Peds Practice: CH 37, 38, & 39

A child diagnosed with acute otitis media has been given a prescription for benzocaine. The nurse is correct when she makes which statement?

"Benzocaine drops should be placed in your ear to numb it and reduce pain."

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.

The causative organism for Meningitis at birth to 3 months

Escherichia coli, Streptococcus group B

diagnostic for Roundworm, Tapeworm, and Hookworm

Feacal smear

A nurse is assessing a 3-year-old child for possible bacterial meningitis. Which sign would indicate irritation of the meninges?

Positive Kernig sign

When can a child return to school after being diagnosed with pediculosis capitis?

after day 1 of treatment

Signs and symptoms of pediculosis capitis

itching, whitish colored eggs at shaft of hair, redness at site of itching

treatment for tapeworm

niclosamide

treatment for Hookworm

pamoate and pyrantel

Diagnostic test for Acute Otitis Media

pneumatic otoscopy

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. a. Ice packs to the back of the neck and feet to reduce body temperature b. Antiviral medications c. Administering tepid baths as needed d. Acetaminophen e. Antibiotic therapy

- Acetaminophen - Antibiotic therapy - Administering tepid baths as needed

signs and symptoms of tapeworm (Taenia Saginata)

anorexia, weight loss

The mother of a child with pediculosis capitis infestation tells the nurse that she does not understand why her child still has the infestation. The mother states, "I used the prescribed treatment just like I was instructed." How should the nurse respond? A. "Have you been combing the hair for nits from the hair on a weekly basis?" B. "After finding the infestation did you wash items that your child's head came into contact with, like bed linen?" C. "Maybe you should use some of the home remedies like petroleum jelly or mayonnaise." D. "Do you wash your child's hair daily? Having clean hair will help get rid of the infestation."

"After finding the infestation did you wash items that your child's head came into contact with, like bed linen?"

Signs and Symptoms of roundworm (Ascaris lumbricoides) includes

Abdominal pain, vomiting with bile staining, and abdominal obstruction

The nurse is teaching parents of a 6-year-old child about otitis media (OM). What predisposes the child to OM infections? A. Swimming and other water activities B. Eustachian tubes that are long and narrow in children C. The use of cotton swabs, which can damage the eardrum D. Bacteria entering through the eustachian tube

Bacteria entering through the eustachian tube

To detect complications as early as possible in a child with meningitis who's receiving I.V. fluids, monitoring for which condition should be the nurse's priority? a) Cerebral edema b) Renal failure c) Left-sided heart failure d) Cardiogenic shock

Cerebral edema

If the child is following a normal development process, visual acuity gradually increases from birth. What is most accurate regarding the age children develop 20/20 vision?

Children usually develop 20/20 vision by 5 years of age.

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 typmpanic membrane.

How to diagnose a enterobius vermicularis "pinworm" infection?

Scotch tape test

A child is diagnosed with aseptic meningitis. The child's mother states, "I don't know where she would have picked this up." The nurse prepares to respond to the mother, based on the understanding that this disorder is most likely caused by which of the following? a) Haemophilus influenza type B b) Escherichia coli c) Streptococcus group B d) Enterovirus

Enterovirus

A child is playing in the mud. What helminthic infection can they get?

Hookworm

A child returns to the clinic after an episode of otitis externa, which has resolved. What would the nurse emphasize as the priority for preventing future episodes?

Keeping ear canals dry

What would the nurse include in the teaching plan for parents and their child with a pruritic rash? Select all that apply. a. Keeping fingernails trimmed short b. Using distraction to prevent scratching c. Encouraging pressure on the skin rather than scratching d. Making sure the child's hands are clean e. Using warm baths to soothe the skin

Keeping fingernails trimmed short Using distraction to prevent scratching Encouraging pressure on the skin rather than scratching Making sure the child's hands are clean

The nurse is educating the parents of a 6-year-old child about preventing hearing loss. Which of the following will be included in the discussion? a) Playing the radio loudly b) Tendency to act silly in the classroom c) Prevention and treatment of otitis media d) Suddenly doing poorly in school

Prevention and treatment of otitis media

The nurse is performing a physical assessment for an 8-year-old with an earache. Which of the following signs and symptoms indicates acute otitis externa? a) The child cries out when the ear is grasped. b) Symptoms of upper respiratory infection are present. c) The tympanic membrane reacts to a puff of air. d) The ear canal is devoid of cerumen.

The child cries out when the ear is grasped.

The mother of a child with pediculosis capitis infestation says that she doesn't know what treatment she should use on her child. Which treatment is best?

use Kwell shampoo and combing out nits daily; and washing linens and clothes in hot soapy water

Which of the following are important things to do once a child is diagnosed with pediculosis capitis? a. fumigate the house b. vacuum all floors and rugs c. wash bedding with cold water d. remove nits and use anti-lice shampoo

vacuum all floors and rugs remove nits and use anti-lice shampoo

A nurse is assessing a toddler who is brought to the clinic by his mother. The mother states, "He's been so irritable lately and I've noticed him frequently pulling on his right ear." The nurse suspects acute otitis media based on an assessment of which of the following? Select all that apply. a) Low-grade fever b) Upper respiratory infection 3 months ago c) Red bulging tympanic membrane d) Loss of appetite

• Low-grade fever • Red bulging tympanic membrane • Loss of appetite

A child with persistent otitis media with effusion is to undergo insertion of pressure-equalizing tubes via a myringotomy. The child is to be discharged later that day. After teaching the parents about caring for their child after discharge, which statement indicates that the teaching was successful? A) "The tubes will stay in place for about a month and then fall out on their own." B) "His chances for ear infections now have dramatically decreased." C) "He should wear earplugs when swimming in a pool or a lake." D) "We should keep the ears protected with cotton balls for the first 24 hours."

"He should wear earplugs when swimming in a pool or a lake."

The nurse has finished teaching the parents of a 10-month-old male ways to prevent another acute otitis media infection. Which statement by the mother indicates she has the correct understanding of the information provided?

"I should continue to breastfeed my son because it lowers the incidence of acute otitis media."

A child having myringotomy tubes placed asks, "How and when will the tubes be removed?" What is your best response?

"The tubes remain in place for 6 to 12 months until they come out by themselves."

The nurse is educating the parents of a 7-year-old boy who has hearing loss due to otitis media with effusion. Which of the following statements by the parents indicates that further education is needed? a) "We need to make sure we are speaking clearly." b) "We need to face our son when we are speaking." c) "We need to raise the volume of our voices significantly so he can hear us." d) "Using hand gestures as visual cues should help our child understand a little better."

"We need to raise the volume of our voices significantly so he can hear us."

treatment for scabies

- permethrin cream or Elimite - Clothing & bedding washed in hot soapy water - Kwell lotion -vacuum all hard surfaces

6-month-old infant is admitted with a diagnosis of bacterial meningitis. The nurse would place the infant in which room? a) A room with an 8-month-old infant with failure to thrive b) A private room near the nurses' station c) A room with a 12-month-old infant with a urinary tract infection d) A two-bed room in the middle of the hall

A private room near the nurses' station

The nurse is caring for a near-term pregnant woman who has not taken prenatal vitamins or folic acid supplements. Which congenital defect is most likely to occur based on the mother's prenatal history? Neonatal conjunctivitis Facial deformities A neural tube defect Incomplete myelinization

A neural tube defect

A child is diagnosed with bacterial meningitis. The nurse would suspect which abnormality of cerebrospinal fluid (CSF)? a) Cloudy appearance b) Elevated sugar c) Decreased leukocytes d) Decreased pressure

Cloudy appearance

Antibiotic therapy to treat meningitis should be instituted immediately after which event? a) Identification of the causative organism b) Collection of cerebrospinal fluid (CSF) and blood for culture c) Initiation of I.V. therapy d) Admission to the nursing unit

Collection of cerebrospinal fluid (CSF) and blood for culture

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? a) Take vital signs every 4 hours b) Encourage the parents to hold the child c) Monitor temperature every 4 hours d) Decrease environmental stimulation

Decrease environmental stimulation

The nurse is preparing a care plan for the school-age child with a congenital hearing loss of 60 to 80 dB. Which nursing diagnoses should the nurse include on the care plan for this child? Select all that apply. a. Risk for infection b. Delayed growth and development c. Impaired verbal communication d. Risk for injury e. Pain

Delayed growth and development Impaired verbal communication Risk for injury

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? a. Constant fluid draining from the child's ears. b. Slow increases in language development. c. Improvement of the child's language and speech development. d. Decreased ability for the child to hear.

Improvement of the child's language and speech development

A 6-year-old child is being treated for a parasitic infection. When reviewing results from the child's white blood cell count, which finding would be anticipated?

Increased eosinophils levels

The causative organism for Meningitis at 3 months to 16 years old

Neisseria meningitides

A nurse is giving instructions to the parents of a girl with otitis media with effusion who has just undergone placement of myringotomy tubes in her ears. Which of the following should she mention to the parents? a) Use cotton-tipped applicators to clean around the tubes b) Have the child shower rather than bathe c) Notify the school nurse of the child's condition d) Encourage the child to swim for exercise

Notify the school nurse of the child's condition

Which of the following infections should institute contact isolation precautions? a. Scabies b. Pinworm c. Roundworm d. Head Lice

Scabies and Head Lice

A nurse is preparing a presentation for a local health fair about meningitis and has developed a display that lists the following causes: Streptococcus group B Haemophilus influenzae type B Streptococcus pneumoniae Neisseria meningitidis What would the nurse highlight as the most common cause of meningitis in newborns?

Streptococcus group B

A mother asks the nurse if there is any way to prevent acute otitis media. What would the nurse state to the mother?

The frequency of otitis media is reduced in breast-fed infants.

After teaching a group of parents about ear infections in children, which statement indicates that the teaching was successful? A) Infants with congenital deformities have an increased risk for ear infections. B) Ear infections typically increase as the child gets older. C) The shorter and wider eustachian tubes of an infant increase the risk. D) Adenoids shrink as the child grows, allowing more bacteria to enter.

The shorter and wider eustachian tubes of an infant increase the risk.

A nurse is preparing a presentation for a parent group about ear infections. The nurse would identify the highest incidence of acute otitis media as occurring during which time? a) Spring b) Fall c) Summer d) Winter

Winter

How to use Permethrin cream

at night, massage into all skin surfaces (neck to the sole of feet) and leave on for 8 to 14 hrs; reapply one week later

What are the risk factors for pediculosis capitis?

day care and schools, overcrowded conditions, and sharing combs, brushes, or hats

Signs and Symptoms of Hookworm (Necator americanus)

dermatitis, blood loss, malnutrition

How would you pull the pinna when using a pneumatic otoscopy on a 6-month-old infant when testing for acute otitis media

pull pinna down and back

How would you pull the pinna when using a pneumatic otoscopy on a 5-year-old child when testing for acute otitis media

pull pinna up and back

A 5-year-old develops an otitis media with effusion. Myringotomy tube insertion is scheduled. The mother asks, "Why does this have to be done at the hospital?" What would be your best response?

"He will need to lie still afterward, so he will need to remain at the hospital for a short time."

Signs of scabies include

*intense itching* and *fine, dark, wavy lines* at the flexor surface of the wrist or elbow, the webbed area of the fingers, the axilla, and the genitals.

The nurse is observing an infant who may have acute bacterial meningitis. Which finding might the nurse look for?

Irritability, fever, and vomiting

Which nursing assessment data should be given the highest priority for a child with clinical findings related to meningitis? a) Occurrence of urine and fecal contamination b) Degree and extent of nuchal rigidity c) Onset and character of fever d) Signs of increased intracranial pressure (ICP)

Signs of increased intracranial pressure (ICP)

A community health nurse investigates an outbreak of pinworm at a local day care center. In order to minimize the spread of infection, which of the following suggestions would the nurse provide to the day care workers? a. Close the day care until all surfaces are cleaned. b. No action is necessary because it is easily treated with oral vermicides. c. Using good hand washing is important to prevent the transmission. d. Every child in the day care should be treated because they all are probably infected.

Using good hand washing is important to prevent the transmission.

A nurse is caring for a client who has been diagnosed with a parasitic infection. Which of the following information should the nurse know when caring for this client? a. The medication to prescribe to treat these infections b. The nature and symptoms of all parasitic illnesses c. What specimens to collect and how and when to collect them d. Public policy about parasitic infections

What specimens to collect and how and when to collect them

The nurse is caring for a preschool-aged child diagnosed with acute otitis media. Which intervention should be a priority for the nurse? a) Relief of pain b) Administration of a mydriatic c) Cautioning the child not to blow the nose d) Cautioning the child not to pull on the ear

Relieving pain

In caring for the child with meningitis, the nurse recognizes that which of the following nursing diagnoses would be the most important to include in this child's plan of care? a) Risk for injury related to seizure activity b) Risk for acute pain related to surgical procedure c) Delayed growth and development related to physical restrictions d) Ineffective airway clearance related to history of seizures

Risk for injury related to seizure activity

The nurse is caring for a 2-year-old girl with persistent otitis media with effusion. Which intervention is most important to the developmental health of the child? a) Informing the parents to avoid nonprescription drugs b) Telling parents not to smoke in the house c) Educating the parents about proper antibiotic use d) Reassessing for language acquisition

Reassessing for language acquisition

The nurse has just admitted a 17-year-old diagnosed with bacterial meningitis. The parents of the adolescent tell the nurse, "We just don't understand how this could have happened. Our child has always been healthy and also just received a booster vaccine last year?" How should the nurse respond? a. "Maybe your child's immune system isn't strong enough to fight off the infection, even with having received the vaccine." b. "Your child was likely exposed to a strain of bacteria not covered with the meningitis vaccine received." c. "Are you sure your child received a vaccine for meningitis? Maybe it was a flu vaccine." d. "I understand your frustration. Unfortunately immunizations are not 100% effective in preventing the infection."

"I understand your frustration. Unfortunately immunizations are not 100% effective in preventing the infection."

The caregiver of a 2-year-old calls the clinic concerned that her child may have pushed paper into her ears, and she asks the nurse what to do. The mother found the child pushing on her ears with torn paper on the floor in front of her. What would be the appropriate response by the nurse?

"The child should be seen by a care provider. Don't put anything in her ear and bring her in right away."

A toddler has been diagnosed with otitis media with effusion. The parents of a toddler tell the nurse, "We really don't understand what that diagnosis means." How should the nurse respond? A. "It's just a medical term that means an infection of the middle ear." B. "The diagnosis means unwanted fluid is within the middle ear space, and there may or may not be an infection present." C. "It would probably be best if you talked to the doctor again about the diagnosis." D. "There is an infection somewhere in the ear canal and their is fluid in the canal."

"The diagnosis means unwanted fluid is within the middle ear space, and there may or may not be an infection present."

The mother of a child having myringotomy tubes placed asks, "Will my son lose his hearing while the tubes are in place?" What is the nurse's best answer? a. "Your child's hearing will decrease while the tubes are in place." b. "Have you asked your child's surgeon about that?" c. "The tubes are inserted into a section of eardrum in which the hearing is not affected." d. "There is some risk of permanent deafness, but the benefit of decreasing the infection is worth it."

"The tubes are inserted into a section of eardrum in which the hearing is not affected."

The meningococcal vaccine should be offered to high-risk populations. If never vaccinated, who has an increased risk of becoming infected with meningococcal meningitis? Select all that apply.

- 18-year-old student who is preparing for college in the fall and has signed up to live in a dormitory with two other suite mates - 12-year-old child with asthma - 5-year-old child who routinely travels in the summer with her parents on mission trips to Haiti - 9-year-old child who was diagnosed with diabetes mellitus when he was 7 years old

The nurse is caring for a 4-year-old on the pediatric unit who has intensive pruritus and lesions on their palms, soles, and axillae. What is the priority nursing intervention? 1. administer griseofulvin with a fatty meal 2. institute contact isolation precautions 3. apply topical antibiotic cream 4. apply topical antifungal cream

institute contact isolation precautions

The nurse is caring for a 20-month-old girl with equivocal bacterial otitis media, a severe earache, and a temperature of 39°C (102.2°F). Which intervention would the nurse expect to implement?

Administering antibiotics as soon as they're available

Which nursing action should be included in the care plan to promote comfort in a 4-year-old child hospitalized with meningitis?a) Avoid making noise when in the child's room b) Keep the lights on brightly so that he can see his mother c) Rock the child frequently d) Have the child's 2-year-old brother stay in the room

Avoid making noise when in the child's room

Treatment of roundworms

Mebendazole, Pyrantel, pamoate

Hearing aids can improve hearing for children who have inner ear or nerve deafness.

False

The nurse is caring for an 8-year-old boy with otitis media with effusion. Which situation may have caused this disorder? A. He is experiencing recurrent nasal congestion. B. He has good attendance at school. C. He frequently goes swimming. D. He had recent bacterial conjunctivitis.

He is experiencing recurrent nasal congestion.

A 6-month-old infant is admitted with suspected bacterial meningitis. She is crying, irritable, and lying in the opisthotonic position. Which of the following interventions should the nurse take initially? a) Institute droplet precautions in addition to standard precautions. b) Palpate the child's fontanels. c) Encourage the mother to hold and comfort the infant. d) Educate the family about preventing bacterial meningitis.

Institute droplet precautions in addition to standard precautions.

The nurse is examining a 3-year-old boy with acute otitis media who has a mild earache and a temperature of 38.5º C. Which of the following actions will be taken? A) Obtain a culture of the middle ear fluid. B) Instruct the parents to watch for worsening symptoms. C) Administer antibiotics. D) Administer antivirals.

Instruct the parents to watch for worsening symptoms.

After teaching a class to a group of nursing students about reporting infectious diseases to the Centers for Disease Control and Prevention, the instructor determines a need for additional discussion when the students identify which infection as being reportable: a) Gonorrhea b) Pinworm c) Pertussis d) Lyme disease

Pinworm

Which of the following infections should institute standard isolation precautions? a. Scabies b. Pinworm c. Roundworm d. Hookworm

Pinworm, Roundworm, Hookworm

A child puts a contaminated toy in their mouth. What helminthic infection can they get?

Roundworm

The nurse is caring for a 6-month-old infant diagnosed with otitis media. Which of the following clinical manifestations would likely have been noted in this child? a) Shaking the head and pulling the ear b) Severe vomiting and confusion c) High-pitched cry and nuchal rigidity d) Body stiffening and loss of consciousness

Shaking the head and pulling the ear

A 16-year-old boy reports to the school nurse of headaches and a stiff neck. Which sign or symptom would alert the nurse that the child may have bacterial meningitis?

Sunlight is "too bright"

You eat infected beef or pork. What helminthic infection can they get?

Tapeworm

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? a. The eustachian tube in the infant is straighter and wider than in the adult. b. The infant usually responds to sounds around the age of 6 months. c. The eardrum is located between the middle and the internal ear. d. Most children do not have acutely developed hearing until the age of 5 years.

The eustachian tube in the infant is straighter and wider than in the adult.

Diagnostic test/Confirmation test for Otitis Media Effusion

Tympanometry

Which of the following would the nurse include when teaching parents how to prevent otitis externa? A) Daily ear cleaning with cotton swabs B) Wearing ear plugs when swimming C) Using a hair dryer on high to dry the ear canals D) Using hydrogen peroxide to dry the canal skin

Wearing ear plugs when swimming

The most effective approach to prepare a school-aged boy for a myringotomy procedure is to

explain the procedure to the child using puppets.

What causes bacterial otitis media? select all that apply

hemophilus influenza streptococcus pneumoniae