Toddler

A 2-year-old is being treated for pneumonia. After reviewing the respiratory section of the client care flow sheet, the nurse concludes that which position is most beneficial to maximize oxygenation?

Right-side lying. The client would be positioned on the right side. Gravity will help mobilize secretions from the affected (left) lung, thereby allowing for improved blood flow and oxygenation. Elevating the head of the bed does not facilitate drainage removal.

The nurse is caring for a child whose mother is deaf and untrusting of staff. She frequently cries at the bedside, but refuses intervention from social work or the chaplain. Which issue is most important for the nurse to address with the mother to promote a trusting relationship?

Communication barriers between the mother and staff The communication barrier is the most significant and would require immediate attention. Strategies need to be implemented that include taking the time to share information via the written word with all new members of the healthcare team and the mother. Fear, loss of control, and lack of knowledge about the illness of the child may contribute to the overall stress of the situation.

A child, age 3, is brought to the emergency department in respiratory distress caused by acute epiglottiditis. Which assessment finding is most concerning for the nurse?

Severe sore throat, drooling, and inspiratory stridor A child with acute epiglottiditis 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.

A nurse is caring for a 14-month-old infant being treated for an upper respiratory infection. The physician would like to order a series of X-rays for the infant, who has been in a foster home for 4 months. How should the nurse obtain consent?

Obtain consent from the foster parents. Foster parents have the right to consent to medical care of minors in their care. The parents of a minor in foster care don't have authority to make decisions regarding his care. The nurse should call Child Protective Services only if she has concerns about a foster parent's authenticity. The nurse needn't notify the director of nursing unless complications occur.

A nurse is caring for a toddler with Down syndrome. To help the toddler cope with painful procedures, the nurse can:

hold and rock him and give him a security object. The child with Down syndrome may have difficulty coping with painful procedures and may regress during his illness. Holding, rocking, and giving the child a security object is helpful because it may be comforting to the child. An older child or a child without Down syndrome may benefit from positive self-talk, time limits, and diversionary tactics, such as counting and singing; however, the success of these tactics depends on the child.

The nurse is caring for a young child who has been admitted to the hospital with pertussis. To prevent the spread of the infection, which of the following is the most important action of the nurse?

Provide masks for everyone entering the room. Pertussis is spread via droplet transmission, so droplet precautions are necessary for the first 5 days after the child has begun medical treatment. This requires that everyone entering the room wears a mask.

The mother calls the nurse to report that her toddler just been burned on the arm. The nurse should advise the mother to first:

run cool water over the burned area, and then wrap it in a clean cloth. The best advice for the nurse to give the child's mother is to run cool water over the burned area to stop the burning process. Then the area should be wrapped in a clean cloth. Once these initial actions are completed, the mother can call the child's HCP. Packing the arm in ice may cause more damage to the burned area because cold can cause burns just as heat can. For most burns, it is not advised to apply ointment until the area has been evaluated.

The nurse is educating the parents of a 2-year-old child regarding immunizations. When the parents ask where the injections will be given the nurse answers that the most appropriate site for an intramuscular injection for a child this age is the:

vastus lateralis muscle. When administering an intramuscular injection to a 2-year-old child, the preferred site is the vastus lateralis. The dorsogluteal muscle is not a recommended injection site for any age, due to the risk of damaging nerves in the area. The deltoid muscle is underdeveloped in this age group, and therefore not recommended. The ventrogluteal muscle may be developed enough, but is not the first choice.

When assessing a toddler's growth and development, the nurse understands that a child in this age-group displays behavior that fosters which developmental task?

Autonomy The toddler's developmental task is to achieve autonomy while overcoming shame and doubt. Developing initiative is the preschooler's task whereas developing trust is the infant's task. Developing industry is the task of the school-age child.

For a child with a circumferential chest burn, what is the most important factor for the nurse to assess?

Breathing pattern Breathing pattern is the most important factor to assess because eschar impedes chest expansion in a child with a circumferential chest burn, causing breathing difficulty. Wound characteristics, body temperature, and heart rate are also factors that should be assessed, but they aren't as important as breathing pattern.

A parent brings a toddler, age 19 months, to the clinic for a regular checkup. When palpating the toddler's fontanels, what should the nurse expect to find?

Closed anterior and posterior fontanels By age 18 months, the anterior and posterior fontanels should be closed. The diamond-shaped anterior fontanel normally closes between ages 9 and 18 months. The triangular posterior fontanel normally closes between ages 2 and 3 months.

Which of the following is a priority nursing action for a child with croup?

Continually assessing respiratory status Respiratory status should be assessed continually as the child may have laryngeal spasms without notice. Antipyretics may be given as well as oxygen, but respiratory status takes priority. Parents would be encouraged to stay with their child but this is not an immediate priority.

The nurse is caring for a 3-year-old child with iron deficiency anemia and providing dietary instructions to the parents. Which of the following should be a priority for the nurse to include in the teaching?

Recommending lean meats From the list, meat is the food source with the highest iron content.

A 2-year-old child is brought to the emergency department with a broken arm. Which finding should lead the nurse to suspect child abuse?

The child's father alters the story of the injury each time he tells it. The nurse should suspect child abuse when the child's caregiver changes the story of the injury each time it is told. A child who is still learning to walk and run commonly will have bruises on the forearms and shins; bruises on the upper arms and thighs are suspicious. Children commonly become dirty and tear clothes when they play. A parent may not be able to come to the hospital with the child for many reasons, such as care of other children, illness, or lack of transportation.

A toddler is hospitalized for evaluation and management of congenital heart disease (CHD). During discharge preparation, the nurse should discuss which topic with the parents?

When to administer prophylactic antibiotics In CHD, areas of turbulent blood flow provide an optimal environment for bacterial growth. Therefore, a child with CHD is at increased risk for bacterial endocarditis, an infection of the heart valves and lining, and requires prophylactic antibiotics before dental work and invasive procedures. These children should receive all childhood immunizations. They don't require postural drainage or dietary fat restriction.

Which family should the nurse determine as most in need of follow-up?

a single parent with a toddler who has third-degree burns over 20% of the body Toddlers receive burns usually as the result of not being closely supervised. Toddlers are very inquisitive and need constant supervision; therefore, close follow-up is necessary. In addition, the child probably will need some type of wound care requiring involvement of the parent and possibly others. The amount of support available to the single parent of the 7-month-old child is not known. Although immunization schedules need to be adhered to, it is very possible for a 7-month-old to be delayed in receiving immunizations because of illness or other conflicts. An automobile accident can happen to anyone and does not indicate a lack of safety or supervision. A history of caustic liquid ingestion in a foster child may have been from a time before the child began living with the foster parents; it does not indicate a lack of safety or supervision.

A parent asks the nurse about using corporal punishment. The nurse should tell the parent that corporal punishment:

can result in children becoming accustomed to spanking. Corporal punishment is an aversion technique that teaches children what not to do. Children can commonly become accustomed to physical punishment, so the punishment must be more severe to get the same results. Parents commonly use physical punishment when they are in a rage; injury to the child can result. Corporal punishment, such as spanking, can reinforce the idea that violence is acceptable in certain circumstances. Corporal punishment is not beneficial. It causes children to be fearful and may lead children to redirect their anger in destructive ways.

A parent asks the nurse about using a car seat for a toddler who is in a hip spica cast. The nurse should tell the parent:

"You will need a specially designed car seat for your toddler." The toddler in a hip spica cast needs a specially designed car seat. The one that the mother already has will not be appropriate because of the need for the car seat to accommodate the cast and abductor bar.

Which toy should the nurse give to a toddler to use in the hospital playroom?

blocks As toddlers begin imaginative play, blocks are an excellent toy choice. Children can use blocks any way they desire, thus fostering imaginative play. A tricycle, wheelbarrow, or truck is an appropriate toy for a preschooler because it requires the use of specific motor skills developed during the preschool period. These motor skills are lacking in a toddler.

When preparing a 3-year-old child to have blood specimens drawn for laboratory testing, the nurse should:

use distraction techniques during the procedure. A 3-year-old child responds best to distraction during a procedure because of the typical level of cognitive development of a 3-year-old and the fear of painful events. Preparation for the procedure should be done immediately beforehand, so that the child will not become too frightened. A 3-year-old is not concerned about the why of the procedure but about whether the procedure will hurt. This child is too young for verbal explanations alone because of the limited verbal abilities at this age and the fear of a painful event.

A nurse is teaching parents about accident prevention for a toddler. Which guideline is most appropriate?

Make sure all medications are kept in containers with childproof safety caps. Making sure all medications are kept in containers with childproof safety caps is the most appropriate guideline because poisoning accidents are common in toddlers owing to the toddler's curiosity and his increasing mobility and ability to climb. When riding in a car, a toddler should be strapped into a car seat, not a seat belt. A seat belt is an appropriate guideline for a school-age child. Never leaving a child alone on a bed is an appropriate guideline for parents of infants. Toddlers already have the ability to climb on and off of beds and other furniture by themselves. Note, however, that toddlers should never be left unattended on high surfaces, such as an examining table in a physician's office. Teaching the rules of the road for bicycle safety is an appropriate safety measure for a school-age child. Toddlers should not be allowed in the road unsupervised.

Parents ask the nurse for advice about handling their 2-year-old's negativism. What is the best recommendation?

Set realistic limits for the child, and then be sure to stick to them. A characteristic of 2-year-olds is negativism, a response to their developing autonomy. Setting realistic limits is important so that the toddler learns what behavior is and is not acceptable. Ignoring the behavior may lead the child to believe that there are no limits. As a result, the child does not learn appropriate behavior. Having the grandmother visit will give the parents a break, but setting limits is more important to the child's development. Limits need to be realistic to ensure that the child learns appropriate behavior. Limits that are too strict are inappropriate, interfering with learning appropriate behavior.

Which of the following objects poses the most serious safety threat to a 2-year-old child in the hospital?

Side rails in the halfway position Side rails in the halfway position pose the biggest threat because the most common accidents in hospitals are falls. To prevent falls, the crib rails always should be raised and fastened securely unless an adult is at the bedside. Crayons and paper and a stuffed teddy bear are safe toys for a 2-year-old child. Although a mobile could pose a safety threat to this child, the threat is less serious than that posed by an incorrectly positioned side rail.

Which approach by a nurse is the best for trying to take a crying toddler's temperature?

Talk to the mother first and then to the toddler. When dealing with a crying toddler, the best approach is to talk to the mother first then to the toddler. This approach helps the toddler get used to the nurse before she attempts any procedures. It also gives the toddler an opportunity to see that the mother trusts the nurse. Ignoring the crying and screaming may be the second step. The nurse should encourage the mother to hold the toddler because it will likely help the situation. The last resort is to bring in assistance so the procedure can be completed quickly.

A toddler is diagnosed with iron deficiency anemia. When teaching the parents about using supplemental iron elixir, the nurse should provide which instruction?

"Give the elixir with water or juice." Because iron preparations may stain the teeth, the nurse should instruct the parents to give the elixir with water or juice. The iron preparation shouldn't be given with milk because milk impedes iron absorption. This preparation may darken the stools and cause constipation, not diarrhea; parental instruction regarding increased fluid intake and fiber intake can relieve constipation. To prevent GI upset, the nurse should instruct the parents to mix the iron preparation with water or fruit juice and have the child take it with, not before, meals. (Giving it with fruit juice may be preferable because vitamin C enhances iron solubility and absorption.)

A day-shift nurse tells a night-shift nurse that she has been attempting to reduce the risk for Impaired skin integrity related to immobility in a toddler. Which statement by the night-shift nurse should the day-shift nurse question? Select all that apply.

"I'll gently massage the skin with a lubricating substance." "I'll wipe the pressure points with alcohol wipes to keep them clean." Using a lotion on the pressure points will soften the skin and promote its breakdown and therefore, should be avoided. The use of alcohol is drying and should be avoided. Changing the toddler's position frequently will help minimize pressure, prevent edema, and stimulate circulation. Keeping the skin clean will lessen the chances of irritation and breakdown.

A 2-year-old child brought to the clinic by her parents is uncooperative when the nurse tries to look in her ears. What should the nurse try first?

Allow a parent to assist. Parents can be asked to assist when their child becomes uncooperative during a procedure. Most commonly, the child's difficulty in cooperating is caused by fear. In most situations, the child will feel more secure with a parent present. Other methods, such as asking another nurse to assist or waiting until the child calms down, may be necessary, but obtaining a parent's assistance is the recommended first action. Restraints should be used only as a last resort, after all other attempts have been made to encourage cooperation.

For a child with a Wilms' tumor, which preoperative nursing intervention takes highest priority?

Avoiding abdominal palpation Explanation: Because manipulating the abdominal mass may disseminate cancer cells to adjacent and distant sites, the most important intervention for a child with a Wilms' tumor is to avoid palpating the abdomen. Restricting oral intake and monitoring acid-base balance are routine interventions for all preoperative clients; they have no higher priority in one with a Wilms' tumor. Isolation isn't required because a Wilms' tumor isn't infectious.

Which suggestion would be most helpful to the parents of a 2-year-old child when managing separation anxiety during hospitalization?

Bring the child's favorite toys from home. Bringing a child's favorite toys, security blanket, or familiar objects from home can make the transition from home to hospital less stressful. The child receives comfort and reassurance from these items. Leaving without explaining may decrease the child's trust in the parents, ultimately adding to the child's level of anxiety. The parents should tell their toddler when they are leaving and when they will return, not by time but in relation to the child's usual activities (e.g., by bedtime). Typically, 2-year-old children have a limited sense of time. Short parental visits do not satisfy a toddler's overwhelming need for comfort because toddlers need to spend lots of time with parents due to separation anxiety.

A nurse is caring for a 2-year-old child admitted for long-term treatment of a chronic illness. Which action should the nurse take to promote normal childhood growth and development?

Consult with a play therapist about activities in which the child can participate. Play is an important part of a child's growth and development. A nurse should facilitate play even when a child has a chronic illness. Consulting a play therapist is one way of facilitating such play. Although it's important for children to get adequate sleep, it isn't necessary for a toddler to get 12 hours' sleep per night. A child with a chronic illness may need to be temporarily isolated, but he should still have interaction with family members. A diet high in carbohydrates and low in fat isn't indicated for every toddler with a chronic illness.

An 18-month-old child is admitted to the pediatric unit. Which of the following can the nurse do to reduce the stress on the client during this hospitalization?

Encourage the client's caregivers to be with the client as much as possible For infants through preschoolers, separation from the family is the major stressor posed by hospitalization. To minimize the effects of separation, the nurse may suggest that a family member stay with the child as much as possible. Reducing this stressor may help a young child withstand other possible stressors of hospitalization, such as fear of bodily injury, loss of control, and fear of pain. Allowing the child to explore their environment would not impact potential stressors, and at this age the child engages in parallel play; therefore, encouraging play times would not reduce stressors.

Which action should the nurse take when suspecting that a child has been abused by the mother?

Ensure that any and all findings are reported to the proper authorities. Evidence of child abuse is legally reportable by anyone who works with children. The nurse should ensure that the findings are reported to the proper authorities. Laws ordinarily provide immunity from legal actions for people who are required to report suspicion of child abuse, if the report is done in good faith. Suspicion, not absolute proof, is necessary for reporting abuse. The nurse's primary responsibility is to the primary client, the child, and not the mother. Any professional who works with children can report suspected child abuse, not just a primary care provider.

When developing the preoperative teaching plan for a 14-month-old child with an undescended testis who is scheduled to have surgery, which method is appropriate?

Explain to the parents how the defect will be corrected. Preoperative teaching would be directed at the parents because the child is too young to understand the teaching. Telling the child that his penis and scrotum will be "fixed," telling the child he will not see incisions after surgery, and using a doll to illustrate the surgery are appropriate interventions for a preschool-age child.

The mother of a toddler asks the nurse what she should do with her toddler when he has a temper tantrum. Which suggestion would be most appropriate?

Leave the toddler alone during the tantrum as long as he is safe. Toddlers have temper tantrums in their attempt to develop autonomy. Toddlers should be left alone as long as they are safe during a tantrum. Moving the child to a time-out chair or punishing the child reinforces the behavior and is to be avoided. Attempting to talk to the toddler also reinforces the behavior. Additionally, at this cognitive level, toddlers do not understand as well as older children do.

What should a nurse do to ensure a safe hospital environment for a toddler?

Move the equipment out of reach. Moving the equipment out of reach ensures a safe environment because toddlers are curious and may try to play with items within their reach. Toddlers in a strange hospital environment still need the security of a crib. Stacking toys don't need to be moved out of reach because they don't present a safety hazard and are appropriate for this age-group. Padded crib rails are necessary only if seizure activity is present.

When assessing for pain in a toddler, which method should be the most appropriate?

Observe the child for restlessness. 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. While the FACES pain scale can be used in young children numeric rating 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.

Which of the following techniques is best for the nurse to use in evaluating the parents' ability to administer eardrops correctly?

Observe the parents instilling the drops in the child's ear. Return demonstrations are the best way to evaluate a person's ability to perform a skill. This technique enables the teacher to observe not only the learner's sequencing of steps of the procedure but also the learner's ability to perform the skill.

An uncle is shopping for a toy to give his niece. He has no children of his own and asks his neighbor, a nurse, what would be the most appropriate toy to give a 15-month-old. Which toy should the nurse recommend to facilitate learning and development?

a push-pull toy A push-pull toy will aid in development of gross motor skills and muscle development. A stuffed animal is age appropriate for a toddler but is not the toy to promote development. A music box is and nursery mobile are most appropriate to stimulate development for an infant.

The parents report that their child has a runny nose, fever, and cough and is irritable and constantly rubbing his ears. When assessing the ear, how should the nurse expect the child's tympanic membrane to appear

bulging and red Based on the report of the child's signs and symptoms, the nurse should suspect otitis media. On assessment, the tympanic membrane would appear bulging and bright red (because of increased middle ear pressure), typically indicative of otitis media. Other characteristic findings include rhinorrhea, fever, cough, fussiness, pulling at the ears, and earache. A clear, inverted membrane may indicate a blockage of the eustachian tubes. A pearly gray tympanic membrane is normal. A scarred tympanic membrane indicates that the membrane has burst due to pressure, but this condition would have occurred earlier if scar tissue has formed.

A young child who has been sexually abused has difficulty putting feelings into words. Which approach should the nurse employ with the child?

engaging in play therapy The dolls and toys in a play therapy room are useful props to help the child remember situations and reexperience the feelings, acting out the experience with the toys rather than putting the feelings into words. Role-playing without props commonly is more difficult for a child. Although drawing itself can be therapeutic, having the abuser see the pictures is usually threatening for the child. Reporting abuse to authorities is mandatory, but does not help the child express feelings.

A 3-year-old child receiving chemotherapy after surgery for a Wilms' tumor has developed neutropenia. The parent is trying to encourage the child to eat by bringing extra foods to the room. Which food would not be appropriate for this child?

fresh strawberries When a client receiving chemotherapy develops neutropenia, eating uncooked fruits and vegetables may pose a health risk due to possible bacterial contamination. All other foods are either cooked or pasteurized and would not produce a health risk.

When planning home care for a 3-year-old child with eczema, what should the nurse teach the mother to remove from the child's environment at home?

stuffed animals For the child with eczema, which is commonly related to an allergic response, stuffed animals should be avoided because they tend to collect dust and are difficult to clean. Metal toy trucks, plastic figures, and wooden blocks are suitable toys for a 3-year-old child. They are easy to keep clean.

A mother tells the nurse that she wants to begin toilet training her 22-month-old child. Which statement by the mom offers the greatest likelihood of success?

"My son says "pee-pee" and runs to the potty chair." The most important factor is developmental readiness because if the child is not developmentally ready, both the child and parent will become frustrated. Consistency is important when toilet training is started; the mother's positive attitude is important when the child is determined to be ready. Developmental levels of children are individualized and comparison to peers is not useful.

A 2-year-old child with a low blood level of the immunosuppressive drug cyclosporine comes to a liver transplant clinic for her appointment. The mother says the child hasn't been vomiting and hasn't had diarrhea, but she admits that her daughter doesn't like taking the liquid medication. Which statement by the nurse is most appropriate?

"Offer the medication diluted with chocolate milk or orange juice to make it more palatable." Because liquid cyclosporine has a very unpleasant taste, diluting it with chocolate milk or orange juice will lessen the strong taste and help the child take the medication as ordered. It is not acceptable to miss a dose because the drug's effectiveness is based on therapeutic blood levels, and skipping a dose could lower the level. Cyclosporine should not be given by NG tube because it adheres to the plastic tube and, thus, all of the drug may not be administered. Taking the medication over a period of time could negatively affect the blood level.

A boy, age 2, is diagnosed with hemophilia, an X-linked recessive disorder. His parents and newborn sister are healthy. The nurse explains how the gene for hemophilia is transmitted. Which statement by the father indicates an understanding of X-linked recessive disorders?

"Our newborn daughter may be a carrier of the trait." The father stating that his newborn daughter may be a carrier of the trait demonstrates understanding of X-linked recessive disorders. X-linked recessive genes behave like other recessive genes. A normal dominant gene hides the effects of an abnormal recessive gene. However, the gene is expressed primarily in male offspring because it's located on the X chromosome. Male offspring of a carrier mother and an unaffected father have a 50% chance of expressing the trait whereas female offspring are more likely to carry the trait than express it. These parents may produce offspring who neither express nor carry the trait for hemophilia.

Which statement by a mother of a toddler with nephrotic syndrome indicates that the nurse's discharge teaching was effective?

"I've been checking the urine for protein so I'll be able to do it at home." The mother stating that she'll check her toddler's urine for protein indicates effective teaching because such testing helps detect the progression of nephrotic syndrome. The child doesn't need to be kept quiet and usually isn't placed on a specific diet. How the child feels will dictate the child's activity level. Most children return to normal soon but may relapse.

A nurse is teaching a group of parents about otitis media. When discussing why children are predisposed to this disorder, the nurse should mention the significance of which anatomical feature?

Eustachian tubes The nurse should mention the importance of the eustachian tubes because they're short in a child and lie in a horizontal plane, promoting entry of nasopharyngeal secretions into the tubes and thus setting the stage for otitis media. The nasopharynx, tympanic membrane, and external ear canal have no unusual features that would predispose a child to otitis media.

The nurse is caring for a toddler who has been diagnosed with pernicious anemia. Which of the following should the nurse include in the health teaching about pernicious anemia for the parents?

The need to comply with lifelong injections of vitamin B12 Pernicious anemia requires lifelong monthly intramuscular injections of vitamin B12. All other choices refer to other types of anemia.

The inability of an 18-month-old child to perform what activity would cause the nurse to be concerned?

playing with pull toys Playing with pull toys is a typical task of a normally developed 18-month-old child. Inability of the toddler to do so would be a concern. Copying a circle and building a tower of eight or more blocks is a behavior typical of a 3-year-old child. Playing tag with other children requires cooperative play and the ability to follow rules; this behavior develops at about age 5 years.

A 23-month-old child pulls a pan of hot water off the stove and spills it onto her chest and arms. Her mother is right there when it happens. What should the mother do immediately?

Place the child in a bathtub of cool water. The emergency treatment of both minor and major burns includes stopping the burning process by immersing the burned area in cool, but not cold, water. Thus, the mother should place the child in a bathtub of cool water. Applying ice directly to the burned area is inappropriate at this time because more tissue damage can result. Antibiotic ointment should not be applied to the burned area at this time because the burning process must be stopped first. Calling a neighbor for help is appropriate after the mother has placed and then removed her child from the bathtub.

A nurse on the pediatric floor is caring for a toddler refusing to take liquid acetaminophen for fever. What would be the best option?

Allow the mother to hold the child and give the medication. A toddler's increasing autonomy is commonly expressed by negativism. They are unreliable in expressing pain — they respond just as strongly to painless procedures as they do to painful ones. Toddlers have little concept of danger and have common fears. The toddler has trust in mother and may be more willing to take the medication from her.

A toddler with a ventricular septal defect is receiving digoxin to treat heart failure. Which assessment finding should be the nurse's priority concern?

Bradycardia Digoxin enhances cardiac efficiency by increasing the force of contraction and decreasing the heart rate. An early sign of digoxin toxicity is bradycardia (an abnormally slow heart rate). To help detect digoxin toxicity, the nurse always should measure the apical heart rate before administering each digoxin dose. Other signs and symptoms of digoxin toxicity include arrhythmias, vomiting, hypotension, fatigue, drowsiness, and visual halos around objects. Tachycardia, hypertension, and hyperactivity aren't associated with digoxin toxicity.

A toddler diagnosed with nephrotic syndrome has a fluid volume excess related to fluid accumulation in the tissues. Which measure should the nurse anticipate including in the child's plan of care?

Weigh the child before breakfast. The best indicator of fluid balance is weight. Therefore, daily weight measurements help determine fluid losses and gains. Although limiting visitors to 2 to 3 hours per day or maintaining strict bed rest would help to ensure that the child gets adequate rest, this is unrelated to the child's fluid balance. In nephrotic syndrome, urine is tested for protein, not specific gravity.

A 2-year-old child in the cardiac step-down unit is experiencing supraventricular tachycardia. Which intervention should be attempted first?

Immersing the child's hands in cold water Vagal maneuvers, such as immersing the child's hands in cold water, are commonly tried first as a mechanism to decrease heart rate. Other vagal maneuvers include breath-holding, gagging, and placing the child's head lower than the rest of the body. Digoxin may be given after vagal maneuvers to help decrease heart rate; verapamil isn't recommended. Synchronized cardioversion may be necessary if vagal maneuvers fail and drugs are ineffective.

A staff nurse is caring for a child with a urinary tract infection. The nurse is 1 hour late administering the child's prescribed antibiotic therapy and pain medication. The charge nurse challenges the staff nurse about the lateness of the medications. The staff nurse responds, "It's no big deal; at least the child got the medication." What is the best course of action for the charge nurse to take?

Speak to the unit manager and fill out a medication error report. Nurses are expected to demonstrate professional conduct, including safely administering medication. Administering scheduled medication 1 hour late is a medication error and should be identified to the unit manager to speak directly with the nurse as per his/her job responsibilities.

A nurse is teaching a new mother about intussusception. Which signs and symptoms should the nurse include?

Abdominal distension and vomiting Intussusception occurs when a portion of the bowel slides into the next, like the pieces of a telescope. When this occurs it can create a blockage in the bowel, with the walls of the intestines pressing against one another. This leads to abdominal swelling, inflammation, and decreased blood flow to the part of the intestines involved. Additional symptoms include vomiting, passing of stools mixed with blood and mucus, and grunting due to pain.

The parent of a toddler hospitalized for episodes of diarrhea reports that when the toddler cannot have things the way she wants, she throws her legs and arms around, screams, and cries. The mother says, "I do not know what to do!" After teaching the parent about ways to manage this behavior, which statement indicates that the nurse's teaching was successful?

"Next time she screams and throws her legs, I'll ignore the behavior." The child is demonstrating behavior associated with temper tantrums, which are relatively frequent normal occurrences during toddlerhood as the child attempts to develop a sense of autonomy. The development of autonomy requires opportunities for the child to make decisions and express individuality. Ignoring the outbursts is probably the best strategy. Doing so avoids rewarding the behavior and helps the child to learn limits, promoting the development of self-control. However, the mother should intervene in a temper tantrum if the child is likely to injure herself. Allowing the child to have what she wants occasionally would typically add to the problems associated with temper tantrums because doing so rewards the behavior and prevents the child from developing self-control. Toddlers do not possess the capacity to understand explanations about behavior. Expressing disappointment in the child's behavior or telling her that she is being a bad girl reinforces feelings of guilt and shame, thus interfering with the child's ability to develop a sense of autonomy.

A 15-month-old child is being discharged after treatment for severe otitis media and bacterial meningitis. Which statement by the parents indicates effective discharge teaching?

"We'll go to the physician if our child pulls on the ears or won't lie down." The parents indicate full understanding of discharge teaching by repeating the specific, common signs of otitis media in toddlers, such as pulling on the ears and refusing to lie down, and by verbalizing the need for immediate follow-up care if these signs arise. Expressing that they should have gone to the physician sooner doesn't indicate effective teaching because it implies a sense of guilt — a feeling not promoted through teaching. Stating that they'll take the child to the physician's office every week addresses only weekly follow-up care and expressing that they're happy the problem is behind them is unrealistic because the child's condition may recur.

The nurse in the emergency department is caring for a 3-year-old child with a fractured humerus. The child is crying and screaming, "I hate you!" Which action would be most appropriate?

Reassure the parents that this a normal behavior under the circumstances. Explaining to the parents that this is a normal reaction under the circumstances is most appropriate. The child's outburst is related to the child's fears of the unknown. The child is scared and anxious and needs the parents for support. Asking the parents to wait outside would only add to the child's fear and anxiety. The reaction is normal for a child her age and does not usually call for a change in staff assignments. Asking the parents to discipline their child for her behavior is inappropriate. The nurse needs to handle the situation.

A nurse teaches a mother how to provide adequate nutrition for her toddler, who has cerebral palsy. Which observation indicates that teaching has been effective?

The child eats finger foods by himself. The child eating finger foods by himself indicates effective teaching because a child with cerebral palsy should be encouraged to be as independent as possible. Finger foods allow the toddler to feed himself. Because spasticity affects coordinated chewing and swallowing as well as the ability to bring food to the mouth, it's difficult for the child with cerebral palsy to eat neatly. In terms of a specified period of time, the child with cerebral palsy may require more time to bring food to the mouth; thus, chewing and swallowing shouldn't be rushed. A child shouldn't lie down to rest after eating because doing so may cause the child to vomit from a hyperactive gag reflex. Therefore, the child should remain in an upright position after eating to prevent aspiration and choking.

Which observation by the nurse should suggest that a 15-month-old toddler has been abused?

The child is underdeveloped for his age. An almost universal finding in descriptions of abused children is underdevelopment for age. This may be reflected in small physical size or in poor psychosocial development. The child should be evaluated further until a plausible diagnosis can be established. A child who appears happy when personnel work with him is exhibiting normal behavior. Children who are abused often are suspicious of others, especially adults. A child who plays alongside others is exhibiting normal behavior, that of parallel play. A child who sucks his thumb contentedly is also exhibiting normal behavior.

A toddler has a temperature above 101° F (38.3° C). The physician orders acetaminophen, 120 mg suppository, to be administered rectally every 4 to 6 hours. The nurse should question an order to administer the medication rectally if the child has a diagnosis of:

thrombocytopenia. A child with thrombocytopenia or neutropenia shouldn't receive rectal medication because of the increased risk of infection and bleeding that may result from tissue trauma. No contraindications exist for administering rectal medication to a child with sepsis, leukocytosis, or anemia.

A parent calls the pediatric clinic to express concern over her child's eating habits. She says the child eats very little and consumes only a single type of food for weeks on end. The nurse knows that this behavior is characteristic of:

toddlers. The nurse knows that erratic eating is typical of toddlers because the physiologic need for food decreases at about age 18 months as growth declines from the rapid rate of infancy. The toddler also develops strong food and taste preferences, sometimes eating just one type of food for days or weeks and then switching to another.

When a toddler with croup is admitted to the facility, a physician orders treatment with a mist tent. As the parent attempts to put the toddler in the crib, the toddler cries and clings to the parent. What should the nurse do to gain the child's cooperation with the treatment?

Encourage the parent to stand next to the crib and stay with the child. The nurse should encourage the parent to stand next to the crib and stay with the child. This approach promotes compliance with treatment while minimizing the toddler's separation anxiety. Because the mist helps thin secretions and make them easier to clear, turning off the mist or letting the toddler sit next to the mist tent defeats the treatment's purpose. To prevent falls, the nurse should keep the side rails up and shouldn't permit the toddler to climb into and out of the crib.

A nurse is caring for a toddler who has just been immunized. When teaching the child's parents about potential adverse effects, the nurse should instruct the parents to immediately report:

generalized urticaria. The nurse should instruct parents to immediately report generalized urticaria because it can herald the onset of a life-threatening episode. A child may experience some pain, redness at the sight, localized swelling, or mild temperature elevation; however, these reactions can be treated symptomatically and aren't life-threatening.

The parents of a toddler do not want their child to have a varicella immunization, stating, "My child will have better immunity if he or she gets the disease now." Which of the following is the nurse's best response?

"If the child contracts the disease, it could be very serious, even life threatening." The varicella vaccine protects the child from chicken pox. Although most cases of chicken pox are not life threatening, children can die from the disease. It is highly contagious, and other children, or immunocompromised adult and children, may be exposed to the unvaccinated child. The vaccine is specific for chicken pox disease.

The nurse is caring for a toddler who is visually impaired. What is the most important action for the nurse to take to ensure the safety of the child?

Maintain a tidy environment around the child. Visually impaired children explore their environment by feel. A tidy and organized environment can support this and promote the child's safety. It is a priority to make sure all items that could potentially injure the child are removed from the environment. This includes meal trays and supplies for procedures.

A registered nurse (RN) has been "care-paired" with a licensed practical nurse (LPN) during the evening shift. Whose care should the RN assign to the LPN?

The 2-year-old child who has started eating soft, solid foods following a tonsillectomy The nurse can delegate care of the child who had the tonsillectomy to the LPN because he/she is stable and likely preparing for discharge. The infant with a WBC count of 34/μl and fever requires close monitoring for additional signs of infection. Infection could lead to sepsis or septic shock. Although the infant with contusions from the motor vehicle accident may be stable, children sometimes experience delayed reactions to injury. This infant requires close monitoring for signs or injury or shock. The RN should care for the infant with type 1 diabetes, who could become ill very quickly.

An 18-month-old boy is admitted to the pediatric unit with a diagnosis of celiac disease. What finding would the nurse expect in this child?

A protuberant abdomen The nurse would expect to find a protuberant abdomen caused by the presence of fat, bulky stools; undigested food; and flatus, which are associated with celiac disease. A concave abdomen, bulges in the groin area, and a palpable abdominal mass aren't associated with celiac disease.

Which statements would indicate that the parents of a child being treated with antibiotics for an ear infection understand the reason for a follow-up visit after the child completes the course of therapy?

"We need to make sure that her ear infection has completely cleared." Because ear infections are sometimes difficult to treat, determining if the antibiotic has resolved the infection is essential. If the child is not rechecked, it will be difficult to determine if another infection is a continuation of a previous infection or a separate, new infection. Although studies may be done to determine if an infection has impaired the child's hearing, they are not done routinely after each course of antibiotic therapy. A visit to the primary care provider's office cannot validate that all the medication was taken. A follow-up visit helps to determine if the infection has completely cleared. If the infection is resolved with one course of antibiotics, another course would not be prescribed.

When developing a teaching plan for parents of toddlers about poisonous substances, the nurse should emphasize which safety points? Select all that apply.

Toddlers should be adequately supervised at all times. All poisonous substances should be kept out of the reach of children and stored in a locked cabinet if necessary. The difference between pediatric and adult dosages of medicines is significant, and adult dosages given to children can have serious, harmful effects. Following any poisoning, the parents should call the Poison Control Center for instructions for appropriate treatment. Safety measures for poisonous substances include close supervision of children, safely storing toxic substances, teaching proper dosages and differences between adult and child doses, and the proper way to contact the Poison Control Center for instructions. Poison Control should be notified as soon as the poisoning has occurred and airway and circulation have been assessed. Poison Control will direct any further treatment. Syrup of ipecac is rarely used today in the treatment of ingested substances due to the potential for aspiration. It is contraindicated in cases of arsenic poisoning, seizures, and the ingestion of petroleum or corrosive substances.

The mother of a toddler who has just been admitted with severe dehydration secondary to gastroenteritis says that she cannot stay with her child because she has to take care of her other children at home. Which response by the nurse would be most appropriate?

"I understand, but feel free to visit or call anytime to see how your child is doing." The nurse's best course of action would be to support the mother. This is best done by conveying understanding and encouraging the mother to visit or call. Telling the mother that she should not leave and that the child is very sick is critical and insensitive. Additionally, it implies guilt should the mother leave. Commenting that the child does not need anyone is not appropriate or true. Toddlers, in particular, need family members present because of the stresses associated with hospitalization. They experience separation anxiety, a normal aspect of development, and need constancy in their environment. Asking the mother to find someone else to stay with her children is inappropriate. The children at home also need the support of the mother and/or other family members to minimize the disruptions in family life resulting from the toddler's hospitalization and to maintain consistency.

A mother brings her child, age 3, to the clinic for an annual checkup. After plotting the child's height and weight on a pediatric growth chart, the nurse identifies which percentile range as normal?

5th to 95th percentile Height and weight measurements that fall between the 5th and 95th percentiles represent normal growth for most children. Children whose measurements fall outside this range require further evaluation.

A 3-year-old child is to receive 500 ml of dextrose 5% in normal saline (D5NSS) solution over 8 hours. At what rate (in milliliters/hour) would the nurse set the infusion pump? Record your answer using one decimal place.

62.5 To calculate the rate per hour for the infusion, the nurse would divide 500 ml by 8 hours: 500 ml ÷ 8 hours = 62.5 ml/hour.

When developing the plan of care for a toddler who has taken an acetaminophen overdose, which intervention should the nurse expect to include as part of the initial treatment?

gastric lavage Initial management of a child who has ingested a large amount of acetaminophen would include inducing vomiting or performing gastric lavage with or without activated charcoal to aid in the removal of the substance. Frequent blood level determinations may be obtained during the follow-up phase, but they are not done as part of the initial treatment. Tracheostomy is not typically part of the initial treatment for acetaminophen overdose. However, it may be necessary later if respiratory distress develops. Acetaminophen primarily affects the liver, not the heart. Therefore, an electrocardiogram would not be considered part of the initial treatment plan.

After teaching the parents of a 15-month-old child who has undergone cleft palate repair how to use elbow restraints, which statement by the parents indicates effective teaching?

"We will remove the restraints temporarily at least three times a day to check his skin, then put them right back on." Elbow restraints help to keep the child from placing fingers or any other object in the mouth that would cause injury to the operative site. The restraints are worn at all times except when they are removed to check the skin. Because of the risk for skin breakdown, the restraints are removed periodically during the day to assess the child's underlying skin. It is advisable to remove only one restraint at a time while keeping hold of the child's hand on the unrestrained side. Toddlers are quick and usually want to explore the area in the mouth that the surgery has made feel different. The restraints should be in place at all times during sleep and play to prevent inadvertent injury to the operative site. Taping the restraints directly to the skin is not advised because skin breakdown can occur when tape is reapplied to the same area over several weeks. The restraints can be fastened to clothing to keep them from slipping.

A 21-month-old child admitted with the diagnosis of croup now has a respiratory rate of 48 breaths/minute, a heart rate of 120 bpm, and a temperature of 100.8° F (38.2 ° C) rectally. The nurse is having difficulty calming the child. What should the nurse do next?

Notify the health care provider (HCP) immediately. The nurse may be having difficulty calming the child because the child is experiencing increasing respiratory distress. The normal respiratory rate for a 21-month-old is 25 to 30 breaths/minute. The child's respiratory rate is 48 breaths/minute. Therefore the HCP needs to be notified immediately. Typically, acetaminophen is not given to a child unless the temperature is 101° F (38.6° C) or higher. Letting the toddler cry is inappropriate with croup because crying increases respiratory distress. Offering fluids every few minutes to a toddler experiencing increasing respiratory distress would do little, if anything, to calm the child. Also, the child would have difficulty coordinating breathing and swallowing, possibly increasing the risk of aspiration.