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Tx Plan Toddler Nursing
For a child with a circumferential chest burn, what is the most important factor for the nurse to assess? - ✔✔Breathing pattern Breathing pattern is the most important factor to assess because eschar impedes chest expansion in a child with a circumferential chest burn, causing breathing difficulty. Wound characteristics, body temperature, and heart rate are also factors that should be assessed, but they aren't as important as breathing pattern. A nurse is teaching parents about accident prevention for a toddler. Which guideline is most appropriate? - ✔✔Make sure all medications are kept in containers with childproof safety caps. Making sure all medications are kept in containers with childproof safety caps is the most appropriate guideline because poisoning accidents are common in toddlers owing to the toddler's curiosity and his increasing mobility and ability to climb. When riding in a car, a toddler should be strapped into a car seat, not a seat belt. A seat belt is an appropriate guideline for a school-age child. Never leaving a child alone on a bed is an appropriate guideline for parents of infants. Toddlers already have the ability to climb on and off of beds and other furniture by themselves. Note, however, that toddlers should never be left unattended on high surfaces, such as an examining table in a physician's office. Teaching the rules of the road for bicycle safety is an appropriate safety measure for a school-age child. Toddlers should not be allowed in the road unsupervised. A nurse is caring for a toddler with Down syndrome. To help the toddler cope with painful procedures, the nurse can: - ✔✔hold and rock him and give him a security object. The child with Down syndrome may have difficulty coping with painful procedures and may regress during his illness. Holding, rocking, and giving the child a security object is helpful
because it may be comforting to the child. An older child or a child without Down syndrome may benefit from positive self-talk, time limits, and diversionary tactics, such as counting and singing; however, the success of these tactics depends on the child. Which approach by a nurse is the best for trying to take a crying toddler's temperature? - ✔✔Talk to the mother first and then to the toddler. When dealing with a crying toddler, the best approach is to talk to the mother first then to the toddler. This approach helps the toddler get used to the nurse before she attempts any procedures. It also gives the toddler an opportunity to see that the mother trusts the nurse. Ignoring the crying and screaming may be the second step. The nurse should encourage the mother to hold the toddler because it will likely help the situation. The last resort is to bring in assistance so the procedure can be completed quickly. A nurse is caring for a 2-year-old child admitted for long-term treatment of a chronic illness. Which action should the nurse take to promote normal childhood growth and development? - ✔✔Consult with a play therapist about activities in which the child can participate. Play is an important part of a child's growth and development. A nurse should facilitate play even when a child has a chronic illness. Consulting a play therapist is one way of facilitating such play. Although it's important for children to get adequate sleep, it isn't necessary for a toddler to get 12 hours' sleep per night. A child with a chronic illness may need to be temporarily isolated, but he should still have interaction with family members. A diet high in carbohydrates and low in fat isn't indicated for every toddler with a chronic illness. A nurse is caring for a 14-month-old infant being treated for an upper respiratory infection. The physician would like to order a series of X-rays for the infant, who has been in a foster home for 4 months. How should the nurse obtain consent? - ✔✔Obtain consent from the foster parents.
Return demonstrations are the best way to evaluate a person's ability to perform a skill. This technique enables the teacher to observe not only the learner's sequencing of steps of the procedure but also the learner's ability to perform the skill. A 3-year-old child receiving chemotherapy after surgery for a Wilms' tumor has developed neutropenia. The parent is trying to encourage the child to eat by bringing extra foods to the room. Which food would not be appropriate for this child? - ✔✔fresh strawberries When a client receiving chemotherapy develops neutropenia, eating uncooked fruits and vegetables may pose a health risk due to possible bacterial contamination. All other foods are either cooked or pasteurized and would not produce a health risk. A 3-year-old child is to receive 500 ml of dextrose 5% in normal saline (D5NSS) solution over 8 hours. At what rate (in milliliters/hour) would the nurse set the infusion pump? Record your answer using one decimal place. - ✔✔62. To calculate the rate per hour for the infusion, the nurse would divide 500 ml by 8 hours: 500 ml ÷ 8 hours = 62.5 ml/hour. The parents report that their child has a runny nose, fever, and cough and is irritable and constantly rubbing his ears. When assessing the ear, how should the nurse expect the child's tympanic membrane to appear - ✔✔bulging and red Based on the report of the child's signs and symptoms, the nurse should suspect otitis media. On assessment, the tympanic membrane would appear bulging and bright red (because of increased middle ear pressure), typically indicative of otitis media. Other characteristic findings include rhinorrhea, fever, cough, fussiness, pulling at the ears, and earache.
A clear, inverted membrane may indicate a blockage of the eustachian tubes. A pearly gray tympanic membrane is normal. A scarred tympanic membrane indicates that the membrane has burst due to pressure, but this condition would have occurred earlier if scar tissue has formed. When planning home care for a 3-year-old child with eczema, what should the nurse teach the mother to remove from the child's environment at home? - ✔✔stuffed animals For the child with eczema, which is commonly related to an allergic response, stuffed animals should be avoided because they tend to collect dust and are difficult to clean. Metal toy trucks, plastic figures, and wooden blocks are suitable toys for a 3-year-old child. They are easy to keep clean. A 2-year-old child is brought to the emergency department with a broken arm. Which finding should lead the nurse to suspect child abuse? - ✔✔The child's father alters the story of the injury each time he tells it. The nurse should suspect child abuse when the child's caregiver changes the story of the injury each time it is told. A child who is still learning to walk and run commonly will have bruises on the forearms and shins; bruises on the upper arms and thighs are suspicious.
Any professional who works with children can report suspected child abuse, not just a primary care provider. An uncle is shopping for a toy to give his niece. He has no children of his own and asks his neighbor, a nurse, what would be the most appropriate toy to give a 15-month-old. Which toy should the nurse recommend to facilitate learning and development? - ✔✔a push-pull toy A push-pull toy will aid in development of gross motor skills and muscle development. A stuffed animal is age appropriate for a toddler but is not the toy to promote development. A music box is and nursery mobile are most appropriate to stimulate development for an infant. A nurse on the pediatric floor is caring for a toddler refusing to take liquid acetaminophen for fever. What would be the best option? - ✔✔Allow the mother to hold the child and give the medication. A toddler's increasing autonomy is commonly expressed by negativism. They are unreliable in expressing pain — they respond just as strongly to painless procedures as they do to painful ones. Toddlers have little concept of danger and have common fears. The toddler has trust in mother and may be more willing to take the medication from her. The nurse is caring for a 3-year-old child with iron deficiency anemia and providing dietary instructions to the parents. Which of the following should be a priority for the nurse to include in the teaching? - ✔✔Recommending lean meats From the list, meat is the food source with the highest iron content.
The nurse is educating the parents of a 2-year-old child regarding immunizations. When the parents ask where the injections will be given the nurse answers that the most appropriate site for an intramuscular injection for a child this age is the: - ✔✔vastus lateralis muscle. When administering an intramuscular injection to a 2-year-old child, the preferred site is the vastus lateralis. The dorsogluteal muscle is not a recommended injection site for any age, due to the risk of damaging nerves in the area. The deltoid muscle is underdeveloped in this age group, and therefore not recommended. The ventrogluteal muscle may be developed enough, but is not the first choice. A boy, age 2, is diagnosed with hemophilia, an X-linked recessive disorder. His parents and newborn sister are healthy. The nurse explains how the gene for hemophilia is transmitted. Which statement by the father indicates an understanding of X-linked recessive disorders? - ✔✔"Our newborn daughter may be a carrier of the trait." The father stating that his newborn daughter may be a carrier of the trait demonstrates understanding of X-linked recessive disorders. X-linked recessive genes behave like other recessive genes. A normal dominant gene hides the effects of an abnormal recessive gene. However, the gene is expressed primarily in male offspring because it's located on the X chromosome. Male offspring of a carrier mother and an unaffected father have a 50% chance of expressing the trait whereas female offspring are more likely to carry the trait than express it. These parents may produce offspring who neither express nor carry the trait for hemophilia. A nurse is teaching a group of parents about otitis media. When discussing why children are predisposed to this disorder, the nurse should mention the significance of which anatomical feature? - ✔✔Eustachian tubes The nurse should mention the importance of the eustachian tubes because they're short in a child and lie in a horizontal plane, promoting entry of nasopharyngeal secretions into the tubes and thus setting the stage for otitis media. The nasopharynx, tympanic membrane, and external ear canal have no unusual features that would predispose a child to otitis media.
The nurse should instruct parents to immediately report generalized urticaria because it can herald the onset of a life-threatening episode. A child may experience some pain, redness at the sight, localized swelling, or mild temperature elevation; however, these reactions can be treated symptomatically and aren't life-threatening. What should a nurse do to ensure a safe hospital environment for a toddler? - ✔✔Move the equipment out of reach. Moving the equipment out of reach ensures a safe environment because toddlers are curious and may try to play with items within their reach. Toddlers in a strange hospital environment still need the security of a crib. Stacking toys don't need to be moved out of reach because they don't present a safety hazard and are appropriate for this age-group. Padded crib rails are necessary only if seizure activity is present. A young child who has been sexually abused has difficulty putting feelings into words. Which approach should the nurse employ with the child? - ✔✔engaging in play therapy The dolls and toys in a play therapy room are useful props to help the child remember situations and reexperience the feelings, acting out the experience with the toys rather than putting the feelings into words. Role-playing without props commonly is more difficult for a child. Although drawing itself can be therapeutic, having the abuser see the pictures is usually threatening for the child. Reporting abuse to authorities is mandatory, but does not help the child express feelings. The mother of a toddler asks the nurse what she should do with her toddler when he has a temper tantrum. Which suggestion would be most appropriate? - ✔✔Leave the toddler alone during the tantrum as long as he is safe.
Toddlers have temper tantrums in their attempt to develop autonomy. Toddlers should be left alone as long as they are safe during a tantrum. Moving the child to a time-out chair or punishing the child reinforces the behavior and is to be avoided. Attempting to talk to the toddler also reinforces the behavior. Additionally, at this cognitive level, toddlers do not understand as well as older children do. When developing a teaching plan for parents of toddlers about poisonous substances, the nurse should emphasize which safety points? Select all that apply. - ✔✔Toddlers should be adequately supervised at all times. All poisonous substances should be kept out of the reach of children and stored in a locked cabinet if necessary. The difference between pediatric and adult dosages of medicines is significant, and adult dosages given to children can have serious, harmful effects. Following any poisoning, the parents should call the Poison Control Center for instructions for appropriate treatment. Safety measures for poisonous substances include close supervision of children, safely storing toxic substances, teaching proper dosages and differences between adult and child doses, and the proper way to contact the Poison Control Center for instructions. Poison Control should be notified as soon as the poisoning has occurred and airway and circulation have been assessed. Poison Control will direct any further treatment. Syrup of ipecac is rarely used today in the treatment of ingested substances due to the potential for aspiration. It is contraindicated in cases of arsenic poisoning, seizures, and the ingestion of petroleum or corrosive substances. A 2-year-old child brought to the clinic by her parents is uncooperative when the nurse tries to look in her ears. What should the nurse try first? - ✔✔Allow a parent to assist. Parents can be asked to assist when their child becomes uncooperative during a procedure. Most commonly, the child's difficulty in cooperating is caused by fear. In most situations, the child will feel more secure with a parent present. Other methods, such as asking another nurse
Applying ice directly to the burned area is inappropriate at this time because more tissue damage can result. Antibiotic ointment should not be applied to the burned area at this time because the burning process must be stopped first. Calling a neighbor for help is appropriate after the mother has placed and then removed her child from the bathtub. Which suggestion would be most helpful to the parents of a 2-year-old child when managing separation anxiety during hospitalization? - ✔✔Bring the child's favorite toys from home. Bringing a child's favorite toys, security blanket, or familiar objects from home can make the transition from home to hospital less stressful. The child receives comfort and reassurance from these items. Leaving without explaining may decrease the child's trust in the parents, ultimately adding to the child's level of anxiety. The parents should tell their toddler when they are leaving and when they will return, not by time but in relation to the child's usual activities (e.g., by bedtime). Typically, 2-year-old children have a limited sense of time. Short parental visits do not satisfy a toddler's overwhelming need for comfort because toddlers need to spend lots of time with parents due to separation anxiety. Which toy should the nurse give to a toddler to use in the hospital playroom? - ✔✔blocks
As toddlers begin imaginative play, blocks are an excellent toy choice. Children can use blocks any way they desire, thus fostering imaginative play. A tricycle, wheelbarrow, or truck is an appropriate toy for a preschooler because it requires the use of specific motor skills developed during the preschool period. These motor skills are lacking in a toddler. Which family should the nurse determine as most in need of follow-up? - ✔✔a single parent with a toddler who has third-degree burns over 20% of the body Toddlers receive burns usually as the result of not being closely supervised. Toddlers are very inquisitive and need constant supervision; therefore, close follow-up is necessary. In addition, the child probably will need some type of wound care requiring involvement of the parent and possibly others. The amount of support available to the single parent of the 7-month-old child is not known. Although immunization schedules need to be adhered to, it is very possible for a 7- month-old to be delayed in receiving immunizations because of illness or other conflicts. An automobile accident can happen to anyone and does not indicate a lack of safety or supervision. A history of caustic liquid ingestion in a foster child may have been from a time before the child began living with the foster parents; it does not indicate a lack of safety or supervision. A toddler diagnosed with nephrotic syndrome has a fluid volume excess related to fluid accumulation in the tissues. Which measure should the nurse anticipate including in the child's plan of care? - ✔✔Weigh the child before breakfast. The best indicator of fluid balance is weight. Therefore, daily weight measurements help determine fluid losses and gains. Although limiting visitors to 2 to 3 hours per day or maintaining strict bed rest would help to ensure that the child gets adequate rest, this is
A day-shift nurse tells a night-shift nurse that she has been attempting to reduce the risk for Impaired skin integrity related to immobility in a toddler. Which statement by the night-shift nurse should the day-shift nurse question? Select all that apply. - ✔✔"I'll gently massage the skin with a lubricating substance." "I'll wipe the pressure points with alcohol wipes to keep them clean." Using a lotion on the pressure points will soften the skin and promote its breakdown and therefore, should be avoided. The use of alcohol is drying and should be avoided. Changing the toddler's position frequently will help minimize pressure, prevent edema, and stimulate circulation. Keeping the skin clean will lessen the chances of irritation and breakdown. A toddler with a ventricular septal defect is receiving digoxin to treat heart failure. Which assessment finding should be the nurse's priority concern? - ✔✔Bradycardia Digoxin enhances cardiac efficiency by increasing the force of contraction and decreasing the heart rate. An early sign of digoxin toxicity is bradycardia (an abnormally slow heart rate). To help detect digoxin toxicity, the nurse always should measure the apical heart rate before administering each digoxin dose. Other signs and symptoms of digoxin toxicity include arrhythmias, vomiting, hypotension, fatigue, drowsiness, and visual halos around objects. Tachycardia, hypertension, and hyperactivity aren't associated with digoxin toxicity. A toddler is hospitalized for evaluation and management of congenital heart disease (CHD). During discharge preparation, the nurse should discuss which topic with the parents? - ✔✔When to administer prophylactic antibiotics In CHD, areas of turbulent blood flow provide an optimal environment for bacterial growth. Therefore, a child with CHD is at increased risk for bacterial endocarditis, an infection of the heart valves and lining, and requires prophylactic antibiotics before dental work and invasive procedures. These children should receive all childhood immunizations. They don't require postural drainage or dietary fat restriction.
A mother brings her child, age 3, to the clinic for an annual checkup. After plotting the child's height and weight on a pediatric growth chart, the nurse identifies which percentile range as normal? - ✔✔5th to 95th percentile Height and weight measurements that fall between the 5th and 95th percentiles represent normal growth for most children. Children whose measurements fall outside this range require further evaluation. A toddler has a temperature above 101° F (38.3° C). The physician orders acetaminophen, 120 mg suppository, to be administered rectally every 4 to 6 hours. The nurse should question an order to administer the medication rectally if the child has a diagnosis of: - ✔✔thrombocytopenia. A child with thrombocytopenia or neutropenia shouldn't receive rectal medication because of the increased risk of infection and bleeding that may result from tissue trauma. No contraindications exist for administering rectal medication to a child with sepsis, leukocytosis, or anemia. A 15-month-old child is being discharged after treatment for severe otitis media and bacterial meningitis. Which statement by the parents indicates effective discharge teaching? - ✔✔"We'll go to the physician if our child pulls on the ears or won't lie down." The parents indicate full understanding of discharge teaching by repeating the specific, common signs of otitis media in toddlers, such as pulling on the ears and refusing to lie down, and by verbalizing the need for immediate follow-up care if these signs arise. Expressing that they should have gone to the physician sooner doesn't indicate effective teaching because it implies a sense of guilt — a feeling not promoted through teaching. Stating that they'll take the child to the physician's office every week addresses only weekly follow-up care and expressing
nasal flaring, retractions, chest pain, dyspnea, decreased breath sounds, and crackles indicate pneumococcal pneumonia. A sore throat, fever, and general malaise point to viral pharyngitis. A 2-year-old child with a low blood level of the immunosuppressive drug cyclosporine comes to a liver transplant clinic for her appointment. The mother says the child hasn't been vomiting and hasn't had diarrhea, but she admits that her daughter doesn't like taking the liquid medication. Which statement by the nurse is most appropriate? - ✔✔"Offer the medication diluted with chocolate milk or orange juice to make it more palatable." Because liquid cyclosporine has a very unpleasant taste, diluting it with chocolate milk or orange juice will lessen the strong taste and help the child take the medication as ordered. It is not acceptable to miss a dose because the drug's effectiveness is based on therapeutic blood levels, and skipping a dose could lower the level. Cyclosporine should not be given by NG tube because it adheres to the plastic tube and, thus, all of the drug may not be administered. Taking the medication over a period of time could negatively affect the blood level. A registered nurse (RN) has been "care-paired" with a licensed practical nurse (LPN) during the evening shift. Whose care should the RN assign to the LPN? - ✔✔The 2-year-old child who has started eating soft, solid foods following a tonsillectomy The nurse can delegate care of the child who had the tonsillectomy to the LPN because he/she is stable and likely preparing for discharge. The infant with a WBC count of 34/μl and fever requires close monitoring for additional signs of infection. Infection could lead to sepsis or septic shock. Although the infant with contusions from the motor vehicle accident may be stable, children sometimes experience delayed reactions to injury. This infant requires close monitoring for signs or injury or shock. The RN should care for the infant with type 1 diabetes, who could become ill very quickly. The mother of a toddler who has just been admitted with severe dehydration secondary to gastroenteritis says that she cannot stay with her child because she has to take care of her
other children at home. Which response by the nurse would be most appropriate? - ✔✔"I understand, but feel free to visit or call anytime to see how your child is doing." The nurse's best course of action would be to support the mother. This is best done by conveying understanding and encouraging the mother to visit or call. Telling the mother that she should not leave and that the child is very sick is critical and insensitive. Additionally, it implies guilt should the mother leave. Commenting that the child does not need anyone is not appropriate or true. Toddlers, in particular, need family members present because of the stresses associated with hospitalization. They experience separation anxiety, a normal aspect of development, and need constancy in their environment. Asking the mother to find someone else to stay with her children is inappropriate. The children at home also need the support of the mother and/or other family members to minimize the disruptions in family life resulting from the toddler's hospitalization and to maintain consistency. When developing the preoperative teaching plan for a 14-month-old child with an undescended testis who is scheduled to have surgery, which method is appropriate? - ✔✔Explain to the parents how the defect will be corrected. Preoperative teaching would be directed at the parents because the child is too young to understand the teaching. Telling the child that his penis and scrotum will be "fixed," telling the child he will not see incisions after surgery, and using a doll to illustrate the surgery are appropriate interventions for a preschool-age child. The nurse in the emergency department is caring for a 3-year-old child with a fractured humerus. The child is crying and screaming, "I hate you!" Which action would be most appropriate? - ✔✔Reassure the parents that this a normal behavior under the circumstances. Explaining to the parents that this is a normal reaction under the circumstances is most appropriate. The child's outburst is related to the child's fears of the unknown. The child is scared and anxious and needs the parents for support. Asking the parents to wait outside would only add to the child's fear and anxiety. The reaction is normal for a child her age and
