Chapter 23: The School-Age Child With a Major Illness
1. The father of a 7-year-old boy reports to the nurse that two or three times over the past weeks he has observed his son seemingly staring into space and rubbing his hands. The behavior lasts for a minute or so, followed by an inability of the child to understand what’s being said to him. When the nurse asks the child about his experience, he says he doesn’t know what his father is talking about. The symptoms this child is exhibiting might indicate the child is having:
A. simple partial sensory seizures.
B. simple partial motor seizures.
C. complex partial seizures.
D. absence seizures.
Answer: C
Rationale: Complex partial seizures, also called psychomotor seizures, begin in a small area of the brain and change or alter consciousness. They cause memory loss and staring. Nonpurposeful movements such as hand rubbing, lip smacking, arm dropping, and swallowing may occur. Following the seizure, the child may sleep or be confused for a few minutes. The child is often unaware of the seizure. Simple partial sensory seizures may include sensory symptoms called an aura (a sensation that signals an impending attack) involving sight, sound, taste, smell, touch, or emotions (a feeling of fear, for example). The child may also have numbness, tingling, paresthesia, or pain. Simple partial motor seizures cause a localized motor activity such as shaking of an arm, leg, or other part of the body. Absence seizures rarely last longer than 20 seconds. The child loses awareness and stares straight ahead but does not fall. The child may have blinking or twitching of the mouth or an extremity along with the staring. Immediately after the seizure, the child is alert and continues conversation but does not know what was said or done during the episode.
Chapter: 23
Objective: 1
Cognitive Level: Application
Client Needs: B
Integrated Process: Caring
Difficulty: Moderate
2. The caregivers of an 8-year-old bring their child to the pediatrician and report that the child has not had breathing problems before, but since taking up lacrosse, the child has been coughing and wheezing at the end of every practice and game. Their friend’s child has often been hospitalized for asthma; they are concerned that their child has a similar illness. The nurse knows that because the problems seem to be directly related to exercise, it is likely that the child will be able to be treated with:
A. decreased activity and increased fluids.
B. corticosteroids and leukotriene inhibitors.
C. removal of allergens in the home and school.
D. a bronchodilator and mast cell stabilizers.
Answer: D
Rationale: Mast cell stabilizers are used to help decrease wheezing and exercise-induced asthma attacks. A bronchodilator often is given to open up the airways just before the mast cell stabilizer is used. Corticosteroids are anti-inflammatory drugs used to control severe or chronic cases of asthma. Leukotriene inhibitors are given by mouth along with other asthma medications for long-term control and prevention of mild, persistent asthma.
Chapter: 23
Objective: 3
Cognitive Level: Analysis
Client Needs: D-2
Integrated Process: Nursing Process
Difficulty: Moderate
3. In developing a plan of care for the child diagnosed with rheumatic fever, the nursing intervention thatis the highest priority for this child is to:
A. position the child to relieve joint pain.
B. monitor the C-reactive protein and ESR levels.
C. provide age-appropriate diversional activities.
D. promote rest periods and bed rest.
Answer: D
Rationale: As long as the rheumatic process is active, progressive heart damage is possible. To prevent heart damage, bed rest is essential to reduce the heart’s work load. Laboratory tests for ESR and C-reactive protein can be used to evaluate disease activity and guide treatment but do not improve the child’s health in and of itself. The child’s comfort is important, so it is essential to relieve joint pain and prevent injury with padded bed rails. But these measures are less important than rest when it comes to preventing long-term complications such as residual heart disease.
Chapter: 23
Objective: 6
Cognitive Level: Application
Client Needs: A-1
Integrated Process: Caring
Difficulty: Moderate
4. The nurse admits a 9yearold who is complaining of pain in the lower-right quadrant of the abdomen, nausea, and constipation. She also has a fever of 101° Fahrenheit. Of the following nursing actions, which will most likely be done at this time for this child? The nurse will:
A. give a laxative to alleviate constipation.
B. place a heating pad or hot water bottle on her abdomen.
C. help her find a comfortable position.
D. give her an analgesic such as acetaminophen.
Answer: C
Rationale: The child’s symptoms indicate that she may have appendicitis. When appendicitis is suspected, laxatives and enemas are contraindicated because they increase peristalsis, which increases the possibility of rupturing an inflamed appendix. Heat to the abdomen is also contraindicated because of the danger of rupture of the appendix. Preoperatively, analgesics are not given because they may conceal signs of tenderness that are important for diagnosis. Comfort can be provided through positioning.
Chapter: 23
Objective: 7
Cognitive Level: Analysis
Client Needs: D-1
Integrated Process: Caring
Difficulty: Moderate
5. A young child has been admitted with a diagnosis of enterobiasis (pinworm infection). This child will most likely have a history of which of the following?
A. Bedwetting
B. Restlessness
C. Perianal itching
D. Malnutrition
Answer: C
Rationale: Intense perianal itching is the primary symptom of pinworm infection, enterobiasis. Young children who cannot clearly verbalize their feelings may be restless, sleep poorly, or have episodes of bedwetting. Pinworm infestation is as common as an infection or cold, making a history of malnutrition less likely. Chronic hookworm infestation can cause malnutrition, however.
Chapter: 23
Objective: 8
Cognitive Level: Knowledge
Client Needs: B
Integrated Process: Caring
Difficulty: Easy
6. The nurse is caring for a 7yearold diagnosed with pinworms. The nurse talks with the child’s caregiver about proper treatment and prevention of future infections. Which of the following statements made by the caregiver indicates a need for further teaching?
A. “I always have to remind him to wash his hands before eating.”
B. “We just bought a washer and dryer and the hot water works well.”
C. “Thank goodness my other children and I are not sick too.”
D. “He hates having his nails trimmed but I will insist they are kept short.”
Answer: C
Rationale: The life cycle of pinworms is 6 to 8 weeks. Clothing, bedding, food, toilet seats, and other articles become infected, and the infestation spreads to other members of the family. Pinworm eggs also can float in the air and be inhaled. Family members may be infected and not realize it. Because pinworms are so easily transmitted, the nurse should encourage all family members to be treated as well. Washing hands before eating and after using the toilet, frequent laundering of bedding and underclothes in hot water, and short, clean fingernails are all ways to prevent subsequent infections.
Chapter: 23
Objective: 8
Cognitive Level: Application
Client Needs: A-2
Integrated Process: Teaching/learning
Difficulty: Moderate
7. The caregivers of a child just diagnosed with diabetes express concern that they won’t remember the different signs and symptoms of hyperglycemia and hypoglycemia. As a result, they are afraid they won’t handle an emergency correctly. The best initial response by the nurse would be to:
A. instruct them to treat the reaction as if it’s hypoglycemia, which is more likely.
B. repeat the signs and symptoms over and over until they seem to understand.
C. suggest that the child wear an insulin pump for continuous insulin administration.
D. give the caregivers educational pamphlets and videos about diabetes.
Answer: A
Rationale: Hypoglycemia is much more likely to occur than hyperglycemia, so if there is any doubt as to whether the child is having a hypoglycemic or hyperglycemic reaction, it should be treated as hypoglycemia. While the pump may offer continuous insulin, it does not sense blood glucose level; insulin reactions can still occur. Careful monitoring of blood glucose is still needed. While repeating signs and symptoms may be helpful, caregivers of a recently diagnosed child have lots of information to absorb and the repetition may create more anxiety. Assuming that the caregivers can read and understand them, written materials and videos may be helpful, but they should not take the place of an initial teaching session with a nurse.
Chapter: 23
Objective: 9
Cognitive Level: Application
Client Needs: D-1
Integrated Process: Teaching/learning
Difficulty: Moderate
8. A caregiver brings her 7-year-old son to the pediatrician’s office, concerned about the child’s wetting the bed. The caregiver reports that the child has wet the bed rarely over the previous 2years, but in the past month, ever since he returned from a week away from home on a fishing trip, he has wet the bed each night. The child refuses to talk about the topic. The nurse notes that the child is shy, skittish, and will not make eye contact. Physical examination reveals signs of a healed rectal tear. Further evaluation will most likely be done to rule out the possibility this child has:
A. developed a UTI from not bathing while on the fishing trip.
B. gotten out of the habit of waking himself up in the night to empty his bladder.
C. been forced to go on the fishing trip against his will and is now retaliating.
D. been sexually abused, possibly while away on the fishing trip.
Answer: D
Rationale: Enuresis may have a physiologic or psychological cause and may indicate a need for further exploration and treatment. Enuresis in the older child may be an expression of resentment toward family caregivers or a desire to regress to an earlier level of development to receive more care and attention. Emotional stress can be a precipitating factor. The health care team also needs to consider the possibility that enuresis can be a symptom of sexual abuse. Bruising, bleeding, or lacerations on the external genitalia, especially in the child who is extremely shy and frightened, may be a sign of child abuse and should be further explored.
Chapter: 23
Objective: 10
Cognitive Level: Application
Client Needs: C
Integrated Process: Caring
Difficulty: Moderate
9. The nurse caring for a child who has been put into a leg cast must be on the alert for signs of nerve and muscle damage. Which of the following symptoms might be an early warning signal that the child has developed compartment syndrome? The child:
A. cannot plantarflex his foot.
B. feels increasing severe pain.
C. has a weak femoral pulse.
D. has blue-looking nail beds on the toes.
Answer: B
Rationale: Any complaint of pain in a child with a new cast or immobilized extremity needs to be explored and monitored closely for the possibility of compartment syndrome.
Chapter: 23
Objective: 12
Cognitive Level: Application
Client Needs: A-1
Integrated Process: Nursing Process
Difficulty: Moderate
10. The caregivers of an 8-year-old child diagnosed with muscular dystrophy are discussing appropriate activities for their child. The nurse might suggest to these caregivers that they do which of the following in regard to their child’s activities?
A. Find a Little League team that encourages participation of kids at all disability levels.
B. Find an art class that will allow the child to participate without physical exertion.
C. Modify family activities so they are more sedentary for the child.
D. Teach the child at home so that the child does not feel overly different.
Answer: A
Rationale: The child must be encouraged to be as active as possible to delay muscle atrophy and contractures. To help keep the child active, physiotherapy, diet to avoid obesity, and parental encouragement are important. The nurse should advise the family to keep the child’s life as normal as possible.
Chapter: 23
Objective: 15
Cognitive Level: Application
Client Needs: D-1
Integrated Process: Teaching/learning
Difficulty: Moderate
11. The nursing is talking with the caregiver of a 13yearold diagnosed with scoliosis. The child has come to the clinic to be fitted with a brace to begin her treatment. The child appears upset and angry and states, “I hate this brace; I hate it already.” In an effort to support this child, which of the following statements would be the most appropriate for the nurse to make to this child’s caregiver?
A. “Remind your child that her spine needs to be corrected to keep her whole musculoskeletal system healthy for a long, long time.”
B. “Take your daughter to an oncology floor for a few minutes so she can see children who are much sicker than she is.”
C. “If you can afford it, let your daughter choose an article or two of clothing that she can wear with the brace that will help her feel that she looks good.”
D. “Children her age often withdraw during stressful times; let her have some time alone to think about the situation and to get used to the brace.”
Answer: C
Rationale: Help the child select clothing that blends with current styles but is loose enough to hide the brace. Self-image and the need to be like others are very important at this age. Wearing a brace creates a distinct change in body image, especially in the older child or adolescent, at a time when body consciousness is at an all-time high. The need to wear the brace and deal with the limitations it involves may cause anger; the change in body image can cause a grief reaction. Handling these feelings successfully requires understanding support from the nurse, family, and peers. It is important for the child to have an opportunity to talk about his or her feelings.
Chapter: 23
Objective: 18
Cognitive Level: Application
Client Needs: C
Integrated Process: Teaching/learning
Difficulty: Moderate
12. The caregiver of a fifth-grade boy calls the pediatrician’s office and reports that her son has been scratching at his groin for a week or so. Despite his need for privacy, he’s finally allowed the caregiver to look at the groin area. The caregiver describes the area to the nurse saying, “It looks like black pin dots that seem to have dark tails.” The nurse suspects that the child may have which of the following?
A. Lice
B. Scabies
C. Ringworm
D. Prickly heat
Answer: B
Rationale: Scabies burrows are visible as dark lines and the mite is seen as a black dot at the end of the burrow. Lice can be seen as tiny pearly white flecks attached to the hair shafts. They look much like dandruff, but dandruff flakes can be flicked off easily, whereas the nits are tightly attached and not easily removed. Ringworm of the scalp begins as a small papule on the scalp and spreads, leaving scaly patches of baldness. Ringworm of the body appear as a scaly ring with clearing in the center. Ringworm of the feet, is more commonly known as athlete’s foot. It is evidenced by the scaling or cracking of the skin between the toes.
Chapter: 23
Objective:19
Cognitive Level: Analysis
Client Needs: D-1
Integrated Process: Nursing Process
Difficulty: Moderate