Ch. 72 Care of the Infant, Toddler, or Preschooler

Question 1

Reconstruction of the eardrum, usually with a graft of temporalis fascia, is known as _____.

Answer 1

myringoplasty

Question 2

Phenylketonuria (PKU) is caused by the absence of the enzyme phenylalanine _____.

Answer 2

hydroxylase

Question 3

Surgical repair of the cleft lip is called _____.

Answer 3

cheiloplasty

Question 4

Acute _____ of the meninges of the brain is known as meningitis.

Answer 4

inflammation

Question 5

Narrowing of the right ventricular outflow tract of the heart, including the valve, is known as __________ stenosis.

Answer 5

pulmonary

Question 6

Tricuspid atresia is a/an of an __________ opening between the right atrium and the right ventricle allowing no blood to flow from the right atrium to the right ventricle greatly decreasing pulmonary blood flow.

Answer 6

Absence

Question 7

What is the purpose of a shunt?

Answer 7

The purpose of the shunt is to remove excessive
cerebrospinal fluid from the ventricles and shunt it to the peritoneum. A one-way value is present in the tubing behind the ear.

Question 8

Hematuria

Answer 8

Glomerulonephritis

Question 9

Nuchal rigidity

Answer 9

Meningitis

Question 10

Lower-back ache

Answer 10

Pyelonephritis

Question 11

Drooling of saliva

Answer 11

Epiglottitis

Question 12

Write the correct sequence that occurs during the administration of ribavirin.

1. Set up the equipment and medication.
2. Administer ribavirin using the hood.
3. Auscultate the lung fields thoroughly.
4. Disinfect the hands thoroughly.

Answer 12

4 Disinfect the hands thoroughly.

1 Set up the equipment and medication.

3 Auscultate the lung fields thoroughly.

2 Administer ribavirin using the hood.

Question 13

How does leukemia affect children?

Answer 13

Symptoms of leukemia include fatigue, aches in bones and joints, headaches, fever, swollen lymph nodes, unexplained weight loss, bleeding of gums or nose, frequent bruising, and slow healing. The child is pale and lethargic and bruises easily. Sometimes, the child becomes ill gradually, with increasing weakness and pallor. The child is anemic, with a hemoglobin count as low as 4 to 8 g/dL.

Question 14

What are the phases of chemotherapy for leukemic clients?

Answer 14

Chemotherapy in the leukemic client includes the following phases:
* Phase 1: Induction. It helps to put the disease in remission.
* Phase 2: Consolidation. It helps to keep the disease in remission.
* Phase 3: Prophylaxis. In this phase, various chemotherapies may be combined with irradia- tion to prevent metastasis to the brain and central nervous system.
Phase 4: Maintenance. It consists of scheduled visits to the health provider, who monitors the client’s overall condition and reviews laboratory test

Question 15

What are the stages of Wilms tumor?

Answer 15

The following are the stages of Wilms tumor:
* Stage I: The tumor is well encapsulated and is limited to the kidney.
* Stage II: The tumor extends into the abdominal cavity.
* Stage III: The tumor extends into the abdominal cavity to such an extent that it cannot be removed completely.
* Stage IV: The tumor has metastasized to distant sites (e.g., lungs, liver, bone, brain).
* Stage V: Existence of bilateral kidney metastasis.

Question 16

What are the symptoms of rheumatic fever?

Answer 16

Symptoms of rheumatic fever range from mild to severe. Loss of weight and appetite, fatigue, irritability, aches, joint pain, and tenderness are some of the usual symptoms of rheumatic fever. The most significant symptom of rheumatic fever is polyar- thritis, in which the child’s shoulders, elbows, wrists, or knees swell and become excruciatingly painful. Pain migrates from one joint to another and may affect several joints at the same time. It usually lasts for a few days to a week in each joint, and then subsides gradually. Polyarthritis does not cause any deformities to joints, and the joints will return to their normal condition after the attack.

Question 17

What is cat-scratch fever?

Answer 17

Cat-scratch fever is a benign, self-limited illness that occurs as a result of a cat scratch. The child may have a low-grade fever and malaise, and the lymph- adenopathy may last for 2 to 3 months.

Question 18

What are the signs of sexual abuse?

Answer 18

The following are signs of sexual abuse:

• Sudden changes in behavior, such as fear of one or both the parents or people when entering a room.
• Pain in the abdomen, gastric distress, or head- aches.
• Emotional disturbances.
• Avoidance of touching or physical contact.
• Bleeding or lesions in the vagina or rectum.
• Wearing clothing that is inappropriate for the
  season of the year.

Question 19

During a routine visit to the healthcare clinic, a mother tells the nurse that her 2-year-old child is still in the habit of bottle feeding. She wants to know if this could have any adverse effects.

What could be the possible adverse effects of baby-bottle syndrome?

Answer 19

Continuing bottle feeding even after the develop- ment of teeth or use of the bottle as a pacifier may contribute to baby-bottle syndrome. If the contents of the bottle continually come into contact with the baby’s teeth for prolonged periods, the result may be numerous dental caries.

Question 20

During a routine visit to the healthcare clinic, a mother tells the nurse that her 2-year-old child is still in the habit of bottle feeding. She wants to know if this could have any adverse effects.

What instructions should the nurse give the parents to prevent this condition?

Answer 20

The nurse should provide the following instruc- tions to the parents to prevent this condition:
* The parents should not promote bottle feeding.
* The infant should not be given a bottle in bed to fall asleep with.
* The child’s mouth should be cleaned and brushed after feeding.
* The infant should be changed to cup feeding by 1 year of age.
* The child should not be allowed to walk or run around with a bottle.
* Regular dental checkups after tooth eruption should be conducted.
* The baby should be given juice in a cup as early as possible.
* Pacifiers should be kept clean.

Question 21

An 8-year-old child is brought to the primary healthcare facility with symptoms of easy bruising and frequent nosebleeds. The healthcare provider diagnoses the condition as idiopathic thrombocytopenic purpura.

What symptoms should the nurse monitor for in such a case?

Answer 21

The nurse should monitor symptoms, such as easy bruising without an obvious cause, petechiae, formation of tiny internal hemorrhages on the mucous membranes, frequent epistaxis, and bleeding into the bladder or gastrointestinal tract.

Question 22

An 8-year-old child is brought to the primary healthcare facility with symptoms of easy bruising and frequent nosebleeds. The healthcare provider diagnoses the condition as idiopathic thrombocytopenic purpura.

What are the nursing considerations to be employed when caring for the client?

Answer 22

The nursing considerations should involve close observation for hemorrhage, avoidance of injury, and bed rest. The child should not be given intramuscular injections because of the danger of hematoma formation. Enemas should not be administered because of the possibility of trauma to the mucous membranes. The side rails of the bed should be raised and padded to prevent accidental bruising. A soft toothbrush should be used for oral care to avoid gum injury. Invasive procedures, such as venipuncture and urinary catheterization, should be avoided because of the danger of hemorrhage and infection. Parents should be instructed on the importance of avoiding contact sports.

Question 23

A 10-year-old girl complains of frequent urination and pain during micturition. On further examination, she is diagnosed with a urinary tract infection. What instruction should the nurse provide to prevent urinary tract infection in the future? Select all that apply.

a. Wipe the perineal area from back to front.
b. Drink plenty of cranberry juice and water.
c. Take a bubble bath to prevent irritation.
d. Use white, unscented toilet paper.
e. Wear loose, white cotton underwear.

Answer 23

Answer: b, d, and e
Rationale: The nurse should instruct the client to drink plenty of cranberry juice and water; to wear loose, white cotton panties; and to use unscented white toilet paper. The nurse should also instruct the client to wipe the perineal area from front to back, instead of from back to front. The nurse should also inform the client not to take bubble baths, because they can be irritating.

Question 24

A 7-year-old child was admitted to the healthcare facility because of frequent passage of loose and watery stools. The healthcare provider diagnoses it as a case of diarrhea. Which should be included in the nursing care plan for the child?

a. Encourage the late reintroduction of regular nutrients.
b. Provide only clear fluids and juices to the child.
c. Observe the child for any signs of dehydration.
d. Cover the child’s buttocks to prevent contact with air.

Answer 24

Answer: c
Rationale: When caring for a client with diarrhea, the nurse should observe the child for any signs of dehydration. The nurse should encourage the early reintroduction of regular nutrients. Clear fluids and juices are inadequate because they are high in carbohydrates but low in electrolytes. Instead, the nurse should provide oral rehydration solution (ORS) and other low-carbohydrate food supple- ments to the client. The nurse should expose the child’s buttocks to air as much as possible to prevent maceration of the skin.

Question 25

A 5-year-old child is diagnosed with iron deficiency anemia. The physician has prescribed administration of iron-containing preparations. Which should be taken into consideration when administering iron-containing preparations to the client?

a. Administer the preparation along with food to enhance absorption.
b. Dilute the liquid iron preparation with water before administration.
c. Avoid rinsing of the mouth after ingestion of the preparation.
d. Avoid giving orange juice along with the medicine.

Answer 25

Answer: b

Rationale: The liquid iron preparation should be well diluted with water or fruit juice before admin- istration. Iron preparations should be given on an empty stomach to enhance absorption. Orange juice can be administered with iron preparations; it helps to enhance the body’s iron absorption. The mouth can be rinsed to reduce staining after administration of the iron preparation

Question 26

A nurse is required to care for a 9-year-old child who has a Wilms tumor. Which nursing care measures should be employed when caring for the child?

a. Take tympanic temperatures to reduce hemorrhage.
b. Gently touch or move the child to prevent injury.
c. Avoid palpating the abdomen preoperatively.
d. Give gavage feedings or parenteral nutrition.

Answer 26

Answer: c
Rationale: When caring for a client with Wilms tumor, the nurse should not palpate the abdomen unnecessarily. Doing so could cause rupture and dissemination of the tumor. The nurse need not take tympanic temperatures to reduce hemorrhage in the case of Wilms tumor. When caring for a client with spina bifida, the nurse should gently touch or move the child to prevent injury. Hydrocephalic clients are fed through gavage feedings or parenteral nutrition.

Question 27

A 2-vear-old child with a distended abdomen and absence of stool is diagnosed with cystic fibrosis. The client is prescribed a pancreatic enzyme preparation and some fat-soluble vitamin supplements. Which of the following nursing care measures should be followed when caring for the child? Select all that apply.

a. Administer water-soluble forms of fat-soluble vitamins.
b. Restrict salt in client’s diet plan.
c. Monitor the weight of the client frequently.
d. Provide a low-calorie, low-protein, moderate-fat diet.
e. Give a pancreatic enzyme preparation along with cold milk.

Answer 27

Answer: a, c, and e

Rationale: When caring for a child with cystic fibrosis, the nurse should provide food containing supplementary water-soluble forms of fat-soluble vitamins, because such clients have poor fat digestion. Frequent monitoring of the weight of the client is necessary. The nurse need not restrict salt in the client. High-calorie, high-protein, moderate- fat food should be included in the client’s diet plan. The nurse should give the pancreatic enzyme preparation along with cold, not hot, milk, because heat can decrease the activity of the enzyme.

Question 28

A 7-year-old boy is brought to the healthcare facility with complaints of painful enlargement of the scrotum. Which term should be used to describe this condition?

a. Encephalocele
b. Meningocele
c. Hydrocele
d. Meningomyelocele

Answer 28

Answer: c
Rationale: Hydrocele is the term used to describe the condition in which accumulation of serous fluid within the scrotal sac occurs, causing the scrotum to become large and painful. Encephalo- cele is a condition in which a portion of the brain protrudes through an opening. Meningocele is the condition in which one layer of the meninges protrudes through an opening in the vertebral column. Meningomyelocele is the condition in which the meninges and part of the spinal cord protrude through an opening.

Question 29

A 10-month-old baby who had a facial deformity has undergone Cheiloplasty. Which of the following should be included in the postoperative care plan? Select all that apply.

A. Apply a tongue-blade arm restraint
B. Use a straw to feed the baby
C. Cleanse the suture line after each feeding
E. Position the child on the abdomen

Answer 29

Answer: a, c, and d

Rationale: During the postoperative care of a baby who has undergone surgery for cleft lip, the nurse should apply a tongue-blade arm restraint to prevent the child from bending the elbows to touch the suture line. The child should be positioned on the back or side but not on the abdomen, to prevent the child from rubbing the surgical site against the bed. The suture line should be cleansed after each feeding with the prescribed solution for rapid healing and to prevent undue scarring. The child should be given water after the formula to remove mucus. A straw should not be used for feeding, unless ordered by the healthcare provider, because the use of a straw may cause pressure on the surgical site.

Question 30

A nurse is required to care for a 5-year-old child who is in a cast with traction after a fracture of the right femur. Which should the nurse monitor to check the blood circulation toward the injured area?

a. Heartbeat
b. Urine color
c. Skin color
d. Blood pressure

Answer 30

Answer: c

Rationale: It is important to check the blood circulation toward the injured area after applying a cast and traction. Observing skin color, sensitivity, temperature, motion, and pulse distal to the injury can help check blood circulation. Checking the blood pressure, heartbeat, or urine color does not help to determine the blood circulation toward the injured area.

Question 31

A nurse is required to care for a 10-month-Old baby who has undergone palatoplasty for repair of a cleft palate. Which nursing care measure should be employed when caring for the child?

A. Avoid positioning the child on the abdomen or the side.
b. Discourage the child from sucking and blowing.
c. Avoid feeding the child using a spoon.
d. Always use a nipple or straw to feed the child.

Answer 31

Answer: b
Rationale: The nurse should discourage the child from sucking and blowing, because sucking can cause strain in the suture line, and blowing can force fluids into the eustachian tube. The nurse should position the child on the abdomen or the side to decrease choking and danger of aspiration. The child can be fed from the side of a spoon, but the nurse should not insert the spoon into the child’s mouth. The nurse should not use a nipple or straw to feed the child.