A parent tells a nurse at the clinic, "Each morning I offer my 24monthold juice, and all I hear is 'No.' What should I
do? I know she needs fluid!" What is the best response by the nurse?
Offer the child a choice of
...
A parent tells a nurse at the clinic, "Each morning I offer my 24monthold juice, and all I hear is 'No.' What should I
do? I know she needs fluid!" What is the best response by the nurse?
Offer the child a choice of two juices.
Antibiotic prophylaxis is prescribed for a 2yearold child with a cardiac malformation who is awaiting corrective
surgery. The nurse explains to the child's parents that the antibiotic will prevent:
Subacute bacterial endocarditis
A nurse is teaching dietary management to the parents of a toddler who is undergoing chelation therapy to treat lead
poisoning. What should be included in the discussion of the dietary plan?
Ensuring adequate fluid intake
A toddler who was physically abused is admitted to the pediatric unit. What behavior does the nurse expect when
approaching the child?
Exhibiting fear of physical contact initiated by anyone
A nurse is observing two 18monthold children playing side by side in a sandbox. Although they watch each other,
neither interacts with the other. What type of play does the nurse identify?
Parallel
A nurse is caring for a toddler who has undergone bone marrow transplantation. What clinical finding(s) should the
nurse anticipate if an infection develops?
Fever and lethargy
An 18monthold toddler requires an intramuscular injection. As the nurse enters the room with the medication, the
child begins to scream and flail about on the bed. The father is sitting at the child's bedside and gets up to leave.
What action should the nurse take to best handle this situation?
Ask the father to stay to comfort the child while the injection is being given.
How should a nurse respond to parents who are concerned about separation anxiety in their 15monthold toddler?
This is an expected developmental reaction."
A 3yearold child ingests a substance that may be a poison. The parent calls a neighbor who is a nurse and asks
what to do. What is the best response by the nurse?
Call the Poison Control Center.
What does a nurse identify as the priority shortterm goal for a toddler with dehydration caused by diarrhea?
Improvement of fluid balance
A mother tells her neighbor, a nurse, that her toddler has been found to have parasites (worms) and that the whole
family will need to be treated. She asks the nurse what kind of worm it is. What is the most likely type of worm
infestation?
Pinworm (Enterobius)The mother of a 2yearold child tells the nurse that she is concerned about her child's vision. What behavior when
the child is tired leads the nurse to suspect strabismus?
One eye moves inward
A nurse explains to the parents of a toddler why 2yearold children are at risk for lead poisoning. What major risk
factor does the nurse includes in the discussion?
They explore the environment by touching and tasting.
A nurse is assessing a toddler with plumbism (lead poisoning). Which organ system is of most concern because of
the condition's irreversible effects?
Nervous
A 2yearold child with previously diagnosed hemophilia is admitted to the pediatric unit for observation after a motor
vehicle collision. The toddler has several bruises but no other apparent injuries. What is the nurse's specific concern
regarding this child?
Undetected injury
The mother of a 2yearold toddler tells the nurse that her child is frequently constipated. The nurse asks the mother
how she handles the child's toileting. Which response indicates to the nurse that the mother requires further
education?
I schedule my child's toileting for before each meal."
A toddler with hemophilia A is receiving factor VIII. The mother asks the nurse, "If my son hurts himself, I'll give him 2
children's Advil. Is that right?" How should the nurse respond?
Give him Tylenol. Advil may cause bleeding."
What is the priority nursing care in the immediate postoperative period for a toddler with a newly applied hip spica
cast?
Checking the toddler's peripheral circulation
A 30monthold boy who was transferred to a regional hospital has not seen his parents for 2 weeks. He now
responds to the staff with friendliness and affection. When his mother visits he turns away from her and ignores her.
What should the nurse explain to the mother?
Your little boy misses you very much; give him time and he'll reach for you."
A nurse is obtaining a health history from the mother of a 15monthold toddler with celiac disease. The nurse expects
the mother to indicate that her toddler:
Has bulky, foul, frothy stools
An unconscious toddler requires intermittent nasogastric feedings. When should the nurse check placement of the
tube?
Before each feeding
The nurse notes that a 3yearold child in a crib has a clamped jaw and is having a tonicclonic seizure. What is the
priority nursing responsibility at this time?
Protecting the child from selfinjury
The mother of a 2yearold child calls her neighbor, who is a nurse, exclaiming that her child just ate some automatic
dishwasher powder. What should the nurse tell the mother to do first?
Call the Poison Control Center.
After a prolonged period in a regional hospital far from home to which the parents were unable to travel, an 18monthold toddler becomes depressed, withdrawn, and apathetic. Eventually the toddler begins playing with toys and
relating to others, even strangers. When the parents visit, the child ignores them. The parents tell the nurse that their
child has forgotten them. The nurse explains that their child's behavior:
Signifies typical behavior in toddlers who are separated from their parents for prolonged periods and that their child
will need special attention from them
The parents of a toddler tell the nurse the family has been living in a very old building. The nurse should carefully
assess the child for the irreversible effects of possible lead poisoning by focusing on the:
Central nervous systemDuring a wellchild visit the parents tell a nurse, "Our 3yearold doesn't listen to us when we speak—he ignores us!"
An auditory screening reveals that the child has a mild hearing loss. What should the nurse explain to the parents
about this degree of hearing loss?
Speech therapy in addition to hearing aids may be required.
What is the priority nursing responsibility in the care of a young toddler after a circumcision?
Watching for bleeding around the penis
A 13monthold child is undergoing lumbar puncture for confirmation of a diagnosis of bacterial meningitis. During the
procedure the nurse notes that the spinal fluid is cloudy. What does this finding indicate?
Increased white blood cell (WBC) count
A child sitting on a chair in a playroom starts to have a tonicclonic seizure with a clenched jaw. What is the best
initial action by the nurse?
Placing the child on the floor
The parents of a 2½yearold child whose older sibling recently died tell a nurse in the pediatric wellchild clinic that
their child has started to hit them and refuses to go to bed at night. What is the best explanation the nurse can give
for this behavior?
This is an appropriate reaction to anxiety within the household.
A nurse is reviewing how 18monthold children with no hearing impairment usually communicate. What form of
interaction does the nurse expect?
Using at least six words
During a nap, a 3yearold hospitalized child wets the bed. What is the best response by the nurse?
Change the child's clothes without discussing the incident.
A 2yearold toddler has hearing loss caused by recurrent otitis media. What treatment does the nurse anticipate that
the practitioner will recommend?
Myringotomy
A nurse is conducting an assessment of a 1yearold in the wellbaby clinic. What activity does the nurse expect the
infant to have accomplished?
Attempting to climb stairs
An 18monthold child has received all required immunizations. What immunization should the nurse explain to a
parent will be one of the vaccines required between 4 and 6 years of age?
Inactivated poliovirus
What foods should a nurse order for a 30monthold toddler on a regular diet?
Macaroni and cheese and Cheerios
A nurse teaches the mother of a 2yearold child who has celiac disease which foods to avoid. Which foods identified
by the mother indicate that she understands the teaching?
Macaroni and cheese
A child with thalassemia (Cooley anemia) is admitted t
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