An infant needs emergency surgery. A nurse is aware that the child’s mother is 13-years-old and that the father is 16-years-old. The father and the paternal grandmother, who both take care of the infant, are the only family members at the bedside. From whom should the nurse obtain the informed consent?
Ans: The 16-year-old father
Rationale: Regardless of age, parenthood confers the rights of an adult on a teenager. Since the mother is not at bedside, the father has the legal right to sign the surgical consent. The mother has a legal right to give consent but is not available. It is not legal for the grandmother to sign the consent because she is not the legal guardian. The hospital administrator would never provide consent.
The mother of an 8-year-old child with the diagnosis of acute poststreptococcal glomerulonephritis (APSGN) is concerned that a 4-year-old sibling may also have the disorder. What does the nurse recall when preparing to explain the cause of the disease process?
An immune complex disorder occurring after a group A β-hemolytic Streptococcus infection
Rationale: The β-hemolytic Streptococcus immune complex becomes trapped in the glomerular capillary loop, causing acute poststreptococcal glomerulonephritis. APSGN is usually precipitated by a localized pharyngitis. Clots do not form in the small renal tubules with APSGN. Prevention depends on treating an individual with a group A β-hemolytic Streptococcus infection with antibiotics to eliminate the organism before an immune response can occur. APSGN is an acquired, not an inherited, disorder.
As the nurse is teaching a child’s parents about celiac disease, the mother sighs and says, “My neighbor told me that I’ll only need to monitor the diet until our child is 8 years old. I’m so relieved. You know how kids are about eating!” On what fact should the nurse’s response be based?
The basic defect of celiac disease is lifelong
The diet must continue to be followed because the child will always have an absence of peptidase; some variations in the diet may be allowed, but this should not be promised. Each phase of child development may have problems related to dietary management; follow-up care is needed to prevent crises. A restricted diet is never easy to follow, especially for a growing child. Gluten must be avoided for a prolonged period and perhaps indefinitely.
A child is brought to the emergency department after sustaining a blow to the head while playing football after school. The nurse performs a neurologic assessment to determine whether the child has an acute head injury. What should the nurse assess first?
Level of consciousness
Rationale: A declining level of consciousness (LOC) reflects increased intracranial pressure precipitated by injury to the brain. Ocular signs and muscle strength are less indicative of increased intracranial pressure than is a reduced LOC. Injuries to the scalp do not cause increased intracranial pressure because they are outside the cranium.
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A child with a diagnosis of tuberculosis is admitted to the pediatric unit. Which location should the nurse select as the best placement for the child?
Rationale: An isolation room is a private room fitted with special air handling and ventilation to prevent the transmission of airborne droplet nuclei 5 micrometers or smaller. It has monitored negative pressure to prevent air from moving from the room into the corridor of the facility. Room air is exchanged 6 to 12 times an hour to the outdoors or through a monitored high-efficiency filtration system. Mycobacterium tuberculosis remains suspended in the air for prolonged periods and is transmitted in air currents. A private room does not have the technical equipment to manage airborne droplet nuclei of 5 micrometers or smaller. Other children and people on the unit will be exposed to the infected individual’s pathogens that travel through air currents. A four-bed room or semiprivate room will expose the children and other people on the unit to the infected individual’s pathogens.
Mebendazole is prescribed for a 3-year-old child with a pinworm infestation. What information will the nurse include when teaching the parents about this medication?
It may cause transient diarrhea
Rationale: Diarrhea is expected with the administration of mebendazole; the parents should be informed so they do not become alarmed. Reinfestation is common; the medication should be taken again in 2 weeks. The medication will not affect rectal itching; it will eradicate the pinworms, and this takes time to accomplish. All family members should take the medication because cross-contamination frequently occurs.
A school nurse is teaching a unit on nutrition to a sixth-grade class. Why should the nurse include that eating in fast-food restaurants should be limited?
Food is high in calories
Rationale: The American Dietetic Association (Canada: Public Health Agency of Canada) has indicated that the food in fast-food restaurants is calorie dense and higher in fat, sugar, and sodium than the food served at home or in other restaurants. Although fast-food restaurants encourage patrons to eat quickly, this is not the major reason that their food is discouraged. Portions in fast-food restaurants are not large; they are smaller than those in diners and many other restaurants. Fast-food restaurants encourage safe food handling to meet the standards of local health departments.
A nurse in a child health clinic is obtaining the health history of a 5-year-old boy who was just found to have type 1 diabetes. In planning care, what does the nurse anticipate concerning this child?
Must receive continual health teaching based on cognitive ability
Rationale: The nurse must plan teaching based on the child’s present and future cognitive abilities. Piaget describes age-related cognitive abilities that progress through sensorimotor, preoperational, concrete operational, and formal operational stages. Each stage builds on the accomplishments of the previous stage. Adolescents, not preschool children, are usually concerned about being different from their peers. Five-year-olds are not emotionally ready to use the defense mechanism of denial. Testing blood glucose and reporting the findings are beyond the ability of a 5-year-old child. Preschoolers think in terms of one idea but cannot understand that a single idea is part of a whole concept. It is not until they enter the school-aged years that they have the cognitive and psychomotor abilities to self-test blood glucose.
A nurse is counseling the family of a child with AIDS. What is the most important concern that the nurse should discuss with the parents?
Susceptibility to infection
Rationale: Children with AIDS have a dysfunction of the immune system (depressed or ineffective T lymphocytes, B lymphocytes, and immunoglobulins) and are susceptible to opportunistic infections. All children are subject to injury because of their curiosity, inexperience, and lack of judgment. Although inadequate nutrition can be a problem for children with AIDS, the prevention of infection is the priority. Although children with AIDS are usually small for age, altered growth and development is not as life threatening as an infection.
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A school-aged child is being observed overnight for responses to a closed head injury sustained when the child fell off a piece of playground equipment. The nurse knows to call the healthcare provider immediately if which symptom occurs?
The child begins vomiting
Rationale: Vomiting is a sign of increased intracranial pressure. Normal pupil size ranges from 2.0 to 5.0 mm. The expected respiratory rate for a school-aged child is 20 to 30 breaths/min. The systolic blood pressure range for a school-aged child is 80 to 120 mm Hg.
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A nurse is teaching the parents of a school-aged child with celiac disease about the nutrients that must be avoided in a gluten-free diet. What nutrients should the nurse teach the parents to avoid?
Wheat and oat products
Rationale: Wheat, oats, rye, and barley are major dietary sources of gluten; the gliadin fraction of these grains is not tolerated by individuals with celiac disease. There is no gluten in oils and fats. There is no gluten in cheeses and milk. Corn and rice are used as substitute grains because they do not contain gluten.
A nurse is preparing to discharge a school-aged child who has undergone splenectomy for β-thalassemia (Cooley anemia). What information should the discharge teaching include?
A high fever should be reported to the child’s healthcare provider.
A fever higher than 101.5° F (38.6° C) must be reported because of the increased risk of sepsis in a child without a spleen (asplenia). Contact sports are a concern in children with enlarged spleens because of the possibility of rupture; this child has had a splenectomy. A splenectomy will not cure this disorder; β-thalassemia is an inherited disorder of hemoglobin synthesis. The splenectomy was done to decrease the need for blood transfusions.