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RN Pediatric Nursing Practice A
Which of the following potential provider prescriptions should the nurse identify as anticipated or contraindicated? Potential Provider's Prescription: (Anticipated or Contraindicated)
- Administer factor VIII
- Apply ice packs to the infected joints
- Administer morphine PRN pain
- Perform passive range-of-motion (ROM) exercises during the first 12 hr following injury
- Elevate the affected joints - ✔✔Administer factor VIII is anticipated. The child is experiencing an acute episode of hemophilia due to a recent fall. During this acute episode, there is potential for internal bleeding into the joint spaces. Therefore, administering factor VIII is anticipated to control bleeding. Apply ice packs to the affected joints is anticipated. The child is experiencing an acute episode of hemarthrosis due to a recent fall, as evidenced by the bruising and swelling of the knee joint. Therefore, applying ice packs to the affected joints is anticipated to manage discomfort and decrease bleeding into the joint. Administer morphine PRN pain is anticipated. The child is experiencing severe pain. Opioids can be administered in the inpatient setting to relieve pain. Otherwise, acetaminophen can be given at home for pain. Aspirin and NSAIDs should be avoided because they inhibit platelet function and might increase bleeding. Perform passive range-of-motion (ROM) exercises during the first 12 hr following injury is contraindicated. The child is experiencing an acute episode of hemarthrosis. Passive ROM exercises can increase bleeding into the joint for the first 48 hr following injury. The toddler should be encouraged to exercise the joint as tolerated.
Elevate the affected joints is anticipated. The child is experiencing an acute episode of hemarthrosis due to a recent fall, as evidenced by the bruising and swelling of the knee joint. Elevation of the joint, along with the application of ice, is anticipated to help decrease bleeding and swelling in the joint. A nurse is providing discharge teaching to the parent of an 18-month-old toddler who has dehydration due to acute diarrhea. Which of the following statements by the parent indicates an understanding of the teaching? a. "I will offer my child small amounts of fruit juice frequently.." b. "I will avoid giving my child solid foods until the diarrhea has stopped," c. "I will monitor my child's number of wet diapers." d. "I will give my child polyethylene glycol daily for 7 days." - ✔✔c. "I will monitor my child's number of wet diapers." The nurse should teach the parent to closely monitor the child's number of wet diapers. Monitoring the number of wet diapers per day is an effective way for the parent to monitor adequate output and hydration status. A nurse on a pediatric unit is caring for a school-age child. After reviewing the information in the child's medical record, which of the following findings should the nurse address first? The nurse should address the child's (oxygen saturation/joint swelling/fever) followed by the child's (pain/anemia/hydration). - ✔✔Dropdown 1:
WBC count, Oxygen saturation level, Platelets, Abdomen assessment, Temperature, Abdominal dressings assessment - ✔✔WBC count is correct. The child's WBC count has increased significantly following the procedure. The nurse should identify that this is a potential indication of a postoperative infection. Oxygen saturation level is incorrect. The child's oxygen saturation level is within the expected reference range. Therefore this finding does not indicate a potential complication. Platelets is incorrect. The child's platelet count is within the expected reference range. Therefore this finding does not indicate a potential complication. Abdomen assessment is correct. The child's abdomen is rigid and distended and they are reporting increased pain. The nurse should identify that this is a potential indication of a postoperative infection. Temperature is correct. One day following surgery, the child's temperature has increased and is above the expected reference range. The nurse should identify that this is a potential indication of a postoperative infection. Abdominal dressings assessment is incorrect. The child's abdominal dressings have scant serous drainage present, which is an expected finding following surgery. Therefore this finding does not indicate a potential complication. A nurse is reviewing the medical record of a school-age child who is 2 days postoperative following an open repair and casting of a fracture in the right arm. Which of the following findings should the nurse identify as an indication of a potential postoperative complication? a. increased erythrocyte sedimentation rate
b. apical pulse 92/min c. respiratory rate 24/min d. taking an oral analgesic twice daily - ✔✔a. increased erythrocyte sedimentation rate The nurse should identify that an increased erythrocyte sedimentation rate is an indication of osteomyelitis, a potential complication following surgical repair of a fracture. A nurse is caring for a 15-year-old adolescent following a head injury. Which of the following findings should the nurse identify as an indication that the adolescent is developing syndrome of inappropriate antidiuretic hormone secretion (SIADH)? a. increased sodium level b. decreased urine specific gravity c. mental confusion d. weak peripheral pulses - ✔✔c. mental confusion A child who has a head injury can develop SIADH as a result of altered pituitary function, leading to an oversecretion of antidiuretic hormone. Oversecretion of antidiuretic hormone leads to a decrease in urine output, hyponatremia, and hyperosmolality due to overhydration. As the hyponatremia becomes more severe, mental confusion and other neurologic manifestations such as seizures can occur. A nurse is discussing organ donation with the parents of a school-age child who has sustained brain death due to a bicycle crash. Which of the following actions should the nurse take first? a. inform the parents that written consent is required prior to organ donation
a. insert an indwelling urinary catheter b. measure weight and height c. initiate IV access d. maintain ECG monitoring - ✔✔c. initiate IV access 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 nurse is caring for a preschooler whose guardian is going home for a few hours while another relative stays with the child. Which of the following statements should the nurse make to explain to the child when their guardian will return? a. "Your guardian will be back at 7 p.m." b. "Your guardian will be back after taking care of your sibling." c. "Your guardian will be back in the morning." d. "Your guardian will be back after you eat." - ✔✔d. "Your guardian will be back after you eat." Preschoolers make sense of time best when they can associate it with an expected daily routine, such as meals and bedtime. Therefore, the child comprehends time best when it is explained to them in relation to an event they are familiar with, such as eating. 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 an outlined shape using scissors d. draws a stick figure with seven body parts - ✔✔c. cuts an outlined shape using scissors The nurse should recognize that an expected developmental milestone of a 4-year-old child is using scissors to cut out a shape. A nurse in an emergency department is caring for an adolescent who has severe abdominal pain due to appendicitis. Which of the following locations should the nurse identify as McBurney's point? - ✔✔A is correct. The nurse should identify this area of the client's abdomen as McBurney's point. This area of the right lower quadrant located about two-thirds of the way between the umbilicus and the client's anterosuperior iliac spine is the area where a client who has appendicitis is most likely to report pain and tenderness. B is incorrect. The nurse should identify this area as the left lower quadrant. Structures of this area of the client's abdomen include the sigmoid colon and part of the descending colon. This area does not contain the appendix and is therefore not associated with McBurney's point. C is incorrect. The nurse should identify this area as the right upper quadrant. Structures of this area of the client's abdomen include parts of the ascending and transverse colon, liver, and gallbladder. This area does not contain the appendix and is therefore not associated with McBurney's point. A nurse is providing teaching about play activities for social development to the guardians of a preschooler. Which of the following play activities should the nurse recommend for the child? a. playing pat-a-cake b. using a push-pull toy
d. a low uric acid level - ✔✔a. a low hematocrit level The nurse should identify that a low hematocrit level indicates anemia. A child who has anemia can exhibit fatigue, lightheadedness, tachycardia, dyspnea, and pallor due to the decreased oxygen-carrying capacity of the blood cells. A nurse is providing discharge teaching to the parents of a 3-month-old infant following a cheiloplasty. Which of the following instructions should the nurse include? a. "Clean your baby's sutures daily with a mixture of chlorhexidine and water." b. "Expect your baby to swallow more than usual over the next few days." c. "Inspect your baby's tongue for white patches using a tongue depressor every 8 hours." d. "Apply a thin layer of antibiotic ointment on your baby's suture line daily for the next 3 days."
- ✔✔d. "Apply a thin layer of antibiotic ointment on your baby's suture line daily for the next 3 days." The nurse should instruct the parents to apply a thin layer of antibiotic ointment on the infant's suture line daily for 3 days and then continue to apply petroleum jelly to the area for several weeks to promote healing. A nurse is receiving change-of-shift report for four children. Which of the following children should the nurse see first? a. a school age child who has sickle cell anemia and reports decreased vision in the left eye b. a school-age child who has cystic fibrosis and a frequent nonproductive cough c. a preschooler who has asthma and a peak flow meter reading in the green zone
d. an adolescent who has meningitis and reports a sensitivity to lights and noise - ✔✔a. a school age child who has sickle cell anemia and reports decreased vision in the left eye When using the urgent vs. nonurgent approach to client care, the nurse should determine the priority finding is a report of decreased vision in the left eye. This finding indicates that the child is experiencing a vaso-occlusive crisis and should be reported to the provider immediately. Therefore, the nurse should see this child first. A nurse is providing anticipatory guidance to the guardian of a toddler. Which of the following expected behavior characteristics of toddlers should the nurse include? a. controls impulsive feelings b. understands right from wrong c. easily separates from guardian for long periods of time d. expresses likes and dislikes - ✔✔d. expresses likes and dislikes The nurse should include that expressing likes and dislikes is an expected behavior of toddlers. This is the time in life when a toddler is developing autonomy and self-concept. They will try to assert themselves and frequently refuse to comply. The guardian should allow the child to have some control, but also set limits for them so they learn from their behavior and learn to control their actions. A nurse is caring for a preschooler who has neutropenia. Which of the following statements should the nurse make to the child's guardians? a. "Monitor your child's temperature at least once a week." b. "Going to the movie theater might help improve your child's mood."
a. recurrent urinary tract infections b. symmetric burns of the lower extremities c. failure to thrive d. lack of subcutaneous fat - ✔✔b. symmetric burns of the lower extremities The nurse should include that symmetric burns to the lower extremities can indicate physical abuse. The patterns are usually characteristic of the method or object used, such as cigar or cigarette burns, or burns in the shape of an iron. A nurse is caring for a 10-year-old child following a head injury. Which of the following findings should the nurse identify as an indication that the child is developing diabetes insipidus? a. increased urine specific gravity b. increased sodium level c. decreased oral fluid intake d. decreased urine output - ✔✔b. increased sodium level A child who has a head injury can develop diabetes insipidus because of pituitary hypofunction leading to a deficiency of antidiuretic hormone. Underexcretion of antidiuretic hormone leads to polyuria and polydipsia, and dehydration. With the excessive loss of free water, sodium levels increase. A nurse is providing teaching to the parent of an infant who has diaper dermatitis. The nurse should instruct the parent to apply which of the following to the affected area? a. antibiotic ointment
b. zinc oxide c. talcum power d. antiseptic solution - ✔✔b. zinc oxide Diaper dermatitis is a common inflammatory skin disorder caused by contact with an irritant such as urine, feces, soap, or friction, and takes the form of scaling, blisters, or papules with erythema. Providing a protective barrier, such as zinc oxide, against the irritants allows the skin to heal. A nurse is creating a plan of care for an infant who has an epidural hematoma from a head injury. Which of the following interventions should the nurse include in the plan? a. implement seizure precautions for the infant b. perform a neurological assessment every 4 hr c. suction the infant's nares to remove secretions d. position the infant side-lying with their head at a 0-5 degree angle - ✔✔a. implement seizure precautions for the infant An infant who has an epidural hematoma is at great risk for seizure activity. Therefore, the nurse should implement seizure precautions for the child. A charge nurse is preparing to make a room assignment for a newly admitted school-age child. Which of the following considerations is the nurse's priority? a. length of day b. treatment schedule
d. "Mix the medication with applesauce if the child dislikes the taste." - ✔✔a. "Shake the medication prior to administration." The nurse should instruct the parent to shake the medication prior to administration to disperse the medication evenly within the suspension. A nurse is providing teaching to the parents of a preschooler who has heart failure and a new prescription for digoxin twice daily. Which of the following instructions should the nurse include in the teaching? a. "Use a kitchen teaspoon to measure the medication." b. "Brush the child's teeth after giving the medication." c. "Double the next dose if the child misses a dose." d. "Repeat the dose if the child vomits." - ✔✔b. "Brush the child's teeth after giving the medication." The nurse should instruct the parents to brush the child's teeth after administering digoxin to prevent tooth decay caused by the medication, which comes as a sweetened liquid to enhance the taste. A nurse is preparing an adolescent for lumbar puncture. Which of the following actions should the nurse take? a. place a cardiac monitor on the adolescent prior to the procedure b. apply topical analgesic cream to the site 1 hr prior to the procedure c. keep the adolescent in a semi-Fowler's position for 4 hr following the procedure
d. restrict the fluids for 2 hr following the procedure - ✔✔b. apply topical analgesic cream to the site 1 hr prior to the procedure The nurse should apply a topical analgesic to the lumbar site 1 hr prior to the procedure to decrease the adolescent's pain while the lumbar needle is inserted. A nurse in the outpatient pediatric clinic is caring for a 2-year-old child. Click to highlight the findings that require follow-up. Mucous membranes are pale pink and moist. Heart rate increases during inspiration and decreases during expiration. S1, S2, and S3 are heard upon auscultation. Abdomen is soft and nondistended. Bowel sounds are present. Noted genu valgum when child walks. Babinski reflex is negative. Parent reports moving to an older urban house, which is being renovated, about 6 months ago. Parent reports having difficulty getting the child to eat and states, "they are a picky eater." The parent expresses concern that the child seems less active recently and gets tired more quickly. - ✔✔When recognizing cues, the nurse should identify that pale pink mucous membranes, living in an older urban house that is being renovated, and the parent's report that the toddler seems less active and gets tired more quickly are findings that require follow-up. These findings are associated with lead poisoning, and the child's blood lead level should be determined. Pale pink membranes, decreased activity, and tiring more quickly are manifestations of anemia, which can result from increased blood lead levels. Older urban homes are a common source of lead, especially during renovation, which may aerosolize the lead particles. A nurse in the outpatient pediatric clinic is caring for a 2-year-old child. Drag words from the choices below to fill in each blank in the following sentence.
hemoglobin. Addressing the lead level first will cause the hemoglobin level to improve. Kidney damage (ketonuria and glycosuria) is reversible once the lead level has been addressed. The nurse has reviewed the child's nurses notes, assessment, vital signs, provider's prescriptions and laboratory results for the 0800 one month ago visit. Nurses' Notes 2 months ago: The toddler is here for their well-child visit and is accompanied by a parent. Toddler is active, alert, and walking without assistance. The parent reports moving to an older urban house, which is currently being renovated, about 6 months ago. Parent reports having difficulty getting the toddler to eat and states, "they are a picky eater." Parent reports they have not started toilet training. The parent expresses concern that the child seems less active recently and gets tired more quickly. - ✔✔Anticipate: ferrous sulfate elixir, succimer capsule, and to consult social services and dietician. When generating solutions, the nurse should anticipate the provider to prescribe medications (succimer, ferrous sulfate) and consults for a dietitian and Social Services. Succimer is a chelating agent that is used in children who have blood lead levels of greater than 45 mcg/dL and are asymptomatic. The nurse should anticipate a prescription for ferrous sulfate to treat the anemia that has developed due to increased blood lead levels. The nurse should anticipate a consult from Social Services to assist the parent in finding housing until the renovations are completed and to identify other needed resources. The nurse should anticipate consulting a dietitian to assist the parent in providing meals that are high in iron and calcium and low in fat. These foods are important for the child to consume to diminish the effects of lead poisoning. Chelating agents, such as succimer, are eliminated from the body through the kidneys. It is necessary that the child remains well hydrated during chelation therapy. The blood lead level should be rechecked in 1 month.
The nurse has reviewed the provider prescriptions for the 0900, 1 month ago visit. The nurse is providing discharge teaching to the parent. Which of the following information should the nurse include? Select all that apply. Nurses' Notes 2 months ago: The toddler is here for their well-child visit and is accompanied by a parent. Toddler is active, alert, and walking without assistance. The parent reports moving to an older urban house, which is currently being renovated, about 6 months ago...
- notify the provider if the child's stools become black
- use a wet cloth to dust when house cleaning
- prevent the child from playing in soil near the house
- monitor the number of wet diapers
- use a straw to administer the ferrous sulfate
- offer orange juice to the child when giving ferrous sulfate
- notify the provider if the child's stools become black
- prevent the child from playing in soil near the house - ✔✔1, 2, 3, 4, 6, 8 A nurse is teaching the parent of a preschooler about ways to prevent acute asthma attacks. Which of the following statements by the parents indicates and understanding of the teaching? a. "I will use a humidifier in my child's room at night" b. "I will give my child a cough suppressant every 6 hours if he has a cough."
