Peds final (ch 1, 3-7, 13-15, 18-21, 23): part 2 (fixed)

The nurse is examining a 3-year-old girl during a regular visit. Which finding would disclose a developmental delay in this child?
Click the card to flip 👆
1 / 546
Terms in this set (546)
A:
• Cheese
• Pieces of apples
• Orange slices
• Yogurt
R:Good choices for between-meal snacks include fruits such as pieces of apples or orange slices, and protein foods such as cheese or pieces of chicken. Cheese as well as yogurt provide calcium. Cookies and other high carbohydrate foods should be avoided because they promote dental caries
A: A tantrum preceded the event.
R: The fact that there was a precipitating event of frustration and anger points to the likelihood that this is a cyanotic breath-holding spell. Breath-holding spells never occur during sleep, nor do they feature postictal confusion. Unconsciousness is not definitive because it is common to both seizures and breath-holding spells.
While awaiting an appointment at the doctor's office for his 20-month-old daughter, a young father is astonished to see his daughter assume a proper stance and swing a toy golf club in the play area of the waiting room. A nurse also observes the behavior, and the father recalls that his daughter saw him practicing his golf swing in their back yard a few days ago. The nurse explains that this is an instance of which of the following?
A:Deferred imitation
R: Children at this stage are able to remember an action and imitate it later (deferred imitation); they can do such things as pretend to drive a car or put a baby to sleep because they have not seen this just previously but at a past time. Toddlers engage in assimilation when they learn to change a situation (or how they perceive it) because they are not able to change their thoughts to fit the situation, such as shaking a toy hammer as if it were a rattle, because they are more familiar with rattles than hammers. All during the toddler period, children play beside children next to them, not with them. This side-by-side play (called parallel play) is not unfriendly but is a normal developmental sequence that occurs during the toddler period. Autonomy, or independence, is the primary developmental task of the toddler years, according to Erikson. Although this child's act may be a sign of autonomy, it is more specifically an act of deferred imitation
The nurse is observing a play group of children of all ages. The toddlers in the group would most likely be doing which of the following activities?A:Playing with the plastic vaccum cleaner pushing it around the room R: Playtime for the toddler involves imitation of the people around them such as adults, siblings, and other children. Push-pull toys allow them to use their developing gross motor skills. Preschool children have imitative play, pretending to be the mommy, the daddy, a policeman, a cowboy, or other familiar characters. The school-age child enjoys group activities and making things, such as drawings, paintings, and craft projects. The adolescent enjoys activities they can participate in with their peersOnce temper tantrums have started, which of the following interventions are appropriate?A:Move objects out of the way or move the child to prevent injury. R:Appropriate interventions include moving objects out of the way or moving the child to prevent injury from occurring during the temper tantrum. The caregiver should not speak to the child and should avoid eye contact until the child has calmed down. The child's behavior should not be engaged. Do not talk excessively about the tantrum because this can negatively impact the child's self-esteemA toddler's mother tells you that no matter what she asks of her child, he says, "No." A suggestion you might make to help her handle this problem is for her toA:give him secondary, not primary, choices. R: Encouraging toddlers to express their opinion aids in developing a sense of autonomy; allowing secondary choices encourages this without disrupting family life.The nurse is talking to the mother of a 19-month-old girl about setting limits and supervising activities. In which of the following situations will the nurse recommend letting the child do as she pleases?A:Exploring her body R:It is normal for toddlers to explore their genitals when they are undressed. The parent should allow this and not punish the child. Choosing food and deciding bedtimes need to be done by an adult. Likewise, safety dictates that the picnic table is not a safe play areaWhat statement by the mother of a 20-month-old indicates a need for further teaching about nutrition?A:"I give my daughter juice at breakfast and when she is thirsty during the day." R:High juice intake can contribute to either obesity or appetite suppression. None is needed, but if juice is given limit the amount to 4 to 6 ounces daily. Water should be the choice for thirst. The other statements support good toddler nutrition. Whole milk is needed through age 2 years. Two cups daily is adequate. Nutritious snacks support quality intake when quantity is poor. New foods offered with old ones provide sameness along with the new.Which of the following would you include when teaching the parents of an infant about colic? a) Colic symptoms will probably fade at 3 months of age. b) Symptoms will decrease if she is laid on her back after feedings. c) Their child will need future follow-up for a "nervous" bowel. d) Formula intake should be doubled to keep her from losing weight.A) Colic symptoms will probably fade at 3 months of age.Which developmental milestone would the nurse expect an 11-month-old infant to have achieved? a) Turning a doorknob b) Building a tower of four cubes c) Sitting independently d) Walking independentlyC) Sitting independently Infants typically sit independently, without support, by age 8 months. Walking independently may be accomplished as late as age 15 months and still be within the normal range. Few infants walk independently by age 11 months. Building a tower of three or four blocks is a milestone of an 18-month-old. Turning a doorknob is a milestone of a 24-month-old. (less)What is the correct amount of urine diapers a mature infant should have each day? a) An infant should have 1 to 2 wet diapers/day. b) An infant should have 9 to 10 wet diapers/day. c) An infant should have 3 to 5 wet diapers/day. d) An infant should have 6 to 8 wet diapers/day.D) An infant should have 6 to 8 wet diapers/day. Urination occurs in the first 24 hours of life. A normal amount of urine is 200 to 300ml/day as the infant matures. This amount is equal to 6 to 8 wet diapers/day.The nurse is educating the mother of a 6-month-old boy about the symptoms for teething. Which symptom would the nurse identify? a) Choosing soft foods over hard foods b) Increased biting and sucking c) Running a mild fever or vomiting d) Frequent loose stoolsB) Increased biting and sucking The nurse would advise the mother to watch for increased biting and sucking. Mild fever, vomiting, and diarrhea are signs of infection. The child would more likely seek out hard foods or objects to bite onThe nurse goes in to check on Lilly and how breast-feeding is going with her new son. The nurse observes the infant is on her lap with the blanket unwrapped, and Lilly is washing his face, and gently stroking the baby. Lily has had trouble breast-feeding the last few times. What is the appropriate response from her nurse? a) "Lilly, you are doing a wonderful job attempting to waken the baby." b) "Lilly, you will never get him to eat all unwrapped like that." c) "Lilly, maybe you should watch the breast-feeding video again." d) "Lilly, that is not how you get him to eat."A) Lilly, you are doing a wonderful job attempting to waken the baby." The nurse should be emotionally supportive to the new mom. The mom's techniques are commonly used in breast-fed infants who are sleeping. The encouragement from the nurse will support the mom through this learning period. The other responses do not emotionally support the mom or contribute to a positive learning environmentAnticipatory guidance for an infant for the 4th month should include the fact that she probably will a) insist on things being done her way. b) be able to turn over onto the back. c) develop a fear of strangers. d) have many "blue" or moody periods.B) be able to turn over onto the back. Infants typically turn over front to back at 4 months, enlarging the area of the house that needs to be childproofed.The best way for an infant's father to help his child complete the developmental task of the first year is to a) talk to her at a special time each day. b) keep her stimulated with many toys. c) expose her to many caregivers to help her learn variability. d) respond to her consistently.D) Respond to her consistently. A sense of trust is difficult to learn if things are constantly changing. Consistently responding to an infant's needs helps to build a sense of trust.The nurse is assessing the sleeping practices of the parents of a 4-month-old girl who wakes repeatedly during the night. Which parent comment might reveal a cause for the night waking? a) They put her to bed when she falls asleep. b) The child has a regular, scheduled bedtime. c) They sing to her before she goes to sleep. d) If she is safe, they lie her down and leave.A) They put her to bed when she falls asleep. If the parents are keeping the child up until she falls asleep, they are not creating a bedtime routine for her. Infants need a transition to sleep at this age. If the parents are singing to her before she goes to bed, if she has a regular, scheduled bedtime, and if they check on her safety when she wakes at night, then lie her down and leave, they are using good sleep practicesA teen mom asks the discharge nurse if it is okay to sleep in bed with the baby. She says her mom always did it with her siblings and it seemed okay. The nurse should respond how? a) "Bed sharing has positive effects on babies, let me get you information." b) "Sure, you can, make sure you use a soft mattress for support." c) "Bed sharing is okay, just make sure the infant is between two people." d) "Sure, you can do whatever you want, it is your baby."A) Bed sharing has positive effects on babies, let me get you information." The nurse should enforce that bed sharing is sometimes a positive experience if the parents are safe and responsible. When done properly, the effect can be positive on infant nutrition and physiology. The other responses do not promote safety or educate the teenJulie is an 18-year-old new mother. When the nurse discharges the mom and infant, she notices that the car seat is in the front seat of the car. What is the appropriate response for the nurse to make regarding the car seat? a) "With the car seat in front, you can keep an eye on your baby." b) "You should never put the car seat in the front." c) "Let me go over car seat safety with you, so you can install your car seat properly." d) "I see you have a car seat, that is great."C) "Let me go over car seat safety with you, so you can install your car seat properly." The nurse should notice this is not the proper place for a car seat. The car seat should be rear facing and in the center of the back seat of the car. The nurse would review car seat safety with Julie and have Julie install the seat properly. The nurse should provide written materials if available. The other responses are not appropriate and do not ensure that proper installation will occur and that infant safety will be maintainedThe nurse is assessing the oral cavity of a 4-month-old infant. Which finding is consistent with a child of this age? a) 1 to 3 natal teeth b) 1 to 2 lower teeth c) 1 upper tooth d) No teethD) No teeth Normally infants are not born with teeth. Occasionally there are one or more teeth at birth. These are termed natal teeth and are often associated with anomalies. The first primary teeth typically erupt between the ages of 6 and 8 months.A newborn infant requires skin care that includes bathing. Besides hygiene, what are other reasons for bathing an infant? a) Bathing helps moisten the skin. b) Bathing can prevent infection. c) Bathing is a great time to apply lotion. d) Bathing is a time for bonding with the parents.D) Bathing is a time for bonding with the parents. The parents can use bath time for bonding with their infant. This can be done with talking, cooing, and singing. Bath time should be paced and non-stressful.The caregiver of an infant tells the nurse that her dentist told her not to let the child go to bed with a bottle of milk. The caregiver states she doesn't understand the reason for this since her baby seems to enjoy the bottle. The most appropriate response to this caregiver would be: a) "You could give your baby a bottle of water at bedtime occasionally." b) "Bottles given at bedtime can cause erosion of the enamel on the teeth." c) "Giving your baby a pacifier at bedtime will satisfy the need to suck." d) "Giving a bottle of milk when the infant goes to bed can lead to obesity."B) Bottles given at bedtime can cause erosion of the enamel on the teeth." The sugar from formula or sweetened juice coats the infant's teeth for long periods and causes erosion of the enamel on the deciduous teeth. While giving water in a bottle at bedtime is acceptable (D) and a pacifier will satisfy the sucking need (C), the most appropriate response is B. Giving a bottle at bedtime is not a factor that leads to obesity.In working with the infant age child, the nurse recognizes which of the following as a characteristic of the infant. a) The child has an increased attention span and can be interested in an activity for a long length of time b) The child takes in new information at a rapid rate and asks "why" and "how" c) The child grows and develops skills more rapidly than at any other time in their life d) The child insists they can "do it," the next moment they revert to being dependentC) The child grows and develops skills more rapidly than at any other time in their life The infant grows and develops skills more rapidly than he or she ever will again. The toddler insists they can do things one minute and then becomes dependent the next minute. The preschool age child soaks in information and asks "why" and "how" over and over. The school-age child has a longer attention span and can become absorbed in a craft or activity for several hours.A 5-month-old infant being assessed was born at 32 weeks. The nurse doing the well-child check-up should compare the baby to what norms? a) The growth of a 5-month-old b) The development of a 10-week-old c) The growth of a 2-month-old d) The development of a 3-month-oldD) The development of a 3-month-old The infant was born 8 weeks early. Two months are subtracted from the present age of 5 months. Both growth and development should be assessed using 3-month norms.The infant weighs 6 lbs. 8 oz. at birth. If the infant is following a normal pattern of growth, which of the following would be an expected weight for this child at the age of four months? a) 16 lbs. b) 13 lbs. c) 15 lbs. 4 oz. d) 10 lbs. 8 oz.B) 13 lbs. Most infants double their birthweight by 4 months of age and triple their birthweight by the time they are 1 year old.The infant weighs 7 lbs. 4 oz. at birth. If the infant is following a normal pattern of growth, which of the following would be an expected weight for this child at the age of 12 months? a) 25 lbs. b) 28 lbs. 4 oz. c) 14 lbs. 8 oz. d) 21 lbs. 12 oz.D) 21 lbs. 12 oz. By one year of age, the infant has tripled his or her birth weight and has grown 10 to 12 inches.Which of the following milestones would you expect an infant to accomplish by 8 months of age? a) Sitting without support b) Being able to sit from a standing position c) Creeping on all fours d) Pulling self to a standing positionA) Sitting without support Most babies sit steadily at 8 months, creep at 9 months, and pull to standing at 10 months.A new mother asks for advice from the nurse about bathing her infant. Which of the following should the nurse tell her? a) Be sure to give the baby a complete bath every day b) Be sure to oil the scalp with mineral oil and leave it on overnight before bathing the infant the next day c) Be sure to wash the infant's face, hands, and diaper area daily d) Be sure to brush the scalp with a soft toothbrush during the bath to prevent seborrheaC) Be sure to wash the infant's face, hands, and diaper area daily Except in very hot weather, an infant does not need a bath every day. If a parent is tired and would not enjoy bath time or if some days are just too rushed, a complete bath can be omitted, with only the infant's face, hands, and diaper area washed. Some infants do need their head and scalp washed frequently (every day or every other day) to prevent seborrhea, a scaly scalp condition often called cradle cap. If seborrhea lesions do develop, they adhere to the scalp in yellow, crusty patches. The skin beneath them may be slightly erythematous. The patches can be softened by oiling the scalp with mineral oil or petroleum jelly and leaving it on overnight. The crusts can then be removed by shampooing the hair the next morning. A soft toothbrush or fine-toothed comb can be used to help remove themA staff nurse is talking about Piaget's theory with a nursing student. Infants are in the sensorimotor stage of cognitive development during which object permanence is mastered. An example of an infant displaying this ability is: a) Pushing a spoon from her high chair tray to the floor b) Looking for a toy in her crib at the last place she saw it c) Shaking a rattle to enjoy the sound d) Smiling at herself in the mirrorB) Looking for a toy in her crib at the last place she saw it Looking for the toy where it was last seen indicates object permanence. The infant knows the object still exists even though she cannot see it. All the rest of the infant behaviors show use of her senses and motor activity but do not illustrate object permanence.The nurse at a family health clinic is teaching a group of parents about normal infant development. What patterns of communication should the nurse tell parents to expect from an infant at age 1? a) Uses speech-like rhythm when talking with an adult b) Uses multisyllabic babbling c) Understands "no" and other simple commands d) Squeals and makes pleasure soundUnderstands "no" and other simple commands At age 1, most babies understand the word "no" and other simple commands. Children at this age also learn one or two other words. Babies squeal, make pleasure sounds, and use multisyllabic babbling at age 6 months. Using speech-like rhythm when talking with an adult usually occurs between ages 9 to 12 monthsMartha asks the nurse if her 2-month-old could have baby bananas yet. The nurse would respond and educate Martha on the nutrition stages of infants by which of these responses? a) "In two months you can try bananas if you think she is ready." b) "When did you feed your other child bananas? c) "Sure, if you feel she is ready to have bananas." d) "In one month you can try bananas if you think she is ready."A) "In two months you can try bananas if you think she is ready." The nurse should choose this response because no solid foods are recommended for infants until 3 months of age. The age of 4 to 6 months is the age recommended to introduce solid foods. The other responses are the incorrect age or are letting the parent decide the appropriate answer.The nurse is teaching healthy eating habits to the parents of a 7-month-old girl. Which recommendation is the most valuable advice? a) Actively urge the child to eat new foods b) Let the child eat only the foods she prefers c) Serve new foods several times d) Provide small portions that must be eatenC) Serve new foods several times When introducing a new food to an infant, it may take multiple attempts before the child will accept it. Parents must demonstrate patience. Letting the child eat only the foods she prefers, forcing her to eat foods she does not want, or actively urging the child to eat new foods can negatively affect eating patternsThe nurse is examining a 6-month-old girl who was born 8 weeks early. Which finding is cause for concern? a) Head size has increased 5 in (12 cm) since birth. b) The child weighs 10 lb 2 oz (4.6 kg). c) The child measures 21 in (53 cm) in length. d) The child exhibits palmar grasp reflex.A) Head size has increased 5 in (12 cm) since birth. The child's head size is large for his adjusted age of 4 months, which would be cause for concern. Normal growth would be 3.6 in (9 cm). At 10 lb, 2 oz (12 cm), the child is the right weight for a 4-month-old adjusted age. Palmar grasp reflex disappears between 4 and 6 months adjusted age, so this would not be a concern yet. The child is of average weight for a 4-month-old adjusted age.The nurse is educating the mother of a newborn about feeding practices. The nurse correctly advises the mother: a) most newborns need to eat about 4 times per day. b) demand scheduled feeding is associated with increased difficulty getting the baby to sleep through the night. c) the newborn's stomach can hold between one-half to 1 ounce. d) the best feeding schedule offers food every 4 to 6 hours.C) the newborn's stomach can hold between one-half to 1 ounce. The capacity of the normal newborn's stomach is between one-half and one ounce. The recommended feeding plan is to use a demand schedule. Newborns may eat as often as 1½ to 3 hours. Demand scheduled feedings are not associated with problems sleeping at nightThe nurse is providing helpful feeding tips to the mother of a 2-week-old boy. Which recommendations will best help the child feed effectively? a) Maintain adequate diet and fluid intake b) Apply warm compresses to the breast c) Maintain a feed-on-demand approach d) Encourage the infant to latch on properlyA) Maintain a feed-on-demand approach The best way to ensure effective feeding is by maintaining a feed-on-demand approach rather than a set schedule. Applying warm compresses to the breast helps engorgement. Encouraging the infant to latch on properly helps prevent sore nipples. Maintaining proper diet and fluid intake for the mother helps ensure an adequate milk supply.A 12-month-old seen at a walk-in clinic weighed 8 pounds 4 ounces (3.75 kg) at birth. Weight now is 20 pounds 8 ounces (9.3 kg). The nurse determines: a) The child weighs less than expected for age. b) The weight assessment is blatantly inaccurate. c) The child weighs more than expected for age. d) The child weighs the expected amount for age.A) The child weighs less than expected for age. Birth weight should triple by 12 months. The child should weigh near 24 pounds 12 ounces (11.25 kg). The child is underweight for age.The infant in the exam room has the following signs and symptoms. Which ones will the nurse attribute to teething? (Select all that apply.) a) Drooling and biting b) Refusing to eat c) Irritability and awakening from sleep d) Increased sucking on hands e) Fever and diarrheaDrooling and biting Refusing to eat Irritability and awakening from sleep Increased sucking on handsA 15-year-old client's parent comments on the fact that the adolescent seems to always choose the opposite of what everyone else wants and that mood swings are a common occurrence. What statement shows the nurse that the client's parent understands these changes? -"I know that my adolescent is doing this because of all the hormones." -"This is common for this age group and it will get better with time." -"This is my adolescent's temperament, and we will have to learn how to deal with it." -"My adolescent will never find anyone to live with if the adolescent acts like this.""This is common for this age group and it will get better with time." During middle adolescence, the adolescent spends more time ignoring adult authority and becomes more reliant on peer relationships. Adolescents might choose a stance directly opposite that of their parents and use peer support to back their ideas. Mood swings are a common occurrence during the adolescent period. They tend to smooth out and the adolescent will become more introspective. By late adolescence emotions become more consistent. Making statements such as "my adolescent will never find anyone to live with" or "we will have to learn to live with [my adolescent's temperment]" does not demonstrtae the parent has a good idea of what is happening during the adolescent period.The mother of a 13-year-old boy confides to the pediatric nurse practitioner that her son has recently had a nocturnal seminal emission. The mother is concerned, and the nurse explains "wet dreams" and the other male traits of puberty to the mother. Which response indicates a need for further discussion? -"My son must be sexually active or having overly sexual thoughts to have a nocturnal emission." -"My son's spontaneous erections and nocturnal emissions are very normal." -"My son is not doing anything to cause the nocturnal emissions; they occur spontaneously." -"My son is developing normally and the traits of puberty vary from child to child.""My son must be sexually active or having overly sexual thoughts to have a nocturnal emission." Spontaneous erections and nocturnal seminal emissions do not mean that the child is sexually active or having overactive sexual thoughts. Parents need to be instructed that these occurrences are spontaneous and that the child is not doing anything to cause them.The nurse is admitting a 15-year-old adolescent to the hospital pediatric unit. What does the nurse recognize as a priority for this adolescent? -The adolescent's need for privacy should be respected. -The adolescent should be encouraged to call friends often. -The adolescent's need for parental support should be discussed. -The adolescent should be given freedom to participate in unit activities as desired.The adolescent's need for privacy should be respected. When an adolescent is ill or injured, it affects the body and body image. A hospitalized adolescent's primary concerns are pain and the loss of privacy. The adolescent is also anxious about being separated from friends and losing control of one's life. When an adolescent is hospitalized, it is very important the adolescent be given privacy. The adolescent needs individualized attention, confidentiality, and the right to participate in decisions about one's own health care. The adolescent should have contact with friends and be allowed in unit activities. Because the adolescent is under the age of 18, the parents should be involved and informed of the care. The nurse can talk with the adolescent and parents about care decisions and the adolescent's need for support from family.A 15-year-old adolescent is seen at a health care facility for facial acne. When counseling the teen, the nurse would teach that the basic cause of acne is: -lack of showering adequately after gym class. -activation of androgen hormones. -vitamin deficiency from an inadequate diet. -thyroid-gland secretions increasing with adolescence.activation of androgen hormones. Acne occurs in adolescence as the result of hormone influence. With increased androgen production the sebaceous glands become more active. With increased testosterone production (in both boys and girls) increased sebum is produced. These increased hormone productions leads to the development of acne. Showering will certainly lead to a cleaner skin and the removal of oils but the lack of showering does not cause acne. Diet and thyroid hormones do not play a role in the development of acne.The mother of a 15-year-old boy expresses sadness to the nurse that her son is "much more connected to his friends than his family." What understanding would benefit this parent? Select all that apply. -Peers are needed for emotional security while stepping away from family. -Peers provide opportunity to learn and practice social roles. -Peers can be positive or negative influences. -Adolescents need parental support and guidance as they move toward greater peer involvement. -Parents should wait until the adolescent introduces them to their peers.-Peers are needed for emotional security while stepping away from family. -Peers provide opportunity to learn and practice social roles. -Peers can be positive or negative influences. -Adolescents need parental support and guidance as they move toward greater peer involvement. The parent should understand that at this stage of development, it is normal for peers to have a large role in the adolescent's life. The adolescent is finding his/her place outside the home filling a need for emotional security, an opportunity to learn and practice societal roles. It is true that peers can have a positive influence or a negative influence over the adolescent. Adolescents still need their parents involvement in their life with support and guidance. The parents should take a proactive approach at getting to know their adolescent's peers.For reasons of anticipatory guidance, nurses should be aware that menarche appears earlier in some ethnic groups than others. In which ethnic group is menarche likely to appear first? -Black -White -Hispanic -South AsianBlack Black girls on average reach menarche slightly earlier than White, Hispanic, and South Asian girls.A nurse is attending to a group of boys at a school. The nurse is required to document the sexual development in boys on a regular basis. The nurse would anticipate which clients having the highest incidence of nocturnal emissions? -Clients who have reached adulthood -Clients in the age group of 18 to 20 years -Clients who are showing pubertal changes -Clients with strong, muscular appearanceClients who are showing pubertal changes The nurse should know that boys who are undergoing pubertal changes are more likely to experience nocturnal emissions. The first sign of pubertal changes and sex maturation is testosterone secretion. As this increased so does the penis and scrotum enlargement. This is a time when nocturnal emissions occur. In late adolescence, which lasts from age 18 to 20, the transition into adulthood is completed. The nurse should also know that boys in the age group of age 12 to 20 experience various chemical and physical changes taking place within their body. A strong, muscular appearance does not indicate the presence of nocturnal emissions.A client has confided in a nurse that her 13-year-old daughter has recently changed dramatically in her social interactions with others. What is a social behavior most likely to be exhibited by a girl at this age? -Banding together with other girls and dressing like them -Banding together with boys and girls but maintaining her own unique style -Hanging out primarily with boys her own age -Hanging out with girls but maintaining her own unique styleBanding together with other girls and dressing like them In early adolescence, girls tend to band together with girls. They dress identically with other members of their group: jeans and sweatshirts, special jackets, or whatever the fashion may be. On the surface, this makes adolescents appear to be losing their identities rather than finding them.The school nurse is assessing a 16-year-old girl who was removed from class because of disruptive behavior. She arrives in the nurse's office with dilated pupils and is talking rapidly. Which drug might she be using? -Opiates -Barbiturates -Amphetamines -MarijuanaAmphetamines Amphetamine use manifests as euphoria with rapid talking and dilated pupils. Signs of opiate use are drowsiness and constricted pupils. Barbiturates typically cause a sense of euphoria followed by depression. Marijuana users are typically relaxed and uninhibited.The school nurse is preparing health promotion presentations regarding unintentional injuries for a high school health fair. On which topic should the nurse place as the priority when preparing the presentation? -Poison prevention -Water sports injuries -Motor vehicle safety -Drug and alcohol use preventionMotor vehicle safety All options should be included in the presentation, but motor vehicle safety has the highest priority because motor vehicle accidents are the leading cause of injury and death followed by poisoning, which includes prescription drug overdose.A 16-year-old adolescent is talking with the nurse at a local health clinic about skin care. Which comments by the teen does the nurse determine require additional conversation? Select all that apply. -"I only tan before going on spring break to get a base tan so I won't burn." -"My mom had melanoma so she always makes me wear a sunscreen with an SPF of 30." -"My favorite time of day to be outside is the middle of the day, around noon." -"Our coach makes us wear sun-protective clothes when we practice outside on the weekends." -"The more exposure and burns I get now will toughen my skin so I won't get skin cancer when I'm older."-"I only tan before going on spring break to get a base tan so I won't burn." -"My favorite time of day to be outside is the middle of the day, around noon." -"The more exposure and burns I get now will toughen my skin so I won't get skin cancer when I'm older." The nurse should further discuss comments that demonstrate incorrect information about sun exposure. Any exposure to tanning beds should be avoided to prevent skin cancer risks. Other risks for skin cancer include being in the sun between the times of 10:00 am and 4:00 pm, and sun exposure and burns during childhood and adolescence. A minimum SPF of 15 should be used, so SPF 30 is good practice, as is wearing sun-protective clothing when outside during the day.A 16-year-old client has been hospitalized 100 miles from home for 1 week to repair a fractured patella suffered in a skateboarding accident. She was cheerful and chatty when she first arrived, but the nurse notes in recent days she has become increasingly quiet and seems lonely. Which nursing intervention should the nurse prioritize for this client? -Call the hospital's mental health unit to see if she can get some counseling. -Take her to the teen lounge so she can meet other teens, use a phone, and check her e-mail. -Suggest that she read books and magazines from the hospital bookmobile. -Ask her caregivers to bring her siblings and friends to visit.Take her to the teen lounge so she can meet other teens, use a phone, and check her e-mail. Adolescents need access to their peers so they can keep up social contacts. Access to a phone, computer, and e-mail will help the teen stay connected. Recreation areas are important. In settings specifically designed for adolescents, recreation rooms can provide an area where teens can gather to do schoolwork, play games and cards, and socialize. Because she is 100 miles from home, a visit from friends might be difficult.The nurse is preparing to participate in a community discussion on the needs of the adolescents in the local school. The nurse should point out which goal is the primary concern for these young individuals as the committee makes plans? -Teens are busy developing their own personal identity. -They want to successfully complete activities. -Each child is learning to do things on his or her own. -They understand and respond to discipline.Teens are busy developing their own personal identity. According to Erikson, the central task of adolescence is to develop unique personality and identity. The developmental task for the school-age child is to develop a sense of industry, and completing activities builds that feeling of confidence. Erikson's psychosocial developmental task for toddlers is to achieve autonomy (independence) and do things on their own. Learning to speak and to understand and respond to discipline are not developmental tasks, according to Erikson.The school nurse is meeting with a group of 11-year-old girls to discuss expected puberty changes in their bodies. When one of the girls states, "I just feel like my whole body is changing and I don't know why" what should the nurse point out to this group? -"You will feel better about yourself as you get older." -"You have lots of hormone changes going on right now." -"You may feel like you are changing, but you still look the same." -"Your other friends are feeling like this too.""You have lots of hormone changes going on right now." Preadolescents need information about their changing bodies and feelings. Sex education that includes information about the hormonal changes that are occurring or will occur is necessary to help them through this developmental stage. Although adjustments will occur as the child gets older and friends are important, these responses are not the most direct and appropriate.The nurse is meeting with a group of caregivers of adolescents and discussing sex and sexuality, including how to discuss these issues with their children. Which comment should the nurse prioritize with this group of caregivers? -Teenagers spend so much time with their peers, and that is usually how they find out about sex. -Being honest and straightforward with teenagers will encourage them to ask about subjects like sexuality. -Most schools have excellent programs to teach adolescents about sex and sexuality. -Internet resources, movies, and television have the most accurate and current information for your adolescent to learn about sexuality issues.Being honest and straightforward with teenagers will encourage them to ask about subjects like sexuality. The most important aspect of discussions about sexuality with adolescents is giving honest, straightforward answers in an atmosphere of caring concern. Children whose need for information is not met through family, school, or community programs will get the information—often inaccurately—from peers, movies, television, or other media.A 17-year-old female is meeting with the nurse for an annual well-visit and is asking the nurse questions about how to know when one is in love. The nurse should point out which factor to help decide if both individuals have reached a mutual agreement and are ready for an intimate relationship? -A sense of trust and identity -An ability to be autonomous -A willingness to take initiative -An understanding of socialization and of isolationA sense of trust and identity In order to be intimate or to share one's deepest feelings with another person, it is impossible unless both persons have established a sense of trust and a sense of identity. Being autonomous or taking initiative are not aspects that lead toward intimate relationships. Socialization and isolation are not relevant to the establishment of intimate relationships.The nurse is meeting with a group of caregivers of adolescents. Which example should the nurse point out is most effective for the caregiver to support the adolescent? -Leave pamphlets about topics such as drugs and alcohol in their room so they can read them. -Let them choose their hairstyle, even though it may not look the best for them. -Discourage spending too much time with school friends since we know they can be a negative influence. -Our house rules are stricter than their friends but everyone follows the same rules in our home.Let them choose their hairstyle, even though it may not look the best for them. The adolescent whose family caregivers make it difficult to conform are adding another stress to an already emotion-laden period. By allowing the adolescent to follow trends and fads in clothing choices, hairstyles, and music, the caregiver decreases the stress for the child. Information about drugs and alcohol is important to share, but these topics would be better discussed with the child. It is important the adolescent spend time with peers.A black adolescent male has been diagnosed with hypertension. Which statement made by the adolescent indicates to the nurse that additional teaching is needed? -"My blood pressure should remain less than 130/90 mm Hg." -"Playing baseball is good exercise for me." -"Drinking sodas is not related to my blood pressure." -"My dad has hypertension, so I have to be careful.""Drinking sodas is not related to my blood pressure." Hypertension is present if the blood pressure is above the 95th percentile, or 127/81 mm Hg for 16-year-old girls and 131/81 mm Hg for 16-year-old boys for two consecutive readings. Adolescents who are obese, who are black, who eat a diet high in salt, or who have a family history of hypertension are most susceptible to developing the condition. Drinking soda regularly increases the amount of sodium intake daily, thus having an impact on the blood pressure.The nurse is assessing an adolescent's risk for harm from guns being present in the home. What question would be best to ask during the assessment? -"Have you been taught how to use a gun?" -"Are the guns in your home locked in a safe?" -"Do you understand that it is important for you not to handle a gun?" -"Do you and your dad hunt?""Are the guns in your home locked in a safe?" Common causes of death in adolescents are homicide and self-harm. These are related to the easy accessibility of guns, especially when added to depression, binge drinking, and impulsivity. Gang violence and the desire to protect themselves are additional factors. Having the gun locked in a safe provides a way for limited access. Knowing how to use a gun and going hunting demonstrate expertise, but the safest way to prevent harm is to have the gun locked when not in use for these purposes. Telling the adolescent it is important not to use a gun provides no explanation why and comes across as a rule to be broken.A nurse is reading a journal article about adolescents and major causes of injuries in this age group. The nurse demonstrates understanding of this information by identifying which situation as the major cause of adolescent injuries? -Drowning -Motor vehicle crashes -Violence -SuicideMotor vehicle crashes Although drowning, violence, and suicide are causes of adolescent injury, the largest number of adolescent injuries are due to motor vehicle crashes.An adolescent's parent states not knowing what to do with the adolescent. The parent reports the teenager is taking two or three showers a day when not that long ago the parent could barely get the teen to take a shower at all. What should the nurse's reply be to the parent? -"Reinforce the family rules but also allow the adolescent to develop one's own routine." -"Remind the adolescent about needing to be on a schedule so as to not disrupt the family." -"Do not encourage multiple baths; it can be very drying to the skin." -"Reevaluate the adolescents's ability to perform hygiene care since showering is so frequent.""Reinforce the family rules but also allow the adolescent to develop one's own routine." Adolescents find that frequent baths and deodorants are important due to the apocrine sweat gland secretion activity. The increases in sex hormones and steroids cause the skin to be oily. This leads to more showers or baths daily. This is a time when the adolescent is defining what type of personal hygiene products are preferred. Hygiene and personal care can become a source of family arguments as the young person develops a style of personal care. Parents need to be mindful of the adolescent yet maintain family rules and boundaries regarding aspects of personal care. It is important for teenagers to feel that they have some ability to develop their own personal care standards and daily patterns.An 18-year-old adolescent reveals the presence of nipple ring and is looking to get a tattoo in the next few months. What is the most important thing that the nurse can teach the adolescent at this time? -Complications are more likely when you tattoo yourself. -Review the safety rules for those who do the tattooing. -Tattooing carries risks such as infection, disease, and nerve damage. -It is not recommended to get the tattoo from your friend in his garage.Tattooing carries risks such as infection, disease, and nerve damage. The nurse needs to emphasize that tattoos and body piercing can be painful, and carry risks of complications such as infection, blood-borne diseases, keloids and granulomas, allergic reactions, excessive bleeding, nerve damage, or damage to the piercing site. Complications are more likely if a person tattoos oneself or has the tattoo done by a friend. The nurse needs to encourage the adolescent to seek the expertise of a trained technician, doctor, or nurse to have the piercing, tattooing, or branding done. There are developed safety rules for those who do piercing and tattoos.A 15-year-old adolescent shows a pattern of gaining weight, not a large amount but a little more each visit. The adolescent is not active in any sports and eats out frequently with parents. What is the best way for the nurse to assess the adolescent's eating pattern? -Ask the adolescent to recall what was eaten in the last 3 days. -Have the adolescent guess the calorie intake in a 24-hour period. -Have the adolescent keep a food diary for 1 week. -Ask the adolescent to show the nurse what a healthy portion looks like.Have the adolescent keep a food diary for 1 week. Having the adolescent keep a food diary over 1 week allows the nurse as well as the client to examine what the client eats and when the client is eating it. Keeping a food journal allows a discussion of the choices made and the substitutes that the client could possibly make. The times that the client eats may also lead to weight gain. Asking for recall of 3 days' intake would be difficult, and most information would be inaccurate due to forgetting some item of food intake or when the food was eaten. Most people have no idea how many calories are in a food item unless they are specifically counting calories for dieting or health reasons. An adolescent would have a difficult time demonstrating a healthy portion size unless it has been demonstrated first.The school nurse is developing a school wellness program to promote healthy eating habits and regular physical activity. Each class will be engaging in lessons, contests, and goal setting to develop healthy habits. What is the most important element to emphasize to maximize compliance and long-term change? -Eliminate sweetened, carbonated beverages in the cafeteria. -Serve only low-fat, flavored milk and real fruit juices in the cafeteria. -Incorporate physical activity as part of each child's daily school schedule. -Include both parents and children in the wellness program.Include both parents and children in the wellness program. Every campaign to support good nutrition and daily physical activity must include parents and their children as active members of the learning community. Programs implemented without a family-centered approach are doomed to fail when the child's home life and school life are disconnected.The nurse is caring for a 13-year-old girl. The child has been identified as overweight with no underlying psychological or secondary causes. The nurse is reviewing the child's weight-loss progress and nutrition at a follow-up visit. What finding indicates a need for further discussion and teaching? -"My daughter is helping us plan our family's weekly menu." -"We are using family outings and activities as a reward for weight loss." -"Her goal is to be a size smaller by our vacation in two weeks." -"Our whole family has changed our eating habits.""Her goal is to be a size smaller by our vacation in two weeks." The mother must be reminded that a successful weight loss program emphasizes long-term permanent changes, not rapid weight loss or short-term diets to meet a short-term goal.According to Erikson, the adolescent develops his or her own sense of being an independent person with individual thoughts and goals. This stage is referred to as: -identity vs. role confusion. -autonomy vs. doubt and shame. -industry vs. inferiority. -intimacy vs. isolation.identity vs. role confusion. Adolescents must develop their own personal identity—a sense of being independent people with unique ideals and goals. This is the period Erickson calls identity versus role confusion. Erickson believes during this time the adolescent goes back through all previous developmental periods to achieve this identity. The stage of autonomy versus shame and doubt occurs between 18 months and 3 years. Industry versus inferiority occurs between 5 to 12 years. Intimacy versus isolation occurs in adulthood between the ages of 19 to 40 years.Nurses should provide anticipatory guidance to males to prepare them for what particular pubertal change in late adolescence? -Nocturnal emissions -Lengthening of the penis -Reddening of the scrotum -Breast enlargementNocturnal emissions This involuntary ejaculation during the night can be disturbing to the adolescent male who has little or no understanding of what is happening in his body. Lengthening of the penis begins to occur in early adolescence as does reddening of the scrotum. Breast enlargement occurs in some males in middle adolescence and resolves in late adolescence.A nurse is explaining cognitive development in children to a client, with the help of Piaget's theory of cognitive development. What would be the best explanation by the nurse about the formal operations level of cognitive development? -Up to age 2, children learn by touching, tasting, and feeling. They learn to control body movement. -Children from ages 2 to 7 years investigate and explore the environment and look at things from their own point of view. -From ages 7 to 11 years, children internalize actions and can perform them in the mind. -After age 12 children can think in the abstract, including complex problem solving.After age 12 children can think in the abstract, including complex problem solving. The nurse should explain that there are four levels of cognitive development in Piaget's theory. The sensorimotor level is up to age 2 where children learn by touching, tasting, and feeling. They learn to control body movement. Preoperational level is children from ages 2 to 7 years who investigate and explore the environment and look at things from their own point of view. At the concrete operations level from ages 7 to 11 years, children internalize actions and can perform them in the mind. At the formal operations after the age 12 children can think in the abstract. Complex problem solving is included in this category.A female client tells the nurse about noticing an increase in weight and fat deposits during the past year. The nurse reviews the client's chart and recognizes that the client is most likely going through puberty. Which nursing action is most appropriate at this time? -Provide reassurance that these are normal changes. -Review dietary measures to assist in controlling weight gain. -Encourage increased exercise to control weight gain. -Share what foods can be eaten on a low-fat diet to prevent fat deposits.Provide reassurance that these are normal changes. Increased fat deposits and weight and height changes are normal as girls begin hormonal changes of puberty. During adolescence, girls are very sensitive about their appearance and experience a constant need for reassurance. Puberty is a period when children are very self-conscious about their overall appearance. Reassurance needs to be provided that increased fat deposits and weight and height changes are normal. Dietary management is indicated if a true weight problem is present, but healthy eating should be encouraged rather than dieting. Adolescents should be encouraged to participate in appropriate exercise programs. Dieting issues such as anorexia and bulimia can threaten the health of adolescents.True adolescence is said to begin when what occurs? -Sperm is produced in the male. -The areola separate from the contour of the breasts in the female. -The voice deepens in the male. -The growth spurt in the female ends.Sperm is produced in the male. True adolescence begins with the onset of menstruation in the female and the production of sperm in the male. In early adolescence (10 to 13 years) the female experiences the first menstrual cycle and the male experiences growth of the testes. In middle adolescence (14 to 16 years) the female aerola and papilla separate from the contour of the breast to form a mound and the male testes and scrotum grow and the voice changes. In late adolescence (17 to 20 years) breast enlargement stops in the female and the male achieves adult size penis and scrotum. The growth spurt in the female adolescent ends about 2 to 2.5 years after menarche. For boys it occurs around age 14 years.A 17-year-old adolescent chats excitedly with the nurse about plans for college and a career. The adolescent states having checked out every college in the region and determined which one is the best fit and would give the adolescent the best career options. The nurse recognizes which developmental aspect in this client? -Formal operational thought -Socialization -Identification of identity -SensorimotorFormal operational thought The final stage of cognitive development, the stage of formal operational thought, begins at age 12 or 13 years and grows in depth over the adolescent years, though it may not be complete until about 25. This step involves the ability to think in abstract terms and use the scientific method (deductive reasoning) to arrive at conclusions. With the ability to use scientific reasoning, adolescents can plan their future. They can create a hypothesis (What if I go to college? What if I do not?) and think through the probable consequences (In the long run, I will earn more money; I could begin earning money immediately). This scenario does not pertain to socialization, role identification, or sensorimotor development.A 15-year-old girl is in the hospital for surgery and is confined to bed. The nurse can tell that the client is nervous about being in the hospital. She tells the nurse that she feels "gross" and "on display" in her hospital gown. What should the nurse do to encourage a sense of autonomy and dignity related to the girl's body image? -Offer to assist the girl in washing her hair and let her pick the shampoo. -Allow the girl to wear her own clothes, despite hospital policy. -Brush the girl's hair for her. -Assist the girl with using the bedpan to urinate.Offer to assist the girl in washing her hair and let her pick the shampoo. Remember when caring for hospitalized adolescents, providing time for self-care, such as shampooing hair, is important to include in an adolescent's nursing care plan. Offering to assist the client in washing her hair and letting her pick the shampoo both encourages a sense of autonomy to the client and offers her dignity related to her body image. Brushing the girl's hair for her and assisting her with using the bed pan for urination do not encourage a sense of autonomy. If it is the hospital's policy to require clients to be dressed in a hospital gown while admitted, the nurse should not allow the girl to wear her own clothes.The school nurse is providing nutritional guidance to a 9th-grade health class. Which foods should the nurse recommend as good sources for calcium? -Strawberries, watermelon, and raisins -Beans, poultry, and fish -Peanut butter, tomato juice, and whole grain bread -Cheese, yogurt, and white beansCheese, yogurt, and white beans Cheese, yogurt, white beans, milk, and broccoli are good sources of calcium. Strawberries, watermelon, raisins, peanut butter, tomato juice, and whole grain bread are all foods high in iron.The nurse is counseling an overweight, sedentary 15-year-old girl. The nurse is assisting her to make appropriate menu choices. Which statement indicates the adolescent understands how to make appropriate dietary selections? -"I avoid all fat intake." -"Because of my age, my dairy intake is unlimited." -"I need to have 4 servings of fruit each day." -"To lose weight my protein intake should be limited to 2 to 4 servings per day.""I need to have 4 servings of fruit each day." The sedentary teen needs to consume approximately 1,600 calories each day. The recommended number of daily servings of fruit is four. A balanced diet includes a small amount of fat. To avoid all fat could place the child's health at risk. Protein intake is important for the development of tissue. The teen will need about 5 ounces of protein daily.The nurse is providing anticipatory guidance to the parents of a 15-year-old who voice concerns with their teenager's sleep habits. They state, "Left to her own devices, I'm sure she'd stay up until 3:00 in the morning on the weekends and sleep until after lunchtime." Which should the nurse explain to the parents? -"I can hear that this is exasperating for you, but know that children do grow out of this in time, with no ill effects." -"That must be hard for you to manage. Perhaps we can explore some strategies with her to establish more predictable sleep patterns." -"This is expected at this stage of development. Are there any ways that you could adjust your family routines to accommodate this?" -"It's very important that you communicate to your daughter that this is unacceptable because it can have a negative effect on her health.""That must be hard for you to manage. Perhaps we can explore some strategies with her to establish more predictable sleep patterns." It is common for adolescents to adopt habits of going to bed late and awakening late, especially on weekends. Despite the fact that this is common, it is not ideal; the nurse should explore strategies for changing the adolescent's behavior in a collaborative and inclusive manner. Simply communicating that it is unacceptable is unlikely to bring about change.The physician has made a notation in the medical record of a 17-year-old that the teen is not demonstrating successful completion of Erikson's stages of development. What behavior would be consistent with this assessment? -The teen is distrustful of others. -The teen is anxious to move away from his parent's home. -The teen is sexually promiscuous. -The teen is uncertain and frequently unable to make decisions.The teen is uncertain and frequently unable to make decisions. According to Erikson's stages of development, the teen develops a sense of identity. Failure to successfully complete this stage will result in a lack of self confidence and an inability to see one's self as in independent being. The establishment of the ability to trust is completed in an earlier stage of psychosocial development. A desire to move away from the parental home is not uncommon and is not a sign of impaired navigation of this level of psychosocial development.During the assessment of a 15-year-old female the nurse notes a new body piercing in the navel. Which statements by the nurse would be appropriate in regard to this new piercing? -"You are very young to have a navel piercing. Do your parents know you have this?" -"I really like your belly ring. Where did you get it?" -"I notice you have a new piercing. Be sure to clean it twice a day so you don't get an infection." -"Did they tell you when you got your piercing how important cleaning it is? Infections can take up to a year to heal in a naval piercing." -"A navel piercing is a lot better than a tattoo. At least the piercing doesn't have to be permanent if you don't want it to be."-"I notice you have a new piercing. Be sure to clean it twice a day so you don't get an infection." -"Did they tell you when you got your piercing how important cleaning it is? Infections can take up to a year to heal in a naval piercing." Informing the client about infection risks and prevention are appropriate responses by the nurse when noticing a new body piercing. Judgmental responses and personal responses are not appropriate from the nurse.The parents of a 16-year-old male are worried about recent changes in his behavior, ignoring his schoolwork and sports, and spending almost all of his free time interacting with his girlfriend. Which suggestion should the nurse point out would best address this situation? -He is not developmentally mature enough to make healthy choices about the ways in which he spends his time, so it would be helpful if they would make a schedule for him that includes about a half-hour per day to talk with his girlfriend. -He has developed his own identity by now; being able to establish close relationships with girls is important preparation for all of his adult relationships. They should honor his need to be with, or talk to, his girlfriend as long as he has completed his schoolwork for the day. -He is not developmentally mature enough to have an intimate relationship with one girl; they should encourage him to spend time with groups of friends rather than time alone with his girlfriend. -He has chosen a girl who is overly dependent on him. They should talk to him about making sure he meets his own needs, including doing the schoolwork he enjoys, in any relationship.He has developed his own identity by now; being able to establish close relationships with girls is important preparation for all of his adult relationships. They should honor his need to be with, or talk to, his girlfriend as long as he has completed his schoolwork for the day. When identity has been established, generally between the ages of 16 and 18 years, adolescents seek intimate relationships, usually with members of the opposite sex. Intimacy, which is mutual sharing of one's deepest feelings with another person, is impossible unless both persons have established a sense of trust and a sense of identity. Intimate relationships are a preparation for long-term relationships, and people who fail to achieve intimacy may develop feelings of isolation and experience chronic difficulty in communicating with others.An adolescent who is depressed states, "Nothing ever seems to be right in my life." Which would be the most appropriate response by the nurse? -"Things will be better when you go off to college." -"You are feeling sad right now. It's a hard time." -"Try to look at the bright side of things." -"Being a teenager is hard work.""You are feeling sad right now. It's a hard time." Some degree of depression is present in most adolescents because they are not only losing their parents while they grow apart from them but also their carefree childhood. When using therapeutic communication, it is important for the nurse to accept the client's verbalization as real. Support should be real. Telling the adolescent that things will be better in college provides false reassurance. Telling the adolescent to "look on the bright side of things" or that "being a teen is hard work" offer platitudes and interrupt the client's interactions.The nurse is caring for adolescent athlete who is being seen for a fractured arm. The parent reports that this is the third sports injury in the past 2 years. The parent asks the nurse why the adolescent who is healthy overall continues to have injuries. How should the nurse respond? -Some adolescents are accident prone. -There may be some underlying problems that your adolescent should be evaluated for. -The bones, joints and tendons of adolescents are vulnerable to injury due to their rapid state of growth. -These are accidents and random in occurrence.The bones, joints and tendons of adolescents are vulnerable to injury due to their rapid state of growth. Rapidly growing bones, muscles, joints, and tendons are more vulnerable to unusual strains and fractures. While some people may seem to be accident prone, this adolescent's injuries are most likely the result of the stage of physical growth. There is no evidence the adolescent has any underlying medical conditions.The parents of an 8-year-old girl with a slow-to-warm temperament are concerned about their daughter's reaction when she visits the dentist for the first time after having a cavity filled at the last visit. How should the nurse respond? -"Remind your daughter of the importance of proper oral hygiene." -"Tell your daughter that it is just like going to see the pediatrician." -"Remind her in simple terms what will happen in the dentist's office." -"Wait to tell her about the visit until just before the appointment.""Remind her in simple terms what will happen in the dentist's office." Due to the girl's temperament, it is best if the parent's talk to the dentist before the first visit to find out exactly what the dentist will be doing and then describe to the child in simple terms what will occur. Reminding the child about the importance of proper oral hygiene is unhelpful. Telling the child that the dental checkup is just like going to see the pediatrician is untrue. It is inappropriate to advise the parents to not prepare the girl in advance.The nurse is teaching a group of caregivers of school-age children about the importance of setting a consistent bedtime for the school-age child. Which statement made by a caregiver indicates an understanding of the sleep patterns and needs of the school-age child? -"My child sleeps between 11 and 12 hours a night." -"My child stays up late when the child takes a nap after school." -"My child does not even know when he or she is tired." -"My teenage child does not sleep as much as my 9-year-old child does.""My child sleeps between 11 and 12 hours a night." Sleep for the school-age child varies with the age of the child. A child between the ages 6 to 8 years needs 12 hours of sleep each night. The child between the ages of 8 to 10 years needs 10 to 12 hours of sleep each night. The 10 to 12 year old needs 9 to 10 hours of sleep each night. Staying up late after taking an after-school nap, not knowing when the child is tired, and sleeping more than a teenager when compared with a school-age child refer to sleep behaviors and needs of children of younger and older ages.The developmental task of the school-aged period, according to Erikson, is gaining a sense of: -autonomy versus shame. -independence versus dependence. -industry versus inferiority. -identity versus failure.industry versus inferiority. The school-age years, according to Erickson, are the stage of industry versus inferiority. The developmental stage helps increase the child's sense of self worth. Industry is associated with the child's increased interest in knowledge and the development of social skills. Autonomy versus shame is the developmental tasks of 1 to 3 year old children. Erickson's stages do not include the developmental tasks of independence versus dependence nor identity versus failure.A parent tells the nurse that the 6-year-old child has been biting the fingernails since beginning first grade. After analysis, the cause is determined to be increased stress. What advice would the nurse give the parent regarding this behavior? -encourage the child to drink more milk for stronger nails -distract the child by teaching a new skill, such as whistling -allow some time every day for the child to talk about new experiences -allow the child to choose a reward for not biting the nailsallow some time every day for the child to talk about new experiences The developmental task of the school-age child is industry. They are busy learning, achieving and exploring. With school comes separation from the parents, new people, new activities. Beginning school can be a time of extreme stress for children. Biting the nails can be a symptom that something is concerning the child. Spending time with the child and allowing the child time to discuss these new experiences of school helps the child to put experiences in perspective and begin to deal with them. Allowing the child a reward for not biting the nails does not address the underlying issue of why the child is biting the nails in the first place. The underlying issue is emotionally based, so adding milk or providing a distraction will not correct the problem.A 7-year-old child has taken money from the sibling's dresser on two occasions. When counseling the parent mother about this behavior, what would the nurse advise? -"You may need to remind your child about property rights." -"You should buy your other child a bank that cannot be opened." -"Stealing is unusual for a 7-year-old child." -You should talk to the child's teacher about putting less pressure on your child.""You may need to remind your child about property rights." Antisocial behaviors develop during the school-age years. Between the ages of 6 and 8 years, the child has difficulty understanding the concept of ownership and property rights. At this age, children often take things because they like the look of an item. By age 9, children learn to respect other's possessions and property. Buying a more secure bank may keep the child from taking the money, but it does not take into consideration the child's developmental level. The behavior is a developmental issue not an emotional issue of having too much pressure.The nurse is taking a health history for a 12-year-old boy who is seriously overweight. Which general question would the nurse direct to the child's parents? -"Is there a family history of hypertension, heart disease, or diabetes?" -"Is breakfast eaten regularly?" -"What beverages are preferred?" -"How important is exercise?""Is there a family history of hypertension, heart disease, or diabetes?" Parents would be more knowledgeable than the child regarding health problems within the family. The other questions are appropriate for the child to answer and may motivate him to think about meal patterns, diet, and exercise habits. The parents will benefit from listening to these questions also since their habits influence the child.A nurse is caring for a hospitalized 10-year-old child. What would be an appropriate activity for this child to meet the developmental tasks of this age group? -Participating in a craft project -Playing with a jack-in-the-box -Playing with blocks -Writing letters to friendsParticipating in a craft project During this stage, the child is interested in how things are made and run. The child learns to manipulate concrete objects. The child likes engaging in meaningful projects and seeing them through to completion. Playing jack-in-the-box and blocks are for much younger children. If anything, the child would be texting back and forth with friends, not writing a letter.The mother of a 7-year-old girl is asking the nurse's advice about getting her daughter a 2-wheel bike. Which response by the nurse is most important? -"Teach her where she'll land on the grass if she falls." -"Be sure to get the proper size bike." -"She won't need a helmet if she has training wheels." -"Learning to ride the bike will improve her coordination.""Be sure to get the proper size bike." It is very important to get a bike of the proper size for the child. Getting a bike that the child can "grow into" is dangerous. Training wheels and grass to fall on are not acceptable substitutes for the proper protective gear. The child should already demonstrate good coordination in other playing skills before attempting to ride a bike.The nurse is educating the parents of a 10-year-old girl in ways to help their child avoid tobacco. Which suggestion should be part of the nurse's advice? -"Keep your cigarettes where she can't get to them." -"Always go outside when you have a cigarette." -"Tell her only losers smoke and chew tobacco." -"As parents, you need to be good role models.""As parents, you need to be good role models." The nurse would recommend that the parents be good role models and quit smoking. Locking up or hiding your cigarettes and going outside to smoke is not as effective as having a tobacco-free environment in the home.The parents of an 8-year-old boy report their son is being bullied and teased by a group of boys in the neighborhood. Which response by the nurse is best? -"Perhaps teaching your son self-defense courses will help him to have a greater sense of control and safety." -"Bullying can have lifelong effects on the self-esteem of a child." -"Fortunately the scars of being picked on will fade as your son grows up." -"Your son is at high risk for bullying other children as a result of this situation.""Bullying can have lifelong effects on the self-esteem of a child." The child can be permanently scarred by negative experiences such a bullying. Activities such as self-defense and sports can promote a sense of accomplishment but don't relate directly to the problem of bullying. There is no indication the child in the scenario will become a bully.The parents of a 10-year-old tell the clinic nurse that they are concerned because they noticed that their child has gained about 10 pounds over the past 2 years. What is the best response by the nurse? -"Your child doesn't seem to be overweight, so it isn't a concern." -"We see most children of this age in our clinic gaining similar amounts." -"Normal growth and development for this age results in an average weight gain of 7 pounds per year." -"I understand why you are concerned. Is your child sedentary quite a bit? Encouraging activity may limit weight gain.""Normal growth and development for this age results in an average weight gain of 7 pounds per year." Children of school-age grow an average of 2.5 inches (6 to 7 centimeters) per year and gain an average of 7 pounds per year; therefore, the 10 pounds over 2 years is normal and it is important for the parents to know this, regardless if they are not overweight. Simply comparing them to other children seen in the clinic doesn't mean it is a normal expectation. While activity is important, the nurse must first address the parent's concern.An 11-year-old boy is significantly above the 100% percentile for height. The boy tells the school nurse that his parents expect so much out of him when he is playing basketball for the school team that he is thinking of quitting. What action should the nurse take? -Tell the parents that they should stop putting so much pressure on their son just because he is tall. -Remind the boy that being so much taller than the other boys is why others have higher expectations for him. -Arrange a conference with the parents, son, and nurse to discuss the child's concerns. -Encourage the boy to talk to his coach to determine if his parents expectations are realistic.Arrange a conference with the parents, son, and nurse to discuss the child's concerns. The best action is for the nurse to speak with the parents and the child together to discuss concerns in order to establish open dialogue and possible resolution. During the conference the nurse can point out that physical maturity is not necessarily associated with emotional and social maturity and that the expectations placed on these children are unrealistic and can impact the self-esteem and competence of the child.The school nurse asks a group of school-age children about pedestrian safety. Which comments by the children should the nurse address with either the child or parents of the child? Select all that apply. -"I am 6 years old and I walk my younger brother to the park that is 5 blocks from our house." -"I always remind my sister to look right, then left, then right again before we cross the street." -My friends and I like to walk on the side of the road because our sidewalk is very uneven." -"My mom always says she looks around really well to be sure I'm not playing behind our car before she leaves." -"I think it is funny to hide behind my dad's car before he leaves for work and scare him."-"I am 6 years old and I walk my younger brother to the park that is 5 blocks from our house." -My friends and I like to walk on the side of the road because our sidewalk is very uneven." -"I think it is funny to hide behind my dad's car before he leaves for work and scare him." Older children and adults should provide supervision of younger children, but 6 years old is not considered an older child, especially for 5 blocks of supervision of a younger sibling. Children should always walk on sidewalks because cars may not see children walking in the streets or be distracted while driving. Children should stay away from vehicles when a vehicle is about to be driven and definitely not behind a vehicle.The father of a 12-year-old girl reports his daughter does not have high self-esteem. He asks for suggestions to increase her feels of self-worth. What activities would be appropriate for the nurse to suggest? Select all that apply. -Encourage the child to join a club at school. -Recommend she begin to participate in after-school activities. -Provide her with a weekly allowance. -Allow the child to begin staying home alone after school when possible. -Recommend the child investigate opportunities for volunteering at local charities.-Encourage the child to join a club at school. -Recommend she begin to participate in after-school activities. -Recommend the child investigate opportunities for volunteering at local charities. The child is developing his or her sense of self-worth by becoming involved in multiple activities at home, at school, and in the community, which develops his or her cognitive and social skills. The child is very interested in learning how things are made and work. The school-age child's satisfaction from achieving success in developing new skills leads him to an increased sense of self-worth and level of competence.The parents of a 10-year-old are experiencing problems with their son having fears when faced with new experiences. Which actions by the parents will be beneficial in helping the child effectively manage new experiences? Select all that apply. -The parents should show support to the child by agreeing that these new experiences are indeed scary. -The parents should limit exposing the child to new experiences. -Teach the child relaxation techniques to use when feeling anxious. -Encourage the child to use positive self-talk, such as saying, "I can do this" when faced with new experiences. -The parents should allow the child to avoid situations when they feel anxious.-Teach the child relaxation techniques to use when feeling anxious. -Encourage the child to use positive self-talk, such as saying, "I can do this" when faced with new experiences. Fears and anxiety to a degree are normal in children. The child should be encouraged to work through his fears. The child would benefit from positive self-talk and utilizing relaxation techniques. The parents should acknowledge fears and anxiety but should avoid catering to them.The school nurse has completed an educational program for parents at a local elementary school. Which statement by a parent would indicate the need for further education? -"It's okay for my 10-year-old to sit in the front seat of the car since he doesn't need a booster seat anymore." -"My son should wear his helmet whenever he rides his bicycle. " -"I will teach my 8-year-old to watch for cars backing up in parking lots." -"I need to get childproof locks fixed on the back doors of my car.""It's okay for my 10-year-old to sit in the front seat of the car since he doesn't need a booster seat anymore." Children under 12 should ride in the back seat of the car, even if they do not need a booster seat. Wearing helmets when riding, watching for cars backing up in parking lots, and using childproof locks on back doors in cars are all correct statements.An 8-year-old boy's foster mother is concerned about three recent cavities found in his permanent teeth and reports the child eats a nutritional diet, doesn't eat junk food, and the town water supply is fluoridated. Which suggestion should the nurse prioritize to this mother in regard to the child's dental health? -Encourage the child to abstain from eating sugary snacks at school. -Accept that the child is genetically predisposed to having more cavities than most children. -Ensure that the child brushes his teeth after each meal and snacks. -Have the child's teeth professionally cleaned every 3 months.Ensure that the child brushes his teeth after each meal and snacks. Proper dental hygiene includes a routine inspection and conscientious brushing after meals. A well-balanced diet with plenty of calcium and phosphorus and minimal sugar is important to healthy teeth. Foods containing sugar should be eaten only at mealtimes and should be followed immediately by proper brushing. The school-aged child should visit the dentist at least twice a year for a cleaning and application of fluoride.The mother of a 6-year-old is asking the nurse how to handle the child's lying and fabricated stories when confronted with questionable actions. Which response would be most appropriate by the nurse? -"Your child could be in serious trouble in school if he continues to tell lies." -"The child should have privileges taken away for several days each time he tells a lie." -"Is there any possibility he is telling the truth and you just don't know it is the truth?" -"Children this age sometimes can't distinguish between fantasy and reality.""Children this age sometimes can't distinguish between fantasy and reality." Children in the age group 6 to 7 years often engage in magical thinking. They may still believe in the tooth fairy, Santa Claus, monsters under the bed, and other imaginary characters. These keen imaginations may also conjure up fears—especially at night—about remote, fanciful, or imaginary events. If a child of this age has trouble distinguishing fantasy from reality, it may incline them to lie to escape punishment or to boost self-confidence. The other choices do not consider this child's stage of development or give the mother the most appropriate information for the situation.A mother tells the nurse she is very concerned because her 7-year-old tattles on the other siblings and it causes much friction among them. How can the nurse best help the mother to understand the underlying problem with tattling? -Children this age have a need to be important. -Children this age have a strong sense of justice. -The child is angry because the siblings will not play. -The child is asking for attention.Children this age have a strong sense of justice. Seven-year-olds are increasingly aware of family roles and responsibilities. Promises must be kept because 7-year-olds view them as definite, firm commitments. Children this age tattle because they have a strong sense of justice. Depending on the age of the other siblings, this can cause much friction among the children. Tattling does not occur because children are angry or seeking attention. It occurs so that an injustice may be made right.A mother states that her 6-year-old has starting biting nails and regressing to baby talk since beginning school. What instructions are best for the nurse to give the mother regarding this behavior? -Make time each day to spend with the child individually. -Apply a nail biting product to the nails to deter biting. -Get a description of the classroom behavior from the teacher. -Remind the child to stop each time the behavior is witnessed.Make time each day to spend with the child individually. Many first graders are capable of mature action at school but appear less mature when they return home. They may bite their fingernails, suck their thumb, or talk baby talk. Scolding, nagging, threatening, or punishing does not stop the problem and can actually make them worse. Methods such as bad-flavored nail polish or restraining the child's hands make the problems worse. These behaviors stop when the underlying stress is discovered and alleviated. Parents should be urged to spend time with the child after school or in the evening so the child continues to feel secure in the family and does not feel pushed out by being sent to school.The nurse is caring for a 6-year-old child. During the course of a routine wellness examination, the parent proudly reports that the child eats whatever the parent puts on the plate. The nurse wants to emphasize the importance of allowing the child to make some choices regarding the types of foods eaten. How should the nurse communicate this to the parent? -"Now is the time to let your child choose some of the meals." -"You must let your child make some choices for oneself." -"You need to make sure your child has input regarding the food eaten." -"I want you to give your child choices about the food eaten.""Now is the time to let your child choose some of the meals." Diet preferences are established in the preschool years and continue to develop as the child ages. The diet is influenced by family, peers, and media. Because of these influences and the child striving for independence, it is important to involve the child in helping select the food choices and guiding the child to healthy food choices. With parents, as well as children, it is more effective and less a matter of personal opinion to say "now is the time" rather than "you need," "I want you to," or "you must" do something. The nurse can emphasize the importance of the child participating in meal selection while encouraging the child's independence in a gentle manner.During a routine wellness examination, the nurse is trying to determine how well a 5-year-old boy communicates and comprehends instructions. What is the best specific trigger question to determine the preschooler's linguistic and cognitive progress? -"Does your son speak in complete sentences all the time?" -"How well does your son communicate or follow instructions?" -"Is your son's speech clear enough that anyone can understand it?" -"Would you say your son has a vocabulary of about 900 words?""How well does your son communicate or follow instructions?" Asking how well the boy communicates and follows instructions is the best trigger question because it is open-ended. Asking if the child uses complete sentences or speaks clearly will elicit a yes or no answer about only those specific areas of development. The parents would have no way of judging the size of their child's vocabulary.During an annual visit of a 6-year-old boy, the nurse observes dental caries on two of the child's primary teeth. Which response by the parents suggests more education is needed regarding the importance of primary teeth? -"These are only his baby teeth so we are not worried." -"I guess we better look for a pediatric dentist for our son." -"I guess we will need to supervise our son while he brushes." -"I see now we need to use a fluoride toothpaste for our child.""These are only his baby teeth so we are not worried." Parents need to understand the value of the primary teeth and not see them only as temporary and soon-to-be replaced. Referral to a pediatric dentist and parental supervision of tooth brushing both lead to dental health and may be better appreciated once parents understand the importance of the primary teeth. Fluoride supplementation is not necessary if fluoride is part of the local water supply.A nurse is caring for a hospitalized 7-year-old child whose family members have been unable to visit for 2 days. The nurse is preparing a diversional activity for the child. Which activity would best be suited for a child in this age group? -A paint-by-numbers activity creating a picture -An activity focusing on learning fractions -A card game such as solitaire -A board game such as monopolyA paint-by-numbers activity creating a picture Between the ages of 6 and 8 years, children begin to enjoy participating in real-life activities, such as helping with gardening, housework, and other chores. They love making things, such as drawings, paintings, and craft projects. The child would need additional instruction to learn fractions, which may not be considered fun. A card game such as solitaire and a board game of monopoly, may be too hard for the 7 year old. In addition, the game of monopoly would require additional players.A mother brings her 8-year-old daughter into the doctor's office because over the past year her tonsils have increased in size to the point that the mother is concerned that her breathing will be obstructed. The girl has no pain, fever or other symptoms. Following this data collection, which instruction is best? -"This may be normal growth of lymphatic tissue for this age." -"With the increase in tissue size, tonsillitis is suspected." -"A pituitary disorder may be the cause. Blood work may be indicated." -"An allergic reaction is often the cause. What type of allergies does she have?""This may be normal growth of lymphatic tissue for this age." The immunoglobulins IgG and IgA each reach adult levels during the school-age period; lymphatic tissue continues to grow in size until about age 9. The resulting abundance of tonsillar and adenoid tissue in schoolchildren is often mistaken for disease as the tonsils seem to fill the entire back of the throat. The fact that there are no other symptoms indicates that this child's enlarged tonsils are simply a result of the normal growth of lymphatic tissue for this age.An 8-year-old boy who says he wants to be a doctor when he grows up pleads with the nurse to let him put on his own band-aid after receiving an injection. The nurse agrees and watches as the boy very carefully lines the band-aid up with the mark left by the injection and applies it to his skin. Then he asks, "Did I do it right?" and waits eagerly for the nurse's feedback. The nurse recognizes in this situation the boy's attempt to master the primary developmental step of school age. What is that step? -Industry -Perfectionism -Accommodation -ConservationIndustry During the early school years, children attempt to master their new developmental step: learning a sense of industry or accomplishment. Accommodation is the ability to adapt thought processes to fit what is perceived, such as understanding there can be more than one reason for other people's actions. Conservation is the ability to appreciate that a change in shape does not necessarily mean a change in size. Perfectionism is the desire to do something perfectly. The boy's desire to apply the band-aid "the right way" is a hallmark of the development of industry. The other answers are not as pertinent.The nurse has taken a health history and performed a physical exam for a 12-year-old boy. Which finding is the most likely? -The child's body fat has decreased since last year. -The child has different diet preferences than his parents. -The child has a leaner body mass than a girl at this age. -The child described a somewhat reduced appetite.The child has a leaner body mass than a girl at this age. The nurse would have found that the child still has a leaner body mass than girls at this age. Both boys and girls increase body fat at this age. Food preferences will be highly influenced by those of her parents. Although caloric intake may diminish; appetite will increase.The school nurse is reviewing the chart of a 12-year-old student who has had excessive absences due respiratory infections. What is the best action by the nurse? -Ask the child if he really has had respiratory infections during these absences -Speak with the parents about the unusual increased number of respiratory infections -Continue to monitor the child's absences -Discuss with the child's teacher to determine if the number of absences has effected academic performanceSpeak with the parents about the unusual increased number of respiratory infections In the school-age child the respiratory system continues to mature with the development of the lungs and alveoli, resulting in fewer respiratory infections. Because the child is absent excessively for respiratory infections the nurse should speak with the parents to aid in determining if there is an underlying cause, or suggest the child visits the pediatrician to discuss the issue.While observing a group of 9-year-old children at school, the nurse is concerned that one of the children is not cognitively developing according the Piaget's stage of concrete-operational thought processes. With which activity is the nurse concerned? -Does not understand the phrase "slow as molasses" when used by the teacher -Arrives to class late from recess and apologizes to the teacher -Believed that not turning in homework on time was acceptable, but has since decided it is not acceptable -Enjoys math instruction and decides to join the math clubDoes not understand the phrase "slow as molasses" when used by the teacher Piaget's stage of cognitive development for the 7- to 11-year-old is the period of concrete-operational thoughts. In developing concrete operations, the child is able to assimilate and coordinate information about his or her world from different dimensions. Abstract thinking, such as understanding the meaning of the phrase "slow as molasses" is expected at this stage of cognitive development.The nurse is talking with a school-aged child about her interests. In which interest do most school-aged children place the most focus? -School -Family -Church -PetsSchool The school-age child typically values school attendance and school activities. During school-age, the focus expands from family to teachers, peers, and other outside influences.The parents of a 9-year-old child voice concern that their daughter seems to be gaining weight rapidly. The nurse reviews the medical record and notes the child has increased his weight by 6 or 7 pounds (2.7 to 3.2 kg) per year for the past 2 years. What response by the nurse is indicated? -"Your child does seem to be rapidly gaining weight." -"Children in this age range on average gain about 5 pounds per year." -"Weight gains of about 7 pounds per year are normal for children in this age range." -"On the contrary, your child's annual weight gain is somewhat low for this age.""Weight gains of about 7 pounds per year are normal for children in this age range." Children who are between the ages of 6 to 12 years usually gain about 7 pounds per year. The child in the scenario is gaining weight an the normal rate.The parents of a 10-year-old boy report they are having problems with their son. The child's mother reports her son is not a talented athlete but her husband continues to encourage him to play and try to excel. The child's father reports sports will help his son build character. What response by the nurse is most appropriate? -"Encouraging involvement in sports can build valuable skills for a child." -"Although your son is not a talented athlete, continue to encourage him to try." -"Perhaps another pursuit would be better suited for your son." -"It is important not to let him quit without trying.""Perhaps another pursuit would be better suited for your son." Children should be encouraged to try new things but, when they are faced with things they are not good at, the pressures can ultimately be counterproductive if they feel they are disappointing their parents or others of importance to them.The nurse is preparing to catheterize an 11-year-old child. The nurse correctly recognizes the child's approximate bladder capacity is what amount? -12 ounces -13 ounces -15 ounces -20 ounces13 ounces The formula for bladder capacity is age in years plus 2 ounces. If a child is 11 years of age, this would be approximately 13 ounces.The student nurse is preparing a presentation on obesity in children. What information should the student nurse include regarding factors linked to causing obesity? Select all that apply. -Family role modeling -Structured meals -Reduced physical education programs -Unsafe neighborhoods -Lack or reduced amount of recess periods during the school day-Family role modeling -Reduced physical education programs -Unsafe neighborhoods -Lack or reduced amount of recess periods during the school day Family role modeling, decreased days that school systems offer physical education programs, unsafe neighborhoods, and lack of recess time in school are all factors associated with obesity. Unstructured meals, not structured meals, are another factor associated with obesity.The school nurse is meeting with a 10-year-boy who is concerned about his weight. He reports he doesn't eat much candy but loves fruit, pasta, potatoes, and bread. Which suggestion should the nurse prioritize to help him maintain a healthy weight? -Encourage portion control at each meal -Change to a very low-fat and no-carbohydrate diet. -Encourage activities that will increase his physical activity. -Encourage the child to not worry about weight until he is older.Encourage activities that will increase his physical activity. Encouraging daily physical activity and following the dietary standards (such as ChooseMyPlate guidelines) will help the child meet necessary nutritional guidelines. Following popular fad diets or using weight-loss supplements must be avoided because they do not supply adequate nutrients for the growing child. The child is aware of the weight problem, but it would not be beneficial to just ignore it because the child may develop harmful eating habits such as bingeing.The nurse is presenting information about school-aged children at a community event. Which statement should the nurse prioritize for further teaching and providing more information? -"Sometimes we have to be firm, but our children wash their hands before eating." "I make sure they have good teeth by giving them calcium and phosphorus." -"Food is so expensive, we always make our children eat everything on their plates." -"Even if the weather is cool and cloudy, our children play outside every day.""Food is so expensive, we always make our children eat everything on their plates." Obesity can be an issue in the school-aged child, especially if they are urged to clean their plates even if they have more food than they want or need on the plate. The parents should be encouraged to use smaller plates for the children so they will still appear to have a full plate but smaller portions. Firm guidance and direction is important with the school-aged child. Calcium and phosphorus are important to healthy teeth. Exercise each day is important, especially outdoor exercise.The nursing instructor is leading a discussion on school-aged children. The instructor determines the session is successful when the students correctly choose which factor as being a priority for the school-aged child? -Needs 10 to 12 hours of sleep per night -Should brush their teeth at bedtime -Have a routine physical exam every 6 months -Be screened for scoliosis once a yearNeeds 10 to 12 hours of sleep per night The school-aged child needs 10 to 12 hours of sleep per night. They need to brush their teeth after every meal and at bedtime. A routine physical exam once a year is all that is necessary. Children are screened around the age of 10 or 11 for scoliosis.A mother tells the nurse she is having difficulty getting her 6-year-old to do chores. Based on the child's developmental level, what activity would be best for the nurse to recommend to the mother? -vacuuming -putting books on shelf -raking leaves -folding clothesputting books on shelf School age children need rewards for their accomplishments. Small chores which can be completed quickly give this type of reward. Children can survey their finished work and see they have done a good job. Picking up toys or putting books on the shelf offers a reward because children can clearly see the result of their work. Vacuuming is a chore children do not necessarily like because once finished the rug looks the same before they started. There is no reward for the process. Raking leaves serves as only a temporary reward because even though the child can see the result of the leaves in a pile the leaves still need to be bagged or disposed. Folding clothes also offers small reward because for many 6-year-olds larger pieces of clothing can be too cumbersome to fold correctly and they are not rewarded as the clothes still need to be put away.The family who are vegetarian voice concern that their child is not growing well. The nurse should suggest which food to increase the calcium intake for adequate bone growth? -oatmeal -kale -quinoa -sweet potatokale The consumption of adequate protein and calcium is important for muscle, bone, and dental development. Foods highest in calcium are green leafy vegetables, enriched breads, and cereals. Soybeans, legumes, grains, and immature seeds are high in protein. Oatmeal and quinoa are both high in protein. Sweet potatoes are high in fiber, vitamin A, and potassium.A group of 10-year-old girls have formed a "girls only" club. It is only open to girls who still like to play with dolls. How should this behavior be interpreted? -poor peer relationships -encouragement for bullying and sexism -appropriate social development -immaturity for this age groupappropriate social development Nine-year-olds take the values of their peer group seriously. They are interested in being with peers of like mind and activities. Clubs are formed with specific exclusions of peers. Such clubs typically have a secret password and secret meeting place. Membership is generally all girls or all boys. These groups are not based on the immaturity of the children nor do they encourage sexism and bullying.The caregivers of a child report that their child had a cold and complained of a sore throat. When interviewed further they report that the child has a high fever, is very anxious, and is breathing by sitting up and leaning forward with the mouth open and the tongue out. The nurse recognizes these symptoms as those seen with which of the following disorders? a) Spasmodic laryngitis b) Tonsillitis c) Laryngotracheobronchitis d) EpiglottitisEpiglottitis The child with epiglottitis may have had a mild upper respiratory infection before the development of a sore throat, and then became anxious and prefers to breathe by sitting up and leaning forward with the mouth open and the tongue out. The child with tonsillitis may have a fever, sore throat, difficulty swallowing, hypertrophied tonsils, and erythema of the soft palate. Exudate may be visible on the tonsils. The child with acute laryngotracheobronchitis develops hoarseness and a barking cough with a fever, cyanosis, heart failure and acute respiratory embarrassment can result.Wheezing in children is best heard a) as the child cries. b) without a stethoscope. c) as the child exhales. d) with the child supine.as the child exhales. Explanation: Wheezing is an expiratory sound from difficulty pushing air through a narrowed airway.A worried mother calls the nurse and tells her that her son has developed a horrible croupy cough and is having trouble breathing. Which of the following would be the best intervention for the nurse to recommend to the mother? a) Administer an analgesic to the boy b) Administer cough syrup to the boy c) Run a hot shower to fill the bathroom with steam and have the boy stay there d) Have the boy drink a full glass of water to clear out the mucusRun a hot shower to fill the bathroom with steam and have the boy stay there Explanation: One emergency method of relieving croup symptoms is for a parent to run the shower or hot water tap in a bathroom until the room fills with steam, then keep the child in this warm, moist environment as this relaxes the airway tissues and widens the bronchi lumens. If this does not relieve symptoms, parents should bring the child to an emergency department for further evaluation and care. Caution parents not to give cough syrup routinely to children as many produce little effect and the risk of overdose, incorrect dosing, and adverse events is greater than the benefit of the syrup. An analgesic might help alleviate pain due to inflammation and irritation of the throat from coughing, but it is not the priority intervention in this case. Drinking would likely be painful for this child and would not provide lasting benefit.If there is a foreign body in the larynx, how will the patient present? a) Edematous b) With stridor c) Speaks clearly d) QuietlyWith stridor Explanation: If a foreign body is in the larynx, the patient presents with a cough, stridor, trouble with phonation, and maybe severe respiratory distress.The caregivers of a 2-year-old who has had a common cold for 4 days calls the nurse in the Emergency Department at 2 AM on a cold winter night to say that the child has awakened with a barking cough and an elevated temperature; she seems blue around her mouth. The nurse would most appropriately recommend which of the following to the caregiver? a) "Turn on all of the hot water taps in the bathroom and close the door. Take the child into the steam filled room for 15 minutes. If there is no relief, bring the child to the emergency room." b) "Bundle the child up and take her out into the cold for a few minutes. Call back if the exposure to the cold air does not provide relief." c) "Bring the child to the emergency room immediately." d) "Put a cool mist humidifier or vaporizer in the room to see if that relieves the cough. Call back if there's no relief in an hour.""Bring the child to the emergency room immediately." Explanation: Acute laryngotracheobronchitis generally occurs after an upper respiratory infection with fairly mild rhinitis and pharyngitis. The child develops hoarseness and a barking cough with a fever that may reach 104 to 105 degrees Fahrenheit. As the disease progresses, marked laryngeal edema occurs and the child's breathing becomes difficult; the pulse is rapid and cyanosis may appear. Heart failure and acute respiratory embarrassment can result. The child needs to be treated immediately. Humidified air is helpful in reducing laryngospasm; humidifiers may be used in the child's bedroom to provide high humidity. Cool humidifiers are recommended, but vaporizers also may be used. Taking the child into the bathroom and opening the hot water taps with the door closed is a quick method for providing moist air, if the water runs hot enough. Sometimes the spasm is relieved by exposure to cold air: for instance, when the child is taken out into the night to go to the emergency department or to see the physician.Which of the following nursing diagnoses would be most appropriate for a child with pneumonia during the acute phase of illness? a) Activity intolerance related to poor oxygen-carbon dioxide exchange b) Altered urinary elimination related to hypervolemic state c) Pain related to swelling of abdominal lymph nodes d) Excess fluid volume related to excessive mucus productionActivity intolerance related to poor oxygen-carbon dioxide exchange Explanation: Children with pneumonia generally feel exhausted during their illness and the immediate period following.The nurse is administering medications to a child with cystic fibrosis. Which of the following methods would the nurse most likely use to give medications to treat the pancreatic involvement seen in this disease? a) Open capsule and sprinkle on food b) Pour in medication cup and have child drink c) Shake inhaler and hold close to mouth d) Draw up in syringe and administer subcutaneouslyOpen capsule and sprinkle on food Pancreatic enzymes come in capsules that can be swallowed or opened and sprinkled on the child's food.The nurse is examining a 4-year-old who is injured and crying. What might the nurse document about the child's breathing? a) Tachypnea b) Tachycardia c) Respirations are slow and shallow d) Respirations are regularTachypnea Explanation: Tachypnea (rapid breathing or panting) may be observed in a child with fear, anxiety, or stress. Slow, shallow, or regular respirations are normal. Tachycardia is an increased heart rate.The nurse is admitting a child who is experiencing an asthma attack. Which of the following clinical manifestations would likely be noted in this child? a) Circumoral cyanosis b) Wheezing c) Hoarseness d) Chest retractionsWheezing Explanation: The onset of an attack can be very abrupt or can progress over several days, as evidenced by a dry hacking cough, wheezing (the sound of expired air being pushed through obstructed bronchioles), and difficulty breathing.Which medication is a bronchodilator? a) Furosemide b) Prednisolone c) Spironolactone d) AminophyllineAminophylline Explanation: Aminophylline is a bronchodilator that opens the airway of the lungs. It relaxes the smooth muscles around the airways.Choice Multiple question - Select all answer choices that apply. The nurse is assisting in the development of a plan of care for a child with asthma. In planning care, all of the following goals would be appropriate for this child and/or family caregiver. Which two goals would be the highest priority for this child or family? a) The child and family will have decreased anxiety. b) The child will have adequate fluid intake. c) The child will have decreased fatigue. d) The child and family will improve knowledge and understanding of home care. e) The child will maintain a clear airway.• The child will maintain a clear airway. • The child will have adequate fluid intake. Explanation: The initial major goals for the child include maintaining a clear airway and an adequate fluid intake and relieving fatigue and anxiety. The family's goals include learning how to manage the child's life with asthma. The airway and fluid intake are the highest priorities.You see a 3-year-old boy in an ambulatory setting for localized wheezing on auscultation. Which statement by his mother would be most important to report? a) The child was eating peanuts yesterday. b) She gives the child hard candy as an afternoon treat. c) She likes the child to play by himself for 15 minutes every afternoon. d) The child has two cousins who have many allergies.The child was eating peanuts yesterday. Explanation: Localized wheezing suggests only a small portion of a lung is involved, such as occurs following aspiration.The student nurse is collecting data on a child diagnosed with cystic fibrosis and notes the child has a barrel chest and clubbing of the fingers. In explaining this manifestation of the disease, the staff nurse explains the cause of this symptom to be which of the following? a) Decreased respiratory capacity b) Chronic lack of oxygen c) Impaired digestive activity d) High sodium chloride concentration in the sweatChronic lack of oxygen Explanation: In the child with cystic fibrosis the development of a barrel chest and clubbing of fingers indicate chronic lack of oxygen. Impaired digestive activity may occur due to a lack of pancreatic enzymes. The high sodium concentration makes the child taste salty, but is not related to the barrel chest and clubbing of the fingers. Respiratory issues are a concern, but the barrel chest and clubbing of the fingers are not because of the child's respiratory capacity.What would the appropriate nursing intervention be for a child with an ineffective breathing pattern? a) Provide oxygen as needed to maintain oxygen saturation above 93%. b) Place child in a supine position in bed. c) Only give medications if condition worsens. d) Have everyone leave child's room so it isn't crowded.Provide oxygen as needed to maintain oxygen saturation above 93%. Explanation: Provide oxygen to increase oxygen saturation. A decrease in oxygen saturation will cause the child to have an increase in the work of breathing. The other choices do not promote an open airway, decrease anxiety, or give reassurance; medications will not decrease inflammation.Which of the following is the most accurate regarding the structure and function of the infant or child's respiratory system? a) Infants and young children have smaller tongues in proportion to their mouths. b) Most infants are nasal breathers rather than mouth breathers c) The diameter of the child's trachea is the same as that of adults. d) The respiratory tract in the child is fully developed by age 2Most infants are nasal breathers rather than mouth breathers Explanation: The infant is a nasal breather and it is essential to keep the nasal passages clear to enable the infant to breath and to eat. The diameter of the infant and child's trachea is about the size of the child's little finger. The respiratory tract grows and changes until the child is about 12 years of age. Dur ing the first 5 years infants and young children have larger tongues in proportion to their mouths.The nurse is doing discharge teaching for a child who has had a tonsillectomy. The nurse tells the patient and family that the child should have plenty of fluids. In addition, the nurse would explain to the child's caregiver that the child may a) Vomit dark, old blood, but the caregiver should call the clinic if the child has bleeding between the fifth and seventh days post operatively b) Have severe throat pain for up to 2 weeks post operatively; this is not a concern c) Have a painful earache around the third day post operatively, but the earache will be gone by the fourth day d) Be given ice cream and milk the first postoperative day because these foods make swallowing easierVomit dark, old blood, but the caregiver should call the clinic if the child has bleeding between the fifth and seventh days post operatively Explanation: Bleeding is most often a concern within the first 24 hours following surgery and between the fifth to seventh days postoperatively. Bright, red-flecked emesis or oozing indicates fresh bleeding. If at any time following the surgery there is bright red bleeding, frequent swallowing, or restlessness, the care provider should be notified. A mild earache may be expected around the third day. Encourage fluid intake but avoid irritating liquids such as orange juice. Be aware that milk and ice cream products tend to cling to the surgical site and make swallowing more difficult; thus they are poor choices despite the old tradition of offering ice cream after a tonsillectomy.Which of the following is a side effect of bronchodilator medications? a) Increased heart rate b) Hypoactivity c) Muscle cramps d) Smooth toneIncreased heart rate Explanation: Side effects of bronchodilators include an increased heart rate, shakiness or tremors, and hyperactivity.A child with a severe lower respiratory tract infection has been prescribed an antibiotics and a bronchodilator. The nurse recognizes that which of the following treatments would be best for delivering the medication directly into the respiratory tract, as well as providing moisture to promote removal of mucus? a) Vaporizer b) Flutter device c) Percussion d) NebulizerNebulizer Explanation: Nebulizers are mechanical devices that provide a stream of moistened air directly into the respiratory tract. Nebulizers also serve as an important means for the delivery of respiratory tract medications. Drugs such as antibiotics or bronchodilators can be combined with the nebulized mist and sprayed into the lungs. Vaporizers humidify the air by emitting a stream of air moistened by fine droplets of water into the air, providing either a cool or a warm mist to the entire room. A mucus-clearing device (a Flutter device), which looks like a small plastic pipe, has a stainless-steel ball inside that moves when the child breathes out, causing vibrations in the lungs, which help loosen mucus so that it can be moved up the airway and expectorated. Percussion involves striking a cupped or curved palm against the chest to determine the consistency of tissue beneath the surface area.A Mantoux skin test is used to screen for tuberculosis. a) False b) TrueTrueA 4-year-old girl has been admitted to the hospital with a diagnosis of pneumococcal pneumonia. Her parents are extremely distraught over her condition and the fact she has not wanted to eat anything for the past 2 days. Which nursing approach would be most important to take to help alleviate the high anxiety level of these parents? a) Encourage the parents to return home and get some rest. b) Avoid telling the parents unnecessary facts regarding her prognosis. c) Allow the parents to remain with the child as much as possible. d) Tell the parents that their child is receiving the best care possible.Allow the parents to remain with the child as much as possible. Pneumonia is a frightening disease for parents because before the age of antibiotics, it was fatal to children. Encouraging them to visit and offer support can increase self-esteem and decrease anxiety.Newborns who are born more than 24 hours after rupture of the amniotic membranes are particularly prone to developing pneumonia in their first few days of life. a) True b) FalseTruePancreatic enzymes are part of the treatment in cystic fibrosis. When should the nurse administer the enzymes? a) Before meals and snacks with milk b) At night after dinner c) Three times a day with water d) Once a dayBefore meals and snacks with milk Explanation: Enzymes should be administered before all meals and snacks to help in normal absorption of nutrients from the food. The other choices do not promote absorption of foods or are not taken with food.Which of the following is a symptom of bacterial pharyngitis? a) Fever as high as 104 °F b) Symptoms have a gradual onset c) Rhinitis d) WBC in normal rangeFever as high as 104 °F Explanation: A fever of up to 104 °F is a symptom of bacterial pharyngitis; others symptoms are an elevated white blood count (WBC), abrupt onset, headache, sore throat, abdominal discomfort, enlargement of tonsils, and firm cervical lymph nodes.The nurse is taking a respiratory history of a newly admitted child. While documenting the symptoms the child has, what other item is important to document when taking a history on an altered respiratory status? a) The child's diet b) The triggers for the environment c) The child's weight d) The child's hospital historyThe triggers for the environment Explanation: When assessing a respiratory history, it is very important for the nurse to find out what in the environment worsens the child's symptoms. These are called "triggers." The other choices would be part of a general health history.A young child is prescribed pancreatic enzymes as part of his treatment plan for cystic fibrosis. The child has difficulty swallowing medications. After teaching the parents of a young child with cystic fibrosis about how to administer pancreatic enzymes, the parents demonstrate understanding by stating which of the following? a) "We need to dissolve the capsule in water." b) "We can open the capsule and sprinkle it on his cereal." c) "We can puncture the capsule and pour the liquid on his tongue." d) "We should crush the capsule to make it smaller.""We can open the capsule and sprinkle it on his cereal." Explanation: If the child has difficulty swallowing the pancreatic enzyme capsules, the parents can open the capsule and sprinkle the contents onto the child's cereal or applesauce. Dissolving the capsule in water or crushing it would be appropriate. The capsule does not contain liquid so there would not be any liquid to pour on the child's tongue.The school nurse is caring for a 12-year-old boy with a bloody nose. Which action would be most appropriate for the nurse to do? a) With the child lying on his back, apply pressure to the bridge of the nose. b) Seat the child with his head tipped back and apply ice or a cold cloth to the nose. c) With the child lying on his back, pinch the anterior portion of the nose closed. d) Seat the child leaning forward and pinch the anterior portion of the nose closed.Seat the child leaning forward and pinch the anterior portion of the nose closed. Explanation: The child should sit up and lean forward. Apply continuous pressure to the anterior portion of the nose by pinching it closed. The bleeding usually stops within 10 to 15 minutes. Ice or a cold cloth on the bridge of the nose may help, but pressure will stop the bleeding. Lying down or tipping the head back may allow aspiration of the blood and should be avoided.What measure at home could help a child with an upper respiratory infection breathe more easily? a) Increasing room humidity b) Playing "rapid breathing" games c) Limiting fluid intake d) Enforcing strict bed restIncreasing room humidity Explanation: A moist environment helps prevent respiratory secretions from drying and becoming difficult to raise.When caring for children with respiratory issues in relationship to the anatomy and physiology of the child's respiratory system, it is important to recognize which of the following? a) As soon as the child is born, respiratory passages needed during fetal life close. b) The newborn uses the thoracic muscles to breathe and as they grow begin using the abdominal muscles to breathe. c) The diameter of the child's trachea is about the size of the child's little finger. d) Full development of the lungs and respiratory organs involved does not occur until the child is an adolescent.The diameter of the child's trachea is about the size of the child's little finger. Explanation: The diameter of the infant's and child's trachea is about the size of the child's little finger. This small diameter makes it extremely important to be aware that something can easily lodge in this small passageway and obstruct the child's airway.The caregivers of an 8-year-old bring their child to the pediatrician and report that the child has not had breathing problems before, but since taking up lacrosse the child has been coughing and wheezing at the end of every practice and game. Their friend's child has often been hospitalized for asthma; they are concerned that their child has a similar illness. The nurse knows that because the problems seem to be directly related to exercise, it is likely that the child will be able to be treated with a) Removal of allergens in the home and school b) Decreased activity and increased fluids c) A bronchodilator and mast cell stabilizers d) Corticosteroids and leukotriene inhibitorsA bronchodilator and mast cell stabilizers Explanation: Mast cell stabilizers are used to help decrease wheezing and exercise-induced asthma attacks. A bronchodilator often is given to open up the airways just before the mast cell stabilizer is used. Corticosteroids are anti-inflammatory drugs used to control severe or chronic cases of asthma. Leukotriene inhibitors are given by mouth along with other asthma medications for long-term control and prevention of mild, persistent asthma.What is a definitive test for cystic fibrosis? a) Blood gas b) Sweat chloride c) Complete blood count d) Blood cultureSweat chloride Explanation: The definitive test in diagnosing CF is the sweat chloride test. This test is performed by stimulating a small patch of sweat glands on the inner aspect of the forearm. There must be two positive tests and clinical symptoms to confirm the diagnosis. The other choices are routine diagnostic tests.The nurse is doing teaching with the caregivers of a child with cystic fibrosis. Of the following, which is most important for the nurse to teach this family? a) Be sure the patient exercises daily. b) Encourage everyone in the family to use good handwashing. c) Watch for signs that the family unit is stressed. d) Avoid overprotecting the child.Encourage everyone in the family to use good handwashing. Explanation: The child with cystic fibrosis has low resistance especially to respiratory infections. For this reason, take care to protect the child from any exposure to infectious organisms. Good handwashing techniques should be practiced by the whole family; teach the child and family the importance of this first line of defense. Practice and teach other good hygiene habits.Which of the following child's history puts them at increased risk for asthma-related death? a) A child who has never been hospitalized b) Current use of corticosteroids c) No history of psychosocial or psychiatric disease d) Compliance with an asthma treatment planCurrent use of corticosteroids Explanation: Current use of corticosteroids is a risk factor for an asthma-related death. Prior hospitalization, a history of psychosocial issues, and noncompliance with an asthma treatment plan also put children at risk for an asthma-related death.A 7-year-old child has been scheduled for a tonsillectomy. Which of the following would be most important to assess prior to surgery? a) Specific gravity of urine b) Pulse and respiratory rate c) Bleeding and clotting time d) Blood pressure both lying down and sitting upBleeding and clotting time Explanation: Because removal of tonsils leaves a large denuded area, not a simple suture line, hemorrhage following surgery can occur.A child is brought to the emergency department late one evening and is diagnosed with croup. The child was noted to have a shrill, harsh respiratory sound when breathing in. This symptom is referred to as which of the following? a) Wheezing b) Stridor c) Hoarseness d) Barking coughStridor Explanation: In the child with croup syndrome, inspiratory stridor (shrill, harsh respiratory sound) is often noted.The nurse is caring for a child who has been admitted with a possible diagnosis of tuberculosis. Which of the following laboratory/diagnostic tools would likely be used to help determine the diagnosis of this child? a) Pulmonary functions test b) Sweat sodium choloride test c) Blood culture and sensitivity d) Purified protein derivative testPurified protein derivative test Explanation: Purified protein derivative tests are used to detect TB. Sweat sodium choloride tests are used for determining the diagnosis of cystic fibrosis. Blood culture and sensitivity is done to determine the causative agent as well as the antiinfective needed to treat an infection. Pulmonary function tests are diagnostic tools for the child with asthma and indicate the amount of obstruction in the bronchial airways, especially in the smallest airways of the lungs.The nurse is caring for a child who has been admitted with a possible diagnosis of cystic fibrosis. Which of the following laboratory/diagnostic tools would likely be used to help determine the diagnosis of this child? a) Pulmonary functions test b) Sweat sodium choloride test c) Purified protein derivative test d) Blood culture and sensitivitySweat sodium choloride test Explanation: Sweat sodium choloride tests are used for determining the diagnosis of cystic fibrosis. Purified protein derivative tests are used to detect TB. Blood culture and sensitivity is done to determine the causative agent as well as the antiinfective needed to treat an infection. Pulmonary function tests are diagnostic tools for the child with asthma and indicate the amount of obstruction in the bronchial airways, especially in the smallest airways of the lungs.The nurse is caring for a child admitted with asthma. Which of the following clinical manifestations would likely have been noted in the child with this diagnosis? a) Wheezing b) Clubbed fingers c) Circumoral cyanosis d) Elevated temperatureWheezing Explanation: Symptoms of asthma include dry hacking cough, wheezing (the sound of expired air being pushed through obstructed bronchioles), and difficulty breathing. Elevated temperature is not usually seen. Circumoral cyanosis is seen with a diagnosis of pneumonia, and clubbing of the fingers is seen in cystic fibrosis.A group of nurses is reviewing the diagnosis of cystic fibrosis. With regard to the effect of this disease on the body, in addition to the lungs which of the following are most affected by this disease? a) Pancreas and liver b) Kidney and bladder c) Brain and spinal cord d) Heart and blood vesselsPancreas and liver Explanation: The major organs affected are the lungs, pancreas, and liver. The brain, spinal cord, heart, blood vessels, kidney and bladder are not the most affected organs.A nurse is providing supplemental oxygen therapy to a young child. Based on the nurse's understanding of oxygen delivery methods, which of the following would the nurse expect to be used to deliver the highest concentration of oxygen to the child? a) Nonrebreathing mask b) Oxygen hood c) Venturi mask d) Partial rebreathing maskNonrebreathing mask A nonrebreathing mask provides 95% oxygen concentration. An oxygen hood provides up to 80% to 90% oxygen concentration. This delivery method is used only for infants. A partial rebreathing mask provides 50% to 60% oxygen concentration. A Venturi mask provides 24% to 50% oxygen concentration.The nurse is reinforcing teaching with a group of caregivers of children diagnosed with asthma. Which of the following statements best indicates an understanding of the management and treatment for this diagnosis? a) "We have taken the carpet out of our house and let my mom take our dog." b) "Even the babysitter helps us keep up the diary with her symptoms." c) "The medications she takes are all in one place, ready for her to take at any time." d) "He knows how and even when he needs to use his peak flow meter.""We have taken the carpet out of our house and let my mom take our dog." Families must make every effort to eliminate any possible allergens from the home. Prevention is the most important aspect in the treatment of asthma. Learning how to use a peak flow meter, using a peak flow and symptom diary, and having the medications available are important aspects of treatment, but prevention is the best.After teaching the parents of an 8-year-old girl with asthma about common allergens their child should avoid, the nurse determines that the parents need additional teaching when they identify which of the following as a common allergen for asthma? a) Dust mites b) Shellfish c) Pet dander d) Indoor moldsShellfish Explanation: Eating shellfish is not a typical asthma trigger. Allergic reactions can occur with shellfish, but usually not an exacerbation of asthma. Indoor molds are a common asthma trigger. Pet dander is a common asthma trigger. Dust mites are a common asthma trigger.The nurse is collecting data on a child admitted with a respiratory concern. The nurse notes that the child is anxious and sitting up and leaning forward in a tripod position to breath. The nurse further notes that the child's mouth is open and the tongue is out. The signs the nurse noted indicate the child likely has which of the following? a) Cystic fibrosis b) Epiglottitis c) Asthma d) TuberculosisEpiglottitis Explanation: The child with epiglottitis is very anxious and prefers to breathe by sitting up and leaning forward with the mouth open and the tongue out. This is called the "tripod" position. Immediate emergency attention is necessary.The nurse working at the child community clinic must administer the influenza vaccine to the high-risk kids first. Which child would she choose? a) 21-month-old Chris who has a cold b) 12-month-old Sally who is very healthy c) 23-month-old Ava who had heart surgery as an infant for a defect d) 22-month-old Jared who has a wound from touching a hot pan at home23-month-old Ava who had heart surgery as an infant for a defect Explanation: Children who are considered high risk and could benefit from the influenza vaccine are: immunocompromised; have a chronic pulmonary disease; have had a congenital abnormality, chronic renal or metabolic diseases, sickle-cell disease, HIV, and any type of neurological disorder (seizures). The other choices would be considered normal and the child is not at high risk.Which of the following is a complication of cystic fibrosis? a) Kidney disease b) Crohn disease c) Pneumothorax d) UTIPneumothorax Explanation: A pneumothorax is a complication of cystic fibrosis. A rupture of the subpleural blebs through the visceral pleura takes place. There is also a high reoccurrence rate and incidence increases with age.Choice Multiple question - Select all answer choices that apply. A child who has had a tracheostomy is admitted to the hospital for abdominal surgery. When assessing the child's tracheostomy, which of the following would the nurse identify as a normal finding? Select all that apply. a) Clear, clean tracheostomy tube b) Small amount of clear drainage from stoma c) Two fingers slide under tracheostomy ties d) Tube free of secretions e) Stoma pale pink• Clear, clean tracheostomy tube • Tube free of secretions • Stoma pale pink Explanation: A tracheostomy tube should be clean and free from secretions and the stoma should appear pink and without bleeding or drainage. The tracheostomy ties should fit securely, allowing one finger to slide beneath the ties.After tonsillectomy surgery, the preferred position of a child until fully awake is on the a) side with the head elevated. b) side with continuous oxygen by cannula at 30%. c) back with warm compresses applied to the throat. d) abdomen with a pillow under the chest.abdomen with a pillow under the chest. Explanation: Lowering the child's head slightly and placing the child on the stomach allows mouth and throat secretions to flow out, avoiding possible aspiration and allowing for better assessment of bleeding from the surgery site.A child with a severe lower respiratory tract infection has been prescribed an antibiotics and a bronchodilator. The nurse recognizes that which of the following treatments would be best for delivering the medication directly into the respiratory tract, as well as providing moisture to promote removal of mucus? a) Vaporizer b) Percussion c) Nebulizer d) Flutter deviceNebulizer Explanation: Nebulizers are mechanical devices that provide a stream of moistened air directly into the respiratory tract. Nebulizers also serve as an important means for the delivery of respiratory tract medications. Drugs such as antibiotics or bronchodilators can be combined with the nebulized mist and sprayed into the lungs. Vaporizers humidify the air by emitting a stream of air moistened by fine droplets of water into the air, providing either a cool or a warm mist to the entire room. A mucus-clearing device (a Flutter device), which looks like a small plastic pipe, has a stainless-steel ball inside that moves when the child breathes out, causing vibrations in the lungs, which help loosen mucus so that it can be moved up the airway and expectorated. Percussion involves striking a cupped or curved palm against the chest to determine the consistency of tissue beneath the surface area.A young child is prescribed pancreatic enzymes as part of his treatment plan for cystic fibrosis. The child has difficulty swallowing medications. After teaching the parents of a young child with cystic fibrosis about how to administer pancreatic enzymes, the parents demonstrate understanding by stating which of the following? a) "We need to dissolve the capsule in water." b) "We can puncture the capsule and pour the liquid on his tongue." c) "We can open the capsule and sprinkle it on his cereal." d) "We should crush the capsule to make it smaller.""We can open the capsule and sprinkle it on his cereal." Explanation: If the child has difficulty swallowing the pancreatic enzyme capsules, the parents can open the capsule and sprinkle the contents onto the child's cereal or applesauce. Dissolving the capsule in water or crushing it would be appropriate. The capsule does not contain liquid so there would not be any liquid to pour on the child's tongue.When the nurse is reinforcing teaching with the caregiver of a 3-year-old child being discharged following a tonsillectomy, the caregiver states to the nurse, "I understand why there might be bleeding in the first 24 hours, but I don't understand why there might be bleeding in a week or so." The most appropriate explanation for the nurse to give this caregiver is which of the following. a) "We don't usually do this surgery until the child is older, so postoperative bleeding is a possible complication because of your child's age." b) "By next week your child will be eating regular foods again and some rough food hitting the tissue would be likely to cause bleeding." c) "Your child will have forgotten about the surgery by that time and might start coughing and the pressure of coughing can cause bleeding." d) "Bleeding can occur at this time because the clots dissolve and new tissue isn't yet present.""Bleeding can occur at this time because the clots dissolve and new tissue isn't yet present." Explanation: Hemorrhage is the most common complication of a tonsillectomy. Bleeding is most often a concern within the first 24 hours after surgery and the fifth to seventh postoperative day. Bleeding can occur when the clots dissolve between the fifth and seventh postoperative days if new tissue is not yet present.The caregivers of a child who was diagnosed with cystic fibrosis 5 months ago report that they have been following all of the suggested guidelines for nutrition, fluid intake, and exercise but the child has been having bouts of constipation and diarrhea. The nurse will teach the caregiver that which of the following likely needs adjustment in the child's diet? The amount of a) Iodized salt b) Calories from protein c) Pancreatic enzymes d) Saturated fatPancreatic enzymes Explanation: Adequate nutrition helps the child resist infections. Pancreatic enzymes must be administered with all meals and snacks. If the child has bouts of diarrhea or constipation, the dosage of enzymes may need to be adjusted. The child's diet should be high in carbohydrates and protein with no restriction of fats. The child may need 1.5 to 2 times the normal caloric intake to promote growth. Low-fat products can be selected if desired. The child also may require additional salt in the diet. Increased caloric intake compensates for impaired absorption.A 4-year-old girl has acute nasopharyngitis (a common cold). Which of the following measures would you want to teach her parents? a) A cough that accompanies a cold should rarely be suppressed. b) Typically the child will pull her ear when a cold is present. c) An antibiotic is prescribed for children under 5 years of age. d) Healthy children rarely have more than one cold per year.A cough that accompanies a cold should rarely be suppressed. Explanation: Coughing can be therapeutic because it raises respiratory secretions and prevents them from becoming infected.The nurse is teaching the parents of a 9-year-old boy with a respiratory disorder about medications. The nurse would be alert for an increased need for medications if the child was exposed to second-hand smoke and has which condition? a) Asthma b) Allergic rhinitis c) Pneumonia d) Common coldAsthma Explanation: In general, it is important for any child with a respiratory illness to avoid second-hand smoke. However, exposure to second-hand smoke increases the need for medications in children with asthma and increases the frequency of asthma exacerbations. In general, it is important for any child with a respiratory illness to avoid second-hand smoke. However, the presence of smoke does not increase the medication needs for children with a cold. In general, it is important for any child with a respiratory illness to avoid second-hand smoke. However, the presence of smoke does not increase the medication needs for children with pneumonia. In general, it is important for any child with a respiratory illness to avoid second-hand smoke. However, the presence of smoke does not increase the medication needs for children with allergic rhinitisWhich of the following age of children have a trachea 4 cm long? a) Newborn b) School-aged child c) Teenager d) ToddlerNewborn Explanation: Pediatric airways are much smaller in diameter and shorter in length than in adults. A newborn trachea is 4 cm long, a toddler's is 7 cm long, and a teenager's is 12 cm long.The nurse caring for the child with asthma weighs the child daily. Which of the following is the most important reason for doing a daily weight on this child? a) To monitor the child's growth pattern b) To determine fluid losses c) To determine medication dosages d) To ensure that the child's food intake is adequateTo determine fluid losses Explanation: During an acute attack the child may lose a great quantity of fluid through the respiratory tract and may have poor oral intake because of coughing and vomiting. Theophylline administration also has a diuretic effect, which compounds the problem. Weigh the child daily to help determine fluid losses. The child's weight is used to determine medication dosages, to ensure that the child is appropriately gaining weight and growing, and that the intake is adequate. However, the most important reason for a daily weight is to determine fluid loss.Which of the following measures would be most effective in aiding bronchodilation in a child with laryngotracheobronchitis? a) Urging the child to continue to take oral fluids b) Administering an oral analgesic c) Teaching the child to take long, slow breaths d) Assisting with racemic epinephrine nebulizer therapyAssisting with racemic epinephrine nebulizer therapy Explanation: A bronchodilator increases the lumen of airways.Which of the following is a symptom of allergic rhinitis? a) Laryngitis b) Purulent secretions c) Sinus pain d) FeverSinus pain Explanation: The following are the symptoms that occur with allergic rhinitis: sinus pain, family history of atopy, and conjunctival pruritis.The most common cause of acute bronchiolitis is which of the following? a) Bacterial infection b) Prenatal complications c) Viral infection d) Hereditary factorsViral infection Explanation: Acute bronchiolitis is caused by a viral infection. Hereditary and prenatal complications do not relate to this disorder and the respiratory syncytial virus which causes the infection is not bacterial.The nurse is caring for a 6-month-old infant who has chronic apneic episodes. Which intervention should the nurse institute? a) Help infant's mother do his morning bath. b) Place on a cardiopulmonary monitor and do frequent assessments. c) Sit infant up in the infant seat to keep airway open. d) Place infant in a crib so he can rest and get stronger.Place on a cardiopulmonary monitor and do frequent assessments. Explanation: The optimal treatments for kids with chronic apnea are hospitalization, frequent monitoring and observation, and parent education. The nurse should continuously monitor the infant on a cardiopulmonary monitor; frequently assess color, breathing patterns, and effort; and assess tone. The other choices do not include constant monitoring and assessments, which are crucial in treatment.You notice that a child is spitting up small amounts of blood in the immediate postoperative period after a tonsillectomy. Which of the following would be the best intervention? a) Continue to assess for bleeding. b) Suction the back of the throat. c) Encourage the child to cough. d) Notify the physician immediately.Continue to assess for bleeding. Explanation: Children will have a small amount of blood mixed with saliva following a tonsillectomy. Suctioning or coughing could irritate the surgical site and cause hemorrhage.Drag and Drop question - Click and drag the following steps to place them in the correct order. Question: The child has been diagnosed with asthma and the child's physician is using a stepwise approach. Rank the following in order of occurrence as the child's condition worsens. The nurse administers albuterol as needed. The nurse administers a medium-dose inhaled corticosteroid. The nurse administers a medium-dose inhaled corticosteroid and salmeterol. The nurse administers a low-dose inhaled corticosteroid.1. The nurse administers albuterol as needed. 2. The nurse administers a low-dose inhaled corticosteroid. 3. The nurse administers a medium-dose inhaled corticosteroid. 4. The nurse administers a medium-dose inhaled corticosteroid and salmeterol. Explanation: The first step is to administer a short acting beta 2-agonist as needed. The second step is to administer a low-dose inhaled corticosteroid. The third step is to administer a medium-dose inhaled corticosteroid. The fourth step is to administer a medium-dose inhaled corticosteroid and a long-acting beta 2-agonist.The nurse is caring for a 7-year-old boy who has just had a tonsillectomy. Which intervention is least appropriate for this child? a) Discouraging the child from coughing b) Placing the child on his side c) Applying an ice collar d) Providing fluids by strawProviding fluids by straw Explanation: Providing fluids by straw may cause trauma to the surgical site and should be avoided. Applying an ice collar, if ordered, helps relieve pain. Placing the child on his side, until he is fully awake, facilitates safe drainage of secretions. The child should be discouraged from coughing, clearing his throat, and blowing his nose to avoid trauma to the surgical site.During an assessment, a child exhibits an audible high-pitched inspiratory noise. The nurse documents this as which of the following? a) Rales b) Stridor c) Tympany d) WheezeStridor Explanation: Stridor is a high-pitched, readily audible inspiration noise that indicates an upper airway obstruction. A wheeze is a high-pitched sound heard on auscultation, usually on expiration. It is due to obstruction in the lower trachea or bronchioles. Rales are crackling sounds heard on auscultation when the alveoli become fluid filled. Tympany is a sound heard with percussion over an air-filled area.Certain respiratory diseases in children result in hypoxia in a child. What should nurses focus on in the nursing care of these children? a) Urine output b) Vital signs c) Blood gases d) DietBlood gases Explanation: Infants may respond to low blood oxygen levels with increased respirations followed by a period of apnea. Conditions such as bronchopulmonary dysplasia, pneumonia, and bronchiolitis can put infants at risk. Nursing care should focus on blood oxygen levels. The other choices are basic nursing assessments.The nurse is preparing a presentation for a local community parent group about measures to prevent the common cold. Which of the following would the nurse stress as a vital prevention measure? a) Antibiotic use for household members with colds b) Frequent hand washing c) Avoiding second-hand smoke d) Minimizing exposure to crowds, especially during the springFrequent hand washing Explanation: Frequent hand washing helps to decrease the spread of viruses that cause the common cold. The common cold is caused by viruses, so antibiotics would be of no assistance in preventing them. Although avoiding second-hand smoke is a preventive measure, it is not the most important measure. Crowds should be avoided, especially during the winter when the colds occur more frequently.The caregiver of a 6-week-old boy calls the nurse, concerned about her child. The child has been vomiting, has diarrhea, and is sneezing. The child's temperature is normal. The nurse suspects that the cause of the symptoms is which of the following? a) A pollen-based allergy b) Cystic fibrosis c) A common cold d) PneumoniaA common cold Explanation: The child with a common cold sneezes and becomes irritable and restless. The congested nasal passages can interfere with nursing, increasing the infant's irritability. Because an older child can mouth breathe, nasal congestion in him or her is not as great a concern as it is in the infant. The child might have vomiting or diarrhea, which might be caused by mucous drainage into the digestive system. Younger infants usually are afebrile. The child with an allergy will not likely have vomiting and diarrhea. The infant with pneumonia will most likely have an elevated temperature. The child with cystic fibrosis will have a hard, nonproductive chronic cough, a barrel chest, and clubbing of fingers. The abdomen be comes distended, and body muscles become flabby.A nurse is applying a nasal cannula with prongs to a 10-year-old boy. Which of the following should the nurse be careful to observe for in this client? a) Development of necrosis on the nasal septum b) Development of hypoxia in the child c) The device slipping and obscuring his view d) The child being scalded by the deviceDevelopment of necrosis on the nasal septum Explanation: Most children do not like nasal prongs or catheters because they are intrusive. Assess their nostrils carefully when using these as the pressure of prongs can cause areas of necrosis, particularly on the nasal septum. Masks, rather than cannulas, tend to slip and obstruct the client's view. Vaporizers, not cannulas, can cause a serious scald burn if children accidentally pull a vaporizer over on themselves. Development of hypoxia while receiving oxygen therapy is highly improbable.The nurse is caring for a child who has been admitted with a diagnosis of asthma. Which of the following laboratory/diagnostic tools would likely have been used for this child? a) Sweat sodium choloride test b) Pulmonary functions test c) Blood culture and sensitivity d) Purified protein derivative testPulmonary functions test Explanation: Pulmonary function tests are valuable diagnostic tools for the child with asthma and indicate the amount of obstruction in the bronchial airways, especially in the smallest airways of the lungs. Purified protein derivative tests are used to detect TB. Sweat sodium choloride tests are used for determining the diagnosis of cystic fibrosis. Blood culture and sensitivity is done to determine the causative agent as well as the antiinfective needed to treat an infection.A 2-year-old boy is seen for acute laryngotracheobronchitis. Which of the following observations would lead you to suspect that airway occlusion is occurring? a) He states he is tired and wants to sleep. b) His nasal discharge is increasing. c) His respiratory rate is gradually increasing. d) His cough is becoming harsher.His respiratory rate is gradually increasing. Explanation: An increasing respiratory rate is a major sign of airway occlusion (breathing faster because less air is received with each breath).Which of the following childhood diseases used to be fatal and now needs a holistic approach to care? a) Cystic fibrosis b) BPD c) Asthma d) PneumoniaCystic fibrosis Explanation: Cystic fibrosis is a highly complex disease that is autosomal and genetic in origin, in which a mucus layer covers and blocks ducts of major organs. Survival rate has greatly improved and life expectancy has risen to 37 years after many new advances.A 6-year-old child is diagnosed as having streptococcal pharyngitis. When planning care, you should be aware that the chief danger of such an infection is that a) lymph nodes will swell and obstruct the airway. b) the infection may spread and cause a tooth abscess. c) four out of five children develop nephrosis afterward. d) a small proportion of children develop rheumatic fever.a small proportion of children develop rheumatic fever. Explanation: Certain strains of streptococci can cause a hypersensitivity reaction that results in either rheumatic fever or glomerulonephritis.A group of nursing students are reviewing information about variations in the anatomy of a child's respiratory tract structures in comparison to adults. The students demonstrate an understanding of the information when they describe the shape of the larynx in infants as which of the following? a) Cylindrical b) Oval c) Spherical d) FunnelFunnel Explanation: In infants and children (younger than the age of 10 years), the cricoid cartilage is underdeveloped, resulting in laryngeal narrowing and a funnel-shaped larynx. In teenagers and adults, the larynx is cylindrical and fairly uniform in width.Fill in the blank (with a number) question - Enter the answer in the space provided. Your answer should contain only numbers and, if necesary, a decimal point. The young child has been diagnosed with group A streptococcal pharyngitis. The physician orders amoxicillin 45 mg/kg in three equally divided doses. The child weighs 23 pounds. Calculate how many milligrams the child will receive with each dose of amoxicillin (round to the nearest whole milligram).157 Explanation: 23 pounds x 1 kg/2.2 pounds = 10.4545 kg 10.4545 kg x 45 g/kg = 470.455 mg 470.455 mg/3 = 156.82 Rounded to 157 mg per doseThe nurse is caring for a 2-year-old diagnosed with bacterial pneumonia. The child has been placed in a mist tent. In caring for the child, it is important for the nurse to do which of the following? a) Check for hyperthermia related to enclosure in the tent b) Avoid contact with the mist if the nurse is a sexually active female of childbearing age c) Monitor the child regularly for signs of cyanosis d) Use contact transmission precautionsMonitor the child regularly for signs of cyanosis Explanation: In some treatment of bacterial pneumonia a croupette or mist tent is used. Children have become cyanotic in mist tents, with subsequent arrest, due to their lack of visibility while in the tent; the child must be constantly observed. Ribavirin (Virazole), an antiviral drug that may be used to treat certain children with RSV, is administered as an inhalant by hood, mask, or tent; it has a high risk for teratogenicity (causing damage to a fetus) so care must be taken when the drug is administered. In treating a patient with bacterial pneumonia, the patient may need to be placed on infection control precautions according to the policy of the health care facility, and the nurse should look for hyperthermia related to the infection process.In caring for the child with asthma, the nurse recognizes that bronchodilator medications are administered to children with asthma for which of the following reasons? a) To stabilize the cell membranes b) Relief of acute symptoms c) Prevention of mild symptoms d) Management of chronic painb) Relief of acute symptoms Explanation: Bronchodilators are used for quick relief of acute exacerbations of asthma symptoms. Mast cell stabilizers help to stabilize the cell membrane by preventing mast cells from releasing the chemical mediators that cause bronchospasm and mucous membrane inflammation. Leukotriene inhibitors are given by mouth along with other asthma medications for long-term control and prevention of mild, persistent asthma. Brochodilators are not effective for pain.A caregiver calls the pediatrician's office and reports to the nurse that her 4-year-old, who was fine the previous day, complained of a sore throat early in the morning and now has a temperature of 102.6 degrees Fahrenheit. The caregiver has tried to get the child to nap but the child gets panicky, immediately sits back up, and leans forward with her mouth open and tongue out when the caregiver encourages her to lie down. The nurse suspects the child has which of the following conditions? a) Spasmodic laryngitis b) Epiglottitis c) Acute laryngotracheobronchitis d) Mild asthmab) Epiglottitis Explanation: Epiglottitis is acute inflammation of the epiglottis that most often affects children ages 2 to 7 years. The child may have been well or may have had a mild upper respiratory infection before the development of a sore throat (difficulty swallowing) and a high fever of 102.2 to 104 degrees Fahrenheit. The child is very anxious and prefers to breathe by to sitting up and leaning forward with the mouth open and the tongue out. This is called the "tripod" position. Immediate emergency attention is necessary.Children have less lung elasticity in the alveoli. Which response would the nurse give a mom who wants to know what risks this poses to her child? a) "They are at risk for diabetes." b) "They are at risk for pulmonary edema." c) "They are at risk for liver cancer." d) "They are at risk for kidney disease."b) "They are at risk for pulmonary edema." Explanation: The alveoli have less elastic tissue in children. This puts them at risk for pulmonary edema, as well as pneumothorax and pneumomediastinum. The minimum elastic recoil can cause pulmonary collapse. The other choices are not directly related to the pulmonary system.A school-aged child develops a nosebleed (epistaxis). Which of the following would you do? a) Elevate the head of the bed slightly and apply pressure to the forehead. b) Keep the child flat and apply pressure to the bridge of the nose. c) Turn the child's head to the side and press on the nasal ridge. d) Sit the child upright and apply pressure to the sides of the nose.d) Sit the child upright and apply pressure to the sides of the nose. Explanation: Keeping a child upright reduces pressure on cerebral vessels and aids coagulation at the site of a broken vessel.The nurse is reinforcing teaching with the parents of a 2-year-old who has cystic fibrosis regarding medications. The nurse suggest that pancreatic enzymes may be given by which method? a) Through a gastrostomy tube b) Sprinkled onto the food c) Directly into the vein d) Using a nebulizerb) Sprinkled onto the food Explanation: Pancreatic enzymes are used in the treatment of cystic fibrosis and are given by opening the capsule and sprinkling the medication on the child's food. If the child with cystic fibrosis has an infection, IV medications may be given, but this is not on a daily basis. Most children do not have a gastrostomy tube. Many of these drugs used in the treatment of asthma can be given either by a nebulizer (tube attached to a wall unit or cylinder that delivers moist air via a face mask) or a metered-dose inhaler ([MDI], which is a hand-held plastic device that delivers a premeasured dose).A child with asthma has been monitoring his peak expiratory flow rate (PEFR) and has been maintaining it within 90% of his personal best. Today, the child is experiencing symptoms and his PEFR is at 40% of his personal best. The child's mother calls the office and asks the nurse what she should do. Which of the following would the nurse instruct the mother to do first? a) "Continue to watch his PEFR readings and call back if they go below 40%." b) "Have him use his short-acting bronchodilator right away." c) "You need to take him to the emergency department right away." d) "Have him use his low-dose steroid inhaler now and again in 15 minutes."b) "Have him use his short-acting bronchodilator right away." Explanation: The child's symptoms and drop in PEFR suggest a medical alert or "red" situation, indicating the need for the short-acting bronchodilator and then a trip to the office or emergency department. The child should use his short-acting bronchodilator first and then go to the physician's or nurse practitioner's office or emergency room. Waiting for a greater drop in his PEFR readings would be inappropriate because the child is experiencing an acute condition that warrants immediate attention. The child is experiencing an acute situation and requires immediate attention. A low-dose steroid inhaler would not be appropriate because it would not help his bronchospasm.Question: The nurse is working with the parents of a child with cystic fibrosis, teaching them how to perform chest physiotherapy. The nurse would instruct the parents to percuss the segments of the lungs for 1 to 2 minutes each. The parents demonstrate the proper technique by demonstrating percussion of the lower lobes. Place these segments in the order in which the parents would percuss them.Anterior basal segments Posterior basal segments Lateral basal segments Superior segments Explanation: When percussing the lower lobes, the anterior basal segments would be done first, followed by the posterior basal segment, lateral basal segments, and finally superior segments.Pneumonia is a disorder involving infection and inflammation of the fine bronchioles and bronchi. a) False b) Truea) False Explanation: Pneumonia is a disorder involving infection and inflammation of the alveoli. Bronchitis is inflammation and infection of the fine bronchioles and bronchi.The young child is wearing a nasal cannula. The oxygen is set at 3 L/minute. Calculate the percentage of oxygen the child is receiving?33 percent Explanation: Room air is 21%. Each 1 liter of oxygen flow is equal to an additional 4% of oxygen. The child is receiving 3 liters of oxygen. 21% (room air) + 3(4%) = 33% of oxygen.A child with a suspected airway obstruction is undergoing arterial blood gas analysis. Which of the following would suggest an airway obstruction? (Select all that apply.) a) SaO2 at 95% b) Low pH c) Increased PCO2 d) Decreased PO2b) Low pH c) Increased PCO2 d) Decreased PO2 Explanation: When children cannot evacuate accumulated CO2 because of an obstruction or hypoventilation, the partial pressure of CO2 (PCO2) in the arterial blood rises and the concentration of carbonic acid (formed when carbon dioxide dissolves in H2O in plasma) also rises. This leads to acidosis (a decrease in serum pH or an increase in acidity). In case of airway obstruction, the partial pressure of oxygen (PO2) would be decreased. Oxygen saturation at 95% is normal.Which test in a CF patient would help monitor airway function? a) Peak flow measurement b) Pulmonary function c) Bronchoprovocation d) Pulse oximetryb) Pulmonary function Explanation: The pulmonary function tests help measure airway function, lung volumes, and gas exchange. Bronchoprovocation provokes bronchospasms to determine airway constriction. Peak flow measurement measures lung velocity. Pulse oximetry monitors blood level oxygen saturation.The nurse is caring for an 11-year-old boy with pneumonia who is exhibiting an increased work of breathing. Which of the following would the nurse identify as the priority for this child? a) Providing supplemental oxygen as ordered b) Administering intravenous fluids as ordered c) Positioning the child in a comfortable position d) Administering analgesics as orderedc) Positioning the child in a comfortable position Explanation: Positioning the child in a comfortable position helps to open the airway and provide more room for lung expansion, resulting in more effective breathing patterns while supplemental oxygen and intravenous fluids are administered. Administering intravenous fluids would be appropriate once the child is positioned in a comfortable position. Oxygen would be administered after the child is positioned comfortably. Analgesics may be ordered and administered if the child is experiencing pain from coughing.A child with a suspected airway obstruction is brought to the emergency room. He produces a harsh, strident sound on inspiration (stridor). Where is the obstruction likely to be located, based on this information? a) Pharynx b) Lower trachea c) In the larynx d) Bronchiolesc) In the larynx Explanation: The vibrations produced as air is forced past obstructions such as mucus in the nose or pharynx, the noise produced is a snoring sound (rhonchi). If the obstruction is at the base of the tongue or in the larynx, a harsher, strident sound on inspiration (stridor) occurs. If an obstruction is in the lower trachea or bronchioles, an expiratory whistle sound (wheezing) occurs.Which diagnostic test is the most useful when a child has respiratory distress? a) Complete blood count b) EEG c) Venous blood gas d) Arterial blood gasd) Arterial blood gas Explanation: The most useful diagnostic test in respiratory distress is an arterial blood gas. Knowing normal blood gas values for children is very important for evaluation.The physician orders fluorescent antibody testing for a child with suspected respiratory syncytial virus infection. The nurse would obtain the specimen for testing from which of the following? a) Sweat b) Sputum c) Arterial blood d) Nasopharyngeal secretionsd) Nasopharyngeal secretions Explanation: A nasopharyngeal specimen is obtained for fluorescent antibody testing. Arterial blood gases require a specimen of arterial blood. A sputum specimen is used for a sputum culture. Collection of sweat on filter paper after stimulation is used for a sweat chloride test to diagnose cystic fibrosis.A child is at risk for infection related to a respiratory disorder. What would the nurse educate the family on to prevent infection? a) The type of medication needed b) Which friends can come and play c) Hygiene, hand washing d) The amount of exercise the patient needsc) Hygiene, hand washing Explanation: The nurse should evaluate the child and family understanding of techniques to prevent infection (hand washing, hygiene, rest, nutrition, and avoiding sick people). The other choices are important in the care of the patient but are not the number-one way to prevent the spread of infection.What is the leading cause of neonatal sepsis and death?Group B streptococcus Sepsis is a systemic overresponse to infection. It is very serious and can produce septic shock and death. In infants under the 3 months of age the most causative agents are group B streptococcus, Escherichia coli, Staphylococcus aureus, enteroviruses, and the herpes simplex virus. Any time a febrile, ill-appearing neonate is seen, a full septic work-up is done. Neonates have the poorest outcomes from sepsis. Neisseria meningitidis is one cause of sepsis in older children. The Epstein-Barr virus is a herpes virus that causes mononucleosis. The cytomegalovirus is a common herpes virus. It is spread through bodily fluids and is not necessarily a concern unless the person is immunocompromised or is pregnant.The student nurse is discussing the plan of care for a child admitted to the hospital for treatment of an infection. Which action should be taken first?Obtain blood cultures When treating a child suspected of having an infection, the blood cultures must be obtained first. The administration of antibiotics may impact the culture's results. A urine specimen may be obtained but is not the priority action. Intravenous fluids will likely be included in the plan of care but are not the priority action.The nurse is caring for multiple clients on the pediatric unit. Which child will the nurse see firsta child with erythema infectiosum experiencing fatigue and confusion A child with erythema infectiosum experiencing fatigue and confusion is showing signs of decreased oxygenation, possibly related to aplasia of erythrocytes caused by the virus. A child with signs and symptoms of decreased oxygenation should be seen first. Nausea and malaise are symptoms of chicken pox. A child with herpes simplex will most likely report pain an pruritis. Signs and symptoms of measles include photophobia and coryza.A nurse is preparing a presentation for parents about common childhood infectious diseases. What conditions would the nurse include as being caused by a tick bite? Select all that apply.Lyme disease Rocky Mountain spotted feverThe nurse is caring for a 5-year-old girl with scarlet fever. Which intervention will most likely be part of her care?Teaching proper administration of Penicillin VThe father of a child with mononucleosis is concerned with his child's fever and cough. The father asks when antibiotic therapy will begin. What is the best response by the nurse?"Mononucleosis is a viral infection so an antibiotic isn't used. We address the symptoms with appropriate therapy."The parents of a child voice concern to the nurse that they believe their child has Lyme disease but their physician won't do the proper testing. The nurse reviews the chart to determine if specific testing for the disease has been performed. Which tests is the nurse looking for?Enzyme immunoassay (EIA) Immunofluorescent assay (IFA) Western immunoblotWhich child will the nurse identify as being at greatest risk for developing a hospital-acquired infection (HAI)?an 18-month-old child receiving chemotherapy over 5 daysThe appearance of which hallmark clinical manifestation occurs in measles?Koplik spotsNursing students are learning about the infectious process. They correctly identify the first stage of an infectious disease to be which period?Incubation period Infection occurs when an organism invades the body and multiplies, causing damage to the tissue and cells. The infectious process goes through four stages. The incubation period is the first stage of the infectious disease. It is the time between the invasion of an organism and the onset of symptoms of infection. The prodromal period is the time from the onset of nonspecific symptoms to specific symptoms, for example, cold/flu-like symptoms before Koplik spots occur in measles. The illness is the time during which symptoms of the specific illness occur. The convalescent stage is the time when the acute symptoms disappear.A 10-year-old child has an unknown infection and will need to provide a urine specimen for culture and sensitivity. To assure that the sensitivity results are accurate, which step is most important?Obtain specimen before antibiotics are given In order to ensure a successful culture, the nurse must determine if the child is taking antibiotics. Throat cultures require specimens taken from the pharyngeal or tonsillar area. Stool cultures may require three specimens, each on a different day. The nurse would use aseptic technique when getting a blood specimen as well as the urine, but antibiotics cannot be received by the child prior to the test being done.A nurse practitioner suspects that a child has scarlet fever based on which assessment finding?Red, strawberry tongue The characteristic assessment finding that distinguishes scarlet fever from other disorders is the appearance of the red, strawberry tongue. Sore throat, an enanthematous and exanthematous rash, and white exudate on the tonsils are also seen with scarlet fever, but it is the strawberry tongue that helps to confirm the diagnosis.Parents bring their 9-year-old child to the clinic for a well-child visit. They are concerned because several children in the neighborhood have developed Lyme disease and ask for suggestions on what to do to reduce their child's risk. What would be appropriate for the nurse to suggest? Select all that apply.Wearing protective clothing when playing in wooded areas. Inspecting the skin closely for ticks after the child plays in wooded areas. Contacting the health care provider if there is any area of inflammation that might be a bite.Which child will the nurse identify as at greatest risk for developing a urinary tract infection?an 8-month-old bottle-fed female with HIV Factors that make an individual more prone to a urinary tract infection include young age, female gender, and immunosuppression. Infants who are formula-fed are at greater risk than infants who are breastfed. To determine the child at greatest risk, the nurse should count risk factors and determine which child has the most risk factors.A child in the clinic has a fever and reports a sore neck. Upon assessment the nurse finds a swollen parotid gland. The nurse suspects which infectious disease?Mumps Mumps is an infectious disease with a primary symptom of a swollen parotid gland. It is a contagious disease spread by droplets. The child is contagious 1 to 7 days prior to the onset of the swelling and 4 to 9 days after the onset of the swelling. Pertussis is a respiratory disorder that causes severe paroxysmal coughing, which produces a whooping sound. Measles is recognized by Koplik spots in the mouth and the classic maculopapular rash that starts on the head and spreads downward. Scabies is a skin condition where lice lay eggs under the skin. The rash is very pruritic and is seen on the hands, feet, and folds of the skin.The nurse is caring for a child whose family recently emigrated from a developing country. While completing the admission history, the parents report all the child's immunizations are up to date. Which nursing action is most appropriateAsk parents which immunizations have been given. Explanation: When caring for a child recently emigrated from a developing country, the nurse should be aware that WHO recommended vaccinations and U.S. recommended vaccinations may be different. The most appropriate action is for the nurse to determine which vaccinations have been given to decide if additional immunizations may be needed.A child is diagnosed with scarlet fever. History reveals that the child has no known drug allergies. When preparing the child's plan of care, the nurse would anticipate administering which agent as the drug of choice?Penicillin V Explanation: Penicillin V is the antibiotic of choice. In those sensitive to penicillin, erythromycin may be used. Trimethoprim-sulfamethoxazole and clarithromycin are not used.A group of nursing students are reviewing the functions of white blood cells. The students demonstrate an understanding of the information when they identify which white blood cell as responsible for combating allergic disorders?Eosinophils Explanation: Eosinophils function to combat allergic disorders and parasitic infestations. Neutrophils function to combat bacterial infections. Lymphocytes function to combat viral infections. Monocytes function to combat severe infections.A 6-year-old child is brought to the clinic by his parents. The parents state, "He had a sore throat for a couple of days and now his temperature is over 102°F (38.9°C). He has this rash on his face and chest that looks like sunburn but feels really rough." What would the nurse suspect?Scarlet fever Explanation: Scarlet fever typically is associated with a sore throat, fever greater than 101° F (38.9° C), and the characteristic rash on the face, trunk, and extremities that looks like sunburn but feels like sandpaper. CAMRSA is typically manifested by skin and tissue infections. Diphtheria is characterized by a sore throat and difficulty swallowing but fever is usually below 102°F (38.9°C). Airway obstruction is apparent. Pertussis is characterized by cough and cold symptoms that progress to paroxysmal coughing spells along with copious secretions.The nurse is caring for a child newly diagnosed with diphtheria. Which nursing interventions would the nurse include in the child's plan of care? Select all that apply.Administering antitoxin intravenously Monitoring for airway obstruction Adhering to droplet precautions Ensuring complete bed rest Explanation: Treatment of diphtheria involves intravenous administration of antitoxin in large doses. In addition, children are given penicillin or erythromycin intravenously. Complete bed rest is crucial during the acute stage of the illness. Droplet precautions must be followed until cultures are negative. Children need careful observation at all times to prevent airway obstruction. If obstruction occurs, endotracheal intubation may be necessary.While assessing a child, the nurse notes a runny nose, temperature 100.4°F (38°C), and a whoop sound when the child coughs. On which diagnosis will the nurse anticipate providing education for this family?pertussis Explanation: Pertussis, also known as whooping cough, begins as an upper respiratory illness and progresses to a persistent cough characterized by a whooping sound. Tuberculosis, influenza, and nasopharyngitis are not characterized by a whooping sound.The nurse is caring for an adolescent diagnosed with syphilis. The drug of choice for treating syphilis is:penicillin Syphilis responds to one intramuscular injection of penicillin G benzathine; if the child is sensitive to penicillin, oral doxycycline, tetracycline, or erythromycin can be administered as alternative treatment.The mother of a 10-year-old child diagnosed with rubella asks what can be done to help her child feel better during her illness. What information can be provided?Encourage rest and relaxation. Explanation: Rubella infection is usually mild and self-limited. The care given is normally supportive. Rest is encouraged. Medications administered are normally limited to anti-pyretics and analgesics. Antibiotic and antiviral therapies are not normally included in the plan of treatment. Range of motion is not needed as mobility of the client is not limited.Which diagnostic tool is used to identify children who may have an infection or inflammatory process?erythrocyte sedimentation rate (ESR) Explanation: Several laboratory tests can be performed to determine infection or inflammation. A complete blood count is used to determine elevation of the white blood cells, which would indicate infection. The erythrocyte sedimentation rate (ESR) is a nonspecific screening procedure used in conjunction with other tests to determine infection or inflammation. A blood culture is utilized to confirm the presence of bacteria or yeast and to determine which type of bacteria is in the bloodstream. Gastric lavage is used to identify TB in a child when bronchoscopy cannot be performed, or it can be used in emergency settings when the child has ingested a toxic substance. An arterial blood gas analysis is performed to determine if there is respiratory or metabolic alkalosis or acidosis.The nurse is assessing a child who presents with a history of fever, malaise, fatigue, and headache. The nurse notes a bulls-eye rash on the child's right leg. Which action will the nurse take?Notify the primary health care provider. Explanation: The nurse would suspect the child has Lyme disease and notify the health care provider for additional testing and potential antibiotic therapy. Precautions are not indicated for clients with Lyme disease. An ECG would only be needed if cardiac symptoms were noted. It is recommended to clean the site of the tick bite with rubbing alcohol when the tick is removed, not at a later time.The nurse is caring for multiple clients on the pediatric unit. Which child will the nurse see first?a child with erythema infectiosum experiencing fatigue and confusion Explanation: A child with erythema infectiosum experiencing fatigue and confusion is showing signs of decreased oxygenation, possibly related to aplasia of erythrocytes caused by the virus. A child with signs and symptoms of decreased oxygenation should be seen first. Nausea and malaise are symptoms of chicken pox. A child with herpes simplex will most likely report pain an pruritis. Signs and symptoms of measles include photophobia and coryza.When the health care provider looks in a child's mouth during a sick-visit examination, the parent exclaims: "The tongue is bright red! It was not like that yesterday." The health care provider would most likely prescribe which medication based on the probable diagnosis?Penicillin to prevent acute glomerulonephritis Explanation: A "strawberry tongue" is a classic sign of scarlet fever. Penicillin is prescribed to treat the beta-hemolytic group A streptococcal infection and to prevent the complication of developing acute glomerulonephritis and rheumatic fever. Erythromycin can be used to treat the disease if the child is allergic to penicillin. Antibiotics are not given prophylactically to siblings. The disease is spread via droplets, so keeping the siblings away from the infected child and handwashing are the best preventive measures. Acetaminophen can be administered for fever control. It works systemically and has very little, if any, affect locally. Antibiotics are the mainstay of treatment. Steroids are used infrequently.A chief danger of scarlet fever is that children may develop:acute glomerulonephritis. Explanation: Scarlet fever infection is the result of group A streptococci. It generally starts with a throat infection (strep throat). The bacteria produce a toxin that causes the rash over the body. Because this is a streptococci-based infection, the child will need to be monitored for the development of rheumatic fever or glomerulonephritis following the illness. Scarlet fever does not cause respiratory symptoms, attack the liver, or have open lesions.A 5-year-old girl catches the flu from a friend at day care after the friend sneezed and wiped mucus on a toy that the girl subsequently played with. In this case, what is the portal of exit in the chain of infection?Upper respiratory excretion Explanation: The portal of exit is the route by which an organism leaves an infected child's body to be spread to others. An organism can be carried out of the body by upper respiratory excretions, feces, vomitus, saliva, urine, vaginal secretions, blood, or lesion secretions. The friend would be the reservoir, which is the container or place in which an organism grows and reproduces. The toy would be the means of transmission. The 5-year-old girl would be the susceptible host.A 9-month-old child has been admitted to rule out sepsis. Which finding offers the most support to the presence of this disorder?The child has had 8 ounces of formula in the past 24 hours. Explanation: Sepsis is a systemic overresponse to infection resulting from bacteria and viruses, which are the most common fungi, viruses, rickettsia, or parasites. It can lead to septic shock, which results in hypotension, low blood flow, and multisystem organ failure. Signs of sepsis include a lack of appetite, lethargy, hypotonia, and temperature elevations.What is a true statement regarding varicella zoster virus infection?Secondary bacterial infections of the skin can occur. Explanation: Varicella zoster virus infection carries with it the complication of a secondary bacterial infection of the skin. The lesions are intensely pruritic, making the child want to scratch the lesions and opening them to a variety of organisms to invade. The incubation period is 10 to 21 days. It is transmitted by direct contact with the vesicles and by airborne route. It tends to be more severe in adolescents and adults.The nurse is preparing to administer acetaminophen to a 4-year-old child to provide comfort. Which precaution is specific to antipyretics?Ensure proper dose and interval Explanation: It is very important to ensure that the proper dose is given at the proper interval because an overdose can be toxic to the child. Concerns with allergies and taking the entire, prescribed dose are precautions when administering antibiotics and all medications. Drowsiness is not a side effect of antipyretics.The parents of a 4-month-old diagnosed with sepsis tell the nurse that the physician explained sepsis to them but they don't really understand it. The parents state, "Could you please explain it to us?" What is the best response by the nurse?"The infection your child has causes the release of toxins into the system, which can lead to impaired function in the lungs, liver, and kidneys."The nurse is caring for a child admitted to the hospital for sepsis. Which assessment finding is the most concerning?urine output of 10 ml over 3 hours Explanation: Children with sepsis will show alteration in temperature, heart rate, respiratory rate, and white blood cell count. Septic shock with organ dysfunction is more serious and can be manifested by decreased urine output.The nurse is caring for a term neonate suffering from meconium aspiration in the nursery. The nurse reviews orders for a peripherally inserted central catheter (PICC) line placement and intubation. Which statement demonstrates the nurse's knowledge of painful procedures as related to a neonate?The newborn's pain pathway components are developed enough at birth to experience pain.Which statement is the goal of distraction techniques used to control pain?to divert the child's attention away from the pain through controlled, purposeful behaviorsThe nurse is caring for a pediatric client following an open appendectomy. The client rates the pain an "8" on a 0 to 10 pain scale and the nurse administers morphine sulfate intravenously to the client per the primary health care provider's prescription. Which nursing action is priority following administration of the medication?Monitor the client's respiratory status.The nurse is caring for a child who is experiencing postoperative pain after having undergone surgery several hours ago. The child's parent reports having taken meperidine for postoperative pain and wonders if that medication would be of benefit to the child. What response by the nurse is indicated?"Meperidine is associated with toxicity issues in children and is usually avoided."Which type of medication lacks a ceiling effect, and therefore is prescribed in initial doses that must be titrated to achieve pain relief while managing side effects?morphineThe nurse is caring for a 2-year-old postoperative PET client. Which consideration is the most appropriate for this child's developmental stage?uses words for pain such as owie, boo-boo, or hurtThe nurse is caring for a 9-year-old boy with episodes of chronic pain. The nurse is educating the parents how to help the child manage pain nonpharmacologically. Which statement indicates a need for further teaching?"We should start the method after he feels pain."The nurse is preparing to assess the postsurgical pain level of a 6-year-old boy. The child has appeared unwilling or unable to accurately report his pain level. Which assessment tool is most appropriate for this child?FLACC Behavioral scale The FLACC behavioral scale is a behavioral assessment tool that is useful in assessing a child's pain when the child is unable to report accurately his or her level of pain or discomfort and is reliable for children from age 2 months to 7 years. The preferred base age for the visual analog and numerical scales is 7 years . The FACES pain rating scale and Oucher pain rating scale are appropriate for children as young as 3; however, in this situation the FLACC is required due to the child's inability to report his level of pain.The nurse is caring for a 5-year-old child who underwent a painful surgical procedure earlier in the day. The nurse notes the child has not reported pain to any of the nursing staff. Which action by the nurse is indicated?Observe for behavioral cues consistent with painWhat are some negative effects that chronic pain can have on the pediatric population?sleep disturbances, exhaustion, irritability, mood disturbances, and depressionA nurse is applying EMLA as ordered. The nurse understands that EMLA is contraindicated in which situation?Infants less than 12 months of age receiving methemoglobin-inducing agents EMLA is contraindicated in children less than 12 months who are receiving methemoglobin-inducing agents, such as sulfonamides, phenytoin, phenobarbital, and acetaminophen. Children with darker skin may require longer application times to ensure effectiveness. EMLA is not contraindicated for children less than 6 weeks of age or those undergoing venous cannulation or intramuscular injections.The nurse is caring for a 2-year-old child who has been hospitalized after being injured in an automobile accident. During the assessment the child is quiet and watchful of all the nurse's actions. When considering the level of pain being experienced by the child what inference can be made?The child's nonverbal behaviors may indicate the presence of discomfort. Responses to pain can vary in children. A child of this age may present with vocal behaviors indicating pain. The child may be tearful or crying loudly. Being quiet can also signal pain.The nurse is caring for a client receiving opioid medication for the treatment of postoperative pain. What are common side effects that the nurse should observe for?respiratory depression, constipation, and pruritisAn adolescent is experiencing severe pain due to a sickle cell crisis. Which medication would be best for the nurse to administer?hydromorphone For managing severe or acute pain, such as postoperative pain or the pain of a sickle cell crisis, opioids (e.g., morphine, oxycodone, and hydromorphone) are frequently prescribed. NSAIDS and acetylsalicylic acid would not help severe pain.The nurse is caring for a pediatric client following an open appendectomy. The client rates the pain an "8" on a 0 to 10 pain scale and the nurse administers morphine sulfate intravenously to the client per the primary health care provider's prescription. Which nursing action is priority following administration of the medication?Monitor the client's respiratory status. It is priority for the nurse to assess the client's respiratory status after administering a narcotic medication. The nurse would reassess the client's pain level and document; however, these are not priority over monitoring the respiratory status. Playing a game may help distract theA 4-year-old child is scheduled for an MRI. The child's parent is informed that the child will be free of pain but sedated to ensure stillness during the procedure. Which type of anesthesia does the nurse expect this child to have?Conscious sedation Explanation: Conscious sedation refers to a state of depressed consciousness, usually obtained through IV analgesia therapy. The technique allows a child to be both pain-free and sedated for a procedure. The child is monitored throughout the process by a nurse. PCA is a pump that delivers pain medication and allows the client to receive medication via continuous infusion or bolus dose. General anesthesia means the client loses all reflexes. This is not necessary for an MRI and it would have to be administered and monitored via an anesthesiologist. An IM injection is painful and frightens the child. It is not necessary when oral and IV medications can be used.The nurse is caring for a group of children who have had recent surgery. Which children will the nurse question to determine the location of their pain? Select all that apply.3-year-old post tonsillectomy 4-year-old with a fractured tibia 5-year-old with sickle cell crisis 6-year-old with juvenile arthritis 7 year old post appendectomy DONT ASK THE 2 YEAR OLD WHO DOESNT UNDERSTAND WELL ENOUGHThe neonatal nurse is assisting the health care provider with a circumcision. Which pain relief method would be most beneficial?anesthetic creamThe nurse is caring for a client who has been diagnosed with a tumor in the small intestine that is pressing on the liver. Which type of pain does the nurse anticipate the client will complain of?Visceral Explanation: Visceral pain is often produced by disease. It usually is diffuse and poorly localized and is described as a deep ache or sharp stabbing sensation that may be referred to other areas. Deep somatic pain typically involves the muscles, tendons, joints, fasciae, and bones and causes dull, aching, or cramping pain. Neuropathic pain usually results in burning, tingling, shooting, squeezing, or spasm-like pain. Chronic pain is defined as pain that continues past the expected point of healing for injured tissue.Visceral Explanation: Visceral pain is often produced by disease. It usually is diffuse and poorly localized and is described as a deep ache or sharp stabbing sensation that may be referred to other areas. Deep somatic pain typically involves the muscles, tendons, joints, fasciae, and bones and causes dull, aching, or cramping pain. Neuropathic pain usually results in burning, tingling, shooting, squeezing, or spasm-like pain. Chronic pain is defined as pain that continues past the expected point of healing for injured tissue.After achieving a relaxed state, begin by guiding the 13-year-old client to image of walking down a sandy beach and collecting seashells, a favorite activity. Imagery begins with achieving a relaxed state. Then, the nurse guides the child to choose a favorite place. Imagery involves the use of imagination to create a mental picture. This image is positive and pleasurable. The child associates the image with colors, sounds, smells, or feelings. When using guided imagery, the nurse should not lead the child. The nurse lets the child become immersed in the personal image and take command of the experience. Guided imagery is not appropriate for preschool-age children and toddlers.The nurse is caring for a burn client with orders for oral ibuprofen and morphine PRN to control pain. Which nursing interaction is the most beneficial for the nurse to implement for pain management?Alternate these medications around the clock to diminish peaks and valleys in pain control.The nurse is providing family education for the administration of ibuprofen. Which response indicates a need for further teaching?"This can be taken with other medications we have at home that didn't require a prescription." The nurse must emphasize that the parents should carefully read labels of over-the-counter medications they already have or will purchase. Some may contain ibuprofen or other nonsteroidal anti-inflammatory drugs, and if given in conjunction with ibuprofen may lead to overdose. The other statements are correct.A client comes to the clinic following an ankle injury. The nurse anticipates which therapeutic effect of heat if applied to injury site?Capillaries dilate and edema reduces to the lower extremityA 7-year-old boy tells the nurse that his head sometimes hurts after he eats ice cream. The nurse recognizes that this type of pain is:Acute referred pain Acute pain means sharp pain, as is the case in this scenario. It generally occurs abruptly after an injury. The pain of a pin prink is an example. Chronic pain is pain that lasts for a prolonged period or beyond the time span anticipated for healing. Referred pain is pain that is perceived at a site distant from its point of origin. In this case, the typical ice cream "brain freeze" is a headache that results from the contact of the cold ice cream with the digestive tract.An infant has a surgical repair of a congenital heart defect. In the immediate postoperative period, which scenarios best indicate that the infant is in pain? Select all that apply.The infant appears restless and wrinkles the face. The best objective data that the infant is experiencing pain include a flexed body position, crying, a wrinkled face, a clenched fist or the inability to find a restful position. Crying when the parent picks up the infant potentially indicates pain or discomfort due to a position change. Physiological changes can also include changes in the infant's vital signs. Infant fatigue may cause a poor suck. Poor interaction may indicate fatigue or a potential bonding issue.The nurse is preparing a 6-year-old for a venipuncture. The boy appears anxious and is crying. How can the nurse foster feelings of control to help minimize his anxiety about the procedure?"Pick your favorite Band-Aid and show me which arm to use." Allowing the child options related to the style of the Band-Aid and the extremity to use gives the child some control over the happenings. Offering a pinwheel is a distraction technique. Encouraging the parent to hold the child during the procedure promotes feelings of security. Encouraging the child or parents to ask questions facilitates communication.The nurse is caring for a 9-year-old boy with episodes of chronic pain. The nurse is educating the parents how to help the child manage pain nonpharmacologically. Which statement indicates a need for further teaching?"We should start the method after he feels pain."A nurse is assessing the pain level of an infant. Which finding is not a typical physiologic indicator of pain?Decreased heart rateThe nurse is caring for a 12-year-old with cerebral palsy who is unable to communicate verbally. Which pain assessment tool is the most appropriate for the nurse to use when assessing pain in this client?Face, leg, activity, cry, and consolability (FLACC) descriptorsThe nurse is caring for a 17-year-old child who was sprained her ankle. The physician has prescribed ibuprofen to manage the pain. What statement by the teen indicates the need for further instruction?"This medication should be taken on an empty stomach."A new nurse is orienting to the newborn nursery and asks the nurse mentor why newborns were not considered to experience pain. How does the mentor explain the rationale used in the past that infants do not experience pain?incomplete nerve myelination In the past, it was believed that infants do not feel pain because of incomplete myelination of peripheral nerves. Evidence-based practice has shown this not to be true because myelination is not necessary for pain perception. Immature nervous system, age, and assessment tools were not factors in prior beliefs that infants do not perceive pain.A 7-year-old boy tells the nurse that his head sometimes hurts after he eats ice cream. The nurse recognizes that this type of pain is:Acute referred pain Acute pain means sharp pain, as is the case in this scenario. It generally occurs abruptly after an injury. The pain of a pin prink is an example. Chronic pain is pain that lasts for a prolonged period or beyond the time span anticipated for healing. Referred pain is pain that is perceived at a site distant from its point of origin. In this case, the typical ice cream "brain freeze" is a headache that results from the contact of the cold ice cream with the digestive tract.A client is experiencing nociceptive pain as a result of a cancerous tumor of the bladder that has metastasized to other organs. What types of pain does the nurse expect the client to report?Dull Deep aching Sharp stabbingA 5-year-old child has been admitted to the hospital and is going to have an IV started in the procedure room. Which instructions will be most helpful for the child and the parent?Have the parent sing softly to the child during the procedure.A parent expresses concern about a 3-year-old child's pain while having blood drawn and asks the nurse what she can do to help the child. Which response by the nurse will be most beneficial?"Focus on a story during the blood draw." Explanation:The nurse is aware of the special needs of children related to pain assessment. What is the priority for the nurse to consider when completing a pain assessment?Developmental age of child Although all of the options are important for assessing pain in children, the priority to provide an appropriate pain assessment is knowing the developmental age of the child. The chronological and developmental ages may differ and care needs to be based on both, but the type of pain assessment tool used will be based on the developmental age. For children who are nonverbal the nurse needs to also consider the parent's statement of pain in the child.The nurse has provided teaching of nonpharmacologic pain management to the parents of a 3-year-old child experiencing postoperative pain. Which comments by the parents indicate that the teaching was effective? Select all that apply."I'm not sure if I am imagining it, but I think my child seems to be in less pain when I rock her." "My child seems to cry a lot less with medical procedures if we are reading a book together." "One of the nurses blows bubbles with our child every time they are preparing to perform a procedure, then allows our child to do the same during the procedure. It really helps." "I try to remind our child to think about our dog at home. Our dog is like a big cuddle toy to our child."A nurse is caring for a child who is grimacing but reports having no pain. What might be the rationale for a child being reluctant to express pain?fearing getting a "shot" to relieve the painThe nurse is assisting with the administration of the child's initial dose of parenteral opioids. Which action should the nurse take first?Ensure naloxone is readily available When administering parenteral or epidural opioids, the nurse should always have naloxone readily available in order to reverse the opioids effects, should respiratory distress occur. Premedication with acetaminophen is not required with opioids. After administration, the nurse should continually assess for adverse reaction. The nurse should assess bowel sounds for decreased peristalsis after administration.A nurse is administering ear drops to a 7-year-old girl. What should the nurse do?Pull the pinna of the ear up and back to straighten the external ear canal. Explanation: Remind the child ear drops can feel odd, as if someone were tickling the ear. Ear drops must always be used at room temperature or warmed slightly as cold fluid, such as medication taken from a refrigerator, does cause pain and may also cause severe vertigo as it touches the tympanic membrane. If the child is older than 2 years, pull the pinna of the ear up and back. Instill the specified number of drops into the ear canal. Hold the child's head in the sideways position while you count to 60 to ensure the medication fills the entire ear canal.The nurse is preparing to administer regular insulin to a nonverbal pediatric client. Which action will the nurse perform prior to administering the medication?Check the full name and birth date on the client's wristband with the medication administration record. Explanation: When administering medications to a child, the nurse needs to use at minimum two client identifiers that are directly associated with the client and the medication to be given, such as full name, client ID number, and birth date. The nurse will take the medication administration record to the room to perform a "double-identifier" check. A client's identity must be verified with two acceptable identifiers, not just one. There is no need to have another nurse verify or have the parent state the client's information. A room number or a bed number is not an acceptable identifier.The nurse is preparing to administer an IV antibiotic to a child. After calculating the recommended dose with the child's weight, the nurse discovers the prescribed dose exceeds the safe dose range in a pediatric drug book. The medication has been given to the child at this dose for 3 days. What action should the nurse take next?Verify the dose with the prescribing health care provider. Explanation: Medication calculations should always be checked before giving the dose. When a medication dose is found to be outside of the safe dose range, the dose should be verified with the prescribing health care provider. Doses that exceed the recommended range should always be verified, even if they have been given before. The parents did not prescribe this medication. Even if the medication has been given for 3 days, it does not make the dose correct. Calling the pharmacy can only verify if the dose is out of the safe range. The pharmacy did not prescribe the medication nor does it know the child's medical background.What method would the nurse use to teach an 8-year-old client how to swallow medications?Have the child practice swallowing an ice chip. Explanation: Hiding the pill in applesauce or crushing it may help the child swallow it easier, but it does not teach the child how to swallow a pill. The nurse should have the child practice swallowing a small piece of ice, as it will melt and not get stuck in the throat. It is best to put the pill as far back on the tongue to make it easier to swallow.A nurse is preparing to give an intramuscular (IM) injection to an infant. Which site does the nurse identify as mandatory for this administration?Vastus lateralis muscle For IM injections in infants, the mandatory site for administration is the vastus lateralis muscle of the anterior thigh. This site should be used for all IM injections in infants younger than 7 months of age. After 7 months of age, the ventrogluteal muscle can be used also. The dorsogluteal muscle should not be used for children. The muscles are not fully developed and the sciatic nerve occupies a large portion of this area. The deltoid muscle is used for older children as well as for adults.The nurse is preparing to administer an intramuscular immunization to a 5-year-old child. What statement to the child is appropriate for inclusion in the preadministration period?"This will help prevent you from getting sick." Explanation: When providing teaching to a child it is important to be open, honest and provide developmentally appropriate information. Explaining that this will prevent later illness is something a child can understand. Saying that pain may result if movement occurs is a scare tactic and counterproductive. Yes, this is an immunization but this is terminology that is too complex for a child. Using the word "shot" is scary for the child and should not avoided if possible.he new graduate nurse is preparing to administer medication to a 4-year-old client. When would it be appropriate for the supervising nurse to intervene? The new graduate:had two whole tablets to administer to the child. Explanation: Many children do not have enough coordination to swallow tablets or pills until they are 6 or 7 years of age. Therefore, the supervising nurse would need to intervene. The other actions are correct. The nurse should explain why the medication is being administered. Medications in children are dosed according to body weight (milligrams per kilogram) or body surface area (BSA) (milligrams per square meter). The vastus lateralis is a good location for an IM injection in a 4-year-old child. Reference:A nurse is providing care for a child diagnosed with beta-thalassemia. The child requires a blood transfusion of packed red blood cells (PRBCs). The health care provider has prescribed a transfusion volume of 10 ml/kg. The child weighs 37 lb (16.8 kg). How many milliliters should the nurse infuse?168 Explanation: The nurse will use the client's weight in kilograms and multiply by the prescribed milliliters/kilogram 16.8 kg × 10 ml PRBCs = 168 mLlIn caring for the child with asthma, the nurse recognizes that bronchodilator medications are administered to children with asthma for which reason?Relief of acute symptoms Explanation: Bronchodilators are used for quick relief of acute exacerbations of asthma symptoms. Mast cell stabilizers help to stabilize the cell membrane by preventing mast cells from releasing the chemical mediators that cause bronchospasm and mucous membrane inflammation. Leukotriene inhibitors are given by mouth along with other asthma medications for long-term control and prevention of mild, persistent asthma. Bronchodilators are not effective for pain.----He needs to take his medicine or he will lose a privilege." The nurse should emphasize that the parents should never threaten the child in order to make him take his medication. It is more appropriate to develop a cooperative approach that will elicit the child's cooperation since he needs ongoing, daily medication. The other statements are correct.The nurse is administering an intramuscular injection of an antibiotic to a 3-month-old infant. Which would be the best site for the nurse to give this medication?vastus lateralis muscle The muscle preferred for intramuscular injections in the infant less than 7 months of age is the vastus lateralis, located on the thigh. The ventrogluteal and deltoid are used in older children to adults. The dorsogluteal is no longer considered suitable for an intramuscular injection due to the risk of injury to the sciatic nerve.A child needs a peripheral IV start as well as a venous blood sample for a laboratory test. The nurse will take what action?Coordinate placing the peripheral IV and the lab blood draw. Explanation Coordinate the IV placement and lab blood draw to minimize the number of venipunctures for the child. Gaining venous access for each purpose separately does not do this and is not necessary. Having a well-hydrated child makes venous access easier, but oral hydration will take some time, thus delaying needed treatment.What are possible complications for a child with a vascular access port? Select all that apply.infection thrombosis hemorrhage air embolismA 3-year-old client is being admitted for a tonsillectomy. The nurse notes the client is fussy, crying, and appears nervous about the procedure. Which action by the nurse will be most helpful in alleviating the child's anxiety?Explain the procedure to the child using dolls and medical equipment. The nurse will explain the procedure to the client using dolls and medical equipment to help the child understand what will happen. This is most appropriate for a client this age. It is appropriate to provide a tour of the operating room, but not show a video due to the child's developmental age. Deep-breathing exercises are not appropriate for a preschool-age client, nor is having another client talk with the child.A family the nurse is working with administers cycled total parenteral nutrition (TPN) over a 12-hour period at night to free their teenage son for activities during the day. In teaching this family, what areas would the nurse stress? Select all that apply.Administering the solution at half-rate during the first and last hour of the infusion Inspecting the insertion site of the catheter regularlyThe nurse is calculating the urinary output for the infant. The infant's diaper weighed 40 grams prior to placing the diaper on the infant. After removal of the wet diaper, the diaper weighed 75 grams. How many milliliters of urine can the nurse document as urinary output? Record your answer using a whole number.35 Explanation: The diaper must be weighed before being placed on the infant and after removal to determine urinary output. For each 1 gram of increased weight, this is the equivalent of 1 milliliter of fluid. 75 grams - 40 grams = 35 grams = 35 mLA child who is receiving TPN has developed the need to have insulin injections. The child's mother questions this and states that her child does not have diabetes. What is the appropriate response by the nurse?"The feedings are high in sugar and insulin is needed to manage this." Explanation: Glucose levels may be elevated when TPN is administered. While illness can impact serum glucose levels, this is not an appropriate response. Telling the parent there is no need to worry minimizes concerns and is not a correct response. The child does not have diabetes but warrants insulin coverage.A child with HIV, weighing 25 kg (55.1 lbs), is about to receive an infusion of IVIG. The recommended dose is 400 mg/kg/dose. The medication is available in a concentration of 50 mg/mL. What is the proper amount of infusion that the child will receive?200 mL Explanation: The dose is calculated as 25 x 400 = 10,000 mg. Because the concentration is 50 mg/mL, calculate the volume as 10,000/50 = 200 mL.The nurse is preparing an emergency IV site for a child who has been admitted to the hospital with burns on his arms, legs, and torso. Which IV site would be most appropriate?intraosseous Explanation: Intraosseous infusion is used in an emergency when it is difficult to establish usual IV access or in a child with such extensive burns that the usual sites for IV infusion are not available. The other sites would not be available in this situation.A nurse is providing care for a child diagnosed with beta-thalassemia. The child requires a blood transfusion of packed red blood cells (PRBCs). The health care provider has prescribed a transfusion volume of 10 ml/kg. The child weighs 37 lb (16.8 kg). How many milliliters should the nurse infuse?168 Explanation: The nurse will use the client's weight in kilograms and multiply by the prescribed milliliters/kilogram 16.8 kg × 10 ml PRBCs = 168 mLlThe pediatric nurse recognizes that what statement is true regarding medications administered via the intravenous route?Giving medications through the intravenous route is less traumatic than multiple injections. Explanation: Delivering medications intravenously is actually less traumatic than administering multiple injections. An injection into the fatty tissue between the skin and the muscle is a subcutaneous injection. Medication absorption is quickest via an IV route. When performed properly, all routes of medication administration are safe.Parents asks the nurse why their premature infant is receiving a feeding through the mouth rather than the nose. What is the best explanation by the nurse?Newborns are obligate nose breathers so nasogastric may obstruct their breathing. Explanation: Whether enteral catheters should be passed through the nares or the mouth is controversial. Because newborns are obligate nasal breathers, passing a catheter through the nose may obstruct their breathing space, and repeated insertion of a nasogastric tube can cause inflammation and obstruction of the nose; thus most tubes are inserted orally in small infants. Orogastric insertion can also decrease the possibility of striking the vagal nerve in the back of the throat and causing bradycardia, whereas nasogastric tubes increase the possibility of striking the vagal nerve.The primary health care provider prescribed ketoconazole for a child with ringworm. Which statement by the parents indicates the nurse needs to provide additional teaching on the prescription?"I will wrap the skin tightly after applying the medication." Explanation: Ketoconazole is an antifungal used to treat tinea infections. The nurse would teach to avoid covering treated skin areas with tightly. The area needs to allow for air to circulate to the skin in order to limit side effects. All other statements indicate correct understanding.A health care provider has prescribed hydroxyurea 20 mg/kg to a child as part of a treatment regimen for sickle cell disease. The child weighs 27 lb (12.2 kg). How many milligrams should the nurse administer?244 Explanation: The nurse will use the client's weight in kilograms and multiply by the prescribed milligrams per kilogram. 12.2 kg × 20 mg/kg = 244 mgThe nurse is caring for a 13-year-old client. The nurse prepares and verifies several medications and brings them and the medication administration record to the client's room. The nurse observes that the client is not wearing an identification band. Which action will the nurse to take?Ask the client to recall his or her name and date of birth. Explanation: If the client does not have an identification band in place, the nurse must first identify the client before administering any medication. A parent should identify an infant or younger child. The nurse can ask an older child his or her name and date of birth or other identifier. There is no need to notify the prescribing health care provider. The nurse should call the admitting department at a later time to obtain a new identification band. Locating another RN to identify the client is not necessary.While working in the emergency room, the nurse receives a call that a 3-year-old child sustained extensive burns in a house fire. Assuming all of the following actions are included in the standing burn-care protocol, which action should be the nurse perform first?Obtain a weight. Explanation: A burn victim will require large amounts of fluid hydration to replace fluid losses. Obtaining a weight provides a base for calculating the fluid that will need to be replaced. Nasogastric tube placement and/or drinking milk are not actions to take at this point. Tetanus can be given later and is not critical to active management.A pediatric client is having difficulty breathing. Which nursing intervention is appropriate for this client?Provide oxygen as needed to maintain oxygen saturation above 93% Explanation: The nurse would provide oxygen to increase oxygen saturation as needed for this child. A decrease in oxygen saturation will cause the child to have an increase in the work of breathing. The positioning does not promote an open airway. Having family members leave the room could increase the child's anxiety, which would worsen the respiratory status. Continuing to monitor the child provides no assistance or relief.When administering medications to an infant, what information would be most important for the nurse to consider?The oral medication should be directed toward the posterior side of the mouth when using a syringe or dropper.] A syringe or dropper should be directed toward the posterior side of the mouth with the infant in the upright position when administering an oral medication.The nurse is mentoring a newly graduated nurse on the pediatric unit. Which action by the new nurse requires further instruction when preparing an intramuscular injection for a 6-month-old? Select all that apply.The nurse prepares to administer 0.7 mL of solution using one injection The nurse prepares to inject the medication into the ventrogluteal site Explanation: No more than 0.5 mL of medication should be administered intramuscularly to an infant, and the preferred site is the vastus lateralis muscle due to muscle development. A 5/8 to 1 inch, 22-25 gauge needle is the preferred range for an infant. Viscosity (thickness) of the medication must be considered when choosing the needle size in order to ensure proper administration.A nurse is providing care for a child diagnosed with beta-thalassemia. The child requires a blood transfusion of packed red blood cells (PRBCs). The health care provider has prescribed a transfusion volume of 10 ml/kg. The child weighs 37 lb (16.8 kg). How many milliliters should the nurse infuse?168 Explanation: The nurse will use the client's weight in kilograms and multiply by the prescribed milliliters/kilogram 16.8 kg × 10 ml PRBCs = 168 mLlA neonate is to receive a hepatitis B vaccine within a few hours after birth. What is the best approach for the nurse to take when giving this medication?Administer the medication in the neonate's vastus lateralis with a 25-gauge needle. Explanation: The vastus lateralis site is a safe choice for intramuscular (IM) injections in a neonate. A 22- to 25-gauge needle is recommended for neonates, but the nurse must assess the neonate's size before determining needle size to use. The 25-gauge needle is recommended for neonates. The dorsogluteal site should not be used until school age. Neither the deltoid muscle nor the dorsogluteal muscle are recommended IM sites for neonates. These muscles should not be used until toddler age or older. The volume of the medication should not exceed 0.5 ml per injection until the child is preschool age.The nursing student identifies which technique as the correct one to use when giving oral medications to an infant?Use a dropper and slowly inject the liquid into the side of the infant's mouth. Explanation: When giving liquid medication to an infant or child, the nurse should never administer it while the child is flat. Doing so could cause a child to aspirate. The nurse uses the dropper by placing it so the fluid flows slowly into the side of the child's mouth. The nurse should make sure the end of the syringe rests at the side of the infant's mouth to help prevent aspiration as well.The charge nurse is assisting the new graduate nurse in administering eye drops to a child. The charge nurse would stop the new graduate if which action was observed?holds the eyelids apart for about 30 seconds Explanation: To prevent the conjunctiva from drying, the nurse should not hold the eyelids apart any longer than necessary. Therefore, the charge nurse would need to stop the new nurse. It is best to use the supine position. Instill the correct number of drops into the conjunctiva of the lower lid. Allow the eyelid to close. Avoid placing the drops directly on the cornea because that can be painful. To prevent the conjunctiva from drying, do not hold the eyelids apart any longer than necessary. After the child has blinked 2 or 3 times, allow the child to sit up.A child is having difficulty swallowing pills. What is the best action for the nurse to take to help this child swallow medications?Place the pills in a bite of ice cream or applesauce. Explanation: The most useful technique when children cannot swallow pills is to put them into some ice cream or applesauce. This allows the medication to be administered in the original form. The nurse should not use candy for practice, because this may suggest to the child that medicine is the same as candy. The nurse should never crush medications which are enteric coated or time released. The nurse shoulThe nurse is showing the student nurse how to flush a pediatric client's peripherally inserted central catheter (PICC) line. The nurse prepares a 3-mL normal saline flush using a 5-mL syringe. The student asks the nurse why the flush was prepared this way. What is the most accurate response by the nurse?"Using a larger-volume syringe exerts less pressure on the PICC line." Explanation: Using a larger-volume syringe (i.e., 5 mL or larger) exerts less pressure on the PICC, thereby reducing the risk of rupture.A 4-year-old child is being prepared to undergo a bronchoscopy to remove an aspirated pea. The nurse knows that the parents need additional teaching based on which statement?We will be able to take our child home immediately after the procedure is completed." Explanation: The child will not leave immediately. Procedural complications are not common but may include compromise to the airway such as hemorrhage, pneumothorax, and airway edema. After the procedure, the nurse will need to continue to assess the child's respiratory function and airway patency. Postprocedure complications may include bronchospasm, stridor, desaturation, or respiratory distress. The nurse will observe children carefully the first time they drink after the procedure to assess that the gag reflex is intact and they do not choke. All of the other options are correct.The parent of a child with a central venous catheter expresses concern about whether the catheter could fall out when the child goes home. What is the nurse's best response?There is a tiny cuff under the skin that secures the catheter. Explanation: Central venous catheters have a wrinkle-resistant fabric cuff that adheres to the subcutaneous tissue and helps to seal the catheter in place and keep out infection. The cuff does not cushion the tubing, facilitate flushing, or prevent rejection.The nurse is administering an oral liquid medication to a 5-year-old child. What would be the most appropriate for the nurse to do when administering this medication?Let the child hold the medication cup. Explanation: Droppers and oral syringes can be used to administer medications to infants and young children. Medication cups and spoons can be used to administer liquid medications to the older child. The child can hold the medication cup and drink the liquid medication. Depending upon the age of the child, he or she may still prefer to take liquid medications via the syringe. It makes taking the medication fun when the child can squirt it into the mouth by himself or herself. The child who is lying down when being given medications should have the head of the bed elevated to at least 45 degrees A 5-year-old child does not need to be restrained for medication administration.A 4-year-old child is admitted to the hospital for surgery. Before the nurse administers medicine, the best way to identify the child would be to:read the child's armband. Explanation: A child may answer to the wrong name or deny his or her identity to avoid an unpleasant situation or if scared of the unknown. If the child is avoiding the situation he or she may fail to answer. Using the child's nickname is okay in conversation but it is not a legal identification of the child. To verify the correct identity the nurse should verify the child's armband and the correct name with the child's caregiver. Bar code scanning the child's armband would also be a correct method of identification.A 5-year-old boy is receiving an analgesic intravenously while in the hospital. What should the nurse do to determine whether the drug is being properly excreted from this child?Monitor the childs fluid intake & outputThe nurse is educating the parents of a 5-month-old on how to administer an oral antibiotic. Which response indicates a need for further teaching?"We can mix the antibiotics into his formula or food." Explanation: Never mix a medication with formula or food. The child may associate the bitter taste with the food and later refuse to eat it.A child is being discharged from the hospital and the nurse has completed discharge teaching regarding prescribed liquid medications. Which comments by the parent demonstrates understanding of discharge instructions for safe medication administration? Select all that apply."I need to make sure to use the medicine dropper the pharmacy gives me instead of the syringe I use for my B12 injections." "I shouldn't use a liquid dropper from my kitchen because it may be a different measurement than one from the pharmacy." "I will be sure to not give too much of the liquid medication at one time." Only droppers given by the pharmacy for the specific medication should be used. Different syringes may have different measurements than pediatric oral syringes. Mixing medication syringes is avoided if a dropper is packaged with a certain medication since the drop size may vary from one dropper to another. Giving small amounts of liquid avoids aspiration. Pinching the child's nose increases the risk for aspiration and interferes with the development of a trusting relationship.The nurse is caring for a 12-year-old post-appendectomy client who weighs 86 pounds. The child has a temperature of 38.5ºC (101.3ºF). The nurse prepares to give the client a dose of oral acetaminophen. The order reads "Tylenol 15mg/kg/dose every 4 to 6 hours PO PRN for fever or pain." How many milligrams of Tylenol should the nurse give the client?587 milligrams Explanation: The child's weight must first be converted to kilograms by dividing 86 by 2.2. The result is 39.1 kilograms. Next, the 39.1 kilograms must be multiplied by 15 milligrams. This answer is 587 milligrams.A child with gastroenteritis has been unable to keep oral medication down. What nursing intervention would be appropriate for this client?Request an intravenous form of the medication. Absorption is the transfer of the drug from its point of entry into the bloodstream, and vomiting and diarrhea interfere with absorption because the drug does not remain in the gastrointestinal tract long enough to be absorbed. Distribution is not affected by vomiting and diarrhea, as it involves movement of the drug through the bloodstream. Metabolism involves conversion of the drug into an active or inactive form, and is unaffected by gastroenteritis. Excretion is the elimination of the drug from the body, usually through the kidneys. This is also unaffected by vomiting and diarrhea.The nurse is preparing to give a 4-month-old an oral medication. Which technique demonstrates the nurse's accurate knowledge of the infant's developmental level?Position the infant upright, offer the infant a bottle of formula, remove the bottle and squirt the medication on the side of the tongue toward the cheek, then offer the infant the bottle again.The nurse is preparing to remove an IV device from the arm of a 6-year-old girl. Which approach is best for minimizing fear and anxiety?Ask the child if they would like to help remove the tape from the IV. The nurse needs to openly discuss the procedure with the child at an age appropriate level. The nurse should explain what is to occur and enlist the child's help in the removal of the tape or dressing. This provides the child with a sense of control over the situation and also encourages his or her cooperation. The nurse should avoid using scissors to remove the tape or dressing and the comment regarding cutting may be perceived as threatening and/or frightening. The procedure may be minorly uncomfortable so it is best to be honest with the child.The site most often used when administering a medication using the intradermal route is the:forearm. Explanation: Intradermal injections deposit medications just under the epidermis. They are most often used for tuberculosis screening and allergy testing. The forearm is the site most often used. The anterior thigh, lateral upper arms, and abdomen are the preferred sites for subcutaneous administration. The deltoid, vastus lateralis and the ventrogluteal are the preferred sited for intramuscular injections.the nurse wishes to promote gastric emptying after administering the preschooler's gastrostomy feeding. Which position will facilitate this?Right side-lying The right side-lying position should be chosen because the stomach empties into the intestine in this direction. It is also helpful to elevate the child's head slightly to prevent reflux of the feeding into the esophagus.A nurse has just given otic medication instructions to the parents of a 12-year-old child. Which statement would indicate that the parents need further education concerning the medication?"I will pull the outer ear down and back before administering the medication." Explanation: The proper technique to instill ear drops in a child older than age 3 involves pulling the pinna up and back. Otic medication should not be administered if it is cold. Cold medication may cause discomfort and produce vomiting or vertigo in the child. If an otic medication must be refrigerated, it should be warmed to room temperature in the palms of the hands. Proper otic administration technique involves holding the dropper 0.5 in (1.25 cm) above the ear canal and being careful not to touch the dropper to the ear to prevent contamination of the dropper with microorganisms. For children young than 3, the parent would pull the pinna down and back.The adolescent weighs 113 lb (51.36 kg). The nurse closely monitors the child's urine output. How many milliliters of urine is the least amount that the adolescent should make during an 8-hour shift? Record your answer using a whole number.411 Explanation: The child weighs 113 lb (51.36 kg). 51.36 kg x 1 mL/1 kg = 51.36 mL/hour. 51.36 x 8 hours = 410.90. Rounded to the nearest whole number = 411 mLA 6-year-old client is prescribed to receive an oral antibiotic. What should the nurse do before giving the child this medication?Check to see if the child can swallow pills. Many children do not have enough coordination to swallow tablets or pills until they are 6 or 7 years of age. Children younger than 9 years of age often have difficulty swallowing tablets. This can make getting a child to agree to try an oral medication difficult. The nurse needs to check to see if the child can swallow pills before providing the oral medication. Drinking a glass of water before giving the medication will not determine if the child can swallow an oral medication. Giving the oral medication at the time of the next meal does not necessarily mean that the child will be able to swallow the oral medication. The nurse should not threaten to give the medication with an injection.A 3-year-old child with asthma and a respiratory tract infection is prescribed an antibiotic and a bronchodilator. The nurse notes the following during assessment: oral temperature 100.2°F (37.9°C), respirations 52 breaths/minute, heart rate 90 beats/minute, O2 saturation 95% on room air. Which action will the nurse take first?Administer the bronchodilator via a nebulizer. Explanation: The nurse would first administer the bronchodilator to open the child's airway and facilitate breathing. Once the airway was open, the nurse could administer oxygen, if indicated. At this time, the child's saturation level is normal but it should be monitored. The nurse would then administer the antibiotic medication. The heart rate is within normal range for a child of this age (65 to 110 beats/minute); therefore, a cardiac monitor is not needed at this time.The student nurse is preparing to care for a recently placed gastrostomy tube. Which action would prompt further instruction from the overseeing nurse?The student obtains an antimicrobial soap to clean the area surrounding the tube. Explanation: The skin around a gastrostomy tube requires cleaning at least once a day. Routine site care includes gentle cleansing with sterile water or saline for newly placed tubes, or for established tubes, soap and water followed by rinsing or cleaning with water alone. To clean under an external disc or bumper, a cotton-tipped applicator may be used.The nurse knows this is a description of peritoneal dialysis when compared to hemodialysis: -The child can live a more normal lifestyle. -There are strict diet and fluid restrictions. -Therapy is only 3 to 4 days per week. -The child must go into a facility to get peritoneal dialysis.The child can live a more normal lifestyle. The child can live a more normal lifestyle with peritoneal dialysis. This is a 7-day-a-week procedure, but there are less diet restrictions and more freedom with this type of procedure. Peritoneal dialysis can be performed at home.In caring for a child with nephrotic syndrome, which intervention will be included in the child's plan of care? -Weighing on the same scale each day -Ambulating 3 to 4 times a day -Increasing fluid intake by 50 ml per hour -Testing the urine for glucose levels regularlyWeighing on the same scale each day The child with nephrotic syndrome is weighed every day using the same scale to accurately monitor the child's fluid gain and loss. The child with nephrotic syndrome is very edematous so increasing fluid intake would be counterproductive to care needed. In nephrotic syndrome the urine is tested for protein, not glucose. Ambulation is important for all but it is not specific to the child with nephrotic syndrome.The caregiver of a child with a history of ear infections calls the nurse and reports that her son has just told her his urine "looks funny." He also has a headache, and his mother reports that his eyes are puffy. Although he had a fever 2 days ago, his temperature is now down to 100℉ (37.8℃). The nurse encourages the mother to have the child seen by the care provider because the nurse suspects the child may have: -a urinary tract infection. -lipoid nephrosis (idiopathic nephrotic syndrome). -acute glomerulonephritis. -rheumatic fever.acute glomerulonephritis. Acute glomerulonephritis is a condition that appears to be an allergic reaction to specific infections, most often group A beta-hemolytic streptococcal infections such as rheumatic fever. Presenting symptoms appear 1 to 3 weeks after the onset of a streptococcal infection such as strep throat, otitis media, tonsillitis, or impetigo. Usually the presenting symptom is grossly bloody urine. Periorbital edema may accompany or precede hematuria. Fever may be 103℉ to 104℉ (39.4℃ to 40℃) at the onset, but decreases in a few days to about 100℉ (37.8℃). Slight headache and malaise are usual, and vomiting may occur.The nurse is reinforcing teaching with the caregiver of 5-year-old twins regarding urinary tract infections (UTIs). The caregiver is puzzled about why her daughter has had three urinary tract infections but her son has had none. She reports that their diets and fluid intake is similar. Which statement would be accurate for the nurse to tell this mother? -"A girl's urethra is much shorter and straighter than a boy's, so it can be contaminated fairly easily." -"Girls tend to urinate less frequently than boys, making them more susceptible to UTI's." -"Girls need more vitamin C than boys to keep their urinary tract healthy, so your daughter may be deficient in vitamin C." -"It is unlikely that your daughter is practicing good cleaning habits after she voids.""A girl's urethra is much shorter and straighter than a boy's, so it can be contaminated fairly easily." Many different bacteria may infect the urinary tract, and intestinal bacteria, particularly Escherichia coli, account for about 80% of acute episodes. The female urethra is shorter and straighter than the male urethra, so it is more easily contaminated with feces.The first method of choice for obtaining a urine specimen from a 3-year-old child with a possible urinary tract infection is: -performing a suprapubic aspiration. -placing a cotton ball in the underwear to catch urine. -placing an indwelling urinary catheter. -obtaining a clean catch voided urine.obtaining a clean catch voided urine. In the cooperative, toilet-trained child, a clean midstream urine may be used successfully to obtain a "clean catch" voided urine. If a culture is needed, the child may be catheterized, but this is usually avoided if possible. A suprapubic aspiration also may be done to obtain a sterile specimen. In the toilet-trained child, using a cotton ball to collect the urine would not be appropriate.The nurse is caring for a child admitted with acute glomerulonephritis. Which clinical manifestation would likely have been noted in the child with this diagnosis? -Loose, dark stools -Tea-colored urine -Strawberry-red tongue -Jaundiced skinTea-colored urine The presenting symptom in acute glomerulonephritis is grossly bloody urine. The caregiver may describe the urine as tea or cola colored. Periorbital edema may accompany or precede hematuria. Loose stools are seen in diarrhea. A strawberry-colored tongue is a symptom seen in the child with Kawasaki disease. Jaundiced skin is noted in hepatitis.The nurse is collecting data on a 6-year-old child admitted with acute glomerulonephritis. Which vital sign would the nurse anticipate with this child's diagnosis? -Pulse rate 112 bpm -Pulse oximetry 93% on room air -Respirations 24 per minute -Blood pressure 136/84Blood pressure 136/84 Hypertension appears in 60% to 70% of clients during the first 4 or 5 days with a diagnosis of acute glomerulonephritis. The pulse of 112 would be a little high for a child this age, but not a concern with this diagnosis. The other vital signs are within normal limits for this age child.The nurse is caring for a 3-year-old child with the surgical repair of hypospadias. The preschooler returned from the postanesthesia care unit with an indwelling urinary catheter. What parental teaching is most helpful? -The catheter insertion site will leave only a minimal scar. -Back pressure from such drainage may result in nephrotic syndrome. -The child must be reevaluated at puberty for testicular function. -The childwill always have tenderness on penile erection.The catheter insertion site will leave only a minimal scar. Hypospadius is a urethral defect in which the opening is on the ventral surface rather than at the end of the penis. If left untreated it may mean the boy will not be able to void standing as the aim will be different; in addition, it will cause intereference with the deposition of sperm during intercourse. The completed surgery requires the use of a catheter. The catheter, along with the penis, is taped to the abdomen to reduce pressure on the urethral sutures.The tube insertion site will leave only a minimal scar, if any. A hypospadias repair should have no long-term consequences.A 16-year-old adolescent tells the nurse about having severe dysmenorrhea. Which action would be the best health teaching measure? -Take over-the-counter ibuprofen for its prostaglandin action. -Take acetaminophen beginning with the first day of a menstrual flow. -Drink a minimum of fluid if having pain. -Use ice to help in reducing inflammation and pain.Take over-the-counter ibuprofen for its prostaglandin action. Dysmenorrhea is pain associated with menstruation. A prostaglandin release is responsible for the smooth muscle contraction of the uterus during menstruation. The nonsteroidal anti-inflammatory drug Ibuprofen has an antiprostaglandin mechanisim that will block the prostaglandin release. It is the best choice for dysmenorrhea. Acetominophen has no antiprostaglandin properties, so it is not the drug of choice. Ice will only work on localized areas so it has limitied, if any, effect on the uterus. Ice also is a vasoconstrictor and reduced blood flow could intensify the pain. Fluid intake has no effect on uterine pain.The nurse is caring for a 2-year-old girl with suspected vulvovaginitis. The nurse suspects the cause as Candida albicans based on which finding? -White cottage cheese-like discharge -Thin gray vaginal discharge with fishy odor -Foul yellow-gray discharge -Irritation of labia and vaginal openingWhite cottage cheese-like discharge White cottage cheese-like discharge indicates C. albicans. Thin gray discharge with a fishy odor points to Bordetella or Gardnerella. Foul yellow-gray discharge indicates Trichomonas vaginalis. Irritation of the labia and vaginal opening is commonly found with poor hygiene.When providing care to a child with vesicoureteral reflux (VUR), which nursing diagnosis would be the priority? -Risk for infection -Excess fluid volume -Imbalanced nutrition less than body requirements -Activity intoleranceRisk for infection When vesicoureteral reflux is present, the primary goal is to avoid urine infection so that infected urine cannot gain access to the kidneys. Fluid volume typically is not a problem associated with VUR. Nutritional problems are not associated with VUR. Activity intolerance is not associated with VUR.A child is being evaluated for renal and urinary tract disease. What would the nurse expect to be ordered to evaluate the child's glomerular filtration rate? -Urinalysis -Creatinine clearance rate -Kidneys, ureter, and bladder x-ray -Computed tomography scanCreatinine clearance rate The glomerular filtration rate is measured by creatinine clearance rate, or the amount of creatinine excreted in 24 hours as determined by a 24-hour urine sample along with a venous blood sample and compared with the urine findings. Urinalysis provides general information about kidney function. A kidneys, ureters, and bladder x-ray provides information about the size and contour of the kidneys. A computed tomography reveals the size and density of kidney structures and adequacy of urine flow.The mother of 6-month-old girl is concerned about her daughter getting a urinary tract infection. What should the nurse mention to the mother to help prevent this condition? -Report any abnormally colored urine to the child's primary care provider. -Wipe from back to front when changing the girl's diaper. -Discontinue prescribed antibiotics once symptoms of UTI have disappeared. -Bathe the child with bubble bath once a week.Report any abnormally colored urine to the child's primary care provider. Several important interventions can help prevent urinary and renal disease in children. The first intervention is to educate parents and caregivers about wiping from front to back (not back to front) when changing diapers of female infants. Remind parents of simple ways to prevent UTI, such as not allowing children to bathe with bubble bath. Teach parents to recognize that abnormally colored urine (red, black, or cloudy) should not be dismissed as this could be the beginning of a UTI or kidney disease. Educating parents about the importance of giving the full course of antibiotics prescribed for UTIs can help prevent return reinfection; giving the full course of antibiotics after a streptococcal infection can help prevent acute glomerulonephritis.The nurse is caring for the parents of a newborn who has an undescended testicle. Which comment by the parents indicates understanding of the condition? -"Our son may need surgery on his testes before we are discharged to go home." -"Our son may have to go through life without two testes." -"Our son's condition may resolve on its own." -"Our son will likely have a high risk of cancer in his teen years as a result of this condition.""Our son's condition may resolve on its own." Normally both testes will descend prior to birth. In the event this does not happen the child will be observed for the first 6 months of life. If the testicle descends without intervention further treatment will not be needed. Surgical intervention is not needed until after 6 months if the testicle has not descended.The nurse is caring for a child who receives dialysis via an AV fistula. Which finding indicates an immediate need to notify the physician? -Presence of a bruit -Presence of a thrill -Dialysate without fibrin or cloudiness -Absence of a thrillAbsence of a thrill The nurse should always auscultate the site for presence of a bruit and palpate for presence of a thrill. The nurse should immediately notify the physician if there is an absence of a thrill. Dialysate without fibrin or cloudiness is normal and is used with peritoneal dialysis, not hemodialysis.The nurse is caring for a child diagnosed with hydronephrosis. Which manifestation is consistent with complications of the disorder? -Hypertension -Hypotension -Hypothermia -TachycardiaHypertension Complications of hydronephrosis include renal insufficiency, hypertension, and eventually renal failure. Hypotension, hypothermia, and tachycardia are not associated with hydronephrosis.Which of these laboratory results would be most important for the nurse to assess in a child who has a diagnosis of urinary tract infection? -urinalysis -chemical reagent strip -specific gravity -blood urea nitrogenurinalysis A urinalysis is one of the simplest tests to reveal kidney function and presence of a urinary tract infection. A chemical reagent strip, specific gravity, and blood urea nitrogen are not the primary tests evaluated for the presence of a urinary tract disease.Which instruction should a nurse give to a client who has a history of urinary tract infection to prevent recurrence? -Wipe from front to back. -Use bubble bath to wash. -Encourage fluids throughout the day. -Finish all antibiotic prescribed. -Limit bathing to once a week.-Wipe from front to back. -Encourage fluids throughout the day. -Finish all antibiotic prescribed. Teaching caregivers to wipe from front to back, encouraging fluids, and finishing all prescribed medications are vital principles in the prevention of recurring UTIs. The use of bubble bath is contraindicated because it can be a source of infection.A parent asks the nurse, "What is precocious puberty?" The nurse's response should be based on which statement? -"Precocious puberty is when children are going through puberty." -"Precocious puberty is early sexual development." -"Precocious puberty only occurs in boys, not girls." -"Precocious puberty is when girls experience a heavy period.""Precocious puberty is early sexual development." Precocious puberty is the early sexual development or maturation of a girl or boy. It occurs most often in girls, not boys, and does not relate to a heavy menses.Which condition is a risk factor for the development of pelvic inflammatory disease? -multiple sexual partners -oral contraceptive use -recurrent urinary infections -history of dysmmenorrheamultiple sexual partners Clients who have had multiple sexual partners have a higher incidence of developing pelvic inflammatory disease. Oral contraceptive use, history of UTI, and dysmmeorrhea are not risk factors for developing pelvic inflammatory disease.A newborn is diagnosed with hypospadias and the parents want the newborn to be circumcised. What would be the best response by the nurse? -The foreskin is needed for repair. -Circumcision is usually performed after 1 year of age. -Circumcision with a hypospadias will cause meatal stenosis. -The circumcision may predispose the newborn to renal failure.The foreskin is needed for repair. Hypospadias occurs when the meatal opening is on the ventral surface of the penis rather than at the end of the penis. The newborn with this condition is not circucised at birth because the excess skin may be needed to reconstruct the meatus during surgical repair. Once the hypospadias is repaired, a circumcision can be performed as part of the procedure. Hypospadias repair is usually done after the newborn is 1 year or older. Meatal stenosis has to do with the urethral opening diameter, not the placement. Circumcision or hypospadias repair does not affect the functioning of the renal system so neither would predispose the newborn to renal failure.A nurse is performing postoperative care on a child with a ureteral stent. Which intervention will help manage bladder spasms? -Allow tubes to dangle freely to encourage flow. -Encourage high fluid intake. -Increase low-fat foods. -Apply antibiotic ointment to tube site.Encourage high fluid intake. Prevent bladder stimulation secondary to a full rectum by completing a preoperative bowel evacuation, encouraging a high fluid intake, promoting early ambulation postoperatively, and administering a stool softener or glycerin suppository postoperatively.The caregiver of a 1-year-old boy calls the nurse, upset that his wife has just told him that their son is being given a hormone. His wife says that the pediatrician called it human chorionic gonadotropic hormone but that is all she understood. The nurse most accurately clarifies the caregiver's question by making which statement regarding the son's treatment? -"Without the hormone your son will have fluid that will collect in his scrotum." -"Without the treatment your child's gonads will not reach normal size." -"The doctor is hoping that the hormone will cause your son's undropped testes to move into their proper place." -"Your child's testes have not dropped, so the hormone is being administered to avoid causing degeneration until they do.""The doctor is hoping that the hormone will cause your son's undropped testes to move into their proper place." Shortly before or soon after birth, the male gonads (testes) descend from the abdominal cavity into their normal position in the scrotum. Occasionally one or both of the testes do not descend, which is a condition called cryptorchidism. The testes are usually normal in size; the cause for failure to descend is not clearly understood. A surgical procedure called orchiopexy is used to bring the testes down into the scrotum and anchor them there. Some physicians prefer to try medical treatment such as injections of human chorionic gonadotropic hormone before doing surgery. If this is unsuccessful in bringing down the testes, orchiopexy is performed. If both testes remain undescended, the male will be sterile. If the processus does not close, fluid from the peritoneal cavity passes through, causing hydrocele. If the hydrocele remains by the end of the first year, corrective surgery is performed.An adolescent girl and her caregiver present at the pediatrician's office. The adolescent reports severe abdominal pain. A diagnosis of pelvic inflammatory disease (PID) is made. The nurse notes in the child's chart that this is the third time she has been treated for PID. The most appropriate action by the nurse would be to: -contact the necessary authorities to report a suspected case of sexual abuse. -take the child to a private room and interview her regarding her sexual history and partners. -take the caregiver to a private room and tell her that the child's diagnosis can only come from sexual activity. -talk to the child and caregiver together and explain that the condition is often a result of a sexually transmitted infection and discuss the importance of safe sex practices.take the child to a private room and interview her regarding her sexual history and partners. Pelvic inflammatory disease can cause sterility in the female primarily by causing scarring in the fallopian tubes that prohibits the passage of the fertilized ovum into the uterus. Adolescents must be made aware of the seriousness of PID, a common result of a chlamydial infection. Be certain to provide the adolescent with a private interview. The adolescent may be extremely reluctant to reveal either social or sexual history especially in the presence of a family member.Most urinary tract infections seen in children are caused by: -hereditary causes. -fungal infections. -intestinal bacteria. -dietary insufficiencies.intestinal bacteria. Although many different bacteria may infect the urinary tract, intestinal bacteria, particularly Escherichia coli, account for about 80% of acute episodes. Hereditary and dietary concerns are not causes of urinary tract infections.The nurse is doing a presentation for a group of nursing students about the topic of menstrual disorders. After discussing the disorder secondary amenorrhea, the students make the following statements. Which statement made by the nursing students is the most accurate regarding the cause of secondary amenorrhea? -"It is caused from taking birth control pills when a girl is younger than 13 years old." -"This disorder is usually seen after a girl has had a spontaneous abortion." -"Emotional stress can be a cause of this disorder." -"This is what happens if a 16-year-old girl has never had any periods at all.""Emotional stress can be a cause of this disorder." Secondary amenorrhea can be the result of discontinuing contraceptives, a sign of pregnancy, the result of physical or emotional stress, or a symptom of an underlying medical condition. A complete physical examination, including gynecologic screening, is necessary to help determine the cause. Primary amenorrhea occurs when a girl has had no previous menstruation. A spontaneous abortion does not cause secondary amenorrhea.To prevent further urinary tract infections in a preschooler, what measures would you teach her mother? -Encourage her to be more ambulatory to increase urine output. -Teach her to take frequent tub baths to clean her perineal area. -Suggest she drink less fluid daily to concentrate urine. -Teach her to wipe her perineum front to back after voiding.Teach her to wipe her perineum front to back after voiding. Escherichia coli can be easily spread from the rectum to the urinary meatus and cause infection if girls do not take precautions against this.A 3-year-old child is scheduled for a surgery to correct undescended testes. For what postoperative consideration would the nurse want to prepare the parents? -the need for complete bed rest for 10 days -some discomfort at the surgery site -a liquid diet for 3 days -the need for maintaining a semi-Fowler positionsome discomfort at the surgery site A orchiopexy is the surgical procedure to release the spermatic cord and pull the testes into the scrotum. After the testes are in the scrotum, they are sutured into place to prevent them from returning to the abdominal cavity. This produces a "tugging" or painful sensation. Complete bed rest, a liquid diet, and remaining in a semi-Fowler position are not required as part of the post surgical care.The nurse is caring for a 5-month-old boy with an undescended left testis. What would the nurse identify as indicative of true cryptorchidism? -Testis cannot be "milked" down inguinal canal -Fluid detected in scrotal sac -Venous varicosity detected along the spermatic cord -Testis can briefly be brought into scrotumTestis cannot be "milked" down inguinal canal With true cryptorchidism, the retractile testis cannot be "milked" down the inguinal canal. Fluid in the scrotal sac is a hydrocele. A venous varicosity along the spermatic cord is a varicocele. Testis that can be brought into the scrotum refers to a retractile testis.The home care nurse is conducting an in-home visit for a child who had corrective surgery for hypospadias 3 days prior. What would alert the home care nurse to provide additional teaching? -The mother indicates the child is fussy, but calms down when she holds him on her hip. -The mother states, "I can't wait until I can bath him the tub again...he enjoys it so much." -The mother expresses relief that the child was not also diagnosed with cryptorchidism at birth. -The mother states, "I have had to buy more diapers since having to double diaper him."The mother indicates the child is fussy, but calms down when she holds him on her hip. Hypospadias is a condition in which the urethral opening in on the ventral surface of the penis. Surgical repair involves a catheter or stent left in place for 3-7 days postoperatively. Activities or play that involves straddling (such a being carried on mom's hip) are discouraged to prevent trauma to the surgical site and catheter/stent. The child should be double diapered to prevent stool from contaminating the catheter/stent and operative site and causing an infection. The child should not be bathed in a tub until the catheter/stent is removed. Crypotoorchidism is a common diagnosis along with hypospadias.A nurse is developing a teaching plan for the parents of an 8-year-old experiencing nocturnal enuresis. The nurse determines that additional teaching is needed when the parents identify what as an appropriate measure? -Encouraging fluid intake after dinner -Practicing bladder-stretching exercises -Giving desmopressin intranasally -Engaging the child in stress reduction measuresEncouraging fluid intake after dinner In many children, limiting fluids after dinner can be helpful for nocturnal enuresis. Bladder-stretching exercises also can be helpful. If these measures are ineffective, desmopressin may be prescribed. Stress factors may be contributing to the child's problem. Therefore, measures to address stress and promote coping would be appropriate.An adolescent is diagnosed with a trichomonal infection. Which medication would the nurse include when teaching the adolescent about treatment for this infection? -Metronidazole -Miconazole -Doxycycline -Acyclovir -CeftriaxoneMetronidazole Metronidazole is used to treat a trichomonal infection. Miconazole is used to treat candidiasis. Doxycycline is used to treat a chlamydial infection. Acyclovir is used to treat herpes genitalis. Ceftriaxone is used to treat gonorrhea.Which is a priority for the nurse caring for a client with bladder exstrophy? -increasing fluid intake -encouraging voiding -preventing skin breakdown -placing the child in prone positionpreventing skin breakdown Prevention of skin breakdown is the priority to prevent infection and the surface from drying out. Encouraging fluids and voiding are not the priority for this client. Prone position is not recommended; the correct position is supine so urine drains freely.Which goal of therapy would be appropriate for a nurse to establish with a client's family and a client who has a diagnosis of enuresis? -The child wakes up once during the night for a glass of water. -The client wets only when involved in an activity. -The client remains continent throughout the night. -The parent takes the client to the bathroom at night.The client remains continent throughout the night. The goal of therapy is for the client to be continent of urine throughout the night. The nurse should encourage the child to awaken and void and not have any fluids before bedtime. During an activity, the child should be encouraged to void before and after the activity to prevent incontinence.A client's mother asks the nurse, "When should my daughter have a pelvic examination?" Which response by the nurse is most appropriate? -"A pelvic examination is not necessary until pregnancy." -"A pelvic exam is necessary at 18 to 20 years of age." -"A pelvic exam is necessary for girls in puberty." -"As her mother, it is your choice when she should have a pelvic exam.""A pelvic exam is necessary at 18 to 20 years of age." A pelvic exam is unnescessary for girls who have not yet reached adolescence. A pelvic exam should be part of routine health care around the age of 18 to 20 years or at the point when she becomes sexually active.A client has been admitted to the emergency department with nausea, vomiting, and severe scrotal pain. These findings indicate what condition? -hydrocele -varicocele -testicular infection -testicular torsiontesticular torsion A hydrocele is a collection of fluid that collects in the fold of the scrotum, requiring no treatment. A variocele is an abnormal dilation of the veins of the spermatic cord. Testicular torsion is evidenced by severe scrotal pain, nausea, and vomiting and is a surgical emergency. Testicular infection is not indicated.A nurse has just admitted a client with symptoms of vulva inflammation, pain, odor, and pruritus. Based on these findings, the nurse could conclude that this client will be diagnosed with which condition? -vulvovaginitis -urinary tract infection -pelvic inflammatory disease -vaginal inflammationvulvovaginitis Vulvovaginitis is diagnosed with clients experiencing vaginal or vulval inflammation, pain odor, and purititis. Pelvic inflammatory disease and urinary tract infection are not consistent with these symptoms.The nurse is caring for a pediatric client who is scheduled for the surgical removal of a Wilms tumor. Which is contraindicated in the client's care? -Intravenous fluids -Abdominal palpation -Foley catheter placement -Supine positioningAbdominal palpation Abdominal palpation is contraindicated preoperatively in a client with a Wilms tumor. Cells may break loose and spread the tumor. Intravenous fluids and supine positioning are appropriate in the client's care. A Foley catheter is typically not placed.The nurse is reviewing the causative organisms noted on laboratory reports. Which organism is transmitted solely by sexual contact? -Bacillus -Trichomonas -Cholera Bacterium -BorelliTrichomonas The organism transmitted solely by sexual contact is Trichomonas. The other organisms are causes of various infections and acquired in various ways.The nurse is caring for a 10-year-old child experiencing nocturnal enuresis with no physiologic cause. The child states, "I am embarrassed and I wish I could stop this right now!" How will the nurse respond? -"You will grow out of this eventually; you just need to be patient." -"There are several things we can do to help you achieve this goal." -"You are not alone. There are almost 5 million people that have enuresis." -"You can wear pull-ups to bed and, since they look like underwear, no one will know.""There are several things we can do to help you achieve this goal." The child wants to stop this problem immediately, so the nurse's most therapeutic response is to assure the child that enuresis is indeed solvable. For some children, learning about the high prevalence of the problem may provide consolation. However, this may not alleviate the child's embarrassment and it does not address the desire for solutions. Telling the child that he or she will "grow out of this" downplays the embarrassment and does not address the desire to solve the problem. Pull-ups conceal the consequences of enuresis but do not provide a solution.A parent is asking how to help the child deal with the peer ridicule at school in regards to enuresis. What is the best response by the nurse? -Demonstrate love and acceptance at home. -Discuss how the child can continue to go to the bathroom instead of in the underwear. -Take away a toy every time the child urinates in his or her pants.- -Demonstrate how to urinate in the bathroom every time the child has an occurence.Demonstrate love and acceptance at home. Enuresis is the contined incontinence of urine past the age of toliet training. It is a source of shame and embarrassment. It affects the child's life emotionally, behaviorally and socially. It causes the child to have a low self-esteem. Demonstrating love and acceptance at home will help counteract the ridicule the child is getting at school.The child should not be punished for a behavior he or she cannot control. Demonstrating how to use the toliet and going to the bathroom to void are good subjects but they do not help a child who has no control of the enuresis. Testing may need to be done to see if there are anatomical reasons and medications may be needed to correct the problem.A nurse is performing postoperative care on a child with a ureteral stent. Which intervention will help manage tube patency? -Monitor output. -Allow tubes to dangle freely to encourage flow. -Maintain fluid restriction. -Provide a low-sodium diet.Monitor output. A ureteral stint is placed in the ureter temporarily to aid in the drainage of urine. It is removed via cystoscopy when it is time for discontinuation. The nurse should monitor output cafefully when a ureteral stint is in place. This is an indication that the stent is patent and functioning properly. The tubes are inserted into the ureter so they would not dangle on the outside of the body. There is no need to maintain fluid restriction or a low-sodium diet just because of the stent. This would only be necessary if there were other disease processes affecting the child.A 2-year-old has a history of fever and fussiness. Which additional symptoms would make the nurse suspect a urinary tract infection? -Swollen lymph nodes -Skin rash -Increased thirst -Abdominal painAbdominal pain The symptoms of urinary tract infection can vary depending on the age of the child. Abdominal pain is a common symptom in children of a UTI. Swollen lymph nodes, skin rash, and thirst are not the common symptoms associated with a UTI.The caregiver of a child being treated at home for acute glomerulonephritis calls the nurse reporting that her daughter has just had a convulsion. The child is resting comfortably but the caregiver would like to know what to do. The nurse would instruct the caregiver to take which action? -Weigh the child in the same clothes she had been weighed in the day before and report the two weights to the nurse while the nurse is on the phone. -Take the child's blood pressure and report the findings to the nurse while the nurse is still on the phone. -Give the child a diuretic and report back to the nurse in a few hours. -Give the child fluids and report back to the nurse in a few hours.Take the child's blood pressure and report the findings to the nurse while the nurse is still on the phone. Blood pressure should be monitored regularly using the same arm and a properly fitting cuff. If hypertension develops, a diuretic may help reduce the blood pressure to normal levels. An antihypertensive drug may be added if the diastolic pressure is 90 mm Hg or higher. The concern is immediate so reporting the findings in a few hours could delay needed treatment. The child should be weighed daily in the same clothes and using the same scale, but the blood pressure is the priority in this situation.The nurse is collecting data for a child diagnosed with acute glomerulonephritis. What would the nurse likely find in this child's history? -The child has a sibling with the same diagnosis. -The child had a congenital heart defect. -The child recently had an ear infection. -The child is being treated for asthma.The child recently had an ear infection. In the child with acute glomerulonephritis, presenting symptoms appear 1 to 3 weeks after the onset of a streptococcal infection, such as strep throat, otitis media, tonsillitis, or impetigo. There is not a family history of the disorder, a history of congenital concerns or defects, nor asthma in children with acute glomerulonephritis.A 4-year-old child with a urinary tract infection is scheduled to have a voiding cystourethrogram. When preparing the child for this procedure, the nurse would want to prepare the child to: -have a local anesthetic injected prior to the procedure. -drink three glasses of water during the procedure. -void during the procedure. -anticipate a headache afterward.void during the procedure. At the start of the voiding cystourethrogram, a catheter is inserted into the bladder. The contrast medium is inserted through the catheter into the bladder. Fluroscopy is performed to demonstrate the filling of the bladder and the collapsing of the bladder upon emptying. The assessment of emptying requires the child to void during the procedure so that bladder emptying and urethra flow can be assessed. No anesthetic is required for this procedure. The fluid filling the bladder is inserted via the catheter so no drinking of water is required. A headache following the procedure would not be expected.The nurse is caring for a 10-year-old boy with end-stage renal disease (ESRD) with metabolic acidosis. What would the nurse expect to administer if ordered? -Sodium bicarbonate tablets -Ferrous sulfate -Vitamin D -ErythropoietinSodium bicarbonate tablets Bicitra or sodium bicarbonate tablets are used for the correction of acidosis. Ferrous sulfate is used for the treatment of anemia. Vitamin D and calcium are used for the correction of hypocalcemia and hyperphosphatemia. Erythropoietin stimulates red blood cell growth.The nurse is taking a health history of a 12-year-old boy presenting with scrotal pain. Which assessment finding would indicate testicular torsion? -Sudden onset of severe scrotal pain with significant hemorrhagic swelling -Enlarged inguinal glands and fever -Hardened and tender epididymitis with edema and erythema of scrotum -Fever, scrotal swelling, and urethral dischargeSudden onset of severe scrotal pain with significant hemorrhagic swelling Testicular torsion is characterized by a testicle that is abnormally attached to the scrotum and twisted. Signs and symptoms include sudden onset of severe scrotal pain with significant hemorrhagic swelling. Enlarged glands and fever point to infection. A hardened and tender epididymitis points to epididymitis. Fever and urethral discharge suggest infection. Scrotal swelling is associated with testicular torsion, epididymitis, and hydrocele.The nurse is preparing a 7-year-old girl for discharge after treatment for nephrotic syndrome. Which instructions would the nurse include in the discharge teaching plan for the parents? -"Let's meet with the dietitian and plan some meals." -"She must severely restrict her sodium intake." -"She should try to avoid protein." -"Here is some written information from the dietitian.""Let's meet with the dietitian and plan some meals." Consultation with a dietitian would be most helpful for meal planning because so many of children's favorite foods are high in sodium. Restricting sodium may not be necessary if the child is not edematous; in addition, the statement does not teach. Protein-rich snacks should be encouraged. The nurse needs to provide the parents with specific instructions, assistance, and resources in addition to simple written instructions.The nurse is caring for a child who is undergoing peritoneal dialysis. Immediately after draining the dialysate, which action should the nurse should take immediately? -Empty the old dialysate -Weigh the old dialysate -Weigh the new dialysate -Start the process over with a fresh bagWeigh the old dialysate The nurse should weigh the old dialysate to determine the amount of fluid removed from the child. The fluid must be weighed prior to emptying it. The nurse should weigh the new fluid prior to starting the next fill phase. Typically, the exchanges are 3 to 6 hours apart so the nurse would not immediately start the next fill phase.An adolescent boy is diagnosed with hepatitis A. Which problem should be considered when planning care? a) Hypothermia is common. b) He will be very irritable and perhaps require sedation. c) He will become fatigued easily. d) His urine will be dark and infectious.He will become fatigued easily. Most children with hepatitis are exhausted. Urine is not infectious.A 4-month-old has had a fever, vomiting, and loose watery stools every few hours for 2 days. The mother calls the physician's office and asks the nurse what she should do. Which response by the nurse is most appropriate? a) "Continue breastfeeding as you have been doing. The fluid from the breast milk is important to maintain fluid balance." b) "Bring the child to the office today so we can evaluate her fluid balance and determine the best treatment." c) "Do not give the child anything to drink for 4 hours. If the fever goes down and the loose stools stop, you can resume breastfeeding." d) "Give a clear pediatric electrolyte replacement for the next few hours, then call back to report on how your child is doing.""Bring the child to the office today so we can evaluate her fluid balance and determine the best treatment." Infants are comprised of a high percentage of fluid that can be lost very quickly when vomiting, fever, and diarrhea are all present. This infant needs to be seen by the physician based on her age and symptoms; hospitalization may be necessary for intravenous rehydration depending upon her status when assessed.Noah is an 18-month-old who is brought to the ER with flu-like symptoms. He is diagnosed with pneumonia secondary to aspiration of stomach contents. The nurse explains to the parents that pneumonia is a condition that often occurs secondary to: a) gastroesophageal reflux disease. b) inflammatory bowel disease. c) cystic fibrosis. d) Hirschsprung disease.gastroesophageal reflux disease. The child with gastroesophageal reflux disease may present with the physical findings of pneumonia secondary to aspiration of refluxed stomach contents.Inguinal hernia usually occurs in girls. a) True b) FalseFalse Inguinal hernia is a protrusion of a section of the bowel into the inguinal ring. It occurs usually in boys (9:1) because, as the testes descend from the abdominal cavity into the scrotum late in fetal life, a fold of parietal peritoneum also descends, forming a tube from the abdomen to the scrotum.You care for a 12-year-old girl with Crohn disease. A primary assessment you would want to make when caring for her would be to note if: a) she has a temperature. b) she has a headache. c) lung sounds are clear. d) her joints are not swollen.she has a temperature. Because Crohn disease leads to patches of inflammation in the bowel, the temperature increases if more patches become involved.The nurse is discussing the treatment of congenital aganglionic megacolon with the caregivers of a child diagnosed with this disorder. Which statement is the best explanation of the treatment for this diagnosis? a) "Your child will be treated with oral iron preparations to correct the anemia." b) "We will give enemas until clear and then teach you how to do these at home." c) "Your child will receive counseling so the underlying concerns will be addressed." d) "The treatment for the disorder will be a surgical procedure.""The treatment for the disorder will be a surgical procedure." Treatment of congenital aganglionic megacolon involves surgery with the ultimate resection of the aganglionic portion of the bowel. Chronic anemia may be present, but iron will not correct the disorder. Enemas may be given to initially achieve bowel elimination, but they will not treat the disorder. Differentiation must be made between this condition and psychogenic megacolon because of coercive toileting or other emotional problems. The child with aganglionic megacolon does not withhold stools or defecate in inappropriate places, and no soiling occurs.A child is scheduled for a urea breath test. The nurse understands that this test is being performed for which reason? a) Detect Helicobacter pylori b) Evaluate gastric pH c) Confirm pancreatitis d) Determine esophageal contractilityDetect Helicobacter pylori Urea breath test is used to detect the presence of H. pylori in the exhaled breath. This test does not evaluate gastric pH. Serum amylase and lipase levels are used to confirm pancreatitis. Esophageal manometry is used to evaluate esophageal contractile activity and effectiveness. (less)The nurse is assessing a 10-day-old infant for dehydration. Which finding indicates severe dehydration? a) Pale and slightly dry mucosa b) Soft and flat fontanels c) Tenting of skin d) Blood pressure of 80/42 mm HgTenting of skin Tenting of skin is an indicator of severe dehydration. Soft and flat fontanels indicate mild dehydration. Pale and slightly dry mucosa indicates mild or moderate dehydration. Blood pressure of 80/42 mm Hg is a normal finding for an infant.The nurse is caring for a 4-year-old with oral vesicles and ulcers from herpangina. The child is refusing fluids due to the pain and the mother is concerned about his hydration status. Which of the suggestions would be most appropriate? a) "Try some Anbesol or Kank-A." b) "Encourage him to have some soda." c) "Offer 'magic mouthwash' followed by a popsicle." d) "Offer him some orange juice.""Offer 'magic mouthwash' followed by a popsicle." Children are more likely to cooperate with interventions if play is involved. "Magic" analgesic mouthwash followed by a popsicle is most likely to alleviate some pain and then provide hydration. Soda should be avoided because it can cause stinging and burning. Orange juice should be avoided because it can cause stinging and burning. Anbesol might be helpful but it will likely be difficult to apply. Additionally, oral analgesics are often necessary.A mother brings her 10-year-old son to the ER with complaints of abdominal pain. The nurse performing a physical assessment notes the following symptoms: upper right quadrant pain that radiates to the back; fever; nausea; and abdominal distention. Which disease would the nurse consider as a diagnosis? a) Crohn disease b) Ulcerative colitis c) Appendicitis d) PancreatitisPancreatitis The child admitted with the suspicion of pancreatitis typically has a complaint of abdominal pain, either epigastric, upper left, or upper right quadrant pain that may radiate to the back. Nausea and vomiting, fever, tachycardia, hypotension, and jaundice may be present. Abdominal signs such as abdominal distention, decreased bowel sounds, rebound tenderness, and guarding also may be noted.The nurse is reinforcing dietary teaching with the caregiver of a child diagnosed with celiac syndrome. Which foods would be permitted in the diet of the child with celiac syndrome? Select all that apply. a) Skim milk b) Rye bread c) Oatmeal d) Applesauce e) Corn flakes f) Bananas• Skim milk • Applesauce • Bananas The child is usually started on a gluten-free, low-fat diet. Skim milk and bananas are usually well tolerated. Lean meats, puréed vegetables, and fruits are gradually added to the diet. Wheat, rye, oat products, corn flour, and cornmeal are not included in the diet.In understanding the gastrointestinal system, the nurse recognizes that this system includes the stomach and intestines as well as: a) The brain and spinal cord b) The pharynx and esopagus c) Nerves throughout the abdomen d) A protective cushion lining the organsThe pharynx and esopagus The main organs of the gastrointestinal (GI) or digestive system are the mouth, pharynx (throat), esophagus, stomach, small intestine, large intestine, rectum, and anal canal. The brain, spinal column, and nerves are part of the nervous system, and there is a protective coating surrounding the nerves.The nurse is doing dietary teaching with the caregivers of a child diagnosed with idiopathic celiac disease. Of the following foods, which would most likely be appropriate in the child's diet? a) Bananas b) Potatoes c) Oatmeal d) ToastBananas The young child should be started on a starch-free, low-fat diet. Bananas contain invert sugar and are usually well tolerated. Products that contain wheat, rye, or oats should be excluded.A physician recommends a gastrostomy for a 4-year-old client with an obstruction. The parents ask the certified wound, ostomy, and continence nurse (CWOCN) what the surgery entails. What is the nurse's best response? a) "The surgery will create an opening to the large intestine." b) "The surgery will create an opening to the small intestine." c) "The surgery is performed to create an opening between the esophagus and the neck." d) "The surgery creates an opening between the stomach and abdominal wall.""The surgery creates an opening between the stomach and abdominal wall." Ostomies can be created at various sites in the GI tract, depending on the child's clinical condition. A gastrostomy provides an opening between the stomach and the abdominal wall, and an esophagostomy communicates between the esophagus and an external site on the neck. Ostomies may be created at various sites in the small intestine (e.g., jejunostomy, ileostomy) or in the large intestine (e.g., colostomy).Constipation may be initially caused by psychological problems T or FTThe nurse is caring for a child who was involved in an automobile accident in which extensive damage to the small intestine occurred. A surgical resection of the small intestine resulted in massive small intestine loss, causing short bowel syndrome. The parents voice concern to the nurse that their child will "never be the same." What is the best response by the nurse? a) "Having a chronic condition is difficult but you have to be strong for your child. You are their main support person." b) "There are so many new treatments available every day. There may be something to correct this in the near future." c) "I can't imagine what you're going through. We will be here to support and educate you on your child's condition and treatments throughout their care." d) "I know it must be difficult but there was nothing you could have done to prevent this.""I can't imagine what you're going through. We will be here to support and educate you on your child's condition and treatments throughout their care." Being empathetic and reassuring the parents that the staff will be there to support them and educate them will provide some relief of anxiety since this is a chronic condition. Telling them their is nothing they could have done to prevent this from happening does not help the current situation. Giving hope is good, but giving possible false hope sets the family up for disappointment. Telling the family to be strong does not provide support.The labor and delivery nurse is caring for a mother who has demonstrated polyhydramnios upon delivery. The newborn displays copious, frothy bubbles of mucus in the mouth and nose, as well as drooling. The nurse is concerned that the infant has what disorder? a) Hiatal hernia b) Gastroschisis c) Esophageal atresia d) OmphaloceleEsophageal atresia Esophageal atresia refers to a congenitally interrupted esophagus where the proximal and distal ends do not communicate; the upper esophageal segment ends in a blind pouch and the lower segment ends a variable distance above the diaphragm. Polyhydramnios is often the first sign of esophageal atresia because the fetus cannot swallow and absorb amniotic fluid in utero, leading to accumulation. Omphalocele and gastroschisis are congenital anomalies of the anterior abdominal wall. Hiatal hernia involves a weakened diaphragm.A mother is alarmed because her 6-week-old boy has begun vomiting almost immediately after every feeding. In the past week, the vomiting has grown more forceful, with the vomit projecting several feet from his mouth. He is always hungry again just after vomiting. At the physician's office, the nurse holds the child and gives him a bottle of water. While he drinks, she notes an olive-size lump in his right abdomen. Which condition should the nurse suspect in this child? a) Appendicitis b) Pyloric stenosis c) Peptic ulcer disease d) Gastroesophageal refluxPyloric stenosis With pyloric stenosis, at 4 to 6 weeks of age, infants typically begin to vomit almost immediately after each feeding. The vomiting grows increasingly forceful until it is projectile, possibly projecting as much as 3 to 4 feet. Infants are usually hungry immediately after vomiting because they are not nauseated. A definitive diagnosis can be made by watching the infant drink. If a pyloric stenosis is present, the sphincter feels round and firm, approximately the size of an olive in the right abdomen. Peptic ulcer disease in neonates usually presents with hematemesis (blood in vomitus) or melena (blood in the stool). Gastroesophageal reflux involves a small (1-2 tsp) volume and is not forceful. Appendicitis typically begins with anorexia for 12 to 24 hours; children do not eat and do not act like their usual selves. Nausea and vomiting may then occur, followed by diffuse abdominal pain.Noah is an 18-month-old who is brought to the ER with flu-like symptoms. He is diagnosed with pneumonia secondary to aspiration of stomach contents. The nurse explains to the parents that pneumonia is a condition that often occurs secondary to: a) Hirschsprung disease. b) cystic fibrosis. c) gastroesophageal reflux disease. d) inflammatory bowel disease.gastroesophageal reflux disease. The child with gastroesophageal reflux disease may present with the physical findings of pneumonia secondary to aspiration of refluxed stomach contents.The nurse is caring for an infant recently diagnoses with thrush and was prescribed nystatin. Which statement by the infant's mother would suggest a need for further education? a) "I will make sure to clean all of her toys before I give them to her." b) "I will use a cotton tipped applicator to apply the medication to her mouth." c) "I will watch for diaper rash." d) "I will add the nystatin to her bottle four times per day.""I will add the nystatin to her bottle four times per day." Administer nystatin suspension four times per day following feeding, not mixed in the bottle, to allow the medication to remain in contact with the lesions. In the younger infant, apply nystatin to the lesions with a cotton-tipped applicator. Infants and young children often mouth their toys, so it is important to clean them appropriately. Explain to parents of infants with thrush the importance of reporting diaper rash because fungal infections in the diaper area often occur concomitantly with thrush and also need to be treated.A nurse prepares a menu for a client with Crohn disease. What is the focus of dietary management for this disease? a) High calorie, high fiber b) Low calorie, high carbohydrate c) High carbohydrate, high protein d) Low fiber, low calorieHigh carbohydrate, high protein The goal of nutritional intervention is to provide adequate nutrient intake to optimize normal growth and development—including pubertal development, which is frequently delayed—and to prevent and correct nutrient deficiencies. Adequate nutrition with a high-protein and high-carbohydrate diet may be recommendedA nurse taking a health history of a newborn notes that there is a maternal history of polyhydramnios. What GI condition might this history precipitate? a) Pyloric stenosis b) Cleft palate c) Esophageal atresia (EA) d) HerniaEsophageal atresia (EA) A maternal history of polyhydramnios is usually present in one-third of cases of EA and in some cases of tracheoesophageal fistula (TEF).A mother calls the doctor's office and tells the nurse that she is concerned because her 4-month-old keeps "spitting up" with every feeding. What would indicate that the child is regurgitating as opposed to vomiting? a) Is projected 1 ft away from infant b) Only occurs with feeding c) Continues until stomach is empty d) Is curdled and extremely sour smellingOnly occurs with feeding Regurgitation typically occurs only with feeding, runs out of the mouth with little force, smells barely sour and is only slightly curdled, appears to cause no pain or distress, occurs only once per feeding, and amounts to only about 1 to 2 tsp. Vomiting may occur at times other than feeding, is forceful and is typically projected 1 ft or more away from infant, is extremely sour smelling and curdled, is typically accompanied by crying, continues until the stomach is empty, and amounts to the full stomach contents.The parents of a 6-month-old have brought their child to the emergency department with vomiting and diarrhea for the past 3 days. The report the child as being very lethargic today. During the assessment the nurse notes decreased skin turgor, delayed capillary refill, and pale, slightly dry skin. Based on the objective and subjective data, what does the nurse determine the child to be? a) Mildly dehydrated b) Moderately dehydrated c) Severely dehydrated d) Well hydratedModerately dehydrated In addition to these signs and symptoms, signs and symptoms of moderate dehydration also include sunken fontanels, mildly sunken orbits, and urine outputA 10-year-old male presents with low-grade fever, nausea, and abdominal pain. The nurse examining him suspects appendicitis and checks for rebound tenderness in what quadrant? a) Lower right b) Upper left c) Upper right d) Lower leftLower right With appendicitis, percussion reveals irritation and pain in the right lower quadrant. Rebound tenderness present with palpation in the right lower quadrant, is referred to as the McBurney point, an area of tenderness 1.5 to 2 in. (3.8 to 5 cm) in from the right anterior superior iliac spine along a line extending to the umbilicus.The nurse is positioning an infant who has just had his left-sided cleft lip repaired. What positions are acceptable for this infant? Select all that apply. a) High fowlers b) Supine c) Prone d) Right side lying e) Left side lying• Right side lying • Supine It is critical to prevent injury to the facial suture line or to the palatal operative sites. Do not allow the infant to rub the facial suture line. To prevent this, position the infant in a supine or side-lying positionA 12-year-old boy has just undergone a liver transplantation and is recovering. After performing a finger stick puncture and assessing the results, the nurse administers a 10% solution of dextrose IV. What is the correct rationale for this intervention? a) Prevention of T-cell rejection of the transplanted liver b) Prevention of hypoglycemia c) Reduction of hypertension d) Maintenance of electrolyte balancePrevention of hypoglycemia Hypoglycemia is a major danger following liver transplantation because glucose levels are regulated by the liver, and the transplanted organ may not function efficiently at first. Assess serum glucose levels hourly by finger stick puncture. A 10% solution of dextrose IV may be necessary to prevent hypoglycemia. Careful tissue matching before the transplantation is needed to reduce the possibility of stimulating T-cell rejection. Sodium, potassium, chloride, and calcium levels are evaluated approximately every 6 to 8 hours to be certain electrolyte balance is maintained, but potassium is rarely added to IV solutions because of the risk that renal failure has occurred. IV therapy with hypotensive agents such as hydralazine (Apresoline) and nitroprusside may be needed to reduce hypertension.The mother of a young child, who has been treated for a bacterial urinary tract infection, tells the nurse her daughter has a white thick covering over her tongue. The mother states that she "has tried everything to get it off my child's tongue." How should the nurse respond? a) "That is a common side effect after taking an antibiotic. It will go away after the antibiotic is out of the system." b) "Have you tried using a toothbrush to get it off?" c) "It is likely an infection was caused by the antibiotic for the urinary tract infection. I am sure a different antibiotic will help it." d) "It's not unusual for a fungal infection to occur while taking an antibiotic for an infection. I will let your primary care provider know so we can get it treated.""It's not unusual for a fungal infection to occur while taking an antibiotic for an infection. I will let your primary care provider know so we can get it treated." Thrush is a fungal infection that can occur on the tongue while on an antibiotic for an unrelated bacterial infection. The antibiotic destroys normal flora, which allows the fungal infection to occur. Thrush requires an antifungal agent, such as nystatin liquid, to destroy the infection. Additional antibiotics will not help since it is a fungal infection.An adolescent boy is diagnosed with hepatitis A. Which problem should be considered when planning care? a) He will be very irritable and perhaps require sedation. b) Hypothermia is common. c) He will become fatigued easily. d) His urine will be dark and infectious.He will become fatigued easily. Most children with hepatitis are exhausted. Urine is not infectious.The nurse observes the interactions of parents with their infant who was born with a cleft lip. The mother is attempting to feed the baby, but does not make eye contact. The father is watching television with his back turned to the mother and baby. What psychosocial nursing intervention would be most helpful to this family? a) Explain to the parents that surgical intervention will fix the defect in the baby's lip. b) Teach the mother the appropriate technique for breast-feeding an infant with cleft lip. c) Refer the family to a social worker or mental health practitioner. d) Ask the parents if they have any questions regarding the care of their child.Ask the parents if they have any questions regarding the care of their child. The family's emotional response to the birth of a child with cleft lip, palate, or both may range from grief to anger to denial. The nurse should encourage the parents to express their feelings and provide the parents with opportunities and support for normal infant-parent interactionsThe nurse is working with the mother of a toddler experiencing constipation. What information regarding childhood constipation should the nurse share with the mother? Select all that apply. a) "Reward your child for sitting on the toilet as asked, not just when they have a bowel movement." b) "Have your son sit on the toilet twice a day, after breakfast and dinner, for 5 to 15 minutes." c) "If your child has a fecal impaction, you can give him an enema." d) "Reward your child only when they have a bowel movement with a sticker." e) "You should not give your son laxatives."• "Have your son sit on the toilet twice a day, after breakfast and dinner, for 5 to 15 minutes." • "If your child has a fecal impaction, you can give him an enema." • "Reward your child for sitting on the toilet as asked, not just when they have a bowel movement." Proper education for constipation in children includes educating the families about the importance of compliance with medication use. Many children present to their physician or nurse practitioner with fecal impaction or partial impaction. Teach parents how to disimpact their children at home; this often requires an enema or stimulation therapy. To facilitate daily bowel evacuation, the child should sit on the toilet twice a day (after breakfast and dinner) for 5 to 15 minutes. Instruct the family to keep a "star" or reward chart to encourage compliance. Parents should award the star for compliance with time sitting on the toilet and should not reserve rewards for successful bowel movements only.The mother of an infant tells the nurse during a routine visit to the clinic that she often notices a bulging mass in the lower abdominal and groin area when her baby cries. She asks the nurse if this is normal. How should the nurse respond? a) "I didn't notice any masses while I was assessing your infant. It may just appear they have a mass due to pressure in the abdomen when crying." b) "I will be sure to note this in your child's chart so it is something we will continue to monitor in future visits." c) "The muscle wall of infants are not yet strong so it isn't unusual to see this happening when the baby is crying or straining." d) "I understand your concern. I will be sure to document this in your child's medical record and report this information to your child's physician immediately.""I understand your concern. I will be sure to document this in your child's medical record and report this information to your child's physician immediately." The mother is describing common symptoms of an inguinal hernia. It may be possible to visualize the mass, but often the mass is seen only during crying or straining, making it difficult to actually identify in the clinic setting. It is important to notify the physician so treatment can be initiated. (less)A mother brings her 3-year-old son to the ER and tells the triage nurse that he has been vomiting blood. A medical history determines that the 3-year-old has no history of GI disturbances and his only symptoms are a slightly elevated fever and vomiting bright red blood. Based on these symptoms, what condition might the nurse suspect? a) Intussusception b) Acute upper GI bleeding c) GI tract obstruction d) Gastroesophageal refluxAcute upper GI bleeding Vomiting bright red blood indicates acute upper GI bleeding. Emesis containing brown, foul-smelling stool indicates GI obstruction. Stool with red blood and mucus is associated with intussusception. Bleeding is not generally indicative of gastroesophageal reflux.The caregiver of a child diagnosed with celiac disease tells the nurse that the child has large amounts of bulky stools and what looks like fat in his stools. The clinical manifestation this caregiver is describing is: a) steatorrhea. b) severe diarrhea. c) projectile stools. d)steatorrhea. Steatorrhea (fatty stools) is a classic symptom of celiac disease. Currant jelly stools are a sign of intussusception. Projectile vomiting is a sign of pyloric stenosis.The nurse has performed client teaching to a 15-year-old boy with Crohn disease, and his parents regarding the cobblestone lesions in his small intestine. Which comment by the family indicates learning occurred? a) "I may end up with a colectomy because the disease is continuous from the beginning to the end of my intestines." b) "It's unusual for someone my age to get Crohn disease." c) "I have a lot of diarrhea every day because of how my small intestine is damaged." d) "I have to be careful because I am prone to not absorbing nutrients.""I have to be careful because I am prone to not absorbing nutrients." Crohn disease typically effects the small intestine more than the large intestine and it's onset is between the ages of 10 to 20 years. The cobblestone lesions in the small intestine prevents absorption of nutrients that normally occurs. The diarrhea is not directly related to the cobblestone lesions, and ulcerative colitis is characterized by the disease effecting the intestine(s) in a continuous pattern.A nurse reads the medical history of a client who is scheduled for a hernia repair that is termed "reducible." What best describes this type of hernia? a) Its contents can be easily manipulated back into the peritoneal cavity. b) The herniated intestines are twisted and edematous. c) Intestinal obstruction and ischemia may occur. d) The abdominal contents have become trapped.Its contents can be easily manipulated back into the peritoneal cavity. A hernia in the abdominal region is considered reducible when its contents are easily manipulated back into the peritoneal cavity. An incarcerated hernia occurs when the abdominal contents become trapped and difficult to reduce. A strangulated hernia occurs when the herniated intestines become twisted and edematous compromising blood flow. Intestinal obstruction and ischemia may occur.A mother brings her 2-week-old newborn to the doctor's office because the child has been experiencing gastroesophageal reflux over the past week. Which interventions should the nurse recommend to the mother at this point? Select all that apply. a) Keep the infant upright in an infant chair for 30 minutes after feeding. b) Feed the infant a formula thickened with rice cereal. c) If breastfeeding, switch to formula. d) Feed the infant while holding her in an upright position. e) Consult a pediatric surgeon regarding having a myotomy procedure performed. f) Consult the physician regarding having botulinum toxin injected into the lower esophageal sphincter.Keep the infant upright in an infant chair for 30 minutes after feeding. • Feed the infant a formula thickened with rice cereal. • Feed the infant while holding her in an upright position. The traditional treatment of GI reflux is to feed infants a formula thickened with rice cereal (1 tbsp of cereal per 1 oz of formula or breast milk) while holding them in an upright position and then keeping them upright in an infant chair for 30 minutes after feeding so gravity can help prevent reflux. There is no need for the mother to switch from breastfeeding to formula. Injection of botulinum toxin into the lower esophageal sphincter and a myotomy procedure are interventions that would be considered only if the problem does not disappear with feeding solid food and maintaining the child in a more upright position during and following feeding; they would not be appropriate at this point.The nurse is caring for a newborn diagnosed with imperforate anus following delivery. The physician has discussed the treatment options and prognosis with the parents. The nurse is talking with the parents and determines that learning has occurred when the parents make which statement? a) "Since our baby has a defect high in the anorectal opening there is a good chance that stool continence won't be a problem." b) "We are worried that our child may have other congenital problems that we aren't aware of." c) "We aren't sure if our baby will need surgery at some point for this problem." d) "We know we will need to use baby wipes around the anal area after surgery to prevent infection.""We are worried that our child may have other congenital problems that we aren't aware of." Imperforate anus is a congenital malformation of the anorectal opening. Other congenital anomalies may be associated with imperforate anus in 50% of cases. Surgical intervention is needed for both high and low types of imperforate anus. After repair, only about 30% with a high defect will achieve continence. To decrease the drying associated with frequent cleaning, avoid baby wipes and frequent use of soap and water.The nurse is teaching an in-service program to a group of nurses on the topic of gastrointestinal disorders. The nurses in the group make the following statements. Which statement is most accurate related to the diagnosis of gastroesophageal reflux? a) There are recurrent paroxysmal bouts of abdominal pain. b) A thickened, elongated muscle causes an obstruction at the end of the stomach. c) In this disorder the sphincter that leads into the stomach is relaxed. d) A partial or complete intestinal obstruction occurs.In this disorder the sphincter that leads into the stomach is relaxed. Gastroesophageal reflux (GER) occurs when the sphincter in the lower portion of the esophagus, which leads into the stomach, is relaxed and allows gastric contents to be regurgitated back into the esophagus. Congenital aganglionic megacolon is characterized by persistent constipation resulting from partial or complete intestinal obstruction of mechanical origin. Colic consists of recurrent paroxysmal bouts of abdominal pain. Pyloric stenosis is characterized by hypertrophy of the circular muscle fibers of the pylorus which leads to an obstruction at the distal end of the stomach.The nurse is preparing an 18-month-old for discharge after treatment for dehydration following diarrhea. What instruction would the nurse most likely include in the discharge teaching? a) "Offer her flavored gelatin if she is hungry." b) "Encourage bananas, applesauce, and crackers." c) "Give her plenty of fruit juice or soda." d) "Make sure she gets lots of clear liquids.""Encourage bananas, applesauce, and crackers." After rehydration is achieved, it is important to encourage the child to consume a regular diet in order to maintain energy and growth. The solid foods presented are easily digested and age appropriate. The parents should avoid prolonged used of clear liquids in the child with diarrhea because "starvation stools" might result. Fluids high in glucose such as fruit juice, gelatin, and soda may worsen diarrhea. Gelatin is high in glucose and may worsen diarrhea.A child with cirrhosis of the liver is admitted to the acute care facility in preparation for a liver transplant. When completing the physical examination, what would the nurse expect to assess? Select all that apply. a) Jaundice b) Facial erythema c) Fatty stools d) Ascites e) Spider angiomas• Jaundice • Ascites • Spider angiomas Assessment findings associated with cirrhosis include jaundice, ascites, spider angiomas, and palmar erythema. Fatty stools are associated with celiac disease.The nurse is caring for a newborn with a cleft palate. Which findings in the maternal medical record are considered to be contributing factors? Select all that apply. a) Moderate maternal alcohol use prior to pregnancy. b) Anticonvulsant therapy used to manage a seizure disorder. c) Reports of marijuana use in early pregnancy. d) Maternal tobacco use. e) Maternal age less than 18 years.• Maternal tobacco use. • Anticonvulsant therapy used to manage a seizure disorder. Infants born with a cleft palate may have mother's with risk factors. These include maternal smoking, prenatal infection, advanced maternal age, use of anticonvulsants or steroidsIn caring for an infant diagnosed with pyloric stenosis, the nurse would anticipate that she would: a) prepare the infant for surgery. b) medicate the infant with analgesics. c) change the infant's diet to lactose-free. d) assist in doing a barium enema procedure on the infant.prepare the infant for surgery. A surgical procedure called a pyloromyotomy (also known as a Fredet-Ramstedt operation) is the treatment of choice for pyloric stenosis.The adolescent has been diagnosed with gastroesophageal reflux disease (GERD). Which statements by the teen indicates that adequate learning has occurred? Select all that apply. a) "The omeprazole could give me a headache." b) "I should try to lie down right after I eat." c) "I will probably need a laxative because of the omeprazole." d) "This famotidine may make me tired." e) "It sounds like the physician is reluctant to give me a prokinetic because of the side effects."• "This famotidine may make me tired." • "The omeprazole could give me a headache." • "It sounds like the physician is reluctant to give me a prokinetic because of the side effects." Famotidine may cause fatigue. Omeprazole can cause headaches. Prokinetics use may result in side effects involving the central nervous system. Omeprazole use more likely will result in diarrhea, not constipation. Children with GERD should not lie down after meals.The nurse is caring for a teenager diagnosed with acute pancreatitis. Which order would the nurse question? a) Nasogastric tube placed to suction b) Serum amylase levels c) NPO d) PO pain managementPO pain management Maintain NPO status and nasogastric tube suction and patency. Administer intravenous fluids to keep the child hydrated and correct any alterations in fluid and electrolyte balance. Pain management is crucial in children with pancreatitis, due to NPO status, medications are typically prescribed intravenously. Serial monitoring of serum amylase levels will determine when oral feeding may be restarted.The nurse is conducting a physical examination of an infant with suspected pyloric stenosis. Which finding indicates pyloric stenosis? a) Perianal fissures and skin tags b) Hard, moveable "olive-like mass" in the upper right quadrant c) Sausage-shaped mass in the upper mid abdomen d) Abdominal pain and irritabilityHard, moveable "olive-like mass" in the upper right quadrant A hard, moveable "olive-like mass" in the right upper quadrant is the hypertrophied pylorus. A sausage-shaped mass in the upper mid abdomen is the hallmark of intussusception. Perianal fissures and skin tags are typical with Crohn disease. Abdominal pain and irritability is common with pyloric stenosis but are seen with many other conditions.You care for a 12-year-old girl with Crohn disease. A primary assessment you would want to make when caring for her would be to note if: a) lung sounds are clear. b) she has a temperature. c) her joints are not swollen. d) she has a headache.she has a temperature. Because Crohn disease leads to patches of inflammation in the bowel, the temperature increases if more patches become involved.The nurse is caring for an infant recently diagnoses with thrush and was prescribed nystatin. Which statement by the infant's mother would suggest a need for further education? a) "I will add the nystatin to her bottle four times per day." b) "I will use a cotton tipped applicator to apply the medication to her mouth." c) "I will make sure to clean all of her toys before I give them to her." d) "I will watch for diaper rash.""I will add the nystatin to her bottle four times per day." Administer nystatin suspension four times per day following feeding, not mixed in the bottle, to allow the medication to remain in contact with the lesions. In the younger infant, apply nystatin to the lesions with a cotton-tipped applicator. Infants and young children often mouth their toys, so it is important to clean them appropriately. Explain to parents of infants with thrush the importance of reporting diaper rash because fungal infections in the diaper area often occur concomitantly with thrush and also need to be treated.The parents of a 6-month-old have brought their child to the emergency department with vomiting and diarrhea for the past 3 days. The report the child as being very lethargic today. During the assessment the nurse notes decreased skin turgor, delayed capillary refill, and pale, slightly dry skin. Based on the objective and subjective data, what does the nurse determine the child to be? a) Moderately dehydrated b) Severely dehydrated c) Mildly dehydrated d) Well hydratedModerately dehydrated In addition to these signs and symptoms, signs and symptoms of moderate dehydration also include sunken fontanels, mildly sunken orbits, and urine outputwhere is Mcburney's PointMcBurney's point is the area in the right lower quadrant of the abdomen where the most pressure tends to be felt upon palpation when the client has appendicitis. It lies between the naval and the right anterior superior iliac spine.The nurse is caring for a child that was dehydrated following gastric surgery but has since been re-hydrated. The physician orders intravenous maintenance fluid rate for the child. How will the nurse determine the intravenous maintenance fluid rate per hour for this child who weighs 40 kg?The formula to determine maintenance fluid rate is: *100 mL/kg for first 10 kg *50 mL/kg for next 10 kg *20 mL/kg for remaining kg *Add together for total mL needed per 24-hour period. *Divide by 24 for mL/hour fluid requirement. Therefore, for a child weighing 40kg the equation is: *100 X 10= 1000 *50 X 10= 500 *20 X 20= 400 *1000 + 500 + 400= 1900 *1900/24= 79.17= 79 mL/hrThe nurse is conducting a physical examination of an 18-month-old with suspected intussusception. Which finding would the nurse identify as the hallmark of this condition? a) Skin tenting b) A sausage-shaped mass in the upper midabdomen c) Abdominal pain and guarding d) Perianal skin tagsA sausage-shaped mass in the upper midabdomen A sausage-shaped mass in the upper midabdomen is the hallmark of intussusception. Perianal skin tags are highly suspicious of Crohn disease. Abdominal pain and guarding are also common with intussusception but are seen with many other conditions. Tenting would indicate dehydration.The nurse is collecting data on a 2 ½-year-old child admitted with a diagnosis of gastroenteritis. When interviewing the caregivers, which question is most important for the nurse to ask? a) "What foods has your child eaten during the last few days." b) "Tell me about the types of stools you child has been having." c) "How long has your child been toilet trained?" d) "How many times a day does your child urinate?""Tell me about the types of stools you child has been having." For the child with gastroenteritis, the interview with the family caregiver must include specific information about the history of bowel patterns and the onset of diarrheal stools, with details on number and type of stools per day. Recent eating patterns, if the child is toilet trained, and how many times a day the child urinates are important questions, but the highest priority is gathering data regarding the stools and stool pattern.The nurse is caring for a child with a diagnosis of pyloric stenosis during the preoperative phase of the child's treatment. What is the highest priority at this time? a) Improving hydration b) Promoting comfort c) Maintaining skin integrity d) Preparing family for home careImproving hydration Preoperatively the highest priority for the child with pyloric stenosis is to improve nutrition and hydration. Maintaining mouth and skin integrity, and relieving family anxiety are important, but these are not the priority. The child will not likely have intense pain. Preparing the family for home care would be a postoperative goal.The nurse is reviewing the medical record of a child with a cleft lip and palate. When reviewing the child's history, what would the nurse identify as a risk factor for this condition? a) Maternal use of acetaminophen in third trimester b) Mother age 42 with pregnancy c) Preterm birth d) History of hypoxia at birthMother age 42 with pregnancy Advanced maternal age is a risk factor for cleft lip and palate. Drugs such as anticonvulsants, steroids, and other medications during early pregnancy are considered risk factors. Acetaminophen is not associated with an increased risk for cleft lip and palate. Preterm birth is not a risk factor for the development of cleft lip and palate. Hypoxia or anoxia is a risk factor for the development of necrotizing enterocolitis.The infant is listless with sunken fontanels and has been diagnosed with dehydration. The infant is still producing at least 1 mL/kg each hour of urine. The infant weighs 13.2 lb (6 kg). At the minimum, how many milliliters of urine will the infant produce during the next 8-hour shift? Record your answer using a whole number.48 Urine output should be calculated using weight in kilograms. 6 kg x 1 mL/kg = 6 mL/hour 6 mL x 8 hours = 48 mL/8-hour shiftThe emergency department nurse is assessing a child who has presented with a 2-day history of nausea and vomiting with pain that is isolated to the right upper quadrant of the abdomen. Which action is most appropriate? a) Assess the child's usual urinary voiding pattern b) Administer antacids as ordered c) Prepare the child for admission to the hospital d) Encourage fluid intakePrepare the child for admission to the hospital The child's presentation is consistent with cholecystitis, which necessitates surgery in most cases. The child should be kept NPO and antacids are of no benefit. Genitourinary involvement is atypical.A nurse taking a health history of a newborn notes that there is a maternal history of polyhydramnios. What GI condition might this history precipitate? a) Cleft palate b) Pyloric stenosis c) Hernia d) Esophageal atresia (EA)Esophageal atresia (EA) Correct Explanation: A maternal history of polyhydramnios is usually present in one-third of cases of EA and in some cases of tracheoesophageal fistula (TEF).What are the classic symptoms of celiacs disease• Constipation • Diarrhea • Steatorrhea • Failure to thrive Classic symptoms of celiac disease include steatorrhea, constipation, diarrhea, failure to thrive, weight loss, abdominal distention or bloating (not a sunken abdomen), and anemia (not polycythemia).What is the only treatment for celiacs diseasestrict gluten free dietA 3-month-old girl is found to have an umbilical hernia at a well visit. On examination, the nurse discovers that the fascial ring through which the intestine protrudes is about 1 cm in diameter. Which of the following should she mention to the girl's father as the likely intervention required to correct this condition? a) No intervention is needed, as the opening will most likely close spontaneously b) Taping a silver dollar over the area will help reduce the hernia c) Surgery at age 1 to 2 years will likely be needed to repair the condition d) Wrapping an elastic band around the child's waist should correct the problemNo intervention is needed, as the opening will most likely close spontaneously An umbilical hernia is a protrusion of a portion of the intestine through the umbilical ring, muscle, and fascia surrounding the umbilical cord. If the fascial ring through which the intestine protrudes is less than 2 cm, closure will usually occur spontaneously after the child begins to walk so no repair of the disorder will be necessary. If the fascial ring is larger than 2 cm, ambulatory surgery for repair is generally indicated to prevent herniation and intestinal obstruction or bowel strangulation. This is usually done at 1 to 2 years of age. Some parents believe holding an umbilical hernia in place by using "belly bands" or taping a silver dollar over the area will help reduce the hernia. These actions can actually lead to bowel strangulation so should be avoided.The nurse is obtaining the history of an infant with a suspected intestinal obstruction. Which response regarding newborn stool patterns would indicate a need for further evaluation for Hirschsprung disease? a) Has had diarrhea for 3 days b) Passed a meconium stool in the first 24 to 48 hours of life c) Passed a meconium plug d) Constipated and passing gas for 2 daysPassed a meconium plug If the parent reports that the child passed a meconium plug, the infant should be evaluated for Hirschsprung disease. Constipation, not diarrhea, is associated with this condition; however, constipation alone would not necessarily warrant further evaluation for Hirschsprung disease. Passing a meconium stool in the first 24 to 48 hours of life is normal.The nurse is talking with a pregnant client about cleft lips and palates. The client has asked if these can be tested for. What information should be included in the nurse's response? Select all that apply. a) The nuchal translucency test can be used to screen for cleft lips and palates. b) The quadruple marker test can be used to detect these conditions. c) Most cleft lips and palates are found at delivery. d) Ultrasounds can be used to assess for these conditions. e) There are no ways to determine the presence of cleft lips or palates prior to delivery.• Most cleft lips and palates are found at delivery. • Ultrasounds can be used to assess for these conditions. Ultrasounds can be used to identify the presence of cleft lips or palates. Most, however, are found after birth. The quadruple screening test assesses for potential down syndrome and neuro tube defects. Nuchal translucency testing is used to assess for down syndrome.The nurse is caring for an infant. The infant's mother asks the mother, "what did the doctor mean when he said she may have regurgitation?" What response by the nurse is appropriate? a) "Regurgitation is the backflow of stomach contents up into the esophagus or mouth." b) "Regurgitation is not normal in infants. She will need more testing to see what is causing this." c) "Regurgitation is just another term for vomiting. All infants vomit some." d) "Regurgitation is when an infant can't tolerate their formula. You will need to switch.""Regurgitation is the backflow of stomach contents up into the esophagus or mouth." Regurgitation is the backflow of stomach contents up into the esophagus and/or oral cavity. The muscle tone of the lower esophageal sphincter is not fully developed until age 1 month, so infants younger than 1 month of age frequently regurgitate after feedings. Many children younger than 1 year of age continue to regurgitate for several months, but this usually disappears with age. (A 9-month-old girl is brought to the emergency room with what appears to be bouts of intense abdominal pain 15 minutes apart in which she draws up her legs and cries, often accompanied by vomiting. In between the bouts, the child recovers and appears to be without symptoms. Blood is found in the stool. What condition should the nurse suspect in this case? a) Volvulus with malrotation b) Intussusception c) Short-bowel/short-gut syndrome d) Necrotizing enterocolitisIntussusception Intussusception, the invagination of one portion of the intestine into another, usually occurs in the second half of the first year of life. Children with this disorder suddenly draw up their legs and cry as if they are in severe pain; they may vomit. After the peristaltic wave that caused the discomfort passes, they are symptom-free and play happily. In approximately 15 minutes, however, the same phenomenon of intense abdominal pain strikes again. After approximately 12 hours, blood appears in the stool and possibly in vomitus, described as a "currant jelly" appearance. Volvulus with malrotation and necrotizing entercolitis typically occur in the first 6 months of life and do not match the symptoms described above. Short-bowel/short-gut syndrome typically occurs when a large portion of the intestine has been removed due to a previous disease or trauma.A child is hospitalized with dehydration as a result of rotavirus. When reviewing the plan of treatment, what can the nurse anticipate will be included? Select all that apply. a) Antidiarrheal agents b) Monitor of intake and output c) Antibiotic therapy d) IV fluid administration e) Daily weight assessment• Monitor of intake and output • IV fluid administration • Daily weight assessment Rotavirus is viral in nature. Antibiotic therapy is not used in the care and treatment of a viral infection. Antidiarrhea medications are not utilized as they are not effective. Intake and output will be observed. Daily weight will aid in the determination of hydration status. IV fluids may be indicated in the rehydration process.A 4-month-old has had a fever, vomiting, and loose watery stools every few hours for 2 days. The mother calls the physician's office and asks the nurse what she should do. Which response by the nurse is most appropriate? a) "Bring the child to the office today so we can evaluate her fluid balance and determine the best treatment." b) "Continue breastfeeding as you have been doing. The fluid from the breast milk is important to maintain fluid balance." c) "Give a clear pediatric electrolyte replacement for the next few hours, then call back to report on how your child is doing." d) "Do not give the child anything to drink for 4 hours. If the fever goes down and the loose stools stop, you can resume breastfeeding.""Bring the child to the office today so we can evaluate her fluid balance and determine the best treatment." Infants are comprised of a high percentage of fluid that can be lost very quickly when vomiting, fever, and diarrhea are all present. This infant needs to be seen by the physician based on her age and symptoms; hospitalization may be necessary for intravenous rehydration depending upon her status when assessed.A nurse is administering an enteral feeding to a child with a G-tube. What is a recommended step in this procedure? a) After feeding, flush the tube with a small amount of saline and leave the gastrostomy tube open for 2 to 5 minutes. b) Position with the head of the bed lowered at a 20° angle. c) Check for gastric residual before starting feeding by gently aspirating from the tube with a syringe. d) Administer feeding by connecting the syringe barrel to the tube and pouring formula into the syringe with a syringe plunger.Check for gastric residual before starting feeding by gently aspirating from the tube with a syringe. The nurse should check for gastric residual before starting feeding by gently aspirating from the tube with a syringe or positioning the tube below the level of the stomach with only the barrel of the syringe attached. The client should be positioned with his or her head elevated 30° to 45° and formula should be allowed to flow with gravity, not plunged unless it is clogged. After feeding, the nurse should flush the tube with a small amount of water, unless contraindicated, and leave the gastrostomy tube open for 5 to 10 minutes after feeding to allow for escape of air.The student nurse is caring for a child with the nursing diagnosis "Risk for fluid volume deficit related to inadequate oral intake". Which statement by the student would indicate a need for further education by the nursing instructor? a) "I will teach her mother to give her small drinks frequently." b) "I will weigh her every morning at the same time." c) "I will monitor her IV line to help maintain her fluid volume." d) "I will make sure there is plenty of orange juice available. It's her favorite juice.""I will make sure there is plenty of orange juice available. It's her favorite juice." Proper interventions for children at risk for fluid volume deficit include maintaining IV line and administer IV fluid as ordered to maintain fluid volume. Offer small amounts of oral rehydration solution frequently to maintain fluid volume. Small amounts are usually well tolerated by children with diarrhea and vomiting. Avoid high-carbohydrate fluids such as Kool-Aid and fruit juice, as they are low in electrolytes, and increased simple carbohydrate consumption can decrease stool transit time. Daily weights are one of the best indicators of fluid volume status in children.The nurse is providing discharge teaching regarding oral fluid rehydration to a mother who brought her child to the clinic because of vomiting over the past 2 days. The child is mildly dehydrated. Which comments by the mother indicated learning occurred? a) "My child can drink milk if they feel like it to help in rehydration." b) "I should be sure my child receives 50 to 100 mL/kg of oral rehydration solution (ORS) over 4 hours." c) "Solutions like Pedialyte are not necessary for mild dehydration." d) "I should not give my child any fluids for 1 to 2 hours after an episode of vomiting." e) "Oral rehydration solutions (ORS) are good sources of fluids for rehydration."• "I should not give my child any fluids for 1 to 2 hours after an episode of vomiting." • "Oral rehydration solutions (ORS) are good sources of fluids for rehydration." • "I should be sure my child receives 50 to 100 mL/kg of oral rehydration solution (ORS) over 4 hours." In the child with mild to moderate dehydration resulting from vomiting, withhold oral feeding for 1 to 2 hours after emesis, after which time oral rehydration can begin. Tap water, milk, undiluted fruit juice, soup, and broth are NOT appropriate for oral rehydration. Oral rehydration solutions include standard ORS solutions include Pedialyte, Infalyte, and Ricelyte. The recommendation for children with mild to moderate dehydration is 50 to 100 mL/kg of ORS over 4 hours.Testing is being performed to confirm the presence of Meckel diverticulum. Which findings are consistent with this condition? Select all that apply. a) Platelet count 200,000 b) Hematocrit 37% c) Stool test reveals occult blood. d) White blood cell count 8 g/dL. e) Hemoglobin 9.4 g/dL• Hemoglobin 9.4 g/dL • Stool test reveals occult blood. Meckel diverticulum is a disorder where there are weaknesses on the intestine resulting in pouchlike areas. Test findings that are consistent with this disorder are anemia and the presence of occult blood. The values listed for white blood cell count, platelet levels, and hematocrit levels are within normal limits.Which intervention is the most effective in treating burn wound infections?Topical antibiotics applied to the wound siteWhat accurately depicts the hemodynamic changes that occur in the body within the first 24 to 48 hours after a burn?Hematocrit and WBC counts elevateThe dermatologist treating a 16-year-old girl with a history of severe acne has ordered a pregnancy test so she can be started on a course of isotretinoin. The teen's caregiver has said that her daughter is a virgin and she refuses to allow her to have the required pregnancy testing. What would be the best action for the nurse to take?Acknowledge the caregiver's discomfort about the pregnancy testing but encourage her to allow the daughter to have the testing so that she can use the medication.The nurse admits a child who has sustained a severe burn. The child's immunizations are up to date. Which immunization would the child most likely be given at this time?Tetanus toxoid vaccine If inoculations are up to date, a booster dose of tetanus toxoid is required to protect the child from infection introduced into the burn.A nurse providing teaching on ways to promote skin hydration for the parents of an infant with atopic dermatitis. Which response indicates a need for further teaching?"We should bathe our child in hot water, twice a day."A nurse is caring for a child with tinea pedis. Which assessment finding should the nurse expect?Red scaling rash on soles and between the toes Tinea pedis presents with red scaling rash on soles, and between the toes. Tinea capitis presents with patches of scaling in the scalp with central hair loss and the risk of kerion development (inflamed boggy mass filled with pustules). Tinea cruris presents with erythema, scaling, maceration in the inguinal creases and inner thighs.The nurse is examining a child for indications of frostbite and notes blistering with erythema and edema. The nurse notes which degree of frostbite?Second degree frostbite Second degree frostbite demonstrates blistering with erythema and edema. First degree frostbite results in superficial white plaques with surrounding erythema. In third degree frostbite, the nurse would note hemorrhagic blisters that would progress to tissue necrosis and sloughing when the fourth degree is reached.The nurse is caring for a child with an order for PO prednisone. Which statement by the child's mother would indicate a need for further education?"I will give it to her at least 1 hour before all of her meals."An adolescent girl is going to be treated for a severe case of acne vulgaris. A pregnancy test should be done prior to the adolescent starting treatment with:Isotretinoin (Accutane) Isotretinoin is a pregnancy category X drug: it must not be used at all during pregnancy because of serious risk of fetal abnormalities.The nurse is collecting data on a child with a diagnosis of atopic dermatitis. While interviewing the caregiver, the nurse will direct questions to the caregiver recognizing that which common allergens are involved in eczema? Select all that apply.Cow's milk Animal dander NylonThe nurse caring for a child with a skin allergy recognizes that the highest priority in the treatment for skin allergies is aimed at:Reducing swelling and relieving itchingAn adolescent is prescribed isotretinoin. Which statement indicates that the adolescent understands the necessary precautions associated with this drug?"I have to make sure that I do not become pregnant while taking this drug."A child has an order for an erythrocyte sedimentation rate (ESR). The child's mother asks what the purpose of the test is. What is the best response by the nurse?"This test will tell if your child has an infection or inflammation somewhere in their body."The client is scheduled to have potassium hydroxide testing performed. What will be needed to complete this test?Skin scrapings Potassium hydroxide (KOH) testing is done to assess for the presence of a fungal infection. Skin scrapings are placed on a microscope slide and a drop of KOH 20% drop is added.The nurse is presenting an in-service to a group of nurses who will be working in a dermatology clinic. One participant asks the nurse about a bacterial skin infection that she has seen in children. The nurse most likely is referring to:impetigo. Impetigo is a superficial bacterial skin infection.The nurse is caring for a 13-year-old girl with acne vulgaris and is teaching the girl about skin care. Which response by the girl indicates a need for further teaching?"I should avoid eating any kind of chocolate."The nurse is providing education to a teenaged boy diagnosed with impetigo. Which statement by the boy indicates the need for further education?"I will need to cover my son's skin lesions with bandages until it has healed." Impetigo is an infectious bacterial infection. The crusts should be removed after soaking prior to applying topical medications. Leaving the lesions open to air is not contraindicated. Children diagnosed with impetigo may attend school during treatment.The nurse is assessing a child who has had an open wound for the last 2 weeks with no signs of healing. The parents report they have been using over-the-counter antibiotic ointment with no signs of improvement. The child is active in football in the fall and the swim team in the winter. What disorder does the nurse suspect?Community acquired MRSA Risk factors for community acquired MRSA (CA-MRSA) are turf burns, towel sharing, participation in team sports, or attendance at day care or outdoor camps. The condition usually presents with a moderate to severe skin infection or with an infection that is not responding as expected to therapyThe nurse is assessing a child who was brought into the clinic. The nurse notes honey-colored crusting on the toddler's face, as seen in the figure. The nurse recognizes this to be what type of infection?Impetigo Impetigo is a readily recognizable skin rash that is characterized with honey-colored crusting.The nurse is caring for a child with suspected child abuse-induced burns. Which assessment findings would support this?A burn to the entire right hand up to 2 cm above wrist with consistent edges A stocking/glove pattern on the hands or feet (circumferential ring appearing around the extremity, resulting from a caregiver forcefully holding the child under extremely hot water) is one sign is one sign of child abuse-induced burns.The nurse is speaking with the mother of a child diagnosed with contact dermatitis from poison ivy. Which statement by the mother indicates a need for further education?"As long as he takes a shower as soon as he gets inside, he shouldn't get this again."The nurse is caring for a client brought to a pediatric clinic for swelling in the lower extremities with reddened skin that has undefined borders and pits slightly when pressed. What is the most likely diagnosis of the client's skin alteration?CellulitisThe nurse is caring for a child with a partial-thickness burn. What assessment findings would the nurse expect to observe?Edema with wet blistering skin Partial-thickness burns are very painful and edematous and have a wet appearance or the presence of blisters. Full-thickness burns appear red, edematous, leathery, dry, or waxy and may display red or charred skin (eschar).A topical corticosteroid is prescribed for a child with contact dermatitis. Which statement by the mother would indicate the teaching was successful?"I should not cover the area with plastic wrap after applying the cream." An occlusive dressing such as plastic wrap over the area should not be used with topical corticosteroids. High-potency preparations should not be used. There is no need to shake topical corticosteroids. Benzoyl peroxide requires shaking before use. Applying the medication at night and rinsing off in the morning is used for coal tar preparations.The nurse has completed client teaching with a 16-year-old female who has been prescribed Accutane (isotretinoin) for cystic acne. Which statements indicate learning has occurred? Select all that apply."If I am sexually active I need to let my doctor know." "This is not a drug to be used for all forms of acne. My sister has minor acne so I told her this wasn't for her." "It's important I get my CBC blood test when my doctor orders it."An adolescent with tinea versicolor is admitted for treatment of the disorder. Which nursing diagnosis will the nurse identify as having the highest priority for this client?Disturbed body imageA 4-month-old infant is experiencing dermatitis in the diaper area. What treatments will be beneficial to this condition? Select all that apply.Allow the diaper area to air dry. Apply petroleum jelly to the diaper area. Apply ointment with vitamin A to the diaper area. Use ointments containing zinc on the diaper area.The camp nurse is caring for a child who was bitten on the leg by a dangerous spider. The child is being taken to a care provider. What is the most appropriate action for the nurse to do with this child?Apply ice to the affected area. Spider bites can cause serious illness if untreated. Bites of black widow spiders, brown recluse spiders, and scorpions demand medical attention. Applying ice to the affected area until medical care is obtained can slow absorption of the poison.The nurse is conducting a physical examination of a boy with erythema multiforme. Which assessment finding should the nurse expect?Lesions over the hands and feet, and extensor surfaces of the extremities with spread to the trunk Erythema multiforme typically manifests in lesions over the hands and feet, and extensor surfaces of the extremities with spread to the trunk. Thick or flaky/greasy yellow scales are signs of seborrhea. Silvery or yellow-white scale plaques and sharply demarcated borders define psoriasis. Superficial tan or hypopigmented oval-shaped scaly lesions specially on upper back and chest and proximal arms are indicative of tinea versicolor.The nurse is discussing dietary intake with the parents of a 4-year-old child who has been diagnosed with atopic dermatitis. Later, the nurse notes the menu selection made by the parents for the child. Which selection indicates the need for further instruction?Peanut butter and jelly sandwich Atopic dermatitis is commonly associated allergies to food. Common culprits may include peanuts, eggs, orange juice, and wheat-containing products.The nurse is developing the plan of care for a 3-year-old child diagnosed with atopic dermatitis. Which client outcomes are common focuses for a child with this diagnosis? Select all that apply.Promotion of skin hydration Maintenance of skin integrity Prevention of infectionA 10-year-old has been bitten on the lower posterior arm by a dog, requiring several stitches. The child was just admitted to the hospital for 3 days of antibiotic therapy. When developing the care plan, the nurse identifies which nursing diagnoses as being the top 2 priorities?Impaired skin integrity Risk for infectionWhat is the best technique to perform an assessment of the skin?Skin assessment involves inspection and palpation in a room with natural daylight.The nurse is caring for an infant who has impetigo and is hospitalized. Which nursing intervention is the highest priority for this child?The nurse follows contact precautions. Impetigo is highly contagious and can spread quickly. The nurse should follow contact (skin and wound) precautions, including wearing a cover gown and gloves. The nurse will soak the crusts with warm water, apply topical antibiotics, and apply elbow restraints, but these are not as high a priority as trying to prevent the spread of the infection by following contact precautions.The nurse is evaluating parents' understanding of atopic dermatitis. Which statement shows their understanding?"Flare-ups of lesions are not uncommon following therapy."When assessing an adolescent for acne, what findings would lead the nurse to identify the acne as severe? Select all that apply.Widespread inflammatory lesions Evidence of cysts Presence of nodules Severe acne is characterized by comedones plus inflammatory lesions such as papules or pustules that are widespread and/or the presence of cysts or nodules and possibly scarring. Comedones are associated with mild acne. Papules localized to the face or back are associated with moderate acne.The nurse is caring for an infant with diaper dermatitis. Which statement by the child's parent would indicate a need for further education?"I will use rubber pants over the cloth diapers in the future." Prevention and management of diaper dermatitis includes avoiding rubber pants, avoiding diaper wipes with fragrance or preservatives. Treatment of a rash includes allowing the child to go diaperless for a period of time each day and using a warm blow dryer on the area for 3 to 5 minutes.The nurse is taking a health history of a 6-week-old boy with a suspected cardiovascular disorder. Which response by the mother would lead the nurse to suspect that the child is experiencing heart failure?"He gets sweaty when he eats." Explanation: Diaphoresis with nipple feeding indicates heart failure. Shortness of breath would suggest heart failure. Children with heart failure experience subtle signs that suggest that something is wrong. Children with heart failure often display subtle signs such as difficulty feeding.A nurse admits an infant with a possible diagnosis of congestive heart failure. Which signs or symptoms would the infant most likely be exhibiting?Feeding problems The indications of CHF vary in children of different ages. Signs in the infant may be hard to detect because they are subtle, but in infants, feeding problems are often seen. In infants and older children, tachycardia is one of the first signs of CHF. In a child with CHF, tachypnea would be seen, not bradypnea. The heart beats faster in an attempt to increase blood flow. Failure to gain weight, weakness, and an enlarged liver and heart are other possible indicators of CHF but are not as common as tachycardia and may take longer to develop.The parents of a 5-year-old child with a cardiovascular disorder tell the nurse they don't understand why their child isn't gaining weight, "We make sure our child has 3 very nutritious meals every day." How should the nurse respond?"It's great you are providing nutritious meals, but smaller frequent meals will tire your child less and promote weight gain." Explanation: Small, frequent feedings will reduce the amount of energy required to feed or eat and prevents overtiring the child. Questioning if the parents are making nutritious foods or foods the child likes does not address the issue of energy expenditure when eating 3 larger meals per day. Just stating that it is "hard to get your child to eat enough" also does not address the situation.When examining a child with congenital heart disease, an organ in the upper right quadrant of the abdomen can be palpated at 4 cm below the rib cage. What would most likely explain this assessment finding?The liver size increases in right-sided heart failure. Explanation: The liver increases in size due to right-sided heart failure. This is one of the cardinal signs of congestive heart failure. The spleen is in the upper left quadrant of the abdomen and would increase in size under certain circumstances, but this is asking for the upper right quadrant information. There are certain medications that can affect the liver, but this would not be the most likely reason for hepatomegaly.A child with a cardiac structural defect is receiving oxygen therapy. In which position should the child be placed to promote optimal benefits?Semi-Fowler Explanation: Due to the hemodynamic changes accompanying the underlying structural defect, oxygenation is key. Provide frequent ongoing assessment of the child's cardiopulmonary status. Assess airway patency and suction as needed. Position the child in the Fowler or semi-Fowler position to facilitate lung expansion.A nurse is preparing to administer a prescribed dose of digoxin to an 6-month-old infant. After assessing the infant's apical pulse, the nurse decides to withhold the dose and notify the health care provider. The nurse bases this decision on which apical pulse rate?80 beats/min Explanation: Prior to administering each dose of digoxin, the nurse would count the apical pulse for 1 full minute, noting rate, rhythm, and quality. The nurse would withhold the dose and notify the health care if the apical pulse is less than 60 in an adolescent, less than 90 in an infant.A nurse is caring for a child with Kawasaki disease. Which assessment finding would the nurse expect to see?Peeling hands and feet; fever Explanation: Kawasaki disease is an acute systemic vasculitis. Symptoms begin with very high fevers. One of the signs of Kawasaki disease is the peeling hands and feet and in perineal region. The child is usually tachycardic and laboratory values would indicate increased platelets and decreased hemoglobin. Another classic sign of Kawasaki is the strawberry tongue. The other symptoms are not necessarily characteristic of Kawasaki disease. The child should be evaluated if there are impalpable pulses because this could indicate a heart defect or some other serious illness.When a child is scheduled for a cardiac catheterization, an important health teaching point for parents is that the:child will return with a bulky pressure dressing over the catheter insertion area. Explanation: Cardiac catheterization is typically performed with the child awake but using moderate sedation. Only under unusual circumstances will the child need general anesthesia. At the completion of the procedure a pressure dressing will be placed over the catheter insertion site. This is to prevent bleeding. The nurse will monitor this dressing every 15 minutes for the first hour and then every 30 minutes for the second hour. A cardiac catheterization is an invasive procedure and any procedure is frightening to children, especially if their parents are not with them. After the child is fully awake from the procedure the diet can resume.A child with heart disease is receiving digoxin and a diuretic. Which laboratory test result would be most important for the nurse to monitor?Serum potassium level Explanation: Children receiving diuretics should have serum potassium levels obtained because diuretics tend to deplete the body of potassium. This is even more important if the child is also receiving digoxin because low serum potassium levels potentiate or increase the effect of the drug. Serum sodium levels may be obtained in children with heart failure to ensure that an increased sodium level is not causing edema. The erythrocyte sedimentation rate identifies inflammation and is unrelated to the use of diuretics and digoxin. Oxygen saturation levels may be done to evaluate for hypoxemia, but these results would be unrelated to the use of digoxin and diuretics.A mother is asking for more information about her infant's patent ductus arteriosus (PDA). What would be included in the education?This is caused by an opening that usually closes by 1 week of age. Explanation: A PDA is caused by an opening called the ductus arteriosus. A PDA usually closes by 1 week of age. If it does not close, the defect is usually fixed by a single surgery or during a cardiac catheterization procedure. IV fluids are not a routine intervention for the PDA. Most of the time a PDA occurs in premature infants.A nurse is assessing the skin of a 12-year-old with suspected right ventricular heart failure. Where should the nurse expect to note edema in this child?Lower extremities Explanation: Edema of the lower extremities is characteristic of right ventricular heart failure in older children. In infants, peripheral edema occurs first in the face, then the presacral region, and the extremities.The nurse is caring for a 7-year-old who is being discharged following surgery with a Gore® Helex device to repair an atrial septal defect. The parents of the child demonstrate understanding of the procedure with which statements? Select all that apply."We will be sure to not allow our child to ride a bicycle for at least 2 weeks." "We will be sure to monitor our child for any signs of infection and notify the doctor if we notice any." "We know how important our child's medications are so we will write out a schedule to be sure medications are taken as prescribed."The health care provider suspects an infant may have a ventricular septal defect. The parents ask the nurse what diagnostic tests the infant will need to have to determine this diagnosis. For what test(s) should the nurse provide education to the family? Select all that apply.magnetic resonance imaging (MRI) echocardiogram cardiac catheterization A ventricular septal defect (VSD) is an abnormal opening between the right and left ventricles. MRI or echocardiogram with color-flow Doppler may reveal the opening as well as the extent of left-to-right shunting. These studies also may identify right ventricular hypertrophy and dilation of the pulmonary artery resulting from the increased blood flow. Cardiac catheterization may be used to evaluate the extent of blood flow being pumped to the pulmonary circulation and to evaluate hemodynamic pressures. Neither a CT nor stress test are used in the diagnosis of the VSD. A chest x-ray may also be used to determine if there is enlargement of the heart.A parent brings an infant in for poor feeding and listlessness. Which assessment data would most likely indicate a coarctation of the aorta?Pulses weaker in lower extremities compared to upper extremities Explanation: With coarctation of the aorta there is a narrowing causing the blood flow to be impeded. This produces increased pressure in the areas proximal to the narrowing and a decrease in pressures distal to the narrowing. Thus, the infant would have decreased systemic circulation. The upper half of the body would have an increased B/P and be well perfused with strong pulses. The lower half of the body would have decreased B/P with poorer perfusion and weaker pulses. Coarctation is not a cyanotic defect. The cyanosis would be associated with tetralogy of Fallot.A group of students are reviewing information about acute rheumatic fever. The students demonstrate a need for additional review when they identify what as a major Jones criterion?arthralgia Arthralgia is considered a minor criterion. Carditis is a major criterion. Erythema marginatum is considered a major criterion. Subcutaneous nodules are considered a major criterion.The nurse is caring for an infant with Down syndrome who has been diagnosed with atrioventricular canal defect. The parents ask the nurse, "Why do you not put oxygen on our baby more often when his lips and fingernails are blue?" What is the best response by the nurse?"While it seems that oxygen would help, it actually worsens this condition. Treating the cause of the disease will help." Explanation: For children with congenital defects with increased pulmonary blood flow, oxygen supplementation is not helpful. Oxygen acts as a pulmonary vasodilator. If pulmonary dilation occurs, pulmonary blood flow is even greater, causing tachypnea, increasing lung fluid retention, and eventually causing a much greater problem with oxygenation; therefore, preventing the development of pulmonary disease via early surgical correction is essential. Although oxygen must be ordered by the physician and it isn't the best treatment, the nurse stating, "While it seems that oxygen would help, it actually makes the condition worse. Treating the cause of the disease will help" best answers the question while also showing empathy.A 6-year-old girl is diagnosed with pulmonary stenosis. The mother asks the nurse what the likely treatment for this condition will involve. What should the nurse tell the mother?Insertion of a catheter with an uninflated balloon tip into the affected valve, followed by inflation of the balloon to break up adhesions Explanation: Balloon angioplasty by way of cardiac catheterization is the procedure of choice for pulmonary stenosis. With this procedure, a catheter with an uninflated balloon at its tip is inserted and passed through the heart into the stenosed valve. As the balloon is inflated, it breaks valve adhesions and relieves the stenosis. The other answers refer to interventions related to patent ductus arteriosus, not pulmonary stenosis.The nurse is auscultating heart sounds of a child with a mitral valve prolapse. The nurse should expect which assessment finding?Mild to late ejection click at the apex Explanation: A mild to late ejection click at the apex is typical of a mitral valve prolapse. Abnormal splitting or intensifying of S2 sounds occurs in children with heart problems, not mitral valve prolapse. Clicks on the upper left sternal border are related to the pulmonary area.After assessing a child, the nurse suspects coarctation of the aorta based on a finding of:femoral pulse weaker than brachial pulse. Explanation: A femoral pulse that is weak or absent in comparison to the brachial pulse is associated with coarctation of the aorta. Bounding pulse is characteristic of patent ductus arteriosus or aortic regurgitation. A narrow or thread pulse is associated with heart failure or severe aortic stenosis. Hepatomegaly is a sign of right-sided heart failure.The nurse is reviewing the laboratory test results of several children who have come to the clinic for evaluation. Which child would the nurse identify as having the least risk for hyperlipidemia?Child A with a total cholesterol of 150 mg/dl and low-density lipoprotein (LDL) of 80 mg/dl. Explanation: ACCEPTABLE RANGE= Total cholesterol levels below 170 mg/dl and LDL levels less than 100 mg/dl are considered within the acceptable range. BORDERLINE= Total cholesterol levels between 170 and 199 mg/dl and LDL levels between 100 and 129 mg/dl are considered borderline. GREAT RISK= Total cholesterol levels greater than or equal to 200 mg/dl and LDL levels greater than or equal to 130 mg/dl are considered elevated and place this child at greatest risk.The nurse performs a cardiac assessment and notes a loud heart murmur with a precordial thrill. This murmur would be classified as a:Grade IV: Explaination: Grade I= is soft and hard to hear. Grade II= is soft and easily heard. Grade III= is loud without thrill Grade IV= A heart murmur characterized as loud with a precordial thrill is classified as Grade IV.A 5-year-old is being prepared for diagnostic cardiac catheterization, in which the catheter will be inserted in the right femoral vein. What intervention should the nurse take to prevent infection?Avoid drawing a blood specimen from the right femoral vein before the procedure Explanation: Because the vessel site chosen for catheterization must not be infected at the time of catheterization (or obscured by a hematoma), never draw blood specimens from the projected catheterization entry site before the procedure (generally a femoral vein). The other interventions listed are performed for reasons other than prevention of infection. Children scheduled for the procedure are usually kept NPO for 2 to 4 hours beforehand to reduce the danger of vomiting and aspiration during the procedure. Be certain to record pedal pulses for a baseline assessment. The site for catheter insertion is locally anesthetized with EMLA cream or intradermal lidocaine.The nurse in a pediatric cardiovascular clinic is talking with the father of a 5-year-old child who underwent cardiac surgery for a heart defect at the age of 3. The father reports that the child has been having increased shortness of breath, tires easily after playing, and has been gaining weight. The nurse is aware that the child is most likely demonstrating symptoms of which acquired cardiovascular disorder?Heart failure Explanation: Infective endocarditis = would present with intermittent, unexplained low-grade fever, fatigue, anorexia, weight loss, or flu-like symptoms. cardiomyopathy= include respiratory distress, fatigue, poor growth (dilated), chest pain, dizziness, and syncope. Kawasaki Disease= Abdominal pain, joint pain, fever, irritabilityThe nurse is educating an adolescent female at risk for hypertension. Which interventions will the nurse recommend? Select all that apply.Increase hours of sleep. Avoid any smoking. Exercise on a daily basis. Maintain a healthy weight.A child is diagnosed with rheumatic fever. For which medication will the nurse educate the caregivers?Aspirin Explanation: Medications used in the treatment of rheumatic fever include penicillin, salicylates (aspirin), and corticosteroids. Insulin would be given for diabetes and dilantin for seizure disorders. Antivirals are not relevant to the treatment of a bacterial infection.A nurse is interviewing a mother who is about to give birth. Which response would alert the nurse for a higher potential for a heart defect in the newborn?The mother states she has lupus. Explanation: A health history should be obtained from the pregnant woman. This history should include having problems during birth of any previous children, frequent infections, chromosomal abnormalities, having a premature birth, having an autoimmune disease or taking long-term medications such as corticosteroids. Lupus= while pregnant could contribute to a congenital heart defect. Acetaminophen & sleeping= do not affect the newborn's potential for developing a heart defect. The seizure medication= can have an impact on the newborn having a heart defect, but not necessarily a history of seizures in the mother. A seizure in the mother would be more related to hypoxia in the newborn than a heart defect.A nurse is caring for an infant who just had open-heart surgery and the parents are asking why there are wires coming out of the infant's chest. What is the best response by the nurse?These wires are connected to the heart and will detect if your infant's heart gets out of rhythm. Following cardiac repair there is always a possibility of arrhythmias. The wires are placed and connected to an external pacemaker. This is done as a preventive measure and can be used if an arrhythmia occurs. Once it is felt the child is in no danger of an arrhythmia, the wires are removed. There is no set time period in which this occurs. The wires do not deliver ongoing electrical shocks to maintain rhythm. This would be done by a permanent pacemaker implanted under the skin. There is no measurement of fluid in the heart by wires. Any measurements would need to be performed by echocardiogram or cardiac catheterization.An infant with poor feeding is suspected of having a congenital heart defect. The parents are asking why a chest x-ray is necessary in their infant. What is the best response from the nurse?"It will determine if the heart is enlarged." Explanation: Chest x-rays= are performed to see if the heart is enlarged. This will determine if the heart muscle is increasing in size. EKG= Disturbances in heart conduction are detected by an EKG. Echocardiogram= Visualizing where blood is being shunted is through the echocardiogram. MRI= The image used to clarify the structures of the heart is the MRI.What would be the most important measure to implement for an infant who develops heart failure?placing the infant in a semi-Fowler position Semi-Fowlers= Placing an infant with heart failure in a semi-Fowler position reduces the pressure of the abdominal contents against the chest and allows for better lung expansion. Supine= Keeping the infant supine would cause more pressure on the heart and lungs and increase the work of the heart and lungs Calories intake= Infants with heart disease need calories to grow. They are given formula or breast milk which is fortified with extra nutrients. Thus the infant can have an intake of the same amount of fluid but receive extra nutrients.On assessment immediately following cardiac surgery, which condition would the nurse expect to find in an infant?Hypothermia Cardiac surgery is often performed under hypothermia to decrease the child's oxygen needs during surgery. The postoperative care nurse should assess the infant's vital signs continuously via monitoring. The temperature should be assessed at least once per hour until an optimal temperature is achieved. The infant would have received IV fluids during surgery so hypovolemia should not be the primary concern. The infant will be sleepy from anesthesia, not hyperexcited. Hypertension, if any, has been monitored throughout the surgery and controlled.A child with a congenital heart defect is getting an echocardiogram. How would the nurse describe this test to the parent?This test will check how blood is flowing through the heart. Explanation: An echocardiogram (echo)= is a noninvasive ultrasound used to assess the heart wall thickness, the size of the heart chambers, the motion of the valves and septa, and the relationship of the great vessels to other cardiac structures. The test evaluates how blood is flowing through the heart and how effective the heart is in pumping. An echo does not check the electrical impulses. This would be done with an electrocardiogram.An infant with tetralogy of Fallot becomes cyanotic. Which nursing intervention would be the first priority?Place the infant in the knee-chest position. Explanation: Placing the infant in the knee-chest position is the first priority when caring for an infant with tetralogy of Fallot. Starting IV fluids and preparing the child for surgery would not be necessary since it is known that the infant has a cyanotic birth defect. Raising the head of the bed would not be a priority since the infant needs to be placed in the knee-chest position.When reviewing the record of a child with tetralogy of Fallot, what would the nurse expect to discover?Polycythemia Explanation: Tetralogy of Fallot= is a congenital heart defect causing decreased pulmonary blood flow. This causes mild to severe oxygen desaturation. To compensate for the low blood oxygenation the kidneys produce erythropoietin to stimulate the bone marrow to make more red blood cells (RBCs). The increased amount of RBCs is known as polycythemia. This increased blood volume causes more workload on the heart. It also does not increase the amount of blood reaching the lungs so the child remains desaturated. Leukopenia, increased platelets, and anemia are not associated with tetralogy of Fallot.A newborn has been diagnosed with a congenital heart disease. Which congenital heart disease is associated with cyanosis?Tetralogy of Fallot Explanation: Tetralogy of Fallot is associated with cyanosis. The defects include ventricular septal defect (VSD), right ventricular hypertrophy, right outflow obstruction, and overriding aorta. Coarctation of aorta, pulmonary stenosis, and aortic stenosis are acyanotic heart diseases and are not associated with cyanosis.The nurse is assessing the heart rate of a 6-month-old infant and determines it to be 82 beats/min. What action should the nurse take first?Conduct a focused cardiovascular assessment. Explanation: The normal infant heart rate averages 90 to 160 beats/min. This infant's heart rate is low. The nurse should first conduct a focused cardiovascular assessment. After that is completed, the findings can be reported to the health care provider. Obtaining a health history can be beneficial, but with a low heart rate the nurse would want to know first if there are any other clinical signs indicating a problem or a reason for the heart rate. The heart rate should be reassessed, but not necessarily in a 5-minute window. The heart rate should be assessed via apical pulse for a full 60 seconds.Which nursing diagnosis would best apply to a child with rheumatic fever?Activity intolerance related to inability of heart to sustain extra workload Explanation: Acute rheumatic fever affects the joints, central nervous system, skin, and soft tissue. It causes chronic, progressive damage to the heart and valves. Children with rheumatic fever need to reduce activity to relieve stress on the heart and joints during the course of the illness. Rheumatic fever does not produce cardiomegaly nor does it interfere with respirations or the ability to oxygenate the body. Children with rheumatic fever may develop chorea. These movements are involuntary and are not related to hyperexcitability.Coarctation of the aorta demonstrates few symptoms in newborns. What is an important assessment to make on all newborns to help reveal this condition?Assessing for the presence of femoral pulses **As a result, the blood pressure will be higher in the upper part of the body and decreased in the lower part of the body.** Explanation: Coarctation of the aorta is a defect where there is narrowing of the aorta, which is the largest vessel carrying oxygenated blood to the body. As a result of this narrowing, blood flow is impeded causing pressure to increase in the area proximal to the defect and decrease distal to the defect. As a result, the blood pressure will be higher in the upper part of the body and decreased in the lower part of the body. The pulses will be full or bounding in the upper part of the body and weak or absent in the lower part of the body. When assessing an infant with coarctation there may be weak or absent femoral pulses. There will also be differences in the blood pressure readings. These infants may or may not have a murmur and will be no more fussy than other babies.The nurse is caring for a 6-year-old with a congenital heart defect. To best relieve a hypercyanotic spell, what action would be the priority?Place the child in a knee-to-chest position. Explanation: The priority nursing action is to place the infant or child in a knee-to-chest position. Once the child has been placed in this position, the nurse should provide supplemental oxygen or administer medication as ordered. A calm, comforting approach should be used but is not the priority action. Once a child is placed in the knee-to-chest position, supplemental oxygen would be provided as ordered.A nurse is examining a 10-year-old girl who has a heart murmur. On auscultation, the nurse finds that the murmur occurs only during systole, is short, and sounds soft and musical. When she has the girl stand, she can no longer hear the murmur on auscultation. Which statement should the nurse make to the girl's mother in response to these findings?"Your daughter has an innocent heart murmur, which is nothing to worry about." Explanation: The symptoms described indicate an innocent heart murmur. Although innocent murmurs are of no consequence, parents need to be told when their child has one because this finding will undoubtedly be discovered again at a future health assessment or during a febrile illness, anxiety, or pregnancy. Activities need not be restricted when a child has an innocent murmur and the child requires no more frequent health appraisals than other children. If a murmur is present as the result of heart disease or a congenital disorder, it is an organic heart murmur. Reference:When caring for a child with a congenital heart defect, which assessment finding may be a sign the child is experiencing heart failure?Tachycardia Why? Lets See... eart failure occurs when the heart has the inability to pump effectively to provide adequate blood, oxygen, and nutrients to the body's organs and tissues. Symptoms occur because of three factors. The neurohormonal influences cause symptoms of tachycardia, pallor, decreased urine output, sweating, hypertension, weight gain and edema. The symptoms seen from systolic dysfunction are dyspnea on exertion, increased work of breathing, and feeding difficulties. Diastolic influences produce hepatomegaly, jugular vein distention and periorbital edema.The nurse is providing education to parents of a child with a blood pressure in the 90th percentile. What would be included in the intervention strategies?he nurse would review the child's 24-hour diet recall. Explanation: With a child in the 90th percentile for blood pressure, diet and physical activity should be the main focus. Blood pressures should be measured but daily measurement is not necessary. Children are not routinely put on beta-blockers, and the child should be allowed to participate in sports if monitored.Which nursing diagnosis will the nurse indicate as priority for the child following cardiac surgery for tetralogy of Fallot?Risk for ineffective cardiopulmonary tissue perfusion Explanation: Nursing priority following cardiac surgery will focus on assessing for ineffective cardiopulmonary tissue perfusion. Monitoring for excess fluid volume, infection, and anxiety will be monitored after ensuring cardiopulmonary tissue perfusion is adequate.What information would be included in the care plan of an infant in heart failureBegin formulas with increased calories. Infants with heart failure need increased calories for growth. The infants are typically given smaller, more frequent feedings to decrease the amount given and to help conserve energy for feeding. They often are given a higher-calorie formula. The infant should be placed in an upright position or in a car seat to increase oxygenation. The infant should not have any pressure on the diaphragm while in this position. Vomiting is a sign of digoxin toxicity and this should be considered before administering.An 8-month-old infant has a ventricular septal defect. Which nursing diagnosis would best apply?Ineffective tissue perfusion related to inefficiency of the heart as a pump Explanation: A ventricular septal defect permits blood to flow across an opening between the right and left ventricles. It results in increased pulmonary blood flow, but it does not cause cyanosis. The blood in the left ventricle, which flows back into the right ventricle, is already oxygenated. Anytime there is an opening between the heart's ventricles, the heart is not as effective as a pump because the pressure gradients are changed. A ventricular septal defect will not cause respiratory problems or problems with peripheral circulation.A child will be undergoing a Holter monitor test. Which statement by the mother indicates the need for further instruction?"My child cannot have any thing to eat or drink after midnight the day of the test." Explanation: Ambulatory electrocardiographic monitoring (Holter) testing is an exam that spans approximately 24 hours. The test is done to review the activity of the heart. The individual is encouraged to follow their normal activities during the test. There is no need for the child to be NPO prior to or during the test.Which collaborative actions will the nurse perform when caring for an infant with transposition of the great arteries scheduled for surgical repair of the defect? Select all that apply.Provide education to the parents. Auscultate lung sounds frequently. Apply a continuous pulse oximeter. Keep oxygen saturation above 75%. Explanation: Collaborative interventions for an infant with transposition of the great arteries include providing education to parents in preparation for their infant's surgery; assessing pulse oximetry and auscultating lung sounds frequently to monitor for signs of increased pulmonary flow; and maintaining normal oxygen saturation for transposition of the great arteries at 75% to 85%. Administering indomethacin would cause closure of the ductus arteriosus, which would prevent mixing of blood.The nurse is teaching an in-service program to a group of nurses on the topic of children diagnosed with rheumatic fever. The nurses in the group make the following statements. Which statement is most accurate regarding the diagnosis of rheumatic fever?Strep throatThe nurse is administering medications to the child with congestive heart failure (CHF). Large doses of what medication are used initially in the treatment of CHF to attain a therapeutic level?Digoxin