Pediatrics Test #1 - End of Chapter Questions
(C)
Veronica's parents were told that their daughter needs ribavirin (Virazole). This drug is used to treat which of the following? (A) Cystic fibrosis (B) Otitis media (C) Respiratory syncytial virus (RSV) (D) Bronchitis
(C) Priorities of care for the child with respiratory distress are to clear the airway and provide oxygen supplementation. Children who experience respiratory distress often deteriorate very quickly, and the nurse must be prepared in the event of respiratory failure or arrest.
A 5-month-old infant with RSV bronchiolitis is in respiratory distress. The baby has copious secretions, increased work of breathing, cyanosis, and a respiratory rate of 78. What is the most appropriate initial nursing intervention? (A) Attempt to calm the infant by placing him in his mother's lap and offering him a bottle. (B) Alert the physician or nurse practitioner to the situation and ask for an order for a stat chest x-ray. (C) Suction secretions, provide 100% oxygen via mask, and anticipate respiratory failure. (D) Bring the emergency equipment to the room and begin bag-valve-mask ventilation.
(A) Because of the hemodynamic changes that occur with open heart surgery repair, particularly with septal defects, transient congestive heart failure may develop. Therefore, the child's sodium intake typically is restricted to 2-3g/day. Activity restrictions are inappropriate. Typically, the child is encourage to walk the halls and unit. Risk for infection after the repair is the same as any postop client; therefore, isolation is not necessary. The child may be placed in a room with other children who are not contagious. Visitors are not restricted unless the pediatric unit has restrictive visiting policies.
As part of the preoperative teaching for the family of a child undergoing a TOF repair, the nurse tells the family upon returning to the pediatric floor that the child may: (A) be placed on a reduced sodium diet (B) have an activity restriction for several ays (C) be assigned to an isolation room (D) have visits limited to a select few
(C)
To decrease the likelihood of bradyarrhythmias in children during endotracheal intubation, succinylcholine (Anectine) is used with which of the following agents? (A) Epinephrine (Adrenalin) (B) Isoproterenol (Isuprel) (C) Atropine sulfate (D) Lidocaine hydrochloride (Xylocaine)
(C) For the child with iron deficiency anemia, the blood study results most likely would reveal decreased mean corpuscular volume (MCV) which demonstrates microcytic anemia, decreased hemoglobin, decreased hematocrit and elevated total iron binding capacity.
Which of the following blood study results would the nurse expect as most likely when caring for the child with iron deficiency anemia? (A) Increased hemoglobin (B) Normal hematocrit (C) Decreased mean corpuscular volume (MCV) (D) Normal total iron-binding capacity (TIBC)
(D) Otitis media is commonly precipitated by an upper respiratory tract infection. Therefore, children prone to otitis should avoid people known to have an upper respiratory tract infection.
Which of the following instructions should Nurse Cheryl include in her teaching plan for the parents of Reggie with otitis media? (A) Placing the child in the supine position to bottle-feed (B) Giving prescribed amoxicillin (Amoxil) on an empty stomach (C) Cleaning the inside of the ear canals with cotton swabs (D) Avoiding contact with people who have upper respiratory tract infections
(A)
Which of the following instructions would Nurse Courtney include in a teaching plan that focuses on initial prevention for Sheri who is diagnosed with rheumatic fever? (A) Treating streptococcal throat infections with an antibiotic (B) Giving penicillin to patients with rheumatic fever (C) Using corticosteroid to reduce inflammation (D) Providing an antibiotic before dental work
(B) 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 10-year-old child proudly tells that 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
(D) Typically, children with aortic stenosis have a murmur that is best heard along the left sternal border. They do not commonly exhibit a gallop, rales, or right ventricular hypertrophy. Blood pressure and pulse discrepancies between the upper and lower extremities occur with coarctation of the aorta, not aortic stenosis.
A 2-day-old infant was just diagnosed with aortic stenosis. What is the most likely nursing assessment finding? (A) gallop and rales (B) blood pressure discrepancies in the extremities (C) right ventricular hypertrophy on ECG (D) heart murmur
(B)
A 2-year-old boy is scheduled to undergo an endoscopic procedure. His parents are asking when they should tell him about it. Based on the nurse's understanding of the child's developmental stage, when would be the most appropriate time to prepare the child for the procedure? (A) About 1 week before the scheduled date (B) A few days in advance of the scheduled date (C) About 1 hour before the procedure is to occur (D) Just before the procedure is to be performed
(B) Holding the head erect when sitting, staring at an object placed in the hand, taking the object to the mouth, cooing and gurgling, and sustaining part of his body weight when in a standing position are behaviors characteristic of a 4-month-old infant.
The nurse notes that an infant stares at an object placed in his hand and takes it to his mouth, coos and gurgles when talked to, and sustains part of his own weight when held in a standing position. The nurse correctly interprets these findings as characteristic of an infant at which age? (A) 2 months (B) 4 months (C) 7 months (D) 9 months
(B) The catheter insertion site will be covered with a bandage. This is important for preschool children to know as they are very concerned about bodily harm. The best time to prepare a preschool child for an invasive procedure is the night before. Bringing a favorite toy to the hospital will help decrease the child's anxiety. To prevent bleeding, the child will b expected to keep the extremity straight for 4-6 hours after the procedure, either in bed or on the parent's lap.
A 4-year-old has been scheduled for a cardiac catheterization. The help prepare the family, the nurse should: (A) Advise the family to bring the child to the hospital for a tour a week in advance (B) Explain that the child will need a large bandage after the procedure (C) Discourage bringing favorite toys that might become associated with pain (D) Explain that the child may get up as soon as the vital signs are stable
(A), (B), (D) Viral pharyngitis is treated with symptomatic, supportive therapy. Treatment includes use of a cool mist vaporizer, feeding a soft or liquid diet, and administration of acetaminophen for comfort. Viral infections do not respond to antibiotic administration. The child does not need to be on secretion precautions because viral pharyngitis is not contagious
A child has viral pharyngitis. What should the nurse advise the parents to do? Select all that apply. (A) use a cool mist vaporizer (B) Offer a soft-to-liquid diet (C) Administer Amoxicillin (D) administer Acetaminophen (F) Place the child on secretion precautions
(C) The nurse should teach the parents to provide for sufficient periods of rest to decrease the client's cardiac workload. The client's condition does not warrant close observation unless cardiac complications develop. The child's activity level will be based on the results of the sed rate, CRP, HR, and cardiac function. The family does not need to be with the client 24 hours a day unless carditis develops and his condition deteriorates
A nurse is planning care for a 12-year-old with rheumatic fever. The nurse should teach the parents to: (A) observe the child closely (B) allow the child to participate in activities that will not tire him (C) provide adequate periods of rest between activities (D) encourage someone in the family to be with the child 24 hours a day
(C) The risk of hemorrhage from a tonsillectomy is greatest when tissue begins sloughing and the scabs fall off. This typically happens 7-10 days after a tonsillectomy.
A nurse is teaching the parents of a preschooler about the possibility of postoperative hemorrhage after a tonsillectomy and adenoidectomy. When should the nurse explain that the risk of bleeding is the greatest? (A) 1-3 days postop (B) 4-6 days postop (C) 7-10 days postop (D) 11-14 days postop
(D) Infants with CHD often have difficulty feeding and gaining weight. They will tire quickly during the feeding. Most will do well with smaller, more frequent feeding. The infant with CHD should not be given more than 20 minutes per feeding. Fortified breast milk or a high-calorie formula will help the infant gain weight and conserve energy. Prolonging the feeding to an hour will merely tire the infant. Positioning the infant in an upright position is recommend for infants with gastrointestinal reflux. Some infants with a CHD may not consume adequate amounts of calories through breast-or bottle feeding and may required supplemental feeding through a nasogastric tube; however, NG tube feedings are not necessary for all infants with CHDs
An 8-week-old infant with congenital heart disease is being discharge. What is the MOST important info for the nurse to convey regarding feeding? (A) Allow the infant 1 hour to complete each feedings (B) Position the infant in an upright position after each feeding (C) Give feedings per nasogastric tube to conserve energy (D) Provide a higher calorie formula or fortified breast milk
(B) Close monitoring of inspiratory pressure and O2 concentration is necessary to prevent BPD, which is related to the use of high inspiratory pressures and O2 concentrations especially in very low-birth-weight and extremely low-birth-weight neonates with lung disorders.
Baby Melody is a neonate who has a very low-birth-weight. Nurse Josie carefully monitors inspiratory pressure and oxygen (O2) concentration to prevent which of the following? (A) Meconium aspiration syndrome (B) Bronchopulmonary dysplasia (BPD) (C) Respiratory syncytial virus (RSV) (D) Respiratory distress syndrome (RDS)
(A)
Beta-adrenergic agonists such as albuterol are given to Reggie, a child with asthma. Such drugs are administered primarily to do which of the following? (A) Dilate the bronchioles (B) Reduce secondary infections (C) Decrease postnasal drip (D) Reduce airway inflammation
(A)
Betty is a 9-year-old girl diagnosed with cystic fibrosis. Which of the following must Nurse Archie keep in mind when developing a care plan for the child? (A) Pulmonary secretions are abnormally thick. (B) Elevated levels of potassium are found in the sweat. (C) CF is an autosomal dominant hereditary disorder. (D) Obstruction of the endocrine glands occurs.
(C) The infant's mouth should be cleansed with a damp washcloth as should the baby's new teeth. It is important to clean the mouth and the teeth in order to prevent dental caries. Toothpaste is unnecessary in infancy. Rinsing the infant's mouth would present a safety hazard.
The nurse is providing anticipatory guidance to the mother of a 6-month-old infant. What is the best instruction by the nurse in relation to the infant's oral health? (A) "Start brushing her teeth after all the baby teeth come in." (B) "Use a washcloth with toothpaste to clean her mouth." (C) "Clean your baby's gums, then new teeth, with a washcloth." (D) "Rinse your baby's mouth with water after every feeding."
(C) Older children with pneumococcal pneumonia may complain of chest pain. A,B: A mild cough and slight fever are commonly assessed with viral pneumonia. D: A bulging fontanel may be seen in infants with meningitis or increased intracranial pressure.
Fred is a 12-year-old boy diagnosed with pneumococcal pneumonia. Which of the following would Nurse Nica expect to assess? (A) Mild cough (B) Slight fever (C) Chest pain (D) Bulging fontanel
(D) Because adolescents absorb less information through reading, providing age-appropriate reading materials is the least effective way to teach parenting skills to an adolescent. The other options engage more than one of the senses and therefore serve as effective teaching strategies.
Hannah, age 12, is 7 months pregnant. When teaching parenting skills to an adolescent, the nurse knows that which teaching strategy is least effective? (A) Providing a one-on-one demonstration and requesting a return demonstration, using a live infant model (B) Initiating a teenage parent support group with first - and - second-time mothers (C) Using audiovisual aids that show discussions of feelings and skills (D) Providing age-appropriate reading materials
(C)
Immunization of children with Haemophilus influenzae type B (Hib) vaccine decreases the incidence of which of the following conditions? (A) Bronchiolitis (B) Laryngotracheobronchitis (LTB) (C) Epiglottitis (D) Pneumonia
(A) Bronchodilators can produce the side effects listed in answer choice (A) for a short time after the patient begins using them.
Kim is using bronchodilators for asthma. The side effects of these drugs that you need to monitor this patient for include: (A) tachycardia, nausea, vomiting, heart palpitations, inability to sleep, restlessness, and seizures. (B) tachycardia, headache, dyspnea, temp . 101 F, and wheezing. (C) blurred vision, tachycardia, hypertension, headache, insomnia, and oliguria. (D) restlessness, insomnia, blurred vision, hypertension, chest pain, and muscle weakness.
(C)
Molly, with suspected rheumatic fever, is admitted to the pediatric unit. When obtaining the child's history, the nurse considers which information to be most important? (A) A fever that started 3 days ago (B) Lack of interest in food (C) A recent episode of pharyngitis (D) Vomiting for 2 days
(B) SIDS can occur any time between 1 week and 1 year of age. The incidence peaks at 2 to 4 months of age.
Sudden infant death syndrome (SIDS) is one of the most common causes of death in infants. At what age is the diagnosis of SIDS most likely? (A) At 1 to 2 years of age (B) At I week to 1 year of age, peaking at 2 to 4 months (C) At 6 months to 1 year of age, peaking at 10 months (D) At 6 to 8 weeks of age
(A), (B), (C), (D), (E) The report made when nurses are handing off a client from one nursing unit to another must include info about the condition of the client, potential for changes in condition, current meds, and care and service received. It is not necessary to know what meds were given in surgery to provide safe care at this point.
The nurse is transferring a child who has had open heart surgery from the ICU to the peds unit. The child's BP has been fluctuating but has been stable during the last 2 hours. The nurse from the peds ICU should include which info in the report to the nurse on the peds unit? Select all that apply. (A) meds being used (B) current VS (C) potential for BP to drop (D) drip rate for the IV infusion (E) time of most recent dose of pain meds (F) meds given during surgery
(B) Cephalexin is a first-gen cephalosporin. Because clients with a hx of anaphylaxis to penicillin, or related antibiotics, have an increased risk of having a cross-reaction to first-gen cephalosporin, the nurse should question a prescription for cephalexin.
The nurse caring for a 3 year-old with otitis media notes that the client has an allergy to amoxicillin that causes wheezing. Which prescription should the nurse questions? (A) azithromycin (B) cephalexin (C) trimethoprim-sulfamethoxazole (D) cefdinir
(C) Although children may be influenced by their peers and smell and appearance of foods may be important, children are most likely to be influences by the example and atmosphere provided by their parents. Coaxing and badgering a child to eat most likely will aggravate poor eating habits.
The nurse discusses the eating habits of school-age children with their parents, explaining that these habits are MOST influenced by: (A) food preferences of their peers (B) smell and appearance of foods offered (C) examples provided by parents at mealtimes (D) parental encouragement to eat nutritious foods
(D) More than 90% of of 9-month-olds are able to stand holding onto objects. Rolling over is expected at 4-6 months, and sitting without support is expected at 6 months. Crawling is expected at 9 months.
Which infant most needs a developmental referral for a gross motor delay? (A) 2-month-old who does not roll over (B) 4-month-old who does not sit without support (C) 6-month-old who does not crawl (D) 9-month-old who does not stand holding on
(B), (D) During early adolescence (11 to 14 years of age), adolescents are in conflict over becoming independent from their parents. They still at times want the role of the parents to be as it was during the school-age years. They are influenced by peers and value membership in cliques. Adolescents develop scientific reasoning and incorporate their own set of morals and values in middle and late adolescence
Which is associated with early adolescence? (Choose all that apply.) (A) Uses scientific reasoning to solve problems (B) Still at times wants to be dependent upon parents (C) Incorporates own set of morals and values (D) Is influenced by peers and values memberships in cliques
(D) The child must not lie down, to prevent risk of aspiration. Nosebleeds most often occur in the lower third of the nose, so pinching should occur there.
Which is the most appropriate treatment for epistaxis? (A) With the child lying down and breathing through the mouth, apply pressure to the bridge of the nose. (B) With the child lying down and breathing through the mouth, pinch the lower third of the nose closed. (C) With the child sitting up and leaning forward, apply pressure to the bridge of the nose. (D) With the child sitting up and leaning forward, pinch the lower third of the nose closed.
(C)
Which of the following organisms is responsible for the development of rheumatic fever? (A) Streptococcal pneumonia (B) Haemophilus influenza (C) Group A β-hemolytic streptococcus (D) Staphylococcus aureus
(C)
Which of the following respiratory conditions is always considered a medical emergency? (A) Asthma (B) Cystic fibrosis (CF) (C) Epiglottiditis (D) Laryngotracheobronchitis (LTB)
(D) Atraumatic care involves strategies and interventions to minimize distress. Allowing parents and children an informed choice helps to promote family-centered care and minimizes parent and child separation.
When providing atraumatic care to a child, which action would be the most appropriate? (A) Applying restraints for any procedure that would be uncomfortable (B) Keeping the lights on in the child's room throughout the day and night (C) Limiting the use of topical anesthetics for painful injections (D) Allowing parents and children an informed choice about being together
(B) Infants should be restrained only when necessary. Remove the restraints and provide direct observation as often as possible. Provide appropriate developmental stimulation while the restraints are on as well as off.
A 6-month-old infant requires restraint to prevent removal of his nasogastric tube. What is the priority nursing intervention? (A) Tie the restraint loosely to prevent skin breakdown. (B) Leave the baby unrestrained when directly observed. (C) Position the restrained infant prone to prevent aspiration. (D) Place the infant in a room near the nurses' station.
(C) Application of pressure and immobilization of the affect limb are the first priority. Pressure is required to stop the bleeding , and immobilization aims in reducing swelling and pain. Active ROM is recommends after the bleeding is controlled. Te application of cold packs can be helpful in diminishing swelling and pain. Cold packs will also promote vasoconstriction, which can help reduce the bleeding. The HCP should be informed of the bleeding episode after initial measures to control bleeding are implemented.
A 7-year-old with hemophilia A has fallen and badly bruised his knee. Which intervention should be done first when managing the client's hemarthrosis? (A) Use active ROM to prevent immobility (B) Apply cold packs to promote vasoconstriction (C) Apply pressure and imobilize the joint (D) Notify the HCP of the injury
(C) RSV may be spread through both direct and indirect contact. While contact and standard precautions should be employed, a measure to further decrease the risk of nosocomial infections is to avoid assigning the same nurse caring for an RSV client to a client at risk for infection. A private room is preferred, but if this is not an option, the nurse should understand that children 2 years of age and younger are most at risk fro RSV, especially if they have other chronic problems such as a heart defect. From an infection control perspective, pairing two clients with RSV is ideal. RSV infections are less likely to pose a serious problem in older children.
A charge nurse is making assignments for a group of children on a pediatric unit. The nurse should MOST avoid assigning the same nurse to care for a 2-year-old child with RSV and: (A) an 18-month-old with RSV (B) a 9-year-old 8 hours post-appendectomy (C) a 1-year-old with a heart defect (D) a 6-year-old with sickle cell crisis
(C) In an infant with these symptoms, the first action by the nurse would be to obtain an oxygen saturation reading to determine how well the infant is oxygenating. Because the parent probably can provide no other information, checking the hR would be the second action done by the nurse. Then the nurse would obtain the infant's weight.
A parent brings a 3-month-old to the clinic, reporting that the infant ah s cold, is having trouble breathing, and "just does not seem to be acting right." Which action should the nurse take FIRST? (A) Check HR (B) Weigh infant (C) Assess O2 sats (D) Obtain more info from parent
(A) Children who have undergone open heart surgery with a patch are at risk for infection, especially subacute bacterial endocarditis (SBE), for the first 6 months following surgery. The newest evidence-based guidelines suggest that once the patch has epithelialized, these precautions are no longer necessary. Therefore, parents are instructed about SBE precautions including the need to notify providers before invasive procedures so antibiotics can be prescribed for that time period. Having the child drink a very large amount of water may lead to fluid overload. Children gear their rest schedule to their activities making it unnecessary to schedule frequent rest periods. Bananas and citrus fruit are high in potassium, but there is no evidence provided that the child has an elevated serum potassium requiring restriction.
A child has had open heart surgery to repair TOF with a patch. The nurse should instruct the parents to: (A) notify all healthcare providers before invasive procedures for the next 6 months (B) maintain adequate hydration of at least 10 glasses of water a day (C) provide frequent rest periods and naps during first 4 weeks (D) restrict ingestion of bananas and citrus fruit
(A), (B), (C), (D) Adverse effects of morphine given epidurally include respiratory depression, constipation, pruritus, and nausea and vomiting. Amnesia is an effect of midazolam. Epidural hematoma is a complication associated with insertion of an epidural catheter unrelated to the drug being administered.
A child is receiving epidural analgesia with morphine. The nurse would be alert for which of the following adverse effects? Select all that apply. _______ a. Respiratory depression _______ b. Pruritus _______ c. Constipation _______ d. Vomiting _______ e. Amnesia _______ f. Hematoma
(A) To ensure the effectiveness of EMLA cream for a bone marrow aspiration, which is considered a deep procedure, the nurse would apply the cream 2 to 3 hours before the time of the procedure. Since the scheduled time is 4 PM, applying the cream between 1 and 2 PM would be appropriate. If the procedure was a superficial procedure such as venipuncture or heelstick, then the nurse would apply the cream 1 hour before the procedure, at 3 PM.
A child is scheduled for a bone marrow aspiration at 4 PM. The nurse would plan to apply EMLA cream to the intended site at which time? (A) 1:30 PM (B) 3:00 PM (C) 3:30 PM (D) 4:00 PM
(C) Advantages to outpatient surgery centers include decreased risk for infection, decreased cost, decreased separation from family, and decreased disruption of family functioning. The major disadvantage associated with this site is the inability to accommodate overnight stays if necessary due to complications. The child would usually have to be transferred to a hospital for continued care.
A child is to undergo a tympanostomy tube placement in a freestanding outpatient surgery center. What is the major disadvantage associated with this location? (A) Increased risk for infection (B) Increased health care costs (C) Need to be transferred if overnight stay is required (D) Increased disruption of family functioning
(B), (D) Aspirin needs to be stopped because of its possible link to Reyes syndrome. Additionally, the parents need to watch for s/s of influenza. Children with influenza frequently present with fever, cold symptoms, and GI symptoms.
A child with KD is receiving low-dose aspirin. The mother calls the clinic and states that the child has been exposed to influenza. Which recommendations should the nurse make? Select all that apply. (A) Increase fluid intake (B) Stop the aspirin (C) Keep child at home from school (D) Watch for fever (E) Weight child daily
(C)
A child with a poor nutritional status and weight loss is at risk for a negative nitrogen balance. To help diagnose this problem, the nurse in charge anticipates that the doctor will order which laboratory test? (A) Total iron-binding capacity (B) Hemoglobin (C) Total protein (D) Serum transferrin
(A)
A female child, age 2, is brought to the emergency department after ingesting an unknown number of aspirin tablets about 30 minutes earlier. On entering the examination room, the child is crying and clinging to the mother. Which data should the nurse obtain first? (A) Heart rate, respiratory rate, and blood pressure (B) Recent exposure to communicable diseases (C) Number of immunizations received (D) Height and weight
(D) The stress of starting nursery school may trigger a return to a level of successful behavior from earlier stages of development. A child's skills remain intact, although increased stress may prevent the child from using these skills. Growth occurs when the child does not regress. Parents rarely desire less mature behaviors.
A mother asks the nurse how to handle her 5-year-old child, who recently started wetting the pants after being completely toilet trained. The child just started attending nursery school 2 days a week. Which principle should guide the nurse's response? (A) The child forgets previously learned skills (B) The child experiences growth while regressing, regrouping, and then progressing (C) The parents may refer less mature behaviors (D) The child returns to a level of behavior that increases the sense of security.
(C) If the child is hungry he/she more likely would finish his meals. Therefore, the mother should be advised not to give snacks to the child. The child is a "busy toddler." He/she will not able to keep still for a long time.
A mother tells the nurse that she is very worried because her 2-year old child does not finish his meals. What should the nurse advise the mother? (A) make the child seat with the family in the dining room until he finishes his meal (B) provide quiet environment for the child before meals (C) do not give snacks to the child before meals (D) put the child on a chair and feed him
(C) Based on the assessment findings of increased RR, retractions, and wheezing, this infant needs further evaluation, which could be obtained in an ED. Without a definitive diagnosis, administering a neb treatment would be outside the nurse's scope of practice unless there was a prescription for such a treatment. Sending the infant for a radiograph may not be in the nurse's scope of practice. The findings need to be reported to an HCP who can then determine whether or not a chest radiograph is warranted. The infant is exhibiting signs and symptoms of respiratory distress and is too ill to send out with just instructions on cold care for the mother.
A nurses's assessment of a 6-month-old infant reveals a RR 52 bpm, retractions, and wheezing. The mother states that her infant was doing fine until yesterday. Which action would be MOST appropriate? (A) Administer a nebulizer treatment (B) Send the infant for a chest radiograph (C) Refer the infant to the ED (D) Provide teaching about cold care to the mother
(A), (B), (F) RSV can be spread through direct contact such as kissing the face of an infected person, and it can be spread through indirect contact by touching surfaces covered with infected secretions. Hand washing is one of the best ways to reduce the risk of disease transmission. Palivizumab can prevent severe RSV infections but is only recommend for the most-at risk infants and children. RSV is typically contagious for 3-8 days. RSV frequently manifests in older children as cold-like symptoms. Infected school-age children frequently spread the virus to other family members.
A teaching care plan to prevent the transmission of RSV should include what info? Select all that apply. (A) The virus can be spread via direct contact (B) The virus can be spread via indirect contact (C) Palivizumab is recommended to prevent RSV in all toddlers in day care (D) The virus is typically contagious for 3 weeks (E) Older children seldom spread RSV (F) Frequent hand washing helps reduce the spread of RSV.
(A) Priorities of care for the child with respiratory distress are to clear the airway and provide oxygen supplementation.
A toddler has moderate respiratory distress, is mildly cyanotic, and has increased work of breathing, with a respiratory rate of 40. What is the priority nursing intervention? (A) Airway maintenance and 100% oxygen by mask (B) 100% oxygen and pulse oximetry monitoring (C) Airway maintenance and continued reassessment (D) 100% oxygen and provision of comfort
(B) The best evidence indicates that a catheter as small as 27 gauge may safely be used for transfusion in children, but blood must be infused with normal saline, not dextrose. A 1-year-old should be able to maintain his or her blood glucose for the 2-hour duration of the infusion without the need for a second IV
A transfusion of packed RBCs has been prescribed for a y-year-old with a sickle cell anemia. The infant has a 25-gauge IV infusing dextrose with sodium and potassium. Using the SBAR, the nurses contacts the HCP and recommends: (A) starting a second IV with a 22-gauge catheter to infuse the normal saline with the blood (B) using the existing IV, but changing the fluids to normal saline for the transfusion (C) replacing the IV with a 22-gauge catheter to infuse the prescribed fluids (D) starting a second IV with a 25-gauge catheter to infuse normal saline with the transfusion
(B) The child is exhibiting regression. During periods of stress, children frequently revert to behaviors that were comforting in earlier developmental stages; play therapy is one way to help the child cope with the stress. Teaching a new skill most likely would add more stress. Parents should be instructed to praise positive behaviors and ignore regressive behaviors rather than calling attention to them through encouragement or discouragement. Having someone else hold the child dose not encourage coping with the stress or promoting appropriate development.
After surgery to correct TOF, the child's parents express concern to the nurse that their 4-year-old child wants to be held more frequently than usual. The nurse recommends: (A) introducing a new skill (B) play therapy (C) encouraging the behavior (D) having the volunteer hold the child
(A) Digoxin's effect is to slow the rate of the electrical conduction through the heart and increase the strength of the heart's contraction. Signs of toxicity include anorexia and decrease HR, not visual changes or increases in HR. Digoxin should be taken 1 hour before meals or 2 hours after meals in order to obtain better absorption of the drug. If the child vomits within 15 minutes of administration, the dose should NOT be repeated because it is not known how much of the medication has been absorbed.
An 18-month-old with a CHD is to receive digoxin twice a day. Which instructions should the nurse give the parents? (A) Digoxin enables the heart to pump more effectively with a slower and more regular rhythm. (B) Signs of toxicity include increased pulse and visual disturbances (C) Digoxin is absorbed better if taken with meals (D) If the child vomits within 15 minutes of admin, the dosage should be repeated
(C), (F) Typical abilities demonstrated by 8-month-old infants include playing peekaboo and transferring objects from one hand to another. The ability to say "dada" and "mama" is more typical of 10-month-old infants. Infants usually are at least 12 months old when they achieve the ability to walk independently. Infants who are 15 months old commonly can feed themselves with a spoon and stack two blocks
An 8-month-old infant is seen in the well-child clinic for a routine checkup. The nurse should expect the infant to be able to do which tasks? Select all that apply. (A) say "mama" and "dada" with specific meaning (B) feed self with a spoon (C) play peekaboo (D) walk independently (E) Stack two blocks (F) transfer objects from hand to hand
(C) Clients with cystic fibrosis commonly die from respiratory problems. The mucus in the lungs is tenacious and difficult to expel, leading to lung infections and interference with oxygen and carbo dioxide exchange. The client will likely need supplemental oxygen and respiratory treatments to maintain adequate gas exchange, as identified by the oximeter reading. The child will be on bed rest due to respiratory distress. However, although blood gases will probably be prescribed, the oximeter readings will be used to determine oxygen deficit and are, therefore, more of a priority. A diet high in calories, proteins, and vitamins with pancreatic granules added to all foods ingested will increase nutrient absorption and help the malnutrition; however, this intervention is not the priority at this time. Inserting an IV to administer antibiotics is important and can be done after ensuring adequate respiratory function.
An adolescent with cystic fibrosis has been hospitalized several times. On the latest admission the client has labored respirations, fatigue, malnutrition, and failure to thrive. Which initial nursing actions are MOST important? (A) placing the client on bed rest and obtaining a prescription for a blood gas analysis (B) implementing a high-calorie, high-protein, low-fat, vitamin-enriched diet and pancreatic granules (C) applying an oximeter and initiating respiratory therapy (D) inserting an IV line and initiating antibiotic therapy
(A), (C), (D) The RN's scope of practice includes assessment, planning, implementing, and evaluation. Only aspects of care implementation may be delegate to LPN, and the exact skills that may be delegated vary by state and institution. In general, LPNs have been trained to perform the tasks of administering oral meds, performing hygiene, and recording I&O. LPNs may also take VS, but the nurse must interpret the data. Administering IV morphine requires assessment of the client's respiratory status before, during, and after the procedure. Circulation checks are assessments the RN should complete.
An infant has been transferred from the ICU to the pediatric floor after undergoing surgery to correct a heart defect. Which tasks can the nurse delegate to the LPN? Select all that apply. (A) administering oral meds (B) administering morphine IV (C) obtaining VS (D) morning hygiene (E) circulation checks (F) discharge teaching
(A), (F) An infant with bronchiolitis will have increased respirations and will tire more quickly, so it is best and easiest for the infant to take fluids more often in smaller amounts. The parents also would be instructed to watch for signs of increased difficulty breathing, which signal possible complications. Health infants and even those with bronchiolitis should sleep in the supine position. Calling the clinic for an episode of vomiting would not be necessary. However, the parents would be instructed to call in the infant cannot keep down any fluids for a period of more than 4 hours. Parents would not need to record how much the infant drinks. Chest physiotherapy is not indicated because it does not help and further irritates the infant.
An infant is being treated at home from bronchiolitis. What should the nurse teach the parent about home care? Select all that apply. (A) offering small amounts of fluids frequently (B) allowing the infant to sleep prone (C) calling the clinic if the infant vomits (D) writing down how much the infant drinks (E) perfomring chest physiotherapy q4h (F) watching for difficulty breathing
(B) An above-average pulse rate that is out of proportion to the degree of activity is an early sign of HF in a client with rheumatic fever. The sleeping pulse is used to determine whether th mild tachycardia persists during sleep (inactivity) or whether it is a result of daytime activities. The environmental temperature would need to be quite warmer before it could influence the HR. Digitalis lowers the HR, so the rate would be decreased during the daytime.
The HCP prescribes pulse assessments through the night for a 12-year-old child with rheumatic fever who has a daytime heart rate of 120 bpm. The nurse explains to the mother that this is to evaluate if the elevate HR is caused by: (A) the morning digitalis (B) normal activity during waking hours (C) a warmer daytime environment (D) normal variations in day and evening hours
(C) Over 90% percent of babies can sit unsupported by nine months. Most babies cannot say "mama" in the sense that it refers to their mother at this time.
The nurse is assessing a 9-month-old boy for a well-baby check up. Which of the following observations would be of most concern? (A) The baby cannot say "mama" when he wants his mother. (B) The mother has not given him finger foods. (C) The child does not sit unsupported. (D) The baby cries whenever the mother goes out.
(A) The priority in a sickling crisis is to bring pain under control quickly as this brings the child relief; also, the significant stress resulting from pain can contribute to the further sickling of cells.
The nurse is caring for a child who has just been admitted to the pediatric unit with sickle cell crisis. He is complaining that his right arm and leg hurt. What is the priority nursing intervention? (A) Administer pain medication every 3 hours intravenously until pain is controlled. (B) Perform passive range of motion of the arm and leg to maintain function. (C) Try acetaminophen for pain first, moving up to opioids only if needed. (D) Use narcotic analgesics and warm compresses as needed to control the pain.
(A) Increased urine output, a sign of improving kidney function, typically is the first sign that a child with acute poststreptococcal glomerulonephritis (APSGN) is improving. Increased appetite, an increased energy level, and decreased diarrhea are not specific to APSGN.
The nurse is evaluating a female child with acute poststreptococcal glomerulonephritis for signs of improvement. Which finding typically is the earliest sign of improvement? (A) Increased urine output (B) Increased appetite (C) Increased energy level (D) Decreased diarrhea
(D) There is no need to remove the underwear, and keeping it on gives the boy a sense of control and privacy.
The nurse is preparing a 5-year-old boy for surgery on his lower leg. His mother is helping him into the hospital gown and the boy fights removal of his underwear. What is the most appropriate nursing action? (A) Allow the mother to remove the underwear. (B) Tell the boy he is acting childishly. (C) Notify the OR that the underwear is on. (D) Allow the boy to keep his underwear on.
(B) The FACES pain rating scale is a self-report tool that can be used by children as young as 3 or 4 years of age. Self-report measures should be used in conjunction with observation and discussion with the child and family in children under 5.
The nurse is preparing to assess the pain of a 3-year-old child who had surgery the day before. Which pain assessment method would be most appropriate for the nurse to use? (A) FACES pain rating scale and poker chip tool (B) FACES pain rating scale, observation of the child, and parent report (C) Asking the parents to rate their child's pain using the word-graphic rating scale (D) Visual analog scale
(4) Dark urine is not a potential side effect of taking an iron supplement. Families need education about the possible side effects, including place liquid iron behind the teeth to avoid teeth staining. Stools may become dark in color, even turn black, and some clients may experience anorexia.
The nurses teaches the parents of a 4-year-old diagnosed with iron deficiency anemia about potential side effects of taking an iron supplement. The nurse knows more teaching is required when the parents state a side effect of taking an iron supplement is: (A) teeth staining (B) black stools (C) anorexia (D) dark urine
(A) The toddler is exhibiting cold symptoms. A hoarse cough may be part of the upper respiratory tract infection. The best suggestion is to have the father offer the child additional fluids at frequent intervals to help keep secretions loose and membrane moist. There is no evidence presented to suggest that the child needs to be brought to the clinic immediately Although having the father count the child's RR may provide some additional info, it may lead the father to suspect that something is seriously wrong, possibly leading to undue anxiety. A hot air vaporizer is not recommended. However, a cool mist vaporizer would cause vasoconstriction of the respiratory passages making it easier for the child to breath and loosening secretions.
The parent of a 16-month-old child calls ths clinic because the child has a low-grade fever, cold symptoms, and a hoarse cough. What should the nurse suggest that the parent do? (A) Offer extra fluids frequently (B) Bring the child to the clinic immediately (C) Count the child's RR (D) Use a hot air vaporizer
(A) Typically, a 9-month-old infant should have been voicing single syllables since 6 months of age. Absence of this finding would be a cause for concern. An infant usually is able to stand alone at about 10 months of age. An infant usually is able to build a tower of two cubes at about 15 months of age. An infant usually is able to drink from a cup with little spilling at about 15 months of age.
The parents of a 9-month-old infant expressed concern that the baby "is developing slowly." The nurse is concerned about a developmental delay when finding that baby is unable to accomplish which skill? (A) Vocalizing single syllables (B) Standing alone (C) Building a tower of two cubes (D) Drinking from a cup with little spilling
(B) According to Erikson, the central psychosocial task of a preschooler is to develop a sense of initiative versus guilt. Any environmental situation may affect the child. In this situation, the sibling is probably feeling less attention from the mother and trying to resolve the conflict in an inappropriate way. Three-year-olds are usually active and outgoing. These behaviors represent a change. Data are not sufficient to suggest the child has been exposed to a sexual experience. Symptoms of depression would include withdrawal and fatigue.
The parents of a child hospitalized with TOF tells the nurse that the child's 3-year-old sibling has become quiet and shy and demonstrates more than a usual amount of gential curiosity since this child's hospitalization. The nurse should tell the parents: (A) This is very typical fora 3-year-old (B) This may be how you child expresses feeling a need for attention (C) This may be indicative of sexual abuse (D) This may be a sign of depression in your child
(A), (C), (D) BP percentiles for children are reference by the age, sex, and height. Measurements at or above the 95th percentile are considered indicative of HTN. Weight and elevated BMI contribute to HTN but are not used to define it. The OFC is notu routinely measured in children over 2 years of age and is not used to reference blood pressure readings.
To interpret the results of BP screenings in children over 3 years of age, the nurse compares the results to percentiles for systolic and diastolic BP based on what factors? Select all that apply. (A) age (B) BMI (C) gender (D) height (E) occipital frontal circumference (OFC) (F) weight
(B) The teenager's peer group has the greatest influence on his or her behavior. If peers are drinking, the teenager will be at greater risk of drinking.
What has the most influence in deterring an adolescent from beginning to drink alcohol? (A) Drinking habits of parents (B) Drinking habits of peers (C) Drinking philosophy of adolescent's culture (D) Drinking philosophy of adolescent's religion
(A)
What should be the initial bolus of crystalloid fluid replacement for a pediatric patient in shock? (A) 20 ml/kg (B) 10 ml/kg (C) 30 ml/kg (D) 15 ml/kg
(B) Cardiac status must be monitored carefully in the initial phase of KD because the child at high risk for CHF. Therefore, the nurse needs to assess the child frequently for signs of CHF, which would include respiratory distress and decreased urine output.
When developing the plan of care for a newly admitted 2-year-old child with the diagnosis of Kawasaki disease (KD), which intervention should be the PRIORITY? (A) taking VS q6h (B) monitoring I&O qh (C) minimizing skin discomfort (D) providing passive ROM exercises
(D) An adolescent who demonstrates a preoccupation with death (such as by talking about death frequently) should be considered at high risk for suicide. Although depression, excessive sleepiness, and a history of cocaine use may occur in suicidal adolescents, they also occur in adolescents who are not suicidal.
When evaluating a severely depressed adolescent, the nurse knows that one indicator of a high risk for suicide is: (A) Depression (B) Excessive sleepiness (C) A history of cocaine use (D) A preoccupation with death
(A), (C), (E), (F) Adolescents need to be accepted as unique individuals. Parents should provide unconditional love, respect their privacy, and listen to them. Screening all of their friends and providing strict, inflexible rules would only lead to poor interactions between the parents and the adolescent.
When giving parents guidance for the adolescent years, the nurse would advise the parents to: (Choose all that apply.) (A) Accept the adolescent as a unique individual (B) Provide strict, inflexible rules (C) Listen and try to be open to the adolescent's views (D) Screen all of his or her friends (E) Respect the adolescent's privacy (F) Provide unconditional love
(C) with CPR, effectiveness of external chest compression is indicated by palpable peripheral pulses, the disappearance of mottling and cyanosis, the return of pupils to normal size, and warm, dry skin. To determine whether the victim of cardio-pulmonary arrest has resumed spontaneous breathing and circulation, chest compression must be stopped for 5 seconds at the end of the first minute and every few minutes thereafter.
When performing CPR, which finding indicates that external chest compression are effective? (A) mottling of skin (B) pupillary dilation (C) palpable pulse (D) cool, dry skin
(D) Normally the top of the ear aligns with an imaginary line drawn across the inner and outer canthus of the eye. Ears set below this line are associated with renal anomalies or mental retardation
When performing a physical examination on an infant, the nurse in charge notes abnormally low-set ears. This findings is associated with: (A) Otogenous tetanus (B) Tracheoesophageal fistula (C) Congenital heart defects (D) Renal anomalies
(D) The community health nurse should visit as soon after the death as possible because the parents may need help to deal with the sudden, unexpected death of their infant. Parents often have a great deal of guilt in these situations and need to express their feelings to someone who can provide counseling.
When planning a visit to the parents of an infant who died of sudden infant death syndrome at home, the nurse should visit th parents at which time? (A) a few days after the funeral (B) 2 weeks after the funeral (C) as soon as the parents are ready to talk (D) as soon after the infant's death as possible
(B) Always assess the child's and family's learning needs and preferred style of learning first.
When planning education for a child and parents, what is the first step the nurse should take? (A) Decide which procedures and medications the child will be discharged on. (B) Determine the child's and family's learning needs and styles. (C) Ask the family if they have ever performed this type of procedure. (D) Tell the child and family what the goals of the teaching session are.
(C) Before developing any teaching program for a child, the nurse's first step is to assess the child to determine what is already known. Most older preschool children have some understanding of a condition present since birth. However, the child's interest will soon be lost if familiar material is repeated too often. The nurse can then organize the info in a sequence because there are several steps to be demonstrated. These exercises do not require the use of equipment. The nurse should judge the amount and complexity of the info to be provided, based on the child's current knowledge and response to teaching.
When teaching a preschool-age child how to perform coughing and deep breathing exercises before corrective surgery for TOF, which teaching and learning principles should the nurse address FIRST? (A) Organizing info to be taught in a logical sequence (B) arranging to use actual equipment for demonstrations (C) building the teaching on the child's current level of knowledge (D) presenting the info in order from simplest to most complex
(D) For ac hild with arthritis associated with rheumatic fever, the joints are usually so tender that even the weight of bed linnes can cause pain. Use of a bed cradle is recommended to help remove the weight of the linens on painful joints.
Which action should the nurse perform to help alleviate a child's joint pain associated with rheumatic fever? (A) Maintain the joints in an extended position (B) Apply gentle traction to the child's affected joints (C) Support proper alignment with rolled pillows (D) Use a bed cradle to avoid the weight of bed linens on joints
(A), (B), (D), (F) Coughing, especially at night and in the absence of an infection, is a common symptom of asthma. Early signs of respiratory distress include restlessness, tachypnea, tachycardia, and diaphoresis. Other signs also include HTN, nasal flaring, grunting, wheezing, and intercostal retractions. A HR of 95 bpm is normal for a toddler. Malaise typically does not indicate respiratory difficulties
Which assessment findings should lead the nurse to suspect that a toddler is experiencing respiratory distress? Select all that apply. (A) coughing (B) RR of 35 bpm (C) HR 95 bpm (D) restlessness (E) malaise (F) diaphoresis
(A), (D), (E) Stealing in the school-age years occurs for multiple reasons: to escape punishment, because of a lack of sense of propriety or ownership, and because of a strong desire to own something they do not have because of lack of money or refusal by parents. Stealing also occurs when a school-age child has low self-esteem and high expectations from his family or peers that the child cannot meet.
Which of the following are reasons that stealing occurs in school-age children? (Choose all that apply.) (A) To escape punishment (B) High self-esteem (C) Low expectations of family/peers (D) Lack of sense of property (E) Strong desire to own something
(A) The child with congenital heart disease develops polycythemia resulting from an inadequate mechanism to compensate for decreased oxygen saturation
Which of the following is most likely associated with a cerebrovascular accident (CVA) resulting from congenital heart disease? (A) Polycythemia (B) Cardiomyopathy (C) Endocarditis (D) Low blood pressure
(A) Lead poisoning may be caused by inhalation of dusk and smoke from leaded gas. It may also be caused by lead-based paint, soil, water (especially from plumbings of old houses).
Which of the following situations increase risk of lead poisoning in children? (A) playing in the park with heavy traffic and with many vehicles passing by (B) playing sand in the park (C) playing plastic balls with other children (D) playing with stuffed toys at home
(A), (B), (D), (F) TOF is a heart condition with four defects: pulmonic stenosis, right ventricular hypertrophy, VSD, and an overriding aorta. A systolic murmur, cyanosis, and tachypnea are all symptoms of TOF. Toddlers with uncorrected defects instinctively squat (knee-chest position) to decrease the return of systemic venous blood to the heart. Coarctation of the aorta is a narrowing in the descending aorta, obstructing the systemic blood outflow. Infants with severe constriction may present with faint pulse in lower extremities and bounding pulses in upper extremities.
Which signs and symptoms would lead the nurse to suspect a child has TOF? Select all that apply. (A) murmur (B) hx of squatting (C) bounding pulses (D) cyanosis (E) faint pulse (F) tachypnea
(D) Hypercyanotic spells are a dangerous event. Placing the infant in a knee-to-chest position increases systemic vascular resistance, thereby improving pulmonary blood flow. It is the first action the nurse should take.
While assessing a 4-month-old infant, the nurse notes that the baby experiences a hypercyanotic spell. What is the priority nursing action? (A) Provide supplemental oxygen by face mask. (B) Administer a dose of IV morphine sulfate. (C) Begin cardiopulmonary resuscitation. (D) Place the infant in a knee-to-chest position.
