RN Nursing Care of Children Online Practice 2019 A with NGN
The nurse is caring for the child 14 days after admission. Graphic Record 0800: Temperature 37° C (98.6° F)Heart rate 100/minRespiratory rate 20/minBlood pressure 98/56 mm HgSaO2 97% on room airWeight 16.8 kg (37 lb)1300: Temperature 35.8° C (96.4° F)Heart rate 68/minRespiratory rate 14/minBlood pressure 90/50 mm HgSaO2 88% on room air Nurses' Notes Pediatric Burn Unit 0800: Reinforced preoperative teaching with the child and parent. Child is awake and alert. Moving all extremities. Child limits their range-of-motion of the left arm. Anterior neck and upper chest dressings are dry and intact. Left arm and hand dressings are intact and slightly moist with serous drainage. Breath sounds are clear and equal bilaterally. Abdomen is soft and nondistended. Bowel sounds are active in all quadrants. Child remains NPO for surgery. Right antecubital peripherally inserted central catheter (PICC) line dressing is dry and intact. Site is without redness, edema, or drainage. IV maintenance fluids and PCA morphine are infusing through PICC line. Child reports pain as 2 on the FACES pain scale.PACU Nurse 1245: Anterior neck and left chest dressings are dry and intact. Left thigh dressing has a modera
Provide 100% oxygen via face mask is correct. The nurse should provide 100% oxygen via face mask to the child because of their SaO2 and respiratory rate. The SaO2 should be maintained at 95% or higher and if the SaO2 falls below 95%, supplemental oxygen should be initiated. Check anterior neck and chest dressing for bleeding is correct. Upon return from the procedure, all surgical dressings should be assessed for drainage and to ensure the dressing is intact. Place a warm blanket on the child is correct. The child is exhibiting hypothermia. It is important for the child to have a stable body temperature because vasoconstriction can diminish blood flow to the surgical sites and impair healing. Keep the child's head in a neutral position is correct. The child's head should be kept in a neutral alignment to prevent hyperextension or hyperflexion and to prevent graft loss.
A school nurse is assessing an adolescent who has multiple burns in various stages of healing. Which of the following behaviors should the nurse identify as a possible indication of physical abuse?
Denies discomfort during assessment of injuries
A nurse is caring for a school-age child who is receiving a blood transfusion. Which of the following manifestations should alert the nurse to a possible hemolytic transfusion reaction?
Flank pain
A nurse in an emergency department is caring for a school-age child who has appendicitis and rates their abdominal pain as 7 on a scale of 0 to 10. Which of the following actions should the nurse take?
Give morphine 0.05 mg/kg IV.
A nurse is reviewing the laboratory report of a school-age child who is experiencing fatigue. Which of the following findings should the nurse recognize as an indication of anemia?
Hematocrit 28%
A nurse is reviewing the lumbar puncture results of a school-age child who is suspected of having bacterial meningitis. Which of the following findings should the nurse identify as an indication of bacterial meningitis?
Increased protein concentration
A hospice nurse is caring for a preschooler who has a terminal illness. One of the preschooler's parents tells the nurse that they cannot cope anymore and are thinking about moving out of the house. Which of the following statements should the nurse make?
"Let's talk about some of the ways you have handled previous stressors in your life."
A nurse is creating a plan of care for a school-age child who has heart disease and has developed heart failure. Which of the following interventions should the nurse include in the plan?
Provide small, frequent meals for the child.
A nurse is assessing a 3-year-old toddler at a well-child visit. Which of the following manifestations should the nurse report to the provider?
Respiratory rate 45/min
A nurse is teaching the parent of an infant about ways to prevent sudden infant death syndrome (SIDS). Which of the following instructions should the nurse include?
"Give the infant a pacifier at bedtime."
Messed up Question Sorry !!!!! Blood pressure 130/90 mm Hg Heart rate 60/min Temperature 39.1° C (102.4° F) Urinary output 100 mL/hr
Temperature 39.1° C (102.4° F)
A nurse is reviewing the laboratory report of a 7-year-old child who is receiving chemotherapy. Which of the following laboratory values should the nurse report to the provider?
Hgb 8.5 g/dL
A nurse is providing teaching to the parent of an infant who has diaper dermatitis. The nurse should instruct the parent to apply which of the following to the affected area?
Zinc oxide
A nurse is caring for an adolescent who received a kidney transplant. Which of the following findings should the nurse identify as an indication the adolescent is rejecting the kidney?
Serum creatinine 3.0 mg/dL
A nurse is reviewing the laboratory report of an infant who is receiving treatment for severe dehydration. The nurse should identify that which of the following laboratory values indicates effectiveness of the current treatment?
Sodium 140 mEq/L
A nurse is providing discharge teaching to the parent of a child who is 1 week postoperative following a cleft palate repair. For which of the following members of the interprofessional team should the nurse initiate a referral?
Speech therapist
A nurse in an emergency department is performing a physical assessment on a 2-week-old male newborn. Which of the following findings is the priority for the nurse to report to the provider?
Substernal retractions
A nurse is auscultating the lungs of an adolescent who has asthma. The nurse should identify the sound as which of the following? (Click on the audio button to listen to the clip.)
Tachypnea
A nurse in an emergency department is caring for an adolescent who has severe abdominal pain due to appendicitis. Which of the following locations should the nurse identify as McBurney's point? (You will find "hot spots" to select in the artwork below. Select only the hot spot that corresponds to your answer.)
A is correct
A nurse in an emergency department is caring for a school-age child who is experiencing an anaphylactic reaction. Which of the following is the priority action by the nurse?
Administer epinephrine IM to the child.
A nurse is caring for an infant who has RSV Messed up Question Sorry !!!!!
Have a designated stethoscope in the infant's room.
A nurse is caring for a school-age child who is receiving cefazolin via intermittent IV bolus. The child suddenly develops diffuse flushing of the skin and angioedema. After discontinuing the medication infusion, which of the following medications should the nurse administer first? Prednisone Epinephrine Diphenhydramine Albuterol
Epinephrine This child is most likely experiencing an anaphylactic reaction to the cefazolin. According to evidence-based practice, the nurse should first administer epinephrine to treat the anaphylaxis. Epinephrine is a beta adrenergic agonist that stimulates the heart, causes vasoconstriction of blood vessels in the skin and mucous membranes, and triggers bronchodilation in the lungs.
A nurse is caring for a school-age child who has experienced a tonic-clonic seizure. Which of the following actions should the nurse take during the immediate postictal period?
Place the child in a side-lying position.
A school nurse is assessing an adolescent who has scoliosis. Which of the following findings should the nurse expect?
A unilateral rib hump
A nurse is teaching the guardian of a 6-month-old infant about car seat use. Which of the following statements by the guardian indicates an understanding of the teaching?
"I should secure the car seat using lower anchors and tethers instead of the seat belt."
A nurse is teaching a school-age child who has a new diagnosis of type 1 diabetes mellitus. Which of the following statements by the child indicates an understanding of the teaching?
"I will give myself a shot of regular insulin 30 minutes before I eat breakfast."
A nurse is teaching the parent of an infant who has a Pavlik harness for the treatment of developmental dysplasia of the hip. The nurse should identify that which of the following statements by the parent indicates an understanding of the teaching?
"I will place my infant's diapers under the harness straps."
A nurse is providing teaching to the parent of a school-age child who has a new prescription for oral nystatin for the treatment of oral candidiasis. Which of the following instructions should the nurse include?
"Shake the medication prior to administration."
A nurse is caring for a 15-year-old client who is married and is scheduled for a surgical procedure. The client asks, "Who should sign my surgical consent?" Which of the following responses should the nurse make?
"You can sign the consent form because you are married."
A nurse is caring for a preschooler whose father is going home for a few hours while another relative stays with the child. Which of the following statements should the nurse make to explain to the child when their father will return?
"Your daddy will be back after you eat."
A nurse is receiving change-of-shift report for four children. Which of the following children should the nurse see first?
A school-age child who has sickle cell anemia and reports decreased vision in the left eye
A nurse is preparing to administer an immunization to a 4-year-old child. Which of the following actions should the nurse plan to take?
Administer the immunization using a 24-gauge needle.
A nurse is caring for a toddler who has spastic (pyramidal) cerebral palsy. Which of the following findings should the nurse expect? (Select all that apply.)
Ankle clonus is correct. Exaggerated stretch reflexes is correct. Contractures is correct.
A nurse in an emergency department is caring for a 4-year-old child whowas rescued from a home fire by emergency medical services (EMS). Which of the following potential provider prescriptions should the nurse identify as anticipated or contraindicated? For each potential provider's prescription, click to specify if the potential prescription is anticipated or contraindicated for the child.
Apply sterile gauze soaked with cool 0.9% sodium chloride to the burn areas is contraindicated. Insert an indwelling urinary catheter is anticipated. Provide 100% oxygen via face mask is anticipated. Weigh the child is anticipated.
A nurse is caring for a school-age child who is in Buck's traction following a leg fracture 24 hr ago. Which of the following actions should the nurse take?
Assess peripheral pulses once every 4 hr.
A nurse in an emergency department is caring for a toddler who has partial-thickness burns on their right arm. Which of the following actions should the nurse take?
Cleanse the affected area with mild soap and water.
A nurse is assessing a 4-year-old child at a well-child visit. Which of the following developmental milestones should the nurse expect to observe?
Cuts an outlined shape using scissors
A nurse is creating a plan of care for an infant who has an epidural hematoma from a head injury. Which of the following interventions should the nurse include in the plan?
Implement seizure precautions for the infant.
A nurse is admitting a school-age child who has pertussis. Which of the following actions should the nurse take?
Initiate droplet precautions for the child.
A nurse is planning care for a school-age child who is in the oliguric phase of acute kidney injury (AKI) and has a sodium level of 129 mEq/L. Which of the following interventions should the nurse include in the plan?
Initiate seizure precautions for the child.
A nurse is caring for a toddler who is experiencing acute diarrhea and has moderate dehydration. Which of the following nutritional items should the nurse offer to the toddler?
Oral rehydration solution
A nurse is preparing to collect a sample from a toddler for a sickle-turbidity test. Which of the following actions should the nurse plan to take?
Perform a finger stick.
A school nurse is preparing to administer atomoxetine 1.2 mg/kg/day PO to a school-age child who weighs 75 lb. Available is atomoxetine 40 mg/capsule. How many capsules should the nurse administer per day? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)
The nurse should administer atomoxetine 1 capsule PO each day.
A nurse is interviewing the parent of an 18-month-old toddler during a well-child visit. The nurse should identify that which of the following findings indicates a need to assess the toddler for hearing loss?
The toddler received tobramycin during a hospitalization 2 weeks ago.
A nurse is providing dietary teaching to the parent of a school-age child who has celiac disease. The nurse should recommend that the parent offer which of the following foods to the child?
White rice
A nurse in a provider's office is preparing to administer immunizations to a toddler during a well-child visit. Which of the following actions should the nurse plan to take? (Click on the "Exhibit" button for additional information about the client. There are three tabs that contain separate categories of data.)
Withhold the measles, mumps, and rubella (MMR) vaccine.
A nurse on a pediatric unit is admitting a preschooler. Vital Signs 0715: Temperature 38.3° C (100.9° F)Heart rate 126/minRespiratory rate 26/minPulse oximeter 97% Physical Examination 0715:Guardians report that the child has been tired lately and has been experiencing a sore throat and fever. Child is tolerating sips of liquids, but is refusing solid foods. Guardians report that the child is voiding dark yellow urine.0730:Child is alert and responsive to verbal stimuli. Mucous membranes are dry and sticky. Skin turgor without tenting. Tonsils enlarged and erythematous. Respirations are regular and non-labored. No accessory muscle use noted. Lungs clear anterior and posterior bilaterally. Point of maximum intensity (PMI) in the left mid-clavicular line 4th intercostal space. Heart rate is regular without murmurs, gallops, or rubs. Radial and pedal pulse 2+ bilaterally. Capillary refill greater than 2 seconds. Abdomen flat and non-distended. Bowel sounds active in all four quadrants. Extremities are warm and dry to touch. Diagnostic Results 0900: Mononucleosis rapid test: positive (negative) After reviewing the information in the medical record, the nurse should identify that the child i
Dropdown 1: Splenomegaly is correct. Dropdown 2: Positive mononucleosis rapid test is correct.
The nurse is caring for the child 4 days after admission. Graphic Record 0800: Temperature 38.8° C (101.8° F)Heart rate 124/minRespiratory rate 22/minBlood pressure 100/56 mm HgSaO2 97% on room airWeight 17.1 kg (37.7 lb)Urine output 15 mL in past hour Nurses' Notes 0800: Child is awake, watching cartoons on television, and parent is at bedside. IV site in right antecubital is without redness or edema and dressing is dry and intact. Dressings to left arm and hand, anterior neck, and anterior chest are moderately saturated with serous drainage and several small spots of serosanguineous drainage. Dressings remain intact and smell malodorous. Breath sounds are equal and clear bilaterally. Respirations are unlabored. Abdomen is soft and nondistended. Mucous membranes are moist. Skin turgor is slightly brisk. Pupils are equal, round, and reactive to light and accommodation. Child is oriented to place, time, and name. When child attempts to move, they begin to cry. Child reports pain as 8 on the FACES scale. Noted a 1 cm x 2 cm stage 1 pressure injury on the right side of the occiput. Prepared child and parent for transport to hydrotherapy and debridement scheduled for 0830. Provider Prescri
Dropdown 1: Temperature is correct. When using the urgent vs. nonurgent approach to client care, the nurse should determine that an increased temperature is a priority finding, because it can indicate an infection and sepsis. Wound sepsis is most likely to occur between the third and fifth day after a burn. Therefore, the nurse should first address the child's temperature. Dropdown 2: Pain is correct. When using the urgent vs. nonurgent approach to client care, the nurse should determine that an 8 out of 10 pain rating on the FACES scale is a priority finding and should be addressed next. Severe pain impacts the stress response, which can lead to complications and adversely affect healing.
A nurse is caring for a preschooler who has been receiving IV fluids via a peripheral IV catheter. When preparing to discontinue the IV fluids and catheter, which of the following actions should the nurse plan to take? (Move the steps into the box on the right, placing them in the order of performance. Use all the steps.)
First, the nurse should turn off the IV pump. Next, the nurse should occlude the IV tubing, and then remove the tape securing the catheter. Last, the nurse should apply pressure over the catheter insertion site.
A nurse is caring for a school-age child who is receiving chemotherapy and is severely immunocompromised. Which of the following actions should the nurse take?
Screen the child's visitors for indications of infection.
A nurse is assessing a toddler who has gastroenteritis and is exhibiting manifestations of dehydration. Which of the following findings is the nurse's priority?
Tachypnea
A nurse on a pediatric unit is caring for a school-age child. Nurses' Notes 0830:Child is alert and responsive to stimuli. Skin is warm and dry. Capillary refill less than 3 seconds. Respirations regular and shallow. Mild intercostal retractions noted. Expiratory wheezes auscultated in the anterior and posterior lung bases. Abdomen is soft, flat, and non-distended.1100:Child appears restless. Moderate intercostal retractions noted. Scattered rhonchi anterior bases with wheezing noted on inhalation and exhalation. Point of maximum intensity (PMI) in the left mid-clavicular line 4th intercostal space. Heart rate is regular without murmurs, gallops, or rubs. Radial and pedal pulse 2+ bilaterally. Vital Signs 0830: Temperature 37.1° C (98.8° F)Heart rate 100/minRespiratory rate 22/minBlood pressure 90/60 mm HgPulse oximetry 97% on 2 L of oxygen via nasal cannula1100: Temperature 37.1° C (98.8° F)Heart rate 110/minRespiratory rate 30/minPulse oximetry 94% on 2 L of oxygen via nasal cannula Diagnostic Results 1200:CBC:Hemoglobin 10 g/dL (10 to 15.5 g/dL)Hematocrit 32% (32% to 44%)WBC count 11,000/mm3 (5,000 to 10,000/mm3)Arterial Blood Gases (ABGs):pH 7.49 (7.35 to 7.45)PCO2 32 mm Hg (35 to 4
Arterial blood gases is correct. WBC count is correct. Oxygen saturation level is correct. Respiratory assessment is correct.
A nurse in an emergency department is caring for a 4-year-old child who was rescued from a home fire by emergency medical services (EMS The nurse should identify that which of the following findings require immediate follow-up? Select the 3 findings that require immediate follow-up.
Partial- and full-thickness burns to the left upper anterior chest and anterior neck is correct. SaO2 89% on room air is correct. Heart rate 150/min is correct.
A nurse is assessing a school-age child who has meningitis. Which of the following findings is the priority for the nurse to report to the provider?
Petechiae on the lower extremities
A nurse is providing teaching about play activities for social development to the parents of a preschooler. Which of the following play activities should the nurse recommend for the child?
Playing dress-up
A nurse is planning care for a toddler who has a serum lead level of 4 mcg/dL. Which of the following actions should the nurse plan to take?
Schedule the toddler for a yearly rescreening.
A charge nurse in an emergency department is preparing an in-service for a group of newly licensed nurses about the manifestations of child maltreatment. Which of the following manifestations should the charge nurse include as a potential indication of physical abuse?
Symmetric burns of the lower extremities
The nurse is continuing to care for the child. Nurses' Notes 0800: Child is awake, watching cartoons on TV, and parent is at bedside. IV site in right antecubital is without redness or edema and dressing is dry and intact. Dressings to left arm and hand, anterior neck, and anterior chest are moderately saturated with serous drainage and several small spots of serosanguineous drainage. Dressings remain intact and smell malodorous. Breath sounds are equal and clear bilaterally. Respirations are unlabored. Abdomen is soft and nondistended. Mucous membranes are moist. Skin turgor is slightly brisk. Pupils are equal, round, and reactive to light and accommodation. Child is oriented to place, time, and name. When child attempts to move, they begin to cry. Child reports pain as 8 on the FACES scale. Noted a 1 cm x 2 cm stage 1 pressure injury on the right side of the occiput. Prepared child and parent for transport to hydrotherapy and debridement scheduled for 0830. 0815: Pediatric Burn Unit Nurses' Notes Provider notified of 0800 assessment and vital signs. Provider will examine child during hydrotherapy. Morphine given for pain rating of 8 on FACES pain rating scale. Child transported via str
Change the morphine route to family-controlled analgesia via a PCA pump is anticipated. Obtain a wound culture is anticipated. Place the child on a pressure-reduction mattress is anticipated. Limit daily protein intake is contraindicated.
The nurse is providing discharge teaching to the child and their parent 36 days after admission. Exhibit 1 Nurses' Notes 0900: Home care consultation and supply delivery arrangements completed by the child's case manager. 1400: Provided discharge teaching to the parent and child regarding medications, skin and wound care, and psychosocial needs. Parent verbalized understanding of teaching. Select 6 statements by the parent that indicate an understanding of the discharge teaching. "I will give my child hydroxyzine to prevent bacterial infection." "I should apply a moisturizer to the scar tissue." "I will use a measured spoon or medicine cup to give my child hydroxyzine." "I can give my child hydroxyzine every 6 hours as needed." "Puppet play can be helpful for my child." "I should avoid giving hydroxyzine at bedtime." "I will avoid massaging the scar tissue." "My child is too young to be concerned about their body image." "I need to assess for any redness or open skin areas before applying my child's left arm splint." "My child will need to use a compression garment to decrease blood supply to the scarred tissue."
"I should apply a moisturizer to the scar tissue" is correct. Frequent application of a non-perfume moisturizer should be applied to the scar tissue to help reduce itching the child might experience. "I will use a measured spoon or medicine cup to give my child hydroxyzine" is correct. All liquid medications should be administered with a measured spoon or cup to provide an accurate amount of the prescribed dose of medication. "I can give my child hydroxyzine every 6 hours as needed" is correct. Hydroxyzine is administered every 6 to 8 hr each day as needed. "Puppet play can be helpful for my child" is correct. Preschoolers engage in imaginative play. The use of puppets will encourage the child to express their feelings through imaginary play. "I need to assess for any redness or open skin areas before applying my child's left arm splint" is correct. It is important that the child's skin be assessed for redness, open areas, or blisters prior to putting on a splint. The splint is used to prevent contractures of the extremities and promote normal alignment during the healing process. Because the splint might be worn for a long period of time, the child's growth might cause the splint to not fit properly and can cause a pressure injury. "My child will need to use a compression garment to decrease blood supply to the scarred tissue" is correct. Using a compression garment on the scar tissue decreases the blood supply to avoid nourishing the hypertrophic tissue. It also forces the collagen into a more normal alignment. Compression garments are worn during the healing of the burned tissue and should be worn as much as possible.
A nurse in a provider's office is caring for a preschooler. Nurses' Notes 0915:Guardians report that lately the child has had severe itching and is breaking out with sores on their eyebrows, wrists, and ankles. The "sores started to bleed." Guardians report no relief with application of the topical hydrocortisone cream.0930:Child is alert. Multiple small erythematous papules with some scaling noted on the child's eyebrows, forearms, and lower legs bilaterally.1015:Provider in to evaluate the child. Discharge to home after medication administration of new prescriptions and discharge teaching for atopic dermatitis. Medical History Family history of atopic dermatitis Medication Administration Record 1000:Loratadine (oral solution) 5 mg PO daily. Administer first dose now prior to discharge.Tacrolimus 0.03% ointment. Apply thin layer to affected areas twice daily; rub in gently and completely.Return to primary care provider in 1 to 2 weeks for evaluation. Which of the following statements by a guardian indicate that the discharge teaching was effective? Select all that apply.
"We should apply a skin emollient immediately after bathing our child" is correct. An emollient is an oil that moisturizes the skin and should be applied immediately after bathing while the skin is damp to prevent drying. Therefore, this statement by the guardian indicates the teaching has been effective "We should keep our child's fingernails trimmed short" is correct. The child's fingernails and toenails should be kept short, trimmed, and filed to prevent scratching with sharp edges. Therefore, this statement by the guardian indicates the teaching has been effective. g. "We should use a mild detergent for our laundry" is correct. The use of mild detergents for laundry helps prevent allergens and itching. Therefore, this statement by the guardian indicates the teaching has been effective.
