Toddlers (Level 1)
A nurse is planning for the discharge of a child after a sickle cell vaso-occlusive crisis. What is most important for the nurse to emphasize? A high-calorie diet A rigorous exercise regimen An increased intake of fluids An increase in the hours spent sleeping
An increased intake of fluids Dehydration promotes the sickling of erythrocytes. Increased fluid intake minimizes the chance that sickle cell pain will recur. A high-calorie diet is not necessary or helpful for a child with sickle cell anemia. Rigorous exercise is contraindicated because the decrease in oxygenation may cause sickling. An increase in the hours spent sleeping is not necessary.
A 3-year-old child is scheduled for cardiac catheterization. What is the priority nursing care after this procedure? Encouraging early ambulation Monitoring the site for bleeding Restricting fluids until the blood pressure has stabilized Comparing blood pressure readings in the lower extremities
Monitoring the site for bleeding Hemorrhage is a major life-threatening complication because arterial blood is under pressure and a catheter has been inserted into an artery. The child is kept in bed for 6 to 8 hours after an arterial catheterization. Fluids may be given as soon as they are tolerated. Pulses, not blood pressure, must be compared for quality and symmetry.
A nurse in the pediatric clinic is examining a toddler with suspected enterobiasis (pinworm infestation). For which first sign of an infestation should the nurse assess the child? Anal itching Scaly skin patches Maculopapular rash Bald spot on the head
Anal itching In enterobiasis the adult pinworm lays her eggs around the anal opening, producing itchy irritation. Scaly skin patches are commonly seen with eczema or dermatitis. A maculopapular rash may be seen with hookworm (Necator americanus), not pinworm (Enterobius vermicularis), infestation. A bald spot is produced by ringworm of the scalp (tinea capitis), a fungal infection of the skin.
A toddler with hemophilia A is receiving factor VIII. The mother asks the nurse, "If my son hurts himself, I'll give him 2 children's Advil. Is that right?" How should the nurse respond? "That's right. Advil will ease the pain." "Give him Tylenol. Advil may cause bleeding." "No. I'll explain why he isn't allowed pain medications." "You seem concerned about giving medications to your child."
"Give him Tylenol. Advil may cause bleeding." The parent is asking a specific question that should be answered by the nurse. Ibuprofen (Advil) is contraindicated because it may cause more bleeding. Ibuprofen interferes with platelet function and may cause more bleeding; therefore an analgesic such as acetaminophen (Tylenol) should be administered, because it does not interfere with coagulation. Analgesics are permitted, provided they do not have anticoagulant effects.
The parents of a 2-year-old boy are watching the nurse administer the Denver II Developmental Screening Test to their son. They ask, "Why did you make him draw on paper? We don't let him draw at home." What is the best response by the nurse? "I should have asked you about drawing first." "These drawings help us determine his intelligence." "It lets us test his ability to perform tasks requiring his hands." "I don't understand why drawing is forbidden in your home."
"It lets us test his ability to perform tasks requiring his hands." The Denver II Developmental Screening Test is one of the tests used to evaluate young children whose development appears to be behind the norm. It involves the use of a variety of methods to determine the level of development. The parents gave their consent to have the test done and were told that a variety of skills would be tested. A developmental screening test is designed not to test intelligence but rather to test the child's ability to perform specific age-appropriate developmental tasks. It is inappropriate to question the parents' childrearing ability.
A male toddler is scheduled to receive methotrexate for treatment of leukemia. The mother asks the nurse whether the child should be started on vitamin supplements because he seems so weak. How should the nurse respond? "That's a fine suggestion, and I'll ask for a prescription." "Vitamin supplements won't help him feel any better right now." "He'll benefit from a vitamin supplement and will be getting it soon." "Supplements that contain folic acid interfere with the effectiveness of chemotherapy."
"Supplements that contain folic acid interfere with the effectiveness of chemotherapy." Vitamins are contraindicated because methotrexate is a folic acid antagonist and folic acid will counteract the effectiveness of methotrexate. Telling the mother that vitamins won't help her son feel better doesn't answer the question; the parent is asking about improving her son's strength, not his well-being.
A nurse explains to the mother of a 1-year-old with a history of frequent ear infections that the primary cause of otitis media in young children is: Sinusitis Recurrent tonsillitis An inflamed mastoid process An obstructed eustachian tube
An obstructed eustachian tube A blocked eustachian tube impairs drainage and creates negative pressure; when the tube opens, bacteria are pulled into the middle ear. Sinusitis is not related to otitis media. Recurrent tonsillitis is not the direct cause of otitis media. Mastoiditis is a complication, not a cause, of otitis media.
A nurse who is teaching a growth and development class to a group of parents at the daycare center explains that the toddler strives for a sense of: Trust Industry Initiative Autonomy
Autonomy According to Erikson, the toddler strives for autonomy; most exploratory and negativistic behavior is based on the need to achieve this developmental task. Trust is the developmental task of the infant. Industry is the developmental task of the school-age child. Initiative is the developmental task of the preschool child.
After many episodes of otitis media a 3-year-old child is to undergo myringotomy and have tubes implanted surgically. What should the nurse include in the discharge preparation for this family? Keep the child at home for 1 week. Insert earplugs during the child's bath. Apply an ointment to the ear canal daily. Use cotton swabs to clean the inner ears.
Insert earplugs during the child's bath. Water in the ears after myringotomy may be a source of infection. There is no reason that the child cannot be around other children, because there is no infectious process. Applying an ointment to the ear canal daily will clog the ear canal and serves no purpose. Cotton swabs may be used occasionally in the outer ear but should not be inserted into the ear.
A 15-month-old child is admitted to the pediatric unit with a diagnosis of fever of unknown origin. After blood tests are performed, intravenous antibiotic therapy is prescribed. The nurse begins administration of the antibiotic infusion, which is set to run over 1 hour. Within 10 minutes the parent calls the nurse to request that the child's temperature be taken because the child appears flushed. The nurse takes the child's vital signs and notes that the child's neck and face appear flushed while the rest of the body appears normal. The child is playing and the IV line is intact, with no redness or swelling. The nurse checks the child's record. In light of this information, what should the nurse do? Administer acetaminophen. Place on protective isolation. Increase the rate of the vancomycin infusion. Notify the primary health care provider while stopping the infusion.
Notify the primary health care provider while stopping the infusion. The child is exhibiting a common vancomycin reaction called "red man syndrome," or "red neck syndrome." Flushing usually begins in the chest area and spreads upward to the neck and face, usually during the first 15 minutes of administration. This reaction is caused by a release of histamine, which results in vasodilation. If not treated, the syndrome can lead to circulatory collapse. The appropriate response is to stop the infusion and notify the primary health care provider. The provider will usually prescribe diphenhydramine hydrochloride (Benadryl), then resume the vancomycin infusion. Diphenhydramine will be administered before each vancomycin dose and the infusion will be set at a slower rate. Normal temperature is 98.6° F (37° C). It is not necessary to administer acetaminophen for a temperature below 100.4° F (38° C). The child's laboratory results indicate a bacterial infection. Protective (or reverse) isolation is not necessary. Increasing the vancomycin infusion rate will exacerbate the reaction and lead to circulatory collapse.
The parents of an 18-month-old toddler are anxious to know why their child has experienced several episodes of acute otitis media. What should the nurse explain to the parents about why toddlers are prone to middle ear infections? Immunological differences between adults and young children Structural differences between eustachian tubes of younger and older children Functional differences between eustachian tubes of younger and older children Circumference differences between middle ear cavity size of adults and young children
Structural differences between eustachian tubes of younger and older children The eustachian tube in young children is shorter and wider, allowing a reflux of nasopharyngeal secretions. Immunological differences are not a factor in the development of otitis media. There is no difference in the function of the eustachian tube among age groups. The size of the middle ear does not play a role in the occurrence of otitis media in young children.
