ATI RN NURSING CARE OF CHILDREN ONLINE PRACTICE B

A nurse is assessing a 4-year-old child at a well-child visit. Which of the following developmental milestones should the nurse expect to observe? a. Identifies right from left hand b. Uses a utensil to spread butter c. Cuts a shape using scissors d. Draws a stick figure with seven body parts c. Cuts a shape using scissors A- Identifying the right from left hand is an expected developmental milestone of a 6-yearold child. B- Using a utensil to spread butter is an expected developmental milestone of a 6-year-old child. D- Drawing a stick figure with seven body parts is an expected developmental milestone of a 5-year-old child. A school nurse is preparing to administer atomoxetine 1.2 mg/kg/day PO to a schoolage child who weighs 75lb. Available is atomexetine 40 mg/capsule. How many capsules should the nurse administer per day? 1 A nurse in the emergency department is assessing a toddler who has Kawasaki disease. Which of the following findings should the nurse expect? (select all that apply.) a. Increased temperature b. Gingival hyperplasia c. Xerophthalmia d. Bradycardia e. Cervical lymphadenopathy Answer- a,c,e Increased temperature is correct. Kawasaki disease is an acute illness associated with a fever lasting more than 4 days that is unresponsive to antipyretics or antibiotics. Gingival hyperplasia is incorrect. Children who have Kawasaki disease develop a strawberry tongue, cracked lips, and edema of the oral mucosa and pharynx. A child who is receiving phenytoin therapy can develop gingival hyperplasia. Xerophthalmia is correct. Ophthalmic manifestations of Kawasaki disease include reddening of the conjunctiva and dryness of the eyes, or xerophthalmia. Bradycardia is incorrect. Kawasaki disease is an infection that affects the vascular system, including the heart. The nurse should expect the child to be tachycardic with a gallop rhythm. Long term effects of Kawasaki disease include the development of coronary artery aneurysms or myocardial infarction. Cervical lymphadenopathy is correct. The child who has Kawasaki disease may develop enlarged cervical nodes on one side of the neck that are nontender and greater than 1.5 cm in size. A nurse is teaching a school-age child who has a new diagnosis of type 1 diabetes MELITIS. The nurse should identify which of the following statements by the child as understanding the teaching? a. I will puncture the pad of my finger when I am testing my blood glucose." b. "I will give myself a shot of regular insulin 30 minutes before I eat breakfast." c. "I will eat a snack of 5 grams of carbohydrates if my blood glucose is low." d. "I will decrease the amount of fluids I drink when I am sick." Answer- b. "I will give myself a shot of regular insulin 30 minutes before I eat breakfast." The child should administer regular insulin 30 min before meals so that the onset coincides with food intake. A- The child should avoid puncturing the pads of the fingers because they have fewer blood vessels and more nerve fibers. Instead, the child should puncture the skin to either side of the finger pad to promote blood flow and decrease pain. C- The child should eat a snack of 15 g of carbohydrates, such as 120 mL (4 oz) of fruit juice or 66 g (1/2 cup) of ice cream, to rapidly increase a mild hypoglycemic reaction. D- During acute illness the child is prone to hyperglycemia and ketonuria and is at risk for dehydration. Therefore, the child's fluid intake should increase rather than decrease. A school nurse is assessing an adolescent who has scoliosis. Which of the following findings should the nurse expect? a. Increase in anterior convexity of the lumbar spine b. Increased curvature of the thoracic spine c. Lateral flexion of the neck d. A unilateral rib hump Answer- d. A unilateral rib hump When assessing an adolescent for scoliosis, the school nurse should expect to see a unilateral rib hump with hip flexion. This results from a lateral S- or C-shaped curvature to the thoracic spine resulting in asymmetry of the ribs, shoulders, hips, or pelvis. Scoliosis can be the result of a neuromuscular or connective tissue disorder, or it can be congenital in nature. A- An increased anterior convexity of the lumbar spine is a manifestation of lordosis. An expected finding in toddlers, lordosis can indicate a complication of a disease process, such as flexion contractures, congenital dislocation of the hip, or obesity, when seen in older children. B- An increased curvature of the thoracic spine is a manifestation of kyphosis. Kyphosis can be a manifestation of a congenital condition or disease process such as rickets, or it can be posture-related. In posture-related kyphosis, the adolescent presents with rounded shoulders and a slouching posture. C- Lateral flexion of the neck is an indication of torticollis as a result of contracture of the sternocleidomastoid muscle. Torticollis can be congenital, the result of intrauterine fetal posturing or abnormality of the cervical spine, or it can be acquired, due to such factors as a traumatic lesion to the sternocleidomastoid muscle. A nurse is reviewing the lumbar puncture results of a school-age child suspected of having bacterial meningitis. Which of the following results should the nurse identify as a finding associated with bacterial meningitis? a. Decreased cerebrospinal fluid pressure b. Decreased WBC count c. Increased protein concentration d. Increased glucose level Answer- c. Increased protein concentration. The nurse should recognize that an increased protein concentration in the spinal fluid is a finding associated with bacterial meningitis. A- Increased cerebrospinal fluid pressure is a finding associated with bacterial meningitis. B- An increased WBC count in the spinal fluid is a finding associated with bacterial meningitis. D- A decreased glucose level in the spinal fluid is a finding associated with bacterial meningitis. A nurse is planning care for a preschooler who has cystic fibrosis. Which of the following interventions should the nurse include in the plan? a. Administer pancreatic enzymes 2 hr after meals. b. Decrease pancreatic enzymes if steatorrhea develops. c. Limit fluid intake to 750 mL per day. d. Increase fat content in the child's diet to 40% of total calories. Answer - d. Increase fat content in the child's diet to 40% of total calories. A child who has cystic fibrosis is unable to properly digest fats due to fibrosis of the pancreas and limited secretion of pancreatic enzymes. The nurse should increase the child's fat intake to equal 40% of total caloric intake. A- The nurse should plan to administer pancreatic enzymes within 30 min of meals and snacks. B- A child who has cystic fibrosis and develops steatorrhea, or fatty stools, needs to increase the intake of pancreatic enzymes. C- The nurse should encourage fluid intake, rather than restrict it, to prevent dehydration caused by the loss of sodium and chloride through perspiration. A nurse is assessing a toddler who has gastroenteritis and is exhibiting manifestations of dehydration. Which of the following findings should the nurse address first? a. Skin breakdown b. Hypotension c. Hyperpyrexia d. Tachypnea Answer- d. Tachypnea. When using the airway, breathing, circulation approach to client care, the first finding the nurse should address is the toddler's tachypnea, which results when the kidneys are unable to excrete hydrogen ions and produce bicarbonate leading to metabolic acidosis. A- Toddlers who have gastroenteritis and are dehydrated are at increased risk for skin breakdown because of changes in circulation and loss of skin elasticity. However, the nurse should address another finding first. B- Toddlers who have gastroenteritis and are dehydrated may exhibit hypotension because of reduced blood volume. However, the nurse should address another finding first. C- Toddlers who have gastroenteritis and are dehydrated may exhibit hyperpyrexia, or fever, which is caused by the effect of fluid volume depletion on the hypothalamus. However, the nurse should address another finding first. A nurse is discussing organ donation with the parents of a school-age child who has sustained brain death due to a bicycling accident. Which of the following actions should the nurse take first? a. Inform the parents that written consent is required prior to organ donation. b. Provide written information to the parents about organ donation. c. Ask the provider to explain misconceptions of organ donation to the parents. d. Explore the parents' feelings and wishes regarding organ donation. Answer- d. Explore the parents' feelings and wishes regarding organ donation. The first action the nurse should take when using the nursing process is assessment. Exploring the parents' feelings and wishes regarding organ donation will assist the nurse in determining if organ donation is appropriate for this family and should be done prior to taking other actions. A- The nurse should inform the parents that written consent is required prior to organ donation to document that the parents have consented to organ donation and that the provider has addressed any questions or concerns the parents may have. However, there is another action that the nurse should take first. B- The nurse should provide written information to the parents to enhance their understanding about organ donation. However, there is another action that the nurse should take first. C- The nurse should ask the provider to explain misconceptions of organ donation to the parents, because it is important that they have accurate information before making a final decision. However, there is another action that the nurse should take first. A nurse in an emergency department is caring for a school-age child who has appendicitis and rates his abdominal pain 7 on a 0 to 10 scale. Which of the following actions should the nurse take? a. Instill a 500 mL tap water enema. b. Give morphine 0.05mg/kg IV.