RN Nursing Care of Children Online Practice 2019 A with NGN
Where is McBurney's point located?
1/3 distance from ASIS to umbilicus
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? A: Laryngeal edema B: Flank pain C: Distended neck veins D: Muscular weakness
B: Flank pain Flank pain is commonly associated with the breakdown of RBC's due to an incompatibility of the new RBC's with the existing ones. The immune system attacks these new RBC's causing hemolysis. All of these can be an indicator of other complications associated with blood transfusions. Laryngeal edema can indicated an allergic reaction, which is not the same as a hemolytic transfusion reaction. Distended neck veins can be a sign of fluid overload, and muscular weakness can be an indication of an electrolyte imbalance.
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 0-10. Which of the following actions should the nurse take. A: Instill a 500mL tap water enema B: Give morphine 0.05mg/kg IV C: Administer polyethylene glycol 1g/kg PO D: Apply a heating pad to the child's abdomen
B: Give morphine 0.05mg/kg IV Administering any sort of enema or laxative that accelerates bowel motility will increase the risk of perforating the appendix. Similarly the use of a heating pad will increase blood flow to the area and increase the risk of perforation.
A nurse is assessing a school-age child who has meningitis. Which following findings is the priority for the nurse to report to the provider? A: Reports a headache as 6 on a 0-10 pain scale B: Petechiae on the lower extremities C: Nuchal rigidity D: Positive Kernig's sign
B: Petechiae on the lower extremities All of these are expected signs of meningitis, however the petechiae is the most concerning of the symptoms The presence of a petechial or purpuric rash on a child who is ill can indicate the presence of meningococcemia. This type of rash indicates the greatest risk of serious rapid complications from sepsis and should be reported immediately to the provider.
A nurse is caring for an adolescent who received a kidney transplant. Which of the following findings should the nurse identify as in indication the adolescent is rejecting the kidney? A: Negative leukocyte esterase B: Serum creatinine 3.0 mg/dL C: Negative urine protein D: Urine output 40 mL/hr
B: Serum creatinine 3.0 mg/dL The expected range of a serum creatine is 0.4-1.0 mg/dL. An elevated serum creatinine indicates that the kidneys are not functioning and the body could be rejecting them.
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. A: Occupational therapist B: Speech therapist C: Respiratory therapist D: Physical therapist
B: Speech therapist A child with a cleft palate repair will require speech therapy to support speech development and future articulation. An occupational therapist would be indicated for children with a physical disability that inhibits ADLs. A respiratory therapist would be required for those who require airway support. and a physical therapist would be indicated for a patient requiring assistance with mobility and increasing strength.
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? A: Recurrent urinary tract infections B: Symmetric burns of the lower extremities C: Failure to thrive D: Lack of subcutaneous fat
B: symmetric burns of the lower extremities Symmetric burns, meaning the burn itself is symmetric, on the lower extremities can indicate physical abuse from objects like irons and cigarettes. Recurrent UTI's can be an indication of sexual abuse, and failure to thrive and lack of subcu fat can be an indication of physical neglect or malnutrition.
A nurse is admitting a school-age child who has pertussis. Which of the following actions should the nurse take? A: Place the child in a room with positive-pressure airflow. B: Place the child in a room with negative-pressure airflow. C: Initiate contact precautions for the child. D: Initiate droplet precautions for the child.
D: Initiate droplet precautions for the child. Pertussis is a disease that spreads through respiratory droplets. Therefore droplet precautions should be taken to prevent spreading the illness.
what could an elevated WBC count indicate for a child undergoing chemotherapy?
Infection chemotherapy is a myelosuppressant, meaning that is suppresses bone marrow activity which decreases the number of RBC, WBC, and platelets being made. A decreased baseline WBC count leaves the body vulnerable to infection.
What vaccine is contraindicated in a neomycin allergy?
MMR vaccine
A nurse is educating the parents of a preschooler who was diagnosed with atopic dermatitis. Which of the following statements by a guardian indicate that the discharge teaching was effective? (Select all the apply.) A: "We should apply a skin emollient immediately after bathing our child." B: "We should keep our child's fingernails trimmed short." C: "We should rub the sores vigorously to remove scabs." D: "We should allow our child to take a bubble bath prior to bed." E: "We should use a mild detergent for our laundry." F: "We should apply a large amount of the ointment to the sores."
A, B, and E Emollients are oils that moisturizer and sooth the skin. They should be applied immediately after bathing while the skin is damp, in order prevent drying. Fingernails should be kept short to damage from scratching with sharp nails. Mild detergent should be used to prevent further irritation.
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? A: "Shake the medication prior to administration" B: "Provide the medication through a straw" C: " Rinse the child's mouth with water immediately after giving the medication" D: "Mix the medication with applesauce if the child dislikes the taste"
A: "Shake the medication prior to administration" shaking the medication ensures that the active ingredients are evenly dispersed throughout the solution prior to administration. The medication needs to coat the mouth, administering through a straw will make this difficult, and rinsing immediately after will wash the medication away. Mixing the medication with applesauce may interfere with the absorption of the medication.
A nurse is caring for a 15-year-old client who is married and i scheduled for a surgical procedure. The client asks, "Who should sign my surgical consent?" Which of the following responses should the nurse make? A: "You can sign the consent form because you are married." B: "Your spouse should sign the consent form for you." C: "Your parent should sign the consent form for you." D: "You can appoint a legal guardian to sign the consent form."
A: "You can sign the consent form because you are married." adolescents who are married are considered to be emancipated adults and have the legal right to consent to surgical procedures and sign other legal documents.
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? A: Hgb 8.5 g/dL B: WBC 9,500/mm3 C: Prealbumin 18 mg/dL D: Platelets 300,000/mm3
A: 8.5 g/dL a variation in any of these values could indicate different common complications of chemotherapy. However, all of these values are within expected range other than the hemoglobin which is far below the expected range for a 7-year-old child of 10 - 15.5 g/dL
A nurse is receiving change-of-shift report for four children. Which of the following children should the nurse see first? A: A school-age child who has sickle cell anemia and reports decreased vision in the left eye B: A school-age child who has cystic fibrosis and a frequent nonproductive cough C: A preschooler who has asthma and peak flow meter reading in the green zone D: An adolescent who has meningitis and reports a sensitivity to lights and noise
A: A school-age child who has sickle cell anemia and reports decreased vision in the left eye All of the presentations are expected for children with these illness except for the decreased vision in the left eye. This indicates that the patient could be experiencing a vaso-occlusive crisis and should be reported immediately.
A nurse is caring for an infant who has respiratory syncytial virus (RSV). Which of the following actions should the nurse implement for infection control? A: Have a designated stethoscope in the infant's room B: Place the infant in a room equipped with negative airflow C: Administer palivizumab as prescribed for the infant D: remove gloves after leaving the infant's room
A: Have a designated stethoscope in the infant's room droplet precautions would validate having a designated stethoscope in the patients room to avoid spreading the virus. A negative airflow room would only be needed for airborne precautions and a gloves should be removed when exiting any patients room.
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? A: Hematocrit 28% B: Hemoglobin 13.5 g/dL C: WBC 8,000/mm3 D: Platelets 250,000/mm3
A: Hematocrit 28% The expected hematocrit level for a school-age child is 32%-44%. Hematocrit is the proportion of red blood cells in the blood. To few means the body can not transport an adequate amount of oxygen.
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? A: Place the child in a side-lying position B: Delay documentation until the child is fully alert C: Give the child a high-carbohydrate snack D: Administer an oral sedative to the child
A: Place the child in a side-lying position A nurses first priority is always the ABC's, and a side-lying position prevents aspiration.
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? A: Provide small, frequent meals for the child. B: Schedule time in the play room for the child. C: Weigh the child weekly. D: Maintain the child in a supine position.
A: Provide small, frequent meals for the child. Heart failure increases the metabolism of the child and making it difficult to consume large amounts of food. Small frequent meals help conserve energy and provide adequate nutrition. Weight should be taken daily at the same time. The patient should also be maintained in a semi-fowler's position to promote maximal chest expansion, and play should be restricted to minimize energy expenditure.
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. A: Zinc oxide B: Antibiotic ointment C: Talcum powder D: Antiseptic solution
A: Zinc oxide Zinc oxide is a common barrier cream used to protect irritated and broken skin. In diaper dermatitis the zinc oxide protects skin from further irritants such as urine, feces, soap and friction, allowing the skin to heal and prevent further breakdown.
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) A: Negative Babinski reflex B: Ankle clonus C: Exaggerated stretch reflexes D: Uncontrollable movements of the face E: Contractures
B, C, and E a child with spastic cerebral palsy would be expected to exhibit a positive babinksi reflex, ankle clonus, exaggerated stretch reflexes, and contactures.
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. A: Child is awake and crying B: Partial- and full-thickness burns to the left upper anterior chest and anterior neck C: Non-productive cough D: SaO2 89% on room air E: Heart rate 150/min F: Temperature 37.7° C (99.9° F) G: Blood pressure 100/52 mm Hg
B, D, and E The priority for the nurse is to establish the patients ABC's. The crying and non-productive cough indicates that the patient has a clear airway, however the low SaO2 indicates a problem with oxygen transfusion which could lead to hypoxia. The tachycardia is a manifestation of shock and could indicate blood loss from the burns and the child should be monitored for hypovolemic shock. The blood pressure is within normal range for a 4-year-old child and the temperature is not a priority over the other findings although it should be monitored after the other priorities have been addressed.
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 medication should the nurse administer first. A: Prednisone B: Epinephrine C: Diphenhydramine D: Albuterol
B: Epinephrine All of these medications could be indicated in controlling an allergic reaction, however the first medication that should be administered should be the epinephrine to counteract the worst symptoms of the anaphylaxis.
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? A: Place the child in a prone position for the immunization. B: Request that the child's caregiver leave the room during the immunization. C: Administer the immunization using a 24-gauge needle. D: Inject the immunization slowly after aspirating for 3 seconds.
C: Administer the immunization using a 24-gauge needle. a 22-25 gauge needle is ideal for minimizing the amount of pain the child experiences. The immunization should then be injected rapidly and aspiration should be avoided. The caregiver should remain in the room to comfort that patient and the child should sit upright.
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? A: Change the child's position every 2 hr B: Clean the peripheral pin sites with chlorhexidine solution every 4 days C: Assess peripheral pulses once every 4 hr D: Ensure that the head of the bed is elevated to a 90º angle
C: Assess peripheral pulses once every 4 hr Buck's traction is type of skin traction used to immobilize extremities prior to surgery. Frequent neurovascular checks should be done to monitor for any signs of neurovascular impairment such as cyanosis, edema, pain, absent pulses, and tingling. While in buck's traction the patient should maintain a supine position and should not be moved. Cleaning pin sites would be indicated for skeletal traction, where pins are inserted into the bones through the skin in order to immobilize them.
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? A: Insert a nasogastric tube. B: Initiate prophylactic antibiotic therapy. C: Cleanse the affected area with mild soap and water. D: Apply a topical corticosteroid to the affected area.
C: Cleanse the affected area with mild soap and water. gently washing the affected area can remove any debris or loose tissue that could contribute to infection.
A nurse is assessing a 4-year-old child at a well-child visit. Which of the following milestones should the nurse expect to observe. A: Identifies right from left hand B: Uses a utensil to spread butter C: Cuts an outlines shape using scissors D: Draws a stick figure with seven body parts
C: Cuts an outlines shape using scissors Identifying right from left and using a utensil to spread butter would be an expected milestones for a 6-year-old child. Drawing a stick figure with seven body parts is an expected milestones of a 5-year-old child.
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. A: Expresses a reluctance to leave home B: Provides a detailed description of how burns occurred C: Denies discomfort during assessment of injuries D: Describes strong relationships with peers
C: Denies discomfort during assessment of injuries The nurse should suspect child maltreatment in the form of physical abuse if the adolescent has a blunted response to painful stimuli or injury.
A nurse reviewing the lumbar puncture results of a school0age child who is suspected of having bacterial meningitis. Which of the following findings should the nurse identify as an indication of bacterial meningitis? A: Decreased cerebrospinal fluid pressure B: Decreased WBC count C: Increased protein concentration D: Increased glucose level
C: Increased protein concentration The typical results for a lumbar puncture test of a patient with bacterial meningitis is a high protein concentration and a decreased glucose level. WBCs would be increased in the presence of an infection, and there would be an increased cerebrospinal fluid pressure.
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? A: Use surgical asepsis when providing routine care for the child B: Administer the MMR vaccine to the child. C: Screen the child's visitors for indications of infections D: Infuse packed RBCs
C: Screen the child's visitors for indications of infections children with extreme immunocompromised should not receive live virus vaccines, and should avoid exposure to any infectious agents. surgical asepsis is not necessary but strict hand hygiene and medical asepsis is recommended
A nurse is assessing the vital signs of a 10-year-old child following a burn injury. The nurse should identify that which of the following findings is an indication of early septic shock? A: BP of 130/90 mmHg B: HR of 60 bpm C: Temp of 102.4ºF D: Urinary output 100 mL/hr
C: Temp of 102.4ºF A fever is one of the first indicators of septic shock and should immediately alert the nurse that there is a high likelihood that an infection is developing.
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? A: obtain a sputum specimen B: perform an allen test C: perform a finger stick D: obtain a stool specimen
C: perform a finger stick a sickle-turbidity test is used to screen blood for the sickle cell trait. A blood sample from the patient is required and this would be gathered from a finger stick.
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? A: "Place the infant in a prone position to sleep." B: "Allow the infant to sleep on a large pillow." C: "Use a soft mattress in the infant's crib." D: "Give the infant a pacifier at bedtime."
D: "Give the infant a pacifier at bedtime." The nurse should inform the parent that protective factors against SIDS include breastfeeding and the use of a pacifier when the infant is sleeping.
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 and understanding of the teaching? A: "I should remove the harness at night to allow my infant to stretch her legs." B: "I will need to adjust the straps on the harness once each week." C: "I should apply baby powder to my infant's skin twice daily." D: "I will place my infant's diapers under the harness straps."
D: "I will place my infant's diapers under the harness straps." the pavlik harness should be worn continuously and remain unadjusted for 6-12 weeks until the hip joint is stable. The use of powders and lotions with the harness could increase the risk of skin breakdown. Diapers should be placed beneath the harness to prevent soiling, and also because how would you possibly put the diaper over the harness? That seems dumb.
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? A: "It is important that you provide emotional support for your family at this time." B: "You have to do what you feel is best. Everything will turn out fine." C: "I know how you feel. This is an extremely stressful time for your family." D: "Let's talk about some of the ways you have handled previous stressors in your life."
D: "Let's talk about some of the ways you have handled previous stressors in your life." This statement offers a general lead to allow the parent to express their feelings and previous actions when faced with stressful situations. It also helps the parent to focus on ways that they can cope with the current situation.
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? A: "Your daddy will be back at 7 p.m." B: "Your daddy will be back after he takes care of your brother C: "Your daddy will be back in the morning" D: "Your daddy will be back after you eat"
D: "Your daddy will be back after you eat" Preschool age children do not have an accurate understanding of time. Therefore using language that associated time with their expected daily routine and relates to them directly will give them the best understanding.
A school nurse is assessing an adolescent who has scoliosis. Which of the following findings should the nurse expect? A: Increase in anterior convexity of the lumbar spine B: Increased curvature of the thoracic spine C: Lateral flexion of the neck D: A unilateral rib hump
D: A unilateral rib hump all of these findings can be indicators of different spinal conditions. Scoliosis is a condition where the spine curves laterally in an S or a C shape. This will result in a unilateral rib hump.
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? A: Elevate the head of the child's bed. B: Insert a large bore IV catheter for the child. C: Determine the allergen that caused the child's reaction. D: Administer epinephrine IM to the child.
D: Administer epinephrine IM to the child. The priority action is the one that ensures that the patient maintains a patent airway. An epinephrine injection can counteract the bronchoconstriction caused by the histamines released in the anaphylaxis. All other tasks can be completed once the patient is stabilized.
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? A: Position the infant side-lying with their head at a 0-5 degree angle B: Perform a neurological assessment every 4 hrs C: Suction the infant's nares to remove secretions D: Implement seizure precautions for the infant.
D: Implement seizure precautions for the infant An infant who has a epidural hematoma is at a great risk for a seizure and precautions should be taken. The nasal suctioning in contraindicated because of the possibility of a fracture in the nasal passage. The neurological assessment should be performed every 15 min. Additionally the head of the bed should be slightly elevated and the head should be midline.
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? A: Administer ibuprofen to the child for a temperature greater than 38ºC (100.4ºF) B: Assess the child's blood pressure every 8 hr C: Weigh the child weekly at various time of the day D: Initiate seizure precautions for the child
D: Initiate seizure precautions for the child A sodium level of 129 mEq/L indicates hyponatremia which increases the risk for seizure activity. A normal serum sodium level is between 135-145 mEq/L. NSAID's like ibuprofen would be contraindicated because of their potential to be nephrotoxic. The blood pressure and weighing are indicated. But it would be more appropriate to monitor the child's BP every 4-6 hours to prevent complications such as hypertensive encephalopathy, and the weight should be taken every day and the same time in the same clothing on the same scale.
A nurse is caring for a toddler who is experiencing acute diarrhea and has moderate dehydrations. Which of the following nutritional items should the nurse offer to the toddler? A: Apple Juice B: Peanut Butter C: Chicken Broth D: Oral rehydration solution
D: Oral rehydration solution an oral rehydration fluid has the best concentration of electrolytes and a promotes the reabsorption of sodium and water. The other options can be high in sodium, fiber, or low in electrolytes.
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? A: Playing pat-a-cake B: Using a push-pull toy C: Creating a scrapbook D: Playing dress-up
D: Playing dress-up The nurse should instruct the parents that at the preschool age, play should focus on social, mental, and physical development. Therefore, playing dress-up is a recommended play activity for this child.
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? A: Instruct the parents to decrease the calcium in their toddler's diet B: Prepare the toddler for chelation therapy C: Refer the family to Child Protective Services D: Schedule the toddler for a yearly rescreening.
D: Schedule the toddler for a yearly rescreening. a serum lead level of 3.5 is not ideal, but it is not an emergency, so it makes the most sense to schedule the toddler for a rescreening and educate the parents in the mean time to limit their exposure. Chelation therapy may be initiated for serum lead levels >10 mcg/dL, and is required for 45 mcg/dL or higher. A calcium rich diet along with vit C and iron would inhibit the absorption of lead.
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? A: Excoriated scrotal area B: Multiple capillary hemangiomas C: Depressed posterior fontanel D: Substernal retractions
D: Substernal retractions all of these findings should be reported, however when following the ABC approach the priority is the presence of substernal retractions which indicates an increased respiratory effort that could quickly progress to respiratory failure.
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? A: Skin breakdown B: Hypotension C: Hyperprexia D: Tachypnea
D: Tachypnea All of these complications are possible but the one priority for the nurse is the tachypnea, due to the ABC approach (Airway, Breathing, and Circulation.) Tachypnea might occur because dehydration would make it difficult for the kidneys to excrete an adequate amount hydrogen ions and produce enough bicarbonate, which leads to metabolic acidosis.
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? A: Wheat crackers B: Rye bread C: Barley soup D: White rice
D: White rice White rice is the only gluten free food in the list. Rye, barley and wheat, along with oats should be stricken completely from the diet as they all contain gluten.
A nurse is interviewing the parents 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. A: The toddler has a vocabulary of 25 words B: The toddler developed a mild rash following a recent varicella immunization C: The toddler's Moro reflex is absent D: the toddler received tobramycin during a hospitalization 2 weeks ago
D: the toddler received tobramycin during a hospitalization 2 weeks ago tobramycin belongs to the class of antibiotics called aminoglycosides which are known to be ototoxic and cause mild to moderate hearing loss. All other findings are WDL.