NURSING 212/ N212 ATI RN Nursing Care of Children Online Practice 2016 B.

A nurse is assessing a 4-year-old child at a well-child visit. Which of the following developmental milestones should the nurse expect to observe?

a.  Identifies right from left hand

b.  Uses a utensil to spread butter

c.  Cuts a shape using scissors

d.  Draws a stick figure with seven body parts

c. Cuts a shape using scissors

A- Identifying the right from left hand is an expected developmental milestone of a 6-year-old child.

B- Using a utensil to spread butter is an expected developmental milestone of a 6-year-old child. D- Drawing a stick figure with seven body parts is an expected developmental milestone of a 5- year-old child.

A school nurse is preparing to administer atomoxetine 1.2 mg/kg/day PO to a school-age child who weighs 75lb. Available is atomexetine 40 mg/capsule. How many capsules should the nurse administer per day?

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A nurse in the emergency department is assessing a toddler who has Kawasaki disease. Which of the following findings should the nurse expect? (select all that apply.)

a.  Increased temperature

b.  Gingival hyperplasia

c.  Xerophthalmia

d.  Bradycardia

e.  Cervical lymphadenopathy

Answer- a,c,e

Increased temperature is correct. Kawasaki disease is an acute illness associated with a fever lasting more than 4 days that is unresponsive to antipyretics or antibiotics.

Gingival hyperplasia is incorrect. Children who have Kawasaki disease develop a strawberry tongue, cracked lips, and edema of the oral mucosa and pharynx. A child who is receiving phenytoin therapy can develop gingival hyperplasia.

Xerophthalmia is correct. Ophthalmic manifestations of Kawasaki disease include reddening of the conjunctiva and dryness of the eyes, or xerophthalmia.

Bradycardia is incorrect. Kawasaki disease is an infection that affects the vascular system, including the heart. The nurse should expect the child to be tachycardic with a gallop rhythm. Long term effects of Kawasaki disease include the development of coronary artery aneurysms or myocardial infarction.

Cervical lymphadenopathy is correct. The child who has Kawasaki disease may develop enlarged cervical nodes on one side of the neck that are nontender and greater than 1.5 cm in size.

A nurse is teaching a school-age child who has a new diagnosis of type 1 diabetes MELITIS. The nurse should identify which of the following statements by the child as understanding the teaching?

a.  I will puncture the pad of my finger when I am testing my blood glucose."

b.  "I will give myself a shot of regular insulin 30 minutes before I eat breakfast."

c.  "I will eat a snack of 5 grams of carbohydrates if my blood glucose is low."

d.  "I will decrease the amount of fluids I drink when I am sick."

Answer- b. "I will give myself a shot of regular insulin 30 minutes before I eat breakfast." The child should administer regular insulin 30 min before meals so that the onset coincides with food intake.

A- The child should avoid puncturing the pads of the fingers because they have fewer blood vessels and more nerve fibers. Instead, the child should puncture the skin to either side of the finger pad to promote blood flow and decrease pain.

C- The child should eat a snack of 15 g of carbohydrates, such as 120 mL (4 oz) of fruit juice or 66 g (1/2 cup) of ice cream, to rapidly increase a mild hypoglycemic reaction.

D- During acute illness the child is prone to hyperglycemia and ketonuria and is at risk for dehydration. Therefore, the child's fluid intake should increase rather than decrease.

A school nurse is assessing an adolescent who has scoliosis. Which of the following findings should the nurse expect?

a.  Increase in anterior convexity of the lumbar spine

b.  Increased curvature of the thoracic spine

c.  Lateral flexion of the neck

d.  A unilateral rib hump

Answer- d. A unilateral rib hump

When assessing an adolescent for scoliosis, the school nurse should expect to see a unilateral rib hump with hip flexion. This results from a lateral S- or C-shaped curvature to the thoracic spine resulting in asymmetry of the ribs, shoulders, hips, or pelvis. Scoliosis can be the result of a neuromuscular or connective tissue disorder, or it can be congenital in nature.

A- An increased anterior convexity of the lumbar spine is a manifestation of lordosis. An expected finding in toddlers, lordosis can indicate a complication of a disease process, such as flexion contractures, congenital dislocation of the hip, or obesity, when seen in older children. B- An increased curvature of the thoracic spine is a manifestation of kyphosis. Kyphosis can be a manifestation of a congenital condition or disease process such as rickets, or it can be posture- related. In posture-related kyphosis, the adolescent presents with rounded shoulders and a slouching posture.

C- Lateral flexion of the neck is an indication of torticollis as a result of contracture of the sternocleidomastoid muscle. Torticollis can be congenital, the result of intrauterine fetal

posturing or abnormality of the cervical spine, or it can be acquired, due to such factors as a traumatic lesion to the sternocleidomastoid muscle.

A nurse is reviewing the lumbar puncture results of a school-age child suspected of having bacterial meningitis. Which of the following results should the nurse identify as a finding associated with bacterial meningitis?

a.  Decreased cerebrospinal fluid pressure

b.  Decreased WBC count

c.  Increased protein concentration

d.  Increased glucose level

Answer- c. Increased protein concentration. The nurse should recognize that an increased protein concentration in the spinal fluid is a finding associated with bacterial meningitis. A- Increased cerebrospinal fluid pressure is a finding associated with bacterial meningitis.

B- An increased WBC count in the spinal fluid is a finding associated with bacterial meningitis. D- A decreased glucose level in the spinal fluid is a finding associated with bacterial meningitis.

A nurse is planning care for a preschooler who has cystic fibrosis. Which of the following interventions should the nurse include in the plan?

a.  Administer pancreatic enzymes 2 hr after meals.

b.  Decrease pancreatic enzymes if steatorrhea develops.

c.  Limit fluid intake to 750 mL per day.

d.  Increase fat content in the child's diet to 40% of total calories.

Answer - d. Increase fat content in the child's diet to 40% of total calories. A child who has cystic fibrosis is unable to properly digest fats due to fibrosis of the pancreas and limited secretion of pancreatic enzymes. The nurse should increase the child's fat intake to equal 40% of total caloric intake.

A- The nurse should plan to administer pancreatic enzymes within 30 min of meals and snacks.

B- A child who has cystic fibrosis and develops steatorrhea, or fatty stools, needs to increase the intake of pancreatic enzymes.

C- The nurse should encourage fluid intake, rather than restrict it, to prevent dehydration caused by the loss of sodium and chloride through perspiration.

A nurse is assessing a toddler who has gastroenteritis and is exhibiting manifestations of dehydration. Which of the following findings should the nurse address first?

a.  Skin breakdown

b.  Hypotension

c.  Hyperpyrexia

d.  Tachypnea

Answer- d. Tachypnea. When using the airway, breathing, circulation approach to client care, the first finding the nurse should address is the toddler's tachypnea, which results when the

kidneys are unable to excrete hydrogen ions and produce bicarbonate leading to metabolic acidosis.

A- Toddlers who have gastroenteritis and are dehydrated are at increased risk for skin breakdown because of changes in circulation and loss of skin elasticity. However, the nurse should address another finding first.

B- Toddlers who have gastroenteritis and are dehydrated may exhibit hypotension because of reduced blood volume. However, the nurse should address another finding first.

C- Toddlers who have gastroenteritis and are dehydrated may exhibit hyperpyrexia, or fever, which is caused by the effect of fluid volume depletion on the hypothalamus. However, the nurse should address another finding first.

A nurse is discussing organ donation with the parents of a school-age child who has sustained brain death due to a bicycling accident. Which of the following actions should the nurse take first?

a.  Inform the parents that written consent is required prior to organ donation.

b.  Provide written information to the parents about organ donation.

c.  Ask the provider to explain misconceptions of organ donation to the parents.

d.  Explore the parents' feelings and wishes regarding organ donation.

Answer- d. Explore the parents' feelings and wishes regarding organ donation. The first action the nurse should take when using the nursing process is assessment. Exploring the parents' feelings and wishes regarding organ donation will assist the nurse in determining if organ donation is appropriate for this family and should be done prior to taking other actions.

A- The nurse should inform the parents that written consent is required prior to organ donation to document that the parents have consented to organ donation and that the provider has addressed any questions or concerns the parents may have. However, there is another action that the nurse should take first.

B- The nurse should provide written information to the parents to enhance their understanding about organ donation. However, there is another action that the nurse should take first.

C- The nurse should ask the provider to explain misconceptions of organ donation to the parents, because it is important that they have accurate information before making a final decision. However, there is another action that the nurse should take first.

A nurse in an emergency department is caring for a school-age child who has appendicitis and rates his abdominal pain 7 on a 0 to 10 scale. Which of the following actions should the nurse take?

a.  Instill a 500 mL tap water enema.

b.  Give morphine 0.05mg/kg IV.

c.  Administer polyethylene glycol 1g/kg PO.

d.  Apply a heating pad to the child's abdomen.

Answer- b. Give morphine 0.05mg/kg IV. A pain level of 7 on a 0 to 10 scale is considered severe and the nurse should administer an analgesic medication for pain relief.

A- Administering an enema accelerates bowel motility and increases the risk for perforation of the appendix.

C- Administering laxatives accelerates bowel motility and increases the risk for perforation of the appendix.

D- Applying heat to the child's abdomen increases the risk for perforation of the appendix.

A nurse is monitoring the oxygen saturation level of an infant using pulse oximetry. The nurse should secure the sensor to which of the following areas on the infant?

a.  Wrist

b.  Great toe

c.  Index finger

d.  Heel

Answer - b. Great toe. The nurse should secure the sensor to the great toe of the infant and then place a snug-fitting sock on the foot to hold the sensor in place. The nurse should also check the skin under the sensor site frequently for pulses, temperature, and color.

A- It is important for the sensor to be positioned in the correct area in order to obtain an accurate reading. The nurse should avoid placing the sensor on the wrist because this placement will result in an inaccurate reading.

C- The nurse should secure the sensor to the index finger of an older child and then use a self- adhering bandage to hold the sensor in place.

D- It is important for the sensor to be positioned in the correct area in order to obtain an accurate reading. The nurse should avoid placing the sensor on the heel of the infant's foot because this placement will result in an inaccurate reading.

A nurse is assessing a school-age child who has an infratentorial brain tumor. Which of the following findings should the nurse identify as a manifestation of increased intracranial pressure?

a.  Hypotension

b.  Hyperactivity

c.  Decreased attention span

d.  Tachycardia

Answer- c. Decreased attention span. The nurse should recognize decreased attention span, inability to follow commands, and difficulty in school are manifestations of increased intracranial pressure because of the decreased blood flow within the brain.

A- Hypertension is a late manifestation of increased intracranial pressure.

B- Lethargy and decreased activity are manifestations of increased intracranial pressure. D- Bradycardia is a late manifestation of increased intracranial pressure.

A school nurse is assessing a school-age child who has erythema infectious (fifth disease). Which of the following findings should the nurse expect?

a.  Koplik spots

b.  Hoarseness

c.  Facial rash

d.  Splenomegaly

Answer - c. Facial rash. Erythema on the face, predominantly on the child's cheeks, is a manifestation of erythema infectiosum (fifth disease). The erythema causes the child to have the appearance of a "slapped face." The rash lasts from 1 to 4 days.

A- Koplik spots are a manifestation of measles (rubeola).

B- Hoarseness is a manifestation of diphtheria.

d- Splenomegaly is a manifestation of infectious mononucleosis.

A nurse is reviewing laboratory results of a school-age child who is 1 week postoperative following an open fracture repair. Which of the following values should the nurse identify as an indication of a potential complication?

a.  Erythrocyte sedimentation rate 18 mm/hr

b.  WBC 6,200/mm3

c.  C-reactive protein 1.4 mg/L

d.  RBC 4.7 106/µL

Answer- a. Erythrocyte sedimentation rate 18 mm/hr. An erythrocyte sedimentation rate of 18 mm/hr is above the expected reference range and is an indication of osteomyelitis.

B- A WBC count of 6,200/mm3 is within the expected reference range. An elevated WBC count indicates infection.

C- A C-reactive protein level of 1.4 mg/L is within the expected reference range. An elevated C- reactive protein level is an indication of osteomyelitis.

D- A RBC count of 4.7 106/µL is within the expected reference range. A decreased RBC count indicates hemorrhage.

A nurse is teaching a group of parents about infectious mononucleosis. which of the following statements by a parent should the nurse identify as understanding the teaching?

a.  "Mononucleosis is caused by an infection with the Epstein-Barr virus."

b.  "Mononucleosis is a bacterial infection requiring 14 days of antibiotics."

c.  "A Monospot is a throat culture used to diagnosis mononucleosis."

d.  "Children who get mononucleosis will need to refrain from sports for 6 months."

Answer- a. "Mononucleosis is caused by an infection with the Epstein-Barr virus." Mononucleosis is a mildly contagious illness that occurs sporadically or in groups and is primarily caused by the Epstein-Barr virus.

B- Infectious mononucleosis is caused by the Epstein-Barr virus. No known specific treatment is available for mononucleosis.

C- A Monospot is a blood test that uses a special piece of paper to assist in diagnosing

mononucleosis,

D- Acute symptoms last approximately 10 days with fatigue lasting up to 4 weeks. Children who have mononucleosis and develop splenomegaly will need to restrict activities for 2 to 3 months to avoid rupturing the spleen.

A hospice nurse is caring for a preschooler who has a terminal illness. The father tells the nurse that he cannot cope anymore and has decided to move out of the house. Which of the following statements should the nurse make?

a.  "I think it is important that you provide emotional support for your family at this time."

b.  "I agree that you have to do what you feel is best for yourself during this stressful time."

c.  "You can't mean that; I'm sure you want to be there for your family."

d.  "Let's talk about some of the ways you have handled previous stressors in your life."

Answer- d. "Let's talk about some of the ways you have handled previous stressors in your life." This statement offers a general lead to allow the father to express his feelings and previous actions when faced with stressful situations, as well as help him to focus on ways that he can cope with the current situation.

A- This statement presents the nurse's opinion and tells the father how he should behave, which can make him feel as if he has to behave as the nurse does and can lead to dependence. B- This statement offers agreement with the father, which implies that the nurse is giving approval.

C- This statement challenges the father by disregarding his feelings, which can make him defensive and resistant to communicating in the future.

A nurse is an emergency department suspects that a toddler has epiglottis. Which of the following actions should the nurse take?

a.  Obtain a culture from the toddler's throat.

b.  Prepare the toddler for nasotracheal intubation.

c.  Visually inspect the epiglottis using a tongue depressor.

d.  Administer the Haemophilus influenzae type B conjugate vaccine.

Answer- b. Prepare the toddler for nasotracheal intubation. When epiglottitis is suspected the nurse should prepare for nasotracheal intubation or a tracheostomy, which might be required if the toddler begins to experience severe respiratory distress.

A- When epiglottitis is suspected the nurse should avoid any actions, such as obtaining a throat culture, which can cause further inflammation, irritation, or obstruction of the airway.

C- When epiglottitis is suspected the nurse should avoid any actions, such as direct visualization of the epiglottis with a tongue depressor, which can cause further inflammation, irritation, or obstruction of the airway.

D- The nurse should recommend administration of the Haemophilus influenzae type B conjugate vaccine for infants as a prevention of epiglottitis. The immunization is not used in the treatment of acute epiglottitis.

A nurse is caring for a toddler who has acute otitis media and a temperature of 40 C (104 F). After administering acetaminophen, which of the following actions should the nurse plan to take to reduce the toddler's temperature?

a.  Apply a cooling blanket to the toddler.

b.  Dress the toddler in minimal clothing.

c.  Give the toddler a tepid bath.

d.  Administer diphenhydramine to the toddler.

Answer- b. Dress the toddler in minimal clothing. The nurse should recognize that dressing the toddler in minimal clothing will expose the skin to air and maximize heat evaporation from the skin, thus reducing the toddler's temperature.

A- Applying a cooling blanket can cause shivering and discomfort, which increases metabolic requirements and is not effective in reducing the toddler's temperature.

C- A tepid bath is lukewarm, which can cause discomfort to the toddler, and is not effective in reducing fever.

D- Diphenhydramine is an antipruritic rather than an antipyretic medication.

A nurse is assessing an infant who has a ventricular septal defect. Which of the following findings should the nurse expect?

a.  Loud, harsh murmur

b.  Dysrhythmias

c.  Weak femoral pulses

d.  High blood pressure

Answer- a. Loud, harsh murmur. The nurse should expect to hear a loud, harsh murmur with a ventricular septal defect due to the left-to-right shunting of blood, which contributes to hypertrophy of the infant's heart muscle.

B- Ventricular septal defect does not affect the electrical conduction of the heart. Therefore, the nurse should not expect to hear dysrhythmias when assessing this infant.

C- Weak femoral pulses are a manifestation of coarctation of the aorta.

D- Elevated blood pressure is a manifestation of coarctation of the aorta.

A nurse is providing discharge teaching to the parent of a school-age child who has undergone a tonsillectomy. Which of the following statements by the parent should the nurse identify as understanding the teaching?

a.  "My child may resume usual activities since this was just an outpatient surgery."

b.  "My child will be able to drink the chocolate milkshake I promised to get for her tonight."

c.  "I will notify the doctor if I notice that my child is swallowing frequently."

d.  "I will have my child gargle with warm salt water to relieve her sore throat."

Answer- c. "I will notify the doctor if I notice that my child is swallowing frequently." The nurse should instruct the parent that frequent swallowing is a sign of bleeding and, if it is observed, to notify the primary care provider immediately.

A- Activity should be limited for up to 10 days to decrease the risk of hemorrhage.

B- Milk products should be avoided because they coat the child's throat, which can initiate a cough response and increase the risk of bleeding. Brown and red foods should be avoided during the immediate postoperative period so that food and fresh or old blood are distinguishable in the child's emesis.

D- Salt water is likely to cause irritation and discomfort and can increase the risk of bleeding following a tonsillectomy. The child should receive adequate pain medication after the procedure and can wear an ice collar if tolerated.

A nurse is assessing an 8-year-old child who has early indications of shock. After establishing an airway and stabilizing the child's respirations, which of the following actions should the nurse take next?

a.  Insert an indwelling urinary catheter.

b.  Measure weight and height.

c.  Initiate IV access.

d.  Maintain ECG monitoring.

Answer- c. Initiate IV access. Since the child's airway is established and respiratio