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Specific responses that encourage the expression of feelings and ideas and convey acceptance and respect. We utilize this communication by getting close to our patients and allowing them to trust in us as a nurse.
disadvantages of ET tube
discomfort, suppressed cough reflex
indications for trach tube
bypass upper airway obstruction, remove tracheobronchial secretions, long term ventalation, prevent aspiration in unconscious pt, replace et tube
pre-op teaching thoracic surgery
anesthesia, use of chest tube and drainage system
what are chest tubes for
re-expand involved lung & remove air, fluid, blood. Also pneumothorax
management of cuff on tubes
15-25 mm Hg, monitor q 8hrs, handheld pressure gauge
criteria for weaning
serial abg's, vs stable
how do you know if air leak
decreased pressure loss of volume, continuous bubbles
help pt on ventilator communicate
nod or shake head, mouth words, writing, one way speaking valve
difference between cpap and bipap
cpap positive pressure through respiratory cycle most effective, bipap independent control inspiratory and expiratory. Inspiration initiated by pt or machine
when should the nurse use suction
when advantageous breath sounds are present
what is studied before pulmonary resection
activity after thoracotomy
out of bed 8-12 hours, arm and shoulder exercise.
what is assessed prior to suctioning
lung sounds and pulse
how much h2o in chest tube system
how much water in chest tube system
teach pt go7ng home with o2 therapy
look for change In respiratory status, bleeding/drainage, increased chest pain
what type of coughing ifnthe patient has pain
pt comes to the er with ards what to expect
s & sx pneumothorax
sudden pain, tachypnea, acute respiratory distress, anxious,air hunger,accessory muscles, tracheal alignment, hyper resonance, diminished absent breath sounds
what medications after PE
heparin then coumadin for 3-6 months
what is the tx for small flail chest
nothing just o2
tests for ards
plasma brain natriuretic peptide (BNP) lvls, echocardiography, pulmonary artery catheterization
what to teach children about smoking cessation
younger they start smoking better chance of lung cancer
s & sx of acute respiratory failure
impaired oxygenation, restlessness, fatigue, ha,dyspnea, air hunger, tachycardia, increased bp,confusion,lethargy, tachypnea, central cyanosis, diaphoresis, respiratory arrest
2 major complication ards
characteristics of small cell cancer
small cell and combined small cell, due to cigarette smoke, aggressive, grows quickly, starts in center of the chest
tx for ards Intubation ventalation, peep, adequate fluid volume,nutrition
Represents a failure to follow the predictable course of normal grieving to resolution. When the process deviates from the norm, the individual becomes overwhelmed and resorts to maladaptive coping. Often leads to depression.
HGB & HCT decreased
Platelet count increased
Serum albumin decreased
K, Mg, C decreased
AKI: Encourage pt to drink 2-3L daily possible fluid restriction. Promote smoking cessation, weight loss, and use of NSAIDs, control diabetes & HTN w/ meds. Instruct pt to take ALL perscribed meds and ATBs. Decreased dietary potass, phosphate, and mag. during oliguric phase. Increase protein, possible TPN.
CKD: 3L H2O, smoking cess, encourage diet, med reg, yearly albumin in urine testing if pt has DM or HTN.
Monitor Blood o2 lvl
Menopausal Hormone Therapy
- increased risk for blood clots
- long term use increases cancer risk
Monitor Vitals I&O and Labs
Mild- Itching, urticaria, flushing- Administer benadryl
Anaphylactic- wheezing, dyspnea, chest tightness, cyanosis, hypotension
-Apply an initial dressing of gauze and replace with transparent dressing w/i 24 hr
-x ray to ensure placement
- Use 10mL or < syringe to flush
-Clean port for 3 seconds and allow to dry
-flush before, between, and after meds
- no BP on arm with PICC
x ray verification prior to use
Use 10mL or < syringe
Tape cath hub to minimize manipulation
Remove dressing from distal to proximal
note length to help detect cath. migration
Suction secretions to maintain airway and tube patency
Must take for 6-12 months
No alcohol, may interfere with BC, report yellowing skin, drink lots of water, notify provider with vision or hearing changes
-Caused by dysrythmia
-dyspnea, chest pain, air hunger, decreased o2
Administer O2 therapy
nitiate and maintain IV therapy
Provide emotional support
Monitor changes in LOC and mental status
check glucose before meds
if take insulin must eat after
-monitor Vitals and labs
-Add bulk foods and fruit juices
-Assess skin turgor and mucous membranes
-provide skin and mouth care
-encourage pt to drink in response to thirst
Keep trach @ bedside
Indicates Blood sugar for last 120 days
Retinal detachment- flashes of light and blind spots
Glaucoma- increased IOP causing gradual vision loss
-Monitor for IOP
-monitor for decreased vision and light sensitivity
-Assess pt for aching or discomfort around the eye
-Tx severe plain and nausea with analgesics and antiemetics
If it falls out put in lead lined container and return to radiology
-CSF leakage from ears or nose
-"halo" sign- yellow stain surrounded by blood on a paper towel, fluid tests positive for glucose
-report to dr.
C4 or above poses risk for impaired spontaneous ventilation because of the involvement of the phrenic nerve
-Acute febrile state
-Abrupt cessation of antiepileptic drugs
-Acute drug & alcohol withdrawl
-Fluid and electrolyte imbalances
-fluid and electrolyte
While providing care to a Muslim child, whose parents have very strong beliefs when it comes to medical care. The nurse informs the parents about the treatment plans, respects their beliefs, and helps the parents make decisions about the child's care needs. What do this nurse's actions support?
The nurse is responsible for determining that the parents or legal guardians understand what they are signing by witnessing their signatures
The nurse is caring for a 2-year-old boy who needs a lumbar puncture. His mother is present. Which of the following would prevent informed consent from being obtained?
Documenting client care and education (medical records) serves several purposes. Which one of the following is not a reason to document care?
Health promotion rather than health restoration is stressed.
Family members who might not agree on treatments and a plan of care for the child
The nurse is caring for a 12-year-old child hospitalized for internal injuries following a motor vehicle accident. For which of the following medical treatments would the nurse need to obtain an informed consent beyond the one signed at admission?
A 16-year-old child is admitted to the hospital for treatment after a motor vehicle crash. Review of the child's record reveals that she is an emancipated minor. The nurse interprets this as indicating which of the following?
The nurse is providing family-centered care for a 6-year-old boy with cancer. Which of the following actions is most likely to be an asset related to the case management process?
The nurse is functioning in the primary role to care for a 12-year-old boy with metastatic cancer in the liver. Which of the following activities is typical of advocacy?
A nurse is teaching a group of sexually active adolescents about contraception and prevention of sexually transmitted infections. Which measure is the nurse performing?
Determining sole or joint custody by the parents
You are going to provide an education program to early grade-school children. Which of the following topics would address the number one cause of death for this age group?
“We had to sign the form right away so the surgery could get scheduled, we did not have time for any questions”
An older couple approaches the nurse's station seeking information about their hospitalized grandchild. What should be the nurse's response?
Document failed attempts to obtain consent to allow emergency care without consent
a) Immunization; b) Obesity and overweight; c) Injury and violence; d) Physical activity
The nurse is planning an educational session for community members to address the issue of school-age child mortality. Which topic should the nurse identify as the highest priority for this population?
The pediatric nurse knows that the children she is treating are considered minors. Which of the following statements accurately describes the regulations related to consent for medical treatment?
A 15-month-old girl is having her first health visit at a clinic. The mother has no immunization record but says the child was immunized 3 months ago at the local health department. Which of the following is the best action for the nurse to take?
The nurse dealing with global populations knows that the health of individuals in North America continues to improve, but much room for improvement remains. Which one of the following statements accurately reflects the state of health in North America?
The prevalence of chronic diseases is increasing.
The student nurse is learning about the past history of child health and health care in the United States. Which of the following statements accurately reflects the condition of health care in the past and current centuries?
By the late twentieth century unintentional injuries rather than infectious diseases had become the leading cause of death for children older than 1 year old.
A preschool child is scheduled to undergo a diagnostic test. Which action by the nurse would violate a child's bill of health care rights?
After describing the procedure and medical necessity, the nurse asks a 14-year-old child to assent to a skin graft. Which of the following statements accurately describes the requirements for this type of assent?
In some cases, such as cases of significant morbidity or mortality, dissent may need to be overridden
When assessing a family for possible barriers to health care, the nurse would consider which factor to be most important?
The nurse knows that the emancipated minor is considered to have the legal capacity of an adult and may make his or her own health care decisions. Which of the following children would potentially be considered an emancipated minor?
Restraining the child with the nurse's hands and body while the glass removal occurs
The parent of an 11-year-old female patient with an inoperable brain tumor confides to the nurse that her daughter's physician is "pushing them" to convince their daughter to participate in a controversial treatment that has a high risk for side effects. She further states that she told him twice that they were not interested. What would be the nurse's best response to this situation?
More nurses are stepping into the role of the advanced practice nurse. Which of the following would be the nurse to provide care for children under the age of 18?
The nurse is collecting data on a two month old during a well child visit. The new mother is asking questions about the growth chart the nurse is completing. Which of the following is the best response by the nurse?
The nurse is caring for a 12-year-old patient with neuroblastoma. The nurse enters the room to hang a new bag of IV fluid. The mom looks up and states she feels helpless and there is nothing she can do for her child. Which of the following is the best response for the nurse to make?
“Your presence here is very important to your child. Is there some part of his daily care that you would like to do yourself?”
A pregnant client tells her nurse that a friend of hers recently gave birth to an infant who was found to have congenital heart disease. She asks the nurse whether there is anything she can to reduce the risk of this type of condition occurring in her baby. Which of the following should the nurse mention to this patient?
The nurse is caring for a 1-month-old girl with low-set ears and severe hypotonia who was diagnosed with trisomy 18. Which nursing diagnosis would the nurse identify as most likely?
a) Ascertain who is the primary caregiver; b) Ask the child who speaks English perfectly what other languages he speaks in the home; c) Interview separately each member of the family
A new mother who is single is sharing her concerns about the cost of daycare with her nurse. She is new to the area. The nurse recognizes that which of the following trends are likely contributing to this patient's concerns? Select all that apply.
Helping parents access the area's multidisciplinary cystic fibrosis clinic
When providing care to a child, which aspect would be most important for the nurse to consider related to informed consent?
The nurse is caring for a 5-year-old girl with meningitis. Which of the following may be considered ethical behavior?
. The nurse is trying to get consent to care for an 11-year-old boy with diabetic ketoacidosis. His parents are out of town on vacation, and the child is staying with a neighbor. Which action would be the priority?
A nurse is faced with an ethical conflict involving the care of a child. The child's parents disagree with the physician about the use of a feeding tube. The nurse sees the benefits and limitations of both parties' views. Which of the following would be most appropriate?
The nurse is providing care for a 9-year-old girl who is medically fragile. Which of the following is an example of the nursing role of collaboration?
A terminally ill 15-year-old tells the nurse that she wants to stop all treatments and go home despite her parents' directives to provide extraordinary means to keep their child alive. What is the best resource available to this nurse to help solve this dilemma?
An institutional ethics committee
5 to 14 years
A nurse has educated a group of nursing students about the issue of informed consent. Which of the following, if identified by the student, would indicate an understanding of a violation of informed consent?
The school nurse is preparing a nursing care plan for a 2-year-old child with hearing impairment. Which of the following interventions will be part of the plan?
Assess the child's ability to convey information
When you examine a toddler, you suggest to his mother that the activity that could most appropriately foster his developmental task according to Erikson would be to do which of the following?
allow him to pull a talking-duck toy
Based on the principles of growth and development, which of the following assessment findings would lead you to determine that a child is developing normally?
He can throw a large but not a small ball.
Which observation by the nurse indicates that an adolescent's cognitive thinking is developing at an expected level?
A school-aged child always follows the rules and obeys traffic lights when crossing the street. Based on Kohlberg's theory, what type of development is being demonstrated?
Using Erikson's theory, a nurse asks a young adult questions about family, friends, and support systems. Why is this important during assessments of adolescents?
Fear of commitments may lead to loneliness and isolation.
The child should continue to be closely monitored.
A father discusses with the nurse how his daughter, who recently started first grade, is extremely conscientious about her school work and is constantly asking her teachers if she is doing the work correctly. According to Erikson, which of the following developmental tasks is this girl currently learning?
A nurse has moved into a new community and will begin practicing at the local health department. Why is it important for this nurse to become familiar with the community where he or she will work?
The health of a community influences the health of its individuals.
A 2 year old wants to feed herself and becomes agitated when the nurse attempts to feed her. What does the nurse understand is the developmental age of this child according to Erikson?
A 2 year old wants to feed herself and becomes agitated when the nurse attempts to feed her. What does the nurse understand is the developmental age of this child according to Erikson?
The school nurse is discussing the effects of childhood obesity with the mother of a 9-year-old boy who is obese. Which of the following potential effects on the boy's health should the nurse mention to the mother? Select all that apply.
a) Slower development of motor skills; b) Risk for diabetes; c) Lack of a strong and supportive group of friends; d) Depression
. A 15-year-old patient with type 1 diabetes has been noncompliant with his dietary regimen. When educating the teen, what is the most important thing for the school nurse to do to allow the teen to be in control and involved in the decision-making process?
Speak directly to the teen and consider his input in the decisions about care and education.
A nursing student correctly identifies which of the following to be influences on a child's growth and development? Select all that apply.
a) mother's behaviors during the pregnancy; b) mother's general health during the pregnancy; c) mother's nutrition during the pregnancy; d) genetics
After a child plays in the yard, his mother asks him to pick up his toys and put them in the toy bin in the garage. Knowing that he does not want to spend time in his room as a punishment, the child follows his mother's directions. What stage of moral development, according to Kohlberg, is this child demonstrating?
The community health nurse is teaching the parents of a 12-year-old boy about appropriate approaches when raising an adolescent. Which of the following comments should be included in the discussion?
According to Sigmund Freud’s theory of development, which of the following infants is most likely to be experiencing a significant conflict in his or her development?
A nurse is performing a community assessment to determine health care needs. How would the nurse determine if clients can adhere to scheduled visits with the health care provider?
Determine if public transportation is available.
A 10-year-old boy tells his mother that he is going to be just like his father when he grows up. According to Freud, what stage of development is this child experiencing?
A breastfeeding infant will gaze intently into his or her mother's eyes, grasp her finger, and smell and taste the milk. This use of the senses is attributed to a phase of development that is part of which theory?
Which of the following should a nurse do to avoid disrupting a family routine when visiting to provide home care?
A father brings his 2-year-old son in for a well visit, and the nurse asks him how potty training is going with the child. The father says, "Oh, we are pretty laid back about it. We believe he'll learn in time and that it's not healthy to make too big a deal about it." The nurse recognizes that this attitude is most in line with which of the following theories of development?
What should be the first step for the school nurse when developing a teaching plan for a 9 year old who needs education about a gluten-free diet for the treatment of celiac disease?
Assessing the child's current level of understanding
A married couple has 3-year-old twins. They own a dog. The father's mother lives with them. The father is a professor; the mother has resigned from her position as a legal secretary to be the children's primary caregiver. Which type of family does this represent?
Inclusion of the entire family in health care planning and provision
A 2 year old with pneumonia has recently been hospitalized. When the lunch tray arrives to the floor, the nurse caring for the patient sets up the tray and allows the child to self-feed with a spoon despite the mess. What is the nurse's best reason for these actions?
to foster autonomy
The child has learned to crawl and walk, and later throws a ball and knows the names of colors. Which principle of growth and development is the child demonstrating?
When giving directions on safety protection of a toddler's intravenous site, the nurse should do which of the following?
A 6 year old who does not speak English is on bed rest at home and being seen by a home health nurse who speaks only English. The child's mother informs the nurse that her son is very bored, which makes it hard to keep him in bed. What could the nurse do for this patient?
You evaluate a family to see if they are a good candidate for home care. Which of the following factors would be most important to see in their home or family?
A parent is comparing a child's development on the growth chart with those of another child and is concerned that her child is not in the "normal" range. Which of the following is an appropriate answer for the nurse to inform the parent in an effort to alleviate her anxiety?
The parents bring their 4-year-old son to the emergency department. The child is receiving chemotherapy for acute lymphoblastic leukemia. The parents report that the child has become lethargic and has had significant episodes of vomiting and diarrhea. The nurse suspects the child may be experiencing tumor lysis syndrome based on which of the following? Select all that apply.
A 4 year old is in the hospital playroom with the nurse playing a game. The child informs the nurse that he has to know the rules of the game so that no one cheats. What stage of development, according to Erikson, does the nurse recognize in this child?
Initiative versus guilt
A home health nurse is visiting an infant after discharge from the hospital. The nurse observes the mother inserting a mercury rectal thermometer to assess the child's temperature. What should the nurse caution the parent about with the use of the thermometer?
If the family will be using a thermometer, it can release toxic mercury if it breaks. The thermometer should not be used with children younger than 5 years.
Like many 4 year olds, Ethan is constantly seeking out and exploring new experiences and repeatedly asking his parents why-type questions. Ethan’s behavior suggests that he is successfully navigating an important developmental task within the developmental theory of which of the following?
An 8-year-old boy is looking at his father's razor and shaving cream in the bathroom medicine cabinet. He watches his father shave daily and asks his father when he will need to start shaving. This child is demonstrating characteristics common during which of Freud's psychoanalytic developmental stages?
A community health nurse is caring for a terminally ill and hospitalized 7 year old who wishes to go home. What type of referral can this nurse make so that the child can receive care at home?
A 10-year-old girl is excited when she receives the "most improved player" award on her softball team. Although she was not the strongest player on the team, she always tried to perform at her best level and never gave up on practicing her skills. What stage of psychosocial development according to Erik Erikson is this child demonstrating?
A 6-year-old boy e recently drew on the walls of his room. As punishment, his mother told him that he had to clean the walls by dinnertime. Although he agreed that he would do it and she showed him how and provided cleaning materials, he had not even started the job when the deadline arrived. What aspect of child development would explain this?
A child demonstrates increasing language skills and an understanding of symbols. Creative play and the use of imagination is an important activity in the child's life. Based upon these characteristics, what stage of cognitive development according to Jean Piaget's theory is the child demonstrating?
The home health nurse is visiting a 7 year old who had a heart transplant. The parent says to the nurse, "I have been trying not to give him his pain medication too much but when I do give it, it doesn't seem to help." What is the best response by the nurse?
"If he requires pain medication, it would be best to give it to him before the pain becomes intense to allow better control of the pain."
The school nurse is planning to teach a segment on smoking during the freshman health classes. The nurse is aware that this needs to be a forum rather than a lecture. Which of the following techniques will also help deliver a “don't smoke” message?
An 8 month old hospitalized with bronchiolitis is crying in the crib because it is time for a feeding. The parent caring for the child has left the room to eat lunch. If the needs of the child are not met, what phase of the developmental stage will not be achieved according to Erikson?
Which of the following can have an influence over the individual's physiological growth and development trajectory?
When a pediatric patient is cared for in the home, the culture of the family must be assessed to determine which of the following?
Which family members will provide care
The best way for an infant's father to help his child complete the developmental task of the first year is to do which of the following?
The nurse is assessing the psychosocial development of a preschooler. Which of the following are normal activities characteristic of the preschooler? Select all that apply.
In working with the toddler-age child, the nurse recognizes which of the following as a characteristic of the toddler?
The child insists they can “do it,” and the next moment they revert to being dependent
The nurse is assessing a 4-month-old boy during a scheduled visit. Which of the following findings might suggest a developmental problem?
The child does not babble or laugh
a) Uses 4 to 6 words when speaking; b) Scribbles with a crayon
Recently, 5-year-old Jack's father was injured in a motorcycle accident. The father confides to the school nurse that he is concerned about Jack. When questioned further, he tells the nurse that Jack is not acting like he was before the accident. He says he keeps telling Jack he is a good boy; indeed Jack is not testing or challenging his boundaries like he was before the accident. Which of the following best describes the reason for the behavior Jack's father is seeing?
Jack wanted to go with his father on the motorcycle ride. When he was told he couldn't go he told his father he hoped he would crash, so Jack believes he caused the accident.
The nurse is teaching the parents of a 2-year-old toddler methods of dealing with their child's "negativism." Based on Erickson's theory of development, which of the following would be an appropriate intervention for this child?
Reward the child for initiative in order to build self-esteem.
The nurse is talking with a group of caregivers of 3-year-old children. One of the parents asks what an appropriate amount of time would be to have the 3-year-old who is being uncooperative and is out of control to sit alone in a “time out” space? The nurse would suggest that an appropriate amount of time would be which of the following?
Which of the following milestones would you expect an infant to accomplish by 8 months of age?
The nurse is providing discharge education on newborn care at home. The nurse provides instructions that infants need to be placed on their back to sleep. What is the nurse reducing the risk for with this education?
A preschooler's mother is pregnant. She wants to start her preschooler in a child-care program and asks you when would be a good time to do so. You would suggest which of the following?
Three months before the baby is born, after the mother stresses that he is growing up.
a) Around 3 months the infant will mimic the parent's facial movements, such as sticking out the tongue; b) Around 3 months the infant smiles widely and gurgles when interacting with the caregiver; c) Around 3 months the infant will mimic the parent's facial movements, such as widening the eyes; d) Around 2 months the infant exhibits a first real smile.
Which of the following is NOT a cause of jaundice in the newborn?
A mother brings her 3-year-old daughter in for a sick visit for the third time this year. The child, who attends a preschool program, continues to develop upper respiratory infections. The mother is frustrated with the situation and asks the nurse for advice. Which of the following would be the best recommendation for the nurse to give to the mother in this situation?
A nurse is assessing a preschooler and asks the child a question about pets. The child responds by saying, "I-I-I have a t-t-turtle and a f-f-fish." The child's mother states that this problem just started over the past month or so. The nurse interprets this as which of the following?
. A mother of a 4 year old tells the nurse that she is worried about the child. She says that the boy used to play well with others, but lately when she invites two others over for a play date, all they do is argue. What should the nurse tell this mother?
The nurse is assessing a 12-month-old boy with an English-speaking father and a Spanish-speaking mother. The boy does not say mama or dada yet. Which of the following is the priority intervention?
When checking a 5-month-old infant, which symptom would alert the nurse that the infant needs further follow-up?
Presence of Moro embrace reflex
The nurse is providing anticipatory guidance to a mother to help promote healthy sleep for her 3-week-old baby. Which of the following recommended guidelines might be included in the teaching plan?
Place the baby on his or her back when sleeping.
While performing a physical assessment of a newborn boy, the nurse notes diffuse edema of the soft tissues of his scalp that crosses suture lines. The nurse documents this finding as which of the following?
The pediatric nurse is planning quiet activities for hospitalized 18-month-old. Which of the following would be an appropriate activity for this age group?
a) The child demonstrates egocentricity; b) The child has a limited concept of time; c) The child has an imaginary playmate
. Nursing students are reviewing developmental milestones for toddlers. To demonstrate that you have an understanding select all the milestones that toddlers exhibit between the ages of 15 months to 30 months of age. Select all that apply.
a) Name one color; b) Engage in parallel play; c) Creep up stairs; d) Name one body part; e) Run and jump in place
A mother is discussing with the nurse a recent story in the local news about a child being abducted. She is concerned about the safety of her preschool child and wonders what she should tell her child to keep her safe but without frightening her. Which of the following would be the best recommendation for the nurse to give the mother in this case?
Explain in a calm and everyday manner how the child should stay away from strangers in cars
The nurse is discussing the topic of weaning infants with a group of mothers of infants. Which of the following statements made by the nurse is most appropriate related to weaning an infant?
“It is important to let the infant set the pace for weaning, no matter what age they are.”
“This can be from the sudden withdrawal of you hormones. It is not a cause of alarm.”
A nurse is teaching the parents of a toddler how to promote nutrition. Which suggestion would be most helpful? Select all that apply.
: a) "Don't be alarmed if the child wants to eat the same food repeatedly."; b) "Start with a small amount of food on the plate at a time."; c) "Try to use colorful foods on the plate."
The nurse places a newborn with jaundice under the phototherapy lights in the nursery to achieve which goal?
Decrease the serum bilirubin level
The nurse strokes the lateral sole of the newborn's foot from the heel to the ball of the foot when evaluating which reflex?
Baby Tarik has been circumcised, his temperature is stable, his breathing and heart rate are healthy, and he is ready to be discharged from the hospital. What can the nurse tell his parents to check for
Redness at the base of the umbilical cord
Which of the following developmental milestones are appropriate for the infant? Select all that apply
a) Stop activity in response to spoken word; b) Recognizes name when spoken; c) Pincer grasp is refined
A jittery, irritable newborn with a high-pitched cry
A nurse tests the gross motor development of a 2-month-old boy by holding the infant in the ventral suspension position. Which of the following should she expect to see if the infant is developing normally?
The nurse is performing a cognitive assessment of a 2-year-old. Which of the following behaviors would alert the nurse to a developmental delay in this area?
The child does not point to named body parts.
The nurse caring for children on a pediatric oncology care area delays entering some of the children's rooms unless to provide medication or perform a procedure. Which stage of the grieving process is influencing this nurse's ability to provide patient care?
A 17-year-old writes a suicide note and then swallows aspirin. Which of the following factors would make you think that he might do this again?
A nurse is talking with a 9 year old about a procedure that will be done in the morning. The child is expressing fear. What listening skills does the nurse exhibit that makes it clear the nurse is actively listening? Select all that apply.
a) Sitting at the level of the child; b) Maintaining eye contact while the child is talking; c) Nodding in response to comments the child makes
"Honey" can cause children to worry that they have been confused with another child.
When caring for a 4-year-old confined to bed, which of the following play experiences would you plan as being most age appropriate for her?
The nurse is caring for a 2-year-old boy who has been admitted to the hospital. Which of the following should she do to ensure a safe environment for this child?
Check that side rails of the boy's crib are in good repair and raised
The adolescent faces many different decisions during the teen years concerning the future and the adult world.
The mother of a 6-year-old girl tells the nurse she is very concerned that her daughter develops good self-esteem. Which of the following comments provides the most effective advice?
A father brings his 6-year-old son in to the doctor's office. He says his son just began first grade a week ago has refused to go to school, complaining of stomach cramps and nausea. After the nurse examines the boy and finds nothing wrong, the father asks how he should handle the problem. Which of the following should the nurse recommend?
The nurse notices that the 6-year-old sibling of a hospitalized child has a runny nose and is coughing. What action should be taken by the nurse?
The mother of a 15-year-old boy confides in the nurse that she is concerned because her son is about to turn 16 and is pressuring her and her husband to buy him a motorcycle. Her husband is okay with the idea, but she is concerned about his safety. Which of the following should the nurse mention to the mother regarding motorcycle safety? Select all that apply.
a) Require the son to wear long pants; b) Require the son to wear a helmet; c) Require the son to learn all relevant safety rules
The nurse is observing a group of 8-year-olds who are being taught the concept of conservation of weight. Which of the following activities would best help these children understand this concept?
Weighing a pound of oranges and a pound of bricks and counting how many of each make a pound.
A 5-year-old is scheduled to have surgery to remove a brain tumor. Which of the following interventions should the nurse recommend to the parents to help prepare the child for the surgery? Select all that apply.
a) Purchase and read to the child a children's book about hospitalization; b) Have the child act out a hospitalization experience with puppets; c) Explain to the child that he will have to use a bedpan to go potty in, if this is the case; d) Bring the child's favorite blanket to the hospital
A 6-year-old boy is scheduled to have surgery to repair a congenital defect in his heart in about a week. The parents tell the nurse that they are nervous about telling him about the surgery in advance because they fear that he will just worry about it. On the other hand, they also feel that they should prepare him mentally for the surgery. Which of the following should the nurse recommend to the parents?
“Tell him about the surgery about 6 days ahead of time so that he knows what to expect; at his age that would be best."
The school nurse is preparing a program on sexuality and birth control for a class of 14- to 16-year-olds. Which of the following behaviors will have the most influence on how the information is presented?
Adolescents tend to take risks.
The nurse is discussing the topic of psychosocial development with a group of caregivers of school-age children. Which of the following statements made by the caregivers is most appropriate related to the development of self-confidence in this age child?
“If my husband and I have consistent rules and expectations, he will be confident.”
The nurse knows that the school-age child is in Erikson's stage of industry versus inferiority. Which of the following is the best example of a school-ager working toward accomplishing this developmental task?
The child signs up for after-school activities.
A nurse is caring for a young patient with pneumonia who has slight nausea and does not feel like eating. The patient is drinking plenty of fluids. The child's mother says that she is worried and wants the nurse to make the child eat. What is the best action at this time by the nurse?
Do not force the child to eat.
A nurse is preparing a 6-year-old boy for an emergency appendectomy. The boy is in great pain but is also concerned about the operation he will be undergoing. Which of the following would be the best way for her to explain this surgery to him?
"We are going to fix the part that hurts down there so that it doesn't hurt anymore."
Painting pictures in the art corner of the room.
An 8-month-old will be hospitalized for surgery. Which preparation by her parents would be most important?
Pack her favorite toy.
In working with the school-age child, the nurse recognizes which of the following as a characteristic of the school-age child?
What benefits does effective therapeutic communication have in the nurse-patient relationship?
The mother of a 14-year-old girl complains to the nurse that her daughter is moody, shuts herself in her room, and fights with her younger sister. Which of the following comments is most valuable to the mother?
"Your blood pressure reading should be 120/80. Let's talk about some of the things, such as diet and exercise, that can be done to lower the reading and your risk factors for high blood pressure."
The nurse is working with the parents of an 8-year-old child who is identified as having a difficult temperament. Which of the following would be most helpful for the nurse to suggest to the parents? Select all that apply.
a) Staying objective in emotional situations; b) Learning how to deal with high-risk situations
Be certain the parents are present during the admission assessment.
A school-aged child's parents are very upset about having to leave her alone in the hospital. How would you respond to their concern?
A nurse is caring for an infant who has been admitted the hospital for surgery. Which of the following interventions should the nurse implement to ensure the continued growth and development of the infant during his stay?
Provide a singular room for the child and family in the neonatal intensive care unit
While conducting a health assessment of a 13-year-old girl, the mother tells the nurse that her daughter has difficulty falling asleep at night. Which avenue of questioning should the nurse first pursue?
I used to love playing board games with my son. Now that just makes me feel sad.”
A 6 year old says to the nurse, "I am worried that my mom and dad won't be here before I have to have a shot." What statement by the nurse demonstrates reflecting?
Get two more name bands and place one on the infant's arm and the other on the infant's leg.
The parents of a school-aged child with school phobia have taken her to three different psychiatrists trying to resolve this problem. Based on this, which of the following nursing diagnoses would be most appropriate?
The mother of a child newly diagnosed with mental retardation tells the nurse that her partner disagrees with the diagnosis and believes that the child is perfectly normal. The mother shares with the nurse that she finds this reaction frustrating and confusing. Which of the following would be appropriate in supporting this mother? The nurse should do which of the following?
Reassure the mother that her partner's reaction is a normal stage in the grieving process
A parent of a newly diagnosed terminally ill child states, “This cannot be true, not my child.” Which is the most appropriate response by the nurse?
Provide nonjudgmental support to the family
Increased shoulder, chest, and hip widths
The nurse is caring for a patient in an acute care setting whose family do not believe in germs and are frequently seen changing diapers without gloves and neglecting to wash their hands afterwards. Which of the following is the best action for the nurse to take?
To be an effective nurse with a child who is dying, it is first necessary to do which of the following?
identify your own reactions and feelings about death.
The nurse is preparing a 4-year-old patient for surgery. According to unit policy, the surgical site must be marked prior to entering the operating room. The patient shies away from the nurse when approached with a black marker. Which of the following is the best approach to take?
The nurse is talking with a chatty 7-year-old girl during her regular check-up. Which of the following behaviors would the child also be expected to exhibit?
Which of the following would be most appropriate for the nurse to do when assisting parents who have experienced the loss of their preterm newborn?
During therapeutic play, a 4-year-old child draws a girl with a head and body but no arms and only one leg. Your best action in response to this would be to which of the following?
The nurse hears wheezing when auscultating a 4-year-old. Which of the following conditions would the nurse most likely rule out based on the assessment findings?
"Children should not be given morphine, because they are at risk for respiratory depression."
The nurse is reinforcing teaching with a child who has cystic fibrosis regarding the medications she takes and how to properly take them. The nurse recognizes that many medications used on a daily basis for the treatment of cystic fibrosis are given by which of the following methods?
The nurse is caring for a young child in the hospital who is receiving IV therapy. Part of the routine care for this child will involve monitoring the IV site as frequently as every hour. The nurse will assess the IV for which of the following? Select all that apply.
a) Induration at the IV site; b) The IV flow rate; c) Swelling at the IV site; d) Moisture at the IV site
The nurse has applied EMLA cream as ordered. How does the nurse assess that the cream has achieved its purpose?
Lightly tap the area where the cream is.
What is the appropriate care of the nurse for Brad, a 6-month-old infant, after an apneic episode?
Place on a cardiopulmonary monitor with pulse oximetry and do frequent assessments.
The nurse is preparing to perform a physical examination of a child with asthma. Which of the following techniques would the nurse be least likely to perform?
A nurse is instructing the parents of a toddler on the use of an anesthetic cream in advance of an upcoming procedure the child will have. Which of the following should the nurse mention to them?
Be careful not to let your son remove the dressing, as the cream can cause damage to his eyes if he rubs them
A 3-year-old boy has developed otitis media and requires antibiotics. In order to increase the chance that the boy will take his prescribed medication, the nurse should do which of the following?
“Bring the child to the emergency room immediately.”
The nurse is caring for a child who is experiencing pain related to chemotherapy treatment. Which of the following is a behavioral factor that might affect the child's pain experience?
While interviewing a mother about her infant son's illness, the nurse asks, "Why did you bring Clark to the clinic today, Ms. Donovan?" Which part of the health interview is this nurse currently in?
The danger of fluid overload developing is a potential problem in the infant receiving an intravenous infusion. For which of the following would you observe?
The nurse is teaching the student nurse about abnormal findings when assessing the breasts of children. Which of the following may be associated with renal disorders?
The nurse working in pediatrics is aware of the special needs of children related to pain assessment. Which of the following is the highest priority for the nurse to consider when completing a pain assessment?
A child who is undergoing bone marrow aspiration has received conscious sedation. This type of pain management is appropriate for which other procedures? Select all that apply.
a) Wound care; b) Dental extractions; c) Magnetic resonance imaging; d) Endoscopy
To assess for abnormal eye alignment, you would observe a child while you are doing which of the following?
To assess for abnormal eye alignment, you would observe a child while you are doing which of the following?
The nurse is assessing the heart rate of a healthy 13-month-old child. The nurse knows to auscultate which of the following sites to obtain an accurate assessment?
A nurse is preparing a presentation for parents about common childhood infectious diseases. Which of the following would the nurse include as being caused by a tick bite? Select all that apply.
A nurse who works in a pediatric office knows that the American Academy of Pediatrics recommends "age-appropriate" physical examinations. In the case of an infant, which of the following is correct?
The infant should be totally unclothed.
The nurse is assessing a 7-year-old boy with pharyngitis. The nurse would least likely expect to assess which of the following?
Working hard to breathe
. A nurse is performing a physical assessment on a child who is undergoing an asthma attack. Which of the following would the nurse most likely observe?
The nurse is counseling the parents of a 9-year-old boy who is receiving morphine for postoperative pain. Which of the following statements from the nurse accurately reflects the pain experience in children?
The nurse is performing a respiratory assessment on an African-American adolescent experiencing a sickle-cell crisis. Where is the best place for the nurse to check for cyanosis on this patient?
A young boy is in the emergency department with swelling and pain in the right ankle. He states that he was playing soccer, somehow twisted the ankle, and could not walk off the field. The physician tells the patient that it is only a bad sprain. Which type of pain is this patient experiencing?
The nurse is caring for Jessie, a 3-year-old child admitted with pneumonia. The physician has ordered clarithromycin to be administered. The drug guide the nurse is using for a reference lists only the recommended adult dose. What should the nurse do to ensure that the proper dose of the medication is given to Jessie?
Calculate the drug dosage based on Jessie's BSA.
A nurse is administering a liquid oral medication to a 5-month-old girl. Which of the following should the nurse do in this situation? Select all that apply.
a) Administer the medicine such that it flows slowly into the child's mouth; b) Use a medicine dropper; c) Gently restrain the child's arms and head; d) Hold and comfort the infant after administration
A nurse is explaining to the parents of a 6-year-old child suffering from angina why nitroglycerin patches for chest pain would not be appropriate. Which of the following will the nurse include in an explanation?
. A newborn exhibits signs of respiratory distress shortly after birth. The nurse, suspecting the cause of the problem holds the newborn's mouth closed and then gently compresses first one nostril and then the other. When she compresses the second nostril, she notes that the newborn struggles from air hunger. Which disorder should the nurse suspect in this client?
A nurse conducted a health history with a 5 year old admitted with abdominal pain. The nurse stood at the bedside while talking to the mother and child. The patient was in a private room. The nurse made sure the door was closed and referred to the mother as "Mrs. Smith" whenever asking a question. Which of the following actions by the nurse was not conducive to the health history?
Standing at the bedside
The nurse is questioning the parents of a 2-year-old child to obtain a functional history. Which of the following topics might the nurse include? Select all answers that apply.
a) Use of supplements and vitamins; b) Use of car seats and other safety measures; c) The child's toileting habits
You see a 3-year-old boy in an ambulatory setting for localized wheezing on auscultation. Which statement by his mother would be most important to report?
The child was eating peanuts yesterday.
• Lumens are very large to accommodate the hemodialysis procedure or a pheresis procedure that harvests specific blood cells.
• This catheter should not be used for administration of other fluids or medications, except in an emergency.
- one end inserted in an artery and one inserted in a vein so that it loops
- high infection risk!!!
The toddler with a cancer diagnosis is seen for a well-child checkup. Which health maintenance activity will the nurse exclude?
Administering the measles, mumps, rubella (MMR) vaccine
The nurse recognizes that which of the following would be a likely physiologic cause for a child to have enuresis?
Sleeping too soundly
The nurse is conducting a physical examination of a child with suspected Crohn disease. Which of the following findings would be the most highly suspicious of Crohn disease?
Parents ask why their child is receiving prednisone to treat leukemia, because it is not a chemotherapy drug. How should the nurse answer?
“Prednisone interferes with white blood cell production.”
Which intervention is best to use with the 6-year-old who has developed stomatitis as a side effect of chemotherapy?
. The nurse is educating the parents of a 4-year-old boy with a Wilms tumor who is about to have chemotherapy prior to surgery. Which statement by the parents indicates that the nurse should review the instructions about preventing infection?
The nurse is caring for a 3-year-old diagnosed with diabetes mellitus. The child's eating patterns are unpredictable. One day the child will eat almost nothing, the next day the child eats everything on her tray. The nurse recognizes that which of the following types of insulin would most likely be used in treating this child?
A 4-year-old has developed acute lymphocytic leukemia (ALL). Nursing care for the child with ALL involves taking axillary, rather than rectal, temperatures because the child has which of the following?
A low platelet count.
a) Painless cervical lymphadenopathy; b) Low-grade fever; c) Bleeding from the oral mucous membranes
The nurse is developing a teaching plan for the mother of a 4-year-old girl with cold and fever. Which of the following would the nurse include in this teaching plan first?
Ensuring fluid intake to prevent dehydration
A 14-year-old boy is diagnosed with Hodgkin disease. When palpating for enlarged lymph nodes, the nurse would expect to find which nodes as most commonly enlarged? Select all that apply.
The nurse is developing a plan of care for a child who is receiving cyclophosphamide. Which of the following would the nurse expect to include?
After teaching the parents of a child diagnosed with celiac disease about nutrition, the nurse determines that the teaching was effective when the parents identify which foods as appropriate for their child? Select all that apply.
The nurse will use a special needle to start intravenous (IV) fluids through which central venous access device?
A preschooler who received chemotherapy in the pediatric oncology outpatient department 1 week ago now has a temperature of 101.5°F (38.6°C). Which is the most appropriate response by the nurse?
a) Moist skin; b) Nervousness; c) Increased basal metabolic rate; d) Exophthalmos (protruding eyes)
The nurse is caring for a 13-year-old girl with delayed puberty. When developing the plan of care for this child, which of the following would be the priority?