Pediatrics: School-age child practice ?s

DIet for cystic fibrosis

high-fat, high-protein, high-calorie diet use of pancreatic enzyme to help digest fat

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What is school age?

6-12 years

Which sign should lead the nurse to suspect that a child with meningitis has developed disseminated intravascular coagulation? hemorrhagic skin rash edema cyanosis dyspnea on exertion

Correct response: hemorrhagic skin rash Explanation: Disseminated intravascular coagulation is characterized by skin petechiae and a purpuric skin rash caused by spontaneous bleeding into the tissues. An abnormal coagulation phenomenon causes the condition. Heparin therapy is often used to interrupt the clotting process. Edema would suggest a fluid volume excess. Cyanosis would indicate decreased tissue oxygenation. Dyspnea on exertion would suggest respiratory problems, such as pulmonary edema.

A child newly diagnosed with rheumatic fever is to receive penicillin therapy. Which statement by the parents should lead the nurse to judge that the parents understand the teaching about penicillin as part of the treatment plan? A. "Our child should take the medication until the primary health care provider discontinues it." B. "How long will it take for the penicillin to help relieve the joint discomfort?" C. "We need to also give these pills to our other children to prevent them from getting rheumatic fever." D. We should give our child the medication after eating."

Correct response: A. "Our child should take the medication until the primary health care provider discontinues it." Explanation: Penicillin is given to children with rheumatic fever to eradicate the hemolytic streptococci that triggered the autoimmune response that causes the disease.Penicillin does not decrease joint pain.Prophylactic use of penicillin with siblings is not indicated.Penicillin should be given on an empty stomach.

A 12-year-old with asthma wants to exercise. Which activity should the nurse suggest to improve breathing? soccer swimming track gymnastics

Correct response: swimming Explanation: Swimming is appropriate for this child because it requires controlled breathing, assists in maintaining cardiac health, enhances skeletal muscle strength, and promotes ventilation and perfusion. Stop-and-start activities, such as soccer, track, and gymnastics, commonly trigger symptoms in asthmatic clients.

A nasogastric tube is prescribed to be inserted for a child with severe head trauma. Diagnostic testing reveals that the child has a basilar skull fracture. What should the nurse do next? A. Ask for the prescription to be changed to an oral gastric tube. B. Attempt to place the tube into the duodenum. C. Test the gastric aspirate for blood. D. Use extra lubrication when inserting the nasogastric tube.

Correct response: A. Ask for the prescription to be changed to an oral gastric tube. Explanation: Because a basilar skull fracture can involve the frontal and ethmoid bones, inserting a nasogastric tube carries the risk of introducing the tube into the cranial cavity through the fracture. An oral gastric tube is preferred for a client with a basilar skull fracture. The tube would not be placed into the duodenum. Gastric aspirate is not routinely tested for blood unless there is an indication to suggest bleeding, such as a falling hemoglobin or visible blood in the drainage.

A school-age child with cystic fibrosis (CF) is suddenly losing weight, despite having a voracious appetite. The child has large, foul-smelling stools, with excessive gas, distention, and bloating. Which is the nurse's best assessment of the etiology of this problem? A. The dose of pancreatic enzyme needs to be adjusted. B. Fiber and bulk are needed in the child's diet. C. Acid-reducing medications need to be avoided. D. Nothing should be done, as this is to be expected in the child with cystic fibrosis.

Correct response: A. The dose of pancreatic enzyme needs to be adjusted. Explanation: The child with CF requires pancreatic enzyme replacement due to malabsorption and pancreatic insufficiency. The dose of pancreatic enzymes needs to be increased to meet the changing metabolic needs of the child. Children with CF should have a high-fat, high-calorie, high-protein diet. Acid-reducing medications may optimize the enzymes' effects.

A child has a seizure while a nurse is performing a bed bath. Which of the following are priority actions for the nurse to implement? Select all that apply. A. Time the length of the seizure. B. Observe the stages of the seizure. C. Place a tongue depressor in the child's mouth. D. Turn the child to a side-lying position. E. Restrain the twitching extremities.

Correct response: A. Time the length of the seizure. B. Observe the stages of the seizure. D. Turn the child to a side-lying position. Explanation: It is important to assess the characteristics of the seizure to help the physician diagnose the type of seizure. Turning the child to a side-lying position may prevent aspiration of secretions. Placing a tongue depressor in the mouth or restraining extremities can cause injury to the child and is contraindicated.

A child with diabetes insipidus receives desmopressin acetate. When evaluating for therapeutic effectiveness, the nurse should interpret which finding as a positive response to this drug? A. decreased urine output B. increased urine glucose level C. decreased blood pressure D. relief of nausea

Correct response: A. decreased urine output Explanation: The primary action of desmopressin acetate is to stimulate water reabsorption by the kidneys, thereby decreasing the urine output. Desmopressin acetate has no effect on glucose levels, blood pressure, or nausea.

A school-age child experiences symptoms of excessive polyphagia, polyuria, and weight loss. The physician diagnoses type 1 diabetes and admits the child to the facility for insulin regulation. The physician orders an insulin regimen of insulin and isophane insulin administered subcutaneously. How soon after administration can the nurse expect the regular insulin to begin to act? A. ½ to 1 hour B. 1 to 2 hours C. 4 to 8 hours D. 8 to 10 hours

Correct response: A. ½ to 1 hour Explanation: Regular insulin, a rapid-acting insulin, begins to act in ½ to 1 hour, reaches peak concentration levels in 2 to 10 hours, and has a duration of action of 5 to 15 hours.

The nurse admits an 8-year-old child who is unconscious secondary to ketoacidosis. During the admission history, which parental statement is most consistent with the diagnosis of insulin-dependent diabetes? A. "He's become almost hyperactive in the past month." B. "He started to wet his bed at night for the first time in 3 years." C. "He seems to be gaining weight lately." D. "He's lost his appetite in the past 2 weeks."

Correct response: B. "He started to wet his bed at night for the first time in 3 years." Explanation: Bed-wetting in a previously continent child is a sign suggesting hyperglycemia. The enuresis is due to polyuria, one of the cardinal signs of insulin-dependent diabetes mellitus. Other signs include polydipsia (excessive thirst) and polyphagia (excessive hunger). Typically, the child with hyperglycemia secondary to insulin-dependent diabetes is slightly lethargic. Although the child with insulin-dependent diabetes experiences excessive hunger (polyphagia), the child loses weight even though he is eating more.

The parent of several young children calls the nurse when a school-age child comes down with chickenpox. The nurse provides instruction on communicability and home management of this disease. Which response by the parent indicates effective teaching? A. "I should keep my child at home until the fever is gone." B. "I should have my child soak in oatmeal baths twice daily." C. "I should give my child aspirin every 4 hours until the fever is gone." D. "I should start checking my other children for lesions in about 4 weeks."

Correct response: B. "I should have my child soak in oatmeal baths twice daily." Explanation: Chickenpox is characterized by pruritic lesions; colloidal oatmeal baths may soothe the skin and relieve itching. Therefore, the parent demonstrates effective teaching by saying the child will be given oatmeal baths. Although a fever is common during the first 24 hours the communicable period extends beyond the febrile stage and a normal temperature should not be used as the basis for letting the child leave home. Chickenpox is communicable from 1 day before the lesions erupt until they dry — approximately 1 week. The child should stay home during this time to prevent disease transmission. Aspirin is not recommended because it's associated with Reye's syndrome; acetaminophen is a suitable substitute. The incubation period for chickenpox is 2 to 3 weeks; the parent should begin to check the other children for lesions 2 weeks after exposure to the infected child.

The parents of a child on sulfamethoxazole and trimethoprim for a urinary tract infection report that the child has a red, blistery rash. What instructions should the nurse give the parents? A. Apply an anti-itch lotion to the affected areas at least twice a day. B. Discontinue the medicine and come for immediate further evaluation. C. Use sunblock and avoid midday sun while on the medication. D. Increase the child's fluid intake to at least 2,500 mL per day.

Correct response: B. Discontinue the medicine and come for immediate further evaluation. Explanation: Sulfonamides have been associated with severe adverse reactions. A blistering rash may be a sign of Stevens-Johnson syndrome, a severe allergic reaction that manifests as skin lesions. This reaction is life threatening and requires immediate attention. Lotion should not be applied to skin with blisters. Sulfamethoxazole and trimethoprim may cause photosensitivity, but this usually appears as a mild red rash, not blisters. Increasing the child's fluid intake may help the urinary tract infection, but does not address the rash.

Which action should be the priority when caring for a school-age child admitted to the pediatric unit with the diagnosis of Guillain-Barré syndrome? A. Assess the child's ability to follow simple commands. B. Evaluate the child's bilateral muscle strength. C. Make a game of the range-of-motion exercises. D. Provide the child with a diversional activity.

Correct response: B. Evaluate the child's bilateral muscle strength. Explanation: With Guillain-Barré syndrome, progressive ascending paralysis occurs. Therefore, the nurse should assess the child's muscle strength bilaterally to determine the extent of involvement and progression of the illness. Assessing the child's ability to follow simple commands evaluates brain function. Range-of-motion exercises are an important part of treatment, but they are not a priority initially. Although the child may need diversional activities later, they also are not an initial priority.

A school nurse is evaluating a 7-year-old child who is having an asthma attack. The child is cyanotic and unable to speak, with decreased breath sounds and shallow respirations. What is the nurse's next action? A. Monitor the child with a pulse oximeter in the office. B. Prepare to ventilate the child. C. Have the child lie down to conserve energy. D. Contact the child's parent or guardian.

Correct response: B. Prepare to ventilate the child. Explanation: The nurse should recognize these physical findings as signs and symptoms of impending respiratory collapse. Therefore, the nurse's top priority is to assess airway, breathing, and circulation, and prepare to ventilate the child if necessary. The nurse should then notify the emergency medical system to transport the child to a local hospital. Because the child's condition requires immediate intervention, simply monitoring pulse oximetry would delay treatment. This child should not lie down. When the child's condition allows, the nurse can notify the parents or guardian.

Which goal is most important when developing a long-term care plan for a child with hemophilia? A. Increase the parent's and child's knowledge about hemophilia. B. Prevent injury during each stage of development. C. Improve the child's self-esteem during bleeding episodes. D. Manage acute pain when there is bleeding into joints.

Correct response: B. Prevent injury during each stage of development. Explanation: The priority for ongoing care for this child is to prevent injury while maintaining normal growth and interests. As with all chronic illnesses, there is a potential for self-esteem problems, but no data are presented to support this as a priority for care planning. The parents should have a good understanding of the disease process and realize the importance of obtaining regular health care for their child. The client may have episodes of acute pain, for the child who has bleeding into a joint, but this is a transient situation.

A 10-year-old child proudly tells the nurse that brushing and flossing her teeth is her responsibility. How does the nurse interpret the statement? A. She is too young to be given this responsibility. B. She is most likely capable of this responsibility. C. She should have assumed this responsibility much sooner. D. She is probably just exaggerating the responsibility.

Correct response: B. She is most likely capable of this responsibility. Explanation: Children are capable of mastering the skills required for flossing when they reach 9 years of age. At this age, many children are able to assume responsibility for personal hygiene. She is not too young to assume this responsibility, and she should not have been expected to assume this responsibility much earlier. It is not likely that she is exaggerating; this is an expected behavior at this age.

A child, who uses an inhaled bronchodilator only when needed for asthma, has a best peak expiratory flow rate is 270 L/min. The child's current peak flow reading is 180 L/min. How does the nurse interpret this reading? A. The child's asthma is under good control, so the routine treatment plan should continue. B. The child needs to use a short-acting inhaled beta2-agonist medication. C. This is a medical emergency requiring a trip to the emergency department for treatment. D. The child needs to use inhaled cromolyn sodium.

Correct response: B. The child needs to use a short-acting inhaled beta2-agonist medication. Explanation: The peak flow of 180 L/min is in the yellow zone, or 50% to 80% of the child's personal best. This means that the child's asthma is not well controlled, thereby necessitating the use of a short-acting beta2-agonist medication to relieve the bronchospasm. A peak flow reading greater than 80% of the child's personal best (in this case, 220 L/min or better) would indicate that the child's asthma is in the green zone or under good control. A peak flow reading in the red zone, or less than 50% of the child's personal best (135 L/min or less), would require notification of the health care provider (HCP) or a trip to the emergency department. Cromolyn sodium is not used for short-term treatment of acute bronchospasm. It is used as part of a long-term therapy regimen to help desensitize mast cells and thereby help to prevent symptoms.

When teaching the parents of a child with a ventricular septal defect who is scheduled for a cardiac catheterization, the nurse explains that this procedure involves the use of which technique? A. ultra-high-frequency sound waves B. catheter placed in the right femoral vein C. cutdown procedure to place a catheter D. general anesthesia

Correct response: B. catheter placed in the right femoral vein Explanation: In children, cardiac catheterization usually involves a right-sided approach because septal defects permit entry into the left side of the heart. The catheter is usually inserted into the femoral vein through a percutaneous puncture. A cutdown procedure is rarely used. Echocardiography involves the use of ultra-high-frequency sound waves. The catheterization is usually performed under local, not general, anesthesia with sedation.

The nurse assesses a child with ketoacidosis. What manifestations are supportive of the diagnosis of ketoacidosis? A. slow, bounding pulse rate. B. deep, rapid respirations. C. diaphoretic, warm skin. D. elevated blood pressure.

Correct response: B. deep, rapid respirations. Explanation: The accumulation of ketones, organic acids that readily release free hydrogen ions causing blood pH to fall, leads to ketoacidosis. To compensate, the respiratory buffering system is activated, which results in the child taking deep, rapid breaths to rid the body of excess carbon dioxide. This characteristic breathing pattern is known as Kussmaul respirations. Typically with ketoacidosis, the pulse rate would be more rapid and weak due to dehydration and loss of electrolytes. Typically with ketoacidosis, the skin would be dry due to dehydration. With ketoacidosis, hypotension results from the contracted blood volume secondary to dehydration. Remediation:

The nurse is caring for a 10-year-old child who is newly diagnosed with type 1 diabetes mellitus. The nurse is teaching the parents how to recognize signs and symptoms of hyperglycemia. Which of the following is most important for the nurse to include as an initial symptom of hyperglycemia? A. weight gain B. increased thirst C. paresthesia D. decreased urine output

Correct response: B. increased thirst Explanation: Increased thirst, fatigue, and excess urination are usually the first symptoms of hyperglycemia in children.

The parent tells the nurse that an 8-year-old child is continually telling jokes and riddles to the point of driving the other family members crazy. The nurse should explain this behavior is a sign of which factor? A. inadequate parental attention B. mastery of language ambiguities C. inappropriate peer influence D. excessive television watching

Correct response: B. mastery of language ambiguities Explanation: School-age children delight in riddles and jokes. Mastery of the ambiguities of language and of sentence structure allows the school-age child to manipulate words, and telling riddles and jokes is a way of practicing this skill. Children who suffer from inadequate attention from parents tend to demonstrate abnormal behavior. Peer influence is less important to school-age children, and while the child may learn the joke from a friend, he is telling the joke to master language. Watching television does not influence the extent of joke

What is the primary reason that the nurse inserts an indwelling urinary catheter in a child with severe burns? A. to monitor for a urinary tract infection B. to measure urine output accurately C. to prevent urinary retention D.to assess urine specific gravity

Correct response: B. to measure urine output accurately Explanation: Accurate determination of urine output is a crucial factor in the care of a burn victim. Urinary tract infection is typically not a problem with a burn victim, though insertion of the catheter may predispose the child to a urinary tract infection. However, the benefits of using an indwelling catheter to measure urine output to the nearest milliliter outweigh the risk of infection and other problems associated with use. Unless the burns cover the perineal area and make urination painful, urinary retention is usually not a problem. Determining urine specific gravity can be done to assess hydration, but this is not the primary rationale for inserting an indwelling urinary catheter.

A child is admitted to the hospital with a febrile seizure. What action should the nurse take? A. Keep the child supine. B. Place the child in isolation. C. Keep the room temperature low and bedclothes to a minimum. D. Place a padded tongue blade at the bedside.

Correct response: C. Keep the room temperature low and bedclothes to a minimum. Explanation: One nursing goal for a child with febrile seizures is to maintain the child's temperature at a level low enough to prevent recurrence of seizures. Decreasing the environmental temperature and removing excess clothing and blankets will help decrease the child's temperature. There is no reason to keep the child supine; a side-lying position would be acceptable and help decrease intracranial pressure. A febrile seizure, though, results from abnormal electrical activity in the brain due to elevated body temperature. Isolation precautions are not necessary unless the child has a condition that warrants such an isolation. Using a tongue blade to separate the teeth in the upper jaw from the lower jaw in an attempt to prevent the child from biting the tongue has proven to be ineffective and may result in broken teeth.

The nurse is caring for a child with hemophilia who is actively bleeding from the leg. What should the nurse apply to the site? A. direct pressure, checking every few minutes to see if the bleeding has stopped B. ice to the injured leg area several times a day C. direct pressure to the injured area continuously for 10 minutes D. ice bag with elevation of the leg twice a day

Correct response: C. direct pressure to the injured area continuously for 10 minutes Explanation: For the child with hemophilia who is actively bleeding, the nurse should apply direct pressure to the injured area for 10 minutes continuously along with elevating the leg. The continuous application of direct pressure aids in stopping the bleeding. Elevating the leg reduces blood flow to the area, thereby minimizing the extent of blood loss. Although ice will cause local vasoconstriction and slow the bleeding, applying continuous direct pressure is essential.

A 6-year-old child has tested positive for West Nile virus infection. The nurse suspects the child has the severe form of the disease because of which signs and symptoms? A. fever, rash, and malaise B. anorexia, nausea, and vomiting C. fever, muscle weakness, and change in mental status D. fever, lymphadenopathy, and rash

Correct response: C. fever, muscle weakness, and change in mental status Explanation: Severe West Nile virus infection (also called West Nile encephalitis or West Nile meningitis) affects the central nervous system and may cause headache, neck stiffness, fever, muscle weakness or paralysis, changes in mental status, and seizures. Such signs and symptoms as fever, rash, malaise, anorexia, nausea and vomiting, and lymphadenopathy suggest the mild, not severe, form of West Nile virus infection.

Parents of a 6-year-old tell a healthcare provider that the child has been having periods of unawareness with short periods of staring. Based on this history, the child is probably having which type of seizure? A. complex partial B. myoclonic C. typical absence D. tonic

Correct response: C. typical absence Explanation: This child is probably having typical absence seizures. Typical absence seizures have an onset between ages 3 and 12. This type of seizure is exhibited by an abrupt loss of consciousness, amnesia, or unawareness characterized by staring and a 3-cycle/second spike and waveform on an EEG. The attack lasts from 10 to 30 seconds and may occur as frequently as 50 to 100 times a day. No postictal or confused state follows the attack. A complex partial seizure causes a brief impairment of consciousness. A myoclonic seizure occurs in older children and is exhibited by lightning jerks without loss of consciousness. An abrupt increase in muscle tone, loss of consciousness, and marked autonomic signs and symptoms characterize the tonic seizure.

Caregivers of a 9-year-old client in the terminal phase of a fatal illness ask the nurse for guidance in discussing death with the client. Which response is appropriate? A. "Children of that age view death as temporary and reversible, which makes it hard to explain." B. "Children of that age typically fantasize about what dying will be like, which is much better than knowing the truth." C. "At this developmental stage, children are afraid of death, so it's best not to discuss it with them." D. "At this developmental stage, most children have an adult concept of death and should be encouraged to discuss it."

Correct response: D. "At this developmental stage, most children have an adult concept of death and should be encouraged to discuss it." Explanation: By age 9 or 10, most children have an adult concept of death. Therefore, caregivers should discuss death with them in terms consistent with their developmental stage. In addition, school-age children respond well to concrete explanations about death and dying. Preschoolers, not school-age children, typically view death as temporary and reversible. While school-age children may fantasize about the unknown aspects of death, these fantasies may actually increase their anxiety. Although a child may fear death, accurate information about death can ease anxiety.

The nurse is having difficulty communicating with a hospitalized 6-year-old child. What technique is most helpful? Suggest that the child keep a diary. Suggest that the parent read fairy tales to the child. Ask the parent if the child is always uncommunicative. Ask the child to draw a picture.

Correct response: D. Ask the child to draw a picture. Explanation: The 6-year-old is a school age child. The client at this age is creative and can express themselves with art easier than with oral communication. A diary is best for the adolescent who is able to express themselves with the written word. Reading to the client does not give the child the opportunity to express their feelings. Asking the parent if the client does not speak is not a communication technique.

A mother states to the nurse in the health care provider's (HCP's) office that she is frustrated regarding her school-age son's nightly enuresis for the past 3 years. She says she has limited his evening fluids, eliminated all caffeine and soft drinks from his diet, and has had him wash his own sheets, but he still wets the bed almost every night. Her husband has told her he was a bed wetter as a child. He thinks the son will "get over it." The mother is worried that it could negatively affect the son's peer relationships as he grows older. Which action should the nurse take? A. Reinforce that she should be patient since her husband's enuresis stopped without intervention. B. Suggest that the mother ask the HCP about medication to deal with the enuresis. C. Discuss a behavioral treatment plan to improve the child's social skills. D. Suggest the mother ask the HCP about a complete renal workup.

Correct response: D. Suggest that the mother ask the HCP about medication to deal with the enuresis. Explanation: The mother's distress and length of time the problem has existed combined with the efforts she has made to address the problem demonstrate that medication treatment should be considered. The absence of any other symptoms makes a renal workup unnecessary at this time. It is unlikely that social skills training alone will change his nocturnal enuresis. Just waiting for the behavior to stop is likely to further tax the mother and son.

A school nurse at an elementary school has been asked to conduct scoliosis screening for students. What will the nurse consider with the scoliosis screening request? A. The students are too young to screen, and the assessment should be delayed to middle school. B. The students are too old to screen and will no longer benefit from screening for scoliosis. C. Scoliosis screening requires sophisticated equipment and cannot be done in school. D. The request is appropriate and the nurse can arrange to screen these students.

Correct response: D. The request is appropriate and the nurse can arrange to screen these students. Explanation: The school's request is appropriate because screening for scoliosis should begin at age 8 and be performed yearly thereafter. Also, because screening for scoliosis involves inspection of the spine and use of a scoliometer, both can be done in a school setting.

After teaching a child with leukemia about a scheduled bone marrow aspiration, the nurse determines that the teaching has been successful when the child identifies which place as the site for the aspiration? A. right lateral side of the right wrist B. middle of the chest C. distal end of the thigh D. back of the hipbone

Correct response: D. back of the hipbone Explanation: Although bone marrow specimens may be obtained from various sites, the most commonly used site in children is the posterior iliac crest, the back of the hipbone. This area is close to the body's surface but removed from vital organs. The area is large, so specimens can easily be obtained. For infants, the proximal tibia (lower leg towards the center of the body/towards area of attachment) and the posterior iliac crest are used. The middle of the chest or sternum is the usual site for bone marrow aspiration in an adult. The wrist, chest, and thigh are not sites from which to obtain bone marrow specimens.

A nurse is assessing whether a 6-year-old child has received all required immunizations. Which immunizations does the nurse expect to be documented? A. hepatitis A; measles, mumps, and rubella (MMR); and inactivated polio virus (IPV) B. measles, mumps, and rubella (MMR); hepatitis A; and human papilloma virus (HPV) C. human papilloma virus vaccine (HPV); diphtheria, tetanus, and acellular pertussis (DTaP); and inactivated polio virus (IPV) D. diphtheria, tetanus, and acellular pertussis (DTaP); measles, mumps, and rubella (MMR); and inactivated polio virus (IPV)

Correct response: D. diphtheria, tetanus, and acellular pertussis (DTaP); measles, mumps, and rubella (MMR); and inactivated polio virus (IPV) Explanation: Between ages 4 and 6, the child should receive DTaP, MMR, and IPV. Hepatitis A isn't a required immunization. HPV is not recommended until age 9.

A child has a urinary tract infection and is being treated with antibiotics. The nurse should instruct the parents to report which symptom? A. increased urine output B. loss of appetite C. jaundice D. fever

Correct response: D. fever Explanation: The nurse should advise the parents to report an increasing fever which would indicate the infection is not resolving. Increased urine output may occur, but it would be very difficult for the parent to actually determine this and it is not a cardinal sign of increasing infection. The child may have a loss of appetite related to the infection or the medication, but is not indicative of an infection that is becoming worse. The child should not have jaundice from a urinary tract infection that is being treated.

A nurse is assessing the growth and development of a 10-year-old. What is the expected behavior of this child? A. enjoys physical demonstrations of affection B. is selfish and insensitive to the welfare of others C. Is uncooperative in play and school D. has a strong sense of justice and fair play

Correct response: D. has a strong sense of justice and fair play Explanation: School-age children are concerned about justice and fair play. They become upset when they think someone is not playing fair. Physical affection makes them embarrassed and uncomfortable. They are concerned about others and are cooperative in play and school.

A school nurse is examining a student at an elementary school. Which findings would lead the nurse to suspect impetigo? A. small, red lesions on the trunk and in the skin folds B. a discrete pink-red maculopapular rash that starts on the head and progresses down the body C. red spots with a blue base found on the buccal membranes D. vesicular lesions that ooze, forming crusts on the face and extremities

Correct response: D. vesicular lesions that ooze, forming crusts on the face and extremities Explanation: Impetigo starts as papulovesicular lesions surrounded by redness. The lesions become purulent and begin to ooze, forming crusts. Impetigo occurs most commonly on the face and extremities. Small red lesions on the trunk and in the skin folds are characteristic of scarlet fever. A discrete pink-red maculopapular rash that starts on the face and progresses down to the trunk and extremities is characteristic of rubella (German measles). Red spots with a blue base found on the buccal membranes, known as Koplik's spots, are characteristic of measles (rubeola).

The nurse is admitting a 12-year-old child diagnosed with osteomyelitis of the left femur. What will be the nurse's first action for the child's care? Administer intravenous antibiotics as ordered. Draw blood for cultures as ordered. Monitor hepatic and renal studies. Prepare the child for immediate surgery.

Correct response: Draw blood for cultures as ordered. Explanation: Osteomyelitis, an infectious bone disease, typically results from Staphylococcus aureus or Haemophilus influenzae. Although treatment may include high doses of antibiotics, blood cultures must be obtained first to identify the causative organism and determine its sensitivity to antimicrobial agents. Hepatic and renal studies are obtained during the course of antibiotic therapy to monitor the child for adverse effects. Later, surgery may be necessary to drain abscesses.

Which intervention should the nurse perform for a child who is receiving chemotherapy and allopurinol? Encourage a high fluid intake. Omit carbonated fluids. Give foods that are high in potassium. Limit foods that are high in natural sugar.

Correct response: Encourage a high fluid intake. Explanation: Destruction of malignant cells during chemotherapy produces large amounts of uric acid. The child's kidneys may not be able to eliminate the uric acid, and tubular obstruction from the crystals could result in renal failure and uremia. Allopurinol interrupts the process of purine degradation to reduce uric acid buildup. The child should be encouraged to increase fluid intake to further assist in eliminating uric acid.Carbonated fluids need not be omitted when allopurinol is administered.An intake of foods high in potassium is not necessary nor is limiting foods high in natural sugar.

An 11-year-old child is sent to the school nurse reporting difficulty reading the blackboard in the classroom. The nurse assesses that the child does not have difficulty reading a laptop screen or reading books. What is the best action by the nurse? A. Request that the child be screened for myopia. B. Inform the teacher that the child has strabismus. C. Try to determine the cause of the child's photophobia. D. Call the parents to discuss therapy for hyperopia.

Correct response: Request that the child be screened for myopia. Explanation: Myopia is nearsightedness. The light rays focus at a point in front of the retina, and the client is able to see clearly objects directly in front but is unable to see at a distance.

An adolescent client is having surgery to repair a fractured left femur. As a part of the preoperative safety checklist, what should the nurse do? Ask the teen to point to the surgery site. Verify that the site, side, and level are marked. Ask the parents if they have signed the operative permit. Restate the surgery risks to the parents.

Correct response: Verify that the site, side, and level are marked. Explanation: As part of a surgery safety checklist, the nurse must verify that the site, side, and level are marked. Pointing to the area is not sufficient identification of the surgery site. The nurse must verify the form has been signed by reviewing the form. The surgeon holds primary responsibility for explaining the risks of surgery.

A mother states that a health care provider (HCP) described her daughter as having 20/60 vision, and she asks the nurse what this means. The nurse responds based on the interpretation that the child is experiencing which condition? a loss of approximately one-third of her visual acuity ability to see at 60 feet what she should see at 20 feet ability to see at 20 feet what she should see at 60 feet visual acuity three times better than average

Correct response: ability to see at 20 feet what she should see at 60 feet Explanation: A child with 20/60 vision sees at 20 feet what those with 20/20 vision see at 60 feet. A visual acuity of 20/200 is considered to be the boundary of legal blindness.

Parents of a child with cystic fibrosis demonstrate knowledge of the effects of hot weather on their child when they state that hot weather is hazardous because the child has which problem? poor ability to concentrate urine little skin pigment to prevent sunburn poorly functioning temperature control center abnormally high salt loss through perspiration

Correct response: abnormally high salt loss through perspiration Explanation: One characteristic of cystic fibrosis is the excessive loss of salt through perspiration. Extra salt is almost always necessary during warm weather or any other time the child with cystic fibrosis perspires more than usual.In the child with cystic fibrosis, the functioning of the sweat glands is the problem, causing abnormal amounts of salt to be lost with perspiration. The ability to concentrate urine is not the problem.Little skin pigment is not a condition associated with cystic fibrosis.A poorly functioning temperature control center is not a condition related to cystic fibrosis. ALso needs a: high-fat, high-protein, high-calorie diet

A 6-year-old child is being discharged from the emergency department after being diagnosed with varicella (chickenpox). The nurse knows the parents need more medication teaching when they state they will give the child which over-the-counter medication? ibuprofen aspirin acetaminophen naproxen

Correct response: aspirin Explanation: The parents require additional teaching if they state they will give their child aspirin because using aspirin during a viral infection has been linked to Reye's syndrome, a serious illness that can lead to brain damage and death in children. If the child requires medication for fever or discomfort, the nurse should recommend acetaminophen or ibuprofen. Naproxen isn't indicated for the treatment of fever.

A home care nurse is visiting a family with a chronically ill 9-year-old child. What is a priority of client care when working with a family caring for their chronically ill child at home? lack of knowledge anxiety caregiver role strain social isolation

Correct response: caregiver role strain Explanation: The families of children with chronic illness require considerable support to manage the stress and challenges of caring for the child at home. These families are at high risk for caregiver role strain. Nursing support is needed to help families learn new adaptation skills to manage the child's care. Knowledge is a consideration, but not a priority, due to the chronicity of the child's health. The family is past the anxiety state of the illness, and social isolation may be a concern but not a priority.

A nurse should evaluate a school-age child for signs and symptoms of adverse effects from morphine. The nurse should assess for which ones? Select all that apply. constipation nausea and vomiting pruritus anemia hyperglycemia

Correct response: constipation nausea and vomiting pruritus Explanation: Constipation, nausea and vomiting, and pruritus are all treatable adverse effects of morphine. Anemia and hyperglycemia are not adverse effects of morphine.

When taking a diet history from the mother of a 7-year-old child with phenylketonuria, a report of an intake of which food should cause the nurse to gather additional information? diet cola carrots orange juice bananas

Correct response: diet cola Explanation: Foods with low phenylalanine levels include vegetables, fruits, and juices. Foods high in phenylalanine include meats and dairy products, which must be restricted or eliminated. Diet colas contain more phenylalanine than the fruits listed.

Which foods would the nurse teach the parents of a child with phenylketonuria (PKU) to avoid? Select all that apply. hamburger hot dog ice cream juice cereal

Correct response: hamburger hot dog ice cream Explanation: Children with PKU lack an enzyme to metabolize phenylalanine and convert it to tyrosine. Treatment is dietary management to control the amount of phenylalanine ingested. Foods with low phenylalanine levels include fruits, most vegetables, and cereals. High-protein foods have high levels of phenylalanine and include meats and dairy products.

When developing the plan of care for a school-age child with acute poststreptococcal glomerulonephritis who has a fluid restriction of 1,000 mL/day, which fluid should the nurse consider as most appropriate for the client's condition and effective for preventing excessive thirst? diet cola ice chips lemonade tap water

Correct response: ice chips Explanation: The most appropriate and effective choice would be ice chips because they help moisten the mouth and lips while keeping fluid intake low. However, ice chips must still be counted as intake with the fluid restriction. Sweet beverages, such as diet cola or lemonade, commonly increase thirst. Tap water effectively relieves thirst but does not help keep fluid intake low.

An 8-year-old child with severe cerebral palsy is underweight and undersized for his age. He is being fed a diet of pureed foods. The nurse determines the child's biggest nutritional risk is which factor? increased metabolism inability to metabolize fats impaired oral motor control impaired absorption

Correct response: impaired oral motor control Explanation: A child with severe cerebral palsy commonly has a lack of oral motor control that interferes with tongue control, chewing, and swallowing. This is the reason that this child is being fed pureed foods and fluids. Lack of tongue control commonly causes the child to push the food back out of the mouth while trying to chew and swallow. A child with cerebral palsy has a nonprogressive central nervous system insult.Cerebral palsy does not affect the child's metabolism. This child should be able to absorb and metabolize ingested nutrients.Cerebral palsy does not affect the child's metabolism of fats.Cerebral palsy may affect elimination but does not significantly alter absorption.

According to Erikson's theory of development, chronic illness can interfere with which stage of development in an 11-year-old child? intimacy versus isolation trust versus mistrust industry versus inferiority identity versus role confusion

Correct response: industry versus inferiority Explanation: According to Erikson, an 11-year-old child is working through the stage of industry versus inferiority. Chronic illness may interfere with this stage of development in an 11-year-old child because the child may not be able to accomplish tasks, which prevents the child from achieving a sense of industry. Intimacy is the developmental task of a young adult. Trust is the developmental task to be achieved during infancy. Identity is the developmental task of adolescence.

For the child experiencing excessive vomiting secondary to pyloric stenosis, the nurse should assess the child for which acid-base imbalance? respiratory alkalosis respiratory acidosis metabolic alkalosis metabolic acidosis

Correct response: metabolic alkalosis Explanation: Metabolic alkalosis occurs because of the excessive loss of potassium, hydrogen, and chloride in the vomitus. Chloride loss leads to a compensatory increase in the number of bicarbonate ions. The bicarbonate side of the carbonic acid-base bicarbonate increases, and the pH becomes more alkaline.Respiratory alkalosis is caused by conditions such as hyperventilation that result in loss of partial pressure of arterial carbon dioxide (PaCO2).Respiratory acidosis is caused by conditions such as inadequate ventilation that result in excessive retention of PaCO2.Metabolic acidosis results from the loss of large amounts of bicarbonate, such as with severe diarrhea.

The mother of an infant with hemophilia tells the nurse that she is planning to do home teaching when the child reaches school age. She does not want her child in school because the teacher will not watch the child as well as she would. The mother's comments represent what common parental reaction to a child's chronic illness? overprotection devotion mistrust insecurity

Correct response: overprotection Explanation: Overprotection is a typical parental reaction to chronic illness in a child. Characteristics include sacrifice of self and family for the child, failure to recognize the child's capabilities and sense of responsibility, placement of overly stringent restrictions on play and peer friendship, and a lack of confidence in other peoples' capabilities.

The nurse is planning interventions for a school-aged child hospitalized with acute poststreptococcal glomerulonephritis in need of diversional activity. Which activity should the nurse expect to include? playing a card game with someone the same age putting together a puzzle with mother playing video games with a 4-year-old watching a movie with a younger brother

Correct response: playing a card game with someone the same age Explanation: Generally, school-age children enjoy activities with their peers first, then family members, and lastly younger children. School-age children like to be busy but also to accomplish something. This helps to meet their task of industry versus inferiority, feeling good about what they are able to accomplish.

The school nurse is assessing a client for "pinkeye." Which findings would cause the nurse to send the client home? wet eyelids with no evidence of swelling purulent discharge noted from the eyes conjunctiva pink without swelling serous drainage from the conjunctiva

Correct response: purulent discharge noted from the eyes Explanation: A client with purulent discharge from the eyes has bacterial infectious conjunctivitis. Bacterial infectious conjunctivitis will need antibiotic treatment and the client will need to be sent home. Wet eyelids and pink conjunctiva without swelling are normal findings. Serous drainage is associated with viral infectious conjunctivitis.

Upon the child's return from the postanesthesia recovery unit (PACU) after a tonsillectomy, the nurse should place the child in which position? Trendelenburg supine side lying lithotomy

Correct response: side lying Explanation: Placing the child in a side-lying position facilitates drainage of secretions and helps prevent aspiration. The Trendelenburg position is contraindicated because it decreases effective lung volumes. The supine position is contraindicated because of the increased risk of aspiration. The lithotomy position is used for a pelvic examination.