Hesi Peds
The practical nurse (PN) is caring for a toddler who is admitted for cleft palate repair. Which type of restraint should the PN prepare to apply in the postoperative period? a. Wrist b. Mummy c. Elbow d. Jacket
c. Elbow Rationale:Elbow restraints prevent children from bending their arms and bringing their hands to the oral surgical site.
The practical nurse (PN) is caring for a child with an acute respiratory condition. When the PN is monitoring for impending respiratory distress, what sign is the child likely to exhibit first? a. Cyanosis b. Sternal retraction c. Restlessness d. Crowing respiration
c. Restlessness Rationale:Restlessness is an early sign of hypoxemia.
The practical nurse (PN) is assessing an 8-month-old who has a medical diagnosis of tetralogy of Fallot. The child demonstrates cyanosis with crying and exertion. Which other symptom is this infant most likely to exhibit? a. Bradycardia b. Squatting posture c. Weak pedal pulses d. Clubbed fingers
d. Clubbed fingers Rationale:Tetralogy of Fallot, a cyanotic heart defect, causes clubbing of fingers and toes resulting from tissue hypoxia.
The health care provider prescribes amoxicillin 60 mg PO three times a day for a child who weighs 13 pounds. The pediatric dosage range is 20 to 40 mg/kg/day in three equal doses. What is the maximum dosage in 24 hours that should be given? (Fill in the blank.)
236 mg Rationale:First, convert the pounds to kg because the conversion is for kg.1 kg = 2.2 lb13 lb/(2.2 lb/kg) = 5.9 kgSecond, determine the maximum dose the child can have in 24 hours: 40 mg × 5.9 kg = 236 mg. The maximum dose the child can have is 236 mg.
A child with poison ivy weighs 25 kg and receives a prescription for diphenhydramine PO 5 mg/kg. The medication is available as a 125 mg/5 mL solution. How many milliliters should the practical nurse administer? (Fill in the blank.)
5 ml Rationale:First determine how much of the drug the child should get.The order is 5 mg/kg. Multiply 5 mg by the child's weight. 5 mg × 25 kg = 125 mg.The child would get 125 mg.Next, determine how many milliliters to administer using the following formula:Desired dose/available dose × mL/dose of available drug = mL to administer125/125 × 5 mL = 5 mL
An 11-year-old boy is admitted after being hit in the head with a baseball during a Little League game. Which subject is most important for the practical nurse to explore during history taking? A. Inspection of wound for lacerations and bleeding. B. Description of the character and quality of pain. C. Independent observer's account of the event. D. The level of consciousness exhibited after the injury.
D. The level of consciousness exhibited after the injury. Rationale:The priority concern when taking the history involving a head injury is to determine the level of consciousness following the injury.
A child is admitted to the hospital for confirmation of a diagnosis of acute lymphoblastic leukemia. When performing a nursing assessment, which symptoms that are commonly manifested by this condition should the practical nurse (PN) observe in the child? a. Bone pain, pallor b.Weakness, tremors c.Nystagmus, anorexia d.Fever, abdominal distention
a. Bone pain, pallor Rationale:Bone pain and pallor are the most common presenting symptoms of leukemia. Leukemic cells invade the bone marrow, gradually causing a weakening of the bone and a tendency toward pathological fractures. As leukemic cells invade the periosteum, increasing pressure causes severe pain and anemia results from decreased erythrocytes, causing pallor.
Which action should the practical nurse (PN) implement first when obtaining the tympanic temperature of a 2-year-old child? a. Point the thermometer probe tip anteriorly. b. Remove drainage from the external auditory meatus. c. Apply the probe cover to the electronic thermometer. d. Ask the mother to help stabilize the child's head.
c. Apply the probe cover to the electronic thermometer. Rationale:Before a tympanic temperature is obtained, the equipment should be prepared for use without manipulating the electronic thermometer in front of the child, so a clean probe cover should be applied first.
A short arm cast is applied to a child with a fractured right ulna. The practical nurse (PN) is preparing the parents with home instructions and should reinforce that the parents follow which discharge instruction? a. Call the health care provider immediately if the nail beds appear "blue" or "empty." b. Check the child's ability to move his fingers without pain hourly for the first 48 hours. c. Elevate the arm above the heart for the first 24 hours. d. Monitor temperature every 4 hours for the next 2 days and call if an elevation is noted.
a. Call the health care provider immediately if the nail beds appear "blue" or "empty." Rationale:Cyanosis indicates impaired circulation to the fingers and should be reported immediately.
The parents of a 7-month-old infant with spastic cerebral palsy bring him to the pediatric clinic. Which symptom reported by the parents warrants immediate intervention by the practical nurse (PN)? a. Choking while being fed. b. The child's legs continually cross each other. c. Child gets stiff when shifting to a sitting position. d. Older sibling is jealous of the younger sibling.
a. Choking while being fed. Rationale:Aspiration is a priority when caring for an infant with cerebral palsy and dysphagia.
A full-term infant is admitted to the newborn nursery. During the initial PO feeding, the practical nurse (PN) observes the infant for possible tracheal esophageal atresia. Which symptoms are likely to be exhibited during the feeding if this condition is present? a. Choking, coughing, and cyanosis b. Projectile vomiting and cyanosis c. Apneic spells and grunting d. Scaphoid abdomen and anorexia
a. Choking, coughing, and cyanosis Rationale:Choking, coughing, and cyanosis are the "3 Cs" of esophageal atresia caused by the overflow of secretions into the trachea.
A 2-year-old child had tympanostomy ventilating tubes inserted into both tympanic membranes (TMs) 1 week earlier. During a postoperative clinic visit, the practical nurse (PN) notes that the child has a purulent discharge from the right ear, and the mother explains that the toddler has had a cold for 3 days. What action should the PN plan to implement? a. Collect a specimen of the otorrhea for culture. b. Refer the child for audiologic screening tests. c. Administer prescribed antibiotics. d. Perform an otoscopic exam for TM tube placement.
a. Collect a specimen of the otorrhea for culture. Rationale:The presence of the purulent drainage indicates that the middle ear is draining a new infectious process, and a specimen of the otorrhea should be collected for culture. Tympanostomy tubes are surgically placed to manage otitis media with effusion (OME) to provide mechanical drainage of fluid and to equalize pressure within the middle ear. Chronic OME can impede TM and ossicle function, necessitating hearing screening. The immediate problem, however, is infection.
A 2-year-old child who is hospitalized with an acute upper respiratory infection (URI) is crying uncontrollably because her mother went to the cafeteria for lunch. Which action should the practical nurse implement? a. Distract the child with a favorite toy. b. Tell the child that her mother will return. c. Take the child to the cafeteria. d. Calm the child with a dietary treat.
a. Distract the child with a favorite toy. Rationale:The best action is to refocus the child's attention by distracting with a favorite toy.
The practical nurse (PN) is assessing a child with asthma for retractions during respirations. When should the PN recognize the absence or presence of intercostal retractions? a. Inspiration b. Coughing c. Apneic episodes d. Expiration
a. Inspiration Rationale:Intercostal retractions result during the respiratory effort to draw air into restricted airways.
A child with acute appendicitis who is scheduled for surgery in 3 hours is complaining of abdominal pain. Which intervention should the practical nurse implement? a.Assist the child into a position of comfort b.Withhold administration of a narcotic analgesic. c.Place a warm compress over the tender area. d.Offer to provide the child with warm tea or broth.
a.Assist the child into a position of comfort Rationale:Placing the child in a position of comfort best minimizes abdominal pain related to intra-abdominal inflammation of the appendix.
The nurse is preparing a child for transport to the operating room for an emergency appendectomy. The anesthesiologist prescribes atropine sulfate IM STAT. What is the primary purpose for administering this drug to the child at this time? a.Decrease the oral secretions. b.Reduce the child's anxiety. c.Potentiate the opioid effects. d.Prevent possible peritonitis.
a.Decrease the oral secretions. Rationale:Atropine sulfate (Atropine), an anticholinergic agent, is given to decrease oral secretions during a surgical procedure.
The nurse observes that a 3-year-old child combines words in short phrases and understands the concepts of hot and cold and big and little. Which intervention should the PN implement? a.Document that the child's expressive speech is age appropriate. b.Request immediate referrals for speech and hearing evaluations. c.Review the child's history for prior evaluations of developmental lags. d.Ask the parent to leave the room so that findings can be reevaluated.
a.Document that the child's expressive speech is age appropriate. Rationale:A 3-year-old should be able to distinguish between common opposites and speak in short phrases, so the child's age-appropriate speech pattern should be documented.
A child with cystic fibrosis is receiving ticarcillin disodium for Pseudomonas pneumonia. What adverse effect should the nurse assess for and report promptly to the health care provider? a.Petechiae b.Tinnitus c.Oliguria d.Hypertension
a.Petechiae Rationale:Adverse effects of ticarcillin disodium include hypothrombinemia and decreased platelet adhesion, which can result in the presence of petechiae.
The practical nurse (PN) is preparing a child with an intussusception for a prescribed barium enema. The PN should explain to the parent that the purpose for conducting this procedure before surgical intervention is to achieve what objective? a.Evacuate the bowel of impacted feces. b.Reduce the invaginated bowel segment. c.Locate the presence of diverticula. d.Identify the area of esophageal atresia.
b.Reduce the invaginated bowel segment. Rationale:Intussusception, an invagination or telescoping of one portion of the intestine into another, causes intestinal obstruction in children (usually occurs between 3 months and 5 years of age). Nonsurgical treatment is attempted with hydrostatic pressure created by barium instillation, which often reduces the area of bowel intussusception, thereby negating the need for surgical intervention.
Minocycline 50 mg PO every 8 hours is prescribed for a 18-year-old adolescent girl diagnosed with acne. The nurse discusses self-care with the client while she is taking the medication. Which teaching points should be included in the discussion? (Select all that apply.) a.Report vaginal itching or discharge. b.Take the medication at 0800, 1500, and 2200 hours. c.Protect skin from natural and artificial ultraviolet light. d.Avoid driving until response to medication is known. e.Take with an antacid tablet to prevent nausea. f.Use a nonhormonal method of contraception if sexually active.
a.Report vaginal itching or discharge. c.Protect skin from natural and artificial ultraviolet light. d.Avoid driving until response to medication is known. f.Use a nonhormonal method of contraception if sexually active. Rationale:Adverse effects of tetracyclines include superinfections, photosensitivity, and decreased efficacy of oral contraceptives. Therefore, the client should report vaginal itching or discharge, protect the skin from ultraviolet light, and use a nonhormonal method of contraception while on the medication. Minocycline (Minocin) is known to cause dizziness and ataxia, so until the client's response to the medication is known, driving should be avoided.
The practical nurse (PN) should take the vital signs of a 4-month-old child in which sequence to collect the most accurate results? a.Respiratory rate, heart rate, then axillary temperature b.Heart rate, axillary temperature, then respiratory rate c.Axillary temperature, heart rate, then respiratory rate d.Axillary temperature, respiratory rate, then heart rate
a.Respiratory rate, heart rate, then axillary temperature Rationale:The respiratory rate should be taken first in infants, because touching them or performing unpleasant procedures usually makes them cry, which elevates the heart rate and makes respirations difficult to count.
A 15-year-old male with mild mental retardation who is hospitalized for minor surgery tells a female practical nurse (PN), "Wow, you have big ones." Which response is best for the PN to make? a. "Do you really think so?" b. "That language is not permitted." c. "You should nt speak to me like that, such language offends me." d. "Ill notify your parents if you continue to talk that way."
b. "That language is not permitted." Rationale:Limit setting is necessary for inappropriate behavior or suggestive interaction. Sets limits without threatening or degrading the client.
A 2-month-old infant is scheduled to receive the first DPT immunization. What is the preferred injection site to administer this immunization? a. Dorsal gluteal b. Vastus lateralis c. Ventral gluteal d. Deltoid
b. Vastus lateralis Rationale:The preferred intramuscular site for children younger than 2 years of age is the vastus lateralis.
The mother of a 6-month-old asks the practical nurse (PN) when her baby will get the first measles, mumps, and rubella (MMR) vaccine. Based on the recommended childhood immunization schedule published by the Centers for Disease Control and Prevention, which response is accurate? a.3 to 6 months b.12 to 15 months c.18 to 24 months d.4 to 6 years
b.12 to 15 months Rationale:The first measles, mumps, and rubella (MMR) vaccine should be given no sooner than 12 months of age, and ideally between 12 and 15 months of age. Because of the presence of maternal antibodies, the MMR vaccine is not recommended sooner.
The practical nurse (PN) is taking the temperature of a 5-year-old child with otitis media. During the previous 24 hours, the child's temperature readings have ranged from 101.2° F oral to 102° F tympanic. Which statement accurately evaluates these findings and should be considered when planning care for the remainder of the shift? a.The PN should confer with the nursing staff about the temperature method to use. b.A tympanic temperature and an oral temperature are equally accurate techniques in evaluating the child's fever. c.A rectal temperature should be taken q4h to evaluate effectively the clinical course of the fever. d.The pediatrician should be notified of the variances in the oral and tympanic readings.
b.A tympanic temperature and an oral temperature are equally accurate techniques in evaluating the child's fever. Rationale:Tympanic readings obtained using proper technique correlated moderately to strongly with oral temperatures in recent research studies. A tympanic membrane sensor approximates core temperatures because the same circulation perfuses the hypothalamus and eardrum. The sensor is unaffected by cerumen or the presence of suppurative or unsuppurative otitis media.
To minimize separation anxiety in a hospitalized 2-year-old, which nursing intervention is best for the practical nurse to implement? a.Provide for privacy. b.Encourage parents to room-in. c.Explain procedures and routines. d.Encourage contact with children of the same age.
b.Encourage parents to room-in. Rationale:Separation anxiety is especially threatening for toddlers, so encouraging parents to room-in helps the toddler cope with this threat.
The practical nurse (PN) is reviewing signs and symptoms of congestive heart failure with the parents of a 2-year-old child with a congenital heart defect. Which behavior is most important for the parents to report to the health care provider? a.Sits or squats frequently when playing outdoors. b.Exhibits a sudden and unexplained weight gain c.Is not completely toilet trained and has some "accidents." d.Demonstrates irritation and fatigue 1 hour before bedtime.
b.Exhibits a sudden and unexplained weight gain Rationale:Sudden and unexplained weight gain can indicate fluid retention and is a sign of congestive heart failure.
A newborn who has mild transitional (positional) clubfeet is placed in bilateral casts in an overcorrected valgus (outward) position. What is the primary issue the practical nurse should review with the parents during discharge teaching? a.Prevent cast soiling and maintain the cast's edge by petaling. b.Observe for skin and circulation compromise from the cast. c.Manipulate the cast surfaces with the palms of the hands. d.Support and elevate both legs on pillows continuously.
b.Observe for skin and circulation compromise from the cast. Rationale:Reinforcing information with parents about their role in care and about vigilant observation for potential problems of the infant at home such as skin and circulation compromise is the most important nursing intervention.
The teacher reports that a 7-year-old child frequently daydreams in school, experiences abrupt interruptions in conversations, and stares into space. Which action should the practical nurse take? a.Reassure the teacher that this is normal behavior. b.Observe the child's behavior in the classroom. c.Notify the child's parents about this behavior. d.Refer the child for further evaluation.
b.Observe the child's behavior in the classroom. Rationale:Absence (petit mal) seizures are often manifested as daydreaming behaviors. The child should be observed to confirm what the teacher is describing because this child might be experiencing petit mal seizures.
What is the most important information for the practical nurse (PN) to review with a 12-year-old who is receiving long-term and rescue medications for routine management of asthma? a. Drink a large amount of cold fluids after exercising to restore hydration. b. Avoid swimming, which increases the need for oxygen while underwater. c. Use albuterol for prevention of exercise-induced bronchospasm. d. Keep a prescription for a premeasured dose of epinephrine available.
c. Use albuterol for prevention of exercise-induced bronchospasm. Rationale:When used before exercise, the beta-adrenergic agonist albuterol can prevent an asthma attack.
The practical nurse (PN) in the clinic receives a phone call from the mother of a 6-year-old child with a newly applied cast for a fracture of the femur. The mother reports that the child is in pain and is crying and that the child's foot appears swollen and blue. Which nursing diagnosis supports the PN's initial intervention? a.Impaired skin integrity b.Altered comfort (acute pain) c.Altered peripheral tissue perfusion d.Ineffective individual coping
c.Altered peripheral tissue perfusion Rationale:Because the child is exhibiting indications of impaired circulation (pain and cyanosis), altered peripheral tissue perfusion is the highest priority. The PN should instruct the mother to elevate the child's foot and bring the child into the clinic or emergency room immediately for evaluation.
The health care provider prescribes carbamazepine for a child whose tonic-clonic seizures have been poorly controlled. The nurse informs the mother that the child must have blood tests every week. The mother asks why so many blood tests are necessary. What complication is assessed through frequent laboratory testing that the nurse should explain to this mother? a.Renal toxicity b.Inner ear toxicity c.Bone marrow suppression d.Liver damage
c.Bone marrow suppression Rationale:Myelosuppression (bone marrow toxicity) is the highest priority complication that can potentially affect clients managed with carbamazepine therapy. The client requires close monitoring for this condition by weekly laboratory testing.
The health care provider prescribes the anticonvulsant carbamazepine (Tegretol) for an adolescent client with a seizure disorder. The nurse should instruct the client to notify the health care provider if which condition occurs? a.Experiences dry mouth b.Experiences dizziness c.Develops a sore throat d.Develops gingival hyperplasia
c.Develops a sore throat Rationale:Blood dyscrasias (aplastic anemia, leukopenia, anemia, and thrombocytopenia) can be an adverse effect of carbamazepine. Flulike symptoms such as pallor, fatigue, sore throat, and fever, are indications of such dyscrasias.
The practical nurse (PN) is evaluating the play behaviors of a 2-year-old child. Which behavior should the PN expect the toddler to exhibit? a.Builds a house with blocks. b.Rides a small tricycle 6 feet. c.Displays possessiveness with toys. d.Looks at a picture book for 15 minutes.
c.Displays possessiveness with toys. Rationale:Two-year-old children are egocentric and unable to share with other children.
An infant is born with a ventricular septal defect (VSD), and surgery is planned to correct the defect. The practical nurse (PN) should understand that the surgical correction is designed to achieve which hemodynamic outcome? a.Stop the flow of unoxygenated blood into systemic circulation. b.Increase the flow of unoxygenated blood to the lungs. c.Prevent the return of oxygenated blood to the lungs. d.Reduce peripheral tissue hypoxia and nail bed clubbing.
c.Prevent the return of oxygenated blood to the lungs. Rationale:Closure of the VSD will stop shunting of oxygenated blood from the left ventricle (higher pressure) to the right ventricle.
A 12-year-old with type 1 diabetes mellitus complains of abdominal pain and has experienced increased thirst during the previous 24 hours. What action should the practical nurse implement first? a.Obtain blood for a complete blood count (CBC) test. b.Initiate D10W at 50 mL/hour IV. c.Test urine for ketones and glucose. d.Assess temperature and blood pressure.
c.Test urine for ketones and glucose. Rationale:This child is exhibiting signs of impending diabetic ketoacidosis (DKA), so the child's urine should be tested for ketones and glucose to assess for DKA.
A high-school graduate with attention deficit hyperactivity disorder (ADHD) presents to the family health care provider for a precollege physical and tells the practical nurse (PN), "I don't want to take my amphetamine-dextroamphetamine in college." How should the PN respond? a. "There are other medications you can use for ADHD." b. "Your ADHD probably won't be a problem in college." c. "What will happen if you stop your Adderall?" d. "What are your concerns about continuing Adderall?"
d. "What are your concerns about continuing Adderall?" Rationale:It is important to understand the client's concerns about taking amphetamine-dextroamphetamine before making a judgment about his future use of the drug.
A mother phones the clinic because her 6-year-old child has been taking prescribed antibiotics for 7 of the previous 10 days and continues to cough. She also reports that the cough is worsening and is nonproductive. What information should the practical nurse (PN) provide to this mother? a. Watch the child a few more days and see if the cough begins to produce sputum. b. Complete the full 10-day course of antibiotics and reevaluate the cough then. c. Give the child plenty of fluids and an over-the-counter cough suppressant. d. Bring the child to the clinic today for an examination related to the cough.
d. Bring the child to the clinic today for an examination related to the cough. Rationale:The child should be evaluated as soon as possible for pneumonia. Antibiotics usually improve symptoms during the first few days of treatment but should be continued for the full prescribed course. A continued cough after 7 days of antibiotic treatment may indicate an infectious process in the lower lungs, which could cause a nonproductive cough. Children with pneumonia can deteriorate unexpectedly and rapidly and can become seriously ill with no sputum production.
A 5-year-old tells the practical nurse (PN) that she "needs a Band-Aid" when she has an injection. Which action is best for the PN to take? a. Show her that the bleeding has already stopped. b. Explain why a Band-Aid is not needed. c. Ask her why she wants a Band-Aid. d. Apply a Band-Aid over the injection site.
d. Crowing respiration Rationale:Preschool children sometimes think that any hole (e.g., an injection or incision) made in their bodies allows their "insides to leak out," so applying a Band-Aid over the hole prevents this from occurring.
Which intervention should the practical nurse implement when a child cannot swallow prescribed tablets? a. Give the tablets with a very cold beverage of the child's choice. b. Put intact tablets in 1 tablespoon of corn syrup. c. Place the crushed tablet in a gelatin capsule and give with food. d. Crush tablets to a fine powder and mix with a small amount of soft food.
d. Crush tablets to a fine powder and mix with a small amount of soft food. Rationale:For children who have difficulty swallowing tablets, crushing the prescribed dose of tablets (except sustained-released capsules and enteric-coated medications) into a fine powder and mixing in a small amount of applesauce, yogurt, or pudding helps the child swallow the medication.
The practical nurse (PN) observes the unlicensed assistive personnel (UAP) placing a tongue blade at the bedside of a child admitted with a seizure disorder. Which intervention should the PN implement? a. Determine if the tongue blade is the correct size based on the child's height and weight. b. Advise the UAP that a nurse should assume this responsibility. c. Assist the UAP to tape padding securely around the tongue blade. d. Tell the UAP that tongue blades should not be inserted during a seizure.
d. Tell the UAP that tongue blades should not be inserted during a seizure. Rationale:Tongue blades can cause damage or force the tongue to obstruct the airway and should not be inserted during seizure activity. Nothing should be placed in the child's mouth. During a seizure, the airway can be opened with jaw thrust technique, and the child can be turned to the side to prevent pooling of secretions.
A child with nephrotic syndrome is receiving prednisone. The practical nurse (PN) reviews breakfast foods at a fast food restaurant with the child's mother. Which selections indicate that the mother understands the dietary guidelines necessary for her child? a. French toast sticks and orange juice b. Sausage-egg muffin and grape juice c. Canadian bacon slices and hot chocolate d. Toasted oat cereal and low-fat milk
d. Toasted oat cereal and low-fat milk Rationale:A child receiving a corticosteroid for nephrotic syndrome should follow a low-sodium, low-fat, and low-sugar diet. Based on these guidelines, the best breakfast choice is toasted oat cereal and low-fat milk.
The practical nurse (PN) is caring for a child who had a cleft lip repair. What is the most important reason to minimize this child's crying during the postoperative recovery period? a.Tear formation increases salivation. b.This behavior increases respirations. c.Lack of comforting can enhance pain. d.Crying stresses the suture line.
d.Crying stresses the suture line. Rationale:Prevention of stress on the lip suture line is essential for optimum healing and the cosmetic appearance of a cleft lip repair.
The parents of a 1-year-old child, who was recently diagnosed with hypospadias, state that they plan to delay the corrective surgery to see if the child will outgrow the problem. What information is best for the practical nurse (PN) to provide to these parents? a.The prognosis will worsen if surgery is delayed. b.Some children do outgrow this type of problem and waiting may be beneficial. c.Regardless of the decision, the staff is available to assist with the process. d.Discuss the child's diagnosis with the health care provider for additional information and clarity.
d.Discuss the child's diagnosis with the health care provider for additional information and clarity. Rationale:The PN should first ensure that the parents have adequate and correct information. Hypospadias is a congenital anomaly resulting in an abnormally located urethral meatus. Surgical correction is usually done early in childhood, which is considered the best time for the child to face surgery with the fewest fears.
The practical nurse (PN) is caring for a child with a diagnosis of acquired aplastic anemia. What should the PN expect in the child's health history that is a common cause of this type of anemia? a.Bacterial infections b.A diet deficient in iron c.Congenital heart defects d.Exposure to certain drugs
d.Exposure to certain drugs Rationale:Aplastic anemia often follows exposure to certain drugs such as chloramphenicol, sulfonamides, phenylbutazone, insecticides such as DDT, and chemicals, in particular benzene.
The practical nurse (PN) is examining a child with an exacerbation of juvenile rheumatoid arthritis (JRA) and notes that the child's mobility is greatly reduced. What factor should the PN observe that affects the child's mobility? a.Pathologic fractures b.Poor alignment of joints c.Dyspnea on exertion d.Joint inflammation
d.Joint inflammation Rationale:Joint inflammation and pain are the typical manifestations of an exacerbation of JRA.
The practical nurse (PN) is caring for an infant with pyloric stenosis. What nursing intervention should be included in the preoperative period? a.Monitor for signs of metabolic acidosis. b.Estimate the quantity of diarrhea stools. c.Place in a supine position after feeding. d.Observe for projectile vomiting.
d.Observe for projectile vomiting. Rationale:Projectile vomiting, the classic sign of pyloric stenosis, contributes to metabolic alkalosis.
The parent of a 4-year-old often observes his child at day care via a video camera hookup to his computer. The parent tells the practical nurse (PN) at the day care center that the child frequently eats with her fingers rather than with utensils. How should the PN respond? a.Explain that the day care center employs certified child care specialists with knowledge of growth and development. b.Advise the parent that an in-service program will be provided to staff regarding mealtime behavior to be expected of preschoolers. c.Schedule the child for an Ages and Stages Questionnaire to evaluate the child's developmental skill level. d.Offer reassurance that this behavior is normal but that the child can now be taught how to use utensils.
d.Offer reassurance that this behavior is normal but that the child can now be taught how to use utensils. Rationale:Preschoolers should learn to use utensils but often prefer to use their fingers.
The practical nurse (PN) is caring for a child with Wilms' tumor. Which preoperative intervention should the PN implement? a.Gently percuss the abdomen for evidence of trapped air. b.Observe the abdomen for any noticeable discolorations. c.Apply cold compresses to the abdomen to reduce edema. d.Put a sign above the bed reading, "Do not palpate abdomen."
d.Put a sign above the bed reading, "Do not palpate abdomen." Rationale:Prevention of abdominal palpation minimizes the risk of rupturing the encapsulated tumor and subsequent metastasis.
While examining a 6-year-old visiting the clinic for fever and a rash, the practical nurse (PN) notices several elevated 1- to 3-mm white spots on the buccal mucosa. What other signs should the PN expect this child to exhibit? a.Pruritic vesicular skin eruptions on trunk b.Honey-colored crusted exudate from ruptured skin vesicles c.Irregular red macular rash in the perianal area d.Red blotchy macular rash on the face and neck
d.Red blotchy macular rash on the face and neck Rationale:Elevated white spots on the oral mucosa of a child are likely Koplik's spots and are indicative of rubeola. They are accompanied by a red blotchy rash that starts on the face and spreads to the neck, the trunk, and the rest of the body.
