Maternal Child Nursing Chapter 37 Impact of Cognitive and Sensory Impairment on the Child and Family

A child with autism spectrum disorder is hospitalized for a treatment that will last about 1 week. How should the nurse make the child comfortable?1Ask the parents to accompany the child.2Modify the room according to the child's needs.3Explain the surroundings of the room.4Help the child perform daily routine tasks.

1 Children with autism spectrum disorders often are uncomfortable in a new environment and may not like to be with strangers. Therefore children with an autism spectrum disorder must be accompanied by their parents during hospitalization. While caring for a visually impaired child, the nurse modify the room according to the needs of the child. This helps prevent accidents. Because the child is not visually impaired, the nurse need not explain the surroundings of the room. Children with autism spectrum disorders often do not like assistance and prefer to perform their daily chores by themselves. Therefore the nurse should not help the child with such activities.

A 10-year-old female child requires daily medications for a chronic illness. Her mother tells the nurse that she is always nagging her to take her medicine before school. What is the most appropriate nursing action to promote the child's compliance? 1Establishing a contract with her, including rewards 2Suggesting time-outs when she forgets her medicine 3Discussing with her mother the damaging effects of nagging 4Asking the child to bring her medicine containers to each appointment so they can be counted

1 For school-age children, behavior contracting associated with desirable rewards is an effective method for achieving compliance. Time-outs should be used only if the behavioral contracting is not successful. Although nagging is not an effective strategy, the nurse needs to assist the mother in problem-solving rather than criticize the actions. Monitoring the medicine supply may be tried if the contracting is not successful.

A week-old newborn is assessed for body weight, birth marks, and height. The birth weight is lower than what it should be for height. Which physical feature of the newborn makes the nurse conclude that the newborn is affected by Down syndrome?1Short and broad neck2Long and thin fingers3Short and thin lips4Broad and long nose

1 One of the characteristics of Down syndrome is a short, broad neck. These children have an impaired immune system and are at risk for spinal cord compression. Physical features such as long and thin fingers, short and thin lips, and broad and long nose are all common in a normal child and do not indicate any abnormality.

The nurse is assessing a newborn with Down syndrome. The newborn's parent tells the nurse, "We are having a hard time holding our baby. We didn't have this hard of a time with our other children." What would be the nurse's best response?1"Children with Down syndrome have lower muscle tone."2"This happens in some children because of undeveloped bonding."3"Are you more apprehensive because your child has Down syndrome?"4"You should see a counselor to help you cope with your child's condition."

1 Newborns with Down syndrome have joint hyperflexibility and low muscle tone. This can make it difficult to hold the newborn because he or she can go limp like a rag doll. This makes it difficult for the parents to embrace and provide warmth to their newborn. This may make parents feel that the newborn is not bonding with them, but difficulty holding the child does not indicate impaired bonding between the child and parents. Inability to understand the child's needs and nonverbal communication indicates undeveloped bonding. Asking the parents whether they are more apprehensive does not answer their question. It is also a closed-ended question, which is not therapeutic communication. Telling the parents they need to see a counselor is not appropriate. They just need support and teaching.

The nurse is caring for a child who is scheduled to undergo an ostomy procedure. What are possible causes for a child to need undergo an ostomy procedure? Select all that apply. 1 Necrotizing enterocolitis 2 Hirschsprung disease 3 Crohn disease 4 Diseases of the bladder 5 Difficulty urinating

1, 2, 3, 4 Children may require stomas for various health problems such as necrotizing enterocolitis, imperforate anus, and Hirschsprung disease. In older children, the most frequent causes are Crohn's disease and ureterostomies due to bladder defects. Difficulty in urinating is not reason enough for an ostomy unless the health care provider has diagnosed an underlying disorder that requires an ostomy.

The nurse suspects tissue injury in an infant on intravenous therapy. What parameters will the nurse assess to determine tissue injury? Select all that apply. 1 The amount of redness 2 Blanching 3 The amount of swelling 4 Quality of pulses above infiltration 5 Coolness of the area

1, 2, 3, 5The nurse adheres to certain guidelines available for determining the severity of tissue injury. Staging characteristics, such as the amount of redness, blanching, the amount of swelling, pain, capillary refill, and warmth or coolness of the area, are used to determine severity. The quality of pulses below infiltration is assessed and not above it.

The nurse is assessing a child with autism for prognostic factors. What findings in the child suggest a better prognosis? Select all that apply.1 Male sex2 Early recognition3 Functional speech4 Lower intelligence5 Behavioral impairment

1, 2, 3Male sex carries a more favorable prognosis than female sex. Early recognition allows early intervention to help the child recover. Children with functional speech have a better prognosis than those who do not have functional speech. Children with higher intelligence have a more favorable prognosis than children with lesser intelligence. Children who do not have behavioral impairment have a better prognosis than children with behavioral impairment.

The nurse is caring for a child that has a persistent cough for two days and a fever of over 38.3° C. What should be included in the nursing Interventions if the primary health care provider suspects nasopharyngitis? Select all that apply. 1 Obtain throat swab for culture or perform rapid antigen testing. 2 Instruct the parents to administer oral antibiotics as prescribed. 3 Educate parents singly or in groups about hazards of aspiration. 4 Obtain a prescription to administer antipyretics when needed. 5 Educate the parents about monitoring the blood glucose level.

1, 2, 4The nurse should obtain a throat swab for culture or perform rapid antigen testing. The laboratory test will help in confirming the pathogen causing the nasopharyngitis. The nurse should also instruct the parents about administering oral antibiotics and antipyretics as prescribed by the primary health care provider. The nurse should ask the parents to administer the medications in liquid form. It may be effective in decreasing the throat pain.This is done to make the parents aware of the correct administration and dose of oral medication. Parents are educated about the hazards of aspiration, so the child becomes aware of the dangers of trauma to the trachea from sharp objects. However, this is not a related nursing Intervention for a child suffering from nasopharyngitis. Similarly, blood glucose level monitoring is done for a child with diabetes mellitus. It is not related to nasopharyngitis.

The nurse is educating new parents on how to prevent the occurrence of acute otitis media (AOM) in the child. What preventive measures does the nurse include in the teaching? Select all that apply. 1 Breastfeed the infants for at least 6 months. 2 Discontinue use of the pacifier after 6 months. 3 Give the child analgesic drugs as prescribed. 4 Clean the ear canals with sterile cotton swabs. 5 Preventing exposure to second hand smoke

1, 2, 5Parents are encouraged to reduce risk factors for AOM by breastfeeding infants for at least the first 6 months of their life. This prevents the occurrence of AOM and reduces any risks. The parents are also informed to discontinue the use of pacifier after six months and prevent the child from getting exposed to second-hand smoke for the same reason. Analgesics are used to treat mild pain in the ear when the child has AOM. It is a treatment measure not a preventative measure. Similarly, the parents have to clean the external ear of their child by using sterile cotton swabs to drain the fluid in the ear but they never go inside the ear canals. It is a treatment measure advised with topical antibiotic treatment.

A pregnant woman is diagnosed with a rubella infection during a prenatal checkup. What does the nurse expect the health care provider will tell the patient? Select all that apply. "The newborn may:1 Have vision difficulties."2 Have growth impairment."3 Have difficulty hearing."4 Develop breathing problems."5 Not be able to concentrate."

1, 3 Rubella infections during pregnancy may cause hearing and visual loss in the newborn. However, these impairments may disappear as the child grows. Rubella infections do not cause growth retardation. Growth hormone deficiency or Turner syndrome can lead to growth impairment. Respiratory disorders or allergic reactions can result from hypersensitivities and can cause difficulty breathing in the newborn. A decreased ability to concentrate indicates impaired cognition. It usually results from inadequate intake of omega-3 fatty acids by the mother during pregnancy.

A 4-year-old child is seen in a clinic for a hearing impairment. What action does the nurse observe in the child to confirm hearing impairment? Select all that apply. The child:1 Screeches happily when looking at a toy.2 Has difficulty trying to read a book.3 Does not respond when an alarm sounds.4 Points at his tummy to indicate hunger.5 Speaks fast, stutters, and has speech delay.

1, 3, 4 A child with a hearing impairment yells or screeches in pleasure because the child cannot hear how loud these sounds are. The child also does not respond to loud sounds and prefers nonverbal communication such as pointing. A child who has difficulty reading a book may have a visual impairment. Rapid speech with stuttering and speech delay are symptoms of fragile X syndrome.

The nurse is assessing a patient with strabismus. Which finding would suggest the cause of strabismus? Select all that apply.1 Poor vision2 Short eyeball3 Congenital defect4 Muscle imbalance5 Unequal curvature in the lens

1, 3, 4 Strabismus may result from poor vision and the resulting straining of eye muscles. Strabismus may result from a congenital defect as a developmental anomaly. Strabismus may also result from muscle imbalance caused by neuromuscular disorders. Short eyeball results in development of hyperopia, not strabismus. Unequal curvature of lens results in astigmatism, not strabismus.

The nurse is teaching a group of students about pertussis. The nurse says, "Pertussis and several other respiratory infections are common in young children." What represents the possible etiology for that statement? Select all that apply. 1 Children have weaker immune systems. 2Many children do not get vaccinated. 3 Children have small airways. 4 Children are exposed to more germs. 5 Germs have an affinity for children

1, 3, 4Deficiencies of the immune system place children at risk for infection. Anatomic differences influence the response to respiratory tract infections. The diameter of the airways is smaller in young children, and the distance between structures within the respiratory tract is also shorter, so organisms may move rapidly down the respiratory tract, causing more extensive involvement. Children are often exposed to greater variety of germs than are adults. Lack of vaccination usually leads to polio and other such diseases. Germs do not have any greater affinity for children than for adults.

A child with tonsillitis requires nursing care. The child has recently undergone a tonsillectomy. What should the nurse include in the plan of care in order to minimize the risk of bleeding during the post-operative period? Select all that apply. 1 Give the child a soft or a liquid diet. 2 Advise the child to blow the nose. 3 Instruct the child how to use a cool-mist vaporizer. 4 Instruct the child to cough frequently. 5 Instruct on warm salt-water gargles. 6 Provide analgesic-antipyretic drugs.

1, 3, 5, 6A soft to liquid diet is advised for a child who has recently undergone a tonsillectomy. The child can also use a cool-mist vaporizer to keep the mucous membranes moist during periods of mouth breathing. In addition, warm salt-water gargles and analgesic-antipyretic drugs such as acetaminophen (Tylenol) to promote comfort. The child is always discouraged from blowing their nose and coughing, as these activities may aggravate the trauma of the surgery site and cause bleeding.

The nurse is caring for a child with acute laryngotracheobronchitis (LTB). What assessment findings noted by the nurse would warrant immediate notification of the primary health care provider? Select all that apply. 1 Increased pulse and increased respiratory rate 2 The throat is reddened, swollen, and enlarged 3 Substernal, suprasternal, or intercostal retractions 4 The epiglottis is edematous and is cherry red 5 Flaring of the nares and increased restlessness

1, 3, 5The most important Nursing Intervention for the child with LTB is observation and accurate assessment of the respiratory status. The nurse can detect airway obstruction early if it is noticed that the child has an increased pulse and respiratory rate. In addition, the child often has substernal, suprasternal, and intercostal retractions, flaring nares, and increased restlessness.This occurs due to inflammation of the mucosal lining of the larynx and trachea, which causes a narrowing of the airway. Hence, the child inspires air past the obstruction and into the lungs, producing the characteristic inspiratory stridor. Symptoms such as red and distinctively large throat and cherry red, edematous epiglottis are visible when the child is suffering from epiglottitis and not LTB. Usually, children do not suffer from epiglottitis and LTB simultaneously.

The nurse is teaching a group of students about preventing respiratory infections. Which statement by a student suggests a need for additional teaching? Select all that apply. 1 "Playing with ill children is safe. "2 "Do not eat from the utensils of ill children. "3 "Wash your hands as often as possible. "4 "Reuse tissues to cover the mouth when sneezing. "5 "Keep away from children who are at risk.

1, 4, 5Well children should keep away from ill children because respiratory infections are very contagious. Used tissues should be immediately thrown into the wastebasket and not allowed to accumulate in a pile. Children should keep away from those who are already infected, not from those who they think might be at risk but are well. Using the same utensils can transfer the infection. Frequent hand washing is done to wash away germs.

A child has Group A Beta-hemolytic streptococcal or GABHS infection of the upper airway. What precautionary measures should the nurse ask the child and the parents to take after the child is cured? Select all that apply. 1 "Discard old toothbrushes and replace them with new ones. "2 "Maintain adequate fluid intake and consume nutritional foods 3 "No close contact with the sick child and do not share the personal items." 4 "Apply cold or warm compresses to the neck and gargle with warm saline." 5 "Wash the orthodontic appliances thoroughly as per expert advice."

1, 5The nurse should advise the parent and child to discard the old toothbrushes and replace them with new ones after they have been taking antibiotics for 24 hours. This will prevent the spread of causal organism. Orthodontic appliances should be washed thoroughly because they may harbor the organisms. It is necessary that parents and other household members avoid close contact with the sick child or share personal items with the child during the illness, not after it is cured.Maintaining fluid intake or consuming nutritional food is not a precautionary measure. It is done to prevent dehydration and to provide the child with the right amount of nutritional needs. Steps such as application of cold or warm compresses to the neck and gargling with warm saline are done to provide relief. This is not a precautionary measure

The parent of a child with cystic fibrosis calls the clinic nurse to report that the child has developed tachypnea, tachycardia, dyspnea, pallor, and cyanosis. The nurse should tell the parent to bring the child to the clinic because these symptoms are suggestive of: 1pneumothorax. 2bronchodilation. 3carbon dioxide retention. 4increased viscosity of sputum

1The child is exhibiting signs of increasing respiratory distress suggestive of a pneumothorax. The child needs to be seen as soon as possible. Bronchodilation and carbon dioxide retention would not produce the symptoms listed. The increased viscosity of sputum is characteristic of cystic fibrosis. The change in respiratory status is potentially caused by a pneumothorax.

The nurse is caring for a child who has recently undergone a tonsillectomy. What steps should the nurse take to facilitate drainage of the secretions? 1Place the child on the abdomen. 2Provide psychological preparation. 3Apply careful suctioning if necessary. 4Have the child sit up and blow the nose.

1The nurse should place the child on his or her abdomen to facilitate drainage of the secretions. Psychological preparation of the child is done before the surgery. It is not necessary after the surgery to facilitate drainage of secretions. Routine suctioning is usually avoided, but when it is performed, it is done carefully to prevent trauma to the oropharynx. The child should not be advised to sit up and blow their nose. This can cause bleeding to the surgical site.

Which behavior would most likely be manifested in a young child experiencing the protest phase of separation anxiety? 1Inactivity 2Clings to parent 3Depressed, sad 4Regression to earlier behavior

2 In the protest phase, the child aggressively responds to separation from parents (such as clinging to a parent). Inactivity is characteristic of despair. Depression and sadness are characteristics of despair. Regression to earlier behavior is characteristic of despair.

What does the nurse keep in mind while administering an enema to a child? 1The nurse should not give details about the procedure. 2The buttocks of the child should be held together briefly. 3Pillows should not be used during the procedure. 4Administration of enemas should be noninvasive in children

2 Infants and young children are unable to retain the solution after it is administered, so the buttocks must be held together for a short time to retain the fluid. A careful explanation may help ease any concerns or fears the child may have about the procedure. The enema is administered and expelled while the child is lying with the buttocks over the bedpan and with the head and back supported by pillows. An enema is an intrusive procedure.

The nurse needs to start an intravenous (IV) line on an 8-year-old child to begin administering intravenous antibiotics. The child starts to cry and tells the nurse, "Do it later, O.K.?" The nurse should: 1start the IV line because allowing the child to manipulate the nurse is bad. 2start the IV line because unlimited procrastination results in heightened anxiety. 3postpone starting the IV line until the child is ready so that the child experiences a sense of control. 4postpone starting the IV line until the child is ready so that the child's anxiety is reduced.

2 Intravenous antibiotics are a priority action for the nurse. A short delay may be possible to allow the child some choice, but a prolonged delay only serves to increase the anxiety. The nurse should start the IV line, recognizing that the child is attempting to gain control. If the timing of the IV line start was not essential for the start of IV antibiotics, postponing might be acceptable. The child may never be ready. The anxiety is likely to increase with prolonged delay.

Early detection of a hearing impairment is critical because of its effect on areas of a child's life. The nurse should evaluate further for effects of the hearing impairment on:1reading development.2speech development.3relationships with peers.4performance at school

2 The ability to hear sounds is essential for the development of speech. Babies imitate the sounds that they hear. The child will have greater difficulty learning to read, but the primary issue of concern is the effect on speech. Relationships with peers and performance at school will be affected by the child's lack of hearing. The effect will be augmented by difficulties with oral communication.

The nurse is preparing a child for an endotracheal tube (ET) placement. How does the nurse verify the placement of the tube? Select all that apply. 1 Visualization of unilateral chest expansion 2 Auscultation over the epigastrium 3 Examination of water vapor in the tube 4 Waveform verification with continuous capnography 5 Examination using a chest radiography

2, 3, 4, 5 ET tube placement should be verified by at least one clinical sign and at least one confirmatory technology. Such technologies include auscultation over the epigastrium and the lung fields bilaterally in the axillary region, examination of water vapor in the tube, and waveform verification with continuous capnography. Chest radiography can also be used to verify placement. Visualization of bilateral (and not unilateral) chest expansion is used to verify placement of the ET tube.

When admitting a child to the inpatient pediatric unit, the nurse should assess for which risk factors that can increase the child's stress level associated with hospitalization? Select all that apply. 1 Mild temperament 2 Lack of fit between parent and child 3 Below-average intelligence 4 Age 5 Gender

2, 3, 4, 5 Risk factors for increased stress level of a child to illness or hospitalization: "Difficult" temperament; Lack of fit between child and parent; Age (especially between 6 months and 5 years old); Male gender; Below-average intelligence; Multiple and continuing stresses (e.g., frequent hospitalizations).

The nurse is preparing to insert a nasogastric (NG) tube for a child with impaired swallowing capacity. Arrange the steps of the procedure in the correct order. 1.Flush the tube with sterile water. 2.Place child supine with head slightly hyperflexed. 3.Measure the tube for approximate length. 4.Stabilize the tube by holding or taping it to the cheek. 5.Warm the formula to room temperature.

2, 3, 4, 5, 1The child should be in a supine position with head slightly hyperflexed. The tube is measured for approximate length of insertion and marked. After insertion, the tube is stabilized by holding or taping it to the cheek. Warm formula to room temperature before starting the flow. The tube is flushed with sterile water after the feeding.

The nurse is caring for a newly admitted 6-month-old with suspected respiratory syncytial virus (RSV) with these vital signs: temperature 101.2 (ax), pulse 130, respiration 56, and oxygen saturation of 89% on room air. What activities would the nurse anticipate doing within the first three hours of admission? 1Administer intravenous (IV) antibiotics and obtain a throat culture. 2Obtain a culture of the nasal secretions and calculate the infant's fluid requirements. 3Give the infant his or her usual oral feedings and place the infant in an oxyhood. 4Place the infant on airborne precautions and place a pediatric nasal cannula running at 2L/min of oxygen.

2Antibiotics are not indicated unless there is a secondary infection and the source of the problem is in the copious nasal secretions, which will be cultured. Because the respiratory rate is so high (even higher than a newborn's), it would be dangerous to feed this infant because of potential aspiration. An oxyhood is used for neonates in the neonatal intensive care unit (NICU) for oxygen, not for 6-month-old infants. The amount of oxygen is too high for this infant and an infant nasal cannula would be used, not a pediatric cannula, which is used on children, not infants.

Which antipyretic is associated with Reye syndrome in children?1Acetaminophen (Tylenol)2Aspirin (Bayer)3Ibuprofen (Advil)4Norfloxacin (Noroxin)

2Aspirin should not be given to children because of its association in children with influenza virus or chickenpox and Reye syndrome. Other antipyretics include acetaminophen (Tylenol), and nonsteroidal antiinflammatory drugs (NSAIDs). Acetaminophen (Tylenol) is the preferred drug. One nonprescription NSAID, ibuprofen (Advil), is approved for fever reduction in children as young as 6 months of age. Norfloxacin (Noroxin) is an antibiotic and is usually prescribed for bacterial infection of the gastrointestinal system.

A 6-month-old infant with respiratory syncytial virus (RSV) has the following vital signs: temperature 100.4 (ax), pulse 140, respiration 68, oxygen saturation 92%, and has just had his or her nose bulb suctioned. What action should the nurse take to best determine the effectiveness of the suctioning? 1Recheck the oxygenation saturation. 2Recount the respirations. 3Listen to the lung sounds. 4Recount the heart rate.

2When reassessing the infant's condition, re-check the previously abnormal value that correlates with the physiological system or anatomical area where the intervention was done. Because an infant this age is an obligatory nose breather, when the nose is congested with secretions the respiratory rate can increase substantially. In this case, the respiratory rate increased to far above normal for an infant this age. The values of the oxygenation saturation and the heart rate are reflective of the increased respiratory rate needed because of the secretions, which are thick and "bubbling" when RSV is present. The nurse will need to listen to lung sounds, but the best action to evaluate the effectiveness of suctioning is to obtain a respiratory rate following the suctioning activity. Similarly, the nurse will recheck oxygen saturation and heart rate to denote clinical response to therapy.

A child in the clinic exhibits reduced visual acuity in one eye despite appropriate optical correction. The nurse expects the child's health care provider to diagnosis the child with:1myopia.2hyperopia.3amblyopia.4astigmatism.

3 Visual acuity in one eye despite appropriate optical correction is amblyopia. Myopia is nearsightedness, which is the ability to see objects up close but not clearly at a distance. Hyperopia is farsightedness, which is the ability to see distant objects clearly but not those up close. Astigmatism is an alteration in vision caused by unequal curvature in the refractive apparatus of the eye.

The parents of a cognitively impaired child ask the nurse for guidance with discipline. The nurse's best response is:1"Discipline is ineffective with cognitively impaired children."2"Discipline is not necessary for cognitively impaired children."3"Behavior modification is an excellent form of discipline."4"Physical punishment is the most appropriate form of discipline."

3 Behavior modification with positive reinforcement is effective in children with cognitive impairment. Discipline is essential in assisting the child in developing boundaries. Positive behaviors and desirable actions should be reinforced. Most children with cognitive impairment will not be able to understand the reason for the physical punishment; consequently behavior will not change as a result of the punishment.

A couple visits the hospital for a prenatal checkup. On reviewing the genetic analysis report, the nurse finds that the male partner has fragile X syndrome. What should the nurse interpret from these findings? Select all that apply.1 All of their sons will have a 50% chance of being affected.2 All of their sons will be carriers for fragile X syndrome.3 The chance of a daughter being affected is 50%.4 All daughters will be carriers for fragile X syndrome.5 All sons will be carriers and will have fragile X syndrome.

3, 4 Fragile X syndrome is an X-linked dominant syndrome with reduced penetrance. About 50% of daughters with fathers affected by fragile X syndrome will be affected because the dominant X chromosome can be from the affected father. All daughters with an affected father will be carriers. The sons get Y chromosomes from the father, so they are not necessarily carriers of the syndrome or affected by the syndrome. The sons can be carriers or affected if the syndrome is passed from the mother.

The nurse is assessing a child with Down syndrome. What findings in the child should alert the nurse to report to the health care provider immediately? Select all that apply.1 Loss of pain sensation2 Loss of impulse control3 Loss of established motor skill4 Loss of established bowel control5 Loss of established bladder control

3, 4, 5 Loss of established motor skill and bowel and bladder control indicate spinal cord compression and must be reported immediately. The child with Down syndrome may have persistent neck pain caused by spinal cord compression. These children do not have impaired pain sensation. Children with Down syndrome are not aggressive. Loss of impulse control is not seen in such children.

The nursing instructor is explaining the risk factors and pathogenesis of Down syndrome to a group of nursing students. What information should the nurse include in the explanation? Select all that apply. 1 It is caused by a mutation of chromosomes.2 It is more likely to occur if the paternal age is more than 35 years.3 It is more likely to occur if the maternal age is more than 35 years.4 It is caused by acquisition of an extra sex chromosome.5 It is caused by acquisition of an extra autosomal chromosome.

3, 5 Maternal age more than 35 years increases the risk of having babies with Down syndrome. Down syndrome is caused by the presence of an extra autosomal chromosome. Down syndrome is not caused by a mutation of chromosomes. Advanced paternal age is not a risk factor for Down syndrome. There is no extra sex chromosome in children with Down syndrome.

A neonate had corrective surgery 3 days ago for esophageal atresia. The nurse notices that after the child receives his gastrostomy feeding, there is often a backup of formula feeding into the tube. As a result, the nurse should:1position the child in a supine position after feedings.2position the child on his or her left side after feedings.3leave the gastrostomy tube open and suspended after feedings.4leave the gastrostomy tube clamped after feedings.

3By keeping the tube open to air, the buildup of pressure on the operative site will be prevented. The child should be positioned on the right side with head elevated at approximately 30 degrees. The formula is backing up into the tube because of the delayed emptying. Leaving the tube clamped will create pressure on the operative site.

Because the absorption of fat-soluble vitamins is decreased in children with cystic fibrosis, supplementation of which vitamins is necessary? 1C, D 2A, E, K 3A, D, E, K 4C, folic acid

3Vitamins A, D, E, and K are the fat-soluble vitamins that need to be supplemented in higher doses. Vitamin C is not one of the fat-soluble vitamins. Vitamin D also needs to be supplemented. Vitamin C and folic acid are not fat soluble.

What is a common postoperative complication of anesthesia? 1Respiratory tract infections 2Cardiac arrest 3Infection of the joints 4Resistance to anesthetic agents

4

The diagnosis of cognitive impairment is based on the presence of:1intelligence quotient (IQ) of 75 or less.2IQ of 70 or less.3subaverage intellectual functioning, deficits in adaptive skills, and onset at any age.4subaverage intellectual functioning, deficits in adaptive skills, and onset before 18 years of age.

4 The diagnosis of cognitive impairment includes subaverage intellectual functioning and deficits in adaptive skills, including an onset before age 18. IQ is only one component of the diagnosis of cognitive impairment. The onset of the deficit must be before age 18 to meet the diagnosis of cognitive impairment.

The parents brought their child to the emergency department after a needle penetrated the child's eye. Which action should the nurse perform while caring for the child?1Examine the eye to look for foreign bodies.2Irrigate the eye to remove the needle from the eye.3Evert the upper eyelid to wash the eye thoroughly.4Observe for hyphema and reaction of the pupil to light.

4 If a child has a penetrating eye injury of any kind, the nurse should examine the eye to determine whether any aqueous humor has leaked from the penetration site. The nurse should observe the presence of hyphema, or bleeding from the eye. The nurse should also assess for pupillary reaction to light because it helps assess the functioning of the pupil. The nurse does not need to examine the eye for foreign bodies because there is already a foreign body in the eye. If the child is experiencing a penetrating eye injury, the nurse does not irrigate the eye to remove the object because this can further damage the cornea. In the case of chemical burns, the nurse rinses the eye by everting the upper eyelid.

It is important that a child with Group A ß-hemolytic streptococci (GABHS) infection be treated with antibiotics to prevent: 1otitis media. 2diabetes insipidus. 3nephrotic syndrome. 4acute rheumatic fever.

4Children with Group A ß-hemolytic streptococci (GABHS) infection are at risk for acute rheumatic fever and acute glomerulonephritis. Otitis media and diabetes insipidus are not sequelae to GABHS. Otitis media and diabetes insipidus are not sequelae to GABHS. Children are at risk for glomerulonephritis, not nephritic syndrome.

Cystic fibrosis may affect singular or multiple systems of the body. The primary factor responsible for possible multiple clinical manifestations is: 1atrophic changes in the mucosal wall of intestines. 2hypoactivity of the autonomic nervous system. 3hyperactivity of the sweat glands. 4mechanical obstruction caused by increased viscosity of mucous gland secretions.

4Thick mucous secretions are the probable cause of the multiple body system involvement. There is an identified autonomic nervous system anomaly, but it is not hypoactivity. The sweat glands are not hyperactive. The child loses a greater amount of salt because of abnormal chloride movement. Children with cystic fibrosis have thick mucous gland secretions. The viscous secretions obstruct small passages in organs such as the pancreas.

The nurse is preparing to administer a vaccine to a child. The child is refusing to take the vaccination because of fear of bleeding. What should the nurse do in this situation? 1Tell the child he or she can pick the bandage color. 2Tell the child bleeding will stop in a few seconds. 3Request a staff member sit beside the child. 4Give a favorite toy to the child for distraction.

The child is refusing to take vaccination because of fear of bleeding and pain. The nurse should ask the child to select the color of the bandage to be used. This reassures the child and will make him or her feel better. Giving a favorite toy to the child for playing is not helpful for relieving the fear. A favorite toy may help the child sleep at night.

The nurse finds that a patient has developed tachycardia and tachypnea after administration of a muscle relaxant. What is an appropriate nursing action? 1Administer dantrolene sodium intravenously. 2Use hot compresses on the neck and axillae. 3Assess the patient's history of surgical procedures. 4Administer an inhaled anesthetic.

The nurse should administer dantrolene sodium intravenously as the patient is showing signs of malignant hyperthermia (MH). Symptoms of MH include hypercarbia, elevated temperature, tachycardia, tachypnea, acidosis, muscle rigidity, and rhabdomyolysis. The nurse uses ice packs on the groin, axillae, and neck as MH is usually accompanied by hyperthermia. A family or previous history of sudden high fever associated with a surgical procedure and myotonia increase the risk for MH. But the patient will not be assessed for it now as MH has already set in. Use of inhaled anesthetics increase the risk of MH; therefore, they should not be administered as the patient is exhibiting symptoms of MH.

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