NUR2262 - 1: Care of Women and Pediatric Client
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Free NUR2262 - 1: Care of Women and Pediatric Client Questions
A nurse in an emergency department is assessing a 2-year-old child. The nurse notices that the child is drooling, has inspiratory stridor, and is sitting in a tripod position. After applying a pulse ox probe, what should the nurse do next?
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Obtain a throat culture for a rapid strep test
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Administer an albuterol treatment
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Initiate airborne precautions
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Prepare for intubation
Explanation
Drooling, inspiratory stridor, and tripod positioning are classic signs of epiglottitis, a life-threatening condition in which the airway can obstruct rapidly and completely. The nurse should prepare for emergency intubation and avoid any action that could agitate the child or further compromise the airway.
Why the other options are incorrect:
A. Obtain a throat culture for a rapid strep test: Examining or manipulating the throat/airway in a child with suspected epiglottitis is dangerous, as it can trigger laryngospasm and complete airway obstruction.
B. Administer an albuterol treatment: Albuterol treats bronchospasm associated with conditions like asthma or bronchiolitis; it has no role in epiglottitis, which is caused by inflammation and swelling of the epiglottis itself.
C. Initiate airborne precautions: Epiglottitis (commonly caused by Haemophilus influenzae) requires droplet precautions, not airborne precautions, but this is not the priority action when the child's airway is at immediate risk.
A nurse is preparing to administer Ibuprofen to an adolescent client. The order states to give 10mg/kg to this 85kg client. The concentration is 100mg/5mL. The nurse enters the client's room with 42.5 mL of ibuprofen to administer to the adolescent. The client tells the nurse, "Seriously?!? I have to drink that whole thing?!? I can take pills! I'm not a baby!" Which of the following statements is the most therapeutic response for the nurse to make to the client at this time?
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"I'm not trying to insinuate that you're a baby. It's just what the doctor ordered."
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"Well, I didn't know you could swallow pills. Now I know."
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"I hear you. Unfortunately, it's too late to change it now because I've already brought it in."
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"Thank you for letting me know, and I'm sorry I didn't check with you first. I can ask the doctor to change the order to pills if you'd like."
Explanation
This response demonstrates therapeutic communication by validating the client's feelings, acknowledging the oversight, and offering a collaborative solution that respects the adolescent's autonomy and developmental need for independence and control.
Why the other options are incorrect:
A. "I'm not trying to insinuate that you're a baby. It's just what the doctor ordered." — This response is defensive and dismissive of the client's feelings rather than validating and problem-solving.
B. "Well, I didn't know you could swallow pills. Now I know." — This response is somewhat curt and does not offer a solution or fully validate the client's frustration.
C. "I hear you. Unfortunately, it's too late to change it now because I've already brought it in." — This shuts down the client's request without exploring options, and is not accurate — the order can still be changed if requested.
A 10-year-old with moderate persistent asthma arrives in the emergency department accompanied by his father. The father states the child has used his rescue inhaler four times over the last two hours without relief.
Assessment findings include:
- Sitting upright and leaning forward
- RR 38/min
- HR 146/min
- SpO2 91% on room air
- Audible inspiratory and expiratory wheezing
- Unable to speak more than one or two words at a time
- Intercostal and suprasternal retractions
- Anxious facial expression
Which nursing intervention should occur first?
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Administer nebulized albuterol and supplemental oxygen
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Obtain a peak expiratory flow reading
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Begin asthma education with the parent
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Encourage pursed-lip breathing
Explanation
This child is presenting with severe respiratory distress and hypoxemia (SpO2 91%, tachypnea, retractions, inability to speak in full sentences) that has already failed to respond to rescue inhaler treatments. The priority is immediate pharmacologic and oxygen intervention to relieve bronchospasm and correct hypoxemia.
Why the other options are incorrect:
B. Obtain a peak expiratory flow reading — Diagnostic measurements should not delay urgent treatment in a child in acute respiratory distress; treatment takes priority over further assessment tools at this critical point.
C. Begin asthma education with the parent — Education is important but is not appropriate during an acute, severe respiratory emergency.
D. Encourage pursed-lip breathing — This technique is not the priority intervention for an acute severe asthma exacerbation with hypoxemia; pharmacologic treatment and oxygenation are needed first.
Which of the following is a milestone for a 2-year-old child?
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Climb on and off furniture
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Walk holding on to furniture
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Kick a ball
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Ride a tricycle
Explanation
Kicking a ball is a gross motor milestone typically achieved around 2 years of age, reflecting developing balance and coordination.
Why the other options are incorrect:
A. Climb on and off furniture — This is typically achieved earlier, around 18 months of age.
B. Walk holding on to furniture (cruising) — This is an early gross motor milestone typically seen around 9-12 months, well before 2 years.
D. Ride a tricycle — This requires more advanced coordination and balance, typically achieved around 3 years of age, not 2.
A nurse is caring for a hospitalized 18-month-old toddler. Which nursing intervention best supports the child's psychosocial developmental stage?
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Explain each procedure using detailed medical terminology
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Encourage the parents to leave the child alone during procedures
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Encourage the toddler to choose between two snacks
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Encourage competitive play with other children
Explanation
According to Erikson's psychosocial theory, toddlers (1-3 years) are in the autonomy vs. shame/doubt stage. Offering simple choices, like selecting between two snacks, supports the development of independence and autonomy appropriate to this developmental stage.
Why the other options are incorrect:
A. Explain each procedure using detailed medical terminology — An 18-month-old cannot comprehend detailed medical terminology; explanations should be simple and developmentally appropriate.
B. Encourage the parents to leave the child alone during procedures — Toddlers experience significant separation anxiety, and parental presence should be encouraged, not discouraged, during procedures.
D. Encourage competitive play with other children — Toddlers typically engage in parallel play, not competitive or cooperative play, which develops later; this does not match the child's developmental stage.
A 6-year-old child is brought to the emergency department after falling approximately 10 feet from a tree. Witnesses report the child lost consciousness for about 2 minutes before awakening and crying. Upon arrival, the child is immobilized on a backboard with a cervical collar in place.
Assessment findings include:
- HR 102/min
- RR 22/min
- BP 104/66 mm Hg
- SpO2 98% on room air
- Glasgow Coma Scale: 14 (confused conversation)
- Reports severe headache
- Vomited once during transport
- Equal pupils that are 3 mm and reactive
- Complains that "my neck hurts"
Which nursing action is the priority?
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Maintain cervical spine immobilization while completing the neurological assessment
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Administer IV morphine for pain
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Remove the cervical collar to thoroughly assess neck tenderness
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Encourage the child to sit upright to decrease nausea and reduce risk for aspiration
Explanation
Given the mechanism of injury (fall from height), loss of consciousness, neck pain, and altered GCS, the priority is to maintain strict cervical spine immobilization to prevent potential spinal cord injury while completing a thorough neurological assessment to monitor for signs of worsening intracranial injury.
Why the other options are incorrect:
B. Administer IV morphine for pain — Pain management is important but is secondary to protecting the cervical spine and completing the neurological assessment; morphine can also mask changes in level of consciousness.
C. Remove the cervical collar to thoroughly assess neck tenderness — The cervical collar should not be removed until spinal injury has been definitively ruled out via clinical assessment and/or imaging, given the child's mechanism of injury and neck pain.
D. Encourage the child to sit upright to decrease nausea and reduce risk for aspiration — This directly contradicts cervical spine precautions, which require the child to remain immobilized flat/supine on the backboard until cleared.
A nurse on a pediatric neuro unit receives report on four children. Which child should the nurse assess first?
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A 10-year-old with bacterial meningitis whose Glasgow Coma Scale score has decreased from 15 to 12 during the previous hour
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A 4-year-old with bacterial meningitis who vomited after eating breakfast
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A 3-year-old admitted with bacterial meningitis who reports neck pain rated 8/10 and requests pain medication
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A 6-year-old receiving IV antibiotics whose temperature remains 39.2°C (102.6°F) despite acetaminophen
Explanation
A declining GCS score indicates a worsening level of consciousness and potential neurological deterioration, such as increasing intracranial pressure — a life-threatening emergency that requires immediate assessment and intervention, making this child the priority.
Why the other options are incorrect:
B. A 4-year-old with bacterial meningitis who vomited after eating breakfast — Vomiting can be an expected finding with meningitis and, without other neurological changes, is less urgent than a declining GCS.
C. A 3-year-old admitted with bacterial meningitis who reports neck pain rated 8/10 and requests pain medication — Pain, while important to address, is not immediately life-threatening and can be managed after the higher-priority neurological change is assessed.
D. A 6-year-old receiving IV antibiotics whose temperature remains 39.2°C (102.6°F) despite acetaminophen — A persistent fever, while needing monitoring, is an expected finding in bacterial meningitis and is not as acutely dangerous as a decreasing level of consciousness.
Correct Answer Is:
A
Which of the following is an expected finding of a child with hyperopia?
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The child has nystagmus when the nurse performs an extraocular movement check.
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The child complains frequently of headaches.
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The child squints to read the board at school.
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When the child reads a book, they hold it out in front of them with their arms straight.
Explanation
Hyperopia, or farsightedness, occurs when the eye focuses images behind the retina, making close-up objects appear blurry while distant objects remain clearer. Children with hyperopia often hold reading material farther away to bring it into focus.
Why the other options are incorrect:
A. Nystagmus is an involuntary eye movement disorder unrelated to refractive errors like hyperopia.
B. Frequent headaches can occur with uncorrected vision problems in general, but this is a nonspecific finding and not the most characteristic sign of hyperopia.
C. Squinting to see the board (a distant object) is more characteristic of myopia (nearsightedness), where distant objects appear blurry.
A nurse is providing discharge teaching to the parents of a newborn. Which of the following should be included in the teaching? (Select all that apply)
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Provide tummy time for 3-5 minutes, 2-3 times a day
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Use a soft, fluffy mattress for best sleep
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Ensure the baby sleeps in their own bedroom right away
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Place the child on their back to sleep
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Ensure the baby is warm by using extra blankets at night
Explanation
Supervised tummy time helps strengthen neck and shoulder muscles and promotes motor development, while back-sleeping ("Back to Sleep") is the recommended position to significantly reduce the risk of Sudden Infant Death Syndrome (SIDS).
Why the other options are incorrect:
B. Use a soft, fluffy mattress for best sleep — A firm mattress is recommended for infant sleep safety; soft/fluffy surfaces increase the risk of suffocation and SIDS.
C. Ensure the baby sleeps in their own bedroom right away — Current guidelines recommend room-sharing (not bed-sharing) for at least the first 6 months, not immediate separate-room sleeping.
E. Ensure the baby is warm by using extra blankets at night — Loose blankets in the crib increase suffocation and SIDS risk; overheating is also a risk factor for SIDS.
A nurse is preparing to administer 100 mg of gentamycin to an adolescent client. The pharmacy prepares the 100 mg of gentamycin in a 100 mL bag of fluid. The physician's order states to infuse the gentamycin over 30 minutes. What rate should the nurse set the IV pump at?
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200 mL/hr
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100 mL/hr
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50 mL/hr
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400 mL/hr
Explanation
Using the formula: Rate = Volume ÷ Time. The volume is 100 mL, and the time is 30 minutes (0.5 hours). Dividing 100 mL by 0.5 hours gives 200 mL/hr, which is the correct pump rate to infuse the full volume in 30 minutes.
Why the other options are incorrect:
B. 100 mL/hr — This rate would infuse the 100 mL bag over 60 minutes, not the ordered 30 minutes.
C. 50 mL/hr — This rate would take 2 hours to infuse the full bag, far exceeding the ordered infusion time.
D. 400 mL/hr — This rate would infuse the bag in only 15 minutes, which is faster than the ordered 30-minute infusion time.
Correct Answer Is:
A
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