pediatric – Flashcard
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A 2-year-old toddler has hearing loss caused by recurrent otitis media. What treatment does the nurse anticipate that the practitioner will recommend?
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*Myringotomy* is a surgical opening into the eardrum to permit drainage of accumulated fluid associated with otitis media. Ear drops are not used because they will obscure the view of the tympanic membrane. Removal of the mastoid will not relieve pressure within inflamed ears. Antibiotics, not steroids, are used for an infectious process.
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What does the nurse state is the cause of frequent upper respiratory tract infections in toddlers?
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Immature immune system
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A toddler on the pediatric unit is required to have temporary dietary restrictions after colorectal surgery. What is the best way for the nurse to promote adherence to the restrictions?
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Toddlers are ritualistic and do not tolerate change well; *any change in diet should be done matter of factly.*
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age range for toddler years
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12-36mos
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While in the playroom of a pediatric unit the nurse sees several toddlers seated at a table trying to copy the same picture from a book. They are not talking to each other or sharing their crayons. What does the nurse conclude about this behavioral interaction?
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It is a typical expression of toddlers' social development. As part of the socialization process, toddlers enjoy playing beside other children (parallel play).
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A nurse is obtaining a health history from the mother of a 15-month-old toddler with celiac disease. The nurse expects the mother to indicate what about her toddler?
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*Steatorrhea (fatty, foul-smelling, frothy, bulky stools)* occurs with celiac disease because of an intolerance to gluten; toxic substances, which can damage the intestinal mucosal cells, accumulate and cause diarrhea.
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What is the priority nursing care in the immediate postoperative period for a toddler with a newly applied hip spica cast?
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*Checking the toddler's peripheral circulation*. Priority nursing care for any cast application includes checking the color and temperature of the area surrounding the cast to ensure that the cast is not too tight. A tight cast compresses arteries and veins, thereby impairing circulation.
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The parent of a 2-year-old calls a nurse who is a neighbor and reports that the child just ate several multivitamins with iron. What should the nurse say to the parent?
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"Call the Poison Control Center." The Poison Control Center will provide the best guidance for treatment of excess ingestion of a substance; enemas, lavage, or chelation therapy with deferoxamine (Desferal), a heavy metal antagonist, may be recommended, depending on the amount ingested and the child's age and response.
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A nurse in the daycare center is teaching several aides about the play behavior of 2-year-old toddlers. What is this type of play called?
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*Parallel*: Toddlers play independently but beside other children; they are aware of the other children, often grabbing toys from them, but do not socially interact with them.
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Elbow restraints are prescribed for an 18-month-old toddler who just had surgery for a cleft palate. The nurse explains to the parents that the restraints are used to keep the child from doing what?
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The suture lines in the mouth must be protected. Because the toddler uses the mouth to explore the environment, elbow restraints are needed to keep the child from placing fingers or objects in the mouth.
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During which health maintenance visit for a toddler-age client should the nurse assess the ability to throw a ball overhand without losing balance?
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18mos
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While obtaining the health history of a 15-month-old toddler, the child of a migrant worker, a nurse learns that the infant recently had a fever, runny nose, cough, and white spots in the mouth lasting 3 days. A rash started on the face and spread to the whole body. What communicable disease does the nurse suspect the infant suffered from?
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White spots in the mouth (Koplik spots) and the rash, combined with increased mucus secretions (coryza), are indicative of measles *(rubeola)*.
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The nurse discusses discipline with parents of a 4-year-old child. Which parental statement regarding time-out reflects an appropriate application of this method of discipline?
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Explaining the reason for the time-out before and after reinforces the child's association of the time-out with the undesirable behavior, allowing the child to work to control those behaviors.
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The nurse is caring for a young child diagnosed with lead poisoning. Which finding indicates that the client has suffered from high-dose exposure to lead?
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Blindness indicates that the client is suffering from encephalopathy as a result of high-dose exposure to lead.
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The nurse is providing education to the parents of a preschool-age client who is experiencing a severe fear of the dark. Which treatment option should the nurse share with the parents during the teaching session?
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Repetition of brave statements
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A 3-year-old child is admitted to the pediatric unit with a tentative diagnosis of Wilms tumor. The nurse obtains the child's health history from the parents. What does the child's history reveal that will help establish the diagnosis?
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*abdominal swelling* Wilms tumor is a nephroblastoma that is first observed as a firm, painless intraabdominal mass located on one side of the abdomen.
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What change is seen when a child enters from a stage of toddlerhood to the stage of preschooler?
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Preschoolers get into the habit of extending bedtimes.
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At which age would the nurse anticipate the appearance of an imaginary friend for a preschool-age client?
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Imaginary friends typically appear by 3 years of age and can last throughout the preschool stage of development. If an imaginary friend has not appeared by this age, it is unlikely to expect this to surface at 4, 5, or 6 years of age.
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After a tonsillectomy, which finding alerts the nurse to suspect the initial stage of hemorrhage?
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Blood seeping from the surgical site drains into the oral cavity, causing the child to *swallow*. Snoring is to be expected after a tonsillectomy because of edema.
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What is the required average daily intake of calories in preschoolers?
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1800
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A nurse educates a group of parents about how to teach their children to safely cross roads and walk in parking lots. Which age group of the children is the nurse referring to?
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Preschoolers
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Which type of language development is seen in 4-year-olds?
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knows simple songs
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An adolescent visits the allergy clinic because of seasonal environmental allergies, and blood is drawn for testing. Which laboratory finding indicates to the nurse that an allergic response is in progress?
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Increased eosinophil level
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Pulse oximetry is prescribed for an adolescent. What should the nurse do to ensure accuracy of the pulse oximeter reading?
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Capillary beds are closest to the surface in a *finger or earlobe*; this proximity permits more accurate measurement of arterial oxygen saturation.
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What is true about psychosocial changes observed in adolescents?
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search for his or her personal identity and develop his or her own ethical system
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What is true about cognitive changes observed in adolescents?
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consider themselves invincible and consider their parents materialistic
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Which herbal therapies can be recommended to a client with breast pain?
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chamomile, bugleweed, and chaste tree fruit
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What is the minimum respiratory rate in a normal adolescent?
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16
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The parents of a 15-year-old adolescent who is being treated for allergies privately tell a nurse that they suspect that their child is a hypochondriac. What is the most therapeutic response by the nurse?
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Discussing developmental behaviors of adolescents
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What is the maximum heart rate of a 16 year old?
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90 bpm
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What is gynecomastia?
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Gynecomastia is a bilateral or unilateral enlargement of breast seen in adolescent boys. It is an unusual change during growth and development and subsides on its own. Gynecomastia is caused by a hormone imbalance of testosterone and estrogen.
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What is the average diastolic pressure recorded in a 16 year old?
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75 mmHg
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Which complication of anaphylactic shock in the adolescent client is most important for the nurse to detect early?
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*Laryngeal edema* with severe acute upper airway obstruction may be life threatening in anaphylactic shock and requires rapid intervention. The reaction may also involve symptoms of irritability, cutaneous signs of urticaria, tachycardia, and increasing restlessness, but these are not as life threatening as laryngeal edema.
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A preschool-aged child visits the health clinic with his mother. The mother is concerned about the child's interaction with "imaginary friends." What is the best response by the nurse?
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Imaginary friends and imaginary play are normal for children at the preschool developmental level. Their thinking is influenced by role fantasy. Children believe that their wishes are real and that dreams come to life. They believe that inanimate objects have feelings and thoughts. It is important for the mother to know that this form of thinking is normal for a child of this age and that there is no need for a psychiatrist, medication, or a developmental assessment.
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What is the current minimum level of lead in the blood used to identify children associated with exposure to lead hazards, according to the Centers for Disease Control and Prevention, 2012?
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5 mcg/dL
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A 4-year-old child with nephrotic syndrome is admitted to the pediatric unit. What clinical finding does the nurse expect when assessing this child?
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*Dark, frothy urine* is characteristic of a child with nephrotic syndrome; large amounts of protein in the urine cause it to take this appearance
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A 4-year-old child is admitted to the pediatric unit with a diagnosis of Wilms tumor. Considering the unique needs of a child with this diagnosis, the nurse should place a sign on the child's bed that states what?
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*Do not palpate the abdomen.* -- increases risk of tumor rupture
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A student nurse is assessing socialization skills in 3-year-old and 4-year-old children. Which similar characteristics may be seen in the children of the two different ages?
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Both have fear.
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Which areas are sources of stress in four-year-old children?
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Attention, insecurity, and activity level
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What does the nurse state the average weight of a preschooler at the age of 5 years old?
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41 pounds (18.59 kg)
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According to Erikson's theory, what behavior would the nurse explain a preschooler exhibits?
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According to Erikson's theory, a preschooler develops superego or conscience during the initiative versus guilt stage.
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When preparing a child with asthma for discharge, what instructions must the nurse emphasize to the family?
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Parents should be taught to limit allergens in the home that can precipitate asthma attacks (e.g., no carpets, no down pillows, no scented products; wet-mopping floors, vacuuming when the child is not in the home). Medications to control inflammation, including inhaled corticosteroids and long-acting β2-agonists, must be continued to suppress exacerbations of asthma. Environmental moisture is necessary for these children; in addition, cold environments should be avoided. Consistent limits should be placed on the child's behavior, regardless of the illness; a chronic illness does not eliminate the need for limit setting. The child should return to school and continue to interact with schoolmates and friends.
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What is true about a preschooler's imaginary playmates?
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Imaginary playmates experience what a preschooler wants to remember.
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A child undergoes tonsillectomy and adenoidectomy for numerous recurrent respiratory tract infections. After the surgery, what should the nurse teach the parents to do?
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Offer ice chips. Ice chips are soothing and promote vasoconstriction.
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What is the average weight of a three-year-old child?
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32 lb (14.5 kg)
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What should a nurse emphasize when teaching lifelong management of type 1 diabetes to an adolescent?
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Inspecting both feet frequently for signs of trauma
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Levonorgestrel
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an over-the-counter medication that is given without a prescription; emergency contraceptive that should be taken within 120 hours of intercourse.
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Which is a sign of a ruptured ectopic pregnancy in an adolescent?
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Abdominal pain and hypotension
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A 15-year-old with type 1 diabetes has a history of noncompliance with the therapy regimen. What must the nurse consider about the teenager's developmental stage before starting a counseling program?
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The struggle for identity is typical.
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Which of these statements regarding adolescents are true?
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The United States has the highest rate of teenage pregnancy. Anorexia nervosa and bulimia are two eating disorders found in adolescence.
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What is the most common cause of ophthalmia neonatorum in infants born to adolescent mothers?
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Chlamydia
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An 18-year-old adolescent male complains of painful urination and yellow-green mucosal discharge from urethra not associated with abdominal pain. What condition is the client likely to have?
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Epididymitis
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Arrange the events of an examination of a rape victim for a sexually transmitted infection in correct order.
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First, the sexual assault nurse should conduct nucleic acid amplified testing for chlamydia and gonorrhea. Next, the nurse should check for trichomoniasis via a wet mount and culture or point-of-care testing of a vaginal swab specimen. After this, a serum sample for HIV infection, hepatitis B, and syphilis should be conducts. Finally, serologic tests for syphilis and HIV infection are repeated every 3 to 6 months after the assault.
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An adolescent who has just been found to have type 1 diabetes asks a nurse about exercise. What is the best response by the nurse?
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"Extra snacks are needed before exercise." to prevent hypoglycemia
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What over-the-counter drugs are used to treat vulvovaginal candidiases?
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Miconazole and clotrimazole
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A nurse on the pediatric unit is planning recreational activities for a 4-year-old with an exacerbation of nephrotic syndrome. What are the most appropriate activities in light of the child's developmental level and physical status?
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Watching cartoon videos and listening to stories Enjoyment of fantasy and listening to stories are quiet, pleasurable pastimes for a 4-year-old.
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A 4-year-old child shows a motor response score of 3 on the Glasgow Coma Scale. What clinical finding does this signify?
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Abnormal flexion
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Which is a particular source of stress in 4-year-olds?
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attention
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Which step should the nurse follow for the administration of ear drops in children of 4 to 5 years of age?
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Pull the auricle up and out.
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Which description provided by the parent of a preschool-age client would suggest to the nurse that the child is experiencing sleep terrors?
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Sweating profusely
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A 4-year-old child with Wilms tumor undergoes nephrectomy. What essential information should the nurse plan to teach the parents?
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Because the child now has one kidney, the parents must watch carefully for signs and symptoms of urinary tract infection (UTI) on an ongoing basis. A UTI can compromise kidney function; therefore it should be identified in the early stage and treated immediately.
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Which ages are the most critical for language development during the preschool stage of development?
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3 & 4 years
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Which reactions does a nurse expect of a 4-year-old child in response to illness and hospitalization?
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Preschoolers experience loss of control caused by physical restriction, loss of routines, and enforced dependency, which may make them feel out of control. Preschoolers are also likely to experience feelings of regression or overdependency and fear of bodily mutilation.
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A nurse is obtaining a health history from the parents of a preschooler with celiac disease. What characteristic does the nurse expect when the parents describe their child's stools?
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Large, pale, foul-smelling
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The preschool-age client is learning sociocultural mores. What should this imply to the nurse regarding this client?
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The child is developing a conscience.
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A preschool-aged child with leukemia who is undergoing chemotherapy is susceptible to rectal ulcerations. What should the nurse recommend to the parents that will lessen the severity of this problem?
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Clean the child's perianal area after each bowel movement.
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Which clinical manifestation would cause the nurse to suspect that a preschool-age client ingested a corrosive agent, such as bleach?
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Drooling is often associated with the ingestion of a corrosive agent, such as bleach.
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The nurse is assessing a 5-year-old child using the Glasgow Coma Scale after surgery. What rating should the nurse assign if the child shows a confused verbal response?
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4
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A nurse in the child life center encourages preschool children to engage in role play. Why does the nurse consider this an important part of socialization?
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It encourages expression of concerns.
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Which is a particular source of stress in 3-year-olds?
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Speech
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A nurse is planning to teach the parents of a preschool child with recently diagnosed cystic fibrosis why the child has respiratory problems. What should the nurse remember about the underlying pathophysiology?
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Excessively thick mucus obstructs airways.
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What changes are observed in a preschool-aged child?
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Balanced and coordinated body Decreased abdominal protrusion
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Which quantity of iron, ingested by a child, would be considered in the range of mildly to moderately toxic?
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Ingestions of 20 to 60 mg/kg of iron are considered mildly to moderately toxic.
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Which gonadotropin-releasing hormone agonists are used to treat endometriosis?
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Leuprolide and nafarelin
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What is the most major cause of acne in adolescent women?
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hormonal imbalance
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Which is the preferred drug of choice for the treatment of syphilis in a pregnant adolescent?
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Penicillin G
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Arrange in order the steps involved in the changes that occur during puberty.
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Some events trigger the production of gonadotropin-releasing hormone (GnRH) by the hypothalamus. GnRH travels through a network of capillaries to the anterior pituitary gland and stimulates the production and secretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). When the levels of these hormones increase, they in turn stimulate the gonadal response.
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Which behavior patterns may be exhibited by teenagers in their late adolescence?
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Concealed temper and consistent emotions
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Which statements regarding acne are correct?
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Stress and family history may cause acne formation. The causative organism is Propionibacterium acnes.
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According to current statistics, what percent of adolescents try marijuana by the end of high school?
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49%
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An adolescent wants to have bariatric surgery. What are the criteria for this surgery?
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Bariatric surgery is performed on clients with morbid obesity. Adolescent after surgery should strictly adhere to the nutritional guidelines. A body mass index of at least 40 with severe obesity and other health problems is a criterion to have bariatric surgery. The adolescent should agree to avoid pregnancy for 1 year postoperatively. The adolescent should give informed consent to the surgery.
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Which statement about varicocele is true?
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Varicocele occurs most often on the left side.
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Arrange the pathophysiologic events of acne in the correct sequence.
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Excessive sebum production occurs with the maturation of adrenocortical glands. This action is followed by alterations in follicular growth and differentiation. Propionibacterium acnes proliferate and increase in number. This proliferation leads to an accumulation of neutrophils, which causes the formation of papules, pustules, nodules, and cysts and subsequent inflammation.
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Which genetically inherited syndromes are mostly recognized in adolescence?
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Turner syndrome and Klinefelter syndrome
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A nurse is teaching a high school student about scoliosis treatment options. On what should the nurse focus?
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Effect on body image
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Which stage of Kohlberg's theory explains the influence of moral values on an individual's thought?
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During the society-maintaining orientation stage, an individual expands focus from a relationship with others to societal concerns. These individuals may be influenced by moral values.
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What transformations occur during the mid-puberty stage of a normally developing adolescent female?
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Breast enlargement and the growth of pubic hair
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Which medication is the first-line treatment for acne in adolescents?
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Benzoyl peroxide
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A 13-year-old adolescent is found to have idiopathic scoliosis. Because exercise and avoidance of fatigue are essential components of care, which sport should the nurse suggest as the most therapeutic for this preadolescent?
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The hyperextension required in *swimming* helps strengthen back muscles and necessitates deeper respirations, both of which are necessary before surgery and before wearing a brace or cast.
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Which of these statements are true about an adolescent according to Lawrence Kohlberg's theory of moral development?
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"An individual's thoughts are influenced by moral decisions and behaviors." "An individual expands his or her focus from a relationship with others to societal concerns."
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Which event is considered as the hallmark of late puberty in young girls?
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First menstrual period
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According to Erikson's theory, which of these actions can predispose an adolescent to being in a state of confusion?
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If an adolescent fails to establish a sense of identity
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What are the common characteristics of a relationship between a middle adolescent and his or her parents?
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a great push for emancipation, a low point in the parent-child relationship, and major conflicts over independence and control
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What is the minimum heart rate of a 14 year old?
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60
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A client is undergoing highly active antiretroviral therapy (HAART). From what viral disease could the client possibly be suffering?
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HIV
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Which test is used to diagnose trichomoniasis?
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Saline wet smear test
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A nurse is reviewing the laboratory report of an adolescent child with nephrotic syndrome. What does the nurse expect analysis of the child's urine to reveal?
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Protein (albumin) is present in the urine of children with nephrotic syndrome; it is evidence of kidney damage. Proteinuria, combined with oliguria, results in an increased urine specific gravity.
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What is the maximum recommended length for enema tube insertion in an adolescent?
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10 cm
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The nurse receives an order to prepare a solution for administering a cleansing enema for a 15-year-old client. What is the volume of solution that the nurse should prepare?
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500 to 750 mL
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herbal therapies for excessive bleeding during the menstruation
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lady's mantle, raspberry, shepherd's purse
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At what age, the pubertal growth spurt reaches its peak in males?
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14
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An 18-year-old adolescent who was diagnosed with new-onset type 1 diabetes mellitus has stress and reports not having a menstrual cycle for a long time. Which condition is the adolescent experiencing?
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Hypogonadotropic amenorrhea
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Prolonged labor is an incident very common in pregnant adolescents. Which age group of adolescents has the highest risk of prolonged labor?
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12-13yrs
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What drugs are used to induce abortion in an adolescent?
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Misoprostol is a prostaglandin analog that acts directly on the cervix, stimulating contractions. Mifepristone acts by binding to progesterone receptors and blocking the action of progesterone, which is necessary for maintaining a pregnancy. Methotrexate is a cytotoxic drug that can cause early abortion by blocking folic acid in fetal cells.
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What are the manifestations of hypoestrogenism?
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Low levels of estrogen may cause hot flashes, amenorrhea, and reduced bone density.
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What percentage of his or her adult weight does an individual gain during the adolescent years?
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50%
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Which of these statements about pregnancy in the adolescent population are true?
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Pregnant adolescents often seek out less prenatal care Adolescent mothers need competent day care for their infants. Infants of adolescent mothers are at increased risk for prematurity.
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What are the medical concerns in adolescent pregnancies?
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maternal anemia, poor weight gain, and pregnancy-induced hypertension
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According to Piaget's theory, which of these is true about the period of formal operations?
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Children have the capacity to reason with respect to possibilities. Children have a belief that their actions are scrutinized by imaginary audience.
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Which herbal therapies would be beneficial to a client with menstrual cramping?
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catnip, fennel, black haw
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Which side effects are associated with systemic antibiotic therapy for acne in adolescents?
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photosensitivity vaginal candidiasis
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Which growth characteristics does the nurse anticipate for a 16-year-old female client?
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decreasing rate of growth, to have reached ninety-five percent of adult height, and to have well advanced secondary sexual characteristics
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For which clients should the nurse measure head circumference during the growth and development assessment?
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The nurse measures head circumference during the growth and development assessment until 36-months of age.
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After assessing a neonate immediately after birth who was delivered using forceps, the nurse confirms facial paralysis. Which information does the nurse provide to the mother?
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Facial paralysis may occur in a neonate as a result of forceps delivery. This facial paralysis generally disappears within a few hours or days, so no medical intervention is required.
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What body weight is a normal finding in a 1-year-old infant whose birth weight was 3.2 kg?
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The infant's body weight generally triples by 1 year of age. Therefore the infant's normal body weight by 1 year of age should be 3.2 x 3 = 9.6 kg.
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The nurse is caring for a child who has attention deficit-hyperactivity disorder (ADHD). Which changes in the child's classroom will be beneficial?
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A child with ADHD will not be able to concentrate properly and experiences difficulty sitting in one place for a prolonged time. Therefore frequent breaks are helpful to improve the child's concentration. Visual representations also help attract attention and improve concentration. Therefore it is appropriate to write instructions after saying them. The child will have increased concentration under the effect of medication, which is generally in the morning. Therefore academic subjects should be scheduled for the morning. A child with ADHD will have dysgraphia, or poor handwriting. Therefore it is appropriate to concentrate on improving the child's computer skills, instead of improving handwriting. It is appropriate to allot more time to take tests and help the child complete tasks rather than giving homework and assignments.
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Which information related to school-age play should the nurse include in a teaching session for parents of children in this stage of development?
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team play, card games, board games, and club membership
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After assessing a 4-day-old newborn, the nurse anticipates that the newborn has impaired vision. Which finding supports the nurse's conclusion?
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Corneal reflex in infants is activated by a light touch. Therefore the nurse anticipates that the newborn has impaired vision when there is no corneal reflex after a light touch.
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Which nursing actions are appropriate when assessing a client's growth?
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assessing a client's growth include assessing weight, measuring height, and comparing data to norms for the age of the client
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The nurse is providing anticipatory guidance to the parents of a child who has a difficult temperament. Which statement should the nurse include in the teaching session with these parents regarding their child's temperament?
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Children who are classified as having a difficult temperament will benefit from a bedtime routine, will likely adapt slowly to a new daycare setting, and will display intense emotions, including those associated with happiness.
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A mother complains that her three year old still performs thumb sucking. What should the nurse suggest to the mother?
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The nurse should suggest that the mother engage the child in more play activities because playing can help the child release his or her frustration. In a preschooler, thumb sucking may be a sign of stress. Therefore, the mother should try to identify any sources of stress.
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Which teaching points regarding fine motor skills should the nurse include during the health maintenance visit for a 30-month-old toddler-age client? Select all that apply.
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The toddler-age client at 30 months of age exhibits the fine motor skills of drawing a circle, having good hand-eye coordination, and building a tower using eight blocks.
