Toddler
After teaching a group of parents about temper tantrums, the nurse knows the teaching has been effective when one of the parents states which of the following? A) "I will ignore the temper tantrum." B) "I should pick up the child during the tantrum." C) "I'll talk to my daughter during the tantrum." D) "I should put my child in time out."
A) "I will ignore the temper tantrum." Reason: Children who have temper tantrums should be ignored as long as they are safe. They should not receive either positive or negative reinforcement to avoid perpetuating the behavior. Temper tantrums are a toddler's way of achieving independence.
When performing a physical assessment on an 18-month-old child, which of the following would be best? A) Have a parent hold the toddler. B) Assess the ears and mouth first. C) Carry out the assessment from head to toe. D) Assess motor function by having the child run and walk.
A) Have a parent hold the toddler. Reason: The best strategy for assessing a toddler is to have the parent hold the toddler. Doing so is comforting to the toddler. Assessment should begin with noninvasive assessments first while the child is quiet. Typically, these include assessments of the cardiac and respiratory systems. The ears and throat are typically examined last. Using a head-to-toe approach is more appropriate for an older child. For a toddler, assessment should begin with noninvasive assessments first while the child is quiet. Having a toddler run and be active may make it difficult to settle the child down after the physical exertion.
A child, age 3, is brought to the emergency department in respiratory distress caused by acute epiglottitis. Which clinical manifestations should the nurse expect to assess? A) Severe sore throat, drooling, and inspiratory stridor B) Low-grade fever, stridor, and a barking cough C) Pulmonary congestion, a productive cough, and a fever D) Sore throat, a fever, and general malaise
A) Severe sore throat, drooling, and inspiratory stridor Reason: A child with acute epiglottitis appears acutely ill and clinical manifestations may include drooling (because of difficulty swallowing), severe sore throat, hoarseness, a high temperature, and severe inspiratory stridor. A low-grade fever, stridor, and barking cough that worsens at night are suggestive of croup. Pulmonary congestion, productive cough, and fever along with nasal flaring, retractions, chest pain, dyspnea, decreased breath sounds, and crackles indicate pneumococcal pneumonia. A sore throat, fever, and general malaise point to viral pharyngitis.
When assessing for pain in a toddler, which of the following methods should be the most appropriate? A) Ask the child about the pain. B) Observe the child for restlessness. C) Use a numeric pain scale. D) Assess for changes in vital signs.
B) Observe the child for restlessness. Reason: Toddlers usually express pain through such behaviors as restlessness, facial grimaces, irritability, and crying. It is not particularly helpful to ask toddlers about pain. In most instances, they would be unable to understand or describe the nature and location of their pain because of their lack of verbal and cognitive skills. However, preschool and older children have the verbal and cognitive skills to be able to respond appropriately. Numeric pain scales are more appropriate for children who are of school age or older. Changes in vital signs do occur as a result of pain, but behavioral changes usually are noticed first.
A child with a poor nutritional status and weight loss is at risk for a negative nitrogen balance. To help diagnose this problem, the nurse anticipates that the physician will order which laboratory test? A) Total iron-binding capacity B) Hemoglobin (Hb) C) Total protein D) Sweat test
C) Total protein Reason: The nurse anticipates the physician will order a total protein test because negative nitrogen balance may result from inadequate protein intake. Measuring total iron-binding capacity and Hb levels would help detect iron deficiency anemia, not a negative nitrogen balance. The sweat test helps diagnose cystic fibrosis, not a negative nitrogen balance.
After teaching the parents of an 18-month-old who was treated for a foreign body obstruction about the three cardinal signs indicative of choking, the nurse determines that the teaching has been successful when the parents state that a child is choking when he or she cannot speak, turns blue, and does which of the following? A) Vomits. B) Gasps. C) Gags. D) Collapses.
D) Collapses. Reason: The three cardinal signs indicating that a child is truly choking and requires immediate life-saving interventions include inability to speak, blue color (cyanosis), and collapse. Vomiting does not occur while a child is unable to breathe. Once the object is dislodged, however, vomiting may occur. Gasping, a sudden intake of air, indicates that the child is still able to inhale. When a child is choking, air is not being exchanged, so gagging will not occur.
