peds midterm (ch 16, 17, 23)
A nurse on the neurology unit is monitoring an 8-year-old child admitted with seizures. The child experiences a prolonged tonic-clonic seizure. The nurse should first ___________________ followed by ____________________.
- ensure proper oxygenation - administer intravenous (IV) or intramuscular (IM) benzodiazepine
When assessing a neonate for seizures, what would the nurse expect to find? Select all that apply.
- tachycardia - elevated blood pressure - jitteriness
When teaching a parent about amblyopia, it would be most important to explain that:
amblyopia is correctable if the child is properly treated before 6 years of age.
Which child will the nurse identify as at greatest risk for developing a urinary tract infection?
an 8-month-old bottle-fed female with HIV
The mother of a 10-day-old infant reports her baby has been having "lots of eye discharge." What is the best initial response by the nurse?
"Tell me more about this drainage."
An 8-month-old has been diagnosed with infantile eczema. At a follow-up appointment, the child's caregiver seems exhausted and angry. He explains that he has done all of the child's care because his wife is repulsed by the child's raw and uncomfortable appearance. What responses would be appropriate for the nurse to say to this caregiver?
"That's not an uncommon reaction, although it's hard on you and on your child."
The parent of a child having tympanoplasty tubes placed asks, "Will my child lose hearing while the tubes are in place?" What is the nurse's best answer?
"The tubes are inserted into a section of eardrum in which the hearing is not affected."
A topical corticosteroid is prescribed for a child with contact dermatitis. Which statement by the mother would indicate the teaching was successful?
"I should not cover the area with plastic wrap after applying the cream."
A 6-month-old infant is admitted to the hospital with suspected bacterial meningitis. She is crying, irritable, and lying in the opisthotonic position. The priority nursing intervention would be:
Initiate appropriate isolation precautions and begin intravenous antibiotics
The nurse is providing teaching to the parents of a child recently prescribed carbamazepine for a seizure disorder. Which statement by a parent indicates successful teaching?
"I need to watch for any new bruises or bleeding and let my health care provider know about it."
The nurse is talking with the mother of a 4-year-old boy who will soon be going to a pre-kindergarten program. The child has had the Snellen vision test done at home, and he was unable to distinguish the pictures at the distance that would indicate his vision is normal. The child's mother asks the nurse if he will need glasses. Which statement made by the nurse would be most appropriate regarding the child's vision?
"A child's vision is not completely developed by this age. Your child might outgrow this nearsightedness."
The nurse is teaching about skin care for atopic dermatitis. Which statement by the parent indicates that further teaching may be necessary?
"A hot bath will soothe my child's itching when it is severe."
A nursing instructor is teaching about eye disorders in childhood. Which statement made by a student indicates a need for further instruction?
"Cataracts are only present in adults."
The parents of a 17-year-old adolescent diagnosed with bacterial meningitis tell the nurse, "We just do not understand how this could have happened. Our adolescent has always been healthy and just received a booster vaccine last year." How should the nurse respond?
"I understand your frustration. Unfortunately, immunizations are not 100% effective in preventing the infection."
A child has been diagnosed with bacterial conjunctivitis. Which statement(s) by the child's parent indicates the need for further education? Select all that apply.
"I will continue to use eye drops until the redness is gone." "Our child can go back to school in 4 hours, after that thick yellow drainage is gone."
While caring for a child who will be undergoing a lumbar puncture, the nurse explains the procedure to the infant's mother. Which statement by the mother would indicate a need for further education?
"I will cradle her in my arms after the procedure for at least 30 minutes."
The parents of a 4-month-old diagnosed with sepsis tell the nurse that the physician explained sepsis to them but they don't really understand it. The parents state, "Could you please explain it to us?" What is the best response by the nurse?
"The infection your child has causes the release of toxins into the system, which can lead to impaired function in the lungs, liver, and kidneys."
Parents bring their 9-year-old child to the clinic for a well-child visit. They are concerned because several children in the neighborhood have developed Lyme disease and ask for suggestions on what to do to reduce their child's risk. What would be appropriate for the nurse to suggest? Select all that apply.
- Wearing protective clothing when playing in wooded areas. - Inspecting the skin closely for ticks after the child plays in wooded areas. -
A child is hospitalized and diagnosed with bacterial meningitis. What can the nurse anticipate will be included in the plan of care and treatment? Select all that apply.
- acetaminophen - antibiotic therapy - tepid baths as needed
A nurse demonstrates understanding of the various levels of consciousness as they progress from most alert to least alert. Place the levels of consciousness in the order that reflects this progression.
1. Oriented to person, place, and time 2. Disorientation 3. Obtundation 4. Stupor 5. Coma
A health care provider has prescribed cephalexin 30 mg/kg PO daily in 4 divided doses for a child diagnosed with impetigo. The child weighs 30 lb (14 kg). How many milligrams should the child receive each day?
420
The nurse works in a pediatrician office. Which children, who have been diagnosed with acute otitis media, does the nurse expect the physician to treat with antibiotics? Select all that apply.
8-year-old child who is crying due to ear pain and has a temperature of 103 F (39.4 C) 2-month-old child who is having difficulty sleeping and has a fever of 102.6 F (39.2 C) 5-month-old child who is fussy and pulling at her ears 22-month-old child who is irritable with the presence of purulent drainage from her right ear
The nurse is caring for a child admitted to the hospital for sepsis. Which assessment finding is the most concerning?
urine output of 10 ml over 3 hours
The student nurse gives a presentation on the dangers of sun exposure to clients at a community health center. Which statement(s) by the attendees demonstrate that knowledge was gained from the presentation? Select all that apply.
A 17-year-old adolescent states no longer using the tanning bed after attending the presentation. A 15-year-old adolescent states always using sunscreen because "she does not want to get skin cancer like my mother did." A 16-year-old adolescent states that it "scares me to think that my cells are changing when I get a sunburn."
The nurse cares for a 7-year-old child with new-onset seizure disorder. Which prescription will the nurse anticipate for this client?
use of anticonvulsant medications
The nurse is assessing the neurological functioning of a preschool child. What actions will best review functioning of cranial nerve III?
A bright-colored toy is moved in the child's visual fields.
Which assessment finding by the nurse would warrant immediate action?
A child with periorbital cellulitis reports changes in vision and pain with eye movement.
The nurse is teaching skin care for atopic dermatitis. Which statement by the parent that further teaching may be necessary?
A hot bath will soothe my child's itching when it is severe
At a well-child visit, hydrocephalus may be suspected in an infant if upon assessment the nurse finds:
A rapid increase in head circumference
After performing eye tests, the school nurse notes a child has symptoms of myopia. Which recommendation will the nurse make to the child's teacher?
Place the child close to the blackboard.
The nurse is caring for a 3-year-old boy who is experiencing seizure activity. Which diagnostic test will determine the seizure area in the brain?
video electroencephalogram
A nurse is providing care to a child admitted to the hospital with a diagnosis of severe periorbital cellulitis. Which intervention(s) should the nurse expect to implement? Select all that apply.
Administer intravenous antibiotics. Institute contact isolation precautions. Obtain blood cultures.
The nurse is caring for a school-age child who has been having a continuous seizure for the last 40 minutes. What is the priority action by the nurse?
Administer lorazepam IV as prescribed.
The nurse is caring for a 9-year-old child with partial-thickness (second-degree) burns. The client rates the pain at an 8 on a 1 to 10 numerical pain scale. The nurse notes the client is sitting in the bed playing with toys and smiling. Which action will the nurse take?
Administer pain medication as prescribed.
During physical assessment of a 2-year-old child, the nurse becomes concerned that the child may have a cataract in one eye. Which sign or symptom suggests the child has a cataract?
Absence of the red reflex
The nurse is caring for a child with burns in a pediatric hospital. What would be an appropriate nursing diagnosis for this client?
Acute pain related to thermal injuries and procedures
The nurse is developing the plan of care for a child who has suffered a major burn and has just been admitted to the acute care facility. Which nursing diagnosis would be most appropriate?
Acute pain related to thermal injuries and procedures
The nurse performs dressing changes for a pediatric client w/ burns over 20% of the body. The client appears disoriented, has a fever of 38.3C, crying in pain. What nursing intervention would the nurse deem most appropriate when caring for this client?
Administer appropriate analgesics and gather equipment for a dressing change
A nurse is caring for a child with a wasp sting. Which nursing intervention is a priority?
Administer diphenhydramine per protocol.
A 4-month-old infant is experiencing dermatitis in the diaper area. What treatments will be beneficial to this condition? Select all that apply.
Allow the diaper area to air dry. Apply petroleum jelly to the diaper area. Apply ointment with vitamin A to the diaper area. Use ointments containing zinc on the diaper area.
The nurse is screening a 4-year-old girl for vision problems. What problem could result in loss of vision?
Amblyopia
Which situation would cause the nurse to become concerned about possible hearing loss?
An 8-month-old who says only "da".
The nurse is caring for a child diagnosed with hydrocephalus following ventriculoperitoneal shunt placement. The child is currently on a ventilator. Which nursing action is priority?
Assess the client's respiratory status.
A 9-year-old client who suffered a head injury has strabismus. The nurse assesses the client for intracranial pressure (ICP). Which additional intervention is most important for the nurse to perform?
Assess the level of consciousness (LOC).
A school-aged child is brought to the office of the camp nurse with a small, superficial burn (first-degree burn). Which action by the nurse would be most appropriate to take first?
Apply cold compresses to the area.
The camp nurse is caring for a child who was bitten on the leg by a dangerous spider. The child is being taken to a health care provider. What is the most appropriate action for the nurse to do with this child?
Apply ice to the affected area.
What information is most correct regarding the nervous system of the child?
As the child grows, the gross and fine motor skills increase.
The nurse is preparing a nursing care plan for a 2-year-old child with hearing impairment. Which intervention will be part of the plan?
Assess the child's ability to convey information.
An adolescent experiencing contact dermatitis reports experiencing pruritis. What intervention will the nurse recommend to relieve the itching?
Bathe with a product that is oatmeal-based.
A child has been diagnosed with a basilar skull fracture. The nurse identifies ecchymosis behind the child's ear. This would be documented as:
Battle sign.
The nurse shall now instruct the parents to:
Continue to monitor the child at home
For each of the following interventions select if they are inappropriate or appropriate:
Cool bath Tylenol order Continue side-lying position Neurology referral Follow-up MRI if the condition worsens Antiepileptic prescription Antibiotic Outpatient physician follow-up
The nurse is assigned an infant with a possible neurological disorder. Which assessment finding would the nurse communicate to the health care provider as a late sign of increased intracranial pressure?
Decorticate posturing and fixed and dilated pupils
A preschool-age child has just been admitted to the pediatric unit with a diagnosis of bacterial meningitis. The nurse would include which recommendation in the nursing plan?
Decrease environmental stimulation
In children with otitis media, a procedure known as a myringotomy may be performed. Which statement is most accurate regarding this procedure?
During this procedure, small tubes are inserted into the tympanic membrane.
The nurse is caring for a child who has received partial thickness burns to their lower body. What is the priority assessment within the 24 hour period?
Fluid status then respiratory status
A 1-year-old child was brought to the clinic for evaluation of dry, itchy red patches of skin on the arms and legs. A diagnosis of atopic dermatitis (eczema) is made. Which would be an essential element to include in the plan of care for this child?
Frequently rehydrating the skin.
What is the leading cause of neonatal sepsis and death?
Group B streptococcus
The nurse is caring for a child diagnosed with otitis media with effusion (OME). Which information is most important for the nurse to teach the parents?
Have the ear rechecked every 4 weeks.
What accurately depicts the hemodynamic changes that occur in the body within the first 24 to 48 hours after a burn?
Hematocrit and white blood cell (WBC) counts increase.
Providing education for febrile seizure and a treatment plan for the parent. The child is more awake and is nodding yes or no appropriately. Parent was able to administer acetaminophen 240 mg rectally. For each client statement specify whether this statement is understanding or no understanding of the teaching you've provided
I should plan to monitor my childs temp & LOC closely while she remains sick I should plan to admin acetaminophen rectally if my child is awake and alert My child will need ongoing seizure medications Febrile seizures are much more common in teenagers aged 13-18 Febrile seizures are more common in infants to 5 years of age My child is likely experiencing a febrile seizure and should fully recover My child will likely experience a seizure every time she has a seizure
The mother of an infant reports that her child is frequently choking when breastfeeding or taking a bottle. The nurse plans on assessing which cranial nerve when addressing the mother's concerns?
IX
The parents report that the child did not open eyes, has minimal movement and was very lethargic. Respiratory status is shallow, parents check axillary temp and it is 39.5C. The healthcare provider was notified and diagnosed the client with a febrile seizure. Complete the following sentence by choosing from the list of options. The nurse determines the client's status is _______.
Improving
An 8-year-old boy comes to the emergency room with an eye injury after having a glass bottle shatter near his face. Which intervention should the nurse do first while assisting this client?
Instill a few drops of a topical anesthetic into the affected eye
A 6-month-old infant is admitted with suspected bacterial meningitis. She is crying, irritable, and lying in the opisthotonic position. Which intervention should the nurse take initially?
Institute droplet precautions in addition to standard precautions.
What is a true statement regarding status epilepticus?
It is a common neurologic emergency in children.
The nurse is caring for a child who has conductive hearing loss. What is true regarding this type of hearing loss?
It is caused by chronic otitis media or another infection.
A child returns to the clinic after an episode of external otitis (acute otitis externa or swimmer's ear) that has resolved. What would the nurse emphasize as the priority for preventing future episodes?
Keeping ear canals dry
In examining the vision of a 9-year-old girl, the nurse notices that she frequently reaches either too far or not far enough when attempting to take an object from the nurse's hand. Which condition does the nurse suspect?
Lack of depth perception (stereopsis)
Absence seizures are marked by what clinical manifestation?
Loss of motor activity accompanied by a blank stare
A varsity high school wrestler presents with a 'rug burn' type of rash on his shoulder that is not healing as expected, despite use of triple antibiotic cream. Two other wrestler on his team have a similar abrasion. What infection should the nurse be most concerned about, based on the history?
MRSA
A 2-year-old child is brought to the urgent care center for treatment of burns on both hands. The parent reports that the child pulled the coffee pot over and the hot liquid splashed on to the child's hands. The nurse examines the child and notes that the backs of the hands are reddened with a well-defined line of demarcation at the wrists. Several medium to large blisters are also present. What initial action should the nurse take?
Make arrangements to transfer the child to the hospital.
The nurse is collecting data from a child who may have a seizure disorder. Which nursing observations suggest an absence seizure?
Minimal or no alteration in muscle tone, with a brief loss of responsiveness or attention
A 4-month-old infant is seen at the ambulatory care clinic and diagnosed with nasolacrimal duct obstruction. The parent asks what can be done. What information should be included in the information provided to the parent?
Most of these conditions will spontaneously resolve.
The vision impairment in which the child can see objects at close range but not at a distance is known as:
Myopia
A 4-year-old complains of extreme pain when the tragus is touched. Though not diagnostic, this sign is most indicative of which disorder?
Otitis externa.
The nurse is completing the care plan for a pediatric client with deep partial-thickness or second-degree burns on the back and legs. Debridement of the burns is performed 2 to 3 times per week. What nursing diagnosis has the highest priority in regard to this treatment modality?
Pain
A 2-year-old has been prescribed eye patching for strabismus 6 hours per day. What teaching does the nurse provide for the mother?
Patching is necessary to strengthen vision in the weaker eye.
The nurse is caring for an infant who has undergone surgery for infantile glaucoma. What is the priority nursing intervention?
Place elbow restraints on the infant.
A parent calls the nurse triage line to say the child accidentally got hit in the eye and the parent believes the child will have a black eye. Which instruction is important for the nurse to provide this parent?
Place ice on the eye for 20 minutes/off the eye for 20 minutes for 24 hours.
A 10-year-old child is admitted to the hospital due to history of seizure activity. As his nurse, you are called into the room by his mother, who states he is having a seizure. What would be the priority nursing intervention?
Prevention of injury by placing the child on his side and opening his airway
While in a pediatric client's room, the nurse notes that the client is beginning to have a tonic-clonic seizure. Which nursing action is priority?
Protect the child from hitting the arms against the bed.
A child with a burn injury is scheduled for skin grafting. Which intervention would be most appropriate for the nurse to include in the child's plan of care?
Provide around the clock pain medication.
Which intervention is the most beneficial for a burn client undergoing a skin graft?
Provide around-the-clock pain medication as soon as pain is reported.
A nurse completes an assessment on an 8-month-old infant seen in the pediatrician's office for a well-child visit. The nurse notes that the infant's buttocks, perineum and inner thighs are covered in a thick coating of white ointment. When questioned, the parent says the infant has a diaper rash and the ointment is to protect the infant's skin. What is the best action for the nurse to take?
Provide instruction on how to care for a diaper rash.
The nurse is taking a health history for a 9-year-old child with conjunctivitis. Which finding would suggest that this is allergic conjunctivitis?
Recently helped clean the basement
The nurse is preparing a care plan for a child who has a seizure disorder. The child experiences tonic-clonic seizures. Which nursing diagnosis will the nurse identify as having the highest priority?
Risk for injury
A young child has just been admitted to the emergency department with a burn that encompasses the epidermis and the underlying dermis. From which type of burn does this child suffer?
Second-degree or partial-thickness burn
The nurse is caring for a 6-month-old infant diagnosed with otitis media. Which clinical manifestation would likely have been noted in this child?
Shaking the head and pulling the ear
The nurse is collecting data on a child admitted to the burn unit with a partial-thickness or second-degree burn. What is most accurate regarding this type of burn?
The child will likely have blisters.
The nurse is discussing the ears and hearing in a child with a group of peers. Which statement is most accurate related to this topic?
The eustachian tube in the infant is straighter and wider than in the adult.
A parent of a newborn asks the nurse if there is any way to prevent acute otitis media. What would the nurse state to the parent?
The frequency of otitis media is reduced in breastfed infants.
When compared with adults, why are infants and children at an increased risk of head trauma?
The head of the infant and young child is large in proportion to the body and the neck muscles are not well developed.
The nurse is caring for an infant who has impetigo and is hospitalized. Which nursing action is priority?
The nurse follows contact precautions.
Which of these age groups has the highest actual rate of death from drowning?
Toddlers
A child with a burn develops a wound infection. Which intervention would be the most effective form of treatment?
Topical antibiotics applied to the wound site
The nurse is educating the parents of a 7-year-old girl with epilepsy about managing treatment of the disorder at home. Which intervention is most effective for eliminating breakthrough seizures?
Understanding the side effects of medications
The nurse is caring for a pediatric client with multiple wounds from a bike accident. What is the best method for cleansing or washing out the wound?
Use normal saline solution to wash the wound.
The nurse is caring for a child with a suspected head injury. The nurse observes for what response to the child's eye reflex examination that would indicate potential increased intracranial pressure (ICP)?
While assessing the child's pupils, there is no change in diameter in response to a light.
The nurse is caring for a child with suspected child abuse (child mistreatment)-induced burns. Which assessment findings would support this?
a burn to the entire right hand up to 2 cm above wrist with consistent edges
The nurse is caring for a 10-year-old girl with acute periorbital cellulitis. Which nursing intervention (therapy) is primary for this disorder?
administering antibiotics IV as ordered
The nurse is educating a parent about the treatment for a child's tinea cruris. What medication class would the nurse include in the teaching plan?
antifungal
The nurse is caring for an infant on the pediatric unit who has a very red rash in the diaper area, with red lesions scattered on the abdomen and thighs. What is the priority nursing intervention?
apply topical antifungal cream
A group of nursing students are reviewing cerebral vascular disorders and risk factors in children. The students demonstrate understanding of the material when they identify which as a risk factor for hemorrhagic stroke?
arteriovenous malformations (AVMs)
The nurse is caring for a child in the emergency department who was bitten by the family dog, who is fully immunized. What is the priority nursing action?
assess the depth and extent of the wound
The nurse is caring for a child with urticaria. What is the priority action?
assessing the child's airway and breathing and noting any wheezing or stridor
The nurse assesses a child and finds that the child's pupils are pinpoint. What does this finding indicate?
brain stem dysfunction
An adolescent is to receive topical retinoid therapy for his moderately severe acne. The nurse would instruct the adolescent about which adverse effects? Select all that apply.
burning photosensitivity dryness
The nurse is caring for a client brought to a pediatric clinic for swelling in the lower extremities with reddened skin that has undefined borders and pits slightly when pressed. What is the most likely diagnosis of the client's skin alteration?
cellulitis
The nurse is teaching the family of a 6-year-old boy with allergic conjunctivitis how to minimize his exposure to allergens. What action would the nurse anticipate as being most difficult for the family to implement?
encouraging the child to keep his hands away from his eyes
The nurse has developed a nursing plan for the care of a 6-year-old girl with congenital hydrocephalus whose shunt has become infected. The most important discharge teaching point for this family is:
ensuring the parents know how to properly give antibiotics.
The nurse is providing immediate postoperative care for a 3-month-old who had a cataract removed. Which intervention would be the priority?
ensuring the protective eye patch is securely in place
The nurse is caring for a 15-year-old boy with psoriasis. In addition to the plaques, what would the nurse expect to note?
fissures and scaling on palms and soles
The nurse is caring for a child who has received significant partial-thickness burns to the lower body. What is the priority assessment in the first 24h after injury?
fluid balance
The nurse is assessing a child who pulled a boiling pot of soup off of the stove top. The child reports pain at a 9 on a scale of 0 to 10. The burn is red and edematous, and also shows areas of charred skin. The nurse is aware that these signs and symptoms are indicative of what kind of burn?
full-thickness or third-degree
The nurse knows that the heads of infants and toddlers are large in proportion to their bodies, placing them at risk for what problem?
head trauma
The nurse is caring for a child with suspected increased intracranial pressure (ICP). Which assessment finding would indicate increased ICP?
hypertension
The nurse is presenting an in-service to a group of nurses who will be working in a dermatology clinic. One participant asks the nurse about a bacterial skin infection that she has seen in children that involves honey-colored crusted lesions. The nurse most likely is referring to:
impetigo.
The nurse is educating the parents of a 4-year-old boy with strabismus. Teaching for the parents would include the:
importance of patching as prescribed.
Preterm infants have more fragile capillaries in the periventricular area than term infants. This put these infants at risk for which problem?
intracranial hemorrhaging
The nurse is discussing the use of over-the-counter ointments to manage a mild case of diaper rash. What ingredients should the nurse instruct the parents to look for in a compound? Select all that apply.
vitamin A zinc vitamin D
The nurse is providing teaching on ways to maintain skin integrity and prevent infection for the parents of a boy with atopic dermatitis. Which response indicates a need for further teaching?
"We should avoid using petroleum jelly."
The nurse is caring for a child who has suffered a febrile seizure. While speaking with the child's parents, which statement by a parent indicates a need for further education?
"I hate to think that I will need to be worried about my child having seizures for the rest of his life."
A 13-year-old reports she recently saw a television program showing surgery to correct vision problems. She states she hates wearing glasses and wants to have this procedure done. What is the best response by the nurse?
"Although there are surgeries for vision, they are not normally recommended for someone your age."
When reviewing bathing habits for a child with dermatitis, which statements by the child's mother indicates the need for further instruction? Select all that apply.
"Antibacterial soap will be helpful in preventing infections at the site of the rash." "I should use the warmest water my child can tolerate during the bath."
A child has been hospitalized with a diagnosis of severe impetigo. The nurse is interviewing the family. Which question will have the greatest impact on the child's care?
"Does your child have any allergies to medications?"
The nurse is caring for a child with a prescription for PO prednisone. Which statement by the child's mother would indicate a need for further education?
"I will give it to my child at least 1 hour before all meals."
The nurse in the emergency department is caring for a child who has a simple contusion of the right eye following a motor vehicle accident. Upon discharge to home, which response by the parents requires further clarification?
"I will need to apply heat to the eye four times a day."
A newborn has a generalized rash on the skin, which the nurse identifies as erythema toxicum neonatorum. Which information would the nurse include when explaining the condition to the newborn's parent?
"What you see on your newborn's skin is erythema toxicum neonatorum. It is a common newborn skin condition that typically resolves on its own in about 1 week. There is nothing special you will need to do for this."
An adolescent is diagnosed with psoriasis. After speaking with the nurse about treatment options suggested by the primary health care provider, the adolescent states, "Since ultraviolet rays help, I am going to buy a tanning package so I can tan year round." How will the nurse respond?
"Year round tanning is not what your health care provider intended. Tanning puts you at high risk for skin cancer and other problems."
The parent of a 1-week-old infant is concerned with white scales that have begun to flake off the infant's scalp. The parent asks the nurse what to do to treat this. How should the nurse best respond?
"Your child most likely has cradle cap (seborrhea). You can care for it by cleansing the hair and scalp daily with baby shampoo and applying baby oil."
A 1-year-old female has been diagnosed with her fourth ear infection since birth. The nurse understands that children are more susceptible to ear infections than adults because of which anatomical difference?
Infants have horizontally placed Eustachian tubes.
An infant is seen in the emergency department with several raised red welts over the abdomen and lower extremities. The parent states that the symptoms developed suddenly over the past few hours. The infant is fussy and has a low grade temperature. What assessment is most important for the nurse to perform?
Observe the infant's respiratory effort.
The nurse admits a 10-year-old who has just eaten lobster and has hives over much of the body. In collecting data regarding this child, which question should the nurse ask the caregiver first?
"Has the child ever eaten shellfish before now?"
An infant with a ventriculoperitoneal (VP) shunt in place is brought to the clinic because of being drowsy and less responsive. Which question in the health history would provide information to the nurse indicating that the VP shunt is perhaps infected?
"Has your child been eating well the last few days?"
The parents of an 8-year-old boy diagnosed with frostbite are distraught and state to the nurse, "We can't believe we didn't make our child come inside when he complained about his fingers being numb and hurting." How should the nurse respond?
"I can't imagine how you are feeling right now, but I'm sure you had no idea frostbite could happen. We will take good care of your son."
Gabapentin has been prescribed for a pediatric client. Which statement by the client indicates an understanding of teaching related to the medication?
"I can't take this medication within 2 hours of taking my antacid medication."
The nurse is caring for an infant with diaper dermatitis. Which statement by the child's parent would indicate a need for further education?
"I will use rubber pants over the cloth diapers in the future."
The nurse has completed client teaching with a 16-year-old female who has been prescribed isotretinoin for cystic acne. Which statements indicate learning has occurred? Select all that apply.
"If I am sexually active I need to let my doctor know." "This is not a drug to be used for all forms of acne. My sister has minor acne so I told her this wasn't for her." "It's important I get my CBC blood test when my doctor orders it."
A mother has just given birth to an infant born with anencephaly. The mother states, "With all of the technological advances in medicine, I am hopeful of a good prognosis for my baby." How should the nurse respond?
"It must be very difficult to deal with this diagnosis. Tell me what you know about the prognosis."
The nurse is obtaining the history from the parents of an infant who is suspected of having infantile glaucoma. Which statement by the parents would help to confirm this suspicion?
"It seems like bright lights really bother him."
The nurse is educating the parents of a premature newborn diagnosed with retinopathy of prematurity. Which comment will be part of the information provided?
"It's an overgrowth of retinal blood vessels."
The nurse is caring for an infant who is at risk for increased intracranial pressure. What statement by the parent would alert the nurse to further assess the child's neurological status?
"She has been irritable for the last hour....seems like she is just upset for some reason."
A child having tympanostomy tubes placed asks, "How and when will the tubes be removed?" What is the nurse's best response?
"The tubes remain in place for 6 to 12 months until they come out by themselves."
A group of students are reviewing the various causes of bacterial conjunctivitis in children. The students demonstrate understanding of this condition when they identify what as the most common cause?
Staphylococcus aureus
A client is being treated in the burn unit for second and third degree burns to 45% of their body. The primary health care provider prescribed silver sulfur diazine creme which is a topical antibiotic application. Which method is best for the nurse to apply this medication?
Sterile gloved hand
The school nurse is instructing the classroom teacher regarding a student newly diagnosed with amblyopia. To prepare for classroom instruction, which concept is most important for the nurse to convey to the teacher?
Student placement in the room is important but all other teaching methods may remain the same.
An adolescent girl and her caregiver present at the pediatrician's office. The adolescent reports severe abdominal pain. A diagnosis of pelvic inflammatory disease (PID) is made. The nurse notes in the child's chart that this is the third time she has been treated for PID. Which action by the nurse would be most appropriate?
Take the child to a private room and interview her regarding her sexual history and partners.
The nurse is providing education to the parents of a female toddler with hydrocephalus who has just had a shunt placed. Which statement is the best to make during a teaching session?
Tell me your concerns about your child's shunt.
The nurse is caring for a child in the emergency department who was bitten by a family dog who was fully immunized. What is the priority nursing intervention?
Tetanus booster
The school nurse is educating the parents of a child with infectious conjunctivitis. Which comment provides the most value for prevention?
"Don't use anything that touches her face."
The parents of a child diagnosed with atopic dermatitis ask the nurse, "My child has a skin disorder. I don't understand why a complete blood count (CBC) was ordered?" What is the appropriate response by the nurse?
"Eosinophils are a type of white blood cell that are often elevated with atopic dermatitis. These are part of the CBC and helps in making the diagnosis."
The nurse is evaluating the parents' understanding of atopic dermatitis. Which statement shows their understanding?
"Flare-ups of lesions are not uncommon following therapy."
The telehealth nurse in an outpatient clinic receives a call at 12:30 from a mother of a 4 year old child who is concerned that the child may have experienced a seizure. The parents reported that the child had a runny nose, cough and fever. The temp this morning is 40C. She witnessed the child become unresponsive while sitting in the chair. The child became rigid and shaking arms and legs. Parents are unclear on the exact length of the seizure but estimates about 45 minutes in length. Which are the priorities of the triage nurse to ask the patient? SATA
- Medical history - Neurological history - Respiratory status
The nurse is caring for a client with a right sided stroke and dysphagia having swallowing difficulties. Which action of the nurse reflects appropriate care for the client? SATA.
- The nurse assess the client's ability to swallow - The nurse offers the client scrambled eggs - The nurse turns off the clients TV
The nurse is caring for a child who has had persistent otitis media effusions and is scheduled to have pressure equalizing tubes placed in 3 days. What should the parents observe after the tubes have been placed?
improvement of the child's language and speech development
The nurse is conducting a physical examination of a boy with erythema multiforme. Which assessment finding should the nurse expect?
lesions over the hands and feet, and extensor surfaces of the extremities with spread to the trunk
The nurse caring for an infant with craniosynostosis, specifically positional plagiocephaly, should prioritize which activity?
moving the infant's head every 2 hours
The nurse is educating the parents of a 6-year-old child about preventing hearing loss. Which topic will be included in the discussion?
prevention and treatment of otitis media
A nurse is caring for an infant who has just undergone a ventricular tap. In what position should the nurse place the infant immediately after the procedure?
semi-Fowler position with a parent at the bedside
Dexamethasone is often prescribed for the child who has sustained a severe head injury. Dexamethasone is a(n):
steroid.
The nurse is caring for a 7-year-old with burns. Which finding would be highly suggestive of a burn induced by child abuse (child maltreatment)?
stocking-glove pattern on hands or feet
The nurse is educating the parents of a 7-year-old boy who has hearing loss due to otitis media with effusion. Which statement by the parents indicates that further education is needed?
"We need to raise the volume of our voices significantly so he can hear us."
The nurse is caring for a child with an external ventricular drainage device. The nurse is concerned about the minimal drainage in the past few hours. What action(s) by the nurse should be performed now? Select all that apply.
- Check tubing clamps to ensure they are open. - Ensure the tubing is not kinked.
Additional information given to you by the parents at 12:35: the child has not taken any antipyretic meds in the last 24 hours. They did not think that the child hit their head or experienced any injury during seizure. Reports that the child remains listless, and minimally responsive and is lying on their side on the floor. Appears to be breathing normally and lips are pink. Parent states that the child had a febrile seizure as a 2 y/o but has not had any since. Parents state that the child is otherwise healthy w/ NKA. The only meds are multivitamins. The child's last weight was 16.4kg. Which 2 items are the top priority of the nurse to address?
- Level of consciousness - Thermoregulation
The nurse is caring for a child brought to the emergency department by the parents. Upon assessment the physician suspects the child has been bitten by a spider. While obtaining the nursing history of the present condition, which statement by the parent will require clarification from the nurse?
"Since my child just has a rash around the area of the bite there is nothing to worry about."
What will the nurse teach the client about the treatment plan? SATA
- It will be important to follow up with your PCP asap - Rectal acetaminophen is a safe med route if the patient becomes lethargic
The nurse provides education to the parent of an infant being treated for hydrocephalus with a ventriculoperitoneal (VP) shunt. Which statement by the parent indicates the need for further instruction?
"This shunt is the only surgery my baby will need."
The nurse is educating the family of a 7-year-old with epilepsy about care and safety for this child. What comment will be most valuable in helping the parent and the child cope?
"Use this information to teach family and friends."
The nurse is providing education to the parents of a 2-year-old boy with hydrocephalus who has just had a ventriculoperitoneal shunt placed. Which information is most important for the parents to be taught?
"Watch for changes in his behavior or eating patterns."
The parents of a child with a history of seizures who has been taking phenytoin ask the nurse why it's difficult to maintain therapeutic plasma levels of this medication. Which statement by the nurse would be most accurate?
"Small increments in dosage lead to sharp increases in plasma drug levels."
The nurse is discussing acne vulgaris with a group of adolescents. The teenagers make the following statements regarding the topic. Which statement is the most accurate regarding acne vulgaris?
"Sometimes I get acne when I use my sister's makeup."
The parent of a 12-year-old child with Reye syndrome approaches the nurse wanting to know how this happened to the child, saying, "I never give my children aspirin!" What could the nurse say to begin educating the parent?
"Sometimes it is hard to tell what products may contain aspirin."
The nurse is caring for a 2-month-old in a pediatric clinic. The mom states she is going on vacation in Florida in a month and she is concerned about sunburn. She asks if it is okay to use a sunscreen lotion made for children. What is the correct nursing response?
"Sunscreen is not recommended until 6 months of age. Use light clothing and a hat to completely cover the child when in the sun."
A 7-year-old client has been complaining of headache, coughing, and an aching chest. The care provider makes a diagnosis of a viral infection. The child's mother tells the nurse that when she first said she had a headache, the child's father gave her half of an adult aspirin. The mother has heard of Reye syndrome and asks the nurse if her child could get this. Which statement would be the best response by the nurse?
"This might or might not be a problem. Watch your daughter for signs of lethargy, unusual irritability, confusion, or vomiting. If you notice any of these, bring her to the emergency room immediately so she can be checked for Reye syndrome."
The nurse and an adolescent are reviewing the adolescent's record of her headaches and activities surrounding them. What activity would the nurse identify as a possible trigger?
drinking three cans of diet cola
A child is admitted to the acute care facility with a burn injury. The nurse would check the child's immunization status, specifically for which of the following?
tetanus
The parents of a preschool-aged child ask the nurse what can be done to prevent ear infections. What response(s) by the nurse is correct? Select all that apply.
"Avoid exposure to cigarette smoke in the car or home." "Discourage the use of earphones being inserted into the ear." "Encourage the child to use earplugs when swimming." "Use diluted rubbing alcohol to dry the ear after swimming."
The nurse is caring for a mom and her baby on a postpartum unit. The mom states she has received advice not to use baby powder on newborns. She asks the nurse if this is true, and if so, why. Which nurse response is correct?
"Baby powder should not be used on newborns due to the risk of aspiration upon application."
