ATI RN NURSING CARE OF CHILDREN ONLINE PRACTICE 2016 A 

Teaching the parents of a school-aged child who has a new diagnosis of osteomyelitis of the tibia. The nurse should identify that which of the following statements by the parents indicates an understanding of the teaching? my child will have a cast until healing is complete. My child will receive antibiotics for several weeks. My child can return to playing sports once he is discharged. My child needs to be in contact isolation. Answer: b The nurse should instruct the parent that the child will receive antibiotic therapy for at least 4 weeks. Surgery might be indicated if the antibiotics are not successful. A - incorrect Weight bearing must be avoided with osteomyelitis. Therefore, the child is placed in a comfortable position with the limb supported. There is no indication for a cast. C- incorrect Weight bearing should be avoided to prevent complications and minimize pain. Therefore, it will be several weeks to months before the child can play contact sports. D- incorrect Contact isolation is NOT necessary, because osteomyelitis is not a communicable illness. A nurse is auscultating the lungs of an adolescent who has asthma. The nurse should identify the sound as which of the following? Click the audio button to listen. A- Biots respiration B- Chaney Stokes respiration C- tackypnea D - Bradypnea Answer- c The nurse should identify the sound heard during auscultation as tachypnea, which is a rapid, regular breathing pattern. This breathing pattern often occurs with anxiety, fever, metabolic acidosis, or severe anemia. A- Biot's respirations are periods of apnea alternating with two or three shallow breaths. B- Cheyne-Stokes respirations are periods of apnea alternating with periods of hyperventilation. D- Bradypnea is a slow, regular breathing pattern. A nurse in an emergency department is caring for a school-age child who is experiencing an anaphylactic reaction. Which of the following is the priority action by the nurse? A- Elevate the head of the child's bed B- insert a large-bore IV catheter for the child C- determine the allergen that caused the child's reaction D- administer IM epinephrine to the child Answer- d When using the urgent vs nonurgent approach to client care, the nurse determines that the priority action is administering IM epinephrine to the child. During an anaphylactic reaction, histamine release causes bronchoconstriction and vasodilation. This is an emergency because ultimately it causes decreased blood return to the heart. A- Elevating the head of the child's bed is important to facilitate breathing and circulation. However, it is not the priority action the nurse should take. B- Inserting a large bore IV catheter is important to facilitate administration of IV fluids and medications. However, it is not the priority action the nurse should take. C- Determining the allergen that caused the child's reaction is important to prevent any additional episodes of anaphylaxis. However, it is not the priority action the nurse should take. The nurse is preparing to administer an immunization to a four-year-old child. Which of the following actions should the nurse plan to take? A- Place the child in a prone position for the immunization B- request that the child's caregiver leave the room during the immunization C- administer the immunization using a 24 gauge needle D- inject the immunization slowly after aspirating for 3 seconds Answer - c The nurse should administer an immunization for a 4-year-old child using a 24-gauge needle to minimize the amount of pain experienced by the toddler. A- The nurse should place the child in an upright sitting position for the immunization because this decreases the child's fear and anxiety. B- The nurse should allow the caregiver to stay near the child during the immunization to provide a sense of security and reduce the child's anxiety level. D- The nurse should inject the immunization rapidly and avoid aspiration. These actions decrease the risk of needle displacement and lower the child's fear and anxiety level by decreasing the amount of time it takes to administer the immunization. A nurse is reviewing the laboratory report of an infant who is receiving treatment for severe dehydration. The nurse should identify which of the following laboratory values indicates effectiveness of the current treatment? A- Potassium 2.9 mEq/L B- sodium 140 C- urine specific gravity 1.035 D- BUN 25 mg Answer- b The nurse should identify that a sodium level of 140 mEq/L is within the expected reference range and indicates the current treatment regimen the infant is receiving for dehydration is effective. A- A potassium level of 2.9 mEq/L is below the expected reference range and indicates hypokalemia. C- A urine specific gravity of 1.035 is above the expected reference range and indicates concentrated urine. D- A BUN level of 25 mg/dL is above the expected reference range and indicates the kidneys are not excreting BUN as they should be. The nurse is providing teaching about Social Development to the parents of a preschooler. Which of the following play activities should the nurse recommend for the child? A- Play pat-a-cake B- using a push pull toy C- creating a scrapbook D- playing dress-up Answer - d The nurse should instruct the parents that at the preschool age, play should focus on social, mental, and physical development. Therefore, playing dress-up is a recommended play activity for this child. A- Playing pat-a-cake is a recommended play activity for an infant. B- Using a push pull toy is a recommended play activity for a toddler. C- Creating a scrapbook is a recommended play activity for a school-age child. A nurse is teaching the parents of a newborn about ways to prevent sudden infant death syndrome SIDS. Which of the following instructions should the nurse include? A- Place the infant in a prone position to sleep. B- Allow the infant to sleep on a large pillow. C- User soft mattress in the infant's crib. D- Give the infant a pacifier at bedtime. Answer- d The nurse should inform the parent that protective factors against SIDS include breastfeeding and the use of a pacifier when the infant is sleeping. A- The nurse should instruct the parent to place the infant in a supine position to sleep. Prone and side-lying positions are risk factors for SIDS. B- Placing the infant on a large pillow to sleep can increase the risk of suffocation, asphyxiation, and SIDS. C- The nurse should instruct the parent to use a firm mattress and avoid the use of waterbeds, beanbags, or soft mattresses when placing the infant to bed. The use of a soft mattress in the infant's crib is a risk factor for SIDS and can lead to asphyxiation. A nurse is assessing an infant who has pneumonia. Which of the following findings is the priority for the nurse to report to the provider? A- Nasal flaring B- WBC 11,300 C- diarrhea D- abdominal distension Answer- a When using the airway, breathing, circulation approach to client care, the nurse should place the priority on nasal flaring. Nasal flaring indicates that the infant is experiencing acute respiratory distress. B- The nurse should report a WBC of 11,300/mm3 because it is above the expected reference range and indicates infection. However, another finding is the priority for the nurse to report. C- The nurse should report diarrhea because it is a manifestation of pneumonia in infants and indicates the current treatment is not effective. However, another finding is the priority for the nurse to report. D- The nurse should report abdominal distension because it is a manifestation of pneumonia in infants and indicates the current treatment is not effective. However, another finding is the priority for the nurse to report. A school nurse is assessing a school-age child blood pressure while he is seated in a chair. The child starts to experience a tonic-clonic seizure. Which of the following actions should the nurse take first? A- Clear the immediate area around the child of hazardous objects B- loosen the child restrictive clothing C- assist the child to a side-lying position on the floor D- apply an oxygen mask to the child Answer- c The greatest risk to this child is aspiration, occlusion of the airway, and bodily injury from falling out of the chair. The nurse should ease the child down to floor in a side-lying position immediately. This position enables the child's secretions to drain from the mouth, preventing aspiration, and maintaining a patent airway. A- The nurse should clear the area around the child of hazardous objects. However, this is not the first action the nurse should take. B- The nurse should loosen the child's restrictive clothing. However, this is not the first action the nurse should take. D- The nurse should apply an oxygen mask to the child to prevent hypoxia. However, this is not the first action the nurse should take. A nurse is preparing to administer ibuprofen 5 mg per kg every 6 hours PRN for temperatures above 38.0 degrees Celsius or 100.5 degrees Fahrenheit to an infant who weighs 17.6 lb. The infant has a temperature of 38.4 degrees Celsius or 100 + 1.2 degrees Fahrenheit. Available is ibuprofen liquid 100mg/ 5 ml. how many milliliters should the nurse administer to the infant per dose? Round the answer to the nearest whole number. Use a leading zero if it applies. Answer: 2 mL A nurse is receiving change-of-shift Report on for children. Which of the following children should the nurse assess first? A- A toddler who has a concussion and an episode of forceful vomiting B- an adolescent who has infective endocarditis and reports having a headache C- an adolescent who was placed into Halo traction 1 hour ago and rates his pain at a 6 on a 0- 10 scale D- school-age child who has acute glomerulonephritis and brown colored urine Answer- a When using the urgent vs. nonurgent approach to client care, the nurse should assess this child first. An episode of forceful vomiting is an indication of increased intracranial pressure in a toddler who has a concussion. B- A report of a headache is nonurgent because it is an expected finding for a child who has infective endocarditis; therefore, the nurse should assess another child first. C- A report of moderate pain is nonurgent because it is an expected finding for a child who has a new halo traction device; therefore, the nurse should assess another child first. D- Brown-colored urine is nonurgent because it is an expected finding for a school-age child who has acute glomerulonephritis; therefore, the nurse should assess another child first. A nurse in the emergency department is caring for an adolescent who has severe abdominal pain due to appendicitis. Which of the following locations should the nurse identify as mcburney's point? Answer: a A is correct. The nurse should identify the lower right quadrant of the abdomen between the umbilicus and the anterior iliac crest as the location of McBurney's point. B is incorrect. The nurse should not identify the left lower quadrant as the location of McBurney's point. C is incorrect. The nurse should not identify the right upper quadrant as the location of McBurney's point. A nurse is providing teaching to the family of a school-age child who has juvenile idiopathic arthritis. Which of the following instructions should the nurse include in the teaching? A- Limit the movement of the child large joints. B- Encourage the child to perform independent self care. C- Provide the child with a soft mattress for sleeping. D- Schedule a 2-hour daily nap for the child in the afternoon. Answer- b The nurse should teach the family the importance of encouraging the child to perform independent self-care. This will minimize the child's pain while maximizing mobility. Encouraging and praising the child's efforts for independence will also increase his self-esteem. A- Large joints should be exercised regularly to maintain mobility and strengthen muscles. C- Children who have juvenile idiopathic arthritis should sleep on a firm mattress to enhance comfort and rest. A soft mattress can increase pressure to the affected joints and increase the child's pain. D- Daytime naps are discouraged because stiffness can occur quickly and easily with inactivity, and naps can interfere with nighttime sleeping. A nurse is assessing a client who has a new diagnosis of celiac disease. Which of the following clinical manifestations should the nurse expect? A- Steatorrhea B- projectile vomiting C- sunken abdomen D- weight gain Answer- a The nurse should realize that clients who have celiac disease are unable to digest gluten. This will cause damage to the cells in the bowel, leading to malabsorption, steatorrhea, and diarrhea. B- Clients who have pyloric stenosis will exhibit projectile vomiting rather than celiac disease. C- A distended abdomen, rather than a sunken abdomen, is a manifestation of celiac disease. D- Weight loss, rather than weight gain, is a manifestation of celiac disease. A nurse is providing teaching to an adolescent about how to manage tinea pedis. Which of the following statements by the Adolescent indicates an understanding of the teaching? A- I should buy some plastic shoes to wear at the swimming pool B- I should wear sandals as much as possible C- I should place the permethrin cream between my toes twice-daily D- I should I seal my non washable shoes in plastic bags for a couple of weeks Answer- a The use of plastic shoes increases the occurrence of tinea pedis. The nurse should instruct the adolescent to avoid wearing plastic shoes. B- Sandals allow air to circulate around the feet, decreasing perspiration and eliminating the medium for bacteria and fungus to grow. The nurse should inform the adolescent that wearing sandals, open-toed, or well-ventilated shoes will promote healing of his fungal infection. C- Permethrin 5% cream is a scabicide used to place on the lesions created by scabies. This treatment is not recommended for tinea pedis. D- Sealing non-washable items in plastic bags for 14 days is a recommended practice for clients who have pediculosis. This practice is not recommended for tinea pedis. A nurse at an urgent care clinic is assessing an adolescent client who has an upper respiratory tract infection. Which of the following findings should the nurse recognize as a manifestation of pertussis? A- Inflamed throat with exudate B- purulent eye drainage C- dry, hacking cough D- koplik spots on buccal mucosa Answer- c The nurse should recognize that a dry, hacking cough is a manifestation of pertussis. This disease usually begins with indications of an upper respiratory tract infection, which includes a dry, hacking cough that is sometimes more severe at night. A- An inflamed throat with exudate is a manifestation of acute streptococcal pharyngitis. B- Purulent eye drainage is a manifestation of bacterial conjunctivitis. D- Koplik spots on buccal mucosa are a manifestation of rubeola (measles). A nurse is providing teaching about car seat use to the mother of a six-month-old infant. Which of the following statements by the mother indicates an understanding of the teaching? A- I should secure the car seat using lower anchors and tethers instead of the seat belt B- I should position the car seat harness one inch above my baby's shoulders C- I will make sure that the car seat is placed at a 90 degree angle D- I will pad my baby's car seat with a blanket for traveling long distances Answer- a Lower anchors and tethers, or the LATCH child safety seat system, should be used to secure an infant's car seat in the vehicle. This system provides anchors between the front cushion and the back-rest for the car seat. Therefore, if this system is available, the seatbelt does not have to be used. B- The car seat harness in rear-facing car seats should be positioned at or just below the infant's shoulders. C- The car seat should be positioned at a 45 degree angle to prevent slumping and injury to the infant. D- Padding placed underneath the infant or anywhere in the car seat can compress and/or create space between the infant and the harness. This could increase the risk for injury to the infant and should be avoided. A nurse is assessing the pain level of a three-year-old toddler. Which of the following pain assessment scales should the nurse use? A- FACES Pain rating scale B- numeric pain rating scale C- CRIES pain assessment scale D- non communicating children's pain checklist Answer- a The nurse should use the FACES pain rating scale for pediatric clients who are 3 years old and older. This scale allows the toddler to point to the face that depicts the current level of pain. The nurse can then determine the need for pain management. B- The nurse should use the numeric pain rating scale when assessing the need for pain management in pediatric clients who are 5 years old and older. The nurse should identify that the 3-year-old toddler does not yet possess a concept of numbers and numerical value to effectively use this pain rating scale. C- The nurse should use the CRIES pain assessment scale when assessing the need for pain management in infants. D- The nurse should use the noncommunicating children's pain checklist when assessing the need for pain management in pediatric clients who have a cognitive impairment. A nurse is caring for a preschooler who is scheduled for hydrotherapy treatment for wound debridement following a burn injury. Which of the following actions should the nurse take prior to the procedure? A- Apply topical antimicrobial ointment to the child wound B- place a mesh gauze dressing over the child wound C- administer an analgesic to the child D- initiate prophylactic antibiotic therapy for the child Answer- c Hydrotherapy for debridement of a wound is an extremely painful procedure which requires analgesia and/or sedation. When pain is controlled, it leads to reduced physiological demands on the body caused by stress and decreases the likelihood of children developing depression and post-traumatic stress disorder. A- A nurse should apply topical antimicrobial ointment to the child's wound following hydrotherapy to prevent infection. B- A nurse should apply mesh gauze to the child's wound following hydrotherapy to prevent infection. D- Prophylactic antibiotic therapy is not recommended for children who have burns. A nurse is caring for a 10 year old child following a head injury. Which of the following findings should the nurse identify as an indication that the child is developing diabetes insipidus? A- Urine specific gravity of 1.045 B- sodium 155 C- blood glucose 45 D- urine output 35 ml per hour Answer- b A child who has a head injury can develop diabetes insipidus as a result of pituitary hypofunction leading to a deficiency of antidiuretic hormone. Underexcretion of antidiuretic hormone leads to polyuria and polydipsia and possibly dehydration. With the excessive loss of free water, sodium levels rise above the expected reference range. A- Urine specific gravity of 1.045 is above the expected reference range. A child who has diabetes insipidus is more likely to have diluted urine and urine specific gravity below the expected reference range. C- Blood glucose of 45 mg/dL is below the expected reference range. A child who has diabetes insipidus should have a blood glucose level within the expected reference range. D- Urine output of 35 mL/hr is within the expected reference range. A child who has diabetes insipidus is more likely to have polyuria. A nurse is creating a plan of care for a toddler who has minimal change nephrotic syndrome mcns and 3 + pitting edema. Which of the following interventions should the nurse include in the plan? A- Encourage an increased fluid intake for the toddler B- place the child in an Airborne infection isolation room C- increase the toddler's dietary sodium intake D- administer corticosteroids to the toddler Answer- d The nurse should recognize that corticosteroids are the treatment of choice for providers caring for children who have MCNS. Therefore, the nurse should include administration of prescribed corticosteroids in the plan of care for this toddler. A- Children who have MCNS are on dietary fluid restriction during the edema phase. Therefore, the nurse should not encourage fluid intake for the toddler who has 3+ pitting edema. B- Children who have MCNS do not require isolation precautions. Airborne infection isolation room is used for clients who have airborne infections, such as tuberculosis. C- Children who have MCNS are on a low-sodium diet during the edema phase. Therefore, the nurse should not increase dietary sodium intake for the toddler who has 3+ pitting edema. A nurse is providing discharge teaching to the parent of a school-age child who has moderate persistent asthma. Which of the following instructions should the nurse include? A- You should give your child his salmeterol inhaler every 4 hours when he is having an acute episode of wheezing. B- You should monitor your child's weight weekly while he is receiving inhaled corticosteroid therapy C- pulmonary function test will be performed every 12 to 24 months to evaluate how your child is responding to therapy D- when using the peak expiratory flow meter, record your child average of three readings Answer- c The nurse should inform the parent that her child will need pulmonary function tests every 12 to 24 months to evaluate the presence of lung disease and how the child is responding to the current treatment regimen. As children grow, sometimes their symptoms can improve or decline and treatment needs to change accordingly. A- salmeterol - The nurse should inform the parent that long-acting beta2 agonists are to be used in conjunction with a low or medium dosage inhaled corticosteroid, and never used alone. Using this medication alone on an as-needed basis during an acute asthma attack is dangerous and can lead to worsening of the child's condition. B- The nurse should instruct the parent that the use of inhaled corticosteroids has not been shown to have any negative effects on growth. The provider might monitor the child's growth for systemic absorption; however, it is not necessary for the parent to weigh the child weekly. D- The nurse should instruct the parent to measure the child's airflow using a peak expiratory flow meter. This should be done twice daily with the skill repeated in a sequence of three, waiting 30 seconds between each measurement. The parent should record the highest of the three readings, rather than the average. A nurse is assessing a three-year-old toddler at a well-child visit. Which of the following manifestations should the nurse report to the provider?