Peds Final Exam

Peds Final Exam A mother calls a clinic nurse to ask if her infant born prematurely should receive the seasonal influenza vaccine. The nurse's next question should be: a. "How old is your baby?" b. "Did your baby have any respiratory problems?" c. "Does your baby have any allergies?" d. "How much premature was your baby?" Ans- a. "How old is your baby?" Rationale: Flu vaccine and all other vaccines are administered according to chronological age. Flu vaccine is recommended for all infants at 6 months of age and given yearly thereafter. An underlying respiratory problem makes flu vaccine important. Awareness of allergies is also necessary, but the first question is chronological age to determine if the infant is old enough to receive the vaccine. The nurse can refer the special needs infant or toddler to an early intervention federal:state program offered at the local level often through: a. The child's home or daycare center. b. food and nutrition programs c. community religious organizations d. the public school system Ans- The child's home or a day care center Rationale: Observing the mother:child interaction during feeding and hygiene activities would disclose lack of knowledge of child care, poor feeding techniques, or inappropriate maternal bonding and interaction as inorganic causes or failure to thrive. The child's lack of interest in or inability to feed would indicate organic causes, as would determining that the child consumed adequate calories for age and finding a history of prematurity or congenital anomaly. Which statement by the mother of a special needs toddler requires nursing intervention? Select all that apply. a. "we give her lots of finger foods so she can feed herself" b. "she teethed late, and her teeth are still coming in so we haven't looked for a dentist." c. "we take her to the park when the weather is good" d. "she scoots around on the floor so we keep her in a playpen for safety." Ans- b. "she teethed late, and her teeth are still coming in so we haven't looked for a dentist." d. "she scoots around on the floor so we keep her in a playpen for safety." Rationale: Safety is important, but restricting the toddler to a playpen interferes with motor development and learning. Toddlers explore their environment to develop motor skills and learn through trial and error. Being enclosed in one environment (playpen) does not provide for this. Late teething may occur in special needs children. However, dental care is essential to the health of all children, and early evaluation and care is often even more important to the special needs child. Special needs children benefit from problem prevention or correction in all arenas to support development and promote functioning at the highest possible level. Finger foods support self-feeding and the autonomy desired by toddlers. Excursions to the park provide motor and sensory stimulation and fun. A 3-month-old boy was diagnosed with failure to thrive. What action will be most helpful in assisting the nurse to determine if there is an inorganic cause? a. reviewing the medical records for a history of prematurity or a congenital anomaly b. assessing for adequate calorie intake through recording ounces of formula consumed c. observing the mother-child interaction during feeding and hygiene activities d. observing the child's interest in and ability to feed Ans- c. observing the mother-child interaction during feeding and hygiene activities Rationale: Observing the mother:child interaction during feeding and hygiene activities would disclose lack of knowledge of child care, poor feeding techniques, or inappropriate maternal bonding and interaction as inorganic causes or failure to thrive. The child's lack of interest in or inability to feed would indicate organic causes, as would determining that the child consumed adequate calories for age and finding a history of prematurity or congenital anomaly. The nurse is preparing a 7-year-old girl recovering from head trauma and receiving gastrostomy feedings for discharge from the hospital. Which activity is most important before the child is discharged home? a. determining the parents' ability to administer the enteral feedings b. preparing a list of home equipment and supplies needed c. assessing the parents' emotional status d. helping the family to access financial resources Ans- a. determining the parents' ability to administer the enteral feedings Rationale: The parents' ability to maintain their child's nutrition is essential to the child's well-being. The transition can go forward while still resolving financial resource adequacy and the emotional status of the parents. Equipment and supplies will be ordered as part of discharge planning and are not needed until the parents can safely administer feedings. The parents of a 10-year-old boy with cystic fibrosis restrict him from camping, sleepovers with friends, and school field trips. They time his respiratory treatments and log his diet, choosing most foods for him. They have him seen medically between scheduled appointments and call their physician frequently with concerns. The nurse considers these behaviors indicative of: a. parental depression b. need for respite care c. vulnerable child syndrome d. parental denial of the child's condition Ans- c. vulnerable child syndrome Rationale: Descriptors fit vulnerable child syndrome. Parents "see" the child as more fragile and dependent than he actually is. Resultant protective behaviors on the part of the parents interfere with the boy's ability to grow and develop as normally as possible within the restraints of his illness. Media is beginning to promote immunizations for the upcoming influenza season. The mother of a premature infant 7 months chronological age and 5 months corrected age asks about immunizing her child. The nurse responds: a. "no child receives seasonal flu vaccine until age 4 years" b. "your child as a 7-month-old should be immunized." c. "the child's corrected age makes him too young." d. "premature infants should not be immunized against the seasonal flu until 1 year old chronologically." Ans- b. "your child as a 7-month-old should be immunized." Rationale: Infants receive influenza vaccine at 6 months of age. Chronological age is used for premature infants. All the other responses are incorrect. Nurses explain that before the parents of a premature infant leave the hospital with their baby, the child must: a. be immunized against pertussis b. have no apnea episodes c. be able to nipple feed d. maintain oxygenation in a car seat Ans- d. maintain oxygenation in a car seat Rationale: Maintaining satisfactory oxygenation saturation while sitting in a car seat is necessary prior to hospital discharge for premature infants. Special padding of the seat may be necessary. All immunizations will be given based on chronological age with pertussis first given at 2 months. Premature infants may be discharged from hospital units with feeding tubes and apnea monitors. The parents of a 9-year-old girl who is dying from cancer are distraught and guilt-ridden when they find that treatment is no longer successful. What is the best way for the nurse to respond? a. explain that it is not fair to the child to continue present treatment. b. tell the parents there is no more that can be done. c. ask the parents if they wish to fill out a do-not-resuscitate order. d. assure the parents that expert care of their child will continue. Ans- d. assure the parents that expert care of their child will continue. Rationale: The nurse needs to make sure the parents know that the child is not being abandoned by the healthcare team. Instead, treatment is changing but not ending. It is not true there is not anymore that can be done for the child. Palliative care can relieve symptoms and provide comfort even though it will not cure. Waiting to inquire about a do-not-resuscitate decision until parents have some adjustment time is considerate. Claiming it is not fair to continue treatment may enhance the guilt already being expressed by the parents. In working with middle to older adolescents with special needs, the nurse teaches the teens when to seek help from a health professional and about the medical insurance process. This nurse is: a. beginning to prepare the teen for transition to adult care b. promoting improved use of the present healthcare resources c. working to reduce the financial burden to the family d. attemping to relieve stressed parents of some responsibility. Ans- a. beginning to prepare the teen for transition to adult care Rationale: Since stranger fear and separation anxiety is a developmental norm around 8 months, attachment is critical to provide security. All the other interventions should be used to promote development, but attachment is essential. The nurse is caring for a hospitalized 8-month-old girl with special healthcare needs. Which intervention would best help this infant grow and develop? a. support parental attachment to the child. b. promote modified gross motor activities c. use play to encourage fine motor skill development d. role model basic care and talk, read, and sing to the child. Ans- a. support parental attachment to the child. Rationale: Attachment interference may already have occurred due to frequent hospitalizations and multiple therapies and treatments. A basic need of this girl is the development of trust in and attachment to her parents. Since stranger fear and separation anxiety is a developmental norm around 8 months, attachment is critical to provide security. All the other interventions should be used to promote development, but attachment is essential. The mother of a 10-year-old being treated for kidney failure speaks very broken English and is clearly overstressed. What is the priority nursing intervention? a. assuring her and demonstrating that the child will be well cared for b. gaining more information about her stress c. encouraging her to go home and get some rest d. providing her with a bed and food in the child's room Ans- b. gaining more information about her stress rationale: The priority intervention is to determine the sources of the mother's stressors. What are her fears and concerns? What pressures are present in her life? An interpreter may be necessary to ensure effective communication. Until then, the nurse cannot be sure that the other measures are appropriate, although they are caring. A child's medical record contains the diagnosis failure to thrive (FTT). The nurse realizes: Select all that apply. a. the cause may be organic or inorganic b. it may have developmental delay as a contributing facto