Exam 4 NUR 404 | Complete Solutions (Answered)

Exam 4 NUR 404 | Complete Solutions (Answered) A nurse is providing education to parents about readiness for toilet training in toddlers. Which statement by the parents indicates that their child is likely ready for t ...

Exam 4 NUR 404 | Complete Solutions (Answered) A nurse is providing education to parents about readiness for toilet training in toddlers. Which statement by the parents indicates that their child is likely ready for toilet training? A. "My child can walk forward but hasn't mastered walking backwards yet." B. "My child still needs help pulling their pants up and down but is interested in the toilet." C. "My child has some accidents but is able to stay dry for an hour at a time." D. "My child can walk backwards, is able to pull pants up and down, and seems interested in using the toilet." Rationale: Successful toilet training requires a combination of physical, neurological, and behavioral readiness. Complete myelination of the spinal cord allows control over the urinary and anal sphincters. A child should show signs of independence, such as being able to walk backwards, pull pants up and down, and express interest in using the toilet. The nurse is educating a group of parents on drowning prevention strategies for toddlers aged 1-4 years. Which statement by a parent indicates a need for further teaching? A. "We've installed a fence with a self-latching gate around our pool to prevent access when no one is around." B. "I will make sure my child always has a lifejacket on when we are in or near any body of water, including at pools and lakes." C. "As long as I'm within earshot, my child can play in the bathtub for a few minutes alone since it's only a small amount of water." D. "Even in shallow water, I will keep my child within arm's reach and provide constant supervision." Rationale: Children, particularly toddlers, can drown in even small amounts of water, such as in a bathtub. Constant supervision is essential, as drowning can occur silently and quickly. Parents should never leave children unattended in the bathtub, even for a short period. A nurse is assessing a 4-year-old child during a routine well-child visit. Which behavior would the nurse expect to observe that aligns with Piaget's preoperational stage of cognitive development? A. The child shows understanding that other people may have different feelings or thoughts than they do. B. The child demonstrates the ability to connect symbols or pictures with objects and uses them in pretend play. C. The child engages in logical reasoning when solving simple problems. D. The child understands that objects remain the same even when they cannot see them, which indicates an awareness of conservation. Rationale: In Piaget's preoperational stage (ages 2-7), children begin to use symbols, pictures, and objects to represent other things in imaginative play, such as using a block to represent a car. This is typical of their emerging symbolic thought and aligns with expected cognitive development for this stage. The nurse is observing a toddler's behavior during a developmental assessment. Which behavior would indicate that the child is successfully navigating Erikson's Autonomy vs. Shame and Doubt stage? A. The child consistently seeks parental help when trying new tasks to ensure they do it correctly. B. The child refuses to participate in routines and rituals, preferring unstructured play over regular activities. C. The child insists on attempting tasks independently, even if they struggle or make mistakes, and may occasionally display frustration. D. The child frequently asks permission to explore new areas and waits for approval before moving away from their parent. Rationale: In the Autonomy vs. Shame and Doubt stage (ages 1-3), toddlers strive for independence and often insist on doing tasks by themselves, even if they face difficulty. This behavior, coupled with occasional frustration, is a sign that the child is building a sense of autonomy, a critical developmental milestone for this age group. Which clinical manifestation will the nurse anticipate when providing care to a toddler who is diagnosed with acute lead poisoning? Select all that apply. Emesis Nausea Diarrhea Anorexia Hypophosphatemia Seizures Pica Irritability Which clinical manifestation of increasing intracranial pressure (ICP) will the nurse expect to assess in the 2-year-old diagnosed with meningitis? Select all that apply. One, some, or all responses may be correct. Seizures Vomiting Hyperactivity Bulging fontanels Subnormal temperature Decreased respiratory rate Difficulty with speech Decreased blood pressure The parent of a 24-month-old toddler who has been treated for pinworm infestation is taught how to prevent a recurrence. Which statement by the parent indicates that the teaching has been effective? Select all that apply. One, some, or all responses may be correct. "I'll keep the cat off my child's bed." "I'll disinfect my child's room every 2 days." "We'll need to wash all of our sheets every day." "My child's fingernails should be cut short." "I need to tell the school nurse to have the toilets cleaned." "I'll have the whole family take the medication again in 2 weeks." "I will have the child shower each morning." "My child will only play indoors during treatment." A toddler is admitted to the pediatric unit with a temperature of 103.5°F (39.7°C), a runny nose, and a productive cough. Respiratory secretion specimens are sent for culture and sensitivity tests. Which precautions will the nurse include when caring for this client? Select the 4 appropriate precautions. Droplet Contact Airborne Neutropenic Restriction of parental visitation Standard The nurse is providing dietary guidance to the parent of a 2-year-old toddler who is described as a "picky eater." Which statement by the parent indicates a need for further education? A. "I will offer my child finger foods during meals to help them feel more independent." B. "My toddler drinks about 30 ounces of low-fat milk per day, which should be enough to meet their calcium needs." C. "I limit juice intake to no more than 6 ounces each day to avoid excess sugar." D. "For each meal, I serve my child 2 tablespoons of each food item to match their serving size." Rationale: The recommended milk intake for a toddler is around 24 ounces per day; consuming more than this can lead to decreased appetite for other foods, risking nutrient deficiencies, and may increase the risk of iron deficiency anemia. The nurse is evaluating a 3-year-old child's development during a well-child visit. Which observation would indicate typical developmental progress for this age? A. The child engages in cooperative play with other children, actively sharing toys and taking turns. B. The child identifies body parts and refers to themselves by their gender, but frequently plays alone without interest in nearby children. C. The child throws occasional temper tantrums when frustrated, and the parents set consistent limits to address the behavior. D. The child seems disinterested in their gender or body parts and focuses primarily on solitary play with minimal peer interaction. Rationale: By age 3, it is common for children to experience occasional temper tantrums as they learn to assert independence. Consistent discipline with clear boundaries is an effective approach for managing this behavior and aligns with typical developmental needs. A nurse is providing education to parents of a toddler about lead exposure risks and screening. Which statement by the parents would indicate a need for further education? A. "We will make sure our child is screened for lead exposure because they are at high risk due to their age." B. "Lead can affect our child's brain development, so we'll be careful about potential sources of lead in our home." C. "Since our home was built recently, lead exposure is less likely, so we don't need to worry about screening until school age." D. "We'll monitor for any changes in our child's speech and behavior, as these could be signs of lead exposure." Rationale: Children ages 1-2 are at high risk for lead exposure, regardless of housing age, as lead can be present in dust, soil, and imported toys or products. Universal screening is recommended, especially in early childhood, to prevent potential neurodevelopmental harm. A nurse is caring for a patient admitted with suspected acetaminophen overdose. Which finding would most likely support this diagnosis? A. The patient reports epigastric pain and has elevated serum creatinine and BUN levels. B. The patient has nausea, vomiting, and tenderness upon liver palpation, with elevated AST and ALT levels. C. The patient presents with severe headache and tachycardia but normal liver function tests. D. The patient complains of abdominal pain and has elevated white blood cell count with a low platelet count. What is nursing care for sickle cell crisis? Focus on rest, hydration, pain management, fever management, oxygenation What are the symptoms of a sickle cell crisis? severe pain swollen joints hematuria jaundice vision changes fever What can trigger a sickle cell crisis? Dehydration (gastrointestinal illness)• Respiratory illness (lowered O2 exchange, lowered atrial O2)• Extreme strenuous exercise (leads to tissue hypoxia) What is the management of croup? Cool air mist Corticosteroid Dexamethasone Racemic Epinepherine What should parents do FIRST when a toddler ingests poison? CALL POISON CONTROL FIRST What to do when a toddler ingests acetaminophen? Assess respiratory status Acetylcysteine antidote to protect liver What are symptoms of acetaminophen overdose? Anorexia, nausea vomiting What labs do you monitor if a toddler takes too much tylenol? ALT, AST What do you teach parents about medication safety? -lock box for medication -high shelf they can't reach -child proof caps don't work -get rid of their expired medications -making sure there's nothing in their purse or on the counter How do you keep a toddler safe in the bathtub? Never leave them alone, don't fill the tub all the way What is a classic symptom of Rubella? Lymph nodes swollen on both sides of neck What is a classic symptom of Mumps? 1 parotid gland is swollen, testicles is enlarged in boys What is a classic symptom of Measles that differentiates it? Koplik spots in mouth (white bluish spots) When are lesions no longer transmissible in chicken pox? When lesions are crusted over What precautions for chickenpox? Airborne and contact What is supportive care/treatment for Rubella? Keep them out of daycare/preschool, supportive measures, acetaminophen, ibuprofen, fluids What are special considerations when someone has Rubella? Avoid pregnant people (it's a torch disease) What precautions for Rubella? Droplet How is Measles spread? Airborne (wear N95, respiratory, glasses, gowns, gloves, negative pressure room, door closed) How do you treat varicella/chicken pox? Antihistamine lotion, supportive care, fluids, tylenol, ibuprofen, vaccinations What are symptoms of fifth's disease? Slapped cheek rash, fever, sores inside the mouth, blisters on hands and feet What are treatments for fifths disease? Supportive care, keep them home, fluids, tylenol, ibuprofen How is the fifth's disease spread? Contact How is pinworm spread? Fecal oral route How is pinworm treated? Oral doses of meds repeated in 2 weeks How to prevent pinworm? Washing of linen, clothes, hands How is Hep A transmitted? Fecal oral route What are symptoms of Hep A? Jaundice, headache, elevated liver labs What are the symptoms of otitis media? Red bulging tympanic membrane, toddler pulling at ear, loss of appetite, fever, upper respiratory infection How do you treat otitis media? Antibiotics orally, maybe drops in ear, acetaminophen, ibuprofen If ear infections aren't solved or frequent what do you do? Tubal myringotomy- incision in ear to help drain eustachian tube (falls out in 6-12 months) If a child has an ear tube, how do you treat the ear infection? Ear drops What increases risk for otitis media? Smoking around them, propping the bottle, laying down to feed What causes contact dermatitis in children? Usually sensitivity of laundry detergent How do you treat contact dermatitis? Cream (hydrocortisone), get rid of irritant What are sx. of Kawasaki? Inflamed strawberry tongue rash lips are dry and cracked, bloodshot eyes- conjunctivitis red palms/soles of feet and swollen, swollen lymph nodes in neck, always fever What are you concerned about in Kawasaki disease? Cardiac system, cardiac aneursysms What do you assess in child with Kawasaki? Echocardiogram, ESR, CRP will be both elevated, increased WBCs, elevated in platelets What do you teach patients about PCA pumps? Only the patient press the button, there are limits on a PCA pump so no risk for overdose (there's a daily and hourly limit), What is the first line treatment for pain in a patient that has sickle cell crisis? Patient controlled pump (morphine is first line- dilaudid up until fentanyl) What is your number one concern with a sickle cell patient? Clots What would vision changes and headache alert you about the clot in sickle cell? The brain (priority assessment neuro) If a sickle cell patient has shortness of breath, where do you suspect the clot is? The lungs (priority assessment respiratory) If a sickle cell patient has muscle problems what is the priority assessment? Musculoskeletal system assessment What does respiratory failure look like? grunting , nasal flaring, intercostal retractions, subcostal restrictions, substernal restrictions, tracheal tugging, bradypnea, central cyanosis, bradycardia What does croup lungs sound like? Stridor, barking cough What is the number one treatment for croup? #1 racemic epinephrine (open airways), #2 dexamethasone What are you worried about after giving them a racemic epi? Monitor them for 6 hours because they can have rebound airway constriction What is are extremely important considerations for croup? Touch them as little as possible, don't make them mad - agitation can make their airways close even more- do not give them IV, no extreme invasive interventions What's the goal of racemic epinephrine? Open up airway What is asthma? Lower airway inflammation, reactive airway disease causing intermittent obstruction of bronchioles What are symptoms of asthma attack? Shortness of breath, expiratory and inspiratory wheezing, cough, intercostal, subcostal retractions, decreased O2 sat What's the first line of treatment for asthma attack? Nebulized albuterol How do you calm systemic inflammation in asthma? Dexamethasone What do you teach parents about albuterol? Tachycardia, jittery, hunger, elevated blood sugar, anxious, tremors, chest pain How do you prevent asthma attacks? Long acting inhalers (never for rescue, use every single day) albuterol only for rescue What do you educate on metered dose inhalers? Rinse mouth after, needs spacer!!,educate on side effects What happens to the metabolic system with diarrhea? Metabolic acidosis. The sodium lost through stool causing them to become acidic. Increased breathing to get rid of acid What happens to the metabolic system with vomiting? Metabolic alkalosis. Body gets rid of acids due to vomiting. Slows breathing to hold onto acid How do you treat diarrhea in children? Normal saline to give them back the sodium (NEVER GIVE ANTIDIARRHEALS) How do you treat diarrhea? Supportive care, fluids, BRAT diet, pedialyte, clear liquids What does a child look like when they have nausea or vomiting? tired, lethargic, delayed cap refill, tenting skin, dry mucous membranes, lips dry, no tears What's the best way to monitor hydration in a child? Diaper weight, body weight What are the signs of nephrotic syndrome? Proteinuria, pitting edema (typically swollen face), hypoalbuminemia, hyperlipidemia, What are the lab's children with nephrotic syndrome? Low albumin (which causes edema), protein in urine, low hemoglobin, increased lipid proteins, ESR+CRP high What happens to the bloodstream in a child with nephrotic syndrome? Hemoglobin drops, increased lipids, albumin low What is the child going to feel like when they have nephrotic syndrome? Shortness of breath due to ascites, anorexia (lack of appetite), tired What is treatment for nephrotic syndrome? #1 albumin, #2 eating protein What do you encourage in a child with nephrotic syndrome? high protein,, low sodium diet What's the first line of diuretic in children? Furosemide What's the priority for nephrotic syndrome? Reduce the edema!!! You want the extracellular fluid back into cells What is a side effect of long term use of corticosteroids? Moonface What is Hypospadias/Epispadias? Urethral defect in which the urethral opening is not at the end of the penis on the ventral aspect of the penis. (urethra might be below on shaft) What are the complications of hypospadias/epispadias? Increased risk of UTI and infertility How do you treat hypospadias/epispadias? surgery only if baby didn't get circumcision bc/ circumcision would have helped cover the hole What is vesicoureteral reflux? Bladder pressure very strong that causes urine do go back into ureters What do you educate a patient before VCUG? keep full bladder What do you educate the patient after the VCUG procedure? void and bladder scan to check for retention What is the treatment for vesicoureteral reflux? surgery, double voiding, prophylactic antibiotics (prevent UTI) What's your priority for after vesicoureteral reflux surgery? Foley catheter (urine may be red, this is normal)