) may be caused by several factors: head trauma, birth trauma, hydrocephalus, infection, and/or tumors. Whatever the reason, the brain swells and becomes inflamed. Dexamethasone is a steroid. A steroid may be prescribed to reduce inflammation and pressure on vital centers of the brain. The diuretic mannitol may be used to decrease edema. An anticonvulsant is used with increased ICP to prevent seizures. An antihistamine would not be warranted for the treatment of a head injury.

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? "I know it must be frustrating not having a diagnosis yet, but you have to be patient. Seizure disorders are difficult to diagnose." "A lumbar puncture is a routine test that is performed anytime someone has a seizure disorder." "The lumbar puncture can help rule out any infection in fluid surrounding the brain and spinal cord as the cause of the seizures." "Since the EEG was negative there must be some other cause for the seizures. The lumbar puncture is necessary to determine what the cause is."

Answer"The lumbar puncture can help rule out any infection in fluid surrounding the brain and spinal cord as the cause of the seizures."

The nurse is caring for a female child in a pediatric intensive care unit who was struck by lightening while playing softball. The parents state to the nurse, "I don't understand why our child has to be here; the doctor said she was fine?" What is the best response by the nurse? "It is standard protocol to admit a burn client for surveillance; especially if it is an electrical injury." "It's just a precautionary measure. It's better to be safe than sorry if she develops complications." "You should speak with your doctor because that is who admitted your daughter to this unit." "A child who has suffered an electrical burn can develop cardiac arrhythmias up to 72 hours after a burn injury, so we need to monitor her."

answer Electrocardiographic monitoring is important for the child who has suffered an electrical burn to identify cardiac arrhythmias, which can be noted for up to 72 hours after a burn injury; therefore, informing the parents that this is why the child has been admitted effectively answers their question. "If she develops complications" is very elusive and may frighten the parents.

The nurse is teaching parents about the care of diaper rash. The nurse would be concerned about the parents' level of understanding if they made which statement? "I should only use ointments and creams as instructed by the health care provider." "I should not overdress the infant." "I need to wash and rinse clothes thoroughly to be sure all of the detergent is washed out." "I should be certain to use fabric softener in the care of the infant's clothes."

answer Fabric softeners should be avoided because their use can result in skin irritation in the infant. Clothing and other baby items should be washed and rinsed thoroughly. Overdressing should be avoided as sweating irritates the rash, and only ointments and creams that are recommended by health care personnel should be used on the infant.

The nurse has completed client teaching with a 16-year-old female who has been prescribed isotretinoin for cystic acne. Which statements indicate learning has occurred? Select all that apply. "As long as I use two forms of birth control I don't need to have monthly pregnancy testing." "I am young so I won't need to have the liver tests the pamphlet suggests." "It's important I get my CBC blood test when my doctor orders it." "This is not a drug to be used for all forms of acne. My sister has minor acne so I told her this wasn't for her." "If I am sexually active I need to let my doctor know."

answer Accutane (isotretinoin) is a powerful medication used for severe forms of acne and cystic acne when other treatment methods are not effective. Sexual activity should be reported to the physician. Some physicians may order monthly pregnancy tests even if the client says she is not sexually active because of the risk of birth defects to a fetus. No matter what form of birth control is used, pregnancy is possible, so monthly pregnancy tests are still necessary. Liver function tests are important regardless of age because of the side effects of the medication. Any labs ordered by the physician, such as the CBC, to monitor the medication's side effects should be obtained.

Which intervention is the most beneficial for a burn client undergoing a skin graft? Provide around-the-clock pain medication as soon as pain is reported. Provide pain medication on a PRN schedule as soon as pain is reported. Provide an egg-crate mattress or gel mattress for the client to lie upon. Provide diversional activities for the client.

answer A When the child undergoes a procedure, such as skin grafting, that is known to produce prolonged pain, administer pain medication on a scheduled basis, rather than as needed once pain is reported. Around-the-clock pain medication will serve to diminish peaks and valleys in pain relief. Diversional activities and an egg-crate mattress are not effective treatments for severe pain.

The nurse is caring for a child with suspected child abuse (child mistreatment)-induced burns. Which assessment findings would support this? splattered-looking, small burned areas to both legs a burn to the entire right hand up to 2 cm above wrist with consistent edges 911 called immediately after the burn occurred consistent history given by all caregivers

answer B A stocking/glove pattern on the hands or feet (circumferential ring appearing around the extremity, resulting from a caregiver forcefully holding the child under extremely hot water) is one sign of child abuse (child mistreatment)-induced burns. Inconsistent history given by caregivers, delay in seeking treatment by caregivers, and a lack of splattering of water burns are all indicators of child abuse (child mistreatment)-induced burns.

The nurse is caring for an infant who has impetigo and is hospitalized. Which nursing action is priority? The nurse applies elbow restraints to the infant. The nurse follows contact precautions. The nurse soaks the skin with warm water. The nurse applies topical antibiotics to the lesions.

answer B Impetigo is highly contagious and can spread quickly. The nurse should follow contact (skin and wound) precautions, including wearing a cover gown and gloves. The nurse will soak the crusts with warm water, apply topical antibiotics, and apply elbow restraints, but these are not as high a priority as trying to prevent the spread of the infection by following contact precautions.

A nurse is assessing a 6-month-old girl with an integumentary disorder. The nurse notes three virtually identically sized, round red circles with scaling that are symmetrically spaced on both of the girl's inner thighs. What should the nurse ask the mother? "Do you change her diapers regularly?" "Does she wear sleepers with metal snaps?" "Tell me about your family history of allergies." "Has she been exposed to poison ivy?"

answer B Small round red circles with scaling, symmetrically located on the girl's inner thighs, point to nickel dermatitis that may occur from contact with jewelry, eyeglasses, belts, or clothing snaps. The nurse should inquire about any sleepers or clothing with metal snaps. The girl does not have a rash in her diaper area. It is unlikely that an infant this age would have her inner thighs exposed to a highly allergenic plant. Discussing family allergy history is important, but the nurse should first inquire about any clothing with metal that could have come into contact with the girl's skin when she displays a symmetrical rash.

Which intervention is the most beneficial for a burn client undergoing a skin graft? Provide pain medication on a PRN schedule as soon as pain is reported. Provide around-the-clock pain medication as soon as pain is reported. Provide diversional activities for the client. Provide an egg-crate mattress or gel mattress for the client to lie upon.

answer B When the child undergoes a procedure, such as skin grafting, that is known to produce prolonged pain, administer pain medication on a scheduled basis, rather than as needed once pain is reported. Around-the-clock pain medication will serve to diminish peaks and valleys in pain relief. Diversional activities and an egg-crate mattress are not effective treatments for severe pain.

The nurse is discussing dietary intake with the parents of a 4-year-old child who has been diagnosed with atopic dermatitis. Later, the nurse notes the menu selection made by the parents for the child. Which selection indicates the need for further instruction? chicken nuggets carrot and celery sticks peanut butter and jelly sandwich tomato soup

answer C Atopic dermatitis is commonly associated with allergies to food. Common culprits may include peanuts, eggs, orange juice, and wheat-containing products.

The nurse is presenting an in-service to a group of nurses who will be working in a dermatology clinic. One participant asks the nurse about a bacterial skin infection that she has seen in children that involves honey-colored crusted lesions. The nurse most likely is referring to: seborrheic dermatitis. candidiasis. impetigo. miliaria rubra (heat rash).

answer C Impetigo is a superficial bacterial skin infection. Impetigo in the newborn is usually bullous (blister-like, fluid filled); in the older child, the lesions are nonbullous and have a honey-colored, crusted appearance.

The nurse is caring for a child with a prescription for PO prednisone. Which statement by the child's mother would indicate a need for further education? "I will have to watch my child closely for signs of infection." "Since my child has type 1 diabetes, I will need to monitor my child's blood sugar levels closely while on this medication. "My child should take the entire prescription as prescribed by the health care provider." "I will give it to My child at least 1 hour before all meals."

answer D Systemic corticosteroids such as prednisone should be administered with food to decrease gastrointestinal upset. These medications may mask signs of infection. This medication may increase blood sugar levels. Corticosteroid doses should be tapered and should not be stopped abruptly.

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: The child's history indicates she has infantile seizures. The child may begin to have absence seizures every day. The child is in status epilepticus. The child is having generalized seizures.

answer C 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.

The nurse is caring for a child diagnosed with hydrocephalus following ventriculoperitoneal shunt placement. The child is currently on a ventilator. Which nursing action is priority? Monitor the client for signs of infection. Measure the client's head circumference. Assess the client's respiratory status. Educate the family on the shunt.

answer C The nurse would place priority on monitoring the client's respiratory status since the client is on a ventilator and at risk for intracranial pressure. The nurse would educate the family on the shunt, monitor for infection, and measure head circumference; however, these actions are not priority over ensuring the client maintains a patent airway

A 9-year-old boy is suffering from headaches but has no signs of physical or neurologic illness. Which intervention would be most appropriate? Have the parents call the doctor if the child vomits more than twice. Have the child sleep without a pillow under his head. Review the signs of increased intracranial pressure with parents. Teach the child and his parents to keep a headache diary.

answer D 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.

The parents of a child recently diagnosed with atopic dermatitis voice concern to the nurse that their child may develop asthma at some point. How should the nurse respond? "If your child starts having respiratory difficulties, be sure to let your health care provider know." "All children with atopic dermatitis develop both asthma and hay fever, so we will monitor your child for both conditions." "I am not sure why you think a skin disorder would lead to asthma?" "I can understand your concern. We will closely monitor your child for asthma development."

answer D Atopic dermatitis (eczema) is one of the disorders in the atopy family (along with asthma and allergic rhinitis [hay fever]). About 30% to 35% of children who have atopic dermatitis will also develop allergic rhinitis (hay fever) and/or asthma. Therefore, the child will be monitored for the development of asthma.

A newborn has a generalized rash on the skin, which the nurse identifies as erythema toxicum neonatorum. Which information would the nurse include when explaining the condition to the newborn's parent? "This is a normal newborn rash; do not be so worried." "What you see on your newborn's skin is erythema toxicum neonatorum. It is a common newborn skin condition. You will need to apply a topical cream twice a day until it disappears." "What you see on your newborn's skin is erythema toxicum neonatorum. It is an extensive skin condition that is rare in newborns. You will need to treat the infant as soon as possible to prevent its spread." "What you see on your newborn's skin is erythema toxicum neonatorum. It is a common newborn skin condition that typically resolves on its own in about 1 week. There is nothing special you will need to do for this."

answer D Erythema toxicum neonatorum (ETN), or neonatal erythema, is one of the more well-known benign, self-limiting skin eruptions in the newborn period. Incidence estimates range from 50% to 70% of all healthy newborns. The rash usually remits within 1 week with no treatment. It is never appropriate to tell a mother not to be so worried.

Which assessment finding by the nurse would warrant immediate action? A child has a red, warm, edematous area over an old spider bite. A child with cellulitis has a temporal temperature of 101°F (38.3°C). A child with impetigo has honey-colored drainage noted on the skin area. A child with periorbital cellulitis reports changes in vision and pain with eye movement.

answer D In a child with periorbital cellulitis, the nurse musty notify the health care provider immediately if signs of progression to orbital cellulitis occur, such as conjunctival redness, change in vision, pain with eye movement, eye muscle weakness or paralysis, or proptosis. This assessment finding warrants immediate action. In nonbullous impetigo, a honey-colored exudate when the vesicles or pustules rupture may be noted on the skin. This assessment finding would be expected. A localized cellulitis will present with erythema, pain, edema, and warmth at the site of the skin disruption (such as a cut or spider bite). This assessment finding warrants further follow-up but not immediate attention. Fever may occur with bullous impetigo or cellulitis and is common with scalded skin syndrome; therefore, this assessment finding also warrants further, but not immediate, follow-up.

Which assessment finding by the nurse would warrant immediate action? A child with impetigo has honey-colored drainage noted on the skin area. A child with cellulitis has a temporal temperature of 101°F (38.3°C). A child has a red, warm, edematous area over an old spider bite. A child with periorbital cellulitis reports changes in vision and pain with eye movement.

answer D In a child with periorbital cellulitis, the nurse musty notify the health care provider immediately if signs of progression to orbital cellulitis occur, such as conjunctival redness, change in vision, pain with eye movement, eye muscle weakness or paralysis, or proptosis. This assessment finding warrants immediate action. In nonbullous impetigo, a honey-colored exudate when the vesicles or pustules rupture may be noted on the skin. This assessment finding would be expected. A localized cellulitis will present with erythema, pain, edema, and warmth at the site of the skin disruption (such as a cut or spider bite). This assessment finding warrants further follow-up but not immediate attention. Fever may occur with bullous impetigo or cellulitis and is common with scalded skin syndrome; therefore, this assessment finding also warrants further, but not immediate, follow-up.

The nurse is discussing acne vulgaris with a group of adolescents. The teenagers make the following statements regarding the topic. Which statement is the most accurate regarding acne vulgaris? "My mom says I have acne because I eat too much chocolate." "Sometimes I get acne when I use my sister's makeup." "My next door neighbor told me that acne was caused by a fungus." "There is a new immunization that you can get to keep from having acne."

answer b Irritation and irritating substances, such as vigorous scrubbing and cosmetics with a greasy base, can cause acne vulgaris. Increased hormone levels, hereditary factors, and anaerobic bacteria can cause acne vulgaris as well. Eating chocolate and fatty foods does not cause acne, but a well-balanced, nutritious diet does promote healing.

A 6-year-old child is diagnosed with tinea pedis. Which prescription will the nurse question? Cleanse the skin with antibacterial soap. luliconazole cream daily for 2 weeks The child may return to school in 1 week. Perform warm foot soaks daily.

answer c Tinea pedis refers to a fungal infection that typically begins between the toes. The nurse would question the child being out of school for a week. While these infections are highly contagious, children can return to school once treatment is started. Tinea pedis can be treated with topical or oral antifungals or a combination of both. Topical agents, such as luliconazole, are used for 1 to 6 weeks, depending on the brand. Antibacterial soaps help reduce the risk of infection to the affected area. Warm soaks may help soothe painful muscles or joints and can help drain skin infections, if present.