Conditions Interfering With Pediatric Health

1. Which child appears to have been abused?

A 2 year old with bruises on both shins

A 2 year old who won't make eye contact with the nurse

A 3 year old who acts withdrawn and has bruises on his back

A 10 year old who comes to the ER with a broken arm.

3 year olds are typically social, not withdrawn. Bruises on the back should also be investigated. 2 year olds commonly fall and bruise their shins; its also normal for them to be afraid and avoid eye contact with nurses. 10 year olds are commonly injured during play.

Explanation

3 year olds are typically social, not withdrawn. Bruises on the back should also be investigated. 2 year olds commonly fall and bruise their shins; its also normal for them to be afraid and avoid eye contact with nurses. 10 year olds are commonly injured during play.

2. A nurse is caring for a child who supposedly had an accident at home. Which statement by the parents indicates the possibility of cild abuse?

Mom "My husband told me she fell of the bed"Dad "I heard her crying and went to her room"

Mom "She fell off a swing"Dad "She fell off the bed"

Mom "My daughter is so clumsy; she just walks into things"Dad "You really have to keep an eye on her"

Differing of how an accident occurred is a possible indication of child abuse. When parents have conflicting stories or the child has a different story then the parents, the nurse should investigate for possible abuse. The other statements should be investigated as well but they may be innocent statements.

Explanation

Differing of how an accident occurred is a possible indication of child abuse. When parents have conflicting stories or the child has a different story then the parents, the nurse should investigate for possible abuse. The other statements should be investigated as well but they may be innocent statements.

3. A couple has a 2 year old with Hurler's syndrome. When planning their next pregnancy, the couple should undergo ...

Genetic counseling.

Psychological counseling.

Counseling regarding transmission of STD's

A TORCH test.

Hurler's syndrome is an inherited autosomal recessive disorder. Genetic counseling should be offered. TORCH = toxoplasmosis, rubella, cytomegalovirus and herpes simplex .. aka not a screening tool for Hurler's

Explanation

Hurler's syndrome is an inherited autosomal recessive disorder. Genetic counseling should be offered. TORCH = toxoplasmosis, rubella, cytomegalovirus and herpes simplex .. aka not a screening tool for Hurler's

4. A 13 year old with cystic fibrosis is experiencing increasing SOB, cough and sputum production, fatigue and weight loss. He's having trouble taking care of himself without exhaustion. Which approach is most appropriate when setting goals for this adolescent?

Let him set his own goals so he will accomplish them.

Agree to follow what the physician says to do, even if it conflicts with that the adolescent wants.

Tell the adolescent what you would like him to accomplish so that he's aware of whats expected of him.

Agree on mutual goals to increase the adolescent's sense of control in this situation.

Teens with a long-term fatal illness need to be granted as much control as possible. Agreeing on mutual goals fosters the adolescent's sense of control and demonstrates respect for his autonomy. Letting the adolescent set goals completely on his own isn't realistic because he may not fully comprehend all of the medical aspects of his condition. Placing the physician or nurse completely in charge go goal-setting violates the adolescents need to establish a sense of control

Explanation

Teens with a long-term fatal illness need to be granted as much control as possible. Agreeing on mutual goals fosters the adolescent's sense of control and demonstrates respect for his autonomy. Letting the adolescent set goals completely on his own isn't realistic because he may not fully comprehend all of the medical aspects of his condition. Placing the physician or nurse completely in charge go goal-setting violates the adolescents need to establish a sense of control

5. An 8 year old child develops juvenile rheumatoid arthritis. Which factor most influences the way chronic illness or disability impacts a child?

Type of illness

Age of onset

Parents' reactions

Age of siblings

The impact of a chronic illness or disability is influenced by the age of onset and the child's developmental level. Chronic illness affects children of all ages but the developmental aspects of each age-group dictate particular stresses and risks for each child. The parents reaction may not be evident, especially to a young child. The age of the child's siblings has less of an impact on the child than it does on the parents.

Explanation

The impact of a chronic illness or disability is influenced by the age of onset and the child's developmental level. Chronic illness affects children of all ages but the developmental aspects of each age-group dictate particular stresses and risks for each child. The parents reaction may not be evident, especially to a young child. The age of the child's siblings has less of an impact on the child than it does on the parents.

6. A nurse is teaching a school class about malnutrition. She tells them that marasmus is ...

General malnutrition of calories and protein.

A deficiency of the minerals iron, calcium and zinc.

A protein deficiency with an adequate supply of calories.

Impaired fat metabolism that causes deficiency of fat soluble vitamins.

Commonly happens in developing countries during times of drought, especially where ADULTS EAT BEFORE CHILDREN. Whatever food remains is commonly insufficient in quality and quantity for children. Kwashiorkor (NOT MARASMUS) is a protein deficiency in which calorie supply is adequate, fat metabolism is impaired and mineral deficiency is common. Iron deficiency is common with anemia; calcium deficiency causes rickets; zinc deficiency causes skin lesions and decreased taste.

Explanation

Commonly happens in developing countries during times of drought, especially where ADULTS EAT BEFORE CHILDREN. Whatever food remains is commonly insufficient in quality and quantity for children. Kwashiorkor (NOT MARASMUS) is a protein deficiency in which calorie supply is adequate, fat metabolism is impaired and mineral deficiency is common. Iron deficiency is common with anemia; calcium deficiency causes rickets; zinc deficiency causes skin lesions and decreased taste.

7. When conducting a home visit, a nurse notes that the mother of a toddler has cleaning material stored beneath the kitchen and bathroom sinks. Medicines are on a tray on the dining room buffet. The mother explains that the medicines are out so family members can remember to take them. Which nursing diagnosis is most appropriate?

Deficient knowledge related to the child's level of development

Compromised family coping related to role strain

Risk for injury related to lack of awareness of environmental hazards

Impaired parenting related to unrealistic expectations of child development

The lack of awareness of the dangers of the cleaning materials and medicines puts the toddler at risk for injury. Theres no evidence that the child has deficient knowledge or that compromised family coping processes or impaired parenting exists.

Explanation

The lack of awareness of the dangers of the cleaning materials and medicines puts the toddler at risk for injury. Theres no evidence that the child has deficient knowledge or that compromised family coping processes or impaired parenting exists.

8. A 3 year old is admitted with respiratory syncytial virus infection. The nurse obtains a history of ritualistic behavior for the child to ...

Allow the child's routine to be continued.

Make the parents feel more in control of the environment.

Give herself more control over the child's behavior.

Decreases the child's sense of separation.

The nurse should obtain a history that includes the child's ritualistic behavior (like reading before going to bed) so that the child's typical routine can be continued. This decreases fear of the hospital. It doesn't make the parents feel more in control or give the nurse greater control of the child's behavior. It also doesn't decrease the child's sense of separation from his parents.

Explanation

The nurse should obtain a history that includes the child's ritualistic behavior (like reading before going to bed) so that the child's typical routine can be continued. This decreases fear of the hospital. It doesn't make the parents feel more in control or give the nurse greater control of the child's behavior. It also doesn't decrease the child's sense of separation from his parents.

9. A 2 year old boy is brought to the clinic with an upper respiratory infection. During the assessment, the nurse notes some bruising on the arms, legs and trunk. Which findings should prompt the nurse to evaluate for suspected child abuse? Select all that apply.

A few superficial scrapes on the lower legs

Welts/bruises in various stages of healing on the trunk

A deep blue-black patch on the buttocks

One large bruise on the child's thigh

Circular, symmetrical burns on the lower legs

A parent who is hypercritical of the child and pushes the frightened child away

Injuries at various stages of healing in protected or padded areas can be signs of inflicted trauma, leading the nurse to suspect abuse. Burns that are bilateral as well as symmetrical and regular (like a cigarette) are typical of abuse. When a child is burned accidentally, the burns form an erratic pattern and are usually irregular and asymmetrical. Pushing away the child and being hypercritical are typical behaviors of abusive parents.Superficial scrapes and bruises on the lower extremities are normal in a healthy child. A deep blue-black macular patch on the buttocks is more consistent with a Mongolian spot rather than a traumatic injury that would suggest abuse.

Explanation

Injuries at various stages of healing in protected or padded areas can be signs of inflicted trauma, leading the nurse to suspect abuse. Burns that are bilateral as well as symmetrical and regular (like a cigarette) are typical of abuse. When a child is burned accidentally, the burns form an erratic pattern and are usually irregular and asymmetrical. Pushing away the child and being hypercritical are typical behaviors of abusive parents.Superficial scrapes and bruises on the lower extremities are normal in a healthy child. A deep blue-black macular patch on the buttocks is more consistent with a Mongolian spot rather than a traumatic injury that would suggest abuse.

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